{"id":582,"date":"2024-06-11T17:13:57","date_gmt":"2024-06-11T14:13:57","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=582"},"modified":"2024-06-11T17:13:59","modified_gmt":"2024-06-11T14:13:59","slug":"yasli-dostu-acil-servis-nedir","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/yasli-dostu-acil-servis-nedir\/","title":{"rendered":"Ya\u015fl\u0131 Dostu Acil Servis Nedir?"},"content":{"rendered":"\n

Ya\u015fl\u0131 n\u00fcfusun artmas\u0131 d\u00fcnya genelinde \u00f6ne \u00e7\u0131kan, ve hastanelerde yeni planlamalar yap\u0131lmas\u0131 ihtiyac\u0131 do\u011furan global bir durumdur. Birle\u015fmi\u015f Milletlerin verilerine g\u00f6re 2010 y\u0131l\u0131nda 800 milyon civar\u0131 olan 60 ya\u015f \u00fcst\u00fc n\u00fcfusun 2050 sonras\u0131nda 2 milyar\u0131 a\u015faca\u011f\u0131 \u00f6ng\u00f6r\u00fclmektedir. \u00dclkemizde de 65 ya\u015f \u00fcst\u00fc n\u00fcfusun 2030 y\u0131l\u0131nda %12,1\u2019e, 2050 y\u0131l\u0131nda ise %20,6\u2019ya y\u00fckselece\u011fi tahmin edilmektedir.<\/p>\n\n\n\n

Acil servislerde geriatrik ya\u015f grubuna uygun ko\u015fullar\u0131n olu\u015fturulmas\u0131, bak\u0131m verilmesiyle ilgili \u00e7al\u0131\u015fmalar ve bu konuda yay\u0131nlanan k\u0131lavuzlar son y\u0131llarda h\u0131z kazanm\u0131\u015ft\u0131r. (\u015eekil 1)<\/p>\n\n\n\n

\"\"
\u015eekil 1. Acil servislerde geriatrik hasta grubuyla ilgili \u00e7al\u0131\u015fmalar\u0131n ve geriatrik acil servislerin tarihsel geli\u015fimi
Mooijaart SP, Carpenter CR, Conroy SP. Geriatric emergency medicine\u2014a model for frailty friendly healthcare.\u00a0Age and Ageing<\/em>. 2022;51(3). doi:https:\/\/doi.org\/10.1093\/ageing\/afab280<\/figcaption><\/figure>\n\n\n\n

Bu alandaki ihtiya\u00e7lar\u0131 belirleyen ve standartlar olu\u015fturan kurulu\u015flardan biri olan American College of Emergency Physicians (ACEP), ileri ya\u015f hastalara acil serviste uygun ve kaliteli bak\u0131m verilebilmesini sa\u011flamak amac\u0131yla Geriatrik Acil Servis Akreditasyon Program\u0131 (Geriatric Emergency Department Accreditation – GEDA) olu\u015fturmu\u015ftur ve geriatrik acil servislerle ilgili bir k\u0131lavuz yay\u0131nlam\u0131\u015ft\u0131r.<\/p>\n\n\n\n

Acil servisler, ya\u015fl\u0131 hasta grubunun bak\u0131m\u0131n\u0131n iyile\u015ftirilmesinde kritik bir yere sahiptir. T\u0131bbi bak\u0131ma ula\u015fmak i\u00e7in giderek artan bir h\u0131zla kullan\u0131lan ba\u015fvuru noktas\u0131d\u0131r, ve ayaktan ba\u015fvuran veya evde bak\u0131m, aile hekimi, bak\u0131m merkezleri gibi noktalardan y\u00f6nlendirilen, veya acil sa\u011fl\u0131k hizmetleri taraf\u0131ndan getirilen hastalar\u0131n ilk de\u011ferlendirmesi, m\u00fcdahalesi, tan\u0131 ve tedavi s\u00fcre\u00e7lerini y\u00f6neterek gerekirse yatarak tedavi basama\u011f\u0131na ge\u00e7i\u015fi sa\u011flayan yerler acil servislerdir. Bu pozisyonuyla acil servislerin ya\u015fl\u0131 bak\u0131m\u0131na uygun olmas\u0131 daha da \u00f6nem kazanmaktad\u0131r.<\/p>\n\n\n\n

Acil servislerde ayr\u0131 bir \u201cgeriatrik acil servis\u201d alan\u0131 olu\u015fturulam\u0131yorsa bile, belirtilen ekipman ve malzemelerin varl\u0131\u011f\u0131 ile herhangi bir acil servis yata\u011f\u0131 “ya\u015fl\u0131 dostu” haline getirilebilir.<\/p>\n\n\n\n

