[Evolution of the profile of patients attended by a hospital Geriatric Home Care Unit in the last 20 years]. / Evolución del perfil de las personas mayores atendidas por una unidad de atención domiciliaria especializada en geriatría en los últimos 20 años.

OBJECTIVE: To describe the evolution of the profile of patients attended by a Geriatric Home Care (GHC) Unit and its care activity in the last two decades. METHODS: Data on the historical activity of the AGD Unit from 2001 to 2020, grouped into 5-year periods, were recorded. Sociodemographic, clinical, functional (Functional Red Cross Scale and Barthel index) and mental (Mental Red Cross Scale) variables were collected, baseline and at inclusion to AGD. Also the waiting time until first visit, mean follow-up, origin of referral, destination at the end of the intervention, reason for consultation and cause of functional dependence were also included. A descriptive analysis was performed with the SPSSv.23 program. RESULTS: Ten thousand six hundred fifty-four patients attended in AGD (1 January 2001 to 31 December 2020). A progressive increase in age and in the number of geriatric syndromes was observed. Patients presented higher functional and cognitive decline, and the number of patients living alone and in need of private assistance increased. The duration of the intervention decreases and Primary Care remains the main source and destination at the end of the intervention, with dementia standing out as the main cause for functional dependence. CONCLUSION: The vulnerability of the populations in need of specialised geriatric care is increasing: patients are older, and have more geriatric syndromes, high functional and cognitive decline, and suffer social frailty; more work is needed to address the role of these support units in the community, as well as their coordination with Primary Care teams.

Evolución del perfil de las personas mayores atendidas por una unidad de atención domiciliaria especializada en geriatría en los últimos 20 años / Evolution of the profile of patients attended by a hospital Geriatric Home Care Unit in the last 20 years

Objetivo: Describir la evolución del perfil de pacientes atendidos por una unidad de atención geriátrica domiciliaria (AGD) y su actividad asistencial desde en las últimas dos décadas. Métodos: Se registraron los datos de la actividad histórica de la unidad de AGD desde 2001 hasta 2020, agrupados en quinquenios. Se recogieron variables sociodemográficas, clínicas, funcionales (escala de Cruz Roja funcional e índice de Barthel) y mentales (escala de Cruz Roja mental), en condiciones basales y al inicio de la atención en AGD. También el tiempo de espera hasta la 1.ª visita, la duración de la intervención, la procedencia de los pacientes y el destino al alta junto con el motivo de consulta y el motivo principal de dependencia funcional. Se realizó un análisis descriptivo con el programa SPSS® v.23. Resultados: Diez mil seiscientos cincuenta y cuatro pacientes atendidos en AGD (1-1-2001 hasta el 31-12-2020). Se observa un incremento progresivo de la edad y de síndromes geriátricos. Los pacientes presentan mayor deterioro funcional y mental, aumentando los pacientes que viven solos y la necesidad de ayuda privada. Disminuye la duración de la intervención y atención primaria se mantiene como la principal procedencia y destino al alta, destacando la demencia como principal causa de dependencia funcional. Conclusión: El paciente geriátrico domiciliario, en las últimas dos décadas, es cada vez más vulnerable: de mayor edad, más síndromes geriátricos, mayor dependencia funcional y mental y de gran fragilidad social; se necesitan más trabajos que aborden la función de estas unidades de soporte al manejo de la complejidad en la comunidad, así como su coordinación con los equipos de atención primaria referentes de la atención. (AU)

Objective: To describe the evolution of the profile of patients attended by a Geriatric Home Care (GHC) Unit and its care activity in the last two decades. Methods: Data on the historical activity of the AGD Unit from 2001 to 2020, grouped into 5-year periods, were recorded. Sociodemographic, clinical, functional (Functional Red Cross Scale and Barthel index) and mental (Mental Red Cross Scale) variables were collected, baseline and at inclusion to AGD. Also the waiting time until first visit, mean follow-up, origin of referral, destination at the end of the intervention, reason for consultation and cause of functional dependence were also included. A descriptive analysis was performed with the SPSSv.23 program. Results: Ten thousand six hundred fifty-four patients attended in AGD (1 January 2001 to 31 December 2020). A progressive increase in age and in the number of geriatric syndromes was observed. Patients presented higher functional and cognitive decline, and the number of patients living alone and in need of private assistance increased. The duration of the intervention decreases and Primary Care remains the main source and destination at the end of the intervention, with dementia standing out as the main cause for functional dependence. Conclusion: The vulnerability of the populations in need of specialised geriatric care is increasing: patients are older, and have more geriatric syndromes, high functional and cognitive decline, and suffer social frailty; more work is needed to address the role of these support units in the community, as well as their coordination with Primary Care teams. (AU)

Evaluation of quality of life, weight loss and evolution of comorbidities at 6 years after bariatric surgery.

