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2.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 54(3): 136-142, mayo-jun. 2019. tab
Artigo em Espanhol | IBECS-Express | ID: ibc-FGT-2913

RESUMO

Introducción: Diversos autores han demostrado la eficacia de diferentes estrategias de hospitalización a domicilio en pacientes mayores. En estos procesos la identificación de factores pronósticos es imprescindible para una adecuada selección de candidatos. Material y métodos: Se analizó una cohorte de pacientes mayores atendidos en régimen de Hospitalización Domiciliaria Integral por descompensaciones de procesos médicos, ortopédicos o cerebrovasculares con deterioro funcional asociado durante 5años en una organización sanitaria integral. Se analizaron resultados al alta: resolución sanitaria (alta a atención primaria), recuperación favorable (ganancia funcional relativa ≥35%) y la combinación de estas dos variables. Por modelo multivariable de regresión logística se analizó la asociación entre las variables clínicas obtenidas de la valoración geriátrica integral efectuada al ingreso con resultados al alta favorables. Resultados: Se incluyeron 484 pacientes, con edad 84,4 (6,7), género femenino 69%, Barthel basal 74,2 (22,6), cuidador principal familiar-privado/residencia 82/18% y procedencia unidades de hospitalización/urgencias-comunidad 55/45%. Los resultados por procesos (médico/ortopédico/ictus) fueron: resolución sanitaria 71,7/87,5/77,6%; recuperación favorable 72,1/84,9/73,5%; resolución sanitaria con recuperación favorable 67,1/81,6/67,3%. Se asociaron con resolución sanitaria y recuperación funcional favorable (OR [IC95%])-: el ingreso por proceso ortopédico (2,00 [1,22-3,29]), presentar una puntuación en índice de Barthel al ingreso >40 puntos (2,00 [1,18-3,38]) y la ausencia de úlceras por presión al ingreso (2,80 [1,68-4,65]). Conclusiones: Los pacientes con diagnóstico ortopédico, los que tienen una discapacidad no grave al ingreso y los que no presentan úlceras por presión al ingreso pudieron presentar mejores resultados de resolución sanitaria con recuperación favorable. Sufrir deterioro cognitivo o delirium, o estar institucionalizado, no se relacionaron con resultados menos favorables


Introduction: Several authors have demonstrated the efficacy of different hospital-at-home strategies in older patients. The identification of prognostic factors is key for improving the targeting process of candidates. Methods: We performed an analysis of a cohort of older patients attended due to disabling health crises (medical, orthopaedics, or stroke) by a hospital-at-home scheme developed in an integrated care institution over a 5-year period. Main outcomes were: health crisis resolution (discharge to Primary Care); functional resolution (relative functional gain ≥35%), and their combined variable. A logistic regression analysis was performed, including clinical variables from Comprehensive Geriatric Assessment at admission to detect factors related to favourable outcomes. Results: A total of 484 patients were included. The main characteristics were: age 84.4 (6.7), female gender 69%, baseline Barthel score 74.2 (22.6), family-private caregiver/nursing home 82%/18%, referral from hospital wards/emergency department-community in 55%/45%. The main results (for selected processes medical/orthopaedics/stroke) were: health crisis resolution 71.7/87.5/77.6%; functional resolution 72.1/84.9/73.5%; favourable crisis resolution (health crisis resolution with functional resolution) 67.1/81.6/67.3%. Favourable crisis resolution was associated with [OR (95%CI)]: orthopaedic as main diagnosis [2.00 (1.22-3.29)], Barthel score at admission higher than 40 points [2.00 (1.18-3.38)], and the absence of pressure ulcers at admission [2.80 (1.68-4.65)]. Conclusions: Patients presenting with an orthopaedic diagnosis, not having severe disability at admission, and not having pressure ulcers at admission could obtain better results on favourable crisis resolution. Suffering cognitive impairment or delirium, or being institutionalised, was not found related with less favourable results

