{"id":429,"date":"2022-06-16T12:53:02","date_gmt":"2022-06-16T09:53:02","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=429"},"modified":"2022-06-16T12:53:02","modified_gmt":"2022-06-16T09:53:02","slug":"yasli-hastanin-kirilganlik-olcekleri-literatur-guncellemeleri","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/akademik-blog-yazisi\/yasli-hastanin-kirilganlik-olcekleri-literatur-guncellemeleri\/","title":{"rendered":"Ya\u015fl\u0131 Hastan\u0131n K\u0131r\u0131lganl\u0131k \u00d6l\u00e7ekleri: Literat\u00fcr G\u00fcncellemeleri"},"content":{"rendered":"

Giri\u015f<\/strong><\/p>\n

Acil Servis prati\u011finde klinik karar verme a\u015famas\u0131nda hastalar\u0131n olas\u0131 k\u00f6t\u00fc sonlan\u0131mlar\u0131n\u0131n \u00f6ng\u00f6r\u00fclebilmesi zorlay\u0131c\u0131 olabilir. Bu durum \u00f6zellikle ya\u015fl\u0131 hastalarda, semptom, fizik muayene ve laboratuvar bulgular\u0131ndaki farkl\u0131l\u0131klar nedeniyle belirgindir. Klasik acil servis hasta bak\u0131m modelleri ya\u015fl\u0131 hastalardaki farkl\u0131l\u0131klar\u0131 yakalamakta yetersiz kalabilir. Son y\u0131llarda k\u0131r\u0131lganl\u0131k de\u011ferlendirmesi riskli ya\u015fl\u0131 hasta pop\u00fclasyonunu tan\u0131mlamak i\u00e7in triyaj alan\u0131ndan itibaren ara\u015ft\u0131r\u0131lmas\u0131 gereken bir kavram olarak kabul edilmektedir (1).<\/p>\n

K\u0131r\u0131lganl\u0131k Tan\u0131m\u0131<\/strong><\/p>\n

K\u0131r\u0131lganl\u0131\u011f\u0131 tan\u0131mlayan ortak bir g\u00f6r\u00fc\u015f ve tan\u0131 kriteri bulunmamaktad\u0131r. Genel olarak fizyolojik rezervlerde azalmaya yol a\u00e7an, organ sistemlerdeki bozulmalardan kaynakl\u0131, savunmas\u0131zl\u0131k durumu olarak kabul edilir. Fiziksel, kognitif, psikolojik, sosyal ve \u00e7evresel fakt\u00f6rleri de i\u00e7eren \u00e7ok boyutlu bir kavramd\u0131r. Ya\u015flanma k\u0131r\u0131lganl\u0131\u011f\u0131 etkileyen \u00f6nemli bir fakt\u00f6r olmakla birlikte, tek ba\u015f\u0131na k\u0131r\u0131lganl\u0131k belirleyicisi de\u011fildir. K\u0131r\u0131lgan hastalar stres fakt\u00f6rleri ile kar\u015f\u0131la\u015ft\u0131klar\u0131nda (hastal\u0131k, travma vb.) rezervlerindeki azalma nedeni ile daha korunmas\u0131zd\u0131rlar ve de\u011fi\u015fen ortam ko\u015fullar\u0131na adaptasyonlar\u0131 zay\u0131ft\u0131r (2).<\/p>\n

K\u0131r\u0131lganl\u0131\u011f\u0131 Belirlemek \u00d6nemli Midir?<\/strong><\/p>\n

