背景:该指南由意大利全科医生-初级保健和老年病医院-社区协会推广,并由国家卫生研究院和一个专家小组参与,其中包括来自25个科学和卫生专业组织的代表。该指南的目的是制定基于证据的建议,以评估不同临床环境中老年人的CGA疗效以及基于CGA的工具评估预后的准确性和实用性。
方法:根据意大利国家指南和NICE标准体系(英国国家健康与护理卓越研究所)的方法手册,该指南是根据建议评估的分级制定的,发展和评价。最初选择了通过数据库搜索收集的20,000多个记录。根据117项符合纳入标准并在一般实践和初级保健中进行的研究(包括26项研究),确定了16项关于CGA疗效的建议。医疗和外科诊所(16项研究),急诊科(17项研究),医院内科和外科病房(53项研究),长期护理设施和疗养院(5项研究),临终关怀和姑息治疗网络(无研究)。关于基于CGA的预后工具的9项建议是基于42项在一般实践和初级保健中进行的研究(5项研究)的问题,医疗和外科诊所(4项研究),和医院病房(33项研究)。
结果:使用CGA可以减少住院,死亡率,制度化,谵妄的风险,提高药物处方的适当性,并在不同环境下维持功能活动。进一步研究CGA在康复设施中的功效,疗养院,和临终关怀和姑息治疗设置建议。基于CGA的工具,特别是多维预后指数,应该用来预测不同环境下的一些负面结果。
结论:本指南在临床实践中可能是有用的,并且可以作为支持在老年人中使用CGA研究的工具。
BACKGROUND: The
guideline was promoted by the Italian General Practitioners-Primary Care and Geriatrics Hospital-Community Societies and was carried out involving the National Institute of Health and an Expert Panel including representatives from 25 Scientific and Health-Professional Organizations. The aim of the
Guideline was to develop evidence-based recommendations on the efficacy of CGA in older people across different clinical settings and the accuracy and utility of CGA-based tools to assess prognosis.
METHODS: According to the methodological handbook of the Italian National System of
Guidelines and NICE criteria (National Institute for Health and Care Excellence in England), the
Guideline was produced based on the Grading of Recommendations Assessment, Development and Evaluation. Over 20,000 records gathered through databases searches were initially selected. Sixteen recommendations on CGA efficacy were defined based on 117 studies that met the inclusion criteria and were performed in general practices and primary care (26 studies included), medical and surgical clinics (16 studies), emergency departments (17 studies), hospital medical and surgical wards (53 studies), long-term care facilities and nursing homes (5 studies), hospices and palliative care networks (no studies). Nine recommendations on CGA-based prognostic tools were issues based on 42 included studies carried out in general practices and primary care (5 studies), medical and surgical clinics (4 studies), and hospital wards (33 studies).
RESULTS: Using CGA can be useful to reduce hospitalization, mortality, institutionalization, the risk of delirium, and improve appropriateness in drug prescription and maintain functional activities in different settings. Further research on the efficacy of CGA in rehabilitative facilities, nursing homes, and hospice and palliative-care settings is recommended. CGA-based tools, particularly the Multidimensional Prognostic Index, should be used to predict some negative outcomes in different settings.
CONCLUSIONS: This
Guideline may be useful in clinical practice and as a tool to support research on the use of CGA in older people.