4.
Rev Esp Geriatr Gerontol ; 54(3): 136-142, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-30792139

RESUMO

INTRODUCTION: Several authors have demonstrated the efficacy of different hospital-at-home strategies in older patients. The identification of prognostic factors is key for improving the targeting process of candidates. METHODS: We performed an analysis of a cohort of older patients attended due to disabling health crises (medical, orthopaedics, or stroke) by a hospital-at-home scheme developed in an integrated care institution over a 5-year period. Main outcomes were: health crisis resolution (discharge to Primary Care); functional resolution (relative functional gain ≥35%), and their combined variable. A logistic regression analysis was performed, including clinical variables from Comprehensive Geriatric Assessment at admission to detect factors related to favourable outcomes. RESULTS: A total of 484 patients were included. The main characteristics were: age 84.4 (6.7), female gender 69%, baseline Barthel score 74.2 (22.6), family-private caregiver/nursing home 82%/18%, referral from hospital wards/emergency department-community in 55%/45%. The main results (for selected processes medical/orthopaedics/stroke) were: health crisis resolution 71.7/87.5/77.6%; functional resolution 72.1/84.9/73.5%; favourable crisis resolution (health crisis resolution with functional resolution) 67.1/81.6/67.3%. Favourable crisis resolution was associated with [OR (95%CI)]: orthopaedic as main diagnosis [2.00 (1.22-3.29)], Barthel score at admission higher than 40 points [2.00 (1.18-3.38)], and the absence of pressure ulcers at admission [2.80 (1.68-4.65)]. CONCLUSIONS: Patients presenting with an orthopaedic diagnosis, not having severe disability at admission, and not having pressure ulcers at admission could obtain better results on favourable crisis resolution. Suffering cognitive impairment or delirium, or being institutionalised, was not found related with less favourable results.

5.
Nutr Hosp ; 34(5): 1305-1310, 2017 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-29280644

RESUMO

AIM: A retrospective cohort study was performed in order to evaluate the prevalence of pressure ulcers (PrUs) in older patients admitted to a geriatric rehabilitation unit of a postacute care hospital and to investigate the impact of the presence of PrUs on clinical outcomes of the rehabilitation process. METHODS: We studied 668 post-acute patients consecutively attended, from January 2010 to December 2011. The effect of having PrUs at admission was evaluated based on its impact on outcomes: final destination, functional status, mortality and length of stay in the rehabilitation unit. RESULTS: PrUs prevalence at admission was 16%. Patients with PrUs were older, more disabled and had more complex conditions, including malnutrition and cognitive impairment. In the bivariate analysis, we found patients with PrUs at admission had worst final outcome (%): discharge home (69.2 vs.82.5), discharge long term care setting (14 vs.6.4), discharge acute care (8.4 vs.6.2) and death (8.4 vs.4.8); p < 0.001, and worst Barthel Index score at discharge 57 (SD 34.1) vs.83 (SD 33.6); p < 0.001, with longer length of stay in the unit 61 (SD 42.3) vs.53 (SD 37.1); p 0.004. In the multivariate analysis, PrUs presence was found as one of the variables with significant association to no return to home. Finally, a negative association between PrUs at admission and functional gain at discharge of the postacute unit was identified. CONCLUSIONS: PrUs were prevalent and had negative impact on clinical outcomes of our geriatric unit, as discharge destination, functional gain and Length of Stay, in vulnerable patients.


Assuntos
Lesão por Pressão/complicações , Reabilitação , Resultado do Tratamento , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Desnutrição/complicações , Estudos Retrospectivos
6.
Nutr. hosp ; 34(6): 1305-1310, nov.-dic. 2017. tab
Artigo em Inglês | IBECS | ID: ibc-168968

RESUMO

Aim: A retrospective cohort study was performed in order to evaluate the prevalence of pressure ulcers (PrUs) in older patients admitted to a geriatric rehabilitation unit of a postacute care hospital and to investigate the impact of the presence of PrUs on clinical outcomes of the rehabilitation process. Methods: We studied 668 post-acute patients consecutively attended, from January 2010 to December 2011. The effect of having PrUs at admission was evaluated based on its impact on outcomes: final destination, functional status, mortality and length of stay in the rehabilitation unit. Results: PrUs prevalence at admission was 16%. Patients with PrUs were older, more disabled and had more complex conditions, including malnutrition and cognitive impairment. In the bivariate analysis, we found patients with PrUs at admission had worst final outcome (%): discharge home (69.2 vs. 82.5), discharge long term care setting (14 vs. 6.4), discharge acute care (8.4 vs. 6.2) and death (8.4 vs. 4.8); p < 0.001, and worst Barthel Index score at discharge 57 (SD 34.1) vs. 83 (SD 33.6); p < 0.001, with longer length of stay in the unit 61 (SD 42.3) vs. 53 (SD 37.1); p 0.004. In the multivariate analysis, PrUs presence was found as one of the variables with significant association to no return to home. Finally, a negative association between PrUs at admission and functional gain at discharge of the postacute unit was identified. Conclusions: PrUs were prevalent and had negative impact on clinical outcomes of our geriatric unit, as discharge destination, functional gain and Length of Stay, in vulnerable patients (AU)


Objetivo: se realizó un estudio de cohorte retrospectivo para evaluar la prevalencia de úlceras por presión (PRU) en pacientes mayores ingresados en una unidad de rehabilitación geriátrica de postagudos (atención intermedia) e investigar el impacto de la presencia de PrU en los resultados clínicos del proceso de rehabilitación. Métodos: se estudiaron 668 pacientes ingresados de forma