Sa\u011fl\u0131kl\u0131 bir ya\u015flanmadan s\u00f6z edilebilmesi i\u00e7in k\u0131r\u0131lganl\u0131\u011f\u0131n olmamas\u0131 gerekir. K\u0131r\u0131lgan hastalarda; mortalite, uzam\u0131\u015f hastane kal\u0131\u015f s\u00fcreleri, d\u00fc\u015fme, deliryum, yeni geli\u015fen bak\u0131mevi ihtiyac\u0131, tekrar hastane ba\u015fvurusu gibi k\u00f6t\u00fc sonlan\u0131mlar\u0131n s\u0131kl\u0131\u011f\u0131 daha fazlad\u0131r. Bu nedenle risk alt\u0131ndaki pop\u00fclasyonun erken tan\u0131nmas\u0131, kapsaml\u0131 geriatrik de\u011ferlendirmeler ve koruyucu eylemlerin zaman\u0131nda devreye sokulabilmesi a\u00e7\u0131s\u0131ndan \u00f6nemlidir. Acil servisler geriatrik ya\u015f grubunun son y\u0131llardaki ba\u015fvuru s\u0131kl\u0131klar\u0131ndaki art\u0131\u015f g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda k\u0131r\u0131lganl\u0131\u011f\u0131n erken saptanmas\u0131 i\u00e7in bir f\u0131rsat kap\u0131s\u0131d\u0131r. Ancak yap\u0131lan \u00e7al\u0131\u015fmalarda k\u0131r\u0131lganl\u0131k \u00f6l\u00e7eklerinin e\u011fitim yetersizli\u011fi, kaynak k\u0131s\u0131tl\u0131l\u0131\u011f\u0131, acil servis kalabal\u0131kl\u0131\u011f\u0131 gibi fakt\u00f6rler nedeniyle yeterince kullan\u0131lmad\u0131\u011f\u0131 belirtilmektedir (3). Ayn\u0131 zamanda k\u0131r\u0131lganl\u0131k acil servis \u00e7al\u0131\u015fanlar\u0131n\u0131n a\u015fina oldu\u011fu bir kavram de\u011fildir.<\/p>\n

K\u0131r\u0131lganl\u0131\u011f\u0131n erken tespit edilmesi ve bu sayede beslenme, polifarmasinin d\u00fczenlenmesi, egzersiz kapasitesinin art\u0131r\u0131lmas\u0131 gibi baz\u0131 m\u00fcdahalelerin uygulanmas\u0131 ileride \u00f6nlenemeyecek maddi ve manevi sonu\u00e7lar\u0131n ortaya \u00e7\u0131kmas\u0131n\u0131 engelleyebilir veya geciktirebilir.<\/p>\n

K\u0131r\u0131lganl\u0131k Acil Servis Ortam\u0131nda Nas\u0131l Belirlenebilir?<\/strong><\/p>\n

Uluslararas\u0131 Hastal\u0131k S\u0131n\u0131flamas\u0131\u2019nda (ICD) \u2018K\u0131r\u0131lganl\u0131k\u2019 terimine kar\u015f\u0131l\u0131k gelen bir kodlama bulunmamaktad\u0131r. Tarama ve tan\u0131 amac\u0131yla \u00e7e\u015fitli \u00f6l\u00e7ekler zaman i\u00e7erisinde geli\u015ftirilmi\u015ftir. Yak\u0131n zamanl\u0131 yay\u0131mlanan bir derlemede k\u0131r\u0131lganl\u0131\u011f\u0131 \u00f6l\u00e7mek i\u00e7in 67 farkl\u0131 metod oldu\u011fu belirtilmektedir (4). Kapsaml\u0131 geriatrik de\u011ferlendirme gibi zaman al\u0131c\u0131 y\u00f6ntemlerin uygulanmadan \u00f6nce bu \u00f6l\u00e7eklerle k\u0131r\u0131lganl\u0131\u011f\u0131n taranmas\u0131 \u00f6nem arz eder. G\u00fcncel bir \u00e7al\u0131\u015fmada klinisyenlerin k\u0131r\u0131lganl\u0131\u011f\u0131 tespit etmek i\u00e7in \u00e7o\u011funlukla birden fazla \u00f6l\u00e7e\u011fi kulland\u0131\u011f\u0131 bildirilmektedir. K\u0131r\u0131lganl\u0131k \u0130ndeksi (Fraility Index), Klinik K\u0131r\u0131lganl\u0131k \u00d6l\u00e7e\u011fi (Clinical Frailty Scale), K\u0131r\u0131lganl\u0131k Fenotipi (Frailty Phenotype), Edmonton K\u0131r\u0131lganl\u0131k \u00d6l\u00e7e\u011fi, Prisma-7 gibi \u00f6l\u00e7ekler son y\u0131llardaki \u00e7al\u0131\u015fmalarda \u00f6n plana \u00e7\u0131kmaktad\u0131r (2).<\/p>\n

