Regulación de la expresión sexual de los mayores ingresados en residencias: la visión de los profesionales

Introduction

The purpose of this study is to determine the opinion of professionals working in residential aged care facilities on the regulation of sexuality in these settings.

Materials and methods

Fifty-three professionals from five residential aged care facilities located in the metropolitan area of Barcelona answered several questions regarding the advisability of establishing measures for the regulation of sexuality in RACFs, the elements that could contribute to this, and the aspects that such regulations should consider.

Results

Around 50% of the participants recognized the advisability of having some type of measures for sexuality regulation in residential aged care facilities. According to their responses this should be developed taking into account professional opinions, but also the points of view of the residents and their relatives. The most frequently mentioned regulations were those that ensured that any kind of sexually charged situation occurred in a private environment. The development of strategies are suggested to distinguish those people with dementia that are competent to consent to sexual acts from those who are not.

Conclusions

The opinion of professionals working in RACFs regarding the advisability of establishing measures for sexuality regulation seems to be considerably divided. Thus, whilst around 50% of them recognize their potential usefulness, the other half consider them unnecessary or even counterproductive for the sexual freedom of residents. Associating regulation with prohibition and sexuality with sexual activity was not uncommon among the responses of the participants.     

Ofiuroideos de los archipielagos de Chiloe y los Chonos

In marine faunistical prospections made in the Chiloé and Chonos inlets between 1970 and 1973, five ophiuroid species were collected: Gorgonocephalus chilensis (Philippi, 1858),Astrotoma agassizii Lyman, 1875; Ophiomyxa vivipara Studer, 1876; Ophiophragmus chilensis (Müller and Troschel, 1843) and Ophiactis asperula (Philippi, 1858). Morphometric data about the specimens as well as the geographical distribution of the species are given. With the purpose of contributing to the zoogeographical knowledge of this area of the Chilean littoral, an analysis of the geographical distribution of all species mentioned for this region is done.     

Implicaciones de los síntomas depresivos en los ancianos hospitalizados por afección médica

Introduction

Depressive symptoms in hospitalized patients are very common, and they have been related to higher mortality. The aim of the study was to estimate the prevalence of depressive symptoms in hospitalized elderly patients and its relationship to various diseases, as well as their functional and mental status and mortality.

Material and methods

A total of 115 patients over 64 years of age were prospectively studied. The validated Spanish version of the Geriatric Depression Scale of Yesavage (15-item version) was used. Patients were considered to have depressive symptoms if ≥6 points were obtained. The demographic characteristics, the Charlson comorbidity index, the diagnosis at admission, the functional status assessed by the Barthel and Lawton-Brodie index, the mental capacity assessed by the Pfeiffer questionnaire, the length of the hospital stay, and hospital mortality were recorded.

Results

Out of the 115 patients studied, with a mean age of 70.5 years, 71 (61.7%) were female. Depressive symptoms were observed in 46 patients (40%, 95% CI: 34.8-43.9). Patients who died showed a significantly higher score on the Yesavage scale (P=.04). The multivariate analysis showed a significantly independent association between depressive symptoms and functional capacity (P=.026), mental status (P=.021), renal failure (P=.001), liver disease (P=.018), and osteoarthritis (P=.017), but losing the previously seen significant association with diabetes (P=.43).

Conclusions

The prevalence of depressive symptoms in hospitalized elderly patients is high, and is associated with the diagnoses of renal failure, liver disease and osteoarthritis, with a higher comorbidity and especially with a poorer functional capacity.     

Hongos blastosporados de los esputos

Resumen De 100 esputos que proporcionaron cultivos de hongos blastosporados (o levaduri formes) 84% contenían diversas especies deCandida y 16% deTorulopsis. El estudio de 54 cepas deCandida arrojó la siguiente distribucion por especies:C. albicans 57,40%,C. tropicalis 20,37%,C. Krusei 12,96%,C. parapsilosis 3,70% yC. Guilliermondi, Czeylanoides yC. lipolytica (probable) cada una representada por 1,85%. Las dos cepas deTorulopsis estudiadas, fueron clasificadas comoT. pulcherrima.Creemos que la flora del esputo representa, como la de las materias fecales, una     

Nonagenarios en los servicios de Medicina Interna españoles

Objetive

To describe the demographic and clinical profile of nonagenarian patients admitted to Internal Medicine departments in Spanish hospitals, and to compare it with younger patients.

