Priorización por los pacientes de una serie de componentes habituales en la valoración geriátrica integral realizada en Atención Primaria / Prioritization by patients of a series of common components in the standard comprehensive geriatric assessment in Primary Care

Objetivo: Conocer la priorización por personas ≥ 70 años de una serie de componentes habituales en la valoración geriátrica integral (VGI) realizada en Atención Primaria (AP), según su percepción de la influencia en la salud.Método: Estudio transversal en AP mediante cuestionario a 109 personas, excluyendo a pacientes al final de la vida, o con alteración cognitiva, sensorial o psiquiátrica que dificultase su participación.La variable principal fue una selección de 23 ítems del área físico/clínica, funcional, mental y sociofamiliar, habituales en una VGI en AP. Otras: edad, sexo, cuestionario VIDA de actividades instrumentales de la vida diaria, número de medicamentos, índice de comorbilidad de Charlson.Resultados: Mediana de edad 78 años, percentil 75 de 84; 64,2% mujeres. Cuatro personas (3,7%) tenían alterado el cuestionario VIDA (< 32 puntos). Mediana de 5 medicamentos habituales y 98 (90%) sin comorbilidad relevante según el Charlson. Sin diferencias estadísticamente significativas al contrastar sexo con edad, resultado del VIDA y número de medicamentos.Los ítems mejor valorados según estadísticos de centralización fueron fumar y la memoria, y considerando la mejor puntuación (4-5 sobre 5): medicación adecuada (93,6% de los encuestados, IC del 95%, 87,3-96,8), condiciones de boca/dentadura (92,7%, IC del 95%, 86,2-96,2), estado de ánimo (91,7%, IC del 95%, 85,1-95,6), capacidad para realizar AVD (91,7%, IC del 95%, 85,1-95,6).Conclusiones: Los pacientes consideraban fumar, la memoria, la medicación adecuada, el estado de boca/dentadura y de ánimo, y las AVD como más influyentes en la salud. Ante la importancia de la participación de los pacientes en el contenido de la VGI y la escasez de estos trabajos, se hacen pertinentes nuevos estudios que profundicen este tema. (AU)

Objective: To know the prioritization by people aged ≥70 of a series of common components in the comprehensive geriatric assessment (CGA) in primary care (PC), according to the influence on health.Method: Cross-sectional descriptive study through questionnaire to 109 people, have been excluded those at the end of life or with cognitive, sensory or mental/psychiatric impairment that made collaboration difficult.The main variable was a selection of 23 items of the physical/clinical, functional, mental and social/family, common components on a CGA in PC. Others: age, sex, VIDA questionnaire of instrumental activities of daily living (IADL), number of medications, and Charlson comorbidity index.Results: Median age 78 years, 75 percentile of 84; 64.2% women. Four people (3.7%) had altered VIDA questionnaire (<32 points). Median of 5 chronic medications, and 98 (90%) comorbidity absence considering Charlson index. Without statistically significant differences contrasting gender with age, result in VIDA, nor number of chronic medications.The best scored items according to centralization statistics were smoking and memory, and considering the best score (4–5 out of 5) of the Likert scale: proper medication (93.6% of the people surveyed, 95% CI: 87.3–96.8), mouth/teeth condition (92.7%, 95% CI: 86.2–96.2), mood (91.7%, 95% CI: 85.1–95.6), and capacity for ADL (91.7%, 95% CI:85.1–95.6).Conclusions: Smoking, memory, proper medication, mouth/teeth condition, mood and ADL were considered as the most influential in health by patients. Because of the important of patient participation in the content of the CGA and the scarcity of these kind of studies, new studies that deepen this issue become relevant. (AU)

[Prioritization by patients of a series of common components in the standard comprehensive geriatric assessment in Primary Care]. / Priorización por los pacientes de una serie de componentes habituales en la valoración geriátrica integral realizada en Atención Primaria.