G\u00fcncel Literat\u00fcr Verileri I\u015f\u0131\u011f\u0131nda Acil Serviste K\u0131r\u0131lganl\u0131k<\/strong><\/p>\n

En son s\u00f6ylenecek s\u00f6z\u00fc ba\u015fta s\u00f6yleyelim, maalesef k\u0131r\u0131lganl\u0131\u011f\u0131 acil serviste belirleyecek alt\u0131n standart bir tarama testi bulunmuyor. \u00d6l\u00e7eklerin kolay ve h\u0131zl\u0131 uygulanabilir olmas\u0131, objektif de\u011fi\u015fkenler i\u00e7ermesi, ekipman gereksinimi olmamas\u0131, kapsay\u0131c\u0131 olmas\u0131 gibi \u00f6zellikler bar\u0131nd\u0131rmas\u0131 Acil T\u0131p prati\u011finde arzu edilir. Yap\u0131lan \u00e7al\u0131\u015fmalarda gerek \u00f6rneklem b\u00fcy\u00fckl\u00fc\u011f\u00fc yetersizlikleri gerekse kan\u0131t d\u00fczeyi d\u00fc\u015f\u00fck \u00e7al\u0131\u015fmalar (g\u00f6zlemsel \u00e7al\u0131\u015fmalar a\u011f\u0131rl\u0131kl\u0131) olmas\u0131 nedeni ile k\u0131r\u0131lganl\u0131\u011f\u0131 saptaman\u0131n rutin bak\u0131m\u0131 iyile\u015ftirme \u00fczerine etkisi ve en uygun \u00f6l\u00e7e\u011fin ne oldu\u011fu halen belirsiz. Uygulay\u0131c\u0131lar aras\u0131nda uyumun d\u00fczeyi, ka\u00e7 kez \u00f6l\u00e7\u00fcm yap\u0131ld\u0131\u011f\u0131, \u00f6l\u00e7\u00fcm\u00fcn ne kadar s\u00fcrede uyguland\u0131\u011f\u0131 (Acil servisler i\u00e7in \u00f6nemli bir parametre) gibi de\u011fi\u015fkenler \u00e7al\u0131\u015fmalar\u0131n \u00f6nemli bir k\u0131s\u0131m\u0131nda yayg\u0131n g\u00f6r\u00fclen k\u0131s\u0131tl\u0131l\u0131klar aras\u0131nda yer almaktad\u0131r. Bunun yan\u0131 s\u0131ra son y\u0131llarda s\u0131kl\u0131\u011f\u0131 azalmakla birlikte, \u00e7al\u0131\u015fmalar\u0131n \u00f6nemli bir k\u0131sm\u0131n\u0131n k\u0131r\u0131lganl\u0131\u011f\u0131 saptamaya \u00f6zg\u00fc olmayan \u00f6l\u00e7eklerle ger\u00e7ekle\u015ftirildi\u011fi de g\u00f6r\u00fclmektedir (2). Bu nedenlerle konuyu uygun tarama \u00f6l\u00e7ekleriyle irdeleyen randomize kontroll\u00fc \u00e7al\u0131\u015fmalara ihtiya\u00e7 duyulmaktad\u0131r (5).<\/p>\n

