Utilización del servicio de urgencia de un hospital universitario por los adultos mayores en Santiago de Chile

Introduction

An increase in visits to Emergency Departments by older adults has been reported, but there are no data available on this in countries in the early phases of demographic and epidemiological transition. This paper describes the characteristics of people over 60 years-old (AM) who visited the Emergency Department of the Hospital Clínico Universitario de la Pontificia Universidad Católica, Chile (SU-PUC), compared to those less than 60 years-old (AJ).

Material and methods

Demographic data and reasons for admission and re-admission were collected retrospectively from the SU-PUC monthly statistics report. Obstetrics, paediatrics and «scheduled admissions» were excluded. The frequencies were compared using Chi-squared (significance: P < .05).

Results

A total of 37,660 visits to the SU-PUC were recorded (81% AJ; 19% AM; with 8% being older than 75 years). No statistical differences were found in the visit time (70% daytime), or by season between the groups.A total of 7,414 (19.6%) of those who visited were hospitalised, with differences being detected between groups (AM: 48.9% vs 12.9% AJ; P < .001), particularly in those over 75 years (59%). The primary cause of admission was cardiopulmonary in AM (22%) and gastrointestinal in AJ (31%). Re-admissions were 10% in AM and 6% in AJ (P < .001).

Conclusion

The use of SU by AM and some characteristics of their care process (hospitalisation) are similar to those found in countries in more advanced phases of demographic transition.     

Vacunación antigripal en personas mayores

Seasonal flu is a very serious public health problem in the elderly due to its morbidity and mortality and financial and social costs arising from this. The aim of this review is to describe the magnitude and importance of seasonal flu in this population group, and its prevention by means of vaccination. For this reason, an updated account of the composition of the vaccine, its dosage and administration route, vaccine safety and the evaluation of the immunogenicity and effectiveness of vaccination. There is variation between different countries and official organisations on the age at which flu vaccination must be established in the elderly. New flu vaccination strategies need to be introduced, to further improve flu vaccination cover in Spain.     

Relación entre el rendimiento en la prueba de estación unipodal y la velocidad del centro de presión en adultos mayores

Introduction

Frequent falls are one of the most important health problems in the elderly population. The unipedal stance test (UPST), asses postural stability and is used in fall risk measures. Despite this, there is little information about its relationship with posturographic parameters (PP) that characterizes postural stability. Center of pressure velocity (CoPV) is one of the best PP that describes postural stability. The aim of this study was to analyze the relation between UST score and CoPV in elderly population.

Materials and methods

A sample of 38 healthy elderly subjects where divided in two groups according to their UPST score, low performance (LP, n = 11) and high performance (HP, n = 27). The correlation between UPST score and COP mean velocity (CoPmV), recorded from a posturographic test, was analyzed between both groups.

Results

An inverse correlation between UPST score and CoPmV was found in both groups. However, this was higher in the LP group (r = −0.69, P = .02) compared to the HP (r = −0.39, P = .04).

Conclusions

Based on the results of this investigation, it may be concluded that the achievement on UPST has an inverse relationship with CoPmV, especially in subjects with low performance in the UPST.     

Detección de disfagia en mayores institucionalizados

Objective

To determine the prevalence of dysphagia in a population of institutionalised elderly people, and the effectiveness of a clinical method for its detection.

Methodology

A prospective study was conducted on a random sample of elderly residents. A clinical evaluation along with an assessment with different volumes and viscosities (MECVV) were used. Specific care and follow up was arranged following this assessment.

Results

Forty residents were studied. The prevalence of unrecognised dysphagia was 42.5%. Following assessment by the MECVV, the prevalence rose from 22.5% to 65% (P=.012). Dysphagia detected by MECVV was related to nutritional risk, as measured by the Mini-Nutritional Assessment (MNA) (P=.007), and to the diagnosis of dementia (P=.028).

Conclusions

The diagnosis of dysphagia in this sample of institutionalised elderly people increases when applying a clinical method for detection, reaching a prevalence similar to other studies.     

