노인포괄평가 시행 전후의 약물 복용 현황 및 처방 변화

류재은,서예원,이병구,김광일,이은숙 한국병원약사회 2008 병원약사회지 Vol.25 No.2

One of the primary mission for Seoul National University Bundang Hospital is the management Geriatric Center(GC). Therefore, geriatrician, pharmacist, nurse, dietician and social worker was consolidated to provide a better care to geriatric patients in the GC. The role of pharmacist in the team is to identify medicines that are inappropriate, unnecessary and potentially therapeutically problematic(e.g., drug-drug interaction, drug-disease interaction, inappropriate dosage and therapeutic duplication) in geriatric patients. In a previous study, we reported the successful implementation of the Comprehensive Geriatric Assessment(CGA) protocol in the hospital; In particular, we found the assessment score was quite useful in improving the medication assessment. The objective of the current study was to determine further the usefulness of the CGA in the extension of the role of pharmacist in the alteration of prescription. One hundred and fifty geriatric patients, who visited the GC in Seoul National University Bundang Hospital during the period of the 1st of January to the 31st of August of 2006, were involved in this study. Prescription status of the patients indicated that there was a significant incidence of polypharmacy [i.e., more than 4 medications; 114 patients(76%)] and therapeutic duplication [i.e., 28 patients(18.7%)]. In addition, a significant number [i.e., 98(65.3%)] of patients had a reduced renal function(i.e., creatinine clearance below 50 mL/min), suggesting a dose adjustment should have been necessary for the patients, while 48 patients(32%) had inappropriate medication. As for the medication-related characteristics based on ATC codes, the patients were prescribed with drugs for cardiovascular system(82.7%), alimentary tract and metabolism(66%). Particularly, the ratio of patients with inappropriate medication was 1.9-folds higher for patients visiting more than two hospitals, 1.8-folds higher for patients visiting more than two clinics. With the implementation of the CGA, the average number of medicine per patient decreased from 6.9(±4.4) to 3.7(±3.1). In addition, the ratio of polypharmacy(76%->48%) and patients prescribed inappropriate medication(32%->1.3%) were declined. The pharmacist documented 224 recommendations, of which 129(57.6%) were accepted by the physician. The physicians tend to accept the recommendation by the pharmacist for the problems associated with drug-drug interaction(83.3%), inappropriate medication(75.4%) and drug duplication(69.2%). Taken together, these observations indicate that the implementation of CGA is indeed useful in reducing incidences that are related to the pharmacotherapy and the extension of the role of pharmacist for the prescription process. Therefore, the medication assessment of pharmacist may be crucial in the realization of a safer and more appropriate pharmacotherapy.

Development of Korean Frailty Index for Primary Care (KFI-PC) and Its Criterion Validity

Chang Won Won,Yunhwan Lee,이서윤,Miji Kim 대한노인병학회 2020 Annals of geriatric medicine and research Vol.24 No.2

Background: The objective of this study was to develop and validate the Korean Frailty Index for Primary Care (KFI-PC) based on a comprehensive geriatric assessment. Methods: We developed a 53-item KFI-PC comprising 10 standard domains: cognitive status including delirium or dementia; mood; communication including vision, hearing, and speech; mobility; balance; bowel function; bladder function; ability to carry out activities of daily living; nutrition; and social resources. To test its validity, we applied KFI-PC to participants of the Korean Frailty Aging and Cohort Study (KFACS). We analyzed 1,242 participants (mean age, 77.9±3.9 years; 47.2% men) from the KFACS who visited 10 study centers in 2018, after excluding 32 participants with missing data required to assess Fried’s physical frailty phenotype. Results: The mean KFI-PC score was 0.17±0.08, ranging from 0.02 to 0.52. The median KFI-PC score was higher in women than in men, and there was a trend toward higher values in older age groups. The prevalence of frailty when applying a generally used frailty index cutoff point of >0.25 was 17.5% in the whole study sample. As a construct validation of KFI-PC, the area under the receiver operating characteristic curve for Fried’s physical frailty was 0.921, and the optimal cutoff value to predict frailty phenotype was 0.23. The KFI-PC score also correlated well with physical, cognitive, and psychological functions; nutritional status; disability in activities of daily living; and instrumental activities of daily living. The Cronbach alpha coefficient of the 54 total items was 0.737. Conclusion: We developed KFI-PC with 53 deficits, including comprehensive geriatric assessment components, and demonstrated the acceptable construct validity and internal consistency of KFI-PC.

