Estratificación de la población mayor de 65 años en grupos de riesgo clínico: características y valoración enfermera / Stratification of clinical risk groups in a population over 65 years: Features and nursing assessment

OBJETIVO: Analizar las características de la población mayor de 65 años atendida en un Área Básica de Salud según la clasificación de Clinical Risk Groups (CRG, «Grupos de Riesgo Clínico») y la valoración de los test geriátricos realizados por la enfermera en relación con la complejidad que presentan. MÉTODO: Estudio observacional, descriptivo transversal, realizado sobre la población mayor de 65 años atendidos en un Área Básica de Salud. Se recogieron variables sociodemográficas, clasificación CRG, enfermedades (CIE-10), actividad asistencial, valoración geriátrica y actividades preventivas. Se utilizó la clasificación CRG como instrumento de medida. La recogida de datos se realizó mediante la historia clínica informatizada (e-CAP) de Atención Primaria. RESULTADOS: Población mayor de 65 años: 3.219 personas; atendidas a domicilio 130 (4%), y en institución residencial, 92 (2,85%). La población se agrupó en: CRG 1-2: 83 (2,5%); CRG 3: 62 (2%); CRG 4: 99 (3%); CRG 5: 537 (17%); CRG 6: 2077 (64,5%); CRG 7: 276 (8,6%); CRG 8: 61 (2%); CRG 9: 14 (0,4%). Las enfermedades crónicas más frecuentes fueron: 69,12% HTA, 24,94% DM, 19,51% depresión y 11,09% insuficiencia renal. Se analizaron los grupos 6-7-8, que incluían 2.414 personas (75%). De las personas con CRG 6-7-8, solamente 570 (24%) tenían test geriátricos realizados por la enfermera. La media de personas asignadas por enfermera para CRG 6-7-8 fue de 302. CONCLUSIONES: En la práctica clínica, la incorporación de sistemas de clasificación como los CRG conjuntamente con el uso de las nuevas tecnologías de la información y la comunicación permite incorporar modelos predictivos de necesidades sanitarias e impulsar acciones proactivas por parte de enfermería y del equipo para prevenir complicaciones de enfermedades, y mejorar la eficiencia tanto en la utilización de servicios como en la atención a la complejidad

OBJECTIVE: To analyze the characteristics of the population over 65 years served in a Basic Health Area, according to the Clinical Risk Group (CRG) classification and geriatric assessment test performed by the nurse in relation to their complexity. METHODS: A descriptive, cross-sectional and observational prevalence study was conducted on the population over 65 years served in a Basic Health Area. The variables collected were: socio-demographic, CRG classification, diseases (ICD-10), healthcare activity, geriatric assessment, and preventive activities. The CRG classification was used as a measurement tool. Data was collected from the Primary Care computerized clinical history (e-CAP). RESULTS: Population over 65 years: 3,219 people; served at home, 130 (4%), and in residential institutions, 92 (2.85%). The population was grouped into: CRG 1-2: 83 (2.5%); CRG 3: 62 (2%); CRG 4: 99 (3%); CRG 5: 537 (17%); CRG 6: 2,077 (64.5%); CRG 7: 276 (8.6%); CRG 8: 61 (2%); CRG 9: 14 (0.4%). Most frequent chronic diseases: 69.12% AHT; 24.94% DM; 19.51% depression; 11.09% kidney failure. The groups 6-7-8 that were analyzed included 2,414 people (75%). Of those within CRG 6-7-8, only 570 (24%) had tests carried out by the geriatric nurse. The mean number of individuals assigned by a nurse for CRG 6-7-8 was 302. CONCLUSIONS: The introduction of classification systems in clinical practice, such as the CRG, along with the use of the new information and communication technologies, helps to incorporate predictive models of health needs. It also promotes proactive actions by nurses and the team to prevent complications of diseases, as well as improving efficiency in the use of services and in care of the complex patients

[Stratification of clinical risk groups in a population over 65 years: features and nursing assessment]. / Estratificación de la población mayor de 65 años en grupos de riesgo clínico: características y valoración enfermera.

