Pedro Paulo Marín

Impact of delirium on short-term mortality in elderly inpatients: a prospective cohort study.

BACKGROUND Delirium is an important problem especially in older medical inpatients. OBJECTIVE The authors asked whether delirium and its duration are associated with higher mortality in a 3-month follow-up period. METHOD In this prospective cohort study, inpatients age 65 and older were assessed every 48 hours with the Confusion Assessment Method. RESULTS Of 542 patients enrolled, 192 (35.4%) developed delirium. After 3 months, mortality in the delirium cohort was 25.9%, and in the nondelirium cohort was 5.8%. Delirium was independently associated with mortality, and increased by 11% for every 48 hours of delirium. CONCLUSION Delirium and increased delirium durations are significantly associated with higher mortality.

Health care for the elderly in Chile: A country in transition

Chile’s demographic and epidemiological transitions are among the most advanced in Latin America. This article documents the new importance of chronic disease and conditions that significantly affect the quality of life of the older population, noting that primary care-sensitive conditions such as poor vision, hearing, and dental care are among the most common unmet health needs of the older population. An overview of the health care system in Chile shows that it is a mixed public-private system in both insurance and provision, but the organization of the system forces most elderly persons into the public system. The dominance of the public system in the care of the aged has the potential to improve the organization and delivery of needed services, but up to now health care for older persons has not been a top priority compared to broader macro system issues. We discuss directions that Chile could take within its current economic and institutional structure that would make it more responsive to the aging population.

Identificación y caracterización del adulto mayor saludable

Aun no existe una definicion operacional de envejecimiento saludable en la practica clinica, pese a ser una meta de las politicas de salud de la OMS. El objetivo de este estudio es desarrollar un protocolo clinico que permita identificar personas mayores saludables en la comunidad, con el fin de estudiar sus caracteristicas clinicas, de laboratorio y funcionalidad. Metodos: Se invito de manera abierta a participar de este estudio a personas mayores saludables. Se considero saludable a individuos mayores de 60 anos, de la comunidad, funcionalmente activos, con baja carga de comorbilidad y que se auto-percibieran saludables. Los participantes fueron entrevistados telefonicamente y aquellos que cumplieron los criterios fueron evaluados mediante una evaluacion geriatrica integral, que incluia evaluacion clinica, antropometrica, funcional (Timed get up and Go), y laboratorio. Resultados: Un total de 384 personas respondieron al llamado y 83 cumplieron los criterios de saludable, 57% mujeres, edad promedio 71 anos (60-98), 78% no consumia ningun medicamento, 100% tenia una capacidad fisica mayor de 3 Mets . El laboratorio basico mostro que cerca del 90% de los sujetos estaba en el rango de normalidad usando los criterios de referencia estandar establecido para poblacion adulta. Conclusiones: Este estudio revela que el protocolo desarrollado fue capaz de identificar personas mayores saludables, con baja carga de comorbilidad y buena funcionalidad. Ademas valida la historia clinica y la valoracion geriatrica integral como instrumento fidedigno para identificar a estos sujetos. Este protocolo podria ser usado para mejorar el conocimiento sobre las caracteristicas propias de un envejecimiento saludable.

Impacto del Delirium en pacientes de edad avanzada hospitalizados: Un estudio prospectivo de cohortes.

BACKGROUND: Delirium is an important problem in older medical inpatients. AIM: To assess if delirium is associated with higher mortality, functional decline or higher rates of readmission or institutionalization in a one year follow-up period. MATERIAL AND METHODS: Prospective cohort study of consecutive patients 65 years and older, admitted to a general hospital medical ward. A psychogeriatric team assessed patients every 48 h using the Confusion Assessment Method (CAM), functionality, acute severity and comorbidity scores. Analysis of one year mortality and telephone functional assessment was performed. RESULTS: Five hundred forty two patients were enrolled and 35.4% had delirium. After one year, mortality was 34.9 and 13% in delirium and non-delirium cohorts, respectively (p < 0.01). After adjustment for covariates, delirium was independently associated with higher mortality, and higher functional decline and institutionalization. No significant differences were seen in readmission rates. CONCLUSIONS: Delirium was significantly associated with higher mortality and functional decline over a one year follow up period in geriatric inpatients.BACKGROUND Delirium is an important problem in older medical inpatients. AIM To assess if delirium is associated with higher mortality, functional decline or higher rates of readmission or institutionalization in a one year follow-up period. MATERIAL AND METHODS Prospective cohort study of consecutive patients 65 years and older, admitted to a general hospital medical ward. A psychogeriatric team assessed patients every 48 h using the Confusion Assessment Method (CAM), functionality, acute severity and comorbidity scores. Analysis of one year mortality and telephone functional assessment was performed. RESULTS Five hundred forty two patients were enrolled and 35.4% had delirium. After one year, mortality was 34.9 and 13% in delirium and non-delirium cohorts, respectively (p < 0.01). After adjustment for covariates, delirium was independently associated with higher mortality, and higher functional decline and institutionalization. No significant differences were seen in readmission rates. CONCLUSIONS Delirium was significantly associated with higher mortality and functional decline over a one year follow up period in geriatric inpatients.

