Deterioro funcional asociado a la hospitalización en pacientes mayores de 65 años / Hospitalisation as a risk for functional decline in older adults

El deterioro funcional es un riesgo asociado a la hospitalización en las personas mayores, con elevada prevalencia (35-70%) y graves consecuencias. OBJETIVO: Determinar la incidencia del deterioro funcional relacionado con la hospitalización (DFH) en personas mayores ingresadas en el Área Médica del Complejo Hospitalario Universitario de Albacete. MÉTODO: Se ha realizado un estudio de cohortes, cuya variable principal ha sido el DFH (pérdida de capacidad para realizar actividades cotidianas durante el ingreso y tras el alta); se han incluido otras variables (demográficas, relacionadas con el ingreso, patologías asociadas, estado cognitivo). Los datos se recogieron por entrevista presencial al paciente y cuidadores, llamada telefónica tras el alta y revisión de historia clínica. RESULTADOS: Se incluyeron 104 pacientes, de los que un 51,9% eran mujeres; la edad media fue 79,97 años (dt = 7,89), IC 95% [78,43; 81,5] y la estancia media de 10,11 días (dt = 7,65) IC 95% [8,62; 11,6]. El primer día del ingreso 43 (41,4%) pacientes presentaban estado mental intacto. Se produjo DFH en las primeras 24 horas en 60 (57,7%) pacientes; tras el alta hospitalaria, el deterioro existía en un 32,6% de los 92 pacientes que pudieron ser evaluados. En pacientes que antes del ingreso eran independientes para las actividades cotidianas, un 19% quedó con dependencia importante. El DFH se relacionó de forma estadísticamente significativa con los antecedentes de caídas y la edad. CONCLUSIONES: El DFH se produce en un porcentaje elevado de los mayores de 65 años; entre los previamente independientes, casi la quinta parte queda en situación de dependencia

Functional decline: (FD) is a risk associated with hospital admission in older people, due to its high prevalence (35-70%) and its serious consequences. AIM: To determine the incidence of FD in the elderly after hospital admission at the Geriatric and Internal Medicine wards of a tertiary teaching hospital (Albacete, Spain). METHOD: A cohort study has been designed, whose primary focus was FD, defined as the loss of independence to perform the activities of daily living between preadmission status and discharge. Demographic characteristics, comorbidity, length of hospital stay and cognitive status have been analysed. Data collection was performed by interviews with patients and caregivers during hospitalization and after discharge (by phone), as well as by revision of clinical records. RESULTS: 104 patients were evaluated, of which 51.9% were female; the average age was 79.97 years (dt = 7.89) IC 95% [78.43, 81.5] and the average length of stay was 10.11 days (dt = 7.65) IC 95% [8.62,11.6]. The proportion of patients who showed a normal cognitive status on the first in-hospital day was 41.4% (43 patients). FD was present in 60 (57.7%) patients in the first day of hospitalisation; when discharged, 32.6% of 92 patients who could be evaluated showed FD.19% of patients who were previously independent in activities of daily living developed a serious dependence after discharge. FD was associated statistically with age and a history of previous falls. CONCLUSIONS: FD takes place in a high percentage of the elderly PATIENTS: Among the previously independent patients, 19% remains in a situation of dependence after discharge

[Hospitalisation as a risk for functional decline in older adults]. / Deterioro funcional asociado a la hospitalización en pacientes mayores de 65 años.