K\u0131r\u0131lganl\u0131k ba\u015fl\u0131\u011f\u0131 alt\u0131nda acil servis hastalar\u0131nda ger\u00e7ekle\u015ftirilen \u00e7al\u0131\u015fmalar\u0131n bir\u00e7o\u011fu risk belirlemesi yapmak \u00fczerine planlanm\u0131\u015ft\u0131r. Genel olarak tekrar ba\u015fvuru, mortalite, yo\u011fun bak\u0131m yat\u0131\u015f\u0131, hastane kal\u0131\u015f s\u00fcresi, sosyal hizmet kurum ihtiyac\u0131 gibi sonlan\u0131mlar \u00e7al\u0131\u015f\u0131lm\u0131\u015ft\u0131r (6). K\u0131r\u0131lganl\u0131k \u0130ndeksi, Klinik K\u0131r\u0131lganl\u0131k \u00d6l\u00e7e\u011fi, K\u0131r\u0131lganl\u0131k Fenotip, Edmonton K\u0131r\u0131lganl\u0131k \u00d6l\u00e7e\u011fi ge\u00e7erlili\u011fi kan\u0131tlanm\u0131\u015f \u00f6l\u00e7ekler i\u00e7erisinde en s\u0131k kullan\u0131lanlar\u0131d\u0131r. K\u0131r\u0131lganl\u0131k \u00f6l\u00e7e\u011fi olarak tasarlanmam\u0131\u015f olsada ya\u015fl\u0131 hastalarda risk belirlemek amac\u0131yla kullan\u0131lan di\u011fer skorlama sistemleri; ISAR (Identification of seniors at risk), Savunmas\u0131z Ya\u015fl\u0131 Anketi, Barthel \u0130ndeksi\u2019dir (2).<\/p>\n

K\u0131r\u0131lganl\u0131k \u0130ndeksi:<\/strong> Rockwood ve ark. taraf\u0131ndan 92 de\u011fi\u015fkenli, kapsaml\u0131 geriatrik de\u011ferlendirme temel al\u0131narak olu\u015fturulan bir K\u00fcm\u00fclatif Defisit Modelidir (7). Hastada mevcut olan defisitler de\u011ferlendirilen defisit say\u0131s\u0131na oranland\u0131\u011f\u0131nda sonucun >0.25 olmas\u0131 k\u0131r\u0131lganl\u0131k olarak kabul edilir. Uygulanmas\u0131 zor ve zaman al\u0131c\u0131 oldu\u011fundan zaman i\u00e7erisinde yap\u0131lan ara\u015ft\u0131rmalarda 30 de\u011fi\u015fkenli indeksle de benzer sonu\u00e7lar al\u0131nabilece\u011fi bildirilmi\u015ftir(8). Ancak bu \u00f6l\u00e7eklerin Acil Servis pop\u00fclasyonunda g\u00fcvenilirli\u011fi yayg\u0131n olarak kan\u0131tlanm\u0131\u015f de\u011fildir. G\u00fcncel bir uluslararas\u0131 prospektif kohort \u00e7al\u0131\u015fmada 24 de\u011fi\u015fkenden olu\u015fan, K\u00fcm\u00fclatif Defisit Modeli\u2019nden t\u00fcretilen Acil Servise Spesifik K\u0131r\u0131lganl\u0131k \u0130ndeksi (FI-ED)\u2019nin k\u0131r\u0131lganl\u0131\u011f\u0131 belirlemek i\u00e7in kullan\u0131labilece\u011fi saptanm\u0131\u015ft\u0131r(8).<\/p>\n

Klinik K\u0131r\u0131lganl\u0131k \u00d6l\u00e7e\u011fi (KK\u00d6):<\/strong> (Bkz. Tablo-1 ) Acil T\u0131p \u00e7al\u0131\u015fmalar\u0131nda uygulanmas\u0131 en pratik y\u00f6ntem (1 dakikadan daha az s\u00fcrede tamamlanabilir) olarak belirtilmektedir (9). Ayn\u0131 zamanda KK\u00d6\u2019n\u00fcn acil servis hem\u015fireleri ve hekimleri aras\u0131nda olduk\u00e7a iyi bir uyumla kullan\u0131labilece\u011finden bahsedilmektedir (Kappa de\u011feri:0.90, %95 GA: 0.85-0.94) (10). Bu veriler \u0131\u015f\u0131\u011f\u0131nda KK\u00d6\u2019n\u00fcn hekim d\u0131\u015f\u0131 di\u011fer sa\u011fl\u0131k personelleri taraf\u0131ndan da triyaj alan\u0131ndan itibaren kullan\u0131labilece\u011fi d\u00fc\u015f\u00fcn\u00fclebilir. Yine triyaj alan\u0131nda yap\u0131lan KK\u00d6 de\u011ferlendirmeleri ile hastalar\u0131n hastane yat\u0131\u015f ihtiyac\u0131, kal\u0131\u015f s\u00fcresi, tekrar ba\u015fvuru durumu ve mortalite hakk\u0131nda fikir elde edilebilir (1). KK\u00d6\u2019n\u00fcn uzun d\u00f6nemde (1 y\u0131l) t\u00fcm nedenlere ba\u011fl\u0131 mortalite durumunu ESI (Emergency Severity Index) gibi akut durum de\u011ferlendirme \u00f6l\u00e7eklerinden daha iyi bir \u015fekilde \u00f6ng\u00f6rebildi\u011fi de belirlenmi\u015ftir (11).<\/p>\n

