Consumo de alcohol en el adulto mayor chileno que viaja / Alcohol consumption among traveling Chilean older people

Background: Problems associated with alcohol consumption are prevalent in Chile, but little is known about the situation in the elderly. Aim: To perform a screening to detect alcohol-related problems and risks in the Chilean older people who travel. Material and Methods: The Alcohol Use Disorders Identification Test (AUDIT) questionnaire was answered by 1,076 travelers aged 60 to 93 years (66% females), who participated in trips organized by the Chilean National Tourism Service (SERNATUR). Results: Seventy six percent of respondents acknowledged to have ingested an alcoholic drink during the last month. The average AUDIT score was of 2.2 ± 2.6. Only 3.7% of the sample had a score equal or higher than eight, considered as risky use. Within this last group, 60% had symptoms of alcohol dependence. A higher alcohol consumption was associated with male gender (p < 0.01), being younger than 75 years of age (p < 0.01), having a medium-low economic income (p < 0.01) and having a higher education level (p = 0.03). There was no significant association with the respondents´ occupation. Conclusions: In this sample of Chilean traveling older people, there was a high prevalence of alcohol consumption, and nearly 4% of respondents had alcohol related problems.

Niveles de vitamina D en adultos mayores saludables chilenos y su relación con desempeño functional / Vitamin D levels in older healthy Chilean adults and their association with functional performance

Background: People over 60 years old are at risk of Vitamin D deficiency, which can affect functional performance, since this vitamin is involved in muscle function and protein synthesis. Aim: To measure 25OH vitamin D levels in healthy older people from Santiago de Chile, and evaluate their relationship with functional performance. Subjects and Methods: Healthy subjects aged 60 years or more and living in the community were invited to participate. People with chronic diseases, cognitive impairment, physical disability, smokers and those consuming more than three medications per day were excluded. Hand grip and gait speed were measured and a blood sample was obtained to measure 25OH vitamin D by radioimmunoanalysis. Results: One hundred and four participants aged 60 to 98 years (55% females) were studied. Mean vitamin D levels were 17.3 ± 6.1 ng/mL. Females had lower levels than males (15.6 ± 5.8 and 19.2 ± 6.0 ng/mL respectively p < 0.01). Eighty three percent of females and 55.3% of males had values below 20 ng/mL (the cutoff point for deficiency). Only 3.5% of females and 8.5% of males had values of 30 ng/ml or higher. There was a significant correlation between vitamin D levels, gait speed and grip strength (r = 0.32 and 0.34 respectively, p < 0.01), especially in women over 74 years. Conclusions: Vitamin D deficiency is almost universal in healthy adults over 60 years living in Santiago de Chile, especially in women. This deficiency is associated with a deranged functional performance and is a potentially modifiable risk factor for disability.

Riesgo de delirium durante la hospitalización en personas mayores: desarrollo y validación de un modelo de predicción clínica / Development and validation of a clinical predictive model for delirium in hospitalized older people

Background: Delirium is a prevalent problem among older patients and it is frequently underdiagnosed. Aim: To develop and validate a clinical predictive model to identify patients at high risk of delirium. Material and Methods: Two consecutive prospective cohort studies were used to develop and validate the model. The development cohort included 542 consecutive medical inpatients, 65 years or older. The validation cohort included 85 comparable patients. A predictive score was constructed with a multivariate analysis, using variables independently associated with delirium and subsequently tested in the new cohort. Patients were assessed within the first 48 hours of admission, and every 48 hours thereafter, using the Confusion Assessment Method to diagnose delirium, evaluating also the severity of underlying disease, comorbidities, functionality, and laboratory data. Results: Delirium occurred in 192 patients (35.4%) of the development cohort and was independently associated with age and functional status assessed using the Barthel Index. With these two variables, the predictive score for delirium was developed and tested rendering an area under the receiver operating characteristic (ROC) of 0.80 (confidence intervals 0.77-0.85). Cut-off points were chosen to establish low, intermediate, and high-risk groups for delirium. According to these cut-off points, delirium frequencies in the development cohort were 8%, 23%, and 69%, and in the validation cohort 5%, 34%, and 66%, respectively (c² p < 0.05). Conclusions: This simple predictive model based on age and functional status may be a useful tool for identifying older patients risking delirium.

