術前の老年評価とプレハビリテーション

術前の老年評価に関するレビュー論文を紹介します。

Sheilesh Kumar Dewan, Song Bai Zheng, Shi Jin Xia. Preoperative geriatric assessment: Comprehensive, multidisciplinary and proactive. European Journal of Internal Medicine, Available online 4 July 2012, http://dx.doi.org/10.1016/j.ejim.2012.06.009

高齢者に対する手術が増えていますので、術前の老年医学的評価の重要性は高まっています。評価したうえで、必要な場合には術前からプレハビリテーションの介入を行い、術後も介入することが、周術期の予後を改善させる可能性があります。

問題は評価の結果、どのような患者に介入すべきか、介入内容・期間はどうすべきかというところです。このあたりのエビデンス構築はこれからといったところですね。

Abstract
With the changing global demographic pattern, our health care systems increasingly have to deal with a greater number of elderly patients, which consequently also takes its toll on our surgical services. The elderly are not simply older adults. They represent a heterogeneous branch of the population with specific physiological, psychological, functional and social issues that require individualised attention prior to surgery. Increased acknowledgement that chronological age alone is not an exclusion criterion, along with advances in surgical and anaesthetic techniques have today lead to decreased reluctance to deny the elderly surgical treatment. In order to ensure a safe perioperative period, we believe that a comprehensive, multidisciplinary and proactive preoperative assessment will be helpful to detect the multiple risk factors and comorbidities common in older patients, to assess functional status and simultaneously allow room for early preoperative interventions and planning of the intra- and postoperative period. In this review we outline the currently available preoperative geriatric risk assessment tools and provide an insight on how a comprehensive, multidisciplinary and proactive approach can help improve perioperative outcome.