Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 322

There are many well‐founded interventions for the prevention and management of geriatric syndromes in the hospital⁶⁵. These generally fall into the following categories: risk identification and assessment tools, single‐ or multicomponent practical interventions, changes to systems of care, and educational programs. Many of these approaches are complemented by or have been incorporated into national or international campaigns and guidelines for widespread use. All are most effective if underpinned by strong leadership and robust measurement and reporting systems.

Some examples of commonly used risk assessment tools in the UK are the multitude of available falls risk assessment tools, the Waterlow score for assessing pressure sore risk, and the Malnutrition Universal Screening Tool (MUST). There are challenges to the effective use of such screening tools: they should be completed by staff who have a sound understanding of the conditions they are assessing, and identification of risk must be followed by justifiable actions to prevent the development of the geriatric syndrome.

The best known and most widely used general assessment tool for older people is the Comprehensive Geriatric Assessment (CGA). It contains six key elements: assessment of functional ability, cognitive function, physical health, socioeconomic status, nutritional status, mobility, and falls risk. Its purpose is to provide a holistic assessment of all issues relevant to a frail patient: it has been shown that if the CGA is combined with strong and sustained interventions, better long‐term outcomes can be achieved.⁶⁶ However, it is unclear whether it impacts hospital‐acquired complications, although it undoubtedly identifies those who are the frailest and at the highest risk of adverse outcomes.

A good example of a practical intervention designed to prevent the development of a geriatric syndrome in the hospital is the multicomponent intervention for delirium tested as part of the Elder Life Program.⁶⁷ In this study, six well‐known risk factors for delirium (cognitive impairment, visual and hearing impairment, sleep deprivation, immobility, and dehydration) were addressed comprehensively by a trained interdisciplinary team and tested in a controlled clinical trial: the incidence of delirium was reduced from 15% in the ‘usual care’ group to 9.9% in the intervention group (giving a matched odds ratio of 0.60, with p = 0.02). The practical methods used in each protocol were simple, commonsense management that it could be argued should form part of best practice and good, empathetic care for all elderly patients. Other multifactorial interventions, when supported by strong leadership and robust measurement and reporting, have been shown to be key to reducing other geriatric syndromes, such as falls.⁶⁸