Kumlehn Barbara, Brefka Simone, Kocar Thomas, Verri Filippo Maria, Wirth Rainer, Denkinger Michael
Institute for Geriatric Research, Ulm University Hospital, and Geriatric Center at AGAPLESION Bethesda Clinic at Ulm University, Ulm, Germany; Department of Geriatric Medicine and Early Rehabilitation, Marien Hospital Herne - University Hospital of Ruhr University Bochum, Herne, Germany.
Dtsch Arztebl Int. 2025 Mar 21;122(6):156-162. doi: 10.3238/arztebl.m2024.0262.
An increasing number of older people are being treated in German hospitals. In 2022, more than 35.7 million hospitalized patients in Germany were of age 65 or older. Comprehensive geriatric assessment (CGA) can help to structure and improve the diagnosis and treatment of these patients, many of whom suffer from multimorbidity.
The guideline group developed this guideline in accordance with the AWMF recommendations. Answers to questions were either evidence-based or consensus-based; the latter were established with a Delphi procedure followed by a consensus conference. The guideline was issued in May 2024.
The guideline contains twelve evidence-based and eight consensus-based recommendations and statements. The strongest evidence for the effectiveness of CGA was found in the wards for acute geriatric medicine, oncology, and orthopedics/trauma surgery, with weaker evidence from emergency departments and general surgery wards. Core elements of the guideline are the specification of a minimum duration of CGA (15 minutes), the definition of minimum requirements (six core dimensions: self-help ability, mobility, cognitive function/delirium, affect, nutrition, social situation), and setting-specific process recommendations. Specific screening instruments to identify patients who stand to benefit from CGA are recommended mainly in the oncological setting (G8 questionnaire).
The German clinical practice guideline on CGA can serve as a guide to personalized geriatric medicine in the hospital. Further complex interventional studies are needed to evaluate the efficacy of CGA in other settings.
德国医院中接受治疗的老年人数量日益增加。2022年，德国有超过3570万住院患者年龄在65岁及以上。综合老年医学评估（CGA）有助于构建和改善这些患者的诊断与治疗，其中许多患者患有多种疾病。
指南制定小组根据德国医学科学院（AWMF）的建议制定了本指南。问题的答案基于证据或达成共识；后者通过德尔菲法随后召开共识会议确定。该指南于2024年5月发布。
该指南包含12条基于证据和8条基于共识的建议及声明。CGA有效性的最有力证据见于急性老年医学、肿瘤学以及骨科/创伤外科病房，而急诊科和普通外科病房的证据较弱。该指南的核心要素包括CGA最短时长的规定（15分钟）、最低要求的定义（六个核心维度：自理能力、活动能力、认知功能/谵妄、情感、营养、社会状况）以及特定环境下的流程建议。主要在肿瘤学环境中推荐使用特定的筛查工具来识别可能从CGA中受益的患者（G8问卷）。
德国关于CGA的临床实践指南可作为医院个性化老年医学的指南。需要进一步开展复杂的干预性研究来评估CGA在其他环境中的疗效。