Presencia y representación de las personas mayores en la publicidad televisiva: el caso español

Introduction

The demographic shift towards aging population generates a series of socioeconomic and cultural changes that are beginning to transform the role and public image of older people. The elderly have become one of the market segments with a greater future. This fact has attracted little scientific interest in the field of advertising communication and for this reason there is little research that is actually looking into this Spain. This research examines the use that is made of the image of the elderly in the television advertising in Spain, looking at the differences between the advertisement dedicated to the targeting people over 65, and those that are not directed at the elderly, but use older people in their content as actors or main characters in the advertisement.

Material and methods

A content analysis study was conducted on a sample of 2,065 spots obtained from prime time slots (from 20:30 to 22:30 p.m.) from the five major Spanish television channels (TVE 1, La 2, Tele 5, Antena 3 and Cuatro). Two independent judges coded all the advertisements. The reliability coefficient between judges was 0.91.

Results and conclusions

In general, older people, particularly women, are not very often shown in Spanish advertising. Their presence is much stronger and visible in campaigns which aim their communication strategy at different age groups. In those cases, advertising presents the elderly with a stereotyped, self-interested and traditional image.     

Síntomas depresivos en adultos mayores participantes de una universidad abierta a la tercera edad

Introduction

Although depressive disorders prevalence among older adults usually is less than in the younger population, the presence of significant symptoms of depression is common in elderly people. Studies show that taking part in social, educational and pleasure activities is associated with a reduction in depressive symptoms in this population. The purpose of this study was to examine the prevalence of depressive symptoms above the elderly participants of a Third Age Open University, taking the time taking part as a reference.

Material and methods

A cross-sectional design was implemented, with a participation of 95.2% (n = 140) of the total enrolled in the first trimester of 2009 in the activities of the Third Age Open University of the Schools of Arts, Sciences and Humanities of the University of São Paulo. They all answered a socio-demographic questionnaire and the Geriatric Depression Scale (GDS-15).

Results

The prevalence of depressive symptoms found was 3.57%. The statistical analysis showed a relationship between participation formore than one semester in the Third Age Open University and a lower index of depressive symptoms (p < .05).

Conclusions

Participating for longer than one academic semester is associated with less depressive symptoms, possibly being a protector factor against depression.     

Fragilidad como predictor de episodios adversos en estudios epidemiológicos: revisión de la literatura

Several epidemiological studies have analyzed the association between frailty status and adverse geriatric health outcomes, with there being a clear relationship being demonstrated in mortality, disability, mobility loss, institutionalization and falls. However, different studies have evaluated different number of these adverse events, with different criteria, and with different follow-up periods. As a result of this relationship, the objective of geriatric medicine must not only be the prevention, diagnosis and treatment of diseases based on multidisciplinary team work and use of geriatric units according to functional status of patients, but the detection, prevention and treatment of frailty. Frailty must be considered as a pre-disability state that can be prevented and treated to delay its progression towards disability, institutionalization, and death. The characterization of frailty status can also help other medical specialties to stratify the risk of adverse health outcomes in oncology treatments, surgical interventions, or diagnostic procedures.     

Evaluación de un programa de intervención en residencias geriátricas para reducir la frecuentación hospitalaria

Objectives

This study describes the outcomes of an intervention program in Nursing Homes and their effects on emergency room attendance, hospital admissions, and pharmaceutical expenditure.

Material and methods

This involved non-randomised community intervention in Nursing Homes with a control group. The program was implemented gradually from 2007 to 2009 in 10 Nursing Homes (857 beds) which participated voluntarily. The control group consisted of 14 Nursing homes (1,200 beds), which refused to participate or were not assigned to our Primary Care centres. Intervention consisted of comprehensive geriatric assessment and follow-up visits by trained personnel, review and adjustment of drug treatment, case management and staff training.