OBJECTIVE: To analyze the characteristics of the population over 65 years served in a Basic Health Area, according to the Clinical Risk Group (CRG) classification and geriatric assessment test performed by the nurse in relation to their complexity. METHODS: A descriptive, cross-sectional and observational prevalence study was conducted on the population over 65 years served in a Basic Health Area. The variables collected were: socio-demographic, CRG classification, diseases (ICD-10), healthcare activity, geriatric assessment, and preventive activities. The CRG classification was used as a measurement tool. Data was collected from the Primary Care computerized clinical history (e-CAP). RESULTS: Population over 65 years: 3,219 people; served at home, 130 (4%), and in residential institutions, 92 (2.85%). The population was grouped into: CRG 1-2: 83 (2.5%); CRG 3: 62 (2%); CRG 4: 99 (3%); CRG 5: 537 (17%); CRG 6: 2,077 (64.5%); CRG 7: 276 (8.6%); CRG 8: 61 (2%); CRG 9: 14 (0.4%). Most frequent chronic diseases: 69.12% AHT; 24.94% DM; 19.51% depression; 11.09% kidney failure. The groups 6-7-8 that were analyzed included 2,414 people (75%). Of those within CRG 6-7-8, only 570 (24%) had tests carried out by the geriatric nurse. The mean number of individuals assigned by a nurse for CRG 6-7-8 was 302. CONCLUSIONS: The introduction of classification systems in clinical practice, such as the CRG, along with the use of the new information and communication technologies, helps to incorporate predictive models of health needs. It also promotes proactive actions by nurses and the team to prevent complications of diseases, as well as improving efficiency in the use of services and in care of the complex patients.

[Descriptive study of ambulatory blood pressure monitoring in the Primary Care Nursing clinic]. / Estudio descriptivo de la monitorización ambulatoria de la presión arterial en la consulta de Enfermería de Atención Primaria.

OBJECTIVE: To analyze the clinical characteristics and the circadian patterns of patients who received ambulatory blood pressure monitoring (ABPM) by a Primary Care Team. METHOD: A descriptive, observational, cross-sectional study at community level. People older than 18 years on ABPM (2007-2011). VARIABLES: demographic, cardiovascular disease, diabetes mellitus, cardiovascular risk factors, any type of arterial hypertension and circadian pattern. Intruments of measurement: 2 validated instruments with comparable results were used. PROCEDURE: The instruments for ABPM were placed during the nursing visit. The instruments were then removed after 24h, and the data was retrieved and recorded in the computerized clinical history. RESULTS: A total of 326 people were studied, with a mean age of 60.53±12.96 years, of whom 56.7% were male. According to ABPM the patient results showed that: 38.5% had «white coat¼ arterial hypertension, 36.2% were classified as poorly controlled arterial hypertension, 17.2% had masked hypertension, and 8% with isolated hypertension. Dipper circadian patterns were present in 39.6% of patients and non- dipper in 60.4%. CONCLUSIONS: ABPM allows to Primary Health Care professionals to check the actual situation of the blood pressure over 24h and analyze the circadian pattern. In clinical practice this involves having a comprehensive care strategy on life style, as well as adherence to treatment.

Estudio descriptivo de la monitorización ambulatoria de la presión arterial en la consulta de Enfermería de Atención Primaria / Descriptive study of ambulatory blood pressure monitoring in the Primary Care Nursing clinic

Objetivo: Analizar las características clínicas y los patrones circadianos de las personas a las que se les ha realizado una monitorización ambulatoria de la presión arterial (MAPA) en un Equipo de Atención Primaria. Método Estudio descriptivo, transversal, realizado en el Área Básica de Salud Gavarra de Cornellà de Llobregat (Barcelona). Se seleccionaron todas las personas mayores de 18 años con una MAPA realizada entre 2007-2011. Las variables estudiadas fueron: sociodemográficas, enfermedad cardiovascular, diabetes mellitus, factores de riesgo cardiovascular, tipo de HTA y patrón circadiano. Instrumentos de medida: se utilizaron 2 aparatos validados con resultados comparables. Procedimiento Los pacientes acudían a consulta de Enfermería previa citación para colocación del aparato de MAPA. A las 24 h se retiraba y se registraban los datos en la historia clínica informatizada. Resultados Se realizaron 326 MAPA. La edad media de la población fue de 60,53 ± 12,96 años, de los cuales el 56,7% eran hombres. De acuerdo con los resultados de la MAPA se clasificaron en: HTA de bata blanca el 38,5%, HTA mal controlada el 36,2%, HTA enmascarada el 17,2% y HTA aislada el 8%. Entre los patrones circadianos se identificaron como dipper un 39,6% y non dipper un 60,4%.ConclusionesLa MAPA permite a los profesionales de Atención Primaria comprobar la situación real de la presión arterial en 24 h y analizar el patrón circadiano, lo que implica en la práctica clínica poder llevar a cabo una estrategia y abordaje integral tanto en cuidados del estilo de vida como en adherencia al tratamiento (AU)

