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.

Impacto de la modalidad de terapia de reemplazo renal en adultos mayores frágiles / Impact of renal replacement therapy on frail older adults

INTRODUCCIÓN: La enfermedad renal crónica terminal está aumentando en los adultos mayores. La fragilidad es altamente prevalente en los adultos mayores con enfermedad renal crónica terminal. Sin embargo, no existen estudios prospectivos que comparen el rendimiento de las diferentes modalidades de terapia de reemplazo renal (TRR) en adultos mayores frágiles. OBJETIVO: Comparar la ocurrencia de resultados clínicamente relevantes (hospitalizaciones, caídas, fracturas de caderas y mortalidad) en adultos mayores prefrágiles y frágiles según modalidad de TRR: hemodiálisis o diálisis peritoneal. MÉTODO: Estudio observacional prospectivo en adultos mayores prefrágiles y frágiles (según escala FRAIL) en hemodiálisis y diálisis peritoneal en las unidades correspondientes de la Red de Salud UC-Christus. Se evaluaron características basales (edad, Charlson, índice de masa corporal, tiempo en TRR, cumplimiento de Kt/V, hemoglobina y albúmina) y se siguieron a 12 meses, registrando mortalidad, días y número de hospitalizaciones, caídas y fracturas de cadera. RESULTADOS: Cumplieron criterios de ingreso 27 pacientes por grupo. Sus características basales fueron similares, a excepción de la albuminemia y del tiempo en TRR, ambas menores en el grupo en diálisis peritoneal. La escala FRAIL fue similar. La escala FRAIL se correlacionó basalmente con mayor comorbilidad, menor albuminemia y no cumplimiento del Kt/V, mientras que fue independiente de la edad, índice de masa corporal y tiempo en TRR. Los días y número de hospitalizaciones a 12 meses fueron similares para ambas modalidades de TRR. La supervivencia de ambos grupos fue similar. No hubo diferencias en caídas y ningún paciente tuvo fracturas de cadera. CONCLUSIONES: En adultos mayores prefrágiles y frágiles la modalidad de TRR no influyó en la ocurrencia de hospitalización, mortalidad, caídas ni fracturas de cadera

INTRODUCTION: End-stage renal disease prevalence is increasing in older adults. Frailty is highly prevalent in older adults with end-stage renal disease. However, there are no prospective studies comparing the performance of the different modalities of renal replacement therapy (RRT) in frail older adults. OBJECTIVE: To compare clinically relevant outcomes (hospital admission, falls, hip fractures, and mortality) in prefrail and frail older adults according to the modality of RRT: peritoneal dialysis or haemodialysis. METHODS: A prospective observational study in prefrail and frail older adults (according to FRAIL scale) on peritoneal dialysis and haemodialysis was carried out. An evaluation was made using baseline characteristics (age, Charlson, body mass index, time on RRT, compliance with Kt/V dose, haemoglobin, and albumin). The patients were followed-up over 12 months, recording mortality, days and number of hospital admissions, falls, and hip fractures. RESULTS: A total of 54/65 (83%) older adults on RRT met criteria for prefrailty or frailty, and signed informed consent (27 in each modality). Baseline characteristics were similar, except for serum albumin and time on RRT, both of which were significantly lower in the peritoneal dialysis group. The FRAIL score was similar in both groups. Baseline FRAIL correlated with higher comorbidity, lower albumin levels, and non-compliance of Kt/V dose, while it was independent of age, body mass index, and time on RRT. Days and number of hospital admissions at 12 months were similar in patients on peritoneal dialysis and haemodialysis. Survival on peritoneal dialysis and haemodialysis was similar. There were no differences in falls or hip fractures. CONCLUSIONS: Pre-frail and frail older adults on peritoneal dialysis and haemodialysis have similar clinical outcomes

[Impact of renal replacement therapy on frail older adults]. / Impacto de la modalidad de terapia de reemplazo renal en adultos mayores frágiles.