Estimating Radiation Therapy Toxicity and Tolerability with Comprehensive Assessment Parameters in Geriatric Cancer Patients

Ulger, Sukran,Kizilarslanoglu, Muhammet Cemal,Kilic, Mustafa Kemal,Kilic, Diclehan,Cetin, Bekir Eren,Ulger, Zekeriya,Karahacioglu, Eray Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.5

Cancer prevalance and incidence is increasing with aging of populations and age is a critical factor in decision-making for anti-cancer treatment. However it is believed that chronological age is not enough to guide management in elderly cancer patients. Multidisciplinary evaluation and comprehensive geriatric assessment has gained importance regarding the treatment selection especially for definitive anti-cancer therapy recently. We here aimed to analyse the effect of the comprehensive geriatric assessment parameters on radiotherapy toxicity and tolerability in a series of geriatric cancer patients in Turkey.

노인 포괄평가의 개념과 필요성

권인순 대한의사협회 2014 대한의사협회지 Vol.57 No.9

Comprehensive geriatric assessment (CGA) is a diagnostic process evaluating frail older patient’s medical problemsand functional status to make overall plan for treatment and long-term care plan. It emphasizes on functionalstatus and quality of life and uses interdisciplinary team and assessment tool frequently. CGA is associated withsignificant benefit in improved diagnostic accuracy with increased survival, improved physical and cognitive function,appropriate medication use, reduced hospital and nursing home use and reduced health care costs. Although frailtypatients might have greatest benefits, careful periodic screening and follow up monitoring of all older persons isalso very important. The goal of CGA in the older patients might be independence. To improve the quality of life offrail old patients and to reduce long-term care population number and care costs, performing geriatric assessmentwould be the best choice in geriatric field.