Delirium postoperatorio: una consecuencia del envejecimiento poblacional / Postoperative delirium among older people

Delirium (acute confusional state) is a common and disabling complication among surgical older people. It is often underdiagnosed and undertreated. Its incidence varies by type of intervention and it is associated with several complications such as functional impairment, cognitive dysfunction, prolonged hospitalization and institutionalization. These increase hospitalization costs and the risk of death. There are precipitating and predisposing risk factors, which increase the susceptibility for postoperative delirium. This condition should be considered as a syndrome of epidemiological importance, which needs to be prevented or treated in a timely manner through a multidisciplinary intervention. The perioperative care of elderly patients involves different medical specialties and is a subject of general knowledge.

Subdiagnóstico de delirium en adultos mayores hospitalizados / Delirium in Chilean elderly inpatients: an overlooked problem

Background: Delirium is a common underdiagnosed and undertreated problem in elderly inpatients, associated to higher morbidity, mortality and health cost. Aim: To evaluate the prevalence of delirium at hospital admission in medically ill elderly patients and the attending physician's diagnosis and treatment of delirium. Patients and methods: In a prospective and descriptive study, consecutive patients aged 65 years or more, admitted to an internal medicine ward were evaluated by independent physicians, during the first 48 h of admission, to asses the presence of delirium. Diagnosis of delirium was based on the Confusion Assessment Method. Medical and nurse records were reviewed. Family was interviewed when necessary. Results: One hundred eight patients (52% women, age range 65-94 years) with an APACHE II score of 11.6±5, were evaluated. Fifty seven patients (53%) had delirium (32% hyperactive, 72% hypoactive and 5% mixed). Delirium prevalence was significantly higher in older patients (66% among those aged 75 years or older versus 30% in younger, p <0.05) and among patients with more severe conditions (88% among those with an APACHE score over 16 versus 47% below that value, p <0.05). Medical records of patients with delirium showed that this diagnosis was present only in 32% and cognitive deficit was described in 73%. Ten percent of patients with delirium received sedative medication and 38% were physically restricted. There were no environmental interventions to prevent or control delirium. Conclusions: Delirium in elderly inpatients at this unit is an extraordinarily prevalent problem, seriously under diagnosed (68%) and under treated. This study should alerts our medical community to improve the diagnosis and management of delirium in elderly inpatients.

Resultados generales del Proyecto INTRA-OMS en Chile / Results of the INTRA-WHO survey in Chile

Background: The aging speed in developing countries has been faster than predicted. Thus, health care systems must adapt to face this new scenario efficiently. The WHO designed the INTRA study to assess health promotion and protection actions in primary care, for people over 50 years of age. Material and methods: Questionnaries designed by WHO were applied to 1,167 subjects (aged 50-94 years, 68percent female) and 117 health care professionals attending and working respectively, at 33 health care centers of the Viña-Quillota Health Service. Results: Twenty percent of subjects were illiterate and 25percent had less than 6 years of instruction. Forty three percent could reache the health centre by public transportation and 92percent did not need to be accompanied, 39percent spended more than one hour to be attended and 71percent considered that the service in the centre was good. Sixty seven percent attended regular appointments, 63percent did not perform any physical activity and only half of them were advised to start such activity. Weight loss was recommended to 55percent but only one third has achieved such goal. Only one third of patients admitted being interrogated about their drinking habits. Among subjects in whom blood pressure was measured, one fourth had abnormal values. Conclusions: Primary health care in Chile, although having health care programs for the elderly, is loosing opportunities to improve health status and quality of life of this age group.