INTRODUCTION: End-stage renal disease prevalence is increasing in older adults. Frailty is highly prevalent in older adults with end-stage renal disease. However, there are no prospective studies comparing the performance of the different modalities of renal replacement therapy (RRT) in frail older adults. OBJECTIVE: To compare clinically relevant outcomes (hospital admission, falls, hip fractures, and mortality) in prefrail and frail older adults according to the modality of RRT: peritoneal dialysis or haemodialysis. METHODS: A prospective observational study in prefrail and frail older adults (according to FRAIL scale) on peritoneal dialysis and haemodialysis was carried out. An evaluation was made using baseline characteristics (age, Charlson, body mass index, time on RRT, compliance with Kt/V dose, haemoglobin, and albumin). The patients were followed-up over 12 months, recording mortality, days and number of hospital admissions, falls, and hip fractures. RESULTS: A total of 54/65 (83%) older adults on RRT met criteria for prefrailty or frailty, and signed informed consent (27 in each modality). Baseline characteristics were similar, except for serum albumin and time on RRT, both of which were significantly lower in the peritoneal dialysis group. The FRAIL score was similar in both groups. Baseline FRAIL correlated with higher comorbidity, lower albumin levels, and non-compliance of Kt/V dose, while it was independent of age, body mass index, and time on RRT. Days and number of hospital admissions at 12 months were similar in patients on peritoneal dialysis and haemodialysis. Survival on peritoneal dialysis and haemodialysis was similar. There were no differences in falls or hip fractures. CONCLUSIONS: Pre-frail and frail older adults on peritoneal dialysis and haemodialysis have similar clinical outcomes.

[Risk of falls among patients admitted to a medical-surgical ward. Analysis of 376 medical records]. / Prevalencia de pacientes con alto riesgo de caídas en un servicio médico-quirúrgico de un hospital universitario.

BACKGROUND: Detecting patients at risk of falls during hospital stay is of utmost importance to implement preventive measures. AIM: To determine the frequency of patients with a high risk of falls admitted to a medical-surgical ward. To assess the preventive measures implemented. MATERIALS AND METHODS: Review of medical records of 376 patients aged 20 to 97 years (28% older than 70 years) admitted to a clinical hospital in a period of four months. RESULTS: Eleven percent of patients had a history of falls, 50% had a sensory deficit, 68% had unstable gait, 8% had a neurological risk condition, 8% had drowsiness or disorientation, 4% had psychomotor agitation or delirium, 86 % used high risk medications, 73% used 2 or more high risk drugs and 72% were using devices that decrease mobility. One hundred forty-one patients (38%) had a high risk of falling. The mean age of the latter was 77 years, 89% had a sensory deficit, 96% had unstable gait, 4% had psychomotor agitation or delirium and 98% used high risk drugs. Less than 1% had a medical prescription of a caregiver, physical restraints or antipsychotics, however, 21% of patients had a caregiver. CONCLUSIONS: The percentage of patients with a high risk of falling is important. The main risk factors were sensory deficit, unstable gait and the use of high risk medications. The low frequency of preventive measures prescriptions is striking.

Prevalencia de pacientes con alto riesgo de caídas en un servicio médico-quirúrgico de un hospital universitario / Risk of falls among patients admitted to a medical-surgical ward: analysis of 376 medical records

Background: Detecting patients at risk of falls during hospital stay is of utmost importance to implement preventive measures. Aim: To determine the frequency of patients with a high risk of falls admitted to a medical-surgical ward. To assess the preventive measures implemented. Materials and Methods: Review of medical records of 376 patients aged 20 to 97 years (28% older than 70 years) admitted to a clinical hospital in a period of four months. Results: Eleven percent of patients had a history of falls, 50% had a sensory deficit, 68% had unstable gait, 8% had a neurological risk condition, 8% had drowsiness or disorientation, 4% had psychomotor agitation or delirium, 86 % used high risk medications, 73% used 2 or more high risk drugs and 72% were using devices that decrease mobility. One hundred forty-one patients (38%) had a high risk of falling. The mean age of the latter was 77 years, 89% had a sensory deficit, 96% had unstable gait, 4% had psychomotor agitation or delirium and 98% used high risk drugs. Less than 1% had a medical prescription of a caregiver, physical restraints or antipsychotics, however, 21% of patients had a caregiver. Conclusions: The percentage of patients with a high risk of falling is important. The main risk factors were sensory deficit, unstable gait and the use of high risk medications. The low frequency of preventive measures prescriptions is striking.

Are antipsychotics effective for the prevention of postoperative delirium? / ¿Son los antipsicóticos efectivos para prevenir el delirium postoperatorio?