Tablo-1:<\/strong> Klinik K\u0131r\u0131lganl\u0131k \u00d6l\u00e7e\u011fi.*<\/p>\n

\n\n\n\n\n\n\n\n\n
1<\/td>\n\u00c7ok fit<\/td>\nDin\u00e7, aktif, enerjik, d\u00fczenli egzersiz yapar, ya\u015f\u0131na g\u00f6re en zinde grupta<\/td>\n<\/tr>\n
2<\/td>\nFit<\/td>\nAktif hastal\u0131\u011f\u0131 yok, kategori 1 den daha az zinde<\/td>\n<\/tr>\n
3<\/td>\nKontrol alt\u0131nda kronik hastal\u0131k, iyi durumda<\/td>\nKategori 4\u2019e g\u00f6re kronik hastal\u0131k semptomlar\u0131 kontrol alt\u0131nda<\/td>\n<\/tr>\n
4<\/td>\nK\u0131r\u0131lganl\u0131\u011fa yatk\u0131n<\/td>\nBelirgin bir ba\u011f\u0131ml\u0131l\u0131\u011f\u0131 olmasada hastal\u0131k semptomlar\u0131ndan \u015fikayet\u00e7i veya hareketlerinde yava\u015flama var.<\/td>\n<\/tr>\n
5<\/td>\nHafif k\u0131r\u0131lganl\u0131k<\/td>\nEnstr\u00fcmental g\u00fcnl\u00fck ya\u015famsal aktivitelerde s\u0131n\u0131rl\u0131 ba\u011f\u0131ml\u0131l\u0131k<\/td>\n<\/tr>\n
6<\/td>\nOrta derece k\u0131lganl\u0131k<\/td>\nEnstr\u00fcmental ve non-enstr\u00fcmental g\u00fcnl\u00fck ya\u015famsal aktivitelerde yard\u0131m ihtiyac\u0131<\/td>\n<\/tr>\n
7<\/td>\nCiddi k\u0131r\u0131lganl\u0131k<\/td>\nTerminal hastal\u0131k veya g\u00fcnl\u00fck ya\u015famsal aktivitelerde tamamen ba\u015fkas\u0131na ba\u011f\u0131ml\u0131l\u0131k<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n

*4 ve \u00fczerindeki derecelerde ciddi k\u0131r\u0131lganl\u0131\u011fa yatk\u0131nl\u0131k <\/strong>(12). <\/strong><\/p>\n

Fried\u2019\u0131n K\u0131r\u0131lganl\u0131k Fenotipi:<\/strong> Kardiyovask\u00fcler Sa\u011fl\u0131k \u00c7al\u0131\u015fmas\u0131 \u0130ndeksi olarak da bilinir. Fiziksel karakteristik bulgulara g\u00f6re k\u0131r\u0131lganl\u0131\u011f\u0131 tan\u0131maya \u00e7al\u0131\u015f\u0131r. \u0130stemsiz kilo kayb\u0131 (son 1 y\u0131lda 4.5 kg ve \u00fczeri), g\u00fc\u00e7s\u00fczl\u00fck (kavrama g\u00fcc\u00fcnde azalma), t\u00fckenmi\u015flik (hastan\u0131n bildirdi\u011fi), y\u00fcr\u00fcmede yava\u015flama, d\u00fc\u015f\u00fck fiziksel aktivite kapasitesi gibi \u00f6zellikleri vard\u0131r. \u00dc\u00e7 ve daha fazla fakt\u00f6r\u00fcn varl\u0131\u011f\u0131nda k\u0131r\u0131lganl\u0131ktan s\u00f6z edilir. Mortalite gibi sonlan\u0131mlar\u0131 \u00f6ng\u00f6rmesi a\u00e7\u0131s\u0131ndan literat\u00fcrde yayg\u0131n olarak \u00e7al\u0131\u015f\u0131lm\u0131\u015ft\u0131r. K\u0131r\u0131lganl\u0131\u011f\u0131n psikososyal etkenlerini kapsamamas\u0131 ve kavrama g\u00fcc\u00fc de\u011ferlendirmesi i\u00e7in \u00f6l\u00e7\u00fcm yapma zorunlulu\u011fu yayg\u0131n kullan\u0131m\u0131 i\u00e7in engeldir (13).<\/p>\n

