Practical Application of a Battery of Brief Tools to Evaluate Geriatric Medical Inpatients for the Three Ds.

OBJECTIVE: The investigators aimed to identify the clinical characteristics of patients with or without delirium and preexisting depression, dementia, both, or neither by using validated tools easily administered in clinical practice. METHODS: In this cross-sectional prospective observational study conducted in Medellín, Colombia, 200 geriatric inpatients were evaluated with the Delirium Diagnostic Tool-Provisional (DDT-Pro), Informant Questionnaire on Cognitive Decline in the Elderly, Hachinski Ischemic Scale, Cornell Scale for Depression in Dementia, and Charlson Comorbidity Index-short form. Delirium motor subtype, mortality, and length of hospital stay were assessed. RESULTS: The study included 134 patients without delirium (67%), 14 with delirium only (7%), 16 with delirium and dementia (8%), 13 with delirium and depression (7%), and 23 with delirium, dementia, and depression (the three Ds) (12%). Prevalence rates of dementia (59%) and depression (55%) among 66 patients with delirium were higher than prevalence rates among patients without delirium (13% and 28%, respectively), suggesting that both conditions are risk factors. Main medical diagnoses, mortality, and dementia type did not differ among groups. Motor subtypes were similar among delirium groups. Patients in the delirium groups, except those in the delirium and depression group, were older than patients without delirium. Medical burden was highest among the patients with delirium and dementia and those with all three conditions. Delirium and dementia were more severe when comorbid with each other. Depression was most severe among patients with delirium and depression. Patients with all three conditions had a longer length of hospital stay than those without delirium. CONCLUSIONS: Using brief tools to detect dementia and depression in conjunction with the DDT-Pro to assess delirium diagnosis and severity is feasible and enables a more in-depth evaluation of elderly hospitalized patients. Because previous longitudinal research suggests that these comorbid conditions influence prognosis following a delirium episode, better identification of the three Ds offers proactive interventional opportunities. Depression is an underrecognized risk factor for delirium.

Qualitative perspectives of isolation experiences due to COVID-19 from a group of bioethicists in training performing interdisciplinary healthcare activities. Medellin, Colombia. September 2020.

Introduction: In Colombia, there is still little information on how health care personnel have lived and coped with isolation due to COVID-19. Objectives: To explore the experiences related to the isolation of health professionals performing interdisciplinary care activities from March to September 2020, in Medellín, Colombia. Methods: Qualitative, exploratory, with a group of bioethicists in training. Data collected through the focus group, after obtaining the consent and approval of the Institutional Ethics Committee. Open and axial coding was performed. Texts are presented in prose, information was triangulated, and results were validated with the participants. Results: Work increased and staff decreased, with high staff turnover, redistribution and reassignment of loads and roles, facilitating physical and emotional overload. Study participants considered that teleworking facilitated their work, although more work was done. They lived in double isolation, had losses, and took work and family overloads. For fear of infecting and being infected, they separated from their loved ones, "this is an absolutely lonely disease, if people does not die from COVID, sadness and loneliness kills them." It affected "the recovery process, specifically, of psychiatric patients was prolonged, worsening their condition." They live in the present, and prioritize what is most important, because "being healthy and having those you love is the best wealth". Conclusion: Isolation increased workload, with reassignment of roles, affecting health care. For fear of becoming infected and infecting, study participants lived a double isolation, with anguish and uncertainty, which is why now they prioritize the most important health and love.

Introducción: En Colombia, todavía hay pocas informaciones sobre cómo los profesionales sanitarios han vivido y afrontado el aislamiento por la COVID-19. Objetivos: Explorar las experiencias relacionadas al aislamiento de profesionales sanitarios con actividad asistencial interdisciplinar, entre marzo y septiembre de 2020, en Medellín, Colombia. Métodos: Se condujo una investigación cualitativa y exploratoria con un grupo de bioeticistas en formación. Datos recolectados a través de un grupo focal, después de obtener el consentimiento y la aprobación del Comité de Ética Institucional. Se realizó codificación abierta y axial. Los textos se presentan en prosa, se hizo triangulación de la información, y se validaron los resultados con los participantes. Resultados: El trabajo aumentó y el personal disminuyó, con alta rotación de personal, reasignación y redistribución de cargas y roles, facilitando la sobrecarga física y emocional. Los participantes consideraron que el teletrabajo facilitó su trabajo, aunque se ha hecho más trabajo. Además, hubo un doble aislamiento, pérdidas y sobrecargas de trabajo y familiares. Por miedo a infectar e infectarse, se separaron de sus seres queridos, "esta es una enfermedad absolutamente solitaria, si uno no muere de la COVID, lo matan la tristeza y la soledad." La pandemia también afectó el proceso de recuperación, específicamente de los pacientes psiquiátricos, que se alargó, empeorando su condición. Los profesionales viven el presente y priorizan lo más importante: "tener salud y a los que amas es la mejor riqueza". Conclusión: El aislamiento aumentó la carga de trabajo, con reasignación de roles, afectando la atención sanitaria. Por miedo a infectarse e infectar, los participantes del estudio vivieron un doble aislamiento, con angustia e incertidumbre, y ahora priorizan la salud y el amor.