OBJECTIVE: To analyze the clinical characteristics and the circadian patterns of patients who received ambulatory blood pressure monitoring (ABPM) by a Primary Care Team. METHOD: A descriptive, observational, cross-sectional study at community level. People older than 18 years on ABPM (2007-2011). Variables: demographic, cardiovascular disease, diabetes mellitus, cardiovascular risk factors, any type of arterial hypertension and circadian pattern. Intruments of measurement: 2 validated instruments with comparable results were used. PROCEDURE: The instruments for ABPM were placed during the nursing visit. The instruments were then removed after 24h, and the data was retrieved and recorded in the computerized clinical history. RESULTS: A total of 326 people were studied, with a mean age of 60.53±12.96 years, of whom 56.7% were male. According to ABPM the patient results showed that: 38.5% had «white coat» arterial hypertension, 36.2% were classified as poorly controlled arterial hypertension, 17.2% had masked hypertension, and 8% with isolated hypertension. Dipper circadian patterns were present in 39.6% of patients and non- dipper in 60.4%.CONCLUSIONS: ABPM allows to Primary Health Care professionals to check the actual situation of the blood pressure over 24h and analyze the circadian pattern. In clinical practice this involves having a comprehensive care strategy on life style, as well as adherence to treatment (AU)

Abordaje enfermero de un paciente con insuficiencia cardiaca en Atención Primaria / Nursing approach to a patient with cardiac insufficiency in Primary Care

Actualmente, la insuficiencia cardiaca (IC) es una de las enfermedades más frecuentes, costosas, progresivas y discapacitantes de los países desarrollados. Representa la tercera causa de muerte cardiovascular y la primera causa de hospitalización en personas mayores de 65 años. En España, un 8% en personas de entre 65-75 años padecen IC y en mayores de 75 años su prevalencia es de 16%.Mediante la exposición del caso de un paciente con insuficiencia cardiaca y su abordaje por parte de la enfermera de Atención Primaria, se pretende mostrar la importancia del seguimiento desde dicho nivel asistencial y de la continuidad de cuidados ante un problema de salud de tal magnitud y prevalencia. La valoración enfermera se realizó según el modelo de Virginia Hendersony se establecieron los diagnósticos y el plan de cuidados utilizandolas clasificaciones de North American Nursing Diagnosis Association(NANDA), Nursing Outcome Clasification (NOC) y Nursing Interventions Classification (NIC). Los resultados se evaluaron a los tres meses. El seguimiento de la enfermera comunitaria, junto con el trabajo en equipo y el uso de guías de práctica clínica fueron determinantes para evitar descompensaciones y mejorar la calidad de vida del paciente (AU)

Currently, chronic insufficiency (CI) is one of the most prevalent, costly ,progressive and disabling disorders of developed countries. It represents the third leading cause of cardiovascular death and the leading cause of hospitalization in people over 65. In Spain, 8% of people aged 65-75years suffering from CI and in people aged over 75 years the prevalence of this condition reaches 16%.By exposing the case of a patient with cardiac insufficiency and its management on the part of the primary care nurse, we aim to show the importance of monitoring and follow up from that level of care and continuity of care when faced with a health problem of such magnitude and prevalence. The nursing assessment was performed using the Virginia Henderson's model: Diagnoses and care plans were established using the classifications of Norht American Nursing Diagnosis Association (NANDA),Nursing Outcome Clasification (NOC) and Nursing Interventions Classification(NIC). Outcomes were assessed at three months. Follow up of the community nurse, along with teamwork and use of clinical practice guidelines, were crucial to avoid decompensation and improve the quality of life of patients (AU)

Seguimiento domiciliario de una paciente con diabetes mellitus complicada entre la gestora de casos y la enfermera comunitaria II / Joint home follow-up of a patient with complicated diabetes mellitus by the case manager and the community nurse: II

