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Öldrunarendurhæfing innan öldrunarlækninga á Norðurlöndum

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Authors
Ársæll Jónsson
Pálmi V. Jónsson
Yngve Gustafson
Schroll, Marianne
Hansen, Finn R.
Saarela, Mika
Nygaard, Harold A.
Laake, Knud
Valvanne, Jakko
Dehlin, Ove
Issue Date
2002-01-01

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Other Titles
Geriatric Rehabilitation as an Integral Part of Geriatric Medicine in the Nordic Countries
Citation
Læknablaðið 2002, 88(1):29-38
Abstract
Objective: Firstly to outline the theoretical and practical framework for geriatric rehabilitation in Iceland and other Nordic countries and secondly to survey the scientific medical publications for evidence based geriatric rehabilitation. Methods: Brain storming on geriatric rehabilitation in a working group of Nordic teachers in geriatric medicine. Papers on scientific programs for geriatric rehabilitation from Internet sources were collected and analyzed. All articles describing randomized studies in geriatric rehabilitation were selected for overview. The papers were divided into four groups according to diseases, infirmity and resource settings; 1) stroke, 2) hip-fractures, 3) acute admissions and 4) programs conducted in nursing homes, day hospitals and home services. Results: A spectrum of biological and social events creates the conditions underlying most causes for illness and disability in old people. The process of established geriatric services promotes the efficiency of geriatric rehabilitation. The literature survey included 27 scientific studies (8586 patients) on randomized studies with valid endpoints. Geriatric rehabilitation programs for stroke patients in geriatric settings, six studies (1138 patients), reduced mortality and the need for nursing home placement but the outcome for ADL. Function and length of stay was more variable between the studies. The outcome of geriatric rehabilitation was even more decisive in the randomized hip-fracture studies, six studies (2171 patients). Eight studies were found comparing the outcome between acute admission of frail elderly to either geriatric (GEMU, GRU) or general medical wards. The outcome as regards to mortality rate at one year, placement to a nursing home, physical function, contentment with services, readmission rate and cost was all significantly better in the geriatric settings. Internal comparisons of geriatric programs in nursing homes, day hospitals and in home service, seven studies (1261 patient), revealed some differences in outcomes in function, contentment and costs. Conclusions: Specialized geriatric rehabilitation is complicated but effective when properly performed. Interdisciplinary teamwork, targeting of patients, comprehensive assessment and intensive and patient-targeted rehabilitation seem to characterize the most effective programs. Rehabilitation of frail elderly people poses a major challenge for the future and has to be developed further for the sake of quality of life of elderly people as well as for economic reasons.
Markmið: Að gera úttekt á öldrunarendurhæfingu á Íslandi og öðrum Norðurlöndum, marka hinn hugmyndafræðilega grunn, tengja hann norrænum veruleika og taka saman vísindalegar niðurstöður um árangur öldrunarendurhæfingar. Aðferð: Hugarflugsfundir vinnuhóps kennara í öldrunarlækningum um öldrunarendurhæfingu. Sértæk leit í helstu læknatímarita á Medline í greinum sem fjalla um aðferðir og meðferðarleiðir endurhæfingar fyrir aldraða á vísindalegan hátt. Um er að ræða samantekt á rannsóknum sem notast við slembiúrtök og taka til elstu aldurshópa. Greinunum var skipt niður í fjóra flokka eftir sjúkdómum, færni og staðsetningu; 1) heilablóðfall, 2) mjaðmarbrot, 3) bráðveikir og hrumir, 4) prógrömm á hjúkrunarheimilum, dagspítölum og í heimaþjónustu. Niðurstöður: Lífeðlisfræðilegir og félagslegir þættir marka veikindaferli og fötlun aldraðra. Verklag öldrunarþjónustunnar skiptir miklu um árangur öldrunarendurhæfingar. Leit í 27 tímaritsgreinum náði til 8586 sjúklinga en þær báru saman slembiúrtök og höfðu haldbærar viðmiðanir. Endurhæfing aldraðra heilablóðfallssjúklinga á öldrunarlækningadeild, sex rannsóknir (1138 sjúklingar), dró úr dánarlíkum og minnkaði þörf fyrir stofnanavist en breyting á mælanlegri færni og legudagafjöldi varð ekki afgerandi hjá öllum. Enn betri árangur náðist við endurhæfingu eftir mjaðmarbrot, sex rannsóknir (2171 sjúklingur). Átta rannsóknir (4016 sjúklingar) báru saman árangur öldrunarlækningadeilda borið saman við almennar lyflæknisdeildir í meðhöndlun bráðveikra og hrumra sjúklinga. Niðurstöður voru flestar afgerandi betri á öldrunarlækningadeildum hvað varðar dánartíðni að ári, vistun á hjúkrunarheimili, líkamlega færni, ánægju, endurinnlagnir og kostnað. Innbyrðis samanburður á endurhæfingaraðferðum fyrir aldraða á hjúkrunarheimilum, dagspítölum og í heimaþjónustu, sjö rannsóknir (1261 sjúklingur), sýndu mun á nokkrum viðmiðunum í færniþáttum, ánægju og kostnaði. Ályktanir: Sérhæfð endurhæfing aldraðra er flókin en skilar árangri þegar rétt er á haldið. Bestur árangur næst með fjölfaglegri teymisvinnu, val á þeim sjúklingum sem mestu áhættuna hafa, alhliða öldrunarmati og virkri og einstaklingsmiðaðri endurhæfingu. Endurhæfing á hrumu gömlu fólki er og verður vaxandi viðfangsefni fyrir heilbrigðisþjónustuna og mikilvægt að hún nái því markmiði að auka lífsgæði aldraðs fólks. Benda rannsóknir einnig til að við það skapist einnig efnahagslegur ávinningur fyrir land og þjóð.
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http://www.laeknabladid.is/2002/1/fraedigreinar/nr/720/
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