Atención domiciliaria especializada en pacientes con demencia / Specialized home care for patients with dementia

OBJETIVO: Analizar las características de los pacientes con demencia atendidos por un equipo de soporte de atención domiciliaria y establecer si existen diferencias en cuanto a la actuación en pacientes con otras enfermedades. MATERIAL Y MÉTODOS: Estudio analítico prospectivo, comparativo de 2 cohortes de pacientes atendidos en sus domicilios (una afecta de demencia y la segunda sin dicho antecedente), comparando edad, sexo, cuidador principal, número de visitas y tiempo de seguimiento, motivo de alta, antecedentes médicos, índices de Barthel previo a intervención y en la primera visita del equipo de soporte de atención domiciliaria, cuestionario de Pfeiffer, tipo de demencia y escala Global Deterioration Scale de Reisberg, número de fármacos previos, presencia de síntomas (dolor, disnea, náuseas, ansiedad, depresión, insomnio, agitación) tratamiento de síntomas o modificación de tratamiento previo, necesidad de sedación. Análisis de datos con programa SPSS 15.0. RESULTADOS: Del total de pacientes atendidos (N=638), 195 constituyeron la cohorte de pacientes con demencia (30,7%). La causa más frecuente fue demencia vascular 40,4% (N=74). El Global Deterioration Scale medio resultó 6±1,05, con una puntuación media de 8,87 errores en el test de Pfeiffer y con un índice de Barthel medio de 11,9±23. En pacientes sin demencia, se obtienen diferencias significativas en cuanto a la situación funcional y cognitiva (índice de Barthel de 52,34±38 y test de Pfeiffer con una puntuación media de 1,48±3,2 (p < 0,001)). El paciente con demencia, más frecuentemente institucionalizado (el 37,9% frente a 11,8% en no dementes), presenta en mayor cuantía síndrome de inmovilidad (70,3 frente al 24%) y presencia de úlceras por presión (el 19,6 frente al 3,9%), menor presencia de clínica salvo agitación y menor necesidad de sedación paliativa (el 8,2 frente al 20,4%). Son pacientes con una menor mortalidad el 31,8 frente al 53,1%) y una menor necesidad de hospitalización (el 6,7 frente al 17,5%), sin evidenciarse diferencias en la actividad asistencial. CONCLUSIONES: Nuestros resultados muestran que estos pacientes presentan un perfil sintomático y funcional lentamente progresivo que requerirá una atención centrada en los momentos de crisis, pudiendo disminuir ingresos hospitalarios mediante un adecuado control de síntomas

OBJECTIVE: to Analyze the characteristics of patients with dementia attended by a home care support team and to establish whether there are differences from patients with other diseases. MATERIAL AND METHODS: A prospective, comparative analytical study of 2 cohorts of patients attended at home, one with dementia and one without, comparing age, sex, principal caregiver, number of visits and time of follow-up, reason for discharge, medical comorbidity, Barthel index prior to intervention and on the first home care support team visit, Pfeiffer questionnaire, type of dementia and Global Deterioration Scale of Reisberg, amount of previous medication, presence of symptoms (pain, dyspnoea, nausea, anxiety, depression, insomnia, agitation) treatment of symptoms or modification of previous treatment, need for sedation. Data analysis with SPSS 15.0 software. RESULTS: Of all patients attended (N=638), 195 comprised the cohort of patients with dementia (30.7%). The most common cause was vascular dementia 40.4% (N=74). The average Global Deterioration Scale was 6±1.05, with an average score of 8.87 errors in the Pfeiffer test and average Barthel index of 11.9± 23. In the patients without dementia, significant differences were obtained in terms of functional and cognitive status (Barthel index of 52.34±38 and Pfeiffer test with an average score of 1.48 ±3.2 (P<.001)). The patients with dementia, most commonly institutionalised (37.9% versus 11.8% in non-demented), presented a greater amount of immobility syndrome (70.3% versus 24%) and pressure ulcers (19.6% compared to 3.9%), fewer symptoms other than agitation and less need for palliative sedation (8.2% versus 20.4%). These are patients with lower mortality 31.8% versus 53.1%) and a reduced need for hospitalisation (6.7% versus 17.5%), with no differences in clinical activity. CONCLUSIONS: Our results suggest that these patients have a slowly progressive symptomatic and functional profile that will require attention at times of crisis, hospital admissions could be reduced by adequate control of symptoms

Declive funcional y presencia de síntomas en cuidados paliativos: ¿causa o consecuencia? / Functional decline and presence of symptoms in palliative care: cause or consequence?