El presente artículo es la continuación de la publicación «Abordaje integral de un caso de diabetes mellitus en domicilio entre la gestora de casos y la enfermera comunitaria» en Enfermería Clínica. En dicho documento se planteaba el caso de una mujer de 76 años con diabetes mellitus de larga evolución y alta complejidad clínica que formaba parte del programa de atención domiciliaria en el ámbito de atención primaria. En este trabajo se expone el seguimiento del caso en el que se aparecen nuevas complicaciones en la extremidad inferior derecha que conllevan a la amputación de la segunda extremidad. A los 6 meses del plan de cuidados inicial se realiza una nueva valoración según el modelo de Virginia Henderson y se plantean los diagnósticos de enfermería según la North American Nursing Diagnosis Association (NANDA) que conllevan a cambios en los objetivos y los criterios de resultados, Nursing Outcomes Classification (NOC) y Nursing Interventions Classification (NIC). Entre los resultados obtenidos, destacan la mejora de su bienestar al conseguir que la Sra. pudiera interaccionar e integrarse socialmente en su entorno tras movilizar los recursos sociales correspondientes y la familia. Las implicaciones en la práctica clínica son la importancia de la prevención de las complicaciones de la diabetes mellitus y el pie diabético, y la dificultad del abordaje de situaciones complejas que, en ocasiones, superan las posibilidades de la enfermera comunitaria. Ésta se puede beneficiar del apoyo clínico ofrecido por el modelo de gestión de casos y el abordaje global e integrado en un equipo muldisiciplinar (AU)

This is a continuation of the article published in this journal (Enfermeria Clinica), entitled 'Integral approach by the case manager and the community nurse to a complex case of diabetes mellitus in the home'. We present the case of a 76 year- old patient with long-term and clinically complex Diabetes Mellitus. The patient was taking part in the Primary Care home care program. This article describes the follow-up of the case in which new complications appeared in the right limb, which led to the amputation of the second limb. A new evaluation following Virginia's Henderson model was performed six months after the initial care plan. Nursing diagnoses were made following the North American Nursing Diagnosis Association (NANDA). These diagnoses led to changes in objectives and performance criteria using, nursing outcomes classification (NOC) and nursing interventions classification (NIC). One of the results obtained was the improvement of her well-being by enabling the patient to interact and integrate socially within her environment after mobilising the corresponding social and family resources. Involvement in clinical practice is important in the prevention of diabetes mellitus and diabetic foot complications. Difficult and complex situations are sometimes beyond the ability of the community nurse. It can be beneficial to take advantage of the clinical support offered by the case management model and the integrated approach of a multidisciplinary team (AU)

[Joint home follow-up of a patient with complicated diabetes mellitus by the case manager and the community nurse: II]. / Seguimiento domiciliario de una paciente con diabetes mellitus complicada entre la gestora de casos y la enfermera comunitaria II.

This is a continuation of the article published in this journal (Enfermeria Clinica), entitled "Integral approach by the case manager and the community nurse to a complex case of diabetes mellitus in the home". We present the case of a 76 year- old patient with long-term and clinically complex Diabetes Mellitus. The patient was taking part in the Primary Care home care program. This article describes the follow-up of the case in which new complications appeared in the right limb, which led to the amputation of the second limb. A new evaluation following Virginia's Henderson model was performed six months after the initial care plan. Nursing diagnoses were made following the North American Nursing Diagnosis Association (NANDA). These diagnoses led to changes in objectives and performance criteria using, nursing outcomes classification (NOC) and nursing interventions classification (NIC). One of the results obtained was the improvement of her well-being by enabling the patient to interact and integrate socially within her environment after mobilising the corresponding social and family resources.Involvement in clinical practice is important in the prevention of diabetes mellitus and diabetic foot complications. Difficult and complex situations are sometimes beyond the ability of the community nurse. It can be beneficial to take advantage of the clinical support offered by the case management model and the integrated approach of a multidisciplinary team.

Prevalencia de pacientes con alta complejidad y/o alta dependencia para la gestión de casos en atención primaria / Prevalence of patients with high complexity and/or high dependency for case management in primary care

