Síndromes Geriátricos en pacientes de primer nivel de atención médica / Geriatric Syndromes in first level patients

Objetivo: Identificar la frecuencia de síndromes geriátricos en una unidad de primer nivel de atención médica. Material y Métodos: Estudio descriptivo, observacional, prospectivo, transversal, realizado en 376 pacientes de primer nivel de atención. Se utilizaron las escalas de Yesavage y de Katz evaluando depresión y autonomía respectivamente. Para fines de este estudio se interrrogó la presencia de incontinencia urinaria, polifarmacia, trastornos del sueño y estado nutricional. Utilizamos estadística descriptiva. Resultados: 376 pacientes, 219 (58%) femeninos, 157 (42%) masculinos, edad promedio 72.57, mínima: 65, máxima: 95, desviación estándar: ± 7.08. Se observó por lo menos un síndrome en 371 (98.7%) pacientes. La depresión se detectó en 303 (80.9%), la polifarmacia se observó en 282 (75%), en cuanto a los trastornos del sueño se encontraron en 262 (69.7%), las caídas se encontraron en 63 (16.8%), la incontinencia urinaria en 19 (5.1%), en cuanto a la obesidad en 15 (4%) y de la pérdida de la autonomía en 3 (0.8%). Conclusión: El 98.7 % padecen por lo menos un síndrome geriátrico, el género femenino es el más afectado, el síndrome más frecuente es depresión, seguida de polifarmacia, trastorno del sueño, caídas, incontinencia urinaria, obesidad y pérdida de la autonomía (AU)

AIM: to identify the frequency of Geriatric syndromes in a Single First Level Medical Facility. Material and methods: observational, prospective, cross-sectional, study held in 376 patients from First Level Medical Facility. We usedYesavage and Katz scales to evaluate depression and autonomy respectively. For this purpose we interrogate: urinary incontinence, polypharmacy, sleep disturbances and nutritional status. Results: 376 patients, 219 female, 157 male, median age 72, SD 7.08, mínimun 65, maximum 95 years. From the total of patients 303 (80.9%) was in depresion, 282 (75%) with polypharmacy, 262 (69.7%) on sleep disturbances, 63 (16.8%) of the falling down was found it, 19 (5.1%) urinary incontinence, 15 (4%) under obesity, and 3 (0.8%) with loss of the autonomy. conclusions: Geriatric syndrome is presented in more than 90%, female are most affected and depression is the most common syndrome (AU)

Tendencias en las políticas de atención a la dependencia de ancianos y sus reformas / Trends and reforms in long-term care policies for the elderly / Tendências e reformas nas políticas de atenção aos idosos com dependência

Resumen Una de las mayores preocupaciones respecto a la salud pública de los países de renta media y alta es cómo enfrentar los problemas de dependencia funcional de un número cada vez mayor de personas en la tercera edad. El objetivo de este estudio fue identificar aspectos de convergencia de treinta países que poseen un sistema formal de cuidados. Para eso se realizó una revisión sistemática de artículos, estudios e informes comparativos internacionales, publicados entre 2010 y 2015. Los resultados muestran tres tendencias en la concepción y desarrollo de esas políticas: (a) concentrarse en las personas ancianas o en los ancianos más dependientes, (b) ampliación de la base de financiación en función a la contribución individual, (c) promoción de cuidados en casa y beneficios financieros para la atención en centros especializados (asilos, albergues o similares). Todos ellos tienen efectos positivos sobre la contención de costos, pese a que haya pocas evidencias de impactos sobre la salud de las personas.

Abstract One of the main public health concerns in medium and high-income countries is how to deal with problems of functional dependency of a growing number of elderly individuals. This study aimed to identify converging issues in 30 countries with formal long-term care systems. A systematic review included articles, studies, and comparative international reports published from 2010 to 2015. The results show three trends in the design and development of these policies: (a) focus on the oldest or most dependent elderly, (b) expansion of financing based on individual contribution, and (c) promotion of home care and financial benefits for care in specialized centers (nursing homes and similar establishments). All three have positive effects on cost containment, despite limited evidence of impacts on people’s health.

Resumo Uma das maiores preocupações com a saúde pública dos países de renda média e alta é como enfrentar os problemas de dependência funcional de um número cada vez maior de pessoas mais velhas. O objetivo deste estudo foi identificar aspectos de convergência de trinta países que possuem um sistema formal de cuidados. Para isso realizou-se uma revisão sistemática de artigos, estudos e informes comparativos internacionais publicados entre 2010 e 2015. Os resultados mostram três tendências na concepção e desenvolvimento dessas políticas: (a) concentrar-se nas pessoas mais velhas ou nos idosos mais dependentes, (b) ampliação da base de financiamento com base em contribuição individual, (c) promoção de cuidados em casa e benefícios financeiros para atendimento en centros especializados (asilos, albergues ou similares). Todos os três têm efeitos positivos sobre a contenção de custos, embora haja pouca evidência de impactos sobre a saúde das pessoas.

