[Geriatric physical performance assessment in an emergency department]. / Valoración geriátrica de la función física en un Servicio de Urgencias.

BASIS: Premorbid situation with regard to daily life activities is an important prognostic factor in elderly people who needs medical care. This work analyzes the way the parameter evaluation of core processes of daily life (CPDL) is made in patients over 70 years cared in an Emergency Service because of diverse medical conditions. PATIENTS AND METHODS: A prospective study, carried out in a third level medical institution, on 200 patients over 70 years cared in the Emergency medical Service, with questioning a group of 60 physicians on duty (POD) about the informal or subjective assessments of five parameters of CPDL (to get dressed, to be fed, sphincter control, walking, and transfer). POD evaluation is compared with evaluation carried out formally by the research physician. Assessments are evaluated, grouping the patients according to the degree of dependency, age, or sex. RESULTS: 82% of most dependent patients and 53% of those older than 80 years were poorly assessed, and both parameters were statistically significant. The analysis with multiple linear regression showed that the intensity of these errors is only determined by a variable: the greater degree of dependency. CONCLUSIONS: Correct performance assessment of elderly patients in emergency services, especially of those older and most dependent, requires a specific training of professionals in this regard and the use of formal instruments of evaluation.

[Prevalence of cognitive decline in people older than 70 years admitted in an internal medicine service]. / Prevalencia de deterioro cognitivo en mayores de 70 años ingresados en un Servicio de Medicina Interna.

BACKGROUND: Cognitive decline in older people is an important cause of burden for caregivers and assistance staff. It is a poor prognosis marker that favors the onset of different geriatric syndromes and increases the risk of institutionalization. As some causes of cognitive decline can be treated, its early diagnosis is fundamental for patients and caregivers. This, help us to design a care plan and a future follow up. The objective of this article is to measure the prevalence of Cognitive Decline before the onset of the acute disease that led patients older than 70 years, to an admission at the Internal Medicine Service. PATIENTS AND METHODS: A prospective randomized study was performed in the Internal Medicine Service of the Hospital de Mataro, which included 100 patients older than 70 years. Presence of Cognitive Decline was evaluated through the Blessed Scale during the previous month of the onset of the disease that motivated the admission. RESULTS: 43% of the patients had Cognitive Decline (42% male and 44% female). The prevalence of CD in patients older than 80 years was over 60%. CONCLUSIONS: Many of the admitted patients of an Internal Medicine Service older than 70 years had criteria for Cognitive Decline before the onset of the acute disease. Its diagnosis, study and therapeutic plan before the patient's discharge is a great opportunity to improve the quality of assistance.

Prevalencia de deterioro cognitivo en mayores de 70 años ingresados en un Servicio de Medicina Interna / Prevalence of cognitive decline in people older than 70 years admitted in an Internal Medicine Service

Fundamento: El deterioro cognitivo (DC) de los ancianos es una causa importante de sobrecargas de los cuidadores y del personal asistencial. Por otro lado es un marcador de mal pronóstico, favorece diferentes síndromes geriátricos e incrementa el riesgo de institucionalización. Su detección precoz puede ser beneficiosa, tanto para el enfermo como para sus familiares, ya que algunas causas de DC tienen tratamiento y además permite planificar la atención y seguimiento futuros. El objetivo de este trabajo es medir la prevalencia de DC, antes del comienzo de la patologia aguda que motiva su ingreso hospitalario, en pacientes mayores de 70 años ingresados en un Servicio de Medicina Interna de un hospital comarcal. Pacientes y métodos: Estudio prospectivo realizado en el Servicio de Medicina Interna del Hospital de Mataró, en 100 pacientes mayores de 70 años, elegidos de forma aleatoria. Se evalúa la presencia de DC, con la escala de Blessed, durante el mes previo al inicio de la enfermedad que motiva el ingreso. Resultados: el 43 por ciento de los pacientes tenían DC (42 por ciento de los hombres y 44 por ciento de las mujeres). En los mayores de 80 años la prevalencia de DC era superior al 60 por ciento. Conclusiones: A partir de los 70 años muchos de los pacientes ingresados en un Servicio de Medicina Interna tienen criterios de DC, previo al inicio de la enfermedad aguda. Su diagnóstico, estudio y tratamiento precoz permitiría mejorar la calidad asistencial en estos pacientes (AU)