Ya\u015fl\u0131 dostu bir acil servisin genel \u00f6zellikleri \u015fu \u015fekildedir:<\/p>\n\n\n\n

    \n
  1. Personel E\u011fitimi:<\/strong>\n
      \n
    • Acil servis personeli ya\u015fl\u0131 hastalar\u0131n bak\u0131m\u0131yla ilgili konularda e\u011fitilmeli, bu hastalarla ilgilenen t\u00fcm sa\u011fl\u0131k personelinin belirlenen e\u011fitimlere kat\u0131lmas\u0131 sa\u011flanmal\u0131d\u0131r.<\/li>\n\n\n\n
    • Hekimler ya\u015fl\u0131 hasta grubunda s\u0131k g\u00f6r\u00fclen sendromlar\u0131 (deliryum, demans, k\u0131r\u0131lganl\u0131k gibi) tan\u0131yabilmeli ve y\u00f6netebilmelidir. Ya\u015fl\u0131 hastalarda yayg\u0131n acil durumlar\u0131 y\u00f6netmek i\u00e7in ya\u015fl\u0131ya \u00f6zg\u00fc protokoller ve k\u0131lavuzlar olu\u015fturulabilir.<\/li>\n\n\n\n
    • Gerekti\u011finde di\u011fer b\u00f6l\u00fcm uzmanlar\u0131 ile i\u015fbirli\u011fi yap\u0131lmal\u0131d\u0131r.<\/li>\n\n\n\n
    • Personelin ya\u015fl\u0131 hastalar\u0131n ihtiya\u00e7lar\u0131 ve endi\u015felerine duyarl\u0131 olmas\u0131n\u0131 sa\u011flamak i\u00e7in e\u011fitimler d\u00fczenlenebilir.<\/li>\n<\/ul>\n<\/li>\n\n\n\n
    • Kapsaml\u0131 De\u011ferlendirme, Bak\u0131m ve Multidisipliner Yakla\u015f\u0131m:<\/strong>\n
        \n
      • Ya\u015fl\u0131larda s\u0131k g\u00f6r\u00fclen t\u0131bbi, fonksiyonel ve sosyal sorunlar\u0131 dikkate alan ya\u015fl\u0131ya odaklanm\u0131\u015f de\u011ferlendirme protokolleri olu\u015fturulmal\u0131d\u0131r.<\/li>\n\n\n\n
      • \u00c7oklu ila\u00e7 kullan\u0131m\u0131na ba\u011fl\u0131 riskleri ve advers reaksiyonlar\u0131 azaltmak i\u00e7in ila\u00e7lar g\u00f6zden ge\u00e7irilmeli, ila\u00e7 yan etkilerini en aza indirmek i\u00e7in ila\u00e7 dozlar\u0131 ayarlanmal\u0131d\u0131r.<\/li>\n\n\n\n
      • Ya\u015fl\u0131 hastalar i\u00e7in y\u00fcksek riskli ila\u00e7lar listesi olu\u015fturulabilir. Bu, her hastanenin kendi protokol\u00fc olarak olu\u015fturulmal\u0131 ve belirli d\u00f6nemlerde g\u00f6zden ge\u00e7irilerek g\u00fcncellenmelidir. S\u0131kl\u0131kla antikoag\u00fclanlar, kardiyak ila\u00e7lar (digoksin, amiodaron gibi), narkotikler, antipsikotikler, immuns\u00fcpresan ila\u00e7lar bu listede yer al\u0131r.<\/li>\n\n\n\n
      • Kapsaml\u0131 geriatrik de\u011ferlendirme yap\u0131lmal\u0131d\u0131r. Bili\u015fsel bozukluk, deliryum, depresyon, d\u00fc\u015fme riski gibi durumlar i\u00e7in tarama ara\u00e7lar\u0131 rutin kullan\u0131labilir.<\/li>\n\n\n\n
      • B\u00fct\u00fcnc\u00fcl bir bak\u0131m sa\u011flamak i\u00e7in doktorlar, hem\u015fireler, sosyal hizmetler, eczac\u0131lar, fizyoterapistler gibi geriatrik hasta bak\u0131m\u0131na d\u00e2hil olan bran\u015flardan olu\u015fan multidisipliner ekipler kurulabilir.<\/li>\n\n\n\n
      • Hastalar\u0131n otonomisi ve tercihlerine sayg\u0131 duyulmal\u0131d\u0131r, hastayla ilgili kararlar kendileri ve aileleriyle g\u00f6r\u00fc\u015f\u00fclerek al\u0131nmal\u0131d\u0131r.<\/li>\n\n\n\n
      • Acil serviste hastalar\u0131n kal\u0131\u015f s\u00fcresi uzad\u0131\u011f\u0131nda yiyecek ve i\u00e7eceklere eri\u015fimi sa\u011flanmal\u0131d\u0131r.<\/li>\n\n\n\n
      • Hastalar\u0131n te\u015fhis, tedavi plan\u0131, taburculuk s\u00fcreci ve sonras\u0131nda yap\u0131lacaklarla ilgili bilgilendirmeleri anlamalar\u0131na yard\u0131mc\u0131 olmak i\u00e7in sade, anla\u015f\u0131l\u0131r bir dil kullan\u0131lmal\u0131, yak\u0131nlar\u0131na da bilgilendirme yap\u0131lmal\u0131, gerekti\u011finde yaz\u0131l\u0131 olarak iletilmelidir.\u00a0<\/li>\n<\/ul>\n<\/li>\n\n\n\n
      • Hasta g\u00fcvenli\u011fi:<\/strong><\/li>\n\n\n\n
