Pedro Paulo Marín L

Depresión en el adulto mayor: evaluación preliminar de la efectividad, como instrumento de tamizaje, de la versión de 5 ítems de la Escala de Depresión Geriátrica

Introduction: The best approach to improve under-recognition of depression is routine screening, idealy using an instrument that is highly effective and easy to administer. Objective: To test the effectiveness of the 5-item version of the Geriatric Depression Scale (5-GDS) for depression screening in a community-dwelling Chilean elderly population. Participants and Methods: 110 subjects were evaluated at the geriatric outpatient clinic of a university teaching hospital. Patients answered a questionnaire that included the Geriatric Depression Scale (GDS), and demographic information. Using the 15-item GDS score as reference standard to classify subjects as depressed, test characteristics of the 5-GDS were evaluated. Results: Subjects had a mean 15-item GDS score of 5.4; 47% classified as depressed. Depressed and not depressed subjects were similar with regard to demographics, educational level and comorbid conditions. The mean score was 1.9 for the 5-item GDS. Pearson correlation for 15-item and 5-item GDS scores was 0.92, p<0.001. Using 15-item GDS score as reference standard, the 5-item GDS had a sensitivity of 0.88, specificity 0.90, positive predictive value 0.88 and negative predictive value 0.90. Conclusions: The 5-item GDS seems to be a promising screening tool for depression. If revalidated against clinical evaluation, it might be the preferred screening tool for depression in the Chilean community-dwelling elderly. (Rev Med Chile 2000; 128: 1199-1204)

Características de las caídas en el adulto mayor que vive en la comunidad

BACKGROUND Falls by older adults are a frequent problem among ambulatory patients in primary care. AIM To describe the prevalence and features of falls among elders consulting to an ambulatory Geriatric Clinic. PATIENTS AND METHODS Persons aged 60 years or more were surveyed about the number of falls in the preceding six months, the characteristics and consequences of each falls. Biopsychosocial characteristics were recorded and the Tinetti gait and balance test was performed in all patients reporting falls. RESULTS In 104 (18.2%) of 571 clinical consultations, one or more falls were reported. Among patients who fell and provided complete data (n = 95), 64% reported one fall and 36% reported two or more, totaling 156 falls to analyze. The mean age of the patients with falls was 71.8 +/- 6.8 years. The functional and cognitive status was normal in 73 and 71.6% of cases respectively and 38% carried out periodical physical activity. Fifty seven percent of falls occurred outside of home, and an extrinsic factor was a precipitating cause in 55% of the falls. A post-fall syndrome appeared in 21% of cases and 2.6% resulted in fractures. Falling two or more times versus one time during the last six months was statistically associated with an age over 75, an absence of periodic physical activity, functional impairments, three or more chronic diseases, neurological diseases and with living alone, among other variables. CONCLUSIONS Falls among elders occur mainly outside of home, in subjects older than 75 years old, functionally dependent and with an important involvement of extrinsic factors. Physical activity, as well as the control of environmental risks, could be protective factors against recurrent falls.

Adultos Mayores institucionalizados en Chile: ¿Cómo saber cuántos son?

Background: Elderly people (>60 years) in Chile represented 11.4% (n=1.717.478) of the total population in 2002. The group with disabilities or mental problems is increasing and there is no reliable information about the number of institutionalized elderly subjects. Aim: To estimate the number of elderly people living in residences for long term care and their and main characteristics. Patients and methods: Chilean Census does not provide exact information about institutional care, therefore we developed a «proxy» indicator of the percentage of institutionalized elderly (those living in «collective residences with more than 5 elderly persons and in which they represent more than 25% of the residents». This proxy has a R2=0.9859 with the true value of institutionalized persons for those Latin-American countries with exact value in census data at CELADE. Results: Using the proxy we found that institutionalized elderly population had increased from 14,114 (1992) to 26,854 (2002) and is projected to reach 83,500 (2025). In 2002, there were 1.668 institutions (37.4% informal care). In the Metropolitan Area, there were 804 institutions (14.178 elderly persons) and 40.3% of these were registered at the Ministry of Health. The proportion of institutionalized elderly subjects was 1.56% of the total elderly population; this proportion increased from 0.87% in subjects 60-74 years old to 2.5% among subjects aged 75-84 years and 6.1% in subjects 85 years old and over. Among subjects living in institutions, 60.9 were women, 21% were married, 35% were single, approximately 50% receive a pension and around 15% were handicapped. Conclusions: Institutional care affects a small percentage of elderly population, but it will increase in the near future. The main characteristics of institutionalized elderly subjects are not well known. We propose to create a formal Registry of these institutions and to include Nursing Homes and hospitals in type of housing of future Censuses (Rev Med Chile 2004; 132: 832-8). (Key Words: Aged; Housing for the elderly; Institutionalization; Proxy)