시설이용 노인에 있어서 포괄적 노인 평가 및 생만족도간의 관계 연구

조경희(Kyung-Hee Cho),이윤환(Yun-Hwan Lee) 대한임상노인의학회 2000 대한임상노인의학회지 Vol.1 No.1

연구배경 : 포괄적 노인 평가 도구는 노인들이 가지고 있는 의학적, 정신사회적, 그리고 기능적인 능력 및 문제점을 발견해 내고 이를 치료하고 추적 관찰하기 위해 개발된 다차원적이고 유기적인 진단도구이다. "삶의 만족 지수"는 노인 환자들의 정신적인 안녕감을 평가하기 위한 도구이다. 본 연구에서는 요양기관 시설을 이용하는 노인환자들에 있어서 포괄적 노인평가 도구와 삶의 만족도와의 상관관계를 알아보기 위하여 실시하였다. 방법 : 경기도 성남시에 거주하는 65세 이상의 노인중 복지관 이용자 32명, 양로원 거주자 41명, 그리고 한 종합병원에 입원한 35명을 합한 108명을 대상으로 1998년 8월 1일부터 11월 30일까지 설문지를 이용하여 대상인구의 사회경제적 지표, 포괄적 노인평가, 그리고 삶의 만족 지수등을 평가하였다. 통계는 chi-square, 공분산 분석, 다변랑 회귀분석등을 이용하였다. 결과 : 대상군의 평균연령은 75세(표준편차=6.9)로 남자가 23명(21%), 여자가 85명(79%)였다. 서로 다른 시설 이용군 간에 인구사회학적 요인들 중 성, 나이, 교육정도, 배우자 유무, 동거가족 유무, 수입정도 등; 생활습관 중 수면시간; 의료이용 요인 중 병원 입원 여부와 외래 진료 여부; 육체적 건강상태 중 시력, 청력, 요실금, 영양위험도; ADL; IADL; 정신적 건강 상태 중 우울; 사회적지지; 그리고 사회적 지원망 등에 따라 통학적으로 유의한 차이를 보였다. 삶의 만족 지수는 복지관 이용군이 8.69, 양로원 이용군이 7.54, 그리고 병원 이용군이 11.06으로 병원 이용군에서 가장 높게 나타났다. 삶의 만족도와 의미있는 상관관계를 보인 인자들은 이용 시설; 인구사회학적 요인 중 성, 배우자 유무, 월 수입, 동거 가족 유무, 생활습관 중 운동, 수면 시간; 주관적 의료이용평가; 육체적 건강 중 통증, 영양 위험도, 시력; 정신적 건강 상태 중 우울; 그리고 건강 서비스에 대한 만족도 등이었다. 다중 회구 분석에 의해 낮은 점수의 우울 증상(p=0.001), 운동(p=0.41), 그리고 동거가족이 있는 것(p=0.53) 등이 높은 삶의 만족도와 독립적인 연관관계에 있음을 보여 주었다. 시설 간에 따른 차이는 보이지 않았다. 결론 : 세 가지 시설에 이용자들에게 우울, 운동 그리고 가족구조(동거가족 유무)가 삶의 만족도를 결정하는 중요한 요소이다. Background : Comperhensive geriatric assessment(CGA) is a multidimensional imterdisciplinary diagnostic process intended to determine a frail elderly person's medical, psychosocial, and functional capability and problems in order to develop an overall plan for treatment and long-term follow-up. Life Satisfaction Index has been used to assess psychological well-being among elderly people. This study aims to examine the relationship between comprehensive geriatric assessment and life satisfaction among older people using services at three different facilities. Methods : A total of 108 people aged 65 and over living in Sungnam City, Kyunggi Province was surveyed from August 1 to November 30, 1998, which included users of welfare center (32), nursing home residents (41), and those admitted to the hospital (35), Survey items included socioeconomic characteristics, comprehensive geriatric assessment, and life satisfaction scale. Analyses were conduct ed using Chi-square, ANOV A, and multiple regression. Results : Average age was 75 years(SD=6.9) with 23 men (21%) and 85 women (79%). Significant differences (p<.05) were observed among users of facilities according to sociodemographic factors (gender, age, education, presence of spouse, presence of household members, economic status, etc.); life style factor (hour of sleep); health service use (hospitalization, outpatient), physical health (vision, hearing, incontinence, nutrition), activities of daily living, instrumental activities of daily living, mental health (depression), social support, and satisfaction with care services. Life satisfaction index showed 8.69, 7.54, and 11.06 for welfare center, nursing home, and hospital, respectively, showing the highest level of satisfaction among elderly people admitted to the hospital. Factors significantly associ ated (p<.05) with life satisfaction were facility type, sociodemographic characteristics (gender, pres ence of spouse, monthly income, presence of household members) ; life style characteristics (exercise, hour of sleep); self-assessed health service use; physical health(pain, nutrition, vision); mental health (depression) ; social support; and satisfaction with health services (environmental). Multiple regression analysis revealed lower degree of depressive symptoms (p=0.001), exercise (p=0.41), and presence of household members (p=.053) to be independently associated with higher level of life satisfaction. No difference was observed by type of facility. Conclusion : This study demonstrated the importance of depression, exercise, and family structure in determining life satisfaction among elderly users of three different facilities.

