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.

Reflexiones para considerar en una política pública de salud para las personas mayores: Thoughts for action / Health policies for older adults: Thoughts for action

The speed of growth of the population of older adults has been much faster than expected in every country. In Chile today one out of ten persons is an older adult and in the next twenty years this proportion will duplicate. Population aging is a success of development but also presents a medical and social challenge. The health issues of the National Policy addressing the needs of the older population in Chile are severely delayed in their implementation due to the lack of human resources trained in medicine of older adults and geriatric services. The consensus evidence on how to develop appropriate geriatric health services for older adults should include services coordinated in a continuum, including health promotion and disease prevention targeting older people to achieve "healthy aging" in the majority of the older population; outpatient health care services; acute care in hospitals with physicians trained in geriatrics; special services for geriatric rehabilitation and restoration of function (short term care) and a variety of settings and services offering long term care ranging from home to institutions. To be able to implement this vision of appropriate, coordinated and integrated health and social services for older people, the country needs a minimum number of geriatricians (at least 260), health care teams trained in the basics of geriatrics and continuing development of human resources to meet the increasing demand on health services by the fast growing older population.

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.

Adultos Mayores institucionalizados en Chile: ¿cómo saber cuántos son? / Estimation of the number of institutionalized elderly in Chile

Background: Elderly people (>60 years) in Chile represented 11.4 percent (n=1.717.478) of the total population in 2002. The group with disabilities or mental problems is increasing and there is no reliable information about the number of institutionalized elderly subjects. Aim: To estimate the number of elderly people living in residences for long term care and their and main characteristics. Patients and methods: Chilean Census does not provide exact information about institutional care, therefore we developed a ©proxy¼ indicator of the percentage of institutionalized elderly (those living in ©collective residences with more than 5 elderly persons and in which they represent more than 25 percent of the residents¼. This proxy has a R2=0.9859 with the true value of institutionalized persons for those Latin-American countries with exact value in census data at CELADE. Results: Using the proxy we found that institutionalized elderly population had increased from 14,114 (1992) to 26,854 (2002) and is projected to reach 83,500 (2025). In 2002, there were 1.668 institutions (37.4 percent informal care). In the Metropolitan Area, there were 804 institutions (14.178 elderly persons) and 40.3 percent of these were registered at the Ministry of Health. The proportion of institutionalized elderly subjects was 1.56 percent of the total elderly population; this proportion increased from 0.87 percent in subjects 60-74 years old to 2.5 percent among subjects aged 75-84 years and 6.1 percent in subjects 85 years old and over. Among subjects living in institutions, 60.9 were women, 21 percent were married, 35 percent were single, approximately 50 percent receive a pension and around 15 percent were handicapped. Conclusions: Institutional care affects a small percentage of elderly population, but it will increase in the near future. The main characteristics of institutionalized elderly subjects are not well known. We propose to create a formal Registry of these institutions and to include Nursing Homes and hospitals in type of housing of future Censuses.

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).

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).

Valoración geriátrica ambulatoria de 2116 adultos mayores pobres / Geriatric assessment of 2116 free living elders

Background: Geriatric assessment quantifies medical, functional, mental and social capabilities and alterations of elders and is the first step to initiate specific intervention programs. Aim: To report the initial geriatric assessment of a program aimed to help poor elders living in Metropolitan Santiago. Subjects and methods: Two thousand one hundred sixteen free living subjects aged 65 to 99 years old (711 males) were subjected to an assessment using a simple geriatric score validated abroad and used previously in Chile. The resulting score ranges from 0 (better) to 5 (worst). Results: Eighty eight percent of elders did not have problems in the functional evaluation. Subjects over 75 years old needed occasional support for the daily activities with higher frequency than younger subjects (12 and 5.4 per cent respectively, p< 0.001) and had a higher frequency of major functional limitations (7.8 and 3.2 per cent respectively, p< 0.001). Mental assessment was considered normal in 89.4 per cent of subjects. Those over 75 years old had a higher frequency of memory disturbances (11.4 and 6.5 per cent respectively) and cognitive alterations (4.6 and 1.8 per cent respectively). Indefinite social support could be received by 84 per cent of subjects, but 7.4 per cent did not have access to this resource. Conclusions: Geriatric assessment of poor elders gives useful information to identify those subjects that require community help

La situación del adulto mayor en Chile / The situation of elders in Chile

Chile is experiencing a demographic transtition and the causes of death and diseases of elders are similar to those of developed countries. However, these facts do not reflect the real problems that elderly people must face in this country, since they frequently suffer of not well diagnosed or assessed chronic diseases or functional limitations, that render them dependent or prostrated. If Chile wants to improve the physical and mental well being of elders, a global policy towards them must be developed and the financing of health services must be assured. In march 1996, a National Policy for Elderly People, aiming to improve the quality of life of these individuals, was approved by the government. We must succesfully prevent and retard functional impairment and divulge the integral geriatric focus, encouraging global assessment, preventing disabilitties and protecting functional independence. We must develop specialized Geriatric services in general hospitals, day care centers and rehabilitation units. We must teach the general principles of geriatric practise to health teams. Chile has a few trained specialists in geriatric medicine that must train other professionals. Thus, Medical Schools should expand research and post graduate training programs in geriatrics

Experiencia piloto en el uso de una ficha de evaluación geriátrica ambulatoria / Pilot experience with an ambulatory geriatric assessment questionnaire

Ten percent of the chilean population is over 60 years old and general practitioners need an instrument to assess the degree of disability and multiple ailments of elders. Aim: to develop and use an instrument to assess elders consulting in primary care outpatient clinics. An instrument to be used by general practitioners, aimed to assess bio-psico-social risk of elders was devised by the Geriatrics Program at the Faculty of Medicine of the Catholic University of Chile. The instrument was used in 100 elders (82 female) aged 71ñ8 years old consulting in a primary care outpatient clinic. The instrument took less than 5 minutes to be used. The most frequent risk factors found were living alone in 62 percent of subjects, falls in the last year in 47 percent, memory disturbances in 62 percent, overweight in 76 percent, visual impairment in 76 percent, urinary incontinence in 26 percent and depression in 76 percent. Thirty percent had difficulties to climb stairs and 4 percent had no support in case of severe disability. The applied instrument is fast to apply, easily understood by patients and detects problems associated with old age, that will help to plan primary care health programs

Prevalencia de las alteraciones funcionales de la micción en el adulto mayor / Prevalence of functional alterations of micturition in elderly

Las alteraciones funcionales de la micción, entre las cuales figura muy prominentemente la incontinencia urinaria, son frecuentes en los pacientes adultos mayores. No existen en nuestro medio publicaciones que hayan estudiado la incidencia de esta patología en población que no ha consultado. El presente estudio se realizó en un grupo de adultos mayores, aparentemente asintomáticos, por medio de un cuestionario computarizado. Se entrevistaron 116 pacientes cuya edad promedio fue de 74 años. Se encontró una prevalencia de alteraciones funcionales de la micción que alcanzó el 30.1 por ciento en el grupo como globo. Del total de la muestra se analizó a 39 mujeres y 57 varones con un promedio de edad de 72 y 75 años, respectivamente. La prevalencia de alteraciones funcionales de la micción fue 25.4 por ciento en las mujeres y 35.1 por ciento en los hombres. El presente trabajo permite estudiar la prevalencia de alteraciones funcionales de la micción en población de adultos mayores aparentemente sanos y presenta, además, un análisis más detallado de los tipos de alteraciones funcionales que afectan a la población estudiada