Methods

We identified, through the MBDS (Basic Minimum Data Set), every patient older than 90 years admitted to Internal Medicine Departments of the Spanish National Health Service public hospitals between 2005- 2008. Hospital discharge data were obtained from the MBDS. A diagnosis-related group (DRG) was identified for every patient. The DRG 21.0 version was used. We compared this nonagenarian group with data of younger adult people. All centres submit this information to the Spanish Health Ministry. The Charlson Index (CCI) was used to determine comorbidity. All statistical analyses were performed using SPSS 14.0.

Results

The sample included 131,434 patients over 90 years (6% of total patients admitted), with 2,222 patients being over 100 years. There were 45.3% female patients under 90 years, compared to 67.3% over 90 years (P<.001). The top ten DRGs listed in the older group included three new conditions not present in the younger one: pulmonary oedema (DRG: 87), severe urinary tract infection (DRG: 320), and severe respiratory tract infection (DRG: 540). The first 5 DRG were: pneumonia/bronchitis (541): 11.9%, heart failure (127): 8.9%, rhythm disorders (544): 7.5%, pulmonary oedema (87): 3.8%, and other respiratory diseases (89): 3.24%. In any case the incidence of these conditions was higher than those found in younger patients. Among this top ten, only COPD and angina had a higher rate in the younger group. The incidence of hospital deaths were 9.1% among the younger group, and 21.8% among the nonagenarians (P<.001). If only the first 48 hours after admission are taken into account, the rates were 2.2% vs 6% (P<.001). The majority (78.2%) of nonagenarian patients return home after discharge

Conclusions

1) There are a high number of nonagenarians patients admitted in hospital Internal Medicine Departments; 2) The number of women increases with age; 3) List of diagnosis varies according with age; 4) Hospital death rates increase with age, both in first two days and total stay, and 5) The majority of these patients are able to return home after discharge.     

Calidad de vida y sobrecarga de los cuidadores de pacientes con daño cerebral adquirido

Introduction

The health impact of acquired brain injury (ABI) is not only apparent in the patient, but also in the loss of health related quality of life (HRQol) of their carers. The objectives of this study were to measure the loss of HRQol as well as the burden of the carers of patients with ABI.

Material and methods

A retrospective study was conducted with 76 carers of patients with ABI. A questionnaire was used to collect information on the sociodemographic aspects, carer burden (Zarit Scale) and the HRQol (EuroQol Questionnaire) of the carers. A multiple linear regression model was constructed to analyse the effect of the different variables.

Results

The carers were predominantly women over 50 years, retired or dedicated to domestic tasks and who cared for their husband or one of their parents. One third showed a high risk of claudication. The mean HRQol obtained with the EuroQol went from a similar score to that of the general population (0.9) in the group without burden, to 0.67 in the group with risk of claudication. The regression models explained the burden better than the loss in quality of life.

Conclusions

Carers of patients with brain injury suffer a significant loss in HRQol compared to the general population. The deterioration arises from the mental dimensions and depends on the level of burden.     

Fiabilidad interobservador de los 4 índices de comorbilidad más utilizados en pacientes ancianos

Objective

To report on the interrater reliability of four common comorbidity indexes used in the hospitalised elderly: Charlson Index (CI), Geriatric Cumulative Illness Rating Scale (CIRS-G), Index of Co-existent Disease (CoD) and Kaplan-Feinstein Index (KFI).

Method

Four trained observers, independently reviewed the same 40 medical charts of hospitalised geriatric patients. Scores for the four indexes were calculated, along with the intraclass correlations coefficient (ICC) (quantitative index: CI and CIRS-G) and Kappa coefficient (qualitative index: CoD and KFI). The agreement <0.4 was considered deficient, 0-4-0.75 acceptable and >0.75 excellent.

Results

A total of 40 patients (29 women) of 85.93 (±5.35) years were analysed. Intraclass correlations coefficient: CI: 0.78 (95% CI: 0.67-0.86); CIRS-G (score): 0.66 (95% CI: 0.53-0.78). Kappa coefficient: KFI: 0.51 to 0.76; CoD: 0.44-0.66. The application time was lower for the Charlson index (median of 39 seconds [30-45]) and the KFI (42 seconds [35-52]) and higher for CIRS-G (score) (128 seconds [110-160]) and CoD (102 seconds [80-124]).

Conclusions

Of the four comorbidity indexes used in a hospitalised elderly population, the CI, and CIRS-G (score), are those that have better interrater reliability. The Charlson index and KFI show a lower application time than the CIRS-G (score).