INTRODUCTION: Antipsychotics have been proposed as a pharmacological alternative to prevent postoperative delirium. Nonetheless, their actual clinical benefits and harms are a matter of debate. METHODS: To answer this question, we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the chosen systematic reviews, reanalyzed the data from the primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 16 systematic reviews that included eight primary studies, all were randomized trials. We concluded the use of prophylactic antipsychotics reduces the incidence of postoperative delirium, but has no effect on the duration of hospital stay and might increase mortality.

INTRODUCCIÓN: Los antipsicóticos se han propuesto como una medida farmacológica para la profilaxis del delirium postoperatorio. No obstante, su real utilidad clínica y seguridad no han sido demostrados. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos 16 revisiones sistemáticas que en conjunto incluyeron ocho estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que el uso de antipsicóticos profilácticos disminuye la incidencia de delirium postoperatorio, pero no hace diferencia en el tiempo de hospitalización y podría aumentar la mortalidad.

Psychometric properties of the Brief-COPE for the evaluation of coping strategies in the Chilean population.

The Brief-COPE is an abbreviated version of the COPE (Coping Orientation to Problems Experienced) Inventory, a self-report questionnaire developed to assess a broad range of coping responses. Currently, it is one of the best validated and most frequently used measures of coping strategies. The aim of this study was to validate a culturally appropriate Chilean version of the Brief-COPE, assess its psychometric properties and construct and congruent validity. The Spanish version of the Brief-COPE was administrated in a community sample of 1847 Chilean adult (60.4% women) exposed to a variety of stressful experiences. The factorial structure of the inventory was examined by comparing four different models found in previous studies in Latin American population. The results of confirmatory factor analyses revealed, as in the original studies, a 14-factor structure of the Brief-COPE. These dimensions showed adequate internal structure and consistency. The factorial invariance comparing women and men confirmed strict invariance. Additionally, the results showed significant correlation between some Brief-COPE scales, such as denial and substance use, with perceived stress and emotional support and active coping with subjective well-being. Overall, the present work offers a valid and reliable tool for assessing coping strategies in the Chilean population.

Psychometric properties of the Brief-COPE for the evaluation of coping strategies in the Chilean population

Abstract The Brief-COPE is an abbreviated version of the COPE (Coping Orientation to Problems Experienced) Inventory, a self-report questionnaire developed to assess a broad range of coping responses. Currently, it is one of the best validated and most frequently used measures of coping strategies. The aim of this study was to validate a culturally appropriate Chilean version of the Brief-COPE, assess its psychometric properties and construct and congruent validity. The Spanish version of the Brief-COPE was administrated in a community sample of 1847 Chilean adult (60.4% women) exposed to a variety of stressful experiences. The factorial structure of the inventory was examined by comparing four different models found in previous studies in Latin American population. The results of confirmatory factor analyses revealed, as in the original studies, a 14-factor structure of the Brief-COPE. These dimensions showed adequate internal structure and consistency. The factorial invariance comparing women and men confirmed strict invariance. Additionally, the results showed significant correlation between some Brief-COPE scales, such as denial and substance use, with perceived stress and emotional support and active coping with subjective well-being. Overall, the present work offers a valid and reliable tool for assessing coping strategies in the Chilean population.

Optimización perioperatoria del paciente anciano con fractura osteoporótica de cadera / Perioperative care of older patients with hip fractures

The number of osteoporotic fractures is increasing along with population aging. Most patients with these type of fractures are older than 65 years, with multiple chronic conditions and different degrees of disability. Hip fracture is the most relevant osteoporotic fracture due to its frequency, costs, severity and complications. Multidisciplinary management is of the utmost importance to obtain good therapeutic results. We herein review the management of this fracture. Orthogeriatric joint management should be incorporated in fragility fracture treatment. We contribute with general recommendations for the perioperative management, which can be homologated for the management of older patients with other type of fragility fractures.

[Perioperative care of older patients with hip fractures]. / Optimización perioperatoria del paciente anciano con fractura osteoporótica de cadera.

The number of osteoporotic fractures is increasing along with population aging. Most patients with these type of fractures are older than 65 years, with multiple chronic conditions and different degrees of disability. Hip fracture is the most relevant osteoporotic fracture due to its frequency, costs, severity and complications. Multidisciplinary management is of the utmost importance to obtain good therapeutic results. We herein review the management of this fracture. Orthogeriatric joint management should be incorporated in fragility fracture treatment. We contribute with general recommendations for the perioperative management, which can be homologated for the management of older patients with other type of fragility fractures.

