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背景探讨全科医疗老年评估,对以往同年龄段疼痛患病率、位置、影响和医生-患者二元疼痛感知的发现进行补充。方法在横截面研究中,对年龄为70岁及以上患者进行综合性的全科医疗评估,包括基本疼痛评估(严重性、位置和影响)。采用双变量和多变量统计学分析疼痛与其他项目的关系,如整体健康水平、身体损伤、日常功能、跌倒、心情、健康相关生活方式和社会环境。采用kappa评价医生和患者对疼痛严重性感知的一致性。结果297例患者中有219(73.7%)例有疼痛症状,通常出现在多个位置,最常见为膝盖疼痛(33.9%)、腰椎疼痛(33.5%)和臀部疼痛(13.8%)。疼痛通常会带来具体问题,如日常活动限制(膝盖)或睡眠质量下降(脊柱)。结论通过基本疼痛评估能够筛查全科医疗中的老年疼痛患者,相应的疼痛患病率高于问诊随机发现的患病率。老年疼痛评估提供了解决疼痛的新方法,应针对老年患者的需求采取相应干预措施,包括疼痛位置、生活中的具体问题,以及患者的疼痛感知。由于医患疼痛感知一致性较差,优化具体治疗选择和患者核心治疗是一项重要策略。
Background The General Practice Geriatric Assessment explores the past finding that pain prevalence, location, impact, and physician-patient bipolar pain perception in the same age group are complemented. Methods In a cross-sectional study, a comprehensive general medical assessment was conducted for patients 70 years of age and older, including basic pain assessment (severity, location and impact). Bivariate and multivariate statistics were used to analyze the relationship of pain to other items such as overall health, physical impairment, daily functioning, falls, mood, health-related lifestyle, and social environment. Kappa was used to evaluate the consistency of perception of pain severity among physicians and patients. Results Of the 297 patients, 219 (73.7%) had painful symptoms, usually in multiple locations. The most common were knee pain (33.9%), lumbar pain (33.5%) and hip pain (13.8%). Pain often leads to specific problems such as restrictions on daily activities (knees) or decreased quality of sleep (spine). CONCLUSIONS: Elderly patients with pain in general practice can be screened by basic pain assessment. The corresponding prevalence of pain is higher than the randomized prevalence at the interview. Geriatric pain assessment provides a new way to deal with pain. Interventions should be made for the needs of elderly patients, including the location of the pain, specific problems in life, and the patient’s pain perception. Because of the poor coherence of patient perception of pain, optimizing specific treatment options and patient core therapy is an important strategy.