Prevalencia de disfagia orofaríngea en pacientes mayores de 65 años / Prevalence of oropharyngeal dysphagia in patients over 65-year-old

OBJETIVO: describir el porcentaje de pacientes mayores de 65 años con deterioro de la deglución, así como sus características sociodemográficas y clínicas. MÉTODO: se realizó un estudio descriptivo transversal desde octubre de 2013 a febrero de 2014. La población de estudio fueron pacientes de ambos sexos, mayores de 65 años, que asistieron a las consultas de Enfermería en el turno de tarde del Centro de Salud Valdezarza-Sur de Madrid. A los pacientes incluidos en el estudio se les hizo el test EAT 10; si la puntuación en este test era de 3 o mayor (cribado positivo), se les realizaba el método de exploración clínica de volumen-viscosidad MECV-V para la confirmación de disfagia orofaríngea RESULTADOS: de los 161 pacientes evaluados, 33 (20,5%) pacientes obtuvieron cribado positivo al test de despistaje de disfagia EAT 10, es decir, presentaban síntomas de disfagia y 22 (13,7%) fueron positivos al método de exploración clínica volumen viscosidad, es decir, presentaban signos de disfagia. En relación al perfil de estos pacientes, de los 33 pacientes, el 33,3% presentaba algún grado de dependencia para las ABVD y un 39,4% presentaba algún grado de dependencia para las AIVD, un 39,4% se encontraba en situación de anciano de riesgo, el 18,2% presentaba algún grado de deterioro cognitivo. CONCLUSIÓN: se ha encontrado un alto porcentaje de pacientes con alteraciones de la deglución. Este problema no es manifestado por los pacientes, y tampoco detectado en muchos casos por los profesionales en las consultas de Atención Primaria. Se ha evidenciado un infradiagnóstico a pesar de la importante repercusión económica y problemas de morbimortalidad que supone

OBJECTIVE: to describe the proportion of patients >65-year-old with swallowing deterioration, as well as their sociodemographical and clinical characteristics. METHOD: a descriptive transversal study was conducted from October, 2013 to February, 2014. The study population included male and female patients, over 65-year-old, who attended the Nursing Outpatient Unit in the afternoon shift at the Valdezarza-Sur de Madrid Health Centre. Those patients included in the study underwent the EAT 10 Test; if the score test was 3 or higher (positive screening), the clinical exploration method through the Volume-Viscosity Test (V-VST) was used for confirmation of oropharyngeal dysphagia. RESULTS: out of 161 patients assessed, 33 (20,5%) patients had a positive screening at the EAT 10 Dysphagia Test, that is to say, they presented dysphagia symptoms; while 22 (13.7%) patients had a positive result in the Volume-Viscosity clinical exploration method, that is to say, they presented dysphagia symptoms. Regarding the profile of these patients, 33.3% of the 33 patients presented some degree of dependence for DLAs (Daily Life Activities), and 39.4% presented some degree of dependence for IADLs (Instrumental Daily Life Activities); 39.4% of them was in a situation of elderly person at risk, and 18.2% presented some level of cognitive deterioration. CONCLUSION: a high proportion of patients with swallowing alterations has been found. This problem is not reported by patients, and in many cases goes undetected by Primary Care professionals. There is evidence of underdiagnosis, despite the major economic impact and morbidity & mortality problems represented

Effectiveness of a cognitive behavioral intervention in patients with medically unexplained symptoms: cluster randomized trial.

BACKGROUND: Medically unexplained symptoms are an important mental health problem in primary care and generate a high cost in health services.Cognitive behavioral therapy and psychodynamic therapy have proven effective in these patients. However, there are few studies on the effectiveness of psychosocial interventions by primary health care. The project aims to determine whether a cognitive-behavioral group intervention in patients with medically unexplained symptoms, is more effective than routine clinical practice to improve the quality of life measured by the SF-12 questionary at 12 month. METHODS/DESIGN: This study involves a community based cluster randomized trial in primary healthcare centres in Madrid (Spain). The number of patients required is 242 (121 in each arm), all between 18 and 65 of age with medically unexplained symptoms that had seeked medical attention in primary care at least 10 times during the previous year. The main outcome variable is the quality of life measured by the SF-12 questionnaire on Mental Healthcare. Secondary outcome variables include number of consultations, number of drug (prescriptions) and number of days of sick leave together with other prognosis and descriptive variables. Main effectiveness will be analyzed by comparing the percentage of patients that improve at least 4 points on the SF-12 questionnaire between intervention and control groups at 12 months. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. DISCUSSION: This study aims to provide more insight to address medically unexplained symptoms, highly prevalent in primary care, from a quantitative methodology. It involves intervention group conducted by previously trained nursing staff to diminish the progression to the chronicity of the symptoms, improve quality of life, and reduce frequency of medical consultations. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01484223 [http://ClinicalTrials.gov].