综合评估在老年患者急诊就诊中的应用进展

doi:10.3761/j.issn.2096-7446.2023.06.017

摘要/Abstract

摘要： 老年综合评估是指通过多学科方法识别老年患者相关风险,继而进行针对性改善,最大限度维护老年患者的功能状态、提高生活质量。该文综述了提高综合评估在急诊老年患者中应用效果的策略,包括促进多学科合作、加强培训、制订流程等。综合评估有利于早期识别与干预老年患者当前主诉以外的健康风险因素,但更高效和本土化的急诊老年患者综合评估流程仍需进一步完善。

关键词: 老年综合评估, 急诊室, 医院, 危险性评估, 老年人, 综述文献（主题）

Abstract: Comprehensive geriatric assessment refers to the identification of relevant risks of the elderly through multidisciplinary methods,and then targeted improvement,so as to maximize the maintenance of the functional status of the elderly and improve the quality of life. This paper reviews strategies to improve the effectiveness of comprehensive assessment in elderly patients attending emergency departments,including promoting multidisciplinary collaboration,strengthening training,and developing procedures. Comprehensive assessment is beneficial to early identification and intervention of health risk factors beyond the current chief complaint of elderly patients,but a more efficient and localized comprehensive assessment process for elderly patients in emergency setting still needs to be further improved.

Key words: Comprehensive Geriatric Assessment, Emergency Service, Hospital, Risk Assessment, Aged, Review Literature as Topic

梁熠, 应燕萍. 综合评估在老年患者急诊就诊中的应用进展[J]. 中华急危重症护理杂志, 2023, 4(6): 568-572.

LIANG Yi, YING Yanping. The application progress of comprehensive assessment in elderly patients attending the emergency department[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023, 4(6): 568-572.