      • Hastalar d\u00fc\u015fme riski a\u00e7\u0131s\u0131ndan de\u011ferlendirilmeli ve gerekli \u00f6nlemler al\u0131nmal\u0131d\u0131r. Acil servis i\u00e7erisinde d\u00fc\u015fmeleri \u00f6nlemek i\u00e7in genellikle \u015funlar \u00f6nerilir:
        1. Kaymaz yer d\u00f6\u015femeleri, y\u00fczeyin d\u00fcz olmas\u0131<\/li><\/ol>
          1. Duvarlarda, koridorlarda tutamaklar ve korkuluklar<\/li><\/ol>
            1. Alanlar\u0131n iyi ayd\u0131nlat\u0131lmas\u0131<\/li><\/ol>
              1. Yatak kenarlar\u0131nda korkuluklar<\/li><\/ol>
                1. Tuvaletlerde el tutamaklar\u0131<\/li><\/ol>\n
                    \n
                  1. Hastane k\u0131yafetlerinin d\u00fc\u015fme riskini en aza indirecek \u015fekilde olmas\u0131 (k\u0131yafetlerin bol, uzun olmamas\u0131, sarkan uzun ipler olmamas\u0131, kaymaz terlikler kullan\u0131lmas\u0131 gibi)<\/li>\n<\/ol>\n<\/li>\n\n\n\n
                  2. Hastan\u0131n \u00f6yk\u00fcs\u00fc, d\u00fc\u015fme riski hakk\u0131nda da en kritik bilgileri sa\u011flayabilir. D\u00fc\u015fme sebebiyle ba\u015fvuran hastada olas\u0131 nedenlerin de\u011ferlendirilmesi ve d\u00fc\u015fmenin tekrar\u0131n\u0131n \u00f6nlenmesi sa\u011flanabilir. Hastan\u0131n \u00f6yk\u00fcs\u00fcnde baz\u0131 spesifik komorbiditelerin olmas\u0131 (demans, Parkinson, inme gibi), g\u00f6rsel veya n\u00f6rolojik bozukluklar\u0131n\u0131n olmas\u0131, alkol kullan\u0131m\u0131, ila\u00e7 kullan\u0131mlar\u0131 hastan\u0131n d\u00fc\u015fme riskinin daha y\u00fcksek oldu\u011funa dair uyar\u0131c\u0131 olabilir.\u00a0<\/li>\n\n\n\n
                  3. \u00d6zellikle ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 zay\u0131flam\u0131\u015f hastalarda enfeksiyon kontrol\u00fc sa\u011flanmal\u0131, m\u00fcmk\u00fcnse bula\u015f\u0131 \u00f6nlemek i\u00e7in ki\u015fiye \u00f6zel odalar\/alanlar olu\u015fturulmal\u0131d\u0131r.<\/li>\n\n\n\n
                  4. Fiziksel Ortam ve \u00d6zel Ekipmanlar:<\/strong>\n
                      \n
                    1. Mobilyalar:<\/li>\n<\/ol>\n<\/li>\n\n\n\n
                    2. Muayene koltuklar\u0131 ve sedyelerin kollar\u0131 veya yan bariyerleri sa\u011flam olmal\u0131d\u0131r. Hastalar\u0131n g\u00fcvenli bir \u015fekilde oturabilmeleri, transfer edilebilmeleri i\u00e7in uygun, ayarlanabilir y\u00fckseklikte acil servis yataklar\u0131 se\u00e7ilmelidir.\u00a0<\/li>\n<\/ol>\n\n\n\n
                        \n
                      • Ekstra kal\u0131n \/ yumu\u015fak sedye yata\u011f\u0131 se\u00e7ilmesi yatak yaralar\u0131n\u0131n olu\u015fumunu azalt\u0131r.<\/li>\n\n\n\n
                      • Yataklar\u0131n \u00fcst d\u00f6\u015femesi, ya\u015fl\u0131 hastalarda hassasla\u015fan cildi korumak i\u00e7in yumu\u015fak ve nem ge\u00e7irmez, g\u00f6zeneksiz, y\u00fczeyde diki\u015f i\u00e7ermeyen, kolay temizlenebilen bir malzemeden olmal\u0131d\u0131r. Y\u00fczey kontaminasyonunu azaltarak hastane i\u00e7i enfeksiyon geli\u015fimini azaltacak \u00f6zellikte olmal\u0131d\u0131r.\n
                          \n
                        • \u00d6zel ekipmanlar:<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n
                            \n
                          • V\u00fccut \u0131s\u0131s\u0131 art\u0131r\u0131c\u0131 cihazlar, \u0131s\u0131t\u0131c\u0131 battaniyeler<\/li>\n\n\n\n
                          • Kaymaz yer d\u00f6\u015femeleri, korkuluklar<\/li>\n\n\n\n
                          • Y\u00fcr\u00fcme yard\u0131mc\u0131lar\u0131<\/li>\n\n\n\n
                          • \u0130\u015fitme cihazlar\u0131<\/li>\n<\/ul>\n\n\n\n

