Alivio del dolor como parte de los cuidados al final de la vida / Pain relief as part of end-of-life care

Los cuidados al final de la vida deben formar parte de un proceso asistencial que, partiendo de la Valoración Geriátrica Integral y de la elaboración de una detallada Lista de Problemas, permita compatibilizar el tratamiento adecuado y riguroso de las enfermedades crónicas y sus procesos intercurrentes con cuidados paliativos de calidad. Hasta el 25-50% de los mayores que viven en su domicilio y el 45-80% de los que viven en residencias presentan dolor persistente, y hasta el 80% de los pacientes con cáncer presentan dolor. Con tratamiento adecuado podemos lograr el alivio del dolor en el 75-90% de los pacientes, si bien este porcentaje no se obtiene en la práctica clínica habitual. Con herramientas teóricamente a nuestro alcance: atención sectorizada y coordinada, trabajo interdisciplinario y continuidad de cuidados, que incluyan medidas no farmacológicas y tratamiento farmacológico, podríamos hacer una utilización más eficiente de los recursos y al mismo tiempo conseguir nuestro objetivo: el alivio del dolor

End-of-life care must be part of a process, based on comprehensive geriatric assessment and a detailed checklist of clinical problems, that allows appropriate and rigorous treatment of chronic diseases and their intercurrent processes to be combined with high quality palliative care. Up to 25-50% of the community-dwelling elderly population and 45-80% of nursing home residents have persistent pain, and up to 80% of cancer patients suffer pain. Appropriate treatment can ameliorate pain in approximately 75-90% of patients, although this percentage is far from that achieved in routine clinical practice. Tools that are theoretically within our reach, such as sectorised and coordinated healthcare, interdisciplinary approaches and continuity of care, as well as pharmacological and non-pharmacological management, could lead to more efficient resource use and help us reach our main objective: pain relief

Alimentación y cáncer / Diet and cancer

El cáncer es la segunda causa de muerte en los países desarrollados. Su incidencia aumenta con la edad y la dieta es la causante en al menos un 30% de los casos. El riesgo es menor en poblaciones con un alto consumo de alimentos de origen vegetal. Es importante que reconozcamos que el cáncer, como otras enfermedades crónicas, se puede prevenir para reducir los años potenciales de vida perdidos y las tasas de incapacidad. Para conseguirlo disponemos de las guías alimentarias. Cuando la enfermedad se presenta podemos indicar modificaciones dietéticas para mejorar el estado nutricional del paciente, y en la fase terminal debemos respetar su opinión

Cancer is the second cause of death in the developed world. Its incidence increases with age and diet is responsible for at least 30% of cases. The risk is lower in populations with a high consumption of foods of vegetable origin. To reduce the number of potential years of life lost and disability rates, it is important that we recognise that cancer, like other chronic diseases, can be prevented. To achieve this, dietary recommendations are available. When the disease develops, dietary modifications to improve the patient's nutritional status can be indicated. In the terminal phase of the disease, the patient's opinion should be respected

Síndrome de Gilbert / Gilbert's syndrome

Presentamos el caso de un paciente de 89 años con disnea e ictericia. Se procedió al estudio de esta última hasta llegar al diagnóstico final de síndrome de Gilbert. El objetivo era filiar el origen de la ictericia en un paciente anciano, descartando para ello todas las posibles causas. El diagnóstico se confirmó con la realización del test del ayuno y de la prueba de la rifampicina (AU)

[Geriatric emergencies versus adult emergencies: retrospective analysis of medical emergencies at a general hospital]. / La urgencia geriátrica frente a la urgencia en la edad adulta: análisis retrospectivo de las urgencias médicas de un hospital general.

The aim of the study was to evaluate the process of the attention to emergencies in patients older than 65 years and to compare it with the same process in adult patients. To this end, 965 clinical records of medical emergencies from the Hospital Central de la Cruz Roja in Madrid were retrospectively evaluated, and data were obtained regarding age, the cause for consultation, the investigations performed and their yield, the administration of drug therapy, the major diagnosis at the time of discharge from the service and the clinical course. It was found that all evaluated diagnostic investigations were carried out with equal or higher frequency in patients older than 65 years and that their mean clinical effectiveness was also higher. In addition, it was found that the patients older than 65 years were more commonly admitted to the hospital through the emergency service than the rest of the population. It was concluded, therefore, that the process of attention to emergencies has differential characteristics in the elderly population, and that if the number and proportion of old people increase as it will presumably happen during the two next decades, the cost of attention to emergencies and the number of emergency hospital admissions will also increase.