Introducción. Diversas publicaciones han relacionado el declive funcional con la aparición de síntomas, especialmente psicológicos o psiquiátricos, como ansiedad y depresión. Por otra parte, un trastorno depresivo inicial o previo al declive funcional también suele empeorarlo. Nos planteamos conocer la relación entre la existencia de declive funcional medido mediante descenso en índice de Barthel (IB) y la presencia de síntomas. Material y métodos. Estudio analítico prospectivo con los pacientes derivados a un Equipo de Soporte para Atención Domiciliaria (ESAD). Resultados. Seiscientos treinta y ocho casos, 53,9% (N=344) hombres, 56% (N=357) oncológicos y 44% (N=281) no oncológicos. La edad media fue 79,64 ± 10,8 años. Obtuvimos diferencias significativas (p<0,001) en declive funcional medido mediante descenso medio en el IB entre pacientes oncológicos (34,4) y no oncológicos (12,12). Encontramos diferencias significativas (p<0,001) en todos los síntomas registrados (dolor, disnea, anorexia, náuseas, ansiedad, depresión e insomnio) con mayor frecuencia en pacientes oncológicos, salvo en el caso de la agitación psicomotriz. En pacientes con mayor grado de declive funcional, con descensos en IB superior a 20 puntos, se detectó mayor presencia de síntomas. Salvo determinados analgésicos, no hubo diferencias en los tratamientos previos; sí encontramos diferencias en diversos tratamientos pautados por el ESAD. Conclusiones. La existencia de declive funcional y su grado pueden verse relacionados con la aparición de síntomas, especialmente en el paciente oncológico (AU)

Introduction. Several publications have related functional decline to the appearance of symptoms, especially psychiatric or psychological ones, such as anxiety and depression. Moreover, an initial depressive disorder or prior to functional decline usually worsens it. It was decided to investigate the relationship between the presence of functional decline, measured by a decrease in the Barthel index (BI), and the presence of symptoms. Material and methods. A prospective analytical study conducted on patients referred to a Home Care Support Team (HCST). Results. The study included 638 cases, of which 53.9% (N=344) were male, 56% (N=357) with cancer and 44% (N=281) geriatric. The mean age was 79.64 years+- 10.8. Significant differences (P<.001) were found in functional decline measured by mean decline in the BI between cancer (34.4) and non-cancer patients (12.12). Significant differences (P<.001) were also found in all recorded symptoms (pain, dyspnoea, anorexia, nausea, anxiety, depression, and insomnia), more frequently in cancer patients, except psychomotor agitation. A higher presence of symptoms was detected in patients with greater functional decline, with decreases in BI above 20 points. There were no differences in previous treatments, except in certain analgesics. Differences were found in the different treatments prescribed by HCST. Conclusions. The presence of functional decline and its level may be related to the appearance of symptoms, especially in cancer patients (AU)

[Functional decline and presence of symptoms in palliative care: Cause or consequence?] / Declive funcional y presencia de síntomas en cuidados paliativos: ¿causa o consecuencia?

INTRODUCTION: Several publications have related functional decline to the appearance of symptoms, especially psychiatric or psychological ones, such as anxiety and depression. Moreover, an initial depressive disorder or prior to functional decline usually worsens it. It was decided to investigate the relationship between the presence of functional decline, measured by a decrease in the Barthel index (BI), and the presence of symptoms. MATERIAL AND METHODS: A prospective analytical study conducted on patients referred to a Home Care Support Team (HCST). RESULTS: The study included 638 cases, of which 53.9% (N=344) were male, 56% (N=357) with cancer and 44% (N=281) geriatric. The mean age was 79.64 years+- 10.8. Significant differences (P<.001) were found in functional decline measured by mean decline in the BI between cancer (34.4) and non-cancer patients (12.12). Significant differences (P<.001) were also found in all recorded symptoms (pain, dyspnoea, anorexia, nausea, anxiety, depression, and insomnia), more frequently in cancer patients, except psychomotor agitation. A higher presence of symptoms was detected in patients with greater functional decline, with decreases in BI above 20 points. There were no differences in previous treatments, except in certain analgesics. Differences were found in the different treatments prescribed by HCST. CONCLUSIONS: The presence of functional decline and its level may be related to the appearance of symptoms, especially in cancer patients.

Tromboembolia pulmonar en un paciente con trombofilia familiar de origen genético debida a homocigosis en mutación 20209C>T / Pulmonary embolism in a patient with familial thrombophilia due to homozygotic genetic mutation in 20209C>T

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