Validierung des Geriatrie-Checks zur Identifikation geriatrischer Patienten in der Notaufnahme

Background!#!The geriatric check was developed for identification of geriatric patients in emergency departments (ED) as part of the concept for geriatric care in Baden-Württemberg.!##!Aim!#!Determination of convergent and predictive validity of the geriatric check with respect to identification and outcome prediction of geriatric patients in the ED.!##!Material and methods!#!A prospective cohort study between November 2015 and April 2016 including 146 patients older than 70 years in the internal medicine ED of Ulm University Hospital. Separate assessment by physicians and nursing staff of the following: identification of seniors at risk (ISAR), geriatric check, additional cognitive and functional assessments and for outcome: change in care index, Barthel index, living arrangements.!##!Results!#!The ISAR classified 117 patients as geriatric patients and the geriatric check 107. The correlation was 78.1%. With ISAR as the gold standard the geriatric check showed a sensitivity of 82.0% and a specificity of 62.1%. The positive and negative predictive values were 89.7% and 46.1%, respectively. The identification by simple estimation was better for nurses than for doctors (sensitivity 70.5% vs. 58%, specificity 88.9% vs. 83.3%). The predictive validity 5 months after admission with respect to the abovementioned outcome parameters was best for nurses and doctors (especially regarding specificity). Both tests were very sensitive but not very specific.!##!Discussion!#!The geriatric check is comparable to the ISAR. The convergent validity showed little difference. Both the ISAR and geriatric check were slightly more sensitive than doctors and nurses. Regarding predictive validity, doctors and nurses were superior to both scores. An algorithm starting with ISAR or geriatric check and followed by an estimation by doctors or nurses could be most suitable for optimal resource allocation

Characterization of patients admitted to specialized geriatric acute care hospital units with the German version of the Standardized Evaluation and Intervention for Seniors at Risk (SEISAR) screening-instrument

$\bf Background$ The $\bf S$tandardized $\bf E$valuation and $\bf I$ntervention for $\bf S$eniors at $\bf R$isk (SEISAR) screening tool records major geriatric problems, originally applied in the emergency department. Particularly, the distinction of compensated and uncompensated problems is an interesting and new approach. Therefore, we translated the SEISAR in German language and used it to characterize patients in specialized geriatric hospital wards in Germany and to gather initial experience regarding its usability and practicability. $\bf Methods$ The tool was translated by three independent specialists in geriatric medicine and backtranslated for quality-assurance by a non-medical English native speaker. In a second step, 8 acute care geriatric hospital departments used the translated version to characterize all consecutive patients admitted over a period of one month between December 2019 and May 2020 at time of admission. $\bf Results$ Most of the 756 patients (78%) lived in an own apartment or house prior to hospital admission. Participants had on average 4 compensated and 6 uncompensated problems, a Barthel-Index of 40 pts. on admission with a median increase of 15 points during hospital stay, and a median length of stay of 16 days in the geriatric hospital department. $\bf Conclusion$ SEISAR is an interesting standardized brief comprehensive geriatric assessment tool for the identification of compensated and uncompensated health problems in older persons. The data of this study highlights the number, variability, and complexity of geriatric problems in patients treated in specialized acute care geriatric hospital wards in Germany