Impacto del paciente anciano en los servicios de urgencias hospitalarios / Impact of the elderly patient in the emergency department

Introducción. El envejecimiento poblacional, el aumento de pacientes con enfermedades crónicas y la presencia excesiva de visitas no urgentes se consideran las grandes culpables del aumento de carga asistencial en los servicios de urgencia hospitalarios (SUH). El objetivo del estudio es analizar el impacto que ejerce el paciente anciano en los SUH, comparándolo con el resto de la población. Material y métodos. Estudio observacional, descriptivo y retrospectivo, de los 92.627 pacientes que acudieron al servicio de urgencias de los hospitales del área sanitaria iv del Servicio de Salud del Principado de Asturias durante todo el año 2009. Se analizaron el número de visitas totales, triaje de Manchester, destino al alta de los pacientes, estancia media, presión horaria durante las 24horas, pruebas complementarias, reclamaciones y consultas al servicio social. Se comparó la base de datos entre mayores y menores de 70 años. Resultados. Un total de 28.965 (31.27%) pacientes eran≥70años, con una tasa de frecuentación del 52,29% (frente a 25,70% en<70años). Los pacientes mayores presentaban una mayor prioridad en la atención por gravedad, se les realizaron más pruebas complementarias, con una mayor estancia media, tenían una mayor probabilidad de ingreso, de ser exitus y de necesidad de valoración por servicio social. Conclusiones. Los pacientes ancianos acuden de forma justificada a los SUH y con un patrón de uso significativamente diferente a los adultos jóvenes

Introduction. The aging of the population, chronic diseases, and non-urgent visits to the Emergency departments (ED) are considered the reasons for the increase of the demand of care. The aim of this study is to analyse the impact of the older population in the ED, when compared to a younger population. Material and methods. An observational, descriptive and retrospective study including an analysis of the 92,627 patients that attended the ED in Hospitals from Health Area IV belonging to the Principality of Asturias Health Services during 2009. The analysis included the number of visits, degree of urgency when arriving at the ED, length of stay (LOS), destination after ED assessment, demand of care per time of day, laboratory tests, and radiology, complaints, and social services consultation. A comparison was made between the data of patients over and below 70 years of age. Results. At total of 28,965 (31.27%) patients were over 70 years of age, with a frequency rate in the ED of 52.29% (25.70% in those less than 70 years). Patients over 70 years had a higher priority attention through the Manchester triage scale, receiving more laboratory tests, with a higher LOS. They also had a higher probability of being seen by social services, of being admitted, and death. Conclusions. Older patients consult the ED with more justifiable reasons than the younger adult population

[Impact of the elderly patient in the emergency department]. / Impacto del paciente anciano en los servicios de urgencias hospitalarios.

INTRODUCTION: The aging of the population, chronic diseases, and non-urgent visits to the Emergency departments (ED) are considered the reasons for the increase of the demand of care. The aim of this study is to analyse the impact of the older population in the ED, when compared to a younger population. MATERIAL AND METHODS: An observational, descriptive and retrospective study including an analysis of the 92,627 patients that attended the ED in Hospitals from Health Area IV belonging to the Principality of Asturias Health Services during 2009. The analysis included the number of visits, degree of urgency when arriving at the ED, length of stay (LOS), destination after ED assessment, demand of care per time of day, laboratory tests, and radiology, complaints, and social services consultation. A comparison was made between the data of patients over and below 70 years of age. RESULTS: At total of 28,965 (31.27%) patients were over 70 years of age, with a frequency rate in the ED of 52.29% (25.70% in those less than 70 years). Patients over 70 years had a higher priority attention through the Manchester triage scale, receiving more laboratory tests, with a higher LOS. They also had a higher probability of being seen by social services, of being admitted, and death. CONCLUSIONS: Older patients consult the ED with more justifiable reasons than the younger adult population.

Definición y prevalencia del deterioro cognitivo leve / Definition and prevalence of mild cognitive impairment

La cognición es la capacidad que permite al ser humano desarrollar una vida sin dificultad, resolviendo problemas y situaciones, manteniendo un correcto aprendizaje y procesando correctamente la información del ambiente, para recordarla y utilizarla posteriormente. Las personas que presenten un envejecimiento cerebral normal o fisiológico mantendrán esta capacidad durante todos sus años de vida. Sin embrago, las que sufran un envejecimiento anormal o patológico podrán verse afectadas por diferentes grados de deterioro de las funciones mentales superiores. En 1988 se introdujo el constructo deterioro cognitivo leve como un síndrome que comprendía un déficit cognitivo superior al esperado para la edad y el nivel cultural de la persona. En ese momento fue considerado como un proceso degenerativo que antecedía a la demencia. En los últimos 30 años se ha constatado que no todos los pacientes con deterioro cognitivo leve evolucionan hacia demencia. Por ello, el concepto y la definición han sido modificados en sucesivas ocasiones, a la vez que se han establecido diferentes subtipos de deterioro cognitivo leve en función del dominio cognitivo afectado. Es necesario profundizar en la definición de deterioro cognitivo leve y conocer los subtipos, con el objetivo de establecer su impacto sobre una sociedad envejecida, identificar sujetos en riesgo de conversión a demencia e implementar estrategias de intervención precoz dirigidas a mejorar la salud mental de nuestros mayores (AU)

Cognition is the ability that allows humans to carry out their lives without difficulty, resolving problems and situations, and to continue to learn and correctly process information from the environment for its subsequent retrieval and use. In persons with normal or physiological brain ageing, this ability is maintained throughout their lives. However, individuals with abnormal or pathological ageing could be affected by distinct degrees of impairment of higher brain functions. The term mild cognitive impairment (MCI) entered the lexicon in 1988 to describe a syndrome encompassing greater than expected cognitive impairment for the person’s age and cultural environment. At that time, MCI was considered a degenerative process that preceded dementia. In the last 30 years, it has become clear that not all patients with MCI will progress to dementia. Therefore, the concept and definition of this syndrome have been constantly updated, and distinct subtypes of MCI have been established according to the affected cognitive domain. There is a need to define MCI more clearly and identify its subtypes in order to establish its impact on an ageing society, identify persons at risk of progressing to dementia, and implement early intervention strategies aimed at improving the mental health of the elderly population (AU)

[Definition and prevalence of mild cognitive impairment]. / Definición y prevalencia del deterioro cognitivo leve.

Cognition is the ability that allows humans to carry out their lives without difficulty, resolving problems and situations, and to continue to learn and correctly process information from the environment for its subsequent retrieval and use. In persons with normal or physiological brain ageing, this ability is maintained throughout their lives. However, individuals with abnormal or pathological ageing could be affected by distinct degrees of impairment of higher brain functions. The term mild cognitive impairment (MCI) entered the lexicon in 1988 to describe a syndrome encompassing greater than expected cognitive impairment for the person's age and cultural environment. At that time, MCI was considered a degenerative process that preceded dementia. In the last 30 years, it has become clear that not all patients with MCI will progress to dementia. Therefore, the concept and definition of this syndrome have been constantly updated, and distinct subtypes of MCI have been established according to the affected cognitive domain. There is a need to define MCI more clearly and identify its subtypes in order to establish its impact on an ageing society, identify persons at risk of progressing to dementia, and implement early intervention strategies aimed at improving the mental health of the elderly population.