Subdiagnóstico de delirium en adultos mayores hospitalizados

Background: Delirium is a common underdiagnosed and undertreated problem in elderly inpatients, associated to higher morbidity, mortality and health cost. Aim: To evaluate the prevalence of delirium at hospital admission in medically ill elderly patients and the attending physicians diagnosis and treatment of delirium. Patients and methods: In a prospective and descriptive study, consecutive patients aged 65 years or more, admitted to an internal medicine ward were evaluated by independent physicians, during the first 48 h of admission, to asses the presence of delirium. Diagnosis of delirium was based on the Confusion Assessment Method. Medical and nurse records were reviewed. Family was interviewed when necessary. Results: One hundred eight patients (52% women, age range 65-94 years) with an APACHE II score of 11.6±5, were evaluated. Fifty seven patients (53%) had delirium (32% hyperactive, 72% hypoactive and 5% mixed). Delirium prevalence was significantly higher in older patients (66% among those aged 75 years or older versus 30% in younger, p <0.05) and among patients with more severe conditions (88% among those with an APACHE score over 16 versus 47% below that value, p <0.05). Medical records of patients with delirium showed that this diagnosis was present only in 32% and cognitive deficit was described in 73%. Ten percent of patients with delirium received sedative medication and 38% were physically restricted. There were no environmental interventions to prevent or control delirium. Conclusions: Delirium in elderly inpatients at this unit is an extraordinarily prevalent problem, seriously under diagnosed (68%) and under treated. This study should alerts our medical community to improve the diagnosis and management of delirium in elderly inpatients (Rev Med Chile 2005; 133: 1449-54)

Resultados generales del Proyecto INTRA-OMS en Chile

BACKGROUND The aging speed in developing countries has been faster than predicted. Thus, health care systems must adapt to face this new scenario efficiently. The WHO designed the INTRA study to assess health promotion and protection actions in primary care, for people over 50 years of age. MATERIAL AND METHODS Questionnaires designed by WHO were applied to 1,167 subjects (aged 50-94 years, 68% female) and 117 health care professionals attending and working respectively, at 33 health care centers of the Viña-Quillota Health Service. RESULTS Twenty percent of subjects were illiterate and 25% had less than 6 years of instruction. Forty three percent could reach the health centre by public transportation and 92% did not need to be accompanied, 39% spent more than one hour to be attended and 71% considered that the service in the centre was good. Sixty seven percent attended regular appointments, 63% did not perform any physical activity and only half of them were advised to start such activity. Weight loss was recommended to 55% but only one third has achieved such goal. Only one third of patients admitted being interrogated about their drinking habits. Among subjects in whom blood pressure was measured, one fourth had abnormal values. CONCLUSIONS Primary health care in Chile, although having health care programs for the elderly, is loosing opportunities to improve health status and quality of life of this age group.

Evaluación de 1.497 adultos mayores institucionalizados, usando el «sistema de clasificación de pacientes RUG T-18»

: Weassessed 1497 subjects 60 years old and over (73% women), with an age range of 60-106 years.Thirty six percent had urinary incontinence, 19% required assistance for feeding, and 38%needed help for walking or moving. Fifty seven percent were in the lowest category of complexi-ty, «Institutionalization». Very few residents were in the most demanding categories, no one clas-sified as «Rehabilitation», and only 0.7% were in «Special Care».

Diferencias en antioxidantes plasmáticos según nivel socioeconómico en mujeres chilenas

BACKGROUND Free radical-mediated oxidative damage is a known initial event in atherogenesis. Cardiovascular disease is frequent in the Chilean population showing differences in the prevalence of risk factors of the disease according to socioeconomic level (SEL). AIM To determine levels of antioxidants and lipid peroxides in Chilean women from different SEL. PATIENTS AND METHODS Blood samples were taken from 81 women for measurements of plasma ascorbic acid, beta-carotene, alpha-tocopherol, licopene, ubiquinol, glutathione, total plasma antioxidant capacity, and lipid peroxides (TBARS). RESULTS Individuals in the lower SEL showed reduced levels of plasma beta-carotene, ascorbic acid, alpha-tocopherol, and ubiquinol compared to women in the higher SEL. There were no differences between groups in the plasma levels of glutathione, total antioxidant capacity, or TBARS. CONCLUSIONS The results could be explained in part by the higher consumption of fruits and vegetables in women from the upper SEL.

