A New Functional Assessment Tool to Evaluate Medical and Care Need

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Geriatric Scale is defined as sum of signs and symptoms which are listed as geriatric syndrome in the elderly in text books of Geriatric Medicine. We investigated 474 subjects in total. These include 436 institutionalized subjects in acute care hospital, chronic care hospital, and long term care facility as well as 36 community dwelling subjects who use home-based care. Mean value of Geriatric Scale was 6 in home-based care, 6.5 in an acute care hospital, 9 in a chronic care hospital and 9 in a long term care facility. So-called geriatric syndromes were able to be categorized into 3 groups ; syndromes steeply increased after 75 years old (Older Old), syndromes increased gradually after 65 years old (Young Old) and syndromes least influenced by age (Constant).In subjects with home-based care, geriatric scale is relatively small. However 3 layer pattern of geriatric syndrome is basically not different. In a long term care facility, Although, 3 layer pattern is found, the syndromes "Older Old" increased before 75 years old. In other words, in nursing hospital, care-burden with low ADL may be heavy. The pattern in a chronic care hospital is similar that of nursing hospital. According to one year prognosis of patients in a chronic care hospital, the geriatric scale of patients who came back to home is about half of that of patients who were transferred to long term care facilities.Specifically, it should be noted that the element of Older Old is very small in patients who came back to home. In conclusion, the sum of geriatric syndromes and analysis of pattern of geriatric syndromes are new tool to evaluate care need and medical need. And it will help to make a discharge planning.