다학제 팀의료에 의한 노인의료센터 입원환자의 항콜린약물부담 감소효과 분석

이주혜,박가영,서예원,이정화,이은숙,Eunkyung Euni Lee,최정연,김광일,이주연 한국임상약학회 2020 한국임상약학회지 Vol.30 No.2

Background: Reducing the total anticholinergic burden (AB) in older adults is recommended owing to the several peripheral and central adverse effects. This study aimed to identify the AB status of patients admitted to geriatric centers for assessing the influence of the pharmacist-involved multidisciplinary geriatric team care on reducing the AB. Methods: We retrospectively reviewed the medical records of 328 older patients hospitalized in geriatric centers from July 1, 2018 to June 30, 2019, who received comprehensive geriatric assessment and pharmaceutical interventions from a multidisciplinary geriatric team. We measured the total AB scores for the medications at the time of admission and upon hospital discharge using the Korean Anticholinergic Burden Scale (KABS). The pre-admission factors associated with high AB (KABS score ≥3) at the time of admission were identified. Results: The proportion of patients with high AB significantly decreased from 41.8% (136/328) at the time of admission to 25.0% (82/328) on discharge (p<0.001). The pre-admission AB of patients transferred from skilled nursing facilities (odds ratio[OR]: 2.85, 95% CI: 1.26- 3.75), taking more than 10 medications (OR: 3.70, 95% CI: 1.55-8.82), suffering from delirium (OR: 2.80, 95% CI: 1.04-7.50), or depression (OR: 2.78, 95% CI: 1.04-7.41) were significantly high. Antipsychotics were the most frequent classes of drugs that contributed to the total KABS score at the time of admission, followed by antihistamines. Conclusions: This study demonstrated that the multidisciplinary teams for geriatric care are effective at reducing AB in older adults. The factors associated with high AB should be considered when targeting pharmaceutical care in geriatric individuals.

성공노화를 위한 포괄적 노인평가 패키지 개발

김선호(Seonho Kim),오두남(Doo-Nam Oh) 한국콘텐츠학회 2012 한국콘텐츠학회논문지 Vol.12 No.9

본 연구는 다양한 건강상태에 놓여 있는 노인들의 성공노화를 실현하기 위한 통합적인 건강서비스 제공의 근간이 되는 포괄적 노인평가 패키지를 개발하기 위한 목적으로 시행된 방법론적 연구이다. 노인평가도구들에 대한 임상 및 지역사회에서의 사용 실례와 관련문헌 고찰을 통해, 총 9개 평가 영역으로 나누어 관련 평가항목과 평가도구들을 1차적으로 선정하였다. 이후 관련 전문가 3인의 자문 결과와 노인 15명을 대상으로 한 예비조사 실시 결과를 토대로 포괄적 노인평가의 영역과 항목들을 수정 보완하였다. 최종적으로 기본평가, 정신기능평가, 신체기능평가, 생활습관평가, 주관적 건강수준평가, 환경평가로 이루어진 6개의 평가영역에서 각 해당 항목의 수행지침이 포함된 29개 평가항목으로 구성된 포괄적 노인평가 패키지가 구축되었다. This is a methodological study designed to develop a comprehensive geriatric assessment package for successful aging of the elderly in various health condition. Assessment items and tools were primarily selected and categorized into 9 domains through the review of existing geriatric assessment tools, which have been used in the clinic and community settings, and the investigation of related articles. We have obtained professional advice from three experts and conducted a preliminary survey (n=15). Based on findings, the final version of comprehensive geriatric assessment package were devised. It was constructed of 29 assessment items in 6 domains of basic, psychologic function, physical function, life style, subjective health state, and environment. It also contained concrete implementation guide of each tool.