参考文献

[1] 卫生健康委员会. 关于印发“十四五”健康老龄化规划的通知[EB/OL].(2022-03-01)[2022-10-01]. http://www.gov.cn/zhengce/zhengceku/2022-03/01/content_5676342.htm.
National Health Commission. The 14th five-year plan for healthy aging[EB/OL].(2022-03-01)[2022-10-01]. http://www.gov.cn/zhengce/zhengce-ku/2022-03/01/content_5676342.htm.
[2] Mwakilasa MT,Foley C,O'Carroll T,et al. Care experiences of older people in the emergency department:a concurrent mixed-methods study[J]. J Patient Exp,2021,8:23743735211-065267.
[3] 杨志伟,蹇在金,刘跃华,等. 老年危重症患者急诊临床特点[J]. 中国老年学杂志,2021,41(5):1010-1013.
Yang ZW,Jian ZJ,Liu YH,et al.Clinical characteristics of emergency treatment for elderly critically ill patients[J]. Chin J Gerontol,2021,41(5):1010-1013.
[4] 陈旭娇,严静,王建业,等. 中国老年综合评估技术应用专家共识[J]. 中华老年病研究电子杂志,2017,4(2):1-6.
Chen XJ,Yan J,Wang JY,et al.Expert consensus on the appli-cation of comprehensive assessment technology for the elderly in China[J]. Chin J Geriatr Res Electron Ed,2017,4(2):1-6.
[5] 施红,赵烨婧,邓琳子. 老年综合评估的临床意义与应用进展[J]. 中国心血管杂志,2021,26(5):413-417.
Shi H,Zhao YJ,Deng LZ.Clinical significance and application advances of comprehensive geriatric assessment[J]. Chin J Car-diovasc Med,2021,26(5):413-417.
[6] Miller DK,Lewis LM,Nork MJ,et al.Controlled trial of a geriatric case-finding and liaison service in an emergency department[J]. J Am Geriatr Soc,1996,44(5):513-520.
[7] Caplan GA,Williams AJ,Daly B,et al.A randomized,controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department:the DEED Ⅱ study[J]. J Am Geriatr Soc,2004,52(9):1417-1423.
[8] Foo CL,Siu VW,Tan TL,et al.Geriatric assessment and intervention in an emergency department observation unit reduced re-attendance and hospitalisation rates[J]. Australas J Ageing,2012,31(1):40-46.
[9] American College of Emergency Physicians,American Geria-trics Society,Emergency Nurses Association,et al. Geriatric emer-gency department guidelines[J]. Ann Emerg Med,2014,63(5):e7-e25.
[10] Lucke JA,Mooijaart SP,Heeren P,et al.Providing care for older adults in the emergency department:expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine[J]. Eur Geriatr Med,2022,13(2):309-317.
[11] Cassarino M,Robinson K,Trépel D,et al.Impact of assessment and intervention by a health and social care professional team in the emergency department on the quality,safety,and clinical effectiveness of care for older adults:a randomised controlled trial[J]. PLoS Med,2021,18(7):e1003711.
[12] Gladman JR,Conroy SP,Ranhoff AH,et al.New horizons in the implementation and research of comprehensive geriatric assessment:knowing,doing and the ‘know-do’ gap[J]. Age Age-ing,2016,45(2):194-200.
[13] 路明惠,柳国芳,李淑嫒,等. 老年患者急诊就诊综合评估及管理[J]. 护理学报,2016,23(16):26-28.
Lu MH,Liu GF,Li SY,et al.Comprehensive evaluation and management of emergency treatment for elderly patients[J]. J Nurs China,2016,23(16):26-28.
[14] Hesselink G,Demirbas M,Rikkert MO,et al.Geriatric education programs for emergency department professionals:a systematic review[J]. J Am Geriatr Soc,2019,67(11):2402-2409.
[15] Hesselink G,Sir Ö,Öztürk E,et al.Effects of a geriatric education program for emergency physicians:a mixed-methods study[J]. Health Educ Res,2020,35(3):216-227.
[16] Ringer T,Dougherty M,McQuown C,et al. White paper-geriatric emergency medicine education:current state,challenges,and recommendations to enhance the emergency care of older adults[J]. AEM Educ Train,2018,2(Suppl Suppl 1):S5-S16.
[17] Huded JM,Lee A,McQuown CM,et al. Implementation of a geriatric emergency department program using a novel workforce[J]. Am J Emerg Med,2021,46:703-707.
[18] Taylor A,Broadbent M,Gurung A,et al.The development of a modified comprehensive geriatric assessment for use in the emergency department using a RAND/UCLA appropriateness method[J]. Int Emerg Nurs,2021,55:100847.
[19] Gretarsdottir E,Jonsdottir AB,Sigurthorsdottir I,et al.Patients in need of comprehensive geriatric assessment:the utility of the InterRAI emergency department screener[J]. Int Emerg Nurs, 2021,54:100943.
[20] Southerland LT,Vargas AJ,Nagaraj L,et al.An emergency department observation unit is a feasible setting for multidisciplinary geriatric assessments in compliance with the geria-tric emergency department guidelines[J]. Acad Emerg Med,2018,25(1):76-82.
[21] 罗园,安然,王晨,等. 急诊常见老年综合评估工具研究进展[J]. 护理研究,2022,36(12):2191-2195.
Luo Y,An R,Wang C,et al.Research progress of common comprehensive geriatric assessment tools in the emergency department[J]. Chin Nurs Res,2022,36(12):2191-2195.
[22] 朱海兰,孟繁森,林云娟,等. 老年急症患者的InterRAI急性病照护综合评估[J]. 中华老年医学杂志,2020,39(11):1292-1296.
Zhu HL,Meng FS,Lin YJ,et al.The InterRAI acute care for comprehensive geriatric assessment in elderly emergency patients[J]. Chin J Geriatr,2020,39(11):1292-1296.
[23] 李立群,王建宁,詹梦梅,等. 急诊科老年患者谵妄评估工具的研究进展[J]. 中华护理杂志,2019,54(5):776-780.
Li LQ,Wang JN,Zhan MM,et al.A review of delirium assessment tools for elderly patients in emergency department[J]. Chin J Nurs,2019,54(5):776-780.
[24] 苏洋,李欣,邓程霖,等. 老年综合评估工具的研究进展[J]. 中国老年学杂志,2019,39(5):1270-1273.
Su Y,Li X,Deng CL,et al.Research progress of comprehensive assessment tools for the elderly[J]. Chin J Gerontol,2019, 39(5):1270-1273.
[25] Häseler-Ouart K,Arefian H,Hartmann M,et al.Geriatric assessment for older adults admitted to the emergency department:a systematic review and meta-analysis[J]. Exp Gerontol,2021,144:111184.
[26] Lin CF,Lin PC,Hu SY,et al.Comprehensive geriatric assessment and clinical outcomes in the older people at the emergency department[J]. Int J Environ Res Public Health,2021, 18(11):6164.
[27] Southerland LT,Lo AX,Biese K,et al.Concepts in practice:geriatric emergency departments[J]. Ann Emerg Med,2020,75(2):162-170.