Declive funcional y presencia de síntomas en cuidados paliativos: ¿causa o consecuencia? / Functional decline and presence of symptoms in palliative care: cause or consequence?

Introducción. Diversas publicaciones han relacionado el declive funcional con la aparición de síntomas, especialmente psicológicos o psiquiátricos, como ansiedad y depresión. Por otra parte, un trastorno depresivo inicial o previo al declive funcional también suele empeorarlo. Nos planteamos conocer la relación entre la existencia de declive funcional medido mediante descenso en índice de Barthel (IB) y la presencia de síntomas. Material y métodos. Estudio analítico prospectivo con los pacientes derivados a un Equipo de Soporte para Atención Domiciliaria (ESAD). Resultados. Seiscientos treinta y ocho casos, 53,9% (N=344) hombres, 56% (N=357) oncológicos y 44% (N=281) no oncológicos. La edad media fue 79,64 ± 10,8 años. Obtuvimos diferencias significativas (p<0,001) en declive funcional medido mediante descenso medio en el IB entre pacientes oncológicos (34,4) y no oncológicos (12,12). Encontramos diferencias significativas (p<0,001) en todos los síntomas registrados (dolor, disnea, anorexia, náuseas, ansiedad, depresión e insomnio) con mayor frecuencia en pacientes oncológicos, salvo en el caso de la agitación psicomotriz. En pacientes con mayor grado de declive funcional, con descensos en IB superior a 20 puntos, se detectó mayor presencia de síntomas. Salvo determinados analgésicos, no hubo diferencias en los tratamientos previos; sí encontramos diferencias en diversos tratamientos pautados por el ESAD. Conclusiones. La existencia de declive funcional y su grado pueden verse relacionados con la aparición de síntomas, especialmente en el paciente oncológico (AU)

Introduction. Several publications have related functional decline to the appearance of symptoms, especially psychiatric or psychological ones, such as anxiety and depression. Moreover, an initial depressive disorder or prior to functional decline usually worsens it. It was decided to investigate the relationship between the presence of functional decline, measured by a decrease in the Barthel index (BI), and the presence of symptoms. Material and methods. A prospective analytical study conducted on patients referred to a Home Care Support Team (HCST). Results. The study included 638 cases, of which 53.9% (N=344) were male, 56% (N=357) with cancer and 44% (N=281) geriatric. The mean age was 79.64 years+- 10.8. Significant differences (P<.001) were found in functional decline measured by mean decline in the BI between cancer (34.4) and non-cancer patients (12.12). Significant differences (P<.001) were also found in all recorded symptoms (pain, dyspnoea, anorexia, nausea, anxiety, depression, and insomnia), more frequently in cancer patients, except psychomotor agitation. A higher presence of symptoms was detected in patients with greater functional decline, with decreases in BI above 20 points. There were no differences in previous treatments, except in certain analgesics. Differences were found in the different treatments prescribed by HCST. Conclusions. The presence of functional decline and its level may be related to the appearance of symptoms, especially in cancer patients (AU)

Factores condicionantes de sedación en pacientes geriátricos y oncológicos atendidos en el domicilio / Determining factors in the sedation of geriatric and oncology patients treated at home

