Ancianos frágiles: ¿cuántos y por qué? / Frail elderly subjects: how many and why?

OBJETIVO. Conocer la prevalencia de ancianos frágiles en la población atendida en un centro de salud. MÉTODOS. Estudio transversal realizado en un centro de salud urbano de Castelldefels. Se eligieron aleatoriamente 527 pacientes mayores de 65 años, separados en dos grupos: el primero de 65 a 74 años y el segundo de 75 o más años. Hubo 46 no respuestas. Mediciones principales: el test de Barber, validado fuera de nuestro medio, que mide la fragilidad en el anciano. Variables: edad, sexo, número de convivientes, consumo de fármacos y nivel de estudios. RESULTADOS. Se obtuvieron 481 encuestas (91,3%). La edad media fue de 73,5 (desviación estándar [DE]: 6,4) años. El 45,1% eran hombres. Presentaron test de Barber positivo 261 (54,3%). La fragilidad era superior en las mujeres y en el grupo de edad de mayores de 75 años. Reconocieron dificultad visual (94 pacientes, el 17,9%) y auditiva (93 pacientes, el 17,3%). Vivían solos un 17%. El nivel de estudios era inferior en el género femenino (p < 0,0001). Los pacientes tomaban 3,3 (DE: 2,3) fármacos al día, más al aumentar la edad y el género masculino (p < 0,001). La media de convivientes fue de 1,62 (DE:1,24) por paciente, siendo de 1,44 (DE:1,36) en pacientes frágiles y de 1,84 (DE:1,03) en pacientes no frágiles (p = 0,0007). CONCLUSIONES. Más de la mitad de la población mayor de 65 años de la comunidad presenta fragilidad. La fragilidad era más frecuente en mujeres y a mayor edad. La Atención Primaria debe detectar los ancianos frágiles para realizar una valoración geriátrica integral y aplicar medidas preventivas adecuadas a esta población de riesgo

OBJECTIVE. To know the prevalence of frail elderly subjects in the population attended in the health care site. METHODS. Cross-sectional study performed in urban health care site of Castelldefels. A total of 527 patients over 65 years were randomly chosen. They were separated into two groups: the first one from 65 to 74 years and the second one of 75 years and older. Forty six did not answer. Main measurements: Barber test, validated outside of our setting, that measures frailness in the elderly. Variables: age, gender, number of subjects living together, drugs taken and study level. RESULTS. A total of 481 (91.3%) surveys were obtained. Mean age was 73.5 (SD 6.4 years), 45.1% of whom were men. Barber test was positive in 261 (54.3%). Frailness was greater in the women and in the over 75-year old age group. Visual difficulty was found in 94 patients (17.9%) and auditory ones in 93 patients (17.3%). Seventeen percent lived alone. Study level was lower in the women (p < 0.0001). The patients took 3.3 (SD: 2.3) drugs per day, this increasing as age increased and in men (p < 0.001). Mean number of subjects living together was 1.62 (S: 1.24) per patient, this being 1.44 (SD: 1.36) in frail patients and 1.84 (SD: 1.03) in non-frail patients (p = 0.0007). CONCLUSIONS. More than half of the population over 65 years of the community were frail. Frailness was more frequent in women and at an older age. Primary Health Care should detect the frail elderly to made a complete geriatric assessment and apply adequate preventive measures in this risk group

The EFQM excellence model is useful for primary health care teams.

BACKGROUND: Primary care teams are facing an increased need to develop quality programmes at local level. GPs must lead this process and promote a positive organizational culture if they want to achieve and maintain a continuous improvement of the service. OBJECTIVE: The aim of the present study was to test the applicability and reliability of the European Foundation for Quality Management (EFQM) excellence model self-assessment questionnaire in a primary health care organization. METHOD: A cross-sectional study was carried out of the EFQM questionnaire to compare the scores achieved by a primary health care team in Spain caring for 42 000 inhabitants using internal self-assessment with the scores achieved by professional management auditors through an external audit. RESULTS: The scores of each criterion achieved by self-evaluation are similar to or lower than those assessed by the external evaluation. There is agreement in the areas suitable for improvement. CONCLUSIONS: The experience proves the applicability of the EFQM excellence model for primary health care teams and its reliability, at least when the team undergoing self-assessment know they are going to be re-evaluated. There is high concordance in the identification of areas for improvement.