Estrategia y plan de acción sobre demências en las personas mayores / Strategy and action plan on dementia in the elderly

Una estrategia y plan de acción sobre las demencias en personas mayores que busca mejorar y ampliar la atención a los adultos mayores con demencias, prevenir o retrasar su deterioro funcional y dependencia, y aumentar la investigación.

Prevalence of dementia in Colombian populations / Prevalência de demência em populações Colombianas

With the gradual increase in the life expectancy of the population due to scientific progress and public health at the service of society, the prevalence of dementia has been increasing at different rates worldwide. Currently, the prevalence rates range between 5% and 7% (6.4% in the U.S. and up to 8.5 % in Latin America) in subjects older than 60 years. Thelowest prevalence rate (2.1%) has been reported from sub-Saharan Africa, probably due to selective mortality under 60 years of age. By contrast, a very high prevalence of dementia (23.6% dementia in individuals 60 years) was observed in the city of Neiva, Southern Colombia. We believe that this high rate could be explained by the presence of several risk factors such as very low schooling, low socio-economic strata, chronic diseases, the inclusion of geriatric homes among others, and additional unknown factors.

Com o aumento gradual da expectativa de vida das pessoas, devido aos progressos científico e de saúde pública a serviço da sociedade, a prevalência de demência tem aumentado a taxas bastante divergentes em todo o mundo. Atualmente, as taxas de prevalência variam entre 5% e 7% (6,4% em os EUA até 8,5% na América Latina) em indivíduos com idade superior a 60 anos. Prevalência mais baixa (2,1%) foi relatada na África sub-saariana, provavelmente devido a mortalidade seletiva abaixo dos 60 anos de idade. Ao contrário, uma alta prevalência de demência (23,6% de demência em pessoas ?60 anos) foi observada na cidade de Neiva, no sul da Colômbia. Acreditamos que essa taxa alta pode ser explicada pela presença de vários fatores de risco, como: baixa escolaridade, níveis socio-económicos mais baixos, doenças crônicas, inclusão de instituições geriátricas, entre outros, e outros possíveis fatores desconhecidos.

Costo de un sistema de atención de adultos mayores dependientes en Chile, 2012 - 2020 / Cost of a health care system for dependent older adults in Chile, 2012 - 2020

OBJETIVO: Obtener una estimación de los costos relativo y absoluto de un sistema de atención domiciliaria para los adultos mayores dependientes en Chile y reflexionar sobre las consideraciones metodológicas a tener en cuenta en estimaciones para otros modelos en otros países. MÉTODOS: Se utilizaron tasas de prevalencia por sexo y edad con base en los microdatos de la Encuesta Nacional de Dependencia (ENDPM 2009) y se proyectaron tres escenarios para 2012 - 2020. Se estimó la población beneficiaria y la demanda de 12 programas de servicios de atención domiciliaria. Las características de los programas, en horas y tipo de atención se obtuvieron del juicio de expertos, ajustados por la revisión bibliográfica. Se utilizaron salarios/hora del sistema público y privado. RESULTADOS: Entre los mayores de 65 años, 20,3% sería beneficiario del sistema; 21,7% sobre el total de mujeres y 18,4% sobre el total de hombres. Su número asciende a 336 874 personas para 2012. El costo anual del sistema alcanza los 1 214 millones de dólares para 2012. Esto equivale a 0,45% del PIB (producto interior bruto), que se podría incrementar entre 32,1% y 33,1% hasta 2020. CONCLUSIONES: El costo de un sistema inicial para adultos mayores dependientes en Chile es relativamente bajo en comparación con los modelos de los países industrializados. En términos metodológicos, se destaca la importancia de la discusión previa sobre el tipo de modelo que se desee implementar y las posibilidades financieras de llevarlo a cabo. Además, se valida la opción de utilizar juicios de expertos para la evaluación, aunque se aconseja ampliarla.

