ABSTRACT
BACKGROUND: The prevalence of malnutrition in older persons depends on the healthcare setting. In recent years, hospital-based case management programs (CM Programs) targeting individuals in the community with chronic multimorbidity and high use of hospital resources (admissions or emergency visits) have been developed in many countries to reduce the need for complex health care. The objective of this study was to assess the prevalence of risk of malnutrition, using the Short Form of the Mini-Nutritional assessment, of community dwelling patients included in a chronic CM Program. Factors associated with malnutrition risk were also explored. METHODS: Patients included in a hospital-based integrated CM Program for older persons at high risk for hospital readmission after an index admission were studied. MNA-SF was used at program inclusion to assess the risk of malnutrition. An array of factors potentially associated with malnutrition were explored (including feeding route, use of dental prosthesis, dysphagia, consistency of foods, specific therapeutic diets, use of oral nutritional supplements, polypharmacy, falls, and other diseases and geriatric syndromes). RESULTS: 791 participants were included, mean age 79.8 years, 50.1% females. Risk of malnutrition was present in 44.9%. Participants at risk of malnutrition were more frequently female, had a lower BMI, were less likely to be fed orally and used more nutritional supplements. They also had a higher prevalence of dysphagia, needing changes in food consistency or using specific therapeutic diets, and had dementia or cancer more frequently. They also showed a higher need for palliative care. CONCLUSIONS: Risk of malnutrition in patients included in a CM Program is higher than in non-selected community dwelling older individuals. This information may help inform screening policies in similar populations at risk of hospital readmission.
ABSTRACT
OBJECTIVE: We are interested in characterizing the care of these patients in a Short Stay Medical Unit, evaluating their specific necessities and hospital handling. METHOD: By means of an observational study we described the characteristics of 117 elderly patients and/or chronically ill patients who were admitted to our hospital unit for 50 consecutive days in order to determine the specification of the care to these kind of patients. RESULTS: The average age was 76.1 +/- 9.7 años with a similar distribution between men and women. The prevailing chronic illness was the ischemic heart disease (20.5%), and the most frequent cause of admittance was the worsening of chronic obstruction of the air flow (34.2%). 39.5% were terminally ill. 58.1% of the patients showed some dependence to carry out basic activities of daily life (BADL), and the average of geriatric syndromes amongst the patients who were unable to look after themselves, was significantly higher to those who were fully independent (2.29 +/- 1.2 vs 1.57 +/- 0.99 respectively; dif: 0.72; U: 483; p = 0.007). Specially relevant amongst the non-independent patients were non-syncopal falls (31.4% vs 7.1%), vision problems (40% vs 16.7%), and house confinement for severe immobility (25.7% vs 7.1%). In all these cases the difference was significative. A lineal relationship was found between cognitive decline and the incidence of geriatric syndromes with respect to the level of disability for BADL (R = 0.705; b = 0.32; beta: 0.57; p < 0.001 and b = -1.04; beta: -0.22; p = 0.008 respectively). The average hospital stay was of 4.1 +/- 2.6 days; the death rate 9.8%, and early re-admission 11.3%. 99.1% had an identifiable career and in 92.3% of the cases the eventual necessities could be completely satisfied. 25% of the cases were hospitalized in their own homes and 9% were moved to a hospital for longer stays. The impact of the caring activity is seen in the freeing of 15 beds per day during the time of the study. CONCLUSIONS: These findings implicate that in this group of patients, the traditional caring tasks should be complemented with other specific tasks, preventive and of rehabilitation, and its handling needs alternatives that avoid the decline in the quality of the care.
Subject(s)
Aged , Chronic Disease/therapy , Coronary Disease/therapy , Geriatric Assessment , Hospital Units , Lung Diseases, Obstructive/therapy , Terminally Ill , Accidental Falls , Activities of Daily Living , Age Factors , Aged, 80 and over , Female , Humans , Length of Stay , Male , Middle Aged , Quality of Life , Regression Analysis , Vision Disorders/diagnosisABSTRACT
Objetivo: Caracterizar el cuidado de estos pacientes en una unidad de corta estancia, evaluando sus necesidades especificas y su manejo hospitalario. Método: Describimos en un estudio observacional las características de 117 pacientes ancianos y/o crónicos ingresados en nuestra unidad en el transcurso de 50 días consecutivos, a fin de determinar la especificidad en la asistencia a este tipo de pacientes. Resultados: La edad promedio fue de 76,1 ñ 9,7 años, con una distribución similar entre hombres y mujeres. La patología crónica más prevalente resultó ser la cardiopatía isquémica (20,5%), y la causa más frecuente de ingreso la reagudización respiratoria de la obstrucción crónica al flujo aéreo (34,2%). Un 39,3% eran terminales. El 58,1% de la serie mostró alguna dependencia para las actividades básicas de la vida diaria (ABVD), y el promedio de síndromes geriátricos entre los pacientes con discapacidad para el autocuidado, fue significativamente superior al de los plenamente independientes (2,29 ñ 1,2 vs 1,57 ñ 0,99 respectivamente; U: 483; p=0,007). Especialmente prevalentes entre los deficitarios para las ABVD, resultaron las caídas no sincopales (31,4% vs 7,1%), los trastornos de la visión (40%vs 16,7%), y el confinamiento domiciliario por inmovilismo severo (25,7% vs 7,1%). En todos los casos, la diferencia fue significativa. Se encontró relación lineal entre el deterioro cognitivo y la incidencia de síndromes geriátricos con respecto al grado de discapacidad para las ABVD (R = 0,705; b=0,32; b: 0,57; p<0,001; y b=-1,04; b:-0,22; p=0,008 respectivamente). La estancia media hospitalaria resultó ser de 4,1 ñ 2,6 días; la mortalidad del 9,8%; y la prevalencia de los reingresos tempranos, del 11,3%. El 99,1% tenía cuidador identificable, y en el 92,3% de los casos, las necesidades eventuales podían ser satisfechas completamente. Un 25% de los casos fueron hospitalizados en su propio domicilio y un 9% trasladados a un hospital de larga estancia. El impacto de la actividad asistencial se reflejó en la liberación de 15 camas/día, en el tiempo del estudio (AU)
Subject(s)
Female , Male , Middle Aged , Aged, 80 and over , Aged , Humans , Activities of Daily Living , Age Factors , Chronic Disease , Coronary Disease , Length of Stay , Quality of Life , Regression Analysis , Vision Disorders/diagnosis , Accidental Falls , Lung Diseases, Obstructive , Chronic Disease/therapy , Coronary Disease/therapy , Geriatric Assessment , Hospital Units , Terminally Ill , Lung Diseases, Obstructive/therapyABSTRACT
The present study describes the results achieved 6 months after the establishment of a health examination, with different features depending on age and sex groups, which was progressively applied to the population of the C.A.P. "Virgen de la Fuensanta" (Valencia). The preventive activities included: vaccination (rubella, tetanus and influenza), tuberculin skin testing, determination of body weight and mass (BMI), measurement of blood pressure and heart rate, cervical cytology, breast examination and search for occult blood in feces. Among the 388 evaluated individuals (69.4% females and 30.6% males), 10 cases of hypertension, 2 of diabetes, 65 of obesity, 20 of hypercholesterolemia, 23 women with benign breast abnormalities and 8 instances of occult blood in feces were detected. In the age group of 15-26 years, 7 positive tuberculin reactions were detected. In 175 cytological studies no case of malignant disease was discovered. The degree of acceptance of the program by the users was satisfactory, as assessed by the compliance with both the appointments (85%) and the individual interventions (88-100%).
