Abstract
The number of people with functional limitations, cognitive impairment and disability with unscheduled, unintended contact to emergency departments seeking acute medical care is increasing. With this, the problem of how to identify elderly people in need for acute geriatric care has evolved. The best solution to the problem would be to perform comprehensive geriatric assessment during the initial contact; however, comprehensive geriatric assessment is considered too complex and therefore not feasible for emergency departments. Instead, screening instruments have been developed and proposed. In this narrative review, selected screening instruments are discussed. The instrument best studied in various settings and countries is the Identification of Seniors At Risk (ISAR) screening tool which contains six simple questions that are easy to administer and can be assessed even in urgent situations. In recent years, several studies have examined the validity of ISAR in different European countries. Most of these studies, including one German study and a recent systematic review, confirmed the validity of ISAR. Unfortunately, evidence is conflicting, as some studies found only weak or even no association between ISAR and negative health outcomes. Other instruments have been investigated to a lesser extent and do not indicate obvious advantages over ISAR. Despite growing evidence in the field, there are still many uncertainties. Further research is needed to solve existing inconsistencies and to assess how elderly patients screened positive for acute geriatric care needs can best be managed further.
Zusammenfassung
Die Anzahl an Patienten mit funktionellen Einschränkungen, kognitiver Einschränkung oder Behinderung, die ungeplant in Kontakt mit der Notaufnahme eines Krankenhauses kommen und akutmedizinischer Versorgung bedürfen, nimmt zu. Damit stellt sich zunehmend das Problem, wie ältere Patienten mit Bedarf einer akut-geriatrischen Behandlung identifiziert werden können. Die Durchführung eines umfassenden geriatrischen Assessments bei Erstkontakt könnte eine Lösung sein. Allerdings gilt das umfassende geriatrische Assessment als zu aufwendig und komplex, um sinnvoll in der Notaufnahme umsetzbar zu sein. Deshalb wurden verschiedene Screening-Instrumente entwickelt und vorgeschlagen. Das in verschiedenen Versorgungszusammenhängen und unterschiedlichen Ländern am besten untersuchte Instrument ist derzeit das ‚Identification of Seniors At Risk‘ (ISAR) Screening Instrument. Es besteht aus sechs einfachen Fragen, die rasch angewendet und auch in dringlichen Situationen erhoben werden können. In den letzten Jahren wurde die Validität des ISAR-Instruments in verschiedenen europäischen Ländern getestet. Die meisten Studien, eine Studie aus Deutschland und eine aktuelle systematische Übersicht eingeschlossen, bestätigen die Validität. Die Ergebnisse sind aber nicht widerspruchsfrei. Einige Studien haben nur einen schwachen oder gar keinen Zusammenhang zwischen ISAR und negativen Gesundheitsfolgen gefunden. Andere Instrumente wurden deutlich weniger gut untersucht und scheinen keinen offensichtlichen Vorteil zu bieten. Trotz der zunehmenden Evidenz zum Thema bleiben etliche Unsicherheiten bestehen. Weitere Studien werden benötigt, um bestehende Inkonsistenzen aufzulösen und zu klären, wie im Screening positive Patienten am besten weiter behandelt werden können.
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U. Thiem, H.J. Heppner and K. Singler declare that they do not have any conflict of interests.
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Thiem, U., Heppner, H. & Singler, K. Instruments to identify elderly patients in the emergency department in need of geriatric care. Z Gerontol Geriat 48, 4–9 (2015). https://doi.org/10.1007/s00391-014-0852-1
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DOI: https://doi.org/10.1007/s00391-014-0852-1