Edmonton \u00d6l\u00e7e\u011fi:<\/strong> Hastane ortam\u0131nda k\u0131r\u0131lganl\u0131\u011f\u0131 belirlemek i\u00e7in kullan\u0131labilecek ge\u00e7erli ve g\u00fcvenilir bir \u00f6l\u00e7ektir. Bili\u015fsel, genel durum, fonksiyonel ba\u011f\u0131ms\u0131zl\u0131k, sosyal destek, ila\u00e7 kullan\u0131m\u0131, beslenme, ruhsal durum, idrar inkontinans\u0131, fonksiyonel performans olmak \u00fczere 9 farkl\u0131 bile\u015feni bulunmaktad\u0131r. Toplamda 17 puan \u00fczerinden skorlama yap\u0131l\u0131r. 0-5 puan k\u0131r\u0131lgan de\u011fil, 6-7 puan k\u0131r\u0131lganl\u0131\u011fa yatk\u0131nl\u0131k, 8-9 puan hafif k\u0131r\u0131lgan, 10-11 puan orta dereceli k\u0131r\u0131lgan, 12-17 puan ciddi k\u0131r\u0131lgan olarak kabul edilir(14).<\/p>\n

K\u0131r\u0131lganl\u0131kla ilgili acil servis \u00e7al\u0131\u015fmalar\u0131nda daha \u00e7ok yukar\u0131da bahsetti\u011fimiz sonlan\u0131mlar \u00fczerine \u00e7al\u0131\u015fmalar kurgulansada, bu sonlan\u0131m noktalar\u0131 sa\u011fl\u0131k hizmet kalitesini iyile\u015ftirmeye y\u00f6nelik hedeflere hizmet etmektedir. Hasta odakl\u0131 sonlan\u0131mlar\u0131n daha iyi anla\u015f\u0131labilmesi i\u00e7in otonomi (medikal durumun ciddiyetini kavrayabilen, ya\u015fam alan\u0131nda kendini g\u00fcvenli hisseden, kendi kararlar\u0131n\u0131 al\u0131p-uygulayabilen v.b.) ve i\u015flevsellik (fiziksel performans, psikososyal durum, yard\u0131m ihtiyac\u0131 v.b.) gibi hasta merkezli sonlan\u0131m \u00f6l\u00e7\u00fctlerini inceleyen \u00e7al\u0131\u015fmalara da ihtiya\u00e7 duyulmaktad\u0131r. Bu ama\u00e7la COOP\/WONCA i\u015flevsel durum \u00f6l\u00e7e\u011fi, EuroQol Ya\u015fam Kalitesi \u00d6l\u00e7e\u011fi, McGill Ya\u015fl\u0131 Ya\u015fam Kalitesi \u00d6l\u00e7e\u011fi ve Palyatif Bak\u0131m Sonlan\u0131m \u00d6l\u00e7e\u011fi gibi \u00f6l\u00e7eklerin kullan\u0131labilece\u011fi literat\u00fcrde belirtilmektedir (15). Ancak bu \u00f6l\u00e7eklerin acil servisler i\u00e7in uygulanabilir olup olmad\u0131klar\u0131 ile ilgili yeterli literat\u00fcr verisi bulunmamaktad\u0131r. Bunun yan\u0131s\u0131ra k\u0131r\u0131lganl\u0131k \u00f6l\u00e7eklerinin hastan\u0131n acil servise ba\u015fvurmas\u0131na neden olan akut hastal\u0131k durumundan \u00e7ok fizyolojik rezervler hakk\u0131nda bilgi verdi\u011fi d\u00fc\u015f\u00fcn\u00fclecek olursa, mevcut klinik durum ba\u011flam\u0131nda tan\u0131sal ve agresif tedavi se\u00e7eneklerinin ne kadar\u0131n\u0131n devreye sokulaca\u011f\u0131, ihtiya\u00e7 duyulacak geriatrik bak\u0131m kapsam\u0131, ya\u015fam sonu kararlar\u0131n\u0131n al\u0131nmas\u0131 gibi ileri bak\u0131m modelleri planlamalar\u0131n\u0131n yap\u0131lmas\u0131nda ortak karar almaya y\u00f6nelik ne kadar katk\u0131 sa\u011flayabilece\u011finin ara\u015ft\u0131r\u0131lmas\u0131 k\u0131r\u0131lgan geriatrik pop\u00fclasyonda yeni ara\u015ft\u0131rma alanlar\u0131 olarak d\u00fc\u015f\u00fcn\u00fclmelidir.<\/p>\n