                            4.3. Viz\u00fcel iyile\u015ftirmeler:<\/p>\n\n\n\n

                              \n
                            • Ayd\u0131nlatma \u2013 ortam m\u00fcmk\u00fcnse do\u011fal g\u00fcn \u0131\u015f\u0131\u011f\u0131 almal\u0131, ayd\u0131nlatmalarda yumu\u015fak \u0131\u015f\u0131klar kullan\u0131lmal\u0131d\u0131r.
                              • Ayd\u0131nlatmay\u0131 optimize etmek ve parlamay\u0131 azaltmak i\u00e7in mat bir parlakl\u0131kta a\u00e7\u0131k renkli duvarlar ve a\u00e7\u0131k renkli, mat zeminler kullan\u0131lmal\u0131d\u0131r.\u00a0<\/li>
                              • Hastalar\u0131n gece-g\u00fcnd\u00fcz alg\u0131s\u0131n\u0131 koruyabilmek ve sirkadyen ritmlerini olabildi\u011fince koruyabilmek ad\u0131na, uyuyacaklar\u0131 zaman m\u00fcmk\u00fcnse o alandaki \u0131\u015f\u0131kland\u0131rma azalt\u0131lmal\u0131d\u0131r.<\/li><\/ul>\n
                                  \n
                                • Desenler ve renkler \u2013 Kontrast hassasiyeti ve derinlik alg\u0131s\u0131 ya\u015fla azalmaktad\u0131r, bu nedenle karma\u015f\u0131k desenler geriatrik hastalarda ba\u015f d\u00f6nmesi hissi yaratabilir, hareketlerini zorla\u015ft\u0131rabilir. Sade, d\u00fcz planlar kullan\u0131lmal\u0131d\u0131r. Renkler, g\u00f6rsel i\u015flevi ve derinlik alg\u0131s\u0131n\u0131 art\u0131rmak i\u00e7in kullan\u0131labilir. Monokrom renk \u015femalar\u0131ndan ka\u00e7\u0131n\u0131labilir, yatay ve dikey y\u00fczeyler aras\u0131nda kontrast renkler kullan\u0131lmas\u0131 hastalara yard\u0131mc\u0131 olur.\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n
                                    \n
                                  • Y\u00f6nlendirici i\u015faretler net, kolay okunabilir ve basit olmal\u0131d\u0131r.<\/li>\n\n\n\n
                                  • Hastalar\u0131n g\u00f6rebilece\u011fi yerlerde, net okunabilen \u015fekilde saat ve takvimler bulunabilir, bu sayede hasta oryantasyonu artt\u0131r\u0131labilir.<\/li>\n<\/ul>\n\n\n\n

