PubMed Health⌕ Search

Biomedical subjects

U Junius

Publications and source records attributed to U Junius.

8 recordsLinked to original sources
PubMed2002

[Geriatric assessment in family practice--results of concerted action by 7 European countries].

General practitioners are faced with the complex medical care of an increasing number of older people. Traditional demand led care is not able to provide optimal management for this age group, since it has been shown that many important health problems remain unknown or not optimally treated. Preventive geriatric assessment offers primary health care providers new opportunities to focus their management on the particular health problems of older people. A European concerted action involving seven countries formed to develop a "standard assessment for elderly people in primary care (STEP)". The aim was threefold: 1) to identify important and preventable health problems in old age, 2) to supply health care planners and providers with scientific evidence of the corresponding preventive procedures, and 3) to initiate a practical assessment framework for use in European primary care practices. Using a strict methodological protocol, 33 health problems were identified that potentially improve health outcomes in preventive programs for older people. A summary of the evidence is given for each of the included health areas. Taking the best available evidence, patients' preferences, and practice conditions into account, a preventive assessment program was developed containing validated and accepted instruments. The approach is algorithmic with a simple problem identification level and a further diagnostic stage. All recommended procedures are harmonized for common European use. An evidence-based preventive assessment program is expected not only to prevent disease and minimize disability and handicap, but it also offers health care planners a European data set of older peoples' needs for optimized resource allocation.

Aged↗
PubMed1998

[Possibilities and limits of geriatric assessment in general practice].

Geriatric assessment is a means to collect health and functional data of an individual older person in a standard way. It has been developed on the secondary care level in the specialties of geriatric and rehabilitative medicine. Transferring geriatric assessment into primary care may improve health outcomes of older people, especially as it facilitates preventive diagnostic and therapeutic intervention. Yet, it is not possible to use geriatric assessment, as it is carried out in secondary care, under primary care conditions. Several adaptations will be necessary. An assessment instrument will have to be developed which takes epidemiological features of the older population into account. It will have to be tailored to the specific conditions of health delivery in primary care. Moreover, to achieve effectiveness and acceptance by health care providers and users, we see the necessity of creating an algorithmic assessment instrument which allows the use in different health situations with different levels of diagnostic detail. A primary care assessment for older people then would need to be evaluated according to its effectiveness of improving health outcomes. Potential negative effects on health beliefs may be worth considering. The final task lies in the implementation of a primary care assessment instrument into our existing health delivery format.

Aged↗
PubMed1998

[Vision disorders in the elderly].

BACKGROUND: British trials from the 60's reveal that older patients tend to underreport their health problems. They misjudge them as non specific or being caused by old age. In this study we investigate whether standard preventive assessment facilitates the detection and early intervention of ophthalmological problems in old age. METHODOLOGY: For the first time a representative screening trial for older patients visiting their general practitioner was carried out in Germany, 1994. The surgeries as well as the 466 participating patients over 69 years were randomly selected. GPs were asked to examine the visual problems of the participants per standardized questionnaire and visual accuracy test. GPs had to report uncovered problems and planned interventions. RESULTS: Altogether, 75% of the participating patients had some need for a further ophthalmological diagnostic or therapeutic intervention. Every fourth patient had not seen an ophthalmologist within the last two years. 40% of the participants complained of eye problems. 22% had symptoms of a glaucoma. Visual accuracy was low in 17% of the older patients. General practitioners had only been aware of 50% of all visual problems requiring further intervention. About half of the patients with a low visual accuracy and 70% with an indication of glaucoma had been unknown before. For about half of the patients requiring ophthalmological investigation (excluding problems with glasses) an intervention was planned. For every fifth, the general practitioners initiated referrals. CONCLUSION: The standard preventive facilitated to detect a high rate of visual problems in old age. Close cooperation with ophthalmologists is necessary for patients who do not take up the specialists' eye check ups (especially those at risk). Patients with severe eye problems in some cases in spite of specialists' care also require interdisciplinary treatment.

Aged↗
PubMed1996

[A prevention program for health problems in the elderly. Ambulatory Geriatric Screening (AGES) for use in general practice].

Ambulatory Geriatric Screening (AGES) is a standardized interview and examination instrument, the purpose of which is to detect major health or psychosocial problems in the elderly ambulatory patient, and thus prevent secondary illnesses. It comprises a patient and doctor's assistant questionnaire and a doctor's examination sheet with brief instructions for use. In a study conducted between 1992 and 1995, AGES was employed in 67 randomly selected general practitioners' offices in the area around Leipzig and Hannover. An important result was that in an average of 10.2 health-related problems per patient, 4.8, that is almost a half, had been unknown to the care-providing physician. In the case of very old patients, however, the family doctor was usually better informed. The application of the AGES in the office is less time-consuming than might be feared. For the evaluation of the patient questionnaire and the scheduled small examinations, the doctor's assistant needs only 10 to 15 minutes. Thereafter, the family doctor can check the results at a glance and use them as a basis for further talks with the patient and his therapeutic approach.

Aged↗
PubMedDate not supplied

[Ambulatory geriatric screening--an overview. I: Concept and methodologic development].

Scientific literature reveals different levels of efficiency in geriatric screening in the primary care setting. Part I of our review deals with the development of geriatric screening up to the implementation of regular health checks in Great Britain. Studies in primary care show that through screening 1-2 previously unknown conditions per patient can be detected, with a particularly high prevalence of unknown problems in the following areas: vision and hearing, continence, mobility, cognitive function, mood, isolation, and lack of help. Further research is still required to transfer the results of screening studies into primary care, particularly in validating instruments of geriatric assessments and selecting risk groups.

Aged↗
PubMedDate not supplied

[Ambulatory geriatric screening--an overview. II: Evaluation of the effectiveness and current recommendations for screening implementation].

Geriatric screening detects many problems previously unknown to the primary health care physician. In spite of this, a valid judgement can only be made if the effectiveness of the induced intervention is proven. Prospective studies evaluating these screening-induced interventions show diverse results. Nevertheless, international task forces conclude from the evidence of existing studies that there are areas which are effective, efficacious, and enhance the quality of life. It remains a continuing task for research to develop geriatric assessment instruments as well as to set up objective guidelines of intervention in these areas.

Aged↗