Stuck A E, Wieland G D
Geriatrie-Rehabilitation, Zieglerspital, Bern.
Schweiz Med Wochenschr. 1994 Nov 12;124(45):2019-25.
Comprehensive geriatric assessment (CGA) is defined as the process of determining an elderly person's medical, psychosocial, functional, and environmental resources and problems, linked with an overall plan for treatment and follow-up. The principles of geriatric assessment, including the advantages and disadvantages of using quantitative instruments for multi-dimensional evaluation, are reviewed. The findings of a recently published meta-analysis on comprehensive geriatric assessment are discussed and its policy implications addressed. The meta-analysis includes data of 28 controlled trials comprising 4959 subjects allocated to one of five CGA types, and 4912 control subjects. Original investigators provided additional unpublished data from published reports to supplement the data base of this meta-analysis. The combined odds ratios of outcomes in CGA-assessed patients versus control patients were obtained by pooling data from individual trials with a multivariate logistic regression approach. The combined odds ratio (95% confidence interval) of home survival at 1 to 4-year follow-up was 1.7 (1.2-2.3) for inpatient geriatric evaluation and management units, 1.5 (1.1-2.0) for post-discharge home assessment services, and 1.2 (1.1-1.4) for preventive in-home assessment services. Based on these research findings, the establishment of interdisciplinary units with staff trained in multidimensional geriatric assessment for inpatient evaluation and management of frail elderly patients, is recommended. In addition, research to improve geriatric assessment technology and promote its integration into primary care has a great potential for disability prevention and nursing home use reduction in older persons.
综合老年评估（CGA）被定义为确定老年人的医疗、心理社会、功能和环境资源及问题的过程，并与治疗和随访的总体计划相关联。本文回顾了老年评估的原则，包括使用定量工具进行多维度评估的优缺点。讨论了最近发表的关于综合老年评估的荟萃分析结果，并阐述了其政策含义。该荟萃分析纳入了28项对照试验的数据，包括4959名被分配到五种CGA类型之一的受试者以及4912名对照受试者。原始研究者从已发表的报告中提供了额外未发表的数据，以补充该荟萃分析的数据库。通过多变量逻辑回归方法汇总各个试验的数据，得出CGA评估患者与对照患者结局的合并比值比。在1至4年的随访中，住院老年评估与管理单元的居家生存率合并比值比（95%置信区间）为1.7（1.2 - 2.3），出院后居家评估服务为1.5（1.1 - 2.0），预防性居家评估服务为1.2（1.1 - 1.4）。基于这些研究结果，建议设立跨学科单元，配备经过多维度老年评估培训的工作人员，用于虚弱老年患者的住院评估与管理。此外，改进老年评估技术并促进其融入初级保健的研究，在预防老年人残疾和减少养老院使用方面具有巨大潜力。
