Planificación anticipada de los cuidados y del uso de recursos hospitalarios en pacientes con COVID-19 en un programa de atención integrada para adultos mayores frágiles en residencias / Advance care planning and use of health resources among COVID-19 nursing home patients in an integrated health care program for frail elders

Objetivos: Evaluar la magnitud y la trascendencia de un proceso de estratificación y planificación anticipada de los cuidados y el uso de recursos hospitalarios en pacientes con COVID-19 en un programa de atención integrada para pacientes adultos mayores frágiles en residencias. Material y métodos: Estudio de cohorte prospectiva de pacientes >64 años con COVID-19 en un programa en residencias, desde marzo a septiembre de 2020. Se evaluó la identificación de pacientes con necesidad de abordaje paliativo (NECPAL positivo), la realización de la planificación anticipada del cuidado y su registro visible en la historia clínica electrónica. Se evaluó la utilización de cuidados intensivos. Resultados: Trescientos setenta y cuatro pacientes tuvieron COVID-19: el 88% eran mujeres, mediana de edad 88 años. El 79% tenían necesidades de abordaje paliativo, de los cuales el 68% tenía registrada la planificación anticipada del cuidado (p<0,001) en su historia clínica electrónica. Solamente el 1% de los pacientes con necesidad de abordaje paliativo con criterios de severidad utilizó cuidados intensivos. La mortalidad global fue del 25%. De los fallecidos, el 74% tenían criterios de severidad (p<0,001) y el 90% tenían necesidad de abordaje paliativo (p<0,001). Conclusiones: Realizar un proceso de atención basado en la estratificación e identificación de pacientes con necesidad de abordaje paliativo y la planificación anticipada del cuidado, con registro en un lugar central y visible de la historia clínica electrónica, podría mejorar la calidad y la seguridad de la atención, adecuando los recursos a las necesidades del paciente en todo momento y especialmente en situaciones de emergencia sanitaria. (AU)

Objectives: To estimate the magnitude and importance of a process of stratification and advance care planning and the use of health resources, among patients in an integrated health care program for frail elderls in nursing homes,that were referred to the hospital with COVID-19. Material and methods: Prospective cohort study of patients >64 years old with COVID-19 infection, in a health care program in nursing homes (from 3/15/2020 to 9/15/2020). The identification of patients with palliative needs, the performing and visible registration in electronic health records of the advance care planning and the use of intensive care were assessed. Results: We included 374 COVID-19 patients. 88% were women, the median age was 88 years old. The 79% were patients with palliative needs, of which 68% had the advance care planning (P<.001) registered in the electronic health record. Only 1% of patients with palliative needs and severity criteria were admitted to the intensive care unit. Overall mortality was 25%. Of those who died, 74% had severity criteria (P<.001) and 90% had palliative needs (P<.001). Conclusions: Carrying out a care process based on identification of patients with palliative needs and advance care planning and a central and visible registration of advance care planning in health records, could improve the quality and safety of care and optimize the use of intensive care health resources at all times and especially in public health emergencies. (AU)

[Advance care planning and use of health resources among COVID-19 nursing home patients in an integrated health care program for frail elders]. / Planificación anticipada de los cuidados y del uso de recursos hospitalarios en pacientes con COVID-19 en un programa de atención integrada para adultos mayores frágiles en residencias.

OBJECTIVES: To estimate the magnitude and importance of a process of stratification and advance care planning and the use of health resources, among patients in an integrated health care program for frail elderls in nursing homes,that were referred to the hospital with COVID-19. MATERIAL AND METHODS: Prospective cohort study of patients >64 years old with COVID-19 infection, in a health care program in nursing homes (from 3/15/2020 to 9/15/2020). The identification of patients with palliative needs, the performing and visible registration in electronic health records of the advance care planning and the use of intensive care were assessed. RESULTS: We included 374 COVID-19 patients. 88% were women, the median age was 88 years old. The 79% were patients with palliative needs, of which 68% had the advance care planning (P<.001) registered in the electronic health record. Only 1% of patients with palliative needs and severity criteria were admitted to the intensive care unit. Overall mortality was 25%. Of those who died, 74% had severity criteria (P<.001) and 90% had palliative needs (P<.001). CONCLUSIONS: Carrying out a care process based on identification of patients with palliative needs and advance care planning and a central and visible registration of advance care planning in health records, could improve the quality and safety of care and optimize the use of intensive care health resources at all times and especially in public health emergencies.

[Longitudinal follow-up of a population with cognitive complaint: characteristics and progression profile]. / Seguimiento longitudinal de pacientes con queja cognitiva: características y perfiles de progresión.

Cognitive complaint is a common cause of consultation among older adults at the primary care level and it may be the first symptom of cognitive impairment, thus its assessment and follow-up are essential for an early diagnosis. AIM: to describe the baseline neurocognitive profile and evolution of patients with cognitive complaint evaluated at the geriatric assessment unit of the Hospital Italiano de Buenos Aires. METHODS: observational study of a retrospective cohort of 518 patients with cognitive complaint who underwent a comprehensive geriatric evaluation and cognitive impairment screening tests at the first visit and follow-up visits. Patients diagnosed with dementia at baseline were excluded. RESULTS: 323 (62.36%) subjects were diagnosed with mild cognitive impairment at the first visit and 195 (37.64%) had no cognitive impairment. Of the all the patients, 216 (41.7%) subjects showed worsening of their baseline cognitive status. They had an older age at baseline evaluation, a lower educational level and a worse outcome at Mini Mental State Examination and at memory, executive and language tests than those who remained stable. CONCLUSION: in this follow-up study of a cohort with cognitive complaint we verify the impact of age, educational level and poor outcomes on memory, executive function and language domains as variables associated with progression of cognitive impairment.

[Study of the performance of complex activities of daily living in a population of patients with mild cognitive impairment. Mild functional impairment: A new clinical entity?] / Estudio del desempeño de las actividades complejas de la vida diaria en una población de pacientes con Deterioro Cognitivo Leve. Deterioro Funcional Leve: ¿una nueva entidad clínica?

Several papers describe functional changes in the aging population, and its relevance in the early cognitive impairment detection. Alterations in instrumental activities would constitute a diagnostic marker of MCI and predict the progression to Dementia. In order to count on a tool to evaluate the performance in the use of new technologies we have designed a new protocol, Complex Functional Study (CFS), that quantifies performance and functional changes Related to previous states. OBJECTIVES: To compare CFS scores in patients with MCI with a control group without cognitive impairment (CD) and verify their diagnostic performance to detect complex function alterations in reference too the functional scales, Instrumental Activities of Daily Living (AVDI) and Disability Assessment for Dementia (DAD). METHODS: Patients with MCI and controls were included. All subjects were evaluated with a neurocognitive battery, and functional scales (EFE).STATA software version 14.2 was used for data analysis. RESULTS: 269 recruited patients older than 65 years old, 173 with diagnosis of MCI and 96 controls. The MCI patients obtained significantly higher EFE scores tan subjects without DC (p < 0,001).The EFE presented a greater sensitivity to detect the functional alteration (EFE 81.5%, AVDI 25.9%, DAD 18.5%). CONCLUSIONS: The EFE is an instrument of optimal clinical value, with good sensitivity to identify the alteration of the complex activities of daily life in patients with MCI. The results allow to characterize a profile compatible with Light Functional Impairment.