Résumé
El proceso fisiológico de envejecimiento conlleva situaciones de riesgo y el deterioro acelerado de la salud; sin embargo, se detectan insuficiencias en la preparación del médico de la familia para la identificación y el tratamiento del anciano frágil. Por tal motivo, en este artículo se describen los referentes teóricos para la superación profesional sobre el síndrome de fragilidad en la atención primaria de salud. Se analizan criterios diagnósticos y manifestaciones clínicas de dicho síndrome, así como los requerimientos para la integración de los factores multidimensionales necesarios, que garanticen la calidad de la atención al paciente desde los puntos de vista integral e interdisciplinario.
The aging physiologic process leads to risk situations and quick deterioration of health; however, some inadequacies in the preparation of the family doctor for the identification and treatment of the fragile elderly are detected. For such a reason, in this work the theoretical referents for professional training on the fragility syndrome in primary health care are described. Diagnostic criteria and clinical manifestations of this syndrome are analyzed, as well as the requirements for the integration of the necessary multidimensional factors that guarantee quality of patient care from the integral and interdisciplinary points of view.
Résumé
Abstract Background Frailty is a biological syndrome suggested as a better predictor of morbimortality than chronological age. Objective To assess associations between frailty and morbimortality outcomes in postoperative cardiac surgery. Methods A retrospective cohort study was conducted with cardiac surgery patients. Frailty and maximal inspiratory pressure (MIP) were assessed before surgery. Postoperative outcomes were: extracorporeal circulation time; use of vasopressor; mean arterial pressure (MAP); red blood cell (RBC) transfusion; cardiac arrhythmia and/or heart arrest; presence of intra-aortic balloon pump; antibiotic use; extubation time; length of stay in the intensive care unit (ICU); length of postoperative stay; mortality. One-way ANOVA was used to compare postoperative variables between frailty categories; Spearman was used to evaluate the correlations between frailty and postoperative variables. Age, sex, and MIP were introduced into multiple regression models to find the independent association between postoperative variables and frailty. A significance level of p < 0.05 was adopted. Results The medical records of 200 patients were analyzed (65.7±7.2 years; 68.5% men; 63.5% non-frail, 22.5% pre-frail, 14% frail). Frailty was not a predictor of postoperative outcomes. Age was an independent predictor for alterations in MAP (PR: 1.028, 95% CI: 1.003-1.053, p=0.025), need for RBC transfusion (PR: 1.034, 95% CI: 1.007-1.062, p=0.014), longer extubation time (PR: 1.052, 95% CI: 1.023-1.083, p<0.001), length of stay in the ICU (ß: 0.031, 95% CI: 0.010-0.053, p=0.005), length of postoperative stay (ß: 0.017, 95% CI: 0.003-0.031, p=0.015). Conclusions Frailty was not a predictor of morbimortality following cardiac surgery in middle-aged and older adults; however, age did predict morbidities in this setting.