INTRODUCTION: Morbid obesity is a disease with multiple comorbidities and considerably limits the quality of life and life expectancy. Bariatric surgery is an effective therapeutic alternative in these patients; it acts on the decrease and / or absorption of nutrients, achieving a significant weight loss which is maintained over time. The objective of the study is to determine the long-term results, in terms of efficacy, regarding weight loss, the resolution of comorbidities and improvement in the quality of life of our patients. MATERIAL AND METHODS: This was a retrospective study that comprised all patients consecutively undergoing laparoscopic bariatric surgery at our center over a 10 year period. In all patients, the anthropometric and clinical data were collected prior to surgery and in subsequent protocolized visits after surgery. At the end of the follow-up, a BAROS questionnaire was used that recorded weight loss, the resolution of comorbidities, complications and the quality of life test completed by the patients. RESULTS: 353 patients (303 GBPRY and 50 GV), 105 men and 248 women, with a mean age of 42.14 ± 10.16 years, BMI 48.63 kg / m2 and 68.5% had some comorbidity. The mean follow-up was 5.7 ± 2.6 years for 96.7% of the total number operated on. At the end of the follow-up the %EWL was 59.00 ± 19.50, %EBMIL 68.15 ± 22.94, the final BMI 32.65 ± 5.98 and 31.3% of the patients had %EWL ≤ 50. The resolution of comorbidities was as follows: 48.7% hypertension, 70.3% Type 2 Diabetes, 82.6% DLP and 71.6% SAHS. The result of the quality of life test was 1.51 ± 0.93, with 67.2% of patients reporting good or very good quality, with the highest score being for self-esteem, followed by physical condition, work and social activity, and the lowest being for sexual quality of life in that only 40.3% reported an improvement. The BAROS score was 4.35 ±â€¯2.06 with 84.7% of the patients in the good to excellent range, while 91.2% of all patients would undergo surgery again. CONCLUSIONS: Bariatric surgery is an effective technique for reducing weight, resolving comorbidities and improving the quality of life of patients with morbid obesity, mainly in its physical aspect. In our series, the percentage of follow-up and average time was within the range of established quality standards.

Efectos del bypass gástrico sobre el riesgo cardiovascular y resolución de comorbilidades: resultados a 5 años / Effects of gastric bypass on cardiovascular risk and resolution of comorbidities: results at 5 years

ANTECEDENTES: la cirugía bariátrica es una alternativa terapéutica eficaz en la obesidad mórbida para conseguir pérdidas de peso importantes y mantenidas en el tiempo, la resolución de comorbilidades y una disminución del riesgo cardiovascular. MATERIAL Y MÉTODOS: estudio retrospectivo que incluyó a todos los pacientes intervenidos consecutivamente mediante bypass gástrico laparoscópico en nuestro centro durante 10 años, en los que se estudiaron la pérdida ponderal, la comorbilidad y los factores de riesgo cardiovascular previos a la cirugía y al final del seguimiento. RESULTADOS: se incluyeron 303 pacientes, 221 mujeres y 82 hombres, con una edad media de 42,3 ± 10,0 años y un IMC de 48,2 ± 6,0 kg/m2. Se siguió al 96,7 % durante 5,7 ± 2,6 años de media. La resolución de comorbilidades al final del seguimiento fue: 53,4 % para la hipertensión arterial, 70,2 % para la diabetes mellitus de tipo 2, 83,9 % para la dislipemia y 71,4 % para el síndrome de apnea-hipopnea del sueño. El riesgo cardiovascular estimado por el algoritmo REGICOR antes y al final del seguimiento fue de 3,2 ± 2,6 y 2,2 ± 1,7, respectivamente, disminuyendo un 32.2 %, al igual que todos los parámetros incluidos en su cálculo salvo los niveles de HDL-colesterol, que no experimentaron variaciones significativas. El índice de masa corporal y el porcentaje de sobrepeso perdido a los 2 años y al final del seguimiento fueron de 30,7 ± 5,2 kg/m2 vs. 33.0 ± 6.1 kg/m2 y 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectivamente. CONCLUSIONES: el bypass gástrico es un método eficaz para resolver la comorbilidad y disminuir el riesgo cardiovascular, pero es muy importante el seguimiento del mayor número de pacientes posible y la comunicación de los resultados a largo plazo para determinar la efectividad real de estos procedimientos

