Evaluación de 1497 adultos mayores institucionalizados, usando el sistema de clasificación de pacientes RUG T-18 / Assessment of 1497 Chilean nursing home residents, using the Resource Utilization Group method, 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 percent women), with an age range of 60-106 years. Thirty six percent had urinary incontinence, 19 percent required assistance for feeding, and 38 percent needed help for walking or moving. Fifty seven percent were in the lowest category of complexity, ½Institutionalization¼. Very few residents were in the most demanding categories, no one classified as ½Rehabilitation¼, and only 0.7 percent were in ½Special Care¼. Conclusions: This study is an important start point to learn more about elderly subjects living in nursing homes in Chile (Rev Méd Chile 2004; 132: 701-6).

Resultados al aplicar el sistema de clasificación de pacientes RUG-T18 en ancianos ingresados a un hospital universitario / Application of RUG-T18 classification to elderly patients admitted to an university hospital

Background: Among case mix classifications, the best for hospitalized elders is the Resource Utilization Groups (RUG) system, which allows a better location of patients, resource administration and the design of health care strategies for elderly people. Aim: To report the results of RUG-T18 classification of elderly patients admitted to an university hospital. Patients and methods: RUG-T18 classification was applied to 210 patients aged 75.2 ñ 7.2 years old, 108 male, admitted to the Clinical Hospital of the Catholic University of Chile. Results: The clinical classification of assessed patients was rehabilitation in 50.9 per cent of cases, special care in 10.5 per cent, clinically complex in 37.1 per cent and reduced physical functions in 0.5 per cent. None had behavioral alterations. There were no differences between subjects older or younger than 75 years old. Daily life activities showed that help was required for sphincter control in 46 per cent of patients, for feeding in 44 per cent and for mobilization in 64 per cent (28 per cent of patients required help from two or more people). Geriatric assessment showed that, since 1993, the proportion of elders with greater functional derangement increased from 18 to 28 per cent, and the proportion of those with mental disturbances from 4 to 12 per cent, specially among those over 75 years old. Conclusions: Most elders admitted to the hospital are classified in the superior categories of the RUG-T18 system and have severe mental and functional limitations. These patients require a multidisciplinary approach with a great emphasis in rehabilitation

Valoración geriátrica ambulatoria de 2116 adultos mayores pobres / Geriatric assessment of 2116 free living elders

Background: Geriatric assessment quantifies medical, functional, mental and social capabilities and alterations of elders and is the first step to initiate specific intervention programs. Aim: To report the initial geriatric assessment of a program aimed to help poor elders living in Metropolitan Santiago. Subjects and methods: Two thousand one hundred sixteen free living subjects aged 65 to 99 years old (711 males) were subjected to an assessment using a simple geriatric score validated abroad and used previously in Chile. The resulting score ranges from 0 (better) to 5 (worst). Results: Eighty eight percent of elders did not have problems in the functional evaluation. Subjects over 75 years old needed occasional support for the daily activities with higher frequency than younger subjects (12 and 5.4 per cent respectively, p< 0.001) and had a higher frequency of major functional limitations (7.8 and 3.2 per cent respectively, p< 0.001). Mental assessment was considered normal in 89.4 per cent of subjects. Those over 75 years old had a higher frequency of memory disturbances (11.4 and 6.5 per cent respectively) and cognitive alterations (4.6 and 1.8 per cent respectively). Indefinite social support could be received by 84 per cent of subjects, but 7.4 per cent did not have access to this resource. Conclusions: Geriatric assessment of poor elders gives useful information to identify those subjects that require community help

Estudio comparativo de nonagenarios que viven en sus propios hogares versus los institucionalizados / Comparative study of nonagenarians living at their own homes and institutionalized

Subjects and methods: During 24 months, 241 people of 90 years or older were interviewed. One hundred twenty seven (96 female) lived in their own homes and 114 (108 female) lived in institutions. The geriatric evaluation scale, validated in previous studies, was used as the assessment instrument. Results: Mean age of subjetcs was 94 years old (range 90 to 106). Eight percent of subjects were bedridden. No differences in general condition, fecal or urinary continence, nutritional status, blood pressure, cognition, sight and hearing acuity, were observed between free living and institutionalized subjetcs. Free living elders had a significantly higher number of bothers or offspring and 90 percent were happy with the place where they lived. Conclusions: Most nonagenarians in Santiago are in good general medical conditions. Probably, the decision to become institutionalized depends more on lack of family support than on worse medical, functional or mental conditions

Experiencia piloto en el uso de una ficha de evaluación geriátrica ambulatoria / Pilot experience with an ambulatory geriatric assessment questionnaire

Ten percent of the chilean population is over 60 years old and general practitioners need an instrument to assess the degree of disability and multiple ailments of elders. Aim: to develop and use an instrument to assess elders consulting in primary care outpatient clinics. An instrument to be used by general practitioners, aimed to assess bio-psico-social risk of elders was devised by the Geriatrics Program at the Faculty of Medicine of the Catholic University of Chile. The instrument was used in 100 elders (82 female) aged 71ñ8 years old consulting in a primary care outpatient clinic. The instrument took less than 5 minutes to be used. The most frequent risk factors found were living alone in 62 percent of subjects, falls in the last year in 47 percent, memory disturbances in 62 percent, overweight in 76 percent, visual impairment in 76 percent, urinary incontinence in 26 percent and depression in 76 percent. Thirty percent had difficulties to climb stairs and 4 percent had no support in case of severe disability. The applied instrument is fast to apply, easily understood by patients and detects problems associated with old age, that will help to plan primary care health programs