ABSTRACT
INTRODUCTION: Given the growing increase in dementia, the need to control these patients, together with the rise of new technologies, makes a change in the current control system imperative. MATERIAL AND METHOD: We have carried out a single-center, clinical study with two groups, a control group of 72 patients/caregivers, who followed the usual controls in consultations, and another telematic group of 76 patients/caregivers, who followed the controls through of the Tecuide platform. The platform had a survey part to detect problems in patients and caregiver claudication, another training part and another chat for direct communication when the caregiver needed it and also served to respond when a problem was detected. RESULTS: After a year of monitoring with the platform we have obtained: a)in patients, reduce behavioral disorders and use of drugs, increase physical exercise and delay institutionalization (DS not found); b)in caregivers there is an improvement in satisfaction with respect to the control of patients with cognitive impairment, and c)in terms of resources, visits to emergency services and dementia consultations have decreased, although admissions to the psychogeriatric unit have increased. CONCLUSIONS: The use of Tecuide as a telematic tool in the control of patients with cognitive impairment does not seem to be inferior to the usual controls in consultations and improves caregiver satisfaction.
Subject(s)
Caregivers , Dementia , Telemedicine , Humans , Male , Female , Aged , Aged, 80 and overABSTRACT
A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a nosocomiun, i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below (AU)
Un porcentaje progresivamente creciente de las personas mayores viven durante los últimos años de su vida en residencias de ancianos. Dichas instituciones, aunque pretenden remedar lo más posible la vida en el hogar, tienen características que las hace bastante parecidas a un nosocomio, es decir a un establecimiento destinado al tratamiento de enfermos. La propia convivencia entre los ancianos, el hecho de compartir cuidadores y la exposición muy importante a terceras personas, junto con las frecuentes enfermedades predisponentes a la infección de esta población, hacen que la infección sea frecuente entre los residentes y que además sea fácilmente transmisible. Esto nos lleva a preguntarnos qué puede hacerse para prevenir la infección en este medio y más concretamente cuál es el estado del arte de la cuestión en una nación de Europa Occidental como la nuestra. El patronato de la Fundación de Ciencias de la Salud se ha formulado una serie de preguntas sobre el tema de la prevención de la infección en las Residencias de Mayores, la estructura de la misma, la legislación vigente, el cumplimiento de las medidas indicadas, los indicadores de los procesos y por ende, la necesidad de fomentar en España un documento de recomendaciones para evitar infecciones en esta población cuya morbilidad y mortalidad no necesitan ser resaltadas. Para ello, se ha convocado a un grupo multidisciplinar de expertos en distintos aspectos de este problema a los que se les han formulado las preguntas propuestas. Las preguntas han sido discutidas por el grupo en su conjunto y han conducido a una serie de conclusiones consensuadas entre los participantes. Pasamos, a continuación a relatar los resultados de la reunión (AU)
Subject(s)
Humans , Infection Control/methods , Long-Term Care , Old Age Assistance , Homes for the Aged , SpainABSTRACT
La identificación de pacientes en situación de enfermedad crónica avanzada y complejidad, y la fragmentación de cuidados hacia el final de la vida aconsejan trazar un plan terapéutico a largo plazo, congruente con los valores y preferencias de los pacientes, a la vez que con un pronóstico vital y funcional razonables. Disponer de una herramienta de ajuste en la adecuación de la intensidad diagnóstica y terapéutica sería de ayuda en la continuidad de cuidados y podría ser facilitadora de la toma de decisiones en las transiciones y en los cambios dinámicos que presentan los pacientes a medida que se acercan al final del proceso vital
The identification of patients with advanced and complex chronic diseases, and the fragmentation of care towards the end of life, requires the drawing up a long-term therapeutic plan. This should take into account the values and preferences of the patients, as well as the vital and functional prognosis. Having an adjustment tool for determining the diagnostic and therapeutic effort is helpful in the continuity of care, as well as in decision-making in the transitions and dynamic changes of patients as they approach the end of life process
Subject(s)
Humans , Male , Female , Aged , Hospice Care/methods , Multiple Chronic Conditions/epidemiology , Advance Care Planning/organization & administration , Land Management and Planning , Diagnosis of Health Situation , Decision Support Techniques , Hospitalization/statistics & numerical data , Organ Transplantation/statistics & numerical data , Geriatric Assessment/methodsABSTRACT
The identification of patients with advanced and complex chronic diseases, and the fragmentation of care towards the end of life, requires the drawing up a long-term therapeutic plan. This should take into account the values and preferences of the patients, as well as the vital and functional prognosis. Having an adjustment tool for determining the diagnostic and therapeutic effort is helpful in the continuity of care, as well as in decision-making in the transitions and dynamic changes of patients as they approach the end of life process.
Subject(s)
Advance Care Planning/standards , Terminal Care/standards , Consensus Development Conferences as Topic , Humans , Life Support Care/standards , Spain , Urban HealthSubject(s)
Humans , Female , Middle Aged , Aged, 80 and over , Dyskinesias/complications , Dyskinesias/diagnosis , Dyskinesias/drug therapy , Neuroimaging/instrumentation , Neuroimaging/methods , Haloperidol/therapeutic use , Quality of Life/psychology , Dyskinesias/etiology , Dyskinesias/physiopathology , Dyskinesias , Neuroimaging/standards , Neuroimaging/trends , NeuroimagingABSTRACT
La osteoporosis y, secundariamente, la fractura de cadera son dos entidades inseparables que acontecen en la mayoría de los casos en individuos de edad avanzada, principalmente mujeres, y con otros problemas de salud. La elevada prevalencia de síndromes geriátricos en los pacientes con fractura de cadera requiere un abordaje integral, e integrado, entre los diferentes profesionales y niveles asistenciales que priorice la continuidad asistencial y los resultados en salud a largo plazo. Las herramientas clave en este abordaje son la valoración geriátrica integral, el trabajo en equipo interdisciplinar, la atención centrada en el paciente y las guías de práctica clínica. Los modelos de atención integrada emergen como una respuesta más adecuada en la atención a la fractura de cadera porque los diferentes agentes implicados comparten objetivos comunes, colocan al paciente en el centro de la atención, eliminan barreras y permiten racionalizar los recursos(AU)
Osteoporosis and hip fracture are two inseparable conditions in most cases in older female patients with other health problems. A comprehensive-multidisciplinary integrated approach is required because of high prevalence of geriatric syndromes in hip fracture patients. Care continuum and long-term results must be enhanced. Comprehensive geriatric assessment, multidisciplinary teamwork, patientfocused care, and evidenced-based practices are the management key tools for these patients. Integrated care models seems to be the best answer in hip fracture because common targets are shared between all implicated agents, patient is sited in the center of care, barriers are suppressed, and resources rationalized(AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Osteoporosis/complications , Osteoporosis/diagnosis , Hip Fractures/complications , Hip Fractures/diagnosis , Delivery of Health Care, Integrated/methods , Delivery of Health Care, Integrated/trends , Primary Prevention/methods , Osteoporosis/physiopathology , Osteoporosis/therapy , Hip Fractures/prevention & control , Hip Fractures/therapy , Delivery of Health Care, Integrated/organization & administration , Delivery of Health Care, Integrated/statistics & numerical data , Delivery of Health Care, Integrated , Primary Prevention/trends , Exercise/physiologySubject(s)
Humans , Aged , Aged, 80 and over , Infections/complications , Infections/diagnosis , Staphylococcus aureus/isolation & purification , Staphylococcus aureus/pathogenicity , Health Services for the Aged , Geriatric Hospitals , Risk Factors , Retrospective Studies , Drug Resistance/physiologyABSTRACT
BACKGROUND AND OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) asymptomatic colonization is common in long-term care facilities, but the burden of symptomatic infection appears to be low. It is not usually known whether a patient is colonized at the time of admission to the geriatric facility. Our purpose was to determine the prevalence, characteristics and factors associated with MRSA colonization on admission, and the cumulative incidence of colonization over the following 6 months. PATIENTS AND METHOD: Longitudinal and prospective study conducted over a 6-month period. All patients were screened at admission using nasal and ulcers swabs within the first 24h. Patients were screened also at the end of the study to assess carrier status. RESULTS: The prevalence of MRSA colonization was 7.6% at the entry (25 patients). In the multivariate analysis, advanced age, recent use of antibiotics, prior colonization by MRSA, and peripheral vascular disease were independent risk factors for colonization at admission. With standard precautions, the 6-month cumulative incidence of MRSA colonization was 4.2%. CONCLUSIONS: In our long-term care facility, MRSA colonization at the time of admission was frequent. Few patients were colonized during the study and no episodes of infection were reported. Probably, standard precautions, including hand washing and appropriate barrier procedures during the care of wounds, are the most useful control measures.
Subject(s)
Carrier State , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Skilled Nursing Facilities , Adult , Aged , Aged, 80 and over , Female , Humans , Longitudinal Studies , Male , Middle Aged , Prospective StudiesABSTRACT
Fundamento y objetivo: la colonización por Staphylococcus aureus resistente a meticilina (SARM) es frecuente en centros de media y larga estancia, pero las tasas de infección son bajas. Habitualmente se desconoce el estado de portador de un paciente en el momento del ingreso. Nos hemos propuesto estudiar la prevalencia, las características clínicas y los factores relacionados con el hecho de ser portador al ingresar en el hospital, así como la incidencia de colonización de los pacientes una vez ingresados durante un período de 6 meses. Pacientes y método: se ha realizado un estudio longitudinal y prospectivo durante un período de 6 meses. Se efectuó a todos los pacientes un frotis nasal y de las heridas dentro de las primeras 24h de ingreso, estudio que se repitió en el momento del alta o de finalización del estudio. Resultados: la proporción de pacientes colonizados al ingresar fue del 7,6% (n=25). En el análisis multivariable, la edad, el uso reciente de antibióticos, la colonización previa y la presencia de enfermedad vascular periférica fueron las variables asociadas de forma independiente con el estado de portador. Tomando las precauciones estándar sólo un 4,2% de los pacientes se colonizaron durante el ingreso. Conclusiones: en nuestro centro de media y larga estancia, un número importante de pacientes presentó colonización por SARM al ingresar. Fueron pocos los que se colonizaron durante el ingreso y no se describieron episodios de infección durante el período del estudio. Probablemente las precauciones estándar, entre ellas el lavado de las manos y los métodos de barrera en las curas de heridas, son medidas adecuadas para evitar la diseminación de la colonización por SARM (AU)
Background and objective: Methicillin-resistant Staphylococcus aureus (MRSA) asymptomatic colonization is common in long-term care facilities, but the burden of symptomatic infection appears to be low. It is not usually known whether a patient is colonized at the time of admission to the geriatric facility. Our purpose was to determine the prevalence, characteristics and factors associated with MRSA colonization on admission, and the cumulative incidence of colonization over the following 6 months. Patients and method: Longitudinal and prospective study conducted over a 6-month period. All patients were screened at admission using nasal and ulcers swabs within the first 24h. Patients were screened also at the end of the study to assess carrier status. Results: The prevalence of MRSA colonization was 7.6% at the entry (25 patients). In the multivariate analysis, advanced age, recent use of antibiotics, prior colonization by MRSA, and peripheral vascular disease were independent risk factors for colonization at admission. With standard precautions, the 6-month cumulative incidence of MRSA colonization was 4.2%. Conclusions: In our long-term care facility, MRSA colonization at the time of admission was frequent. Few patients were colonized during the study and no episodes of infection were reported. Probably, standard precautions, including hand washing and appropriate barrier procedures during the care of wounds, are the most useful control measures (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Staphylococcus aureus/isolation & purification , Staphylococcus aureus , Methicillin Resistance , Prospective Studies , Longitudinal Studies , Hospital Bed Capacity, 100 to 299 , SpainABSTRACT
La Valoración Geriátrica Integral es la herramienta básica y fundamentalen la priorización de problemas e intervención en la atención alanciano frágil. Independientemente de cuál sea el nivel asistencial,permite realizar un análisis exhaustivo de las capacidades físicas,funcionales, del estado nutricional, de los órganos de los sentidos, delestado de ánimo y del entorno sociofamiliar que envuelve a cadapaciente. De la misma manera, tiene en cuenta las necesidades, lavoluntad y los deseos del paciente. Por este motivo, sólo a través deella, podemos coordinarnos entre los diferentes profesionales de lasalud y niveles asistenciales para priorizar el abordaje de los problemasde salud y ofrecer una asistencia integral de calidad
Integral Geriatric Assessment is the basic and fundamental tool in theprioritization of problems and supervision in the care of the frail elderly.Independent of whatever the level of care is, it permits the realization ofan exhaustive analysis of the physical and functional capabilities, thenutritional state, the sense organs, the state of mind and the social andfamily environment that surrounds each patient. In the same way, theneeds, the will and the wishes of the patient are taken into account.Therefore, only through it can we coordinate between the differenthealth professionals and levels of care to prioritise the broaching of thehealth problems and offer quality integral care