Objetivo. Identificar el porcentaje de personas adultas con alta complejidad y/o alta dependencia en población ≥ 18 años tributaria del modelo de gestión de casos. Método. Estudio descriptivo, observacional, transversal. Ámbito comunitario. Muestreo aleatorio simple. Tamaño muestral: 551 individuos (tasa de reposición por pérdidas del 40%). Variables dependientes: Alta complejidad ≥ 4criterios: edad, comorbilidad, polifarmacia, proceso terminal, ingresos hospitalarios, visitas a urgencias, caídas, dependencia funcional, deterioro cognitivo, vivir solo. Alta dependencia (Barthel ≤ 30 y/o Pfeiffer ≥ 8). Análisis: descriptivo, variables y factores asociados. IC 95%. Índice de Kappa para estudiar la correlación entre variables. Resultados. Participaron 327. X edad=49años (DE=18) y 179 (54,7%) mujeres. Presentaban alta complejidad 6 personas (1,8%, IC 95%: 0,38-3,29), 4 (67%) mujeres, 5; (83%) > 75 años, y 1 < 65 años. X edad=79,5 (DE=12,6). Presentaban alta dependencia 5 mujeres (1,5%, IC 95%: 0,49-3,53), 4 mujeres (80%) > 75 años y 1 < 65 años. X edad=82 años (DE 14,8). Presentaban alta complejidad y/o alta dependencia 7 personas (2,14%, IC 95%: 0,86-4,3), 5 mujeres (71,4%); 6 > 75 años y 1 < 65 años. X edad=81,3 años (DE=12,4). Prevalencia en > 65 años (8,3%) y en < 65 (0,6%) (p=0,001). El índice de correlación de Kappa entre las variables de alta complejidad y alta dependencia fue del 0,723. Discusión. El porcentaje de pacientes que presentan alta complejidad y/o alta dependencia sobre población general es relevante, aunque inferior al esperado. En la planificación de futuros programas de gestión de casos habrá que considerar, además de las personas con alta complejidad, las personas con alta dependencia y las menores de 65 años (AU)

Objective. To identify the percentage of the population over 18 years with high complexity or high dependency using the case management model. Method. Observational, cross-sectional, descriptive study. Community level. Simple random sampling. Sample size calculation: 551 individuals were needed, with a rate of replacement for losing participation of 40%. Variables: High complexity ≥ 4 of following criteria: age, comorbidity, high drug consumption, terminal disease, hospital admissions, visits to Emergency Departments, falls, functional dependency, mental deterioration, to live alone or with family with capacity for limited support; High dependency (Barthel ≤ 30 and/or Pfeiffer ≥ 8; social-demographic variables; health services use; chronic diseases; specific treatments and caregiver data. Analysis: Descriptive for all variables and associated factors (95% CI). Correlation between variables was studied using the Kappa index. Results. A total of 327 patients were studied, with a mean age of 49 years (SD=18), of whom 179 (54.7%) were women. Six individuals had high complexity (1.8%, 95% CI: 0.38%-3.29%), 4 women (67%), 5>75 years old (83%) and 1<65 years old, mean age=79.5 years (SD=12.6). Five women presented high dependency (1.5%, 95% CI: 0.49-3.53), 4>75 years old (80%) and 1<65 years old, mean age= 82 years (SD=14.8). Seven individuals in total presented high complexity and/or high dependency criteria (2.14%, 95% CI: 0.86-4.3), 5 women (71.4%); 6>75 years old and 1<65 years old, mean age=81.3 years (SD=12.4). Prevalence > 65 years (8.3%) and < 65 (0.6%) (P=.001). Correlation Kappa Index between high complexity and high dependency variables was 0.723. Discussion. The percentage of patients who had high complexity or high dependency compared to the general population is significant, although lower than expected. In the planning of future programs for case management those persons who have high dependency and aged less than 65 years should also be taken into account along with those who have high complexity (AU)

[Prevalence of patients with high complexity and/or high dependency for case management in primary care]. / Prevalencia de pacientes con alta complejidad y/o alta dependencia para la gestión de casos en atención primaria.