외래 노인포괄평가의 약물사용 및 약제비 절감에 미치는 효과

조세은,김다혜,서예원,남궁형욱,이정화,김은경,이주연,최정연,김광일 한국병원약사회 2024 병원약사회지 Vol.41 No.2

Background : Seoul National University Bundang Hospital (SNUBH)’s Geriatric Center has established a multidisciplinary approach to enhance care for older adults, integrating pharmacists into Comprehensive Geriatric Assessments (CGA) for medication reconciliation and counseling. This study aimed to evaluate the impact of CGA, including pharmacist-involved interventions, on medication utilization and cost-savings in outpatient setting. Methods : We conducted a retrospective analysis of 280 outpatient medical records, focusing on those who underwent CGA at the Geriatric Center from July 1, 2022, to June 30, 2023. We evaluated the number of medications, and the potentially inappropriate medications (PIM) as per the 2019 Beers Criteria®, Korean Anticholinergic Burden Scale (KABS), and drug duplications before and after CGA. Polypharmacy was defined as the use of more than 10 medications, and those with a KABS score of 3 were considered as strong anticholinergics. Cost savings analysis considered a 365-day duration for chronic medications, and actual supply days for other medications. Results : The mean age of the patients was 79.9 years. There was a significant reduction in the mean number of medications per patient, from (8.9 ± 5.4) to (5.0 ± 4.3) post-CGA. Polypharmacy prevalence decreased from (39.3 to 12.5) % (both p<0.001), PIM use dropped from (49.6 to 27.5) %, and the use of strong anticholinergic drugs declined from (12.9 to 5.0) %. Drug duplications also significantly reduced, from (9.3 to 1.1) % (all p<0.001). The CGA process yielded a total cost saving of approximately 76,246,980 won, averaging 272,311 won per patient. Conclusion : This study demonstrated the effectiveness of a multidisciplinary team, particularly the role of pharmacists in medication reconciliation, in reducing inappropriate polypharmacy and medications costs in older patients. These findings underscore the value of the involvement of pharmacists in enhancing patient safety and reducing healthcare costs in geriatric care settings.

노인 당뇨병에서 다약제 포괄관리

박강서,유혜민 대한의사협회 2024 대한의사협회지 Vol.67 No.7

Background: Diabetes mellitus is a complex group of chronic metabolic conditions. The incidence of frailty, sarcopenia, geriatric syndrome, and multiple chronic conditions is high in older patients with diabetes, who often require multiple medications for optimal glucose control and treatment of associated chronic complications. Unfortunately, polypharmacy is associated with a high risk of adverse outcomes, such as hypoglycemia, drugdrug interactions, and an increased socioeconomic burden in older adults with diabetes. Current Concepts: Elderly patients with diabetes are at a high risk for polypharmacy and consequently, a high risk of adverse drug reactions. Polypharmacy is defined as the cumulative use of five or more medications. Comprehensive management and deprescribing are the most important approaches to reduce polypharmacy. Deprescription refers to reduction in or cessation of inappropriate medications. Discussion and Conclusion: Polypharmacy continues to increase the risk of morbidity and mortality among older adults with diabetes. A comprehensive polypharmacy management and deprescription plan is warranted for significant risk reduction in elderly patients with diabetes.

Frailty and Comprehensive Geriatric Assessment

Hea Yon Lee,Eunju Lee,Il-Young Jang 대한의학회 2020 Journal of Korean medical science Vol.35 No.3

Frailty is defined as a reduced physiologic reserve vulnerable to external stressors. For older individuals, frailty plays a decisive role in increasing adverse health outcomes in most clinical situations. Many tools or criteria have been introduced to define frailty in recent years, and the definition of frailty has gradually converged into several consensuses. Frail older adults often have multi-domain risk factors in terms of physical, psychological, and social health. Comprehensive geriatric assessment (CGA) is the process of identifying and quantifying frailty by examining various risky domains and body functions, which is the basis for geriatric medicine and research. CGA provides physicians with information on the reversible area of frailty and the leading cause of deterioration in frail older adults. Therefore frailty assessment based on understanding CGA and its relationship with frailty, can help establish treatment strategies and intervention in frail older adults. This review article summarizes the recent consensus and evidence of frailty and CGA.