Ambulantes Geriatrisches Assessment in der allgemeinärztlichen Sprechstunde - Wie häufig werden therapeutische Konsequenzen gezogen?

Diese Studie widmete sich der Fragestellung, ob sich ein geriatrisches Assessment in der Hausarztpraxis lohnt. In 67 Allgemeinpraxen aus dem Hannoverschen und Leipziger Raum wurden 446 ältere Patienten untersucht, wobei 4250 medizinische, 374 psychiatrische und 528 soziale Probleme festgestellt wurden. 45,4 % der medizinischen, 61,8 % der psychiatrischen and 56,8 % der sozialen Probleme waren den Ärzten bislang im Rahmen ihrer Routinebetreuung unbekannt geblieben. Die Ergebnisse ergaben wichtige Hinweise, welche Maßnahmen im Praxisalltag erfolgreich umzusetzen sind.

Aims: To evaluate the geriatric assessment of preventable disabilities in primary care. Methods: We used the Ages assessement instrument, a geriatric preventive screening examination with a patient, nurse and doctor administered questionnaire including various indicators of physical, emotional and social functions as well as laboratory exams. The assessment procedure was tested in 67 practices around Hannover and Leipzig, Germany. Results of the assessment procedure in 446 patients aged 70 and over revealed a high prevalence of treatable health problems. In these patients we found 4250 medical, 374 psychiatric and 528 social problems. 45,4 % of medical, 61,8 % of psychiatric and 56,8 % of social problems were hitherto unkown to the GPs. However the proportion of specific medical reactions of general practioners was considerably lower. In most instances the doctors adopted a wait and see strategy with no intervention. Doctors most often choose interventions which are efficient and easy to implement in daily practice.

Conclusions: Broad asessment instruments may detect a lot of morbidity previously unknown to the GP but they do not lead to therapy in all cases. Future research is needed to develop short instruments which focus on health problems both relevant to the elder persons quality of life and to the GPs appreciation of manageable interventions after geriatric assessment. Items to be included in future geriatric assessment procedures should be selected according to evidence based medicine (e.g. the number needed to treet for a desired outcome).

geriatric assessment - primary care - old age - evaluation - trial

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