Introducción. La sedación, como medida terapéutica utilizada en el ámbito de los Cuidados Paliativos, sigue presentando para muchos profesionales dificultad en su manejo e indicaciones. Es muy variada la bibliografía existente en este sentido, muchas veces exclusiva de los pacientes oncológicos. Nuestro objetivo es analizar las características de los pacientes atendidos por un Equipo de Soporte para Atención Domiciliaria que precisaron sedación frente a los no sedados, para determinar posibles factores condicionantes de la misma que puedan ayudar en la toma de decisiones. Método. Estudio analítico prospectivo realizado en el sector sanitario de Barbastro (Huesca) desde septiembre del año 2007 hasta febrero del año 2011. La población a estudio fueron los pacientes derivados al Equipo de Soporte para Atención Domiciliaria de Barbastro. Variables principales. Edad, sexo, antecedentes médicos, síntomas, Barthel previo y actual, Karnofsky, cuidador principal, fármacos previos, fármacos tras intervención, sedación sí/no. Resultado. Requirieron sedación el 16,6% (n=106) de los casos (N=638). Los pacientes sedados fueron más jóvenes, sin diferencias por sexo. Un 83% fueron oncológicos. La presencia de metástasis no mostró diferencias respecto a la necesidad de sedación. Los pacientes sedados presentaron un mayor declive funcional, determinado mediante un descenso en el índice de Barthel y un peor Karnofsky. Los pacientes sedados mostraron una mayor frecuencia de síntomas no controlados, con excepción de agitación psicomotriz, hecho determinado por las medicaciones usadas pre y postintervención. Conclusiones. La presencia de enfermedad oncológica, con existencia de declive funcional marcado, clínica no controlada y necesidad de determinadas medicaciones para el control de la sintomatología pueden determinar la necesidad de sedación al final del proceso, por encima de otros factores como la comorbilidad del paciente (AU)

Introduction. Sedation, used as a therapeutic measure in the field of Palliative Care, continues to present difficulties for many professionals in its management and indications. Is varied existing literature in this regard, often exclusive cancer patients. Our objective is to analyse the characteristics of patients attended by a Home Care Support Team who required sedation compared to non-sedated patients, for possible determining factors for its use that could help in decision-making. Method. A prospective analytical study conducted in Barbastro (Huesca) from September 2007 to February 2011. The study population are patients referred to the Home Care Support Team of Barbastro. Main variables. Age, sex, medical history, symptoms, previous and current Barthel, Karnofsky, primary caregiver, previous drugs, drugs after intervention, sedation yes/no. Results. Required sedation 16.6% (n=106) of the cases (N=638). Sedated patients were younger, with no differences in sex, and the large majority (83%) were oncology patients. The presence of metastases showed no differences in need for sedation. Sedated patients have an increased functional impairment, determined by Barthel index decreased and a worse Karnofsky. Sedated patients showed increased frequency of uncontrolled symptoms, except psychomotor agitation, a fact determined by the medications used pre- and post-intervention. Conclusions. The presence of neoplastic disease, marked with existence of functional decline, and uncontrolled clinical need for certain medications to control symptoms may determine the need for sedation at the end of the process, above other factors such as patient comorbidity (AU)

[Determining factors in the sedation of geriatric and oncology patients treated at home]. / Factores condicionantes de sedación en pacientes geriátricos y oncológicos atendidos en el domicilio.

INTRODUCTION: Sedation, used as a therapeutic measure in the field of Palliative Care, continues to present difficulties for many professionals in its management and indications. Is varied existing literature in this regard, often exclusive cancer patients. Our objective is to analyse the characteristics of patients attended by a Home Care Support Team who required sedation compared to non-sedated patients, for possible determining factors for its use that could help in decision-making. METHOD: A prospective analytical study conducted in Barbastro (Huesca) from September 2007 to February 2011. The study population are patients referred to the Home Care Support Team of Barbastro. MAIN VARIABLES: Age, sex, medical history, symptoms, previous and current Barthel, Karnofsky, primary caregiver, previous drugs, drugs after intervention, sedation yes/no. RESULTS: Required sedation 16.6% (n=106) of the cases (N=638). Sedated patients were younger, with no differences in sex, and the large majority (83%) were oncology patients. The presence of metastases showed no differences in need for sedation. Sedated patients have an increased functional impairment, determined by Barthel index decreased and a worse Karnofsky. Sedated patients showed increased frequency of uncontrolled symptoms, except psychomotor agitation, a fact determined by the medications used pre- and post-intervention. CONCLUSIONS: The presence of neoplastic disease, marked with existence of functional decline, and uncontrolled clinical need for certain medications to control symptoms may determine the need for sedation at the end of the process, above other factors such as patient comorbidity.