BACKGROUND: bariatric surgery is an effective therapeutic alternative for morbid obesity as it achieves significant weight loss, maintained over time, as well as the resolution of comorbidities and a decreased cardiovascular risk. MATERIAL AND METHODS: a retrospective study that included all patients consecutively undergoing laparoscopic gastric bypass in our center for 10 years, in which weight loss, comorbidities, and cardiovascular risk factors were studied prior to surgery and at the end of follow-up. RESULTS: 303 patients, 221 women and 82 men, with a mean age of 42.3 ± 10.0 years and BMI of 48.2 ± 6.0 kg/m2 were included. Of these, 96.7 % were followed for 5.7 ± 2.6 years on average. The resolution of comorbidities at the end of follow-up included: 53.4 % for high blood pressure, 70.2 % for diabetes mellitus type 2, 83.9 % for dyslipemia, and 71.4 % for apnea-hypopnea sleep syndrome. The cardiovascular risk estimated by the REGICOR algorithm before and at the end of follow-up was 3.2 ± 2.6 and 2.2 ± 1.7, respectively, with a decrease by 32.2 %, like all the parameters included in its calculation except for HDL-cholesterol levels, which did not experience significant variations. The body mass index and percentage of overweight lost at 2 years and at the end of the follow-up was 30.7 ± 5.2 kg/m2 vs. 33.0 ± 6.1 kg/m2 and 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectively. CONCLUSION: gastric bypass is an effective method for the resolution of comorbidities and reduction of cardiovascular risk, but it is very important to monitor as many patients as possible, and to report on the long-term results, to determine the real effectiveness of these procedures

[Effects of gastric bypass on cardiovascular risk and resolution of comorbidities: results at 5 years]. / Efectos del baypass gástrico sobre el riesgo cardiovascular y resolución de comorbilidades: resultados a 5 años.

INTRODUCTION: Background: bariatric surgery is an effective therapeutic alternative for morbid obesity as it achieves significant weight loss, maintained over time, as well as the resolution of comorbidities and a decreased cardiovascular risk. Material and methods: a retrospective study that included all patients consecutively undergoing laparoscopic gastric bypass in our center for 10 years, in which weight loss, comorbidities, and cardiovascular risk factors were studied prior to surgery and at the end of follow-up. Results: 303 patients, 221 women and 82 men, with a mean age of 42.3 ± 10.0 years and BMI of 48.2 ± 6.0 kg/m2 were included. Of these, 96.7 % were followed for 5.7 ± 2.6 years on average. The resolution of comorbidities at the end of follow-up included: 53.4 % for high blood pressure, 70.2 % for diabetes mellitus type 2, 83.9 % for dyslipemia, and 71.4 % for apnea-hypopnea sleep syndrome. The cardiovascular risk estimated by the REGICOR algorithm before and at the end of follow-up was 3.2 ± 2.6 and 2.2 ± 1.7, respectively, with a decrease by 32.2 %, like all the parameters included in its calculation except for HDL-cholesterol levels, which did not experience significant variations. The body mass index and percentage of overweight lost at 2 years and at the end of the follow-up was 30.7 ± 5.2 kg/m2 vs. 33.0 ± 6.1 kg/m2 and 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectively. Conclusion: gastric bypass is an effective method for the resolution of comorbidities and reduction of cardiovascular risk, but it is very important to monitor as many patients as possible, and to report on the long-term results, to determine the real effectiveness of these procedures.

INTRODUCCIÓN: Antecedentes: la cirugía bariátrica es una alternativa terapéutica eficaz en la obesidad mórbida para conseguir pérdidas de peso importantes y mantenidas en el tiempo, la resolución de la comorbilidad y una disminución del riesgo cardiovascular. Material y métodos: estudio retrospectivo que incluyó a todos los pacientes intervenidos consecutivamente mediante baypass gástrico laparoscópico en nuestro centro durante 10 años, en los que se estudiaron la pérdida ponderal, la comorbilidad y los factores de riesgo cardiovascular previos a la cirugía y al final del seguimiento. Resultados: se incluyeron 303 pacientes, 221 mujeres y 82 hombres, con una edad media de 42,3 ± 10,0 años y un IMC de 48,2 ± 6,0 kg/m2. Se siguió al 96,7 % durante 5,7 ± 2,6 años de media. La resolución de la comorbilidad al final del seguimiento fue: 53,4 % para la hipertensión arterial, 70,2 % para la diabetes mellitus de tipo 2, 83,9 % para la dislipemia y 71,4 % para el síndrome de apnea-hipopnea del sueño. El riesgo cardiovascular estimado por el algoritmo REGICOR antes y al final del seguimiento fue de 3,2 ± 2,6 y 2,2 ± 1,7, respectivamente, disminuyendo un 32.2 %, al igual que todos los parámetros incluidos en su cálculo salvo los niveles de HDL-colesterol, que no experimentaron variaciones significativas. El índice de masa corporal y el porcentaje de sobrepeso perdido a los 2 años y al final del seguimiento fueron de 30,7 ± 5,2 kg/m2 vs. 33.0 ± 6.1 kg/m2 y 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectivamente. Conclusiones: el bypass gástrico es un método eficaz para resolver la comorbilidad y disminuir el riesgo cardiovascular, pero es muy importante el seguimiento del mayor número de pacientes posible y la comunicación de los resultados a largo plazo para determinar la efectividad real de estos procedimientos.