OBJECTIVE: . To estimate the relative and absolute costs of a home-based health care system for dependent older adults in Chile and to consider the methodological factors to take into account in estimates for other models in other countries. METHODS: Sex- and age-specific prevalence rates were used, based on microdata from the National Dependency Survey (ENDPM 2009), and three scenarios were projected for 2012 - 2020. The beneficiary population and the demand were estimated for 12 home-based health care programs. The characteristics of the programs (number of hours and type of care) were based on expert opinions, adjusted through a literature review. Public and private system wages/hours were used. RESULTS: Overall, 20.3% of people over 65 years of age would be beneficiaries of the system; 21.7% of all women and 18.4% of all men, for a total of 336 874 people in 2012. The annual cost of the system is 1.214 billion dollars for 2012, equivalent to 0.45% of GDP (gross domestic product). This figure could increase by between 32.1% and 33.1% by 2020. CONCLUSIONS: The cost of an initial system for dependent older adults in Chile is relatively low in comparison to the models seen in industrialized countries. In terms of methodology, it is particularly important for there to be prior discussion of the desired model to be implemented and the financial capacity to achieve this. Furthermore, the option of using expert opinions as the basis for the evaluation is validated, although it is recommended that this be expanded.

Prevenção de doenças em idosos: os equívocos dos atuais modelos / Disease prevention in the elderly: misconceptions in current models

A população brasileira está envelhecendo de forma significativa, num contexto de melhora gradual dos índices sociais e econômicos do país. O aumento da longevidade acarreta maior uso dos serviços de saúde, pressionando os sistemas de saúde pública e previdência, gerando mais custos e ameaçando a sustentabilidade do sistema. A alternativa para evitar a sobrecarga desse sistema é investir em políticas de prevenção de doenças, estabilização das enfermidades crônicas e manutenção da capacidade funcional. Este artigo visa a analisar as dificuldades de implantação de programas de prevenção e as razões do fracasso de diversos programas de promoção da saúde, prevenção e gerenciamento de doenças crônicas no grupo etário dos idosos. Não há saída possível para a crise de financiamento e reestruturação do setor sem a implantação da lógica preventiva. O conhecimento científico já identificou corretamente os fatores de risco para a população idosa, mas isso não basta. Precisamos saber utilizar esse conhecimento para efetuar a necessária transição do modelo assistencial para o modelo de prevenção.

The Brazilian population is aging significantly within a context of gradual improvement in the country's social and economic indicators. Increased longevity leads to increased use of health services, pressuring the public and social welfare health services, generating higher costs, and jeopardizing the system's sustainability. The alternative to avoid overburdening the system is to invest in policies for disease prevention, stabilization of chronic diseases, and maintenance of functional capacity. The current article aims to analyze the difficulties in implementing preventive programs and the reasons for the failure of various programs in health promotion, prevention, and management of chronic diseases in the elderly. There can be no solution to the crisis in financing and restructuring the health sector without implementing a preventive logic. Scientific research has already correctly identified the risk factors for the elderly population, but this is not enough. We must use such knowledge to promote the necessary transition from a healthcare-centered model to a preventive one.

The impact of 'comprehensive geriatric assessment (CGA)' implementation on the effectiveness and cost (CEA) of healthcare in an acute geriatric ward.

AIM: to investigate the cost effectiveness of CGA in an acute geriatric ward. METHODS: a non-randomized controlled trial was carried out at Dr. Cipto Mangunkusumo General Hospital from January to December 2005. The inclusion criteria were elderly patients with geriatric syndrome. Exclusion criteria were advanced malignancy, APACHE II score > 34,in-hospital mortality in the first 24 hours, move to another ward before completing CGA management, the presence of dementia. After patients were allocated into CGA and non-CGA group, effectiveness was assessed using ADL/WHO Unescap score, days of hospitalization, proportion of re-hospitalization, survival, quality of life score (EQ5D),patients and nurses satisfaction score. Cost effectiveness analysis was done using TreeAge-Pro 2004 software program. RESULTS: the length of hospitalization was shorter in the CGA group than in non-CGA group (10.99 [0.79] days vs.20.16 [2.62] days; p=0.00). At the end of treatment, mean of ADL score changes was significantly higher in CGA group than non-CGA group. Mean of WHO-Unescap score changes in CGA group was higher than non-CGA group (0.71[0.04]vs 0.61 [0.04]; p=0.09). EQ5D-VAS score was also higher in CGA group (0.79[0,01] vs 0.75[0.01]; p=0,01). Survival proportion in CGA group was lower than non-CGA group(80.37% vs 86.92%; p>0.05). Rehospitalization proportion was higher in non-CGA group than in CGA group (21.5%vs 11.21%; p 0.04). Patient's satisfaction level was higher in CGA group (193.38 [1.25] vs 177.47 [3.04]; p=0.00).Nurse satisfaction level was also higher in CGA group than non-CGA group but not statistically significant (225.06[7.08] vs 220.06[8.26]; p=0.65).Mean of healthcare cost in non-CGA group was higher than in CGA group (Rp. 9,746,426.00 [1,180,331] vs Rp 4,760,965.00 [338,089]). Cost effectiveness analysis indicated that CGA was superior to conventional approach because for each point score of QALD's, total cost was lower in geriatric acute care unit than in conventional ward(Rp 418,199.00 vs Rp 628,695.00). Moreover, QALD's in CGA group was better than in non-CGA group (24.1 vs 22.8; p= 0.03). CONCLUSION: the CGA approach is more cost effective compared to conventional approach. Quality adjusted life days are better in CGA group than in non-CGA group although survival is not statistically different. In CGA group, length of hospitalization was shorter, functional status and patient satisfaction is better in general. Working satisfaction of nurses in CGA group was not lower than in non CGA group.

