Características de las caídas en el adulto mayor que vive en la comunidad / Characteristics of falls among free living elders

Background: Falls by older adults are a frequent problem among ambulatory patients in primary care. Aim: To describe the prevalence and features of falls among elders consulting to an ambulatory Geriatric Clinic. Patients and methods: Persons aged 60 years or more were surveyed about the number of falls in the preceding six months, the characteristics and consequences of each falls. Biopsychosocial characteristics were recorded and the Tinetti gait and balance test was performed in all patients reporting falls. Results: In 104 (18.2 percent) of 571 clinical consultations, one or more falls were reported. Among patients who fell and provided complete data (n=95), 64 percent reported one fall and 36 percent reported two or more, totaling 156 falls to analyze. The mean age of the patients with falls was 71.8ñ6.8 years. The functional and cognitive status was normal in 73 and 71.6 percent of cases respectively and 38 percent carried out periodical physical activity. Fifty seven percent of falls occurred outside of home, and an extrinsic factor was a precipitating cause in 55 percent of the falls. A post-fall syndrome appeared in 21 percent of cases and 2.6 percent resulted in fractures. Falling two or more times versus one time during the last six months was statistically associated with an age over 75, an absence of periodic physical activity, functional impairments, three or more chronic diseases, neurological diseases and with living alone, among other variables. Conclusions: Falls among elders occur mainly outside of home, in subjects older than 75 years old, functionally dependent and with an important involvement of extrinsic factors. Physical activity, as well as the control of environmental risks, could be protective factors against recurrent falls

Diferencias en antioxidantes plasmáticos según nivel socioeconómico en mujeres chilenas / Differences in plasma antioxidants according to socioeconomic level in chilean women

Background: Free radical-mediated oxidative damage is a known initial event in atherogenesis. Cardiovascular disease is frequent in the Chilean population showing differences in the prevalence of risk factors of the disease according to socioeconomic level (SEL). Aim: To determine levels of antioxidants and lipid peroxides in Chilean women from different SEL. Patients and methods: Blood samples were taken from 81 women for measurements of plasma ascorbic acid, ß-carotene, a-tocopherol, licopene, ubiquinol, glutathione, total plasma antioxidant capacity, and lipid peroxides (TBARS). Results:Individuals in the lower SEL showed reduced levels of plasma ß-carotene, ascorbic acid, a-tocopherol, and ubiquinol compared to women in the higher SEL. There were no differences between groups in the plasma levels of glutathione, total antioxidant capacity, or TBARS. Conclusions: The results could be explained in part by the higher consumption of fruits and vegetables in women from the upper SEL

Medición del riesgo funcional en adultos mayores pobres, con un instrumento validado en Canadá / Functional risk assessment of poor Chilean elders using an instrument validated in Canada

Background: Information about medical and social situation of elders is limited in Chile. Aim: To assess the functional risk of Chilean elders using an instrument validated in Canada. Subjects and methods: As part of a project aimed to help poor elders, 2,116 subjects living in Santiago, aged 65 to 99 years old (1,334 female, and 625 older than 75 years old), were interviewed. Results: Thirty percent of these elders were using more than three medications and 13 percent lived alone. Visual problems were detected in 75 percent, memory problems were found in 62 percent, 63 percent felt depressed, 46 percent had hearing problems, 42 percent suffered a fall during the last year, 35 percent had a health problem that forced them to stay at home, 32 percent did not count with help in a case of need, 33 percent referred some type of nutritional problem, 26 percent needed help for daily living activities and 25 percent considered to have a worst health than counterparts of the same age. Among subjects older than 75 years old, the frequency of memory problems, auditory impairment, number of falls, health problems that precluded leaving the house, limitation for daily activities and the use of walking aids, was significantly higher. Although men and women had similar ages, men were in worst functional conditions, and had required more admissions to hospitals. There was a higher proportion of women living alone. Females also had a higher frequency of depression, memory disturbances, falls and use of more than three medications. Conclusions: Women elders tend to be in better functional conditions than men and people older than 75 years old have a higher functional risk. The applied instrument allowed a better focalization of our geriatric program

Resultados al aplicar el sistema de clasificación de pacientes RUG-T18 en ancianos ingresados a un hospital universitario / Application of RUG-T18 classification to elderly patients admitted to an university hospital

Background: Among case mix classifications, the best for hospitalized elders is the Resource Utilization Groups (RUG) system, which allows a better location of patients, resource administration and the design of health care strategies for elderly people. Aim: To report the results of RUG-T18 classification of elderly patients admitted to an university hospital. Patients and methods: RUG-T18 classification was applied to 210 patients aged 75.2 ñ 7.2 years old, 108 male, admitted to the Clinical Hospital of the Catholic University of Chile. Results: The clinical classification of assessed patients was rehabilitation in 50.9 per cent of cases, special care in 10.5 per cent, clinically complex in 37.1 per cent and reduced physical functions in 0.5 per cent. None had behavioral alterations. There were no differences between subjects older or younger than 75 years old. Daily life activities showed that help was required for sphincter control in 46 per cent of patients, for feeding in 44 per cent and for mobilization in 64 per cent (28 per cent of patients required help from two or more people). Geriatric assessment showed that, since 1993, the proportion of elders with greater functional derangement increased from 18 to 28 per cent, and the proportion of those with mental disturbances from 4 to 12 per cent, specially among those over 75 years old. Conclusions: Most elders admitted to the hospital are classified in the superior categories of the RUG-T18 system and have severe mental and functional limitations. These patients require a multidisciplinary approach with a great emphasis in rehabilitation