[Preventing dependency in the elderly]. / Prevención de la dependencia en las personas mayores.

INTRODUCTION: Dependency, i.e. the need to depend on another person to perform activities of daily living, is the main concern and cause of suffering and poor quality of life in the elderly. The prevalence of dependency increases with age and is related to the presence of prior disease and fragility. Dependency is associated with increased morbidity, mortality and institutionalization, as well as with greater health and social resource utilization, all of which increases health costs. OBJECTIVE: To create a consensus document on the main health recommendations for the prevention of dependency in the elderly, based on the scientific evidence available to date, with the collaboration of scientific societies and public health administrations (the Spanish Ministry of Health, Autonomous Communities and Cities). METHODS: a) a preliminary consensus document was drafted by an expert group composed of representatives of various scientific societies and health administrations. This document was based on a review of the recommendations and guidelines published by the main organizations involved in health promotion and the prevention of disease, functional deterioration and dependency in the elderly; b) the consensus document was reviewed by the remaining experts assigned by the scientific societies and central and autonomous administrations; c) the final document was approved after a session in which the text was discussed and reviewed by all the experts participating in the working group (including the academic committee); d) the document was presented and discussed in the First National Conference on Prevention and Health Promotion in Clinical Practice in Spain. All participating experts signed a conflicts of interest statement. RESULTS: The document provides recommendations, with their grades of evidence, grouped in the following three categories: a) health promotion and disease prevention, with specific preventive activities for the elderly, including prevention of geriatric syndromes; b) prevention of functional deterioration, with clinical recommendations that can be applied in primary and specialized care; c) prevention of iatrogeny (drug prescription, inappropriate use of diagnostic and therapeutic modalities and healthcare). These recommendations were tailored to the characteristics of the older person (OP), categorized in five groups: healthy OP, OP with chronic disease, fragile or at risk OP, dependent OP, and OP at the end of life. CONCLUSION: These recommendations should be implemented by public health administrations to improve strategies for the prevention of dependency in the elderly in the xxi century.

[Groups of resource utilization in acute care units and average length of stay at geriatrics services]. / Grupos de utilizacion de recursos en Unidades de agudos y media estancia de Servicios de Geriatria.

BACKGROUND: In recent years, Patient Classifications Systems (PCS's) have been implement in Spain for the purpose of gauging the "hospital product". However, the most conventional systems are not very well-suited to the senior citizen population, among whom illness-related disability is a determining factor with regard to explaining the usage of resources and the results of the health care provided. Therefore, the idea was brought forth of implementing a system in units providing senior citizen care which would entail this parameter, that is, the Resource Usage Groups (RUG's), analyzing the characteristics and differences in the RUG-related spread in four Geriatrics Units. METHODS: A cross-sectional study based on consecutive cutoff points in periods longer than the average stay in each unit, the patients admitted in the acute care units and average stay in the Geriatrics Unit of the Hospital Monte Narango (HMN) (n = 318), Hospital Central de la Cruz Roja (HCCR) (n = 384), Hospital General de Guadalajara (HG) (n = 272) and Hospital Virgen del Valle (HVV) (n = 390), with regard to the spread thereof according to the RUG-T18 classification. The possible differences among the hospitals in question were analyzed by means of the chi-square statistical test (SPSS for Windows). RESULTS: For the overall sample, the patients were divided into groups R, S and C of the classification, groups P and B being represented to a very small degree, differences having been found to exist among the different hospitals. Hence, the HCCR is that which handles the largest percentage of patients in the R group (47.64% vs. 23.66% at HMN; 20.57% at HG and 20.53% at HVV) and a smaller percentage of patients in the S Group (3.12% vs. 6.40% at HMN; 9.92% at HG and 9.76% at HVV) and the C Group (48.94% vs. 76.29% at HMN; 66.89% at HG and 68.36% at HVV). Differences were likewise found to exist in the individual analysis for the acute care units and average length of stay. CONCLUSIONS: The resource usage groups can be useful with regard to ascertaining differences in the health care loads in hospital care for senior citizens.

TAC craneal en el estudio diagnóstico de pacientes con deterioro cognitivo: utilidad de criterios clínicos para mejorar su eficacia / Brain CT on diagnostic investigation of patients with cognitive impairment: usefulness of clinical prediction rules to improve their efficiency

INTRODUCCION: Dentro de la estrategía diagnóstica de pacientes con deterioro cognitivo la tomografía axial computerizada (TAC) craneal figura como una prueba opcional. Diversos criterios clínicos se han establecido para seleccionar los pacientes con indicación de dicha prueba diagnóstica. OBJETIVO: Conocer la capacidad predictiva de diversos criterios clínicos para establecer la indicación de TAC craneal en pacientes con demencia, así como determinar la utilidad del TAC craneal como instrumento diagnóstico de la enfermedad de Alzheimer en una consulta externa de geriatría. PACIENTES Y MÉTODOS: Evaluación retrospectiva de la historia clínica de todos los pacientes derivados por deterioro cognitivo durante 1997. Cumplimiento de criterios Bradshaw, Dietch, Larson y Academia Americana de Neurología indicativos de TAC craneal y su correlación con hallazgos patológicos en el mismo. Igualmente se confrontó el juicio clínico experto para el diagnóstico de enfermedad de Alzheimer versus demencia no Alzheimer con la presencia de hallazgos patológicos en el TAC craneal. RESULTADOS: Se evaluaron 116 pacientes de los cuales 23 no presentaban deterioro cognitivo. De los 93 restantes en 67 por ciento se realizó TAC craneal. La sensibilidad en nuestra muestra estuvo por debajo del 65 por ciento para todos los criterios evaluados. Por el contrario, el diagnóstico de demencia no Alzheimer alcanzaba una sensibilidad para la detección de hallazgos patológicos en el TAC craneal de 80 por ciento. En pacientes con enfermedad de Alzheimer sólo cuatro de un total de 26 pacientes con TAC presentaban hallazgos patológicos CONCLUSIONES: Los diferentes criterios clínicos evaluados tienen un escaso valor predictivo en nuestra muestra. De la revisión de la literatura, los criterios establecidos por Dietch, aparecen como los más sensibles para detectar hallazgos patológicos en el TAC craneal (80-93 por ciento). El escaso porcentaje de TAC patológicos en pacientes diagnosticados previamente de enfermedad de Alzheimer apoya la escasa utilidad del TAC en el diagnóstico de dichos pacientes (AU)