Gerhard Tobias, Mayer Kristina, Braisch Ulrike, Dallmeier Dhayana, Jamour Michael, Klaus Jochen, Seufferlein Thomas, Denkinger Michael
Geriatrische Forschung der Universität Ulm, AGAPLESION Bethesda Ulm, Zollernring 26, 89073, Ulm, Deutschland.
Geriatrisches Zentrum Ulm/Alb-Donau, Universitätsklinikum Ulm, Ulm, Deutschland.
Z Gerontol Geriatr. 2021 Mar;54(2):106-112. doi: 10.1007/s00391-020-01699-1. Epub 2020 Feb 28.
The geriatric check was developed for identification of geriatric patients in emergency departments (ED) as part of the concept for geriatric care in Baden-Württemberg.
Determination of convergent and predictive validity of the geriatric check with respect to identification and outcome prediction of geriatric patients in the ED.
A prospective cohort study between November 2015 and April 2016 including 146 patients older than 70 years in the internal medicine ED of Ulm University Hospital. Separate assessment by physicians and nursing staff of the following: identification of seniors at risk (ISAR), geriatric check, additional cognitive and functional assessments and for outcome: change in care index, Barthel index, living arrangements.
The ISAR classified 117 patients as geriatric patients and the geriatric check 107. The correlation was 78.1%. With ISAR as the gold standard the geriatric check showed a sensitivity of 82.0% and a specificity of 62.1%. The positive and negative predictive values were 89.7% and 46.1%, respectively. The identification by simple estimation was better for nurses than for doctors (sensitivity 70.5% vs. 58%, specificity 88.9% vs. 83.3%). The predictive validity 5 months after admission with respect to the abovementioned outcome parameters was best for nurses and doctors (especially regarding specificity). Both tests were very sensitive but not very specific.
The geriatric check is comparable to the ISAR. The convergent validity showed little difference. Both the ISAR and geriatric check were slightly more sensitive than doctors and nurses. Regarding predictive validity, doctors and nurses were superior to both scores. An algorithm starting with ISAR or geriatric check and followed by an estimation by doctors or nurses could be most suitable for optimal resource allocation.
作为巴登-符腾堡州老年护理概念的一部分，老年检查用于在急诊科识别老年患者。
确定老年检查在急诊科识别老年患者及预测其预后方面的收敛效度和预测效度。
2015年11月至2016年4月进行的一项前瞻性队列研究，纳入乌尔姆大学医院内科急诊科146名70岁以上患者。由医生和护理人员分别评估以下内容：识别高危老年人（ISAR）、老年检查、额外的认知和功能评估，以及预后指标：护理指数变化、巴氏指数、生活安排。
ISAR将117名患者归类为老年患者，老年检查将107名患者归类为老年患者。相关性为78.1%。以ISAR为金标准，老年检查的敏感性为82.0%，特异性为62.1%。阳性预测值和阴性预测值分别为89.7%和46.1%。简单评估识别老年患者时，护士比医生表现更好（敏感性70.5%对58%，特异性88.9%对83.3%）。入院5个月后，上述预后参数方面的预测效度，护士和医生表现最佳（尤其是特异性方面）。两种检查都非常敏感，但特异性不强。
老年检查与ISAR相当。收敛效度差异不大。ISAR和老年检查在识别老年患者方面都比医生和护士稍敏感。在预测效度方面，医生和护士优于两种评分。以ISAR或老年检查开始，随后由医生或护士进行评估的算法可能最适合优化资源分配。
