Department of Internal Medicine, Chonnam National University Bitgoeul Hospital, Republic of Korea.
Clinical Preventive Medicine Center, Seoul National University Bundang Hospital, Republic of Korea.
Arch Gerontol Geriatr. 2020 Jul-Aug;89:104064. doi: 10.1016/j.archger.2020.104064. Epub 2020 Apr 16.
The quality of life of older adults deteriorates when they lose their ability to perform activities of daily living. Therefore, the older adults should be assessed to identify risk factors for functional decline and to correct these factors so that they may live as independently as possible in the community. We developed a medical care model using comprehensive geriatric assessment (CGA) for community-dwelling older patients.
Three hundred and ninety-one older adults who were frail or likely to be frail were selected. CGA was performed before and after the interventions to determine the effect of the interventions. Three interventions-exercise training, nutritional education, and medication reconciliation-were performed for 5.1 ± 0.6 months.
A comparison of the results of the first and second assessments revealed that the participants showed improvement in physical function, quality of life, medication, and nutrition. The average gait speed had increased from 0.77 ± 0.17 m/s to 0.89 ± 0.20 m/s (P < 0.001). For health-related quality of life, the average EuroQol-5 dimension-3L score for each domain decreased significantly. The number of patients with polypharmacy decreased from 181(50 %) to 155(43 %) (P = 0.001). The number of patients who were at risk of malnutrition or malnourished decreased from 72(20 %) to 45(12 %) (P < 0.001). The majority of participants were highly satisfied and were willing to participate again.
Our medical model based on CGA showed a significantly positive effect on the physical function and quality of life of community-dwelling older adults. Our model may be a promising strategy for improving the care of them.
老年人丧失日常生活活动能力时，其生活质量会恶化。因此，应评估老年人，以确定功能下降的危险因素，并纠正这些因素，使他们能够尽可能独立地在社区中生活。我们为社区居住的老年人开发了一种使用综合老年评估（CGA）的医疗保健模式。
选择了 391 名虚弱或可能虚弱的老年人。在干预前后进行 CGA 以确定干预的效果。进行了三种干预措施——运动训练、营养教育和药物重整——持续 5.1±0.6 个月。
首次和第二次评估结果的比较表明，参与者的身体功能、生活质量、药物和营养状况均有所改善。平均步速从 0.77±0.17m/s 增加到 0.89±0.20m/s（P<0.001）。在健康相关生活质量方面，每个领域的平均 EuroQol-5 维度-3L 评分均显著下降。从 181 名（50%）到 155 名（43%）（P=0.001），服用多种药物的患者人数减少。从 72 名（20%）到 45 名（12%）（P<0.001），有营养不良或营养不足风险的患者人数减少。大多数参与者非常满意，并愿意再次参加。
基于 CGA 的我们的医疗模式对社区居住的老年人的身体功能和生活质量产生了显著的积极影响。我们的模式可能是改善对他们护理的有希望的策略。
