| Abstrakt: |
GEMU evaluation is most helpful in complicated cases where frail elderly patients appear likely to require custodial nursing home care in the near future. The best results and most significant reductions in subsequent mortality have occurred in less ill or more recently debilitated elders with a reasonable chance of returning to modified self-care in the home or in assisted living situations. Adapting these principles in an effective, cost-efficient manner for outpatient care is the focus of the majority of current investigations of CGA/GEM. Unfortunately, this option will not be universally available even after the proper parameters for its use are determined. Furthermore, better geriatric assessment and earlier intervention could logically prevent or forestall the patient's functional decline, dependency, and the need for placement. Toward that goal, the reader is referred to a practical guide to efficient outpatient geriatric assessment for general internists and other primary care providers, published by Dr. D.B. Reuben in 1996. A number of questionnaires and rapid screening techniques are included, which make these assessments less cumbersome and thus feasible in this era of austere Medicare reimbursement. However, when managing the care of outpatients with multiple impediments to independent living or hospitalized patients who are partially dependent upon others and are likely to require nursing home placement at (or shortly after) discharge, careful consideration should be given to referral for formal GEM, even if travel to a metropolitan area is required. |