Results

In the Nursing Homes where the program was carried out, emergency room attendance decreased from 1165‰ (95%CI 1100-1240]) in 2006 to 674‰ (95%CI 620-730) in 2009, while in the control group it increased from 1071 (95%CI 1020-1130) to 1246‰ (95%CI 1190-1310). The hospital admissions also decreased from 48.4% (95%CI 45-52) in 2006 to 32.1% (95%CI 29-35) in 2009, while in the control group increased from 43.5% (95%CI 41-46) to 55.8% (95%CI 53-59). There was also a 9% reduction in pharmacy cost compared with an increase of 11.9% in the control group.

Conclusions

The intervention has proved effective at reducing hospital admissions and emergency room attendance in institutionalised patients, thereby streamlining pharmacy costs.     

Elaboración de una herramienta para la estimación del riesgo de mortalidad a corto y medio plazo tras el alta de una Unidad de Hospitalización de Agudos de Geriatría

Objectives

To identify predictive factors for 6 and 12-months mortality after discharge from a geriatric acute care unit, and from these, derive a mortality-risk index.

Methods and analysis

Prospective cohort study will be conducted on patients over 70 years-old admitted to a geriatric acute care unit and survived to hospital discharge. The main outcome measure will be mortality at 6 months and 12 months after discharge. Independent variables include sociodemographics, functional status, comorbidities, and clinical and laboratory characteristics. Risk factors associated with mortality will be constructed using multivariate logistic regression models. To build the mortality index, points will be assigned to each risk factor by dividing each beta coefficient in the logistic model by the lowest beta coefficient. A score will be assigned to each subject by adding up the points for each risk factor present in the model. The predictive accuracy of the model will be determined by comparing the predicted versus observed mortality in the study population and calculating the area under the ROC curves in both populations.

Conclusions

The risk-mortality index developed would allow an easy estimate to be made of individual risk of death at 6 months and 12 months after discharge from a geriatric acute care unit, with the purpose of establishing care plans and individualising treatment, according to real objectives.     

Desarrollo de un instrumento de registro de implicación/engagement en la actividad para la observación sistemática de personas mayores con deterioro cognitivo

Introduction

As the level of cognitive impairment in people with dementia increases, it seems that the interventions aimed at this group do not obtain the expected results. Thus, it is clear that there is a need to develop specific assessment tools. One of the important aspects in people with dementia is the engagement, involvement in task and activities. Engagement is considered a quality of life and quality of care indicator. The aim of the study is to develop an Engagement recording tool for mapping people with dementia, and to obtain reliability measures.

Method

The present paper aims to present the current development of engagement behaviours. The pilot study had a sample of 19 people distributed into two groups, which were observed in order to obtain inter-rater reliability measurements using the percentage of inter-rater agreement.

Results

An observational mapping instrument was developed that achieved a high inter-rater reliability.

Conclusion

The Engagement recording tool makes it possible to gather promising results on the effects of the interventions for people with severe dementia. On the other hand, these results point to the possibilities of more specific tools to assess the different interventions which aim is to improve quality of life and quality of care in people with dementia.     

Prevención de las úlceras de talón en un hospital de media estancia. Estudio comparativo de vendaje clásico almohadillado respecto a las taloneras hidrocelulares de poliuretano

Introduction

The aim of the study is to determine the incidence of heel pressure ulcers (UPPT) and to compare the two systems for UPPT prevention: classic padded bandage and polyurethane heel.

Material and methods

Prospective intervention study in a medium-long hospital stay of all people admitted that had no UPPT but had a risk of UPPT according to the Braden Scale or clinical judgment. The patients were randomized to prevention with classic padded bandage or polyurethane heel. The outcome variable was the incidence of UPPT for each study group, which was recorded every 15 days or when there were clinical changes.

Results

Of the 940 patients evaluated, 409 with a mean age of 80.5 years and 59.1% women,were included in the study. Of these, 78% had Barthel score ≤30; 28.6% dementia; delirium 37.6%; 27.6% diabetes; and 19.6% other UPP. The overall incidence was 2.9% UPPT; 2.49% in the classic padded bandage and 3.37% in the polyurethane heel group (p=0.82).

Conclusions

No statistically significant differences were observed between the group with the classical dressing and the group with the polyurethane heel dressing. The use of multiple measures to prevent UPPT achieved a low incidence of these.     

Resultados preliminares de un programa comunitario de prevención de caídas: estudio Precari (prevención de caídas en La Ribera)

Objective

To evaluate the results of a fall prevention programme designed to be applied to the elderly living in the community.

Material and methods

The sample consisted of 249 participants ≥70 years of age, who were randomly assigned to one of three groups. The monthly intervention group (GIM): instructions on fall prevention and healthy exercises to improve physical function and balance at beginning of the study, and a monthly theoretical and practical refresher session. The quarterly intervention group (GIT), with the same beginning intervention and a refresher session every three months. The control group (GC), the same beginning intervention but no refresher sessions.

Results

The mean age of the sample was 74.47 years (SD 5.33), with 64% women. The incidence of falls was reduced from 0.64 per patient year in the previous year to 0.39 in the post-intervention year in GIM, from 0.49 to 0.47 in GIT, and in the GC it remained at 0.47 before and twelve months after, but with no significant differences in the reduction between groups (P=.062). At the end of the study there was a decrease in Rizzo scale of 0.72 points (95% CI: 0.57-0.88, P<.001).

Conclusion

An interdisciplinary community intervention programme can contribute to reducing the incidence of falls. Further studies are required to continue research into the incidence of falls in the elderly living in the community.     

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.     

Epidemiología infecciosa en centros gerontológicos

Introduction

Infection processes in gerontology centres (GC) are one of the main causes of mortality and aggravation of concomitant chronic diseases. An epidemiological surveillance system was set up to find out their magnitude and distribution.

Material and methods

A prevalence study was conducted during the years 2006-2009 in 4 GCs of the Matia Foundation. Prevalence was measured by making an annual cut-off, recording: infection type, demographic data, risk factors and antibiotic use. The incidence was measured for two years in one GC as a pilot centre, recording: infection type and antibiotic use.

Results

The prevalence in the GCs varied between 4.8% and 6.44%. The infection incidence density in the pilot study was between 3.45-5.77 infections per 1,000 resident days. The most common infection location and in this order were, respiratory, urinary and cutaneous. The incidence of respiratory infection is more statistically significant in the presence of dysphagia, malnutrition and COPD. However, no significant relationship was seen in the incidence of urinary infection with the different risk factors analysed.

Conclusions

The frequency and repercussions of nosocomial infections in GCs demonstrate the need for intervention plans and the development of adequate prevention measures.     

Diseño y validación de las escalas de evaluación del impacto psicológico de sucesos vitales pasados: el papel del pensamiento rumiativo y el crecimiento personal

Introduction

Older people's emotional distress is often related to rumination processes focused on past vital events occurred during their lives. The specific coping strategies displayed to face those events may contribute to explain older adults’ current well-being: they can perceive that they have obtained personal growth after those events and/or they can show a tendency to have intrusive thoughts about those events. This paper describes the development and analysis of the psychometric properties of the Scales for the Assessment of the Psychological Impact of Past Life Events (SAPIPLE): the past life events-occurrence scale (LE-O), ruminative thought scale (LE-R) and personal growth scale (LE-PG).

Material and methods

Participants were 393 community dwelling elderly (mean age=71.5 years old; SD=6.9). In addition to the SAPIPLE scales, depressive symptomatology, anxiety, psychological well-being, life satisfaction, physical function and vitality have been assessed.

Results

The inter-rater agreement's analysis suggests the presence of two factors in the LE-O: positive and negative vital events. Confirmatory Factor Analysis (CFA) supported this two-dimensional structure for both the LE-R and the LE-PG. Good internal consistency indexes have been obtained for each scale and subscale, as well as good criterion and concurrent validity indexes.

Conclusions

Both ruminative thoughts about past life events and personal growth following those events are related to older adults’ current well-being. The SAPIPLE presents good psychometric properties that justify its use for elderly people.