Current Status of Costs and Utilizations of Hospital Based Home Health Nursing Care in Korea / 간호학회지

PURPOSE: The purpose of this study was to describe the current status of utilization and costs of home health nursing care by the levels of medical institutes in Korea. METHOD: A secondary analysis of existing data was used from the national electronic data information(EDI) of 148 home health agencies for 6 months from May to Oct 2005 in total. RESULT: The 148 agencies had multiple services in cerebral infaction, essential hypertension, sequela of cerebrovascular disease, type 2 diabetes mellitus, etc.. The highest 10 rankings of 76 categories of home health nursing services were composed of 96.4% of the total services, such as simple treatment, inflammatory treatment, urethra & bladder irrigation, inserting indwelling catheter etc., in that order. The highest 20 rankings of 226 categories of home examination services were composed of 77.0% of the total home examination services. In addition, the average cost of home health care per visit was 46,088 Won (approximately equal to 48 Dollars, 1 Dollar=960 Won). The costs ranged from 74,523 Won (approximately equal to 78 Dollars, loss of chronic kidney function, N18) to 32,270 Won (approximately equal to 34 Dollars, other cerebrovascular diseases, I67). CONCLUSION: Results suggest that client characteristics of hospital based HHNC are not different from community based HHNC or visiting nursing services for elderly. The national results will contribute to baseline data used to establish a policy for the home health nursing care system and education.

Economic Evaluation of Visitng Nurse Services for the Low-income Elderly with Long-term Care Needs / 간호학회지

PURPOSE: This study aimed to evaluate economic viability of public health center visiting nurse services for the low-income elderly with long-term care needs. METHOD: The sample consisted of 252 community dwelling elderly who enrolled in public health center visiting nurse services for three months or more. Data was collected on physical (ADL and IADL) and cognitive impairments of the elderly, contents and frequency of visiting nurse services, cost per visit, and costs of alternative services for long-term care. RESULT: The mean score of ADL and IADL levels of the elderly was 2.80.4904, which indicated these patients were mostly independent. Eighty four percent of the elderly subjects were cognitively intact. Among visiting nurse services supplied, providing assessment was 34%, followed by education and counseling 26%, medication 22%, and referral. The mean cost per visit was 17,824.1 won, which transformed into a total cost per person per year of 161,130.2 won. Comparing the cost of a visiting nurse service with those of other long-term care alternatives, the visiting nurse service was the least costly alternative, followed by an outpatient clinic, hospital based home care, and nursing home. CONCLUSION: Overall, the results of the study provide evidence of the economic viability of visiting nurse services for the low-income elderly among long-term care alternatives.

Análisis de los costos en la atención geriátrica / Cost analysis in geriatric care

Se realizó un trabajo para conocer los costos de la atención geriátrica en el Hogar de Ancianos "Manuel Ramos Silva" de Camagüey, en el trimestre comprendido de enero a marzo de 1997, para lo cual nos apoyamos en el Departamento de Estadísticas y Contabilidad, en los vales de salida de los almacenes, pedidos de sala de la farmacia y en nóminas salariales; los datos fueron llevados a hojas de vaciamento y procesados manualmente. Se analizó la cantidad de servicios y dotación de camas, el costo unitario o costo por días paciente, el nivel de actividad y el total de gastos, que resultó ser superior al cuarto de millón de pesos, lo que muestra una vez más los esfuerzos que realiza nuestro estado revolucionario por elevar el nivel de vida y proporcionarle las mejores condiciones a las personas de la tercera edad, sin escatimar recursos, tanto humanos como materiales

Hacia un modelo integral de servicios con base comunitaria: La experiencia de Denville, New Jersey / Toward an integrated services model based on the community: The Denville, New Jersey experience

Se presentan datos demograficos de los Estados Unidos de América y en particular del Estado de New Jersey. Describe un modelo teorico de atención geriatrica y la red integral de servicios prestados por el Centro Médico St. Clares. Riverside Medical Center, y el St. Francis Lifecare, en Denville. Describe ademas 3 modelos nuevos de atención para ancianos: 1) El programa de alcance a envejecientes en el hogar (HOPE). 2)El Centro de Informacion sobre Autoayuda. 3) El programa de Servicios Moviles