[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.

[Is vitamin D supplementation effective for the prevention of falls in elderly people?]. / ¿Es efectiva la suplementación con vitamina D para la prevención de caídas en pacientes geriátricos?

Falls in elderly people are common and come with important effects on morbidity and mortality, dependence and institutionalization. It has been proposed that supplementation of vitamin D could prevent the occurrence of this event. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified 18 systematic reviews including 31 randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded the use of vitamin D probably leads to little or no difference in the risk of falling in elderly people.

Las caídas en el adulto mayor son frecuentes y conllevan importante morbimortalidad, dependencia e institucionalización. Se ha planteado que la suplementación con vitamina D podría prevenir la ocurrencia de este evento. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos 18 revisiones sistemáticas que en conjunto incluyen 31 estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que el uso de vitamina D probablemente no disminuye el riesgo de caídas en adultos mayores.

Development and validation of a delirium predictive score in older people.

BACKGROUND: delirium is frequently under diagnosed in older hospitalised patients. Predictive models have not been widely incorporated in clinical practice. OBJECTIVE: to develop and validate a predictive score for incident delirium. DESIGN AND SETTING: two consecutive observational prospective cohorts (development and validation) in a university affiliated hospital. SUBJECTS: inpatients 65 years and older. METHODS: in the development cohort patients were assessed within the first 48 h of admission, and every 48 h thereafter, using the confusion assessment method to diagnose delirium and data were collected on comorbidity, illness severity, functional status and laboratory. Delirium predictive score (DPS) was constructed in the development cohort using variables associated with incident delirium in the multivariate analysis (P < 0.05), and then tested in a validation cohort of comparable patients, admitted without delirium. Receiver operating characteristic (ROC) analysis and likelihood ratio (LR) were calculated. RESULTS: the development cohort included 374 patients, incident delirium occurred in 25. After multivariate analysis incident delirium was independently associated with lower functional status (Barthel Index) and a proxy for dehydration (elevated urea to creatinine ratio). Using these variables, DPS was constructed with a performance in the ROC curve area of 0.86 (95% CI: 0.82-0.91) and (-) LR = 0.16 and (+) LR = 3.4. The validation cohort included 104 patients and the performance of the score was ROC 0.78 (95% CI: 0.66-0.90). CONCLUSIONS: This simple predictive model highlights functional status and a proxy for dehydration as a useful tool for identifying older patients that may benefit from close monitoring and preventive care for early diagnosis of delirium.

[Alcohol consumption among traveling Chilean older people]. / 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 < 0.01), being younger than 75 years of age (p < 0.01), having a medium-low economic income (p < 0.01) and having a higher education level (p = 0.03). There was no significant association with the respondents' occupation. 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.

Resultados a largo plazo de la cirugía coronaria sin circulación extra corpórea en pacientes con lesión de tres vasos y/o tronco coronario izquierdo / Off pump coronary artery surgery in patients with three vessel and / or main left disease: long term results

Introducción: Se presentan los resultados inmediatos y a 6 años de la cirugía coronaria sin circulación extra corpórea (CEC) en pacientes portadores de lesión de tres vasos y/o del tronco coronario izquierdo (TCI). Métodos y Resultados: Se analiza una cohorte histórica de pacientes con lesión de tres vasos y/o TCI a quienes se realizó cirugía coronaria sin CEC entre junio 2005 y diciembre 2008 (N=100). Corresponden a 81 hombres, edad 61,3 +/- 7,9 años. 20 pacientes tenían lesión del TCI. La fracción de eyección del ventrículo izquierdo fue <30 por ciento en 6, 30 - 50 por ciento en 32 y >50 por ciento en 62 pacientes. El Euro SCORE promedio aditivo era 2,83 y el logístico 3,05. Todas las revascularizaciones se consideraron completas. Se realizaron 3,07 puentes/paciente. Hubo 5 conversiones a cirugía con CEC. Hubo complicaciones postoperatorias en 24 pacientes (3 AVE, 2 IAM, 3 insuficiencias renales agudas, 5 reoperaciones, 1 mediastinitis) y fallecieron 2. El seguimiento promedio fue 72,3 meses (rango 54 - 96). En forma alejada fallecieron 14 pacientes (5 de causa cardiovascular). Hubo 3 IAM; 5 AVE y 7 reintervenciones. Conclusión: En esta serie de pacientes con lesión de TCI y/o 3 vasos, la cirugía coronaria sin CEC no tuvo ventajas respecto a la cirugía con CEC.