UNLABELLED: FUNCTIONAL DECLINE: (FD) is a risk associated with hospital admission in older people, due to its high prevalence (35-70%) and its serious consequences. AIM: To determine the incidence of FD in the elderly after hospital admission at the Geriatric and Internal Medicine wards of a tertiary teaching hospital (Albacete, Spain). METHOD: A cohort study has been designed, whose primary focus was FD, defined as the loss of independence to perform the activities of daily living between preadmission status and discharge. Demographic characteristics, comorbidity, length of hospital stay and cognitive status have been analysed. Data collection was performed by interviews with patients and caregivers during hospitalization and after discharge (by phone), as well as by revision of clinical records. RESULTS: 104 patients were evaluated, of which 51.9% were female; the average age was 79.97 years (dt=7.89) IC 95% [78.43, 81.5] and the average length of stay was 10.11 days (dt=7.65) IC 95% [8.62,11.6]. The proportion of patients who showed a normal cognitive status on the first in-hospital day was 41.4% (43 patients). FD was present in 60 (57.7%) patients in the first day of hospitalisation; when discharged, 32.6% of 92 patients who could be evaluated showed FD. 19% of patients who were previously independent in activities of daily living developed a serious dependence after discharge. FD was associated statistically with age and a history of previous falls. CONCLUSIONS: FD takes place in a high percentage of the elderly patients. Among the previously independent patients, 19% remains in a situation of dependence after discharge.

Mejoría de la calidad de vida y efectos adversos en pacientes con enfermedad arterial obstructiva crónica tratados con alprostadil-alfa-ciclodextrina por vía venosa periférica / Improvement in quality of life and adverse effects in patients with chronic arterial occlusive disease treated with alprostadil alpha-cyclodextrin through the peripheral venous route

Objetivos. Evaluar las complicaciones locales y sistémicas que se presentan en pacientes tratados con alprostadil-alfa-ciclodextrina (AAC) por vía venosa periférica, así como los cambios que se producen en la calidad de vida de estos pacientes. Método. Estudio descriptivo observacional prospectivo. Se incluyeron todos los pacientes ingresados en la Unidad de Angiología y Cirugía Vascular del Complejo Hospitalario Universitario de Albacete que cumplían los criterios de indicación terapéutica para la administración de AAC entre septiembre de 2001 y abril de 2002. Cada paciente recibió el tratamiento según un protocolo previamente consensuado en la Unidad. Se recogieron variables sociodemográficas, enfermedades asociadas, tipo y nivel de la enfermedad arterial, complicaciones locales y sistémicas en la administración de cada uno de los ciclos, calidad de vida al inicio y final del tratamiento. Resultados. Se estudiaron 44 pacientes. El 65,5% presentaba enfermedad arterial en su estadio más avanzado. Las complicaciones sistémicas más frecuentes fueron las reacciones alérgicas y las náuseas; el tratamiento tuvo que ser suspendido en el 11,4% de los casos. Como complicaciones locales aparecieron dolor y eritema en la vía venosa (media de 1,29 por cada 10 dosis de tratamiento); se cambió la vía 0,97 veces de media cada 10 dosis, el 38,6% de las veces debido a flebitis. Los resultados del cuestionario EUROQOL muestran mejoría en movilidad, capacidad para el cuidado personal, capacidad para realizar actividades cotidianas, dolor y ansiedad/depresión. Conclusiones. El tratamiento con AAC según el protocolo establecido ofrece seguridad a los pacientes y produce una notable mejora en la calidad de vida percibida

Objectives. To evaluate local and systemic complications in patients treated with alprostadil alpha-cyclodextrin (AAC) through the peripheral venous route, as well as changes in the quality of life of these patients. Method. A descriptive, observational, prospective study was performed. All patients admitted to the Angiology and Vascular Surgery Unit of the University Hospital of Albacete who fulfilled the criteria for therapeutic indication of AAC administration between September 2001 and April 2002 were included. Each patient received the treatment according to a protocol previously established through consensus in the unit. Sociodemographic variables, associated disease, type and degree of arterial disease, local and systemic complications with administration of each of the cycles, and quality of life at the beginning and end of the treatment were studied. Results. Forty-four patients were studied. A total of 65.5% had arterial disease in the most advanced stage. The most frequent systemic complications were allergic reactions and nausea; treatment had to be discontinued in 11.4% of patients. Local complications consisted of pain and erythema in the area of the venous line (mean 1.29 every 10 treatment doses); there was a mean of 0.97 line changes every 10 doses and 38.6% of the changes was due to phlebitis. The results of the EUROQOL questionnaire showed improvement in: mobility, ability to perform personal care, ability to perform daily activities, pain, and anxiety/depression. Conclusions. Treatment with AAC according to the established protocol is safe and improves perceived quality of life