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Geriatrisches Assessment

Sinnvolle Hilfe bei der Auswahl älterer Tumorpatienten für eine belastende Therapie?

Geriatric assessment

Is it useful in the selection of elderly tumour patients for a difficult therapy?

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Zusammenfassung

Mit steigender Lebenserwartung stellt sich in einer Therapiesituation die Frage, welche Ziele primär verfolgt werden sollen. Liegt das Ziel in einer möglichst effektiven Lebensverlängerung oder einem möglichst langen Erhalt der aktiven Lebensspanne? Während bei jüngeren Patienten die Strategie meist eindeutig zugunsten eines möglichst langen Überlebens im Konsens zwischen Arzt und Patient festgelegt wird, stellt die Therapie älterer, funktionell eingeschränkter Patienten andere Anforderungen. Da funktionelle Defizite zwar mit dem Alter korrelieren, aber nicht kausal durch das Alter bedingt sind, besteht eine relevante Heterogenität in der Gruppe der älteren Patienten. Patienten, die ohne relevante Einschränkungen alt geworden sind, sollten für invasive Therapiestrategien in Betracht gezogen werden. Gleichzeitig können kalendarisch jüngere Patienten mit funktionellen Defiziten ohne direkte Verbesserungsmöglichkeit für derartige Therapien nicht mehr geeignet sein. Mit dem geriatrischen Assessment lassen sich funktionelle Defizite systematisch und differenziert erfassen.

Abstract

With increasing life expectancy, a therapeutic decision raises the question of the primary goals to be aimed for. Is an absolute gain in age a goal equal to the preservation of an active life? While in younger patients the strategy followed by the patient and the doctor will usually be that of long-term survival, the decision making process for older patients with functional deficits is more challenging. Though functional deficits show a positive correlation with age, a causal relationship does not exist, which implies considerable inter-individual heterogeneity in the group of older patients. In particular, patients who have reached older ages “successfully” without any major limitations in their health should be considered for more intensive treatment strategies. At the same time, younger patients with relevant functional limitations and without any chance of improvement may not benefit from these interventions. The comprehensive geriatric assessment (CGA) offers the opportunity to describe and classify these deficits systematically. It therefore has a key role in the individual decision making process.

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Authors and Affiliations

  1. Urologische Universitätsklinik Essen

    S. Krege, G. Lümmen & H. Rübben

  2. Klinik für Altersmedizin und Frührehabilitation der Universitätsklinik der Ruhr-Universität Bochum, Marienhospital Herne

    C. Friedrich & L. Pientka

  3. Urologische Klinik am Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen

    S. Krege

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Correspondence to S. Krege.

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Krege, S., Friedrich, C., Lümmen, G. et al. Geriatrisches Assessment. Urologe [A] 43, 922–929 (2004). https://doi.org/10.1007/s00120-004-0637-z

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