OBJECTIVE: To identify the percentage of the population over 18 years with high complexity or high dependency using the case management model. METHOD: Observational, cross-sectional, descriptive study. Community level. Simple random sampling. Sample size calculation: 551 individuals were needed, with a rate of replacement for losing participation of 40%. VARIABLES: High complexity ≥ 4 of following criteria: age, comorbidity, high drug consumption, terminal disease, hospital admissions, visits to Emergency Departments, falls, functional dependency, mental deterioration, to live alone or with family with capacity for limited support; High dependency (Barthel ≤ 30 and/or Pfeiffer ≥ 8; social-demographic variables; health services use; chronic diseases; specific treatments and caregiver data. ANALYSIS: Descriptive for all variables and associated factors (95% CI). Correlation between variables was studied using the Kappa index. RESULTS: A total of 327 patients were studied, with a mean age of 49 years (SD = 18), of whom 179 (54.7%) were women. Six individuals had high complexity (1.8%, 95% CI: 0.38%-3.29%), 4 women (67%), 5 > 75 years old (83%) and 1 < 65 years old, mean age = 79.5 years (SD = 12.6). Five women presented high dependency (1.5%, 95% CI: 0.49-3.53), 4 > 75 years old (80%) and 1 < 65 years old, mean age = 82 years (SD = 14.8). Seven individuals in total presented high complexity and/or high dependency criteria (2.14%, 95% CI: 0.86-4.3), 5 women (71.4%); 6 > 75 years old and 1 < 65 years old, mean age = 81.3 years (SD = 12.4). Prevalence > 65 years (8.3%) and < 65 (0.6%) (P = .001). Correlation Kappa Index between high complexity and high dependency variables was 0.723. DISCUSSION: The percentage of patients who had high complexity or high dependency compared to the general population is significant, although lower than expected. In the planning of future programs for case management those persons who have high dependency and aged less than 65 years should also be taken into account along with those who have high complexity.

El factor de impacto, perspectiva de los profesionales de enfermería asistenciales / The impact factor, the perspective of nursing care professionals

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Abordaje integral de un caso complejo de diabetes mellitus en domicilio entre la gestora de casos y la enfermera comunitaria / Integral approach by the case manager and the community nurse to a complex case of diabetes mellitus in the home

En este artículo se presenta el caso clínico de una paciente de 76 años con diabetes mellitus de larga evolución y de alta complejidad clínica, que forma parte del programa de atención domiciliaria en el ámbito de atención primaria. Presentaba varias complicaciones de la diabetes mellitus que afectaban de forma importante su calidad de vida, tales como ceguera, insuficiencia renal tratada con hemodiálisis y accidente vascular cerebral. Se expone una valoración siguiendo el modelo de Virginia Henderson, realizada en domicilio después del alta del centro sociosanitario donde estuvo ingresada por amputación supracondílea de la extremidad inferior derecha. Posteriormente, se diseñó el plan de cuidados de enfermería con los objetivos y criterios de resultados North American Nursing Diagnosis Association, Nursing Outcomes Classification y Nursing Interventions Classification. Se llevó a cabo de forma conjunta entre la enfermera comunitaria y la enfermera gestora de casos, las que se coordinaron con el resto de los profesionales que intervinieron en el caso. Se evaluaron los resultados a los 6 meses de la valoración inicial. Este caso, que presentaba alta complejidad y alta dependencia, requería un abordaje multidisciplinario y la integración de diversos profesionales, servicios e instituciones para poder implementar el tratamiento del paciente. Por ello, se debe destacar la importancia de una gestión del caso (case management) para garantizar la continuidad asistencial y una atención global e integrada(AU)

We present the case of a patient with long-term and clinically complex Diabetes Mellitus. She was taking part in the home care program in Primary Care. The complications of her DM affected her quality of life: blindness, kidney failure, treated with hemodialysis, and a cerebrovascular attack. We describe the evaluation following Virginia's Henderson model. This evaluation was made in the patient's home after she was discharged from the socio-health centre where she was admitted as her right leg was amputated at a supracondylar level. It was designed a care plan between the community nurse and the case manager using NANDA, NOC and NIC taxonomy. The care plan was carried out as a joint effort between the community nurse and the case manager who coordinated the planning with the rest of professionals. Results were evaluated 6 months after the initial assessment. This case, which had a high dependence and a high clinical complexity, required a multidisciplinary approach and the integration of different professionals, services and institutions to implement the patient's treatment. Because of all the above, it is important to mention the case management function to guarantee continuity, and overall and integrated care (AU)

[Integral approach by the case manager and the community nurse to a complex case of diabetes mellitus in the home]. / Abordaje integral de un caso complejo de diabetes mellitus en domicilio entre la gestora de casos y la enfermera comunitaria.

We present the case of a patient with long-term and clinically complex Diabetes Mellitus. She was taking part in the home care program in Primary Care. The complications of her DM affected her quality of life: blindness, kidney failure, treated with hemodialysis, and a cerebrovascular attack. We describe the evaluation following Virginia's Henderson model. This evaluation was made in the patient's home after she was discharged from the socio-health centre where she was admitted as her right leg was amputated at a supracondylar level. It was designed a care plan between the community nurse and the case manager using NANDA, NOC and NIC taxonomy. The care plan was carried out as a joint effort between the community nurse and the case manager who coordinated the planning with the rest of professionals. Results were evaluated 6 months after the initial assessment. This case, which had a high dependence and a high clinical complexity, required a multidisciplinary approach and the integration of different professionals, services and institutions to implement the patient's treatment. Because of all the above, it is important to mention the case management function to guarantee continuity, and overall and integrated care.

