Characterization in end-of-life care of older people attended by geriatricians / Caracterización de la atención al final de la vida de personas mayores atendidas por geriatría

Background and objective Symptom control at the end of life is essential, and palliative sedation is a viable intervention option for the care of terminally ill patients. This study aims to characterize the elderly population receiving end-of-life care plans and their management with palliative sedation in a geriatric unit at a high complexity hospital. Materials and methods A cross-sectional study was conducted, and a descriptive analysis was performed. Medical records of 163 patients admitted to a high complexity hospital in Bogota, Colombia between January 2016 and December 2019 were reviewed. Results From 163, 141 patients received an end-of-life care plan, and 22 were managed with palliative sedation. The mean age was 84 years, the most frequent cause of death was respiratory infections and 44% of patients had a history of cancer. Prior to admission, functional decline and the presence of moderate to severe dementia were frequently found. About one in ten persons required palliative sedation, which lasted an average of 2.22±5 days. The most common refractory symptom was dyspnea (45.45%), followed by pain (36.36%). Conclusions Palliative sedation is prevalent in the elderly population and characterizing this population can provide increased knowledge to improve end-of-life care (AU)

Antecedentes y objetivos El control de síntomas al final de la vida es fundamental, y la sedación paliativa resulta una opción de intervención en el cuidado de pacientes con enfermedades terminales. El objetivo es caracterizar una población de personas mayores que recibieron un plan de atención del final de la vida, incluyendo sedación paliativa en una unidad de geriatría de un hospital de alta complejidad. Materiales y métodos Estudio de corte transversal, se realizaron análisis descriptivos y se utilizaron métodos de acuerdo con el tipo de variable. Se revisaron las historias clínicas de 163 pacientes entre enero de 2016 y diciembre de 2019 de un hospital de alta complejidad en Bogotá, Colombia. Resultados Sobre 163 pacientes, 141 recibieron plan de atención de final de vida y 22 fueron manejados con sedación paliativa. La edad promedio fue de 84 años y el 58% eran mujeres. La causa de muerte más frecuente fue respiratoria infecciosa; el 44% tenían antecedente oncológico. La declinación funcional previa al ingreso y la presencia de demencia moderada o severa fueron condiciones que frecuentemente se encontraron en quienes se reorientó el esfuerzo terapéutico. Una de cada 10 personas requirió sedación paliativa, cuya duración fue de 2,22±5 días, el síntoma refractario más frecuente fue la disnea (45,45%), seguido de dolor (36,36%). Conclusiones La sedación paliativa resulta frecuente en la población mayor con enfermedades no oncológicas. La caracterización de estas personas promueve el aumento del conocimiento y la preparación para mejorar el manejo del final de la vida (AU)

Characterization in end-of-life care of older people attended by geriatricians.

BACKGROUND AND OBJECTIVE: Symptom control at the end of life is essential, and palliative sedation is a viable intervention option for the care of terminally ill patients. This study aims to characterize the elderly population receiving end-of-life care plans and their management with palliative sedation in a geriatric unit at a high complexity hospital. MATERIALS AND METHODS: A cross-sectional study was conducted, and a descriptive analysis was performed. Medical records of 163 patients admitted to a high complexity hospital in Bogota, Colombia between January 2016 and December 2019 were reviewed. RESULTS: From 163, 141 patients received an end-of-life care plan, and 22 were managed with palliative sedation. The mean age was 84 years, the most frequent cause of death was respiratory infections and 44% of patients had a history of cancer. Prior to admission, functional decline and the presence of moderate to severe dementia were frequently found. About one in ten persons required palliative sedation, which lasted an average of 2.22±5 days. The most common refractory symptom was dyspnea (45.45%), followed by pain (36.36%). CONCLUSIONS: Palliative sedation is prevalent in the elderly population and characterizing this population can provide increased knowledge to improve end-of-life care.

Association of Malnutrition with Functional and Cognitive Trajectories in People Living with Dementia: A Five-Year Follow-Up Study.

BACKGROUND: In dementia, functional status depends on multiple factors in addition to cognition. Nutritional status is a potentially modifiable factor related to homeostasis and proper functioning of body systems and may contribute to cognitive and functional decline. OBJECTIVE: This paper aims to analyze the association of malnutrition with the course of cognitive and functional decline in people living with dementia. METHODS: This is an analysis of a longitudinal cohort study, the Dementia Study of Western Norway. Data of 202 patients diagnosed with mild dementia were analyzed; Alzheimer's disease (AD) (n = 103), Lewy body dementia (LBD) (n = 74), and other dementias (OD) (n = 25). Cognition was assessed with the Mini-Mental State Examination and functional decline through the activities of daily living included in the Rapid Disability Rating Scale. The Global Leadership Initiative on Malnutrition Index was used to determine nutritional status. Associations of nutritional status with cognitive and functional decline were evaluated through adjusted linear mixed models. RESULTS: At baseline, the prevalence of general malnutrition was 28.7%; 17.3% were classified as moderate malnutrition and 11.38% as severe malnutrition (there were no significant differences between AD and LBD). Malnutrition at diagnosis and over follow-up was a significant predictor of functional-decline, but not of cognitive decline. CONCLUSION: According to our results malnutrition was associated with faster functional loss but, not cognitive decline in older adults with dementia. A more comprehensive dementia approach including nutritional assessments could improve prognosis.

Association between self-reported hearing impairment, use of a hearing aid and performance of instrumental activities of daily living.

BACKGROUND AND PURPOSE: Age-related hearing loss is a prevalent condition among the growing elderly population, which has been associated with both cognitive decline and decreased daily functioning. Decreased functioning is linked to lower performance, predominantly regarding instrumental activities of daily living (IADLs). The present study aims to explore the association between hearing loss and impairment in IADLs. METHODS: This is a secondary analysis of The Health, Well-Being, and Aging Colombia study, performed in 2015. Participants were classified into three groups: 1) without hearing loss, 2) hearing loss corrected through the use of a hearing aid, and 3) hearing loss without a hearing aid. Bivariate and adjusted multivariate analyses were performed. The measured outcome was IADLs. RESULTS AND DISCUSSION: Information from a total of 23,694 community-dwelling Colombian older adults (age ≥ 60 years) was used. The prevalence of hearing impairment was 23.4%, 1.8% out of those reported the use of hearing aids. Independent associations were found for having impaired IADLs when comparing participants with hearing loss without a hearing aid and those with normal hearing. However, there was no statistical significance with respect to IADLs when comparing hearing loss corrected by hearing aids versus participants with normal hearing. Participants using hearing aids have better functioning evaluated by IADLs when compared with participants with hearing impairment and no hearing aids. CONCLUSION: This study evidences a positive association between hearing impairment and performance in the IADLs. This association is not significant in older adults using hearing aids.

Hallazgos radiológicos en sistema nervioso central (SNC) del síndrome de MELAS: reporte de caso / Radiological findings of MELAS syndrome in central nervous system (CNS): case report

RESUMEN Presentamos el caso clínico de una paciente adulta joven con episodios recurrentes sugestivos de ataque cerebrovascular, con cambios radiológicos típicos de enfermedad de MELAS con confirmación genética de mutación en el gen A3243G.

SUMMARY A clinical case of a young adult patient with recurrent episodes suggestive of stroke, with typical radiological changes of MELAS disease with genetic confirmation of mutation in A3243G gene.