Uso inapropiado de medicamentos en adultos mayores: resultados de la Encuesta Nacional de Salud 2010 / Inappropriate medication use among Chilean older people

Background: Inappropriate medication use in older people is an important source of adverse events and complications. Aim: To determine the frequency of inappropriate medication use in the general population. Material and Methods: As part of the 2010 Chilean National Health Survey, 1,048 persons aged 65 years or more were interviewed about medication use. The information obtained was analyzed using standardized Beer’s criteria, adapted for the Chilean population, to define inappropriate medication use. A logistic regression model was performed to define risk factors for inappropriate medication use. Results: Ten percent of subjects had a high risk of inappropriate medication use. The most common medications used were chlorphenamine, amitriptyline, diazepam, chlorpromazine, chlordiazepoxide and piroxicam. The risk factors detected were female gender, polypharmacy and a bad health self-perception. Conclusions: Inappropriate medication use is common among Chilean older people and should be discouraged.

Impacto del delirium en pacientes de edad avanzada hospitalizados: un estudio prospectivo de cohortes / Delirium in older medical inpatients: A one year follow up study

Background:Delirium is an important problem in older medical inpatients. Aim: To assess if delirium is associated with higher mortality, functional decline or higher rates of readmission or institutionalization in a one year follow-up period. Material and Methods: Prospective cohort study of consecutive patients 65 years and older, admitted to a general hospital medical ward. A psychogeriatric team assessed patients every 48 h using the Confusion Assessment Method (CAM), functionality, acute severity and comorbidity scores. Analysis of one year mortality and telephone functional assessment was performed. Results: Five hundred forty two patients were enrolled and 35.4% had delirium. After one year, mortality was 34.9 and 13% in delirium and non-delirium cohorts, respectively (p < 0.01). After adjustment for covariates, delirium was independently associated with higher mortality, and higher functional decline and institutionalization. No significant differences were seen in readmission rates. Conclusions: Delirium was significantly associated with higher mortality and functional decline over a one year follow up period in geriatric inpatients.

Deterioro cognitivo e hiperparatiroidismo primario: resultado favorable después de cirugía: Caso clínico / Cognitive impairment associated to primary hyperparathyroidism: Report of one case

We report a 79-year-old male patient presenting with progressive memory loss associated with anxiety and muscularpain. An extensive biochemical control revealed high serum calcium and parathormone levels, and normal thyroid hormones. Cognitive assessment prior to surgery was compatible with mild cognitive impairment, showing significant improvement two months after parathyroidectomy. Our case suggests that, although rare, primary hyperparathyroidism should be considered as a possible cause of cognitive decline in the elderly.

Identificación y caracterización del adulto mayor saludable / A novel method for targeting and characterizing healthy older people

Background: There is no established definition of healthy aging in clinical practice, although it is a World Health Organization goal. Aim: To develop a clinical protocol to identify healthy older people living in the community and study their clinical, laboratory and functional characteristics. Material and Methods: Healthy people aged 60 years or older, were invited to participate in the study, by newspapers and radio, if they selfperceived as healthy, lived in the community, were functionally independent and had low disease burden. Potential participants were initially screened by telephone, and those who met the inclusion criteria were included. They had a comprehensive geriatric assessment which included clinical, anthropometric, laboratory and functional assessments. Results: Of 384 people who answered the call, 83 subjects aged 60 to 98 years (57 percent women) met the inclusion criteria of healthy older people. Seventy eight percent did not consume any medication, 100 percent were able to perform physical activities that required at least three metabolic equivalents (Mets). Basic laboratory showed that approximately 90 percent of subjects had normal values, using standard benchmarks established for an adult population. Conclusions: The protocol used in this work was able to identify healthy older people with low disease burden and good functionality. It also validated history and comprehensive geriatric assessment as reliable instruments to identify these subjects.

Medicina Interna y Salud Pública: Claves para una relación virtuosa / Internal Medicine and Public Health

A special Committee on Internal Medicine and Public Health was established by Sociedad Médica de Santiago (Chilean Society of Internal Medicine) in April 2007 with the duty to write a Consensus Paper on the interaction between both branches of medical profession. The main objective was to find the common grounds on which to construct a positive approach to regain space for Internal Medicine, based on prevalent epidemiológica! features related to adult health issues. The authors describe the reasons to explain the gap between clinical medicine and population health and identify the nature and evolution of chronic diseases as the point of encounter between both. With Chilean health surveys data, they state that chronic diseases explain the high proportion of burden of disease, mortality and disability, and stress that by the year 2025 one in every five inhabitants will be over 65years of age, with ageing as another main problem for the health care sector. Population with multiple risks and multimorbidity is the most important challenge for the Chilean Health Care System. A new model of care is needed to tackle this scenario with new skills regarding psychosocial determinants of health. The leading role of internists and ideally geriatricians, will be crucial in this process and will help the implementation of sound population based interventions. Both individual and community level interventions will help to improve quality of life of Chilean families.

Perfil de morbilidad en menores y mayores de 65 años / Mobidity profile in aged below and above 65 years old

En Chile son escasos los informes publicados sobre la situación general del anciano y las patologías prevalentes que presentan. Por consiguiente, se efectúo un estudio prospectivo en 3.114 pacientes que consultaron, desde Mayo 1983 a Mayo 1984, en el policlínico de Medicina Interna del Centro de Diagnóstico de la Escuela de Medicina de la Pontificia Universidad Católica de Chile. El 25% de ese grupo fueron mayores de 65 años (33% hombres y 67% mujeres) con una edad promedio de 71,4 +/- 5.3 años (+/- DS) y su estado civil era: 10% soltero, 51% casado, 36% viudos, 3% separado. Con respecto a su situación laboral, se encontraban trabajando activamente el 10%, jubilado el 40% y eran dueñas de casa el 50%. Vivían con familiares cercanos el 87%. La frecuencia de morbilidades diagnosticada en porcentaje, en los menores de 65 años versus los mayores de 65 años, fue la siguiente: Infecciones y parasitarias 7,2/2,3 (p < 0.001); Tumores 1,1/1,2; Endocrinas, Metabólicas, Inmunológicas 13,4/14,4; Hematológicas 1,3/0,2 (p < 0.05); Trastornos mentales 8,6/2,1 (p < 0.001); Sistema nervioso y sentidos 2,6/2,5; Aparato Circulatorio 20,8/44,6 (p < 0.00001); Aparato Respiratorio 5,5/4,8; Aparato Disgetivo 13,6/7,8 (p < 0.0001); Aparato Urinario 7,8/8,7; Dermatológicas 1,1/0,7; Osteomuscular y Tejido Conectivo 8,6/6,4 (p: NS); Traumatismo 5,3/3,2 (p < 0.05). Se concluye que en el grupo mayores de 65 años hay deferenciais estadísticamente significativas, con respecto a los menores de esa edad (analizadas mediante chi-cudrado) en cuando a su situación socioeconómica y los diagnósticos realizados