                                    4.4. \u0130\u015fitsel iyile\u015ftirmeler: <\/p>\n\n\n\n

                                      \n
                                    • Hastanede y\u00fcksek sesli g\u00fcr\u00fclt\u00fc kaynaklar\u0131 azalt\u0131lmal\u0131, hastalar i\u00e7in sessiz alanlar olu\u015fturulmal\u0131d\u0131r.\n
                                        \n
                                      • Hastalarla daha iyi ileti\u015fim kurabilmek ve hastalar\u0131n anksiyete seviyelerini azaltmak i\u00e7in gerekti\u011finde \u00f6zel odalar veya akustik perdeleme kullan\u0131labilir. Geriatrik hastalar i\u015fitme azl\u0131\u011f\u0131n\u0131n yan\u0131 s\u0131ra y\u00fcksek seslere kar\u015f\u0131 artm\u0131\u015f duyarl\u0131l\u0131k da g\u00f6sterebilirler. Ses emici malzemelerin (\u00f6rne\u011fin, hal\u0131, perdeler, tavan panelleri) kullan\u0131m\u0131 arka plan g\u00fcr\u00fclt\u00fcs\u00fcn\u00fc azaltabilir ve hastayla ileti\u015fim kurmay\u0131 kolayla\u015ft\u0131rabilir.\u00a0<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n

                                        Genel olarak, bir ya\u015fl\u0131 dostu acil servis, ya\u015fl\u0131 hasta grubunun \u00f6zelliklerini ve \u00f6zel ihtiya\u00e7lar\u0131n\u0131 ele alarak y\u00fcksek kaliteli, hasta merkezli bak\u0131m sunmay\u0131 ama\u00e7lar.<\/p>\n\n\n\n

                                        Kaynaklar<\/strong><\/p>\n\n\n\n

                                          \n
                                        1. Geriatric Emergency Department guidelines. Accessed May 18, 2024. https:\/\/www.acep.org\/siteassets\/sites\/geda\/documnets\/geda-guidelines.pdf.\u00a0<\/li>\n\n\n\n
                                        2. Mooijaart SP, Carpenter CR, Conroy SP. Geriatric emergency medicine-a model for frailty friendly healthcare. Age Ageing. 2022;51(3):afab280. doi:10.1093\/ageing\/afab280\u00a0<\/li>\n\n\n\n
                                        3. Geriatrics-friendly emergency care. Geriatrics-Friendly Emergency Care | HealthInAging.org. Accessed May 20, 2024. https:\/\/www.healthinaging.org\/age-friendly-healthcare-you\/care-settings\/geriatrics-friendly-emergency-care.<\/li>\n\n\n\n
                                        4. Rosenberg M, Rosenberg L. The Geriatric Emergency Department. Emerg Med Clin North Am. 2016;34(3):629-648. doi:10.1016\/j.emc.2016.04.011\u00a0<\/li>\n\n\n\n
                                        5. Ryan D, Liu B, Awad M, Wong K. Improving older patients\u2019 experience in the emergency room: The senior-friendly emergency room.\u00a0Aging Health<\/em>. 2011;7(6):901-909. doi:10.2217\/ahe.11.78\u00a0<\/li>\n\n\n\n
                                        6. Melady D. A senior-friendly ed checklist. Geriatric. April 3, 2017. Accessed May 25, 2024. https:\/\/geriatric-ed.com\/complete-checklist\/.<\/li>\n\n\n\n
                                        7. Kelley ML, Parke B, Jokinen N, Stones M, Renaud D. Senior-friendly emergency department care: an environmental assessment. J Health Serv Res Policy. 2011;16(1):6-12. doi:10.1258\/jhsrp.2010.009132\u00a0<\/li>\n\n\n\n
                                        8. Care of older people in Canadian emergency departments. Accessed June 3, 2024. https:\/\/caep.ca\/wp-content\/uploads\/2022\/04\/CAEP_GED_PS_FINAL.pdf.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

                                          Ya\u015fl\u0131 n\u00fcfusun artmas\u0131 d\u00fcnya genelinde \u00f6ne \u00e7\u0131kan, ve hastanelerde yeni planlamalar yap\u0131lmas\u0131 ihtiyac\u0131 do\u011furan global bir durumdur. Birle\u015fmi\u015f Milletlerin verilerine g\u00f6re 2010…<\/p>\n","protected":false},"author":1185,"featured_media":585,"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":[1,10014],"tags":[10042,10048,10049],"class_list":["post-582","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-acil","tag-geratri","tag-yasli-dostu"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/582","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=582"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/582\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/585"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=582"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=582"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=582"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}