Aim: To present early and long term results of Off Pump Coronary artery surgery in patients with three vessel or Main Left Disease. Methods and Results: 100 patients, mean age 61,3 +/- 7,9 years, 81 percent males, with three vessel or main left disease were submitted to off-pump coronary artery bypass between June 2005 and December 2008. Twenty patients had main left disease. Left ventricular ejection fraction was <30 percent in 6 patients, 30-50 percent in 32 and >50 percent in 62. Mean active and logistic Euro scores were 2.83 and 3.05, respectively. Patients were followed up to June 2013. All interventions were considered to have achieved complete revascularization. A mean of 3.07 bypasses were implanted. Five patients had to be converted to open heart surgery. 24 patients had post-operative complications (CVA in 3, AMI in 2, acute renal failure in 3 and mediastinitis in 1 patient. Operative mortality was 2 percent and 5 patients required reoperation. During a period of 72.3 months of follow-up (range 54-96) 14 patients died (5 from cardiovascular causes). There were 3 patients developing AMI, 5 suffered a CVA and 7 required re-revascularization. The overall results described were not different from those observed in similar patients undergoing open heart surgery at our institution. Conclusion: Off-Pump coronary artery bypass had no advantages over on pump surgery in patients with 3 vessel and/or main left disease at our institution.

Impacto del apoyo familiar en la presencia de quejas depresivas en personas mayores de Santiago de Chile / Impact of family support on depressive complaints in the elderly in Santiago, Chile

Introducción. El envejecimiento poblacional va asociado a cambios epidemiológicos que afectan los vínculos familiares y sociales. Estos vínculos pueden favorecer o amenazar la salud mental de las personas mayores, específicamente la presencia de depresión. El objetivo fue evaluar el impacto del apoyo familiar sobre la presencia de quejas depresivas en personas mayores de la comunidad. Material y métodos. Encuesta cara a cara a una muestra representativa de adultos de 60 y más años de Santiago de Chile. Se usó la pregunta única de depresión y se correlacionó con composición familiar, disponibilidad de apoyo afectivo e instrumental, presencia de conflicto, autopercepción de salud, funcionalidad, autoeficacia, percepción de ingresos. Se calcularon asociaciones bivariadas de variables predictoras y luego un modelo de remisión logística binaria. Resultados. Se incluyeron 394 personas, 62% mujeres, edad promedio 74 años (DE = 8,1). Un 16% refirieron sentirse deprimidos casi todos los días y esto se asoció en forma independiente con autopercepción de salud regular o mala, baja percepción de autoeficacia, mala percepción de disponibilidad de apoyo instrumental y presencia de conflicto. La variable que más contribuyó en el modelo fue la autopercepción de salud regular o mala (odds ratio = 3,2). Conclusiones. La autopercepción de salud aparece muy asociada con las quejas depresivas en las personas mayores de la comunidad, lo que avala los esfuerzos enfocados en optimizar la salud y los programas de apoyo dirigidos a este grupo. Cabe destacar que el apoyo familiar, específicamente el apoyo instrumental y la ausencia de conflicto, tienen importancia, aunque secundaria(AU)

Introduction. Epidemiological changes can have an effect on social and, and in particular, family ties, which are important elements in the mental health of older people. The objective of this study was to evaluate the impact of family support on depressive disorders in older people of the community. Material and methods. Face to face interviews were conducted on a representative sample of adults 60 years and older, living in urban area of Santiago de Chile. The information on depressive disorders was related to family composition, emotional and instrumental support, presence of conflict, health self-perception, functionality and self-efficiency. Data were analyzed using logistic regression models. Results. From a total of 394 participants, 62% females, mean age 74 years (SD=8.1), 16% felt depressed almost every day. Depressive disorders were significantly associated in regression models with impaired self-perception of health and efficacy, lower instrumental support, and with the presence of conflict. The variable that most contributed to the model was self-rated poor health, increasing the odds of depressive disorders by 3.2. Conclusions. Poor perception of health was the main determining factor for depressive complaints in older people, followed by lower family support, specifically instrumental support, and the presence of conflict. This information can help future programs in order to improve the quality of life in older people(AU)