\u00d6zet <\/strong><\/p>\n

    \n
  • Sa\u011fl\u0131kl\u0131 ya\u015flanman\u0131n tesis edilebilmesi i\u00e7in k\u0131r\u0131lganl\u0131\u011f\u0131n erken saptanmas\u0131 \u00f6nemlidir ve acil servisler bu a\u00e7\u0131dan ya\u015fl\u0131lar i\u00e7in f\u0131rsat kap\u0131s\u0131d\u0131r.<\/li>\n
  • K\u0131r\u0131lganl\u0131\u011f\u0131n varl\u0131\u011f\u0131 mortalite, hastane kal\u0131\u015f s\u00fcresi, d\u00fc\u015fme vb. gibi olumsuz sonlan\u0131mlarla ili\u015fkilidir.<\/li>\n
  • K\u0131r\u0131lganl\u0131\u011f\u0131 tespit edebilen alt\u0131n standart bir \u00f6l\u00e7ek bulunmamaktad\u0131r.<\/li>\n
  • K\u0131r\u0131lganl\u0131k \u00f6l\u00e7ekleri ara\u015ft\u0131rma amac\u0131na uygun bir \u015fekilde se\u00e7ilmeli ve ge\u00e7erlili\u011fi kan\u0131tlanm\u0131\u015f \u00f6l\u00e7eklerle \u00e7al\u0131\u015fmalar dizayn edilmelidir.<\/li>\n
  • Klinik K\u0131r\u0131lganl\u0131k \u00d6l\u00e7e\u011fi kolay ve h\u0131zl\u0131 uygulanabilirli\u011fi, uygulay\u0131c\u0131lar aras\u0131nda uyuma f\u0131rsat tan\u0131mas\u0131 ve olumsuz sonlan\u0131mlar\u0131 akut g\u00f6stergelerden daha iyi \u00f6ng\u00f6rebilmesi gibi \u00f6zellikleri ile \u00f6n plana \u00e7\u0131kmaktad\u0131r.<\/li>\n
  • Gelecek \u00e7al\u0131\u015fmalarda k\u0131r\u0131lganl\u0131k \u00f6l\u00e7eklerinin sa\u011fl\u0131k hizmet kalite g\u00f6stergeleri yan\u0131nda otonomi ve i\u015flevsellik temelli sonlan\u0131mlar\u0131 hedefleyerek, tedavi ve bak\u0131m plan\u0131 belirleme gibi konularda hekim-hasta\/hasta yak\u0131n\u0131 ortak karar alma mekanizmalar\u0131 \u00fczerine katk\u0131 sa\u011flay\u0131p sa\u011flamad\u0131klar\u0131n\u0131n belirlenmesi ara\u015ft\u0131r\u0131lmal\u0131d\u0131r.<\/li>\n<\/ul>\n