Envejecer: aspectos positivos, capacidad funcional, percepción de salud y síndromes geriátricos en una población mayor de 70 años / Ageing: positive aspects, functional ability, self-perceived health and geriatric syndromes among people aged more than 70 years old

Objetivo. Conocer la prevalencia de los principales síndromes geriátricos en una población mayor de 70 años, identificar los aspectos positivos del proceso de envejecimiento y relacionarlos con la autonomía y la percepción de salud. Método. Estudio observacional, descriptivo y transversal. Población de estudio: personas mayores de 70 años atendidas en el Centro de Salud Gavarra (Cornellà de Llobregat, Barcelona) o en el domicilio al menos una vez en el último año. Tamaño muestral: 315 personas, seleccionadas mediante muestreo aleatorio sistemático estratificado. Variables: a) Síndromes geriátricos: incontinencia urinaria, polifarmacia, insomnio, deterioro cognitivo, alteraciones de la movilidad, sensoriales y emocionales. b) Autonomía básica e instrumental para las actividades de la vida diaria. c) Percepción de salud. d) Aspectos positivos del envejecimiento: capacidad de tomar decisiones, satisfacción con la vida previa, sentimiento de utilidad, ilusiones y aficiones. Datos recogidos a partir del programa OMI-AP® en el período de junio de 2001 a diciembre de 2002. Resultados. Se estudiaron 283 (89%) personas de las 315 que inicialmente se contactaron. Los principales síndromes geriátricos detectados fueron: incontinencia urinaria (115; 41%), polifarmacia (109; 38%) y pérdida de visión (94; 33%). Destacan los aspectos positivos del envejecimiento: ilusiones (266; 94%), toma de decisiones (241; 85%) y sentirse útil (232; 82%). Percepción de salud: buena (164; 58%) y regular (82; 29%). Conclusiones. Alta prevalencia de síndromes geriátricos, principalmente incontinencia urinaria. El sentimiento de utilidad, la capacidad de tomar las propias decisiones y tener aficiones e ilusiones se asocian con la independencia instrumental y básica. Respecto a la buena percepción de salud, existen otros factores, distintos de la autonomía, pendientes de investigar en futuros estudios

Objective. To determine the prevalence of the main geriatric syndromes among people aged more than 70 years. To identify positive aspects of the aging process and to relate them to autonomy and self-perceived health. Method. Observational, descriptive, cross-sectional study. Subjects. People aged 70 years old or older attending the Gavarra Health Center (Cornellà de Llobregat, Barcelona, Spain) or visited at home at least once a last year. Sample size: 315 people, identified by systematic, randomized, stratified sampling. Measurements: Geriatric syndromes: Urinary incontinence, polypharmacy, insomnia, cognitive impairment, mobility, and sensorial and emotional problems. Instrumental and basic activities of daily living. Self-perceived health. Positive aspects of the ageing process: decision-making, previous satisfaction with life, feeling of usefulness, projects, and hobbies. Information was gathered using the OMI-AP® program from June 2001 to December 2002. Results. Of 315 individuals who were initially contacted, 283 (89%) were studied. The main geriatric syndromes identified were: urinary incontinence (115; 41%), polypharmacy (109; 38%), and loss of vision (94; 33%). The most important positive aspects of aging were: projects (266; 94%), decision-making (241; 85%) and feeling useful (232; 82%). Self-perceived health was good in 164 individuals (58%) and poor in 82 (29%). Conclusions. The prevalence of geriatric syndromes, mainly urinary incontinence, was high. Factors associated with both instrumental and basic autonomy were the feeling of being useful, the ability to make decisions, and having projects and hobbies. Having good self-perceived health involves other factors, which require further study

Las caídas de los ancianos están favorecidas por la anulación conjunta de las aferencias visuales y propioceptivas evaluadas mediante la posturografía / Falls in the elderly are favored by impairment of both visual and propioceptive afferents evaluated by posturography

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La capacidad de los pacientes para tomar decisiones / Ability of patients to take decisions

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