GERIATRIC WORK-UP IN THE NORDIC COUNTRIES - THE NORDIC APPROACH TO COMPREHENSIVE GERIATRIC ASSESSMENT

A group established by the Nordic professors of geriatrics has develop ed a position document presenting a shared and updated review of geria tric work-up as a way of comprehensive geriatric assessment in the Nor dic countries. The main intention is that the document will serve as s upport and help for the clinician concerned with hospital based geriat ric medicine. it may also be useful for quality control and teaching. Not least, it may be useful for health professionals other than geriat ricians. To some extent, the position of geriatric medicine in the Nor dic countries varies between the countries. However, the background fo r developing a Nordic version of geriatric work-up is shared attitudes and principally the same organization of the health care system, and collaboration within geriatrics for many years. Several trials on comp rehensive geriatric assessment and management performed in different s ettings have shown favourable outcomes. Results from controlled Nordic trials are compiled and summaries of meta-analyses are presented. The concept of Nordic geriatric work-up is based on a model defining heal th and disease in old age as dimensions of pathology, impairments, fun ctional limitations, and disability, all being modified by extra- and intraindividual factors. Handicap is defined as the disability gap. Di fferent health professionals have varying responsibilities in the geri atric team-work, but all should be dedicated to establish common goals . The geriatric work-up is presented with success factors and barriers , stating important differences between multidisciplinary and interdis ciplinary processes. Checklists and assessment scales may be very usef ul when performing a geriatric work-up, but they should be used with c aution. Specific scales covering different functional areas of the ger iatric patient are recommended for clinical practice. Such scales must be valid, reliable, acceptable to the patient, responsive to change, and should be in an appropriate format, as well as easy to administer. Prior to the use among geriatric teams in the Nordic countries the sc ales should be translated into all the Nordic languages, and the trans lated versions should ideally have been subjected to validity and reli ability testing. However, so far no scale meets these demands regardin g all the five Nordic languages.