Ghid practic de utilizare evaluare geriatrica.

Ghiduri

Ministerul Sanatatii

Ordin nr. 1454 din 2010

 

Argumente, eficienţa, cuantificarea datelor evaluării, formarea limbajului medical european şi internaţional

Conf. Univ. Dr. LUIZA SPIRU

Preşedinte al Comisiei Naţionale de Geriatrie şi Gerontologie

Catedra de Geriatrie Gerontologie / U.M.F. ,,Carol Davila” Bucureşti

Şef Clinica Universitară Geriatrie Gerontologie/Spit. Univ. de Urg. Elias

Şef Centrul de Diagnostic şi Tratament al Bolilor de Memorie

Coordonator pt România al European Alzheimer’s Disease Consortium

Evaluarea geriatrică (EG) este o abordare interdisciplinară care vizează estimarea medicală şi psihosocială a pacientului, stabilirea unui diagnostic corect şi identificarea strategiilor adecvate pentru prevenţie, tratament şi reabilitare. Astfel, eforturile şi cheltuielile în domeniul îngrijirii medicale pot fi reduse, iar speranţa de viaţa va creşte.

EG include un istoric natural complex al fiecărui pacient, care include date personale, detalii antropometrice, antecedente heredocolaterale, diagnosticări şi tratamentele anterioare şi date referitoare la condiţiile ambientale de viaţa (fumat, alcool, droguri, stress, mediu toxic, statutul social).

Este un proces multidimensional realizat pentru evaluare:

  • clinică,
  • funcţională,
  • psihico-cognitivă,
  • mentală,
  • paraclinică,
  • imagistică,

a persoanelor în vârstă.

EG cuprinde scale de evaluare specifice grupelor de vârstă, de peste 50 de ani, care facilitează într-un timp eficient obţinerea de informaţii pentru stabilirea unui DIAGNOSTIC CORECT DE VÂRSTÂ, în contextul polipatologiei pacientului.

S-a constatat că numeroase persoane vârstnice suferă de:

– probleme medicale,

– probleme mentale,

– probleme sociale complexe

EG vizează o instruire asupra concluziilor modificărilor medicale şi psihosociale ale persoanelor în vârstă.

EG începe cu identificarea deteriorării clinice şi a factorilor de risc ai acestei deteriorări. Deteriorarea clinică se referă la:

– agravarea unei boli

– înrăutăţirea statuss-ului funcţional

Profesioniştii din sănatate dezvoltă strategii de:

– prevenire,

– tratare,

– reeducare

pentru

– ameliorarea capacităţilor funcţionale ale pacientului,

– păstrarea capacităţilor funcţionale ale pacientului,

– creşterea speranţei de viaţă.

Evaluarea de Geriatrie-Gerontologie

  • ISTORIA NATURALĂ A PACIENTULUI- stabilită împreună cu pacientul şi familia acestuia
  • EVALUAREA GERIATICĂ A PACIENTULUI

Realizarea unui istoric corect, elaborat, cu ajutorul pacientului şi aparţinatorului este cheia unui diagnostic corect şi a prioritizării reale a diagnosticului final, în cadrul polipatologiei pacientului.

Istoricul natural este urmat de aplicarea unui set de scale de evaluare specific pentru fiecare grupă de vârstă (începând de la 50 de ani):

  • Mini-evaluare a stării mentale (MMSE), Folstein şi Groupe de Recherche sur les Évaluations Cognitives, Folstein-Greco (vezi ghid scale de evaluare şi anexa 1)
  • Testul orologiului (CDT), H. Brodaty: care reflectă funcţiile cortexului frontal şi temporo-parietal
  • Scorul activităţilor cotidiene (ADL) şi Scorul activităţilor cotidiene ce necesită folosirea instrumentelor (IADL), ambele în variantă prescurtată: pentru evaluarea independenţei/dependenţei pacientului;
  • Scala Depresiei Geriatrice Yesavage (GDS) forma prescurtată pentru detectarea simptomelor depresive;
  • Evaluarea echilibrului static şi dinamic (Tinetti): pentru diagnosticarea bolilor neurodegenerative;
  • Mini-evaluarea nutritională (MNA), Guigoz Y, Vellas B and PJ Garry: pentru evaluarea statutului nutriţional al pacientului,
  • Scala Bedsore Norton pentru pacienţii cu patologie severă
  • Analize paraclinice
  • Explorări funcţionale
  • Investigaţii imagistice
  • Teste pentru diagnostic diferenţial
  • Scale de evaluare specifică pentru pacienţii cu patologie neurodegenerativă
  • Profilul psihologic
  • Evaluarea socio-economică a pacientului şi a familiei acestuia.

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