Silverman M, Musa D, Martin D C, Lave J R, Adams J, Ricci E M
Graduate School of Public Health, University of Pittsburgh, PA 15261, USA.
J Am Geriatr Soc. 1995 Jul;43(7):733-40. doi: 10.1111/j.1532-5415.1995.tb07041.x.
To evaluate the process and outcome of outpatient consultative geriatric assessment compared with traditional community care.
Randomized, controlled clinical trial, with 12-month follow-up.
Four hospital-based ambulatory geriatric assessment clinics and community physicians' offices.
442 recruited older adults with a health problem or recent change in health status.
Outpatient consultative geriatric assessment or usual physician assessment.
Identification of health problems, mortality, nursing home admissions, health status, health services utilization, satisfaction with care, and caregiver well-being.
Geriatric assessment, in comparison with usual community care, resulted in the identification of a significantly greater number of patients with cognitive impairment (P < .0001), depression (P = .0004) and incontinence (P < .0001). The group receiving a geriatric assessment had greater improvement in anxiety levels at 1 year (P = .036). Caregivers of participants in the geriatric assessment group had less caregiver stress at 1 year (P = .002). No outcome differences in mortality, nursing home admissions, cognitive health, functional health, or health services utilization were observed. Some evidence of greater patient satisfaction with respect to qualities of the physician was found for the geriatric assessment group.
Consultative outpatient geriatric assessment led to significantly improved diagnosis of the common health problems of cognitive impairment, depression, and incontinence, to psychological and emotional benefits for patients, and to reduced levels of caregiver stress. Even with limited follow-up care and control of treatment, outpatient geriatric assessment has potential for significant positive effects.
评估门诊咨询老年评估与传统社区护理相比的过程及结果。
随机对照临床试验，随访12个月。
四家医院门诊老年评估诊所及社区医生办公室。
442名招募的有健康问题或近期健康状况发生变化的老年人。
门诊咨询老年评估或常规医生评估。
健康问题的识别、死亡率、养老院入住情况、健康状况、卫生服务利用情况、护理满意度及照料者幸福感。
与常规社区护理相比，老年评估发现认知障碍患者（P < .0001）、抑郁症患者（P = .0004）及尿失禁患者（P < .0001）的数量显著更多。接受老年评估的组在1年时焦虑水平改善更大（P = .036）。老年评估组参与者的照料者在1年时照料压力更小（P = .002）。在死亡率、养老院入住情况、认知健康、功能健康或卫生服务利用方面未观察到结果差异。有证据表明老年评估组患者对医生素质的满意度更高。
门诊咨询老年评估显著改善了对认知障碍、抑郁症和尿失禁等常见健康问题的诊断，对患者有心理和情感益处，并降低了照料者压力水平。即使随访护理有限且治疗控制不足，门诊老年评估仍有产生显著积极影响的潜力。
