[Functional classification of the elderly in primary health care: proposed method]. / Clasificación funcional del anciano en atención primaria de salud: propuesta de un método.

OBJECTIVE: To develop a method of functional classification of the elderly (FCE) in Primary Health Care and to define the age limit for considering someone "a frail elderly person." DESIGN: A descriptive study in two phases: a) the method's design by means of "brainwriting" and b) the evaluation of the method in a descriptive crossover study. SETTING: A rural medical consulting-room. PATIENTS AND OTHER PARTICIPANTS: The research team, in the design of the method; and the elderly population attending for health care (n = 131), in the method's evaluation. MEASUREMENTS AND MAIN RESULTS: The FCE method was based on the Katz (IK) and Lawton-Brodie (IL-B) indices and classified the patients as independent and at different levels of disability. Urinary incontinence (UI) was excluded from the IK. 85.4% of the patients were independent, which bore relation to age (p < 0.001), but not to gender. When UI was included in the IK, the number of people classified as disabled increased by 32% (CI 95%, 23-41%) over when it was not included. Yet 80% of patients with UI were independent. No differences in the percentage of disabled patients were observed when the cut-off age for detecting disabled patients varied from 75 to 80. CONCLUSIONS: The inclusion of UI as a negative factor in the IK gives rise to overestimates of the number of disabled people. In our study the data suggested that the age for considering an elderly person as 'frail' should be 80.

[The exhaustive geriatric evaluation in primary care: an assessment of its utility]. / Evaluación geriátrica exhaustiva en atención primaria: valoración de su utilidad.

OBJECTIVE: To describe the preliminary results from evaluating the application of an exhaustive geriatric evaluation procedure within primary care. DESIGN: A descriptive crossover study of a non-random sample. SETTING: This was carried out in primary care at an out-station clinic serving a suburban population. PATIENTS AND OTHER PARTICIPANTS: Those people aged 70 and over who requested health-care at the clinic. All the 131 people who attended between February and December 1992 were included in the procedure. MEASUREMENTS AND MAIN RESULTS: The Exhaustive Geriatric Evaluation was applied as an instrument to diagnose hidden health problems. The instrument is composed of functional classification (Katz and Lawton-Brody scales), detection of risk factors which might lead to institutionalisation and an exhaustive clinical assessment (biomedical, psychological and socio-family). The diagnostic usefulness of the procedure is 2.4 +/- 0.21 new diagnoses per patient, for 98% of those to whom the complete new procedure was applied (62.6% of the patients included). Problems of hypoacusis (33.3%), senile memory lapses (41.6%) and urinary incontinence (26.2%) were found to a significant degree (p < 0.05) compared with the previously diagnosed morbidity. On the Katz and Lawton-Brody scales, 74% and 41.9% of patients, respectively, were independent. 55.7% of patients presented at least one risk factor leading to institutionalisation, with loneliness being the most common (35.8% of cases). CONCLUSIONS: The exhaustive geriatric evaluation is valid in primary care in looking after the elderly population, as it leads to the detection of functional and hidden bio-psychosocial problems.