¿Por qué son necesarias unidades geriátricas de agudos en el sistema de salud chileno? / Why the Chilean health system needs an acute geriatric units?

For centuries, man has been concerned about health, particularly to achieve successful aging. In this process of health and illness, often the elderly were dying in the attempt to improve, and those requiring more care, it was not possible to do at home, so they sought the help of others, most of whom were Monasteries, which later gave way to hospices, Nurse Homes and Hospitals. Given the growing senior population that required hospital care and elderly care was developing Geriatrics, along with a comprehensive model of confrontation and interdisciplinary intervention, soon found in geriatric acute care setting, the core specialty. Over the past 50 years, it has become clear that in conjunction with the Integral Geriatric Evaluation, these units have shown a change in the prognosis of the elderly. Since Chile is experiencing a rapidly aging population, it is necessary to develop these units in our health care system.

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.