    KAYNAKLAR<\/strong><\/p>\n

      \n
    1. Elliott A, Taub N, Banerjee J, Aijaz F, Jones W, Teece L, et al. Does the Clinical Frailty Scale at Triage Predict Outcomes From Emergency Care for Older People? Ann Emerg Med [Internet]. 2021;77(6):620\u20137. Available from: https:\/\/doi.org\/10.1016\/j.annemergmed.2020.09.006<\/li>\n
    2. Theou O, Squires E, Mallery K, Lee JS, Fay S, Goldstein J, et al. What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr. 2018;18(1).<\/li>\n
    3. O\u2019Caoimh R, Costello M, Small C, Spooner L, Flannery A, O\u2019Reilly L, et al. Comparison of frailty screening instruments in the emergency department. Int J Environ Res Public Health. 2019;16(19):1\u201313.<\/li>\n
    4. Buta BJ, Walston JD, Godino JG, Park M, Kalyani RR, Xue QL, et al. Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Vol. 26, Ageing Research Reviews. Elsevier Ireland Ltd; 2016. p. 53\u201361.<\/li>\n
    5. J\u00f8rgensen R, Brabrand M. Screening of the frail patient in the emergency department: A systematic review. Eur J Intern Med. 2017;45:71\u20133.<\/li>\n
    6. Van Dam CS, Hoogendijk EO, Mooijaart SP, Smulders YM, De Vet RCW, Lucke JA, et al. A narrative review of frailty assessment in older patients at the emergency department. European Journal of Emergency Medicine. Lippincott Williams and Wilkins; 2021. p. 266\u201376.<\/li>\n
    7. Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal. 2001;1:323\u201336.<\/li>\n
    8. Brousseau AA, Dent E, Hubbard R, Melady D, \u00e9mond M, Mercier \u00c9, et al. Identification of older adults with frailty in the Emergency Department using a frailty index: Results from a multinational study. Age Ageing. 2018;47(2):242\u20138.<\/li>\n
    9. Lewis ET, Dent E, Alkhouri H, Kellett J, Williamson M, Asha S, et al. Which frailty scale for patients admitted via Emergency Department? A cohort study. Arch Gerontol Geriatr. 2019 Jan 1;80:104\u201314.<\/li>\n
    10. Lo AX, Heinemann AW, Gray E, Lindquist LA, Kocherginsky M, Post LA, et al. Inter-rater Reliability of Clinical Frailty Scores for Older Patients in the Emergency Department. Vol. 28, Academic Emergency Medicine. Blackwell Publishing Inc.; 2021. p. 110\u20133.<\/li>\n
    11. Rueegg M, Kabell Nissen S, Brabrand M, Kaeppeli T, Dreher T, Carpenter CR, et al. The Clinical Frailty Scale Predicts One\u2010Year Mortality in Emergency Department Patients Aged 65 years and Older . Acad Emerg Med. 2022<\/li>\n
    12. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug 30;173(5):489\u201395.<\/li>\n
    13. Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: A review. Vol. 31, European Journal of Internal Medicine. Elsevier B.V.; 2016. p. 3\u201310.<\/li>\n
    14. Rolfson DB, Majumdar SR, Tsuyuki RT, Tahir A, Rockwood K. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;35(5):526-529. doi:10.1093\/ageing\/afl041<\/li>\n
    15. van Oppen JD, Alshibani A, Coats TJ, Graham B, Holch P, Lalseta J, et al. A systematic review and recommendations for prom instruments for older people with frailty in emergency care. J Patient-Reported Outcomes [Internet]. 2022 Dec 1;6(1):30. Available from: https:\/\/jpro.springeropen.com\/articles\/10.1186\/s41687-022-00438-x<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

      Giri\u015f Acil Servis prati\u011finde klinik karar verme a\u015famas\u0131nda hastalar\u0131n olas\u0131 k\u00f6t\u00fc sonlan\u0131mlar\u0131n\u0131n \u00f6ng\u00f6r\u00fclebilmesi zorlay\u0131c\u0131 olabilir. Bu durum \u00f6zellikle ya\u015fl\u0131 hastalarda, semptom, fizik…<\/p>\n","protected":false},"author":1185,"featured_media":431,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[10014],"tags":[10020,10018,10023],"class_list":["post-429","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-akademik-blog-yazisi","tag-acil-tip","tag-geriatri","tag-kirilganlik"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/429","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=429"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/429\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/431"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=429"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=429"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=429"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}