Predictors of Unmet Needs in Chilean Older People with Dependency: A Cross-Sectional Study.

Approximately one in five Chilean older adults has some degree of dependency. Limited evidence is available on self-perceived needs in Latin-American older people. The main aim of this study was to identify predictors of unmet needs of dependent older persons without cognitive impairment, considering personal and primary informal caregivers' factors. This cross-sectional study was conducted with a sample of 77 dyads of older people with dependency and their caregivers. A survey was administered, evaluating sociodemographic characteristics, anxious and depressive symptomatology, health-related quality of life, and social support. Older people's self-reported met and unmet needs and caregivers' burden and self-efficacy were also assessed. To determine predictors of unmet needs, a multiple regression analysis was carried out. Most participants had mild to moderate levels of dependency. The most frequent unmet needs were "daytime activities" (33.8%), "company" (23.4%), "benefits" (23.4%), and "psychological distress" (24.7%). Older people's higher level of dependency and anxious symptomatology were predictors of a higher number of unmet needs, with a model whose predictive value was 31%. The high prevalence of anxious symptomatology and its relationship with the presence of unmet needs highlight the importance of making older people's psychological and social needs visible and addressing them promptly.

Co-designing a dashboard of predictive analytics and decision support to drive care quality and client outcomes in aged care: a mixed-method study protocol.

INTRODUCTION: There is a clear need for improved care quality and quality monitoring in aged care. Aged care providers collect an abundance of data, yet rarely are these data integrated and transformed in real-time into actionable information to support evidence-based care, nor are they shared with older people and informal caregivers. This protocol describes the co-design and testing of a dashboard in residential aged care facilities (nursing or care homes) and community-based aged care settings (formal care provided at home or in the community). The dashboard will comprise integrated data to provide an 'at-a-glance' overview of aged care clients, indicators to identify clients at risk of fall-related hospitalisations and poor quality of life, and evidence-based decision support to minimise these risks. Longer term plans for dashboard implementation and evaluation are also outlined. METHODS: This mixed-method study will involve (1) co-designing dashboard features with aged care staff, clients, informal caregivers and general practitioners (GPs), (2) integrating aged care data silos and developing risk models, and (3) testing dashboard prototypes with users. The dashboard features will be informed by direct observations of routine work, interviews, focus groups and co-design groups with users, and a community forum. Multivariable discrete time survival models will be used to develop risk indicators, using predictors from linked historical aged care and hospital data. Dashboard prototype testing will comprise interviews, focus groups and walk-through scenarios using a think-aloud approach with staff members, clients and informal caregivers, and a GP workshop. ETHICS AND DISSEMINATION: This study has received ethical approval from the New South Wales (NSW) Population & Health Services Research Ethics Committee and Macquarie University's Human Research Ethics Committee. The research findings will be presented to the aged care provider who will share results with staff members, clients, residents and informal caregivers. Findings will be disseminated as peer-reviewed journal articles, policy briefs and conference presentations.

Met and unmet needs of dependent older people according to the Camberwell Assessment of Need for the Elderly (CANE): A scoping review.

In order to address the complexity of needs of dependent older people, multidimensional and person-centered needs assessment is required. The objective of this review is to describe met and unmet needs of dependent older people, living in the community or in institutions, and the factors associated with those needs. Selection criteria included papers about need asessment which employed the Camberwell Assesment of Need for the Elderly (CANE). A search through MEDLINE, SCOPUS, WOS and CINHAL databases was carried out. Twenty-one articles were finally included. Unmet needs were found more frequently in psychosocial areas (mainly in "company", "daytime activities" and "psychological distress") and in institutionalized population. In addition, unmet needs were often associated with depressive symptoms, dependency, and caregiver burden. Discrepancies between self-reported needs and needs perceived by formal and informal caregivers were identified. It is important that professionals and caregivers try to make visible the perspective of older people and their psychological and social needs, particularly when the person is dependent, depressed or cognitively impaired.

[Inappropriate medication use among Chilean older people]. / 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, 1,048 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.

Uso inapropiado de medicamentos en adultos mayores: resultados de la Encuesta Nacional de Salud 2010 / Inappropriate medication use among Chilean older people

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, 1,048 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.

[Delirium: a marker of health status in the geriatric patient]. / Delirium: marcador de estado del paciente geriátrico.

Delirium is defined as a syndrome characterized by an acute and fluctuating decline in higher cognitive functions. The impact of this syndrome is often underestimated in the geriatric population both from the diagnostic and prognostic points of view. Many clinicians are unaware of the scale of the impact on outcomes of delirium. This review presents evidence that supports the view that delirium is independently associated with a worse overall outcome, assessed in terms of greater functional and cognitive deterioration, intrahospital complications, and a higher risk of mortality. Likewise, the impact of delirium on the health system (increases in hospital stay, referrals and costs) is discussed. Therefore, we propose that delirium be considered as a marker of health status, which would allow assessment of this syndrome to be broadened to include two fundamental considerations: firstly, that persons with delirium belong to a group with a higher risk of adverse events and secondly, that delirium is a marker of health status, which would allow the quality of health services that manage elderly patients to be evaluated, given that delirium is partly preventable and its management is multidisciplinary and complex.

[Results of the INTRA-WHO survey in Chile]. / 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.

[Assessment of 1497 Chilean nursing home residents, using the Resource Utilization Group method, RUG T-18]. / Evaluación de 1,497 adultos mayores institucionalizados, usando el "sistema de clasificación de pacientes RUG T-18".

BACKGROUND: There is little information about Chilean elderly residents of long term care facilities, regarding their characteristics and need for resources. AIM: To describe main characteristics and resource utilization of residents of one of the largest nursing homes in Chile, Fundación Las Rosas de Ayuda Fraterna. MATERIAL AND METHODS: In a cross sectional and descriptive study, all residents were evaluated using the RUG T-18 method, that assess activities of daily living and the complexity of their clinical situation. RESULTS: We assessed 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 complexity, "Institutionalization". Very few residents were in the most demanding categories, no one classified as "Rehabilitation", and only 0.7% were in "Special Care". CONCLUSIONS: This study is an important start point to learn more about elderly subjects living in nursing homes in Chile.