Falta de reconocimiento de osteoporosis y omisión de tratamiento en adultos mayores con fractura de cadera en Chile

Background: Hip fractures are the most severe complication of osteoporosis, yet patients who suffer hip fracture rarely receive adequate treatment. Aim: To assess diagnosis and treatment of osteoporosis in patients with hip fracture. Patients and methods: a retrospective study in 203 patients admitted for hip fracture surgery at two medical institutions in Santiago, Chile. Clinical data from 101 patients from the Hospital Clinico Pontificia Universidad Catolica de Chile (a university tertiary care hospital, HCPUC) and 102 patients from Hospital de Urgencia de la Asistencia Publica (a public emergency hospital, HUAP) were reviewed. We also evaluated incidence of new fractures, further treatment of osteoporosis and functionality, by means of a telephonic survey of 48% of patients (n=99) 12.3±5.3 months after hip fracture in HCPUC and 16.5±3.0 months for HUAP. Results: A previous diagnosis of osteoporosis was present in 2.9% and 1% of cases, and treatment prior to fracture in 3.9% and 0% of cases from HCPUC and HUAP, respectively. None of the patients in HUAP were diagnosed with osteoporosis during hospital stay or given treatment for this condition at discharge, in comparison to 0.9% (n=1) and 2% (n=2), respectively, in HCPUC. Seven and six percent of cases presented prior hip fractures. Telephonic follow up of patients revealed that 75.6% persisted without treatment for osteoporosis. At follow up, 2.9% and 3% of patients in HCPUC and HUAP had presented new hip fractures. At the time of survey 30.9% and 34% of patients, respectively, were considered invalid. Conclusions: Missed diagnosis and failure to treat osteoporosis occurred in over 90% of patients admitted for hip fracture, regardless of the different complexities in the hospitals of admission. The data suggest that lack of medical action on these issues may play a role in failure to prevent new hip fractures (Rev Med Chile 2003; 131: 773-8)

Uso inapropiado de medicamentos en adultos mayores: resultados de la Encuesta Nacional de Salud 2010

Background: Inappropriate medication use in older people is an important source of adverse events and complications. Aim: To determine the frequency of inappropriate medication use in the general population. Material and methods: As part of the 2010 Chilean National Health Survey, 1048 persons aged 65 years or more were interviewed about medication use. The information obtained was analyzed using standardized Beer’s criteria, adapted for the Chilean population, to define inappropriate medication use. A logistic regression model was performed to define risk factors for inappropriate medication use. Results: Ten percent of subjects had a high risk of inappropriate medication use. The most common medications used were chlorphenamine, amitriptyline, diazepam, chlorpromazine, chlordiazepoxide and piroxicam. The risk factors detected were female gender, polypharmacy and a bad health self-perception. Conclusions: Inappropriate medication use is common among Chilean older people and should be discouraged.

Deterioro cognitivo e hiperparatiroidismo primario: resultado favorable después de cirugía: Caso clínico

We report a 79-year-old male patient presenting with progressive memory loss associated with anxiety and muscularpain. An extensive biochemical control revealed high serum calcium and parathormone levels, and normal thyroid hormones. Cognitive assessment prior to surgery was compatible with mild cognitive impairment, showing significant improvement two months after parathyroidectomy. Our case suggests that, although rare, primary hyperparathyroidism should be considered as a possible cause of cognitive decline in the elderly.

Evaluación geriátrica inicial en una comunidad urbana y una rural en Chile con las "Escalas de la Cruz Roja Española y Social UC Chile"

Resumen La mayoria de los adultos mayores funcionan adecuadamente y no requieren una evaluacion geriatrica exhaustiva. No obstante existe un grupo en riesgo de declive, en el cual una deteccion precoz es vital para evitar mayor deterioro. Este articulo presenta los hallazgos de un estudio a gran escala de cribado geriatrico en una poblacion rural y otra urbana de bajos ingresos, en Chile. Se documenta la utilidad de un instrumento simple, la “Escala de la Cruz Roja y Social UC Chile”, para identificar sujetos con deterioro funcional, mental o social, que podrian beneficiarse de una valoracion geriatrica integral. Se anade una evaluacion social (la Escala Social UC Chile) a las Escalas funcional y mental de la Cruz Roja, lo que agrega importante informacion. Se encontro que los adultos mayores rurales tenian mayor discapacidad fisica y mejor soporte social que sus pares urbanos. No hubo diferencias en la evaluacion mental de ambas comunidades. La “Escala de la Cruz Roja y Social UC Chile” resulto ser un instrumento util que puede ayudar a identificar a aquellos adultos mayores que podrian beneficiarse de una valoracion geriatrica integral.

Internal Medicine and Public Health.

A special Committee on Internal Medicine and Public Health was established by Sociedad Medica de Santiago (Chilean Society of Internal Medicine) in April 2007 with the duty to write a Consensus Paper on the interaction between both branches of medical profession. The main objective was to find the common grounds on which to construct a positive approach to regain space for Internal Medicine, based on prevalent epidemiological features related to adult health issues. The authors describe the reasons to explain the gap between clinical medicine and population health and identify the nature and evolution of chronic diseases as the point of encounter between both. With Chilean health surveys data, they state that chronic diseases explain the high proportion of burden of disease, mortality and disability, and stress that by the year 2025 one in every five inhabitants will be over 65 years of age, with ageing as another main problem for the health care sector. Population with multiple risks and multimorbidity is the most important challenge for the Chilean Health Care System. A new model of care is needed to tackle this scenario with new skills regarding psychosocial determinants of health. The leading role of internists and ideally geriatricians, will be crucial in this process and will help the implementation of sound population based interventions. Both individual and community level interventions will help to improve quality of life of Chilean families.