Eutanasia en Chile: una discusión pendiente / Euthanasia in Chile

Euthanasia is a complex medical procedure. Even though end of life decisions are common situations in health practice, there is a lack of consensus about their terminology. In this manuscript, the main concepts about this issue are defined and delimited; including active and passive euthanasia and limitation of therapeutic effort. Then, a revision is made about the international experience on euthanasia, to then go through the Chile’s history in euthanasia and the population’s opinion. In Chile, euthanasia is an act that has been removed from the social dialogue and legislation. In order to have an open discussion in our population about the issue, the debate has to be opened to the citizens, accompanied by clear medical information about the procedure.

Eutanasia activa, una mirada a la situación internacional / Active euthanasia, a view of international situation

International situation on euthanasia varies among countries. Even though in most of the countries worldwide active euthanasia is forbidden by law, to the date four countries (The Netherlands, Belgium, Luxembourg and Colombia) have approved and regulated by law active euthanasia (defined as “physician’s intentionally administering a treatment -usually medication- to cause the patient’s death, with the patient’s full, informed consent”). For a country like Chile, in which all types of euthanasia are forbidden by law, it is important to look forward to the international situation, in order to enrich public policy debate, based on the international empirical experience.

Evaluación de riesgos quirúrgicos y manejo post cirugía del adulto mayor de 80 años / Evaluation of surgical risk and post-surgical treatment of elderly over 80 year

Chile vive un envejecimiento acelerado, con expectativas de vida en aumento. Por otra parte, la tendencia a operar adultos mayores ha sido mayor que la esperada sólo por el envejecimiento de la población. Sin embargo, las complicaciones perioperatorias son más frecuentes en los ancianos. Entre otras razones destaca su mayor comorbilidad y el fenómeno de “homeoestenosis”. Todo esto determina que el paciente anciano requiera evaluaciones y cuidados especiales en el peri-operatorio. Esta revisión explica y discute el rol del Médico Geriatra y de la Evaluación Geriátrica Integralen reducir la morbi-mortalidad peri-quirúrgica del adulto mayor, especialmente del mayor de 80 años; resaltando los componentes de comorbilidad, medicamentos, funcionalidad y exámenes complementarios. También se discuten las principales medidas a considerar en el postoperatorio.

Chile is experiencing a process of accelerated aging with increasing in life expectancies. On the other hand, the tendency to operate elderly patients has been greater than that just explained by that of the aging population. Nevertheless, peri-operative complications are more common for the elderly than for the younger patient. Among other reasons, they have more comorbidities and the “homeoestenosis” phenomenon. All this explains why the elderly patient needs special care and evaluation in the peri-operative period. This review discuses and explains the importance of the Comprehensive Geriatric Assessment and the Geriatrician in reducing morbidity and mortality in the elderly patient, especialy over 80 years of age; emphasizing comorbidity, medications, functionality and lab testing. We also discuss the principal measures that must be considered on the postoperative period.

Caracterización de pacientes y de uso de medicamentos en un grupo de adultos mayores asistentes a una actividad promocional de geriatría / Characterization of patients and pharmaceutical preparations use in a group of adults attending majors to a promotional activity of geriatrics

Study objectives: To establish frequency of polypharmacy, proportion of use of drugs without prescriptions, and personal mean monthly expenditure on drugs among elderly people attendingto a promotional activity on geriatrics at the Hospital Clínico de la Universidad de Chile. Methods: Observational study that analyses answers given by 235 elderly people who attended to the promotional activity on geriatrics. Results: The 99.6percent interviewees lived in the Metropolitan Region, 82.6 percent were females, a big number of them had ages between 60 and 69 years. The 63.8 percent were affiliated to the public secure of heath (FONASA). The 41.6 percent of those nonaffiliated to FONASA expended between 10,000 and 50,000 Chilean pesos by month to buy drugs. The 32.3 percent received polypharmacy (5 drugs), and 17.4 percent of interviewees used auto-prescribed drugs. It was observed a greater frequency of auto-indicated drugs among women (34 percent) than men (24.4 percent). The 235 interviewees communicated a total of 857 diseases (3.64 +- 1.89 diseases/patient), being arterial hypertension the most frequent one (19.1 percent). Conclusion: It seems important to develop other type of studies in Chile that permit to establish frequency of polypharmacy amongelderly people, and its outcomes on health quality of life, clinical and economic conditions.

La atención diferenciada de salud del anciano / The differentiated attention of health of the aged

The world’s population is aging, leading to demographic phenomena hitherto unknown and indeed, different needs for health care, the hitherto prevailing system. Geriatrics is the medical specialty that focuses on overall health care of the elderly, including clinical, mental, social and functional. In Chile is a new discipline, with little more than a decade as a specialty college. His reason for being is that the elderly get sick in a different way, because the manifestations or symptoms of the disease, often have no direct relationship with the organ affected. Moreover, the pathological process may compromise the patient’s autonomy, which often significantly change their future and that of his family. Geriatrics, through a diagnostic procedure and the resulting multidimensional intervention by an interdisciplinary team with varying levels of care, has been shown to improve prognosis and quality of life of many elderly.