CGA在老年人慢病管理康复干预中的应用研究

Application of CGA in elderly chronic disease management and rehabilitation intervention

目的通过对老年医学科住院患者的调查,探讨应用老年医学综合评估(CGA)对老年人慢病管理康复干预的临床价值,分析在我国慢病管理模式中应用老年综合评估的可行性,并为我国老年慢病防控提供指导性建议。方法从2015—2017年期间入住安徽省某三甲医院老年医学科住院患者的千份病例中,按照调查研究入组的标准选择200例年龄在70~85岁之间的患者,通过对患者入院时资料进行回顾性分析,分析内容主要为住院时患者的躯体情况、营养状况、共病、多重用药、功能状态、心理情况、社会环境等,通过分析总结老年人身心存在的潜在问题。然后按照随机分层的原则进行分组,对照组和观察组,观察组由医院-社区共同指导老年人院外健康管理,对照组则日常自我保健,观察一年后,比较两组患者不良事件的发生率:疾病急性发作率,不安全因素如跌倒、误吸、窒息、坠床发生率,药物不良反应发生率,以及老年自身及家属对老人健康的认知评价。结果①两组老年人接近80%有多种合并症,多重用药比率也较高。在老年综合征方面,老年人多有焦虑、抑郁、失眠、视听障碍等症状,老年人肌少症常见并多伴有骨质疏松、关节痛。②观察组在院外实施慢病管理加CGA干预方案后,老年人疾病急性发作、药物不良反应发生率、不安全因素发生率明显低于对照组,观察组老年人对自身疾病的认知率较高。结论老年综合评估对老年患者的慢病康复管理有着积极重要的意义。

Objective:To investigate the clinical value of the application of geriatric comprehensive assessment(CGA)in the management of elderly patients with chronic disease management through the investigation of inpatients in the geriatrics department,and to analyze the feasibility of applying the comprehensive assessment of the elderly in the chronic disease management model in China.And provide guidance for the prevention and control of chronic diseases in China.Methods:From the 1,000 cases of inpatients admitted to the Geriatrics Department of a top three hospital in Anhui Province during 2015-2017,200 patients aged 70-85 years were selected according to the criteria for investigation and admission.The data were retrospectively analyzed.The main contents of the analysis were the physical condition,nutritional status,comorbidity,multiple medications,functional status,psychological status,and social environment of the patients during hospitalization.The potential problems of the elderly's body and mind were analyzed and analyzed.Then,according to the principle of random stratification,the control group and the observation group,the observation group was jointly guided by the hospital-community to guide the elderly outside the health management,and the control group was daily self-care.After one year of observation,the adverse events of the two groups were compared.Rate:the rate of acute exacerbation of the disease,unsafe factors such as falls,aspiration,suffocation,the incidence of falling bed,the incidence of adverse drug reactions,and the cognitive assessment of the elderly and their families for the health of the elderly.Results:1)Nearly 80%of the elderly in the two groups had multiple comorbidities,and the multiple drug use rate was also higher.In the case of senile syndrome,the elderly often have symptoms such as anxiety,depression,insomnia,and audio-visual disorders.Older dystrophy is often accompanied by osteoporosis and joint pain.2)After the implementation of chronic disease management plus CGA intervention program in the observation group,the incidence of acute exacerbation,adverse drug reaction rate and unsafe factors in the elderly was significantly lower than that in the control group.Higher.Conclusion:Comprehensive evaluation of the elderly has a positive and important significance for the management of chronic disease rehabilitation in elderly patients.