Niveles de vitamina D en adultos mayores saludables chilenos y su relación con desempeño functional

: Healthy subjects aged 60 years or more and living in the community were invited to participate. People with chronic diseases, cognitive impairment, physical disability, smokers and those consuming more than three medications per day were excluded. Hand grip and gait speed were measured and a blood sample was obtained to measure 25OH vitamin D by radioimmunoanalysis.BACKGROUND People over 60 years old are at risk of Vitamin D deficiency, which can affect functional performance, since this vitamin is involved in muscle function and protein synthesis. AIM To measure 25OH vitamin D levels in healthy older people from Santiago de Chile, and evaluate their relationship with functional performance. SUBJECTS AND METHODS Healthy subjects aged 60 years or more and living in the community were invited to participate. People with chronic diseases, cognitive impairment, physical disability, smokers and those consuming more than three medications per day were excluded. Hand grip and gait speed were measured and a blood sample was obtained to measure 25OH vitamin D by radioimmunoanalysis. RESULTS One hundred and four participants aged 60 to 98 years (55% females) were studied. Mean vitamin D levels were 17.3 ± 6.1 ng/mL. Females had lower levels than males (15.6 ± 5.8 and 19.2 ± 6.0 ng/mL respectively p < 0.01). Eighty three percent of females and 55.3% of males had values below 20 ng/mL (the cutoff point for deficiency). Only 3.5% of females and 8.5% of males had values of 30 ng/ml or higher. There was a significant correlation between vitamin D levels, gait speed and grip strength (r = 0.32 and 0.34 respectively, p < 0.01), especially in women over 74 years. CONCLUSIONS Vitamin D deficiency is almost universal in healthy adults over 60 years living in Santiago de Chile, especially in women. This deficiency is associated with a deranged functional performance and is a potentially modifiable risk factor for disability.

Estudio comparativo de mujeres mayores de noventa años y ancianas menores institucionalizadas

BACKGROUND The number of nonagenarians is rapidly growing in Chile. This age group is mainly female, with higher frailty markers and in higher risk of being placed at nursing homes. AIM To describe features of nonagenarian women and compare them with a group of women between 60-89 years, both living in nursing homes, in terms of disability and resource use at the institution. SUBJECTS AND METHODS A total of 230 nonagenarian women and 460 women, aged 60-89 years, were evaluated in the nursing home Fundación Las Rosas de Ayuda Fraterna (only for poor elderly) in Santiago, Chile. The assessment instruments were the Geriatric Assessment instrument FEGAUC, functional and mental evaluation scales of Spanish Red Cross and the Resource Utilization System, RUG T18, an independent diagnostic classification system that allows the determination of resource use in terms of cost and personnel needs. RESULTS Nonagenarian women had significantly (p <0.05) more disability (falls, urinary incontinence, memory problems and mobility difficulties), and were classified in RUG categories of higher resource utilization and dependency than younger women. Nevertheless, nonagenarians were a very heterogeneous group, almost half of them were able of moving by themselves or required little assistance and had minimal memory problems. CONCLUSIONS Nonagenarian women assessed in this institution are an heterogeneous group, some with minimal disability and other more frail and dependent than the younger elderly women, being classified in higher categories of resource utilization RUG T18.

Consumo de alcohol en el adulto mayor chileno que viaja

BACKGROUND: Problems associated with alcohol consumption are prevalent in Chile, but little is known about the situation in the elderly. AIM: To perform a screening to detect alcohol-related problems and risks in the Chilean older people who travel. MATERIAL AND METHODS: The Alcohol Use Disorders Identification Test (AUDIT) questionnaire was answered by 1,076 travelers aged 60 to 93 years (66% females), who participated in trips organized by the Chilean National Tourism Service (SERNATUR). RESULTS: Seventy six percent of respondents acknowledged to have ingested an alcoholic drink during the last month. The average AUDIT score was of 2.2 ± 2.6. Only 3.7% of the sample had a score equal or higher than eight, considered as risky use. Within this last group, 60% had symptoms of alcohol dependence. A higher alcohol consumption was associated with male gender (p CONCLUSIONS: In this sample of Chilean traveling older people, there was a high prevalence of alcohol consumption, and nearly 4% of respondents had alcohol related problems. Language: es