[Consensus for the identification of geriatric patients in the emergency care setting in Germany]. / Positionspapier zur Identifizierung geriatrischer Patienten in Notaufnahmen in Deutschland: consensus for the identification of geriatric patients in the emergency care setting in Germany.

For the treatment of geriatric inpatients, the efficacy of a multimodal geriatric intervention based on findings of a comprehensive geriatric assessment has well been established. Therefore, the focus of elderly inpatient care switched to the identification of geriatric patients who have unintended or unscheduled contact to an accident and emergency department. In Germany, a uniform standard on how to correctly identify geriatric patients in such settings has yet to be established.Three medical societies, the Federal Association of Geriatrics ("Bundesverband Geriatrie", BVG), the German Society for Gerontology and Geriatrics ("Deutsche Gesellschaft für Gerontologie und Geriatrie", DGGG) and the German Geriatrics Society ("Deutsche Gesellschaft für Geriatrie", DGG) have reached a consensus on tools and instruments for the identification of geriatric patients in the emergency care setting. Basis of the consensus were the existing scientific evidence and further considerations, especially the applicability of international findings in Germany and feasibility.Three recommendations are made: (1) The use of prognostic indices is not recommended, as prognostic indices appear to be inappropriate to disclose the complex needs of geriatric patients. (2) Comprehensive geriatric assessment is established and effective, but too complex for use in the emergency setting. It is recommended for cases in which information from screening instruments or other sources does not allow a clear decision. (3) Among screening instruments, the Identification of Seniors At Risk (ISAR) screening tool seems to be well established and suitable for screening purposes in Germany. A German adaption is recommended as well as the implementation in settings where no other tools or geriatric expertise are available.

Measurement of drug compliance by continuous electronic monitoring: a pilot study in elderly patients discharged from hospital.

OBJECTIVE: A pilot study to assess patient compliance with medication by using a new measurement technique, continuous electronic monitoring. DESIGN: Survey. Compliance monitors were provided to eligible patients at discharge from the hospital to measure drug intake behavior prospectively for a period of 3 weeks. SETTING: Ambulant patient care after discharge from a geriatric hospital, Krankenhaus Bethanien, which is affiliated with the University Clinic, Heidelberg. PATIENTS: A consecutive convenience sample of 18 independently living elderly patients (median age 76 years) completed the study. The patients were on maintenance therapy with cardiac glycosides and/or potassium-sparing diuretics prescribed to be taken once daily. INTERVENTION: The monitoring method provides information about patients' real timing of drug use by continuously recording date and time of openings and closings of the medication containers (monitors). In addition to a standard measure, the percentage of prescribed doses taken, information about regularity of drug use is obtained. RESULTS: Compliance, percentage of prescribed doses taken, was remarkably variable; it ranged from 24% to 100%, 95% CI: 62%-84%. Mean compliance declined from the first to the third week after discharge, 85% vs 69%, 95% CI: 74%-95% and 56%-81%, respectively (P < 0.05). Omissions of doses, the predominant pattern of non-compliance, were observed in 17 of 18 patients. Regularity of dose timing, as defined by the number of interdose intervals within 24 h +/- 15%, varied from 10% to 100%, 95% CI: 46%-76%. CONCLUSIONS: Continuous electronic monitoring revealed highly variable compliance in patients prescribed maintenance therapy. Even with a once-daily regimen, persistent and high compliance cannot be assumed. The monitoring technique may be of great value to research and, possibly, to practical therapeutic management.