Evaluación de 1497 adultos mayores institucionalizados, usando el sistema de clasificación de pacientes RUG T-18 / Assessment of 1497 Chilean nursing home residents, using the Resource Utilization Group method, RUG T-18

Background: There is little information about Chilean elderly residents of long term care facilities, regarding their characteristics and need for resources. Aim: To describe main characteristics and resource utilization of residents of one of the largest nursing homes in Chile, Fundación Las Rosas de Ayuda Fraterna. Material and Methods: In a cross sectional and descriptive study, all residents were evaluated using the RUG T-18 method, that assess activities of daily living and the complexity of their clinical situation. Results: We assessed 1497 subjects 60 years old and over (73 percent women), with an age range of 60-106 years. Thirty six percent had urinary incontinence, 19 percent required assistance for feeding, and 38 percent needed help for walking or moving. Fifty seven percent were in the lowest category of complexity, ½Institutionalization¼. Very few residents were in the most demanding categories, no one classified as ½Rehabilitation¼, and only 0.7 percent were in ½Special Care¼. Conclusions: This study is an important start point to learn more about elderly subjects living in nursing homes in Chile (Rev Méd Chile 2004; 132: 701-6).

Impacto biomÚdico de los viajes en adultos mayores chilenos / Biomedical impact of traveling for Chilean elderly

Background: In Chile there is a program named "Vacations for Elderly during Low Season". Aim: To characterize participants of this program and to measure the impact of traveling in their health and wellbeing. Material and methods: Two anonymous and voluntary questionnaires were applied to 4200 participants, before and after a ten days vacation package. Results: Before traveling, questionnaires were answered by 802 subjects, and after traveling by 4057 (69 percent women, 22 percent older than 75 years old, 15.8 percent living alone). The presence and maintaining of good health were most appreciated at this age and 59 percent classified their health as good or excellent. Twenty five percent referred sensory problems (seeing or hearing), 12 percent reported urinary incontinence and 21 percent presented falls in the last three months; depression screening (GDS-5) was positive in 16 percent. Chronic disease prevalence was similar to the general Chilean elderly population. After traveling they reported significant improvements in the items sociability, wellbeing, mood, appetite, insomnia and ostheoarthritic pain. Conclusions: Elderly who traveled were mainly women, who thought that maintaining good health is the most precious value. After traveling they improved significantly different aspects of wellbeing. Promotion of this kind of recreation programs is an important tool for integration and enhancement of quality of life in elderly subjects in our country (Rev MÚd Chile 2004; 132: 573-8).

Estudio comparativo de mujeres mayores de noventa años y ancianas menores institucionalizadas / A comparative study of institutionalized nonagenarian and younger elderly women

Background: The number of nonagenarians is rapidly growing in Chile. This age group is mainly female, with higher frailty markers and in higher risk of being placed at nursing homes. Aim: To describe features of nonagenarian women and compare them with a group of women between 60-89 years, both living in nursing homes, in terms of disability and resource use at the institution. Subjects and methods: A total of 230 nonagenarian women and 460 women, aged 60-89 years, were evaluated in the nursing home Fundación Las Rosas de Ayuda Fraterna (only for poor elderly) in Santiago, Chile. The assessment instruments were the Geriatric Assessment instrument FEGAUC, functional and mental evaluation scales of Spanish Red Cross and the Resource Utilization System, RUG T18, an independent diagnostic classification system that allows the determination of resource use in terms of cost and personnel needs. Results: Nonagenarian women had significantly (p <0.05) more disability (falls, urinary incontinence, memory problems and mobility difficulties), and were classified in RUG categories of higher resource utilization and dependency than younger women. Nevertheless, nonagenarians were a very heterogeneous group, almost half of them were able of moving by themselves or required little assistance and had minimal memory problems. Conclusions: Nonagenarian women assessed in this institution are an heterogeneous group, some with minimal disability and other more frail and dependent than the younger elderly women, being classified in higher categories of resource utilization RUG T18 (Rev Méd Chile 2004; 132: 33-9).