ABSTRACT
OBJECTIVE: To analyze the prevalence, causes and outcome of hypothermia in institutionalized elderly. METHODS: Prospective study held from January to December, 2004 at the Hospital Geriátrico e de Convalescentes Dom Pedro II (Geriatric and Convalescent Hospital Dom Pedro II), with 483 long-term care beds. Hypothermia was diagnosed by esophageal thermometer in all patients with axillary temperature below or equal to 35 degrees C or 95 degrees F. Clinical examination and tests were used to obtain etiologic diagnosis and detect complications. Tests included: ECG, chest X-Ray, blood count, blood gas analysis, glycemia, biochemical blood tests, amylase, kidney and liver functions, urinalysis and serology for HIV, syphilis and hepatitis B. Rewarming was adopted, among other actions in the treatment protocol. RESULTS: Thirty nine cases of hypothermia were confirmed, 31 in elderly (60 years old or over), 10 men and 21 women with an average age of 76.9 years. Eighty three percent of these patients had a high degree of dependence (Katz index between 'F' and 'G'). Seventy percent of these cases had mild hypothermia (32-35 degrees C [89.6-95 degrees F]), 25.0% had moderate hypothermia (28-31.9 degrees C [82.4-89.6 degrees F]) and 5.0% had severe hypothermia (<28 degrees C [<82.4 degrees F]). Seventy three percent of these patients died (50.0% during hypothermia and 50.0% after reversal). Infections were the etiology in all cases (Pneumonia [80.0%], urinary tract infection [60.0%] and pressure ulcer [17.1%]). CONCLUSION: Hypothermia in institutionalized elderly is a serious clinical diagnosis with a high level of mortality. Prevention, early diagnosis and measures of central rewarming have collaborated for a better prognosis.
Subject(s)
Health Services for the Aged/statistics & numerical data , Hypothermia/epidemiology , Institutionalization , Aged , Brazil/epidemiology , Female , Hospitals, Special/statistics & numerical data , Humans , Hypothermia/etiology , Hypothermia/mortality , Incidence , Male , Prevalence , Prospective Studies , Severity of Illness IndexABSTRACT
OBJETIVO: Analisar a prevalência, causas e evolução da hipotermia acidental em idosos institucionalizados. MÉTODOS: Estudo prospectivo realizado entre janeiro e dezembro de 2004, no Hospital Geriátrico e de Convalescentes D. Pedro II, com 483 internos. Hipotermia foi confirmada por termômetro esofágico, utilizado em todos os pacientes com temperatura axilar menor ou igual a 35ºC (95ºF). Tanto o diagnóstico etiológico quanto as complicações da hipotermia foram observados em exames clínico e subsidiários de urgência como eletrocardiograma, radiografia de tórax, hemograma, gasometria arterial, glicemia, metabólitos, amilase, função hepática e renal, sorologias para HIV, sífilis e hepatite B e urina tipo I. Foram adotadas medidas de reaquecimento entre outras do protocolo de tratamento. RESULTADOS: A prevalência de hipotermia foi de 7,2 por cento especialmente em mulheres (65,7 por cento), e a média de idade do grupo foi 76,4 anos. A maioria dos pacientes (77,1 por cento) apresentava elevado grau de dependência (Katz "F" e "G"). Hipotermia leve foi identificada na maioria dos idosos (71,4 por cento). A taxa de mortalidade foi de 62,8 por cento, sendo 31,4 por cento em vigência de hipotermia e 31,4 por cento após sua reversão. Em 100,0 por cento dos casos, a etiologia foi infecciosa: pneumonia em 80 por cento, infecção urinária em 60,0 por cento, e úlceras por pressão em 17,1 por cento. Em 60 por cento dos casos havia mais de um foco infeccioso. CONCLUSÃO: A hipotermia em idosos institucionalizados é uma grave condição clínica, com altos índices de mortalidade. A prevenção, o diagnóstico precoce e medidas de reaquecimento central corroboram para um melhor prognóstico.
OBJECTIVE: To analyze the prevalence, causes and outcome of hypothermia in institutionalized elderly. METHODS: prospective study held from January to December, 2004 at the Hospital Geriátrico e de Convalescentes Dom Pedro II (Geriatric and Convalescent Hospital Dom Pedro II), with 483 long-term care beds. Hypothermia was diagnosed by esophageal thermometer in all patients with axillary temperature below or equal to 35°C or 95ºF. Clinical examination and tests were used to obtain etiologic diagnosis and detect complications. Tests included: ECG, Chest X-Ray, blood count, blood gas analysis, glycemia, biochemical blood tests, amylase, kidney and liver functions, urinalysis and serology for HIV, syphilis and hepatitis B. Rewarming was adopted, among other actions in the treatment protocol. RESULTS: Thirty nine cases of hypothermia were confirmed, 31 in elderly (60 years old or over), 10 men and 21 women with an average age of 76.9 years. Eighty three percent of these patients had a high degree of dependence (Katz index between "F" and "G"). Seventy percent of these cases had mild hypothermia (32º-35°C [89.6º-95ºF]), 25.0 percent had moderate hypothermia (28°-31,9°C [82.4º-89.6ºF]) and 5.0 percent had severe hypothermia (<28°C [<82.4ºF]). Seventy three percent of these patients died (50.0 percent during hypothermia and 50.0 percent after reversal). Infections were the etiology in all cases (Pneumonia [80.0 percent], urinary tract infection [60.0 percent] and pressure ulcer [17.1 percent]). CONCLUSION: Hypothermia in institutionalized elderly is a serious clinical diagnosis with a high level of mortality. Prevention, early diagnosis and measures of central rewarming have collaborated for a better prognosis.