OBJECTIVE: To know the prioritization by people aged ≥70 of a series of common components in the comprehensive geriatric assessment (CGA) in primary care (PC), according to the influence on health. METHOD: Cross-sectional descriptive study through questionnaire to 109 people, have been excluded those at the end of life or with cognitive, sensory or mental/psychiatric impairment that made collaboration difficult. The main variable was a selection of 23 items of the physical/clinical, functional, mental and social/family, common components on a CGA in PC. Others: age, sex, VIDA questionnaire of instrumental activities of daily living (IADL), number of medications, and Charlson comorbidity index. RESULTS: Median age 78 years, 75 percentile of 84; 64.2% women. Four people (3.7%) had altered VIDA questionnaire (<32 points). Median of 5 chronic medications, and 98 (90%) comorbidity absence considering Charlson index. Without statistically significant differences contrasting gender with age, result in VIDA, nor number of chronic medications. The best scored items according to centralization statistics were smoking and memory, and considering the best score (4-5 out of 5) of the Likert scale: proper medication (93.6% of the people surveyed, 95% CI: 87.3-96.8), mouth/teeth condition (92.7%, 95% CI: 86.2-96.2), mood (91.7%, 95% CI: 85.1-95.6), and capacity for ADL (91.7%, 95% CI:85.1-95.6). CONCLUSIONS: Smoking, memory, proper medication, mouth/teeth condition, mood and ADL were considered as the most influential in health by patients. Because of the important of patient participation in the content of the CGA and the scarcity of these kind of studies, new studies that deepen this issue become relevant.

Validez predictiva del cuestionario VIDA considerando pérdida funcional, institucionalización o muerte en pacientes pluripatológicos / Predictive validity of the VIDA questionnaire on functional decline, institutionalisation or death in patients with multiple morbidities

INTRODUCCIÓN: El cuestionario español VIDA valora actividades instrumentales de la vida diaria (AIVD) en mayores, con adecuada validez de contenido, constructo y fiabilidad. El objetivo era analizar su validez predictiva, en pacientes pluripatológicos ≥65 años sin dependencia severa/total en actividades básicas de la vida diaria (ABVD, índice de Barthel ≥60 puntos), considerando el cambio a este grado de dependencia severa/total, institucionalización o muerte a 8 y 18 meses de seguimiento. MATERIALES Y MÉTODOS: Estudio prospectivo de prueba diagnóstica. Se consideraron 197 pacientes (a 8 meses) y 185 pacientes (a 18 meses) incluidos en el programa de pluripatológicos según estratificación por Adjusted Clinical Groups (ACG) o cumpliendo criterios de Ollero, excluyendo institucionalizados, al final de la vida o en diálisis, con un índice de Barthel basal ≥60 puntos; se les pasó el cuestionario VIDA al inicio. Otras variables basales fueron: edad, sexo, índice de Charlson, número de medicamentos, índice de Lawton-Brody. El evento de resultado era pasar a un índice de Barthel <60, o institucionalización, o muerte en cada periodo. RESULTADOS: La mediana de edad fue de 81 años (RIC: 74,5-85); el 45,2% eran mujeres. A 8 meses, el mejor punto de corte del VIDA fue ≤31 puntos (sensibilidad [S]: 81,5% [IC95%: 61,2-93]; especificidad [E]: 58,2% [IC95%: 50,4-65,7]; VPP: 23,7%; VPN: 95,2%), ≤30 en mujeres, ≤34 en hombres; a 18 meses, fue ≤29 puntos (S: 61,4 [IC95%: 47,6-73,7]; E: 76,6 [IC95%: 68,1-83,4]; VPP: 53,9; VPN: 81,7). CONCLUSIONES: Se aportan puntos de corte, global y por sexo, para predecir el paso a dependencia severa/total en ABVD, o institucionalización o muerte en pacientes pluripatológicos. Parece mejor para detectar eventos a corto plazo y descartarlos a largo plazo

INTRODUCTION: The VIDA Spanish questionnaire assesses instrumental activities of daily living (IADL) in elderly people, and has shown to have adequate content, construct validity, and reliability. The objective was to analyse its predictive validity in patients with multiple morbidities aged ≥65 years without severe/total dependence in basic activities (BADL, Barthel index ≥60 points), by measuring any changes in this severe/total level of dependence, institutionalisation, or death at 8 and 18 months of follow-up. METHODS: A prospective study of a diagnostic test was conducted on 197 patients (8 months) and 185 (18 months) included in the multiple morbidities program according to stratification by Adjusted Clinical Groups (ACG) or by fulfilling the Ollero criteria. Patients that were institutionalised, at the end of life, or on dialysis, or with a baseline Barthel index ≥60 points were excluded. The VIDA questionnaire was applied at baseline. The other baseline variables included age, gender, Charlson index, number of drugs, and Lawton-Brody index. The outcome event was changing the Barthel index to <60, or institutionalisation, or death, in each follow-up period. RESULTS: The median age was 81 years (IQR 74.5-85), and 45.2% were women. At 8 months, the best cut-off point for VIDA was ≤31 points (Sensitivity [S] 81.5%, [95% CI; 61.2-93.0]; Specificity (Sp) 58.2% [95% CI; 50.4-65.7], PPV 23.7%; NPV 95.2%), ≤30 in women, ≤34 in men. And at 18 months, ≤29 points (S 61.4 [95% CI; 47.6-73.7]; Sp 76.6 [95% CI; 68.1-83.4]; PPV 53.9; NPV 81.7). CONCLUSIONS: Overall cut-off points are provided as well as those for gender, predicting severe/total BADL decline, or institutionalization or death in patients with multiple morbidities. It seems to detect short-term events better and rules them out in the long term

[Predictive validity of the VIDA questionnaire on functional decline, institutionalisation or death in patients with multiple morbidities]. / Validez predictiva del cuestionario VIDA considerando pérdida funcional, institucionalización o muerte en pacientes pluripatológicos.

INTRODUCTION: The VIDA Spanish questionnaire assesses instrumental activities of daily living (IADL) in elderly people, and has shown to have adequate content, construct validity, and reliability. The objective was to analyse its predictive validity in patients with multiple morbidities aged ≥65 years without severe/total dependence in basic activities (BADL, Barthel index ≥60 points), by measuring any changes in this severe/total level of dependence, institutionalisation, or death at 8 and 18 months of follow-up. METHODS: A prospective study of a diagnostic test was conducted on 197 patients (8 months) and 185 (18 months) included in the multiple morbidities program according to stratification by Adjusted Clinical Groups (ACG) or by fulfilling the Ollero criteria. Patients that were institutionalised, at the end of life, or on dialysis, or with a baseline Barthel index ≥60 points were excluded. The VIDA questionnaire was applied at baseline. The other baseline variables included age, gender, Charlson index, number of drugs, and Lawton-Brody index. The outcome event was changing the Barthel index to <60, or institutionalisation, or death, in each follow-up period. RESULTS: The median age was 81 years (IQR 74.5-85), and 45.2% were women. At 8 months, the best cut-off point for VIDA was ≤31 points (Sensitivity [S] 81.5%, [95% CI; 61.2-93.0]; Specificity (Sp) 58.2% [95% CI; 50.4-65.7], PPV 23.7%; NPV 95.2%), ≤30 in women, ≤34 in men. And at 18 months, ≤29 points (S 61.4 [95% CI; 47.6-73.7]; Sp 76.6 [95% CI; 68.1-83.4]; PPV 53.9; NPV 81.7). CONCLUSIONS: Overall cut-off points are provided as well as those for gender, predicting severe/total BADL decline, or institutionalization or death in patients with multiple morbidities. It seems to detect short-term events better and rules them out in the long term.