Comprehensive Geriatric Assessment of Older and Oldest-Old Patients in the Perioperative Period. Russian Gerontology Research and Clinical Centre Experience
Notice bibliographique
Résumé
With the aging population, the significance of preoperative diagnostics and optimizing the treatment of surgical patients with frailty syndrome is gaining momentum. For such patients a comprehensive geriatric assessment (CGA) is carried out to clarify the severity of frailty and the individual characteristics of the geriatric status [1]. The results of this assessment are used to stratify the risk in the postoperative period and to determine targeted interventions for the correction of geriatric syndromes [2]. The introduction of new geriatric technologies during hip and knee replacement in weakened older patients needs scientific justification and confirmation of effectiveness. Objective: to test the method of complex geriatric management of older and oldest-old patients before and after surgical interventions in the provision of planned inpatient orthopedic care (knee and hip arthroplasty). Materials and methods: the study involved two groups of older and oldest-old patients with frailty: 50 patients, average age 69.2 ± 6.0 years [60 to 87 years] with gonarthrosis and 50 patients, average age 67.6 ± 5.5 years [60 to 81 years] with coxarthrosis. At the prehospital stage, patients were diagnosed with frailty, in accordance with the clinical recommendations of «Senile asthenia» [3]. Upon admission to surgical treatment, a CGA was performed, including indicators of basic (Barthel Activities of daily living Index, Barthel scale [4]) and instrumental activity (The Instrumental Activities of Daily Living Scale, IADL scale [5]), nutrition assessment (Mini Nutritional assessment, MNA scale [6]), cognitive functions (The Montreal Cognitive Assessment, MOCA test [7]), depression (Geriatric Depression Scale, GDS-15 scale [8]), as well as quality of life (A Visual Analogue Scale, EQ-VAS scale [9]), multimorbidity and polypragmasia. An individual plan of perioperative management was drawn up. Results. A comparative analysis demonstrated statistically significant improvements in functional status (based on the Barthel scale), cognitive status (based on the MOCA test), nutritional status (based on the MNA scale) and quality of life (based on the EQ-VAS scale) 12 months after surgical intervention in groups of patients after knee and hip replacement. In the group of patients after hip replacement, there was also an improvement in the quality of life of patients 12 months after surgery. The assessment and dynamics of indicators in functional and cognitive status within the control group were not carried out, which makes it difficult to compare the results. However, there was a reduction in hospital stay for patients using geriatric approaches compared with previously used surgical care in the control group. Conclusion: the management of patients with frailty in the perioperative period with the use of CGA allows for preventive measures aimed at maintaining functional, psycho-emotional status. Individual characteristics of the state of psychoemotional and functional status in older and oldest-old patients may not be considered during the traditional preoperative risk stratification and increase the risks of adverse outcomes of surgical treatment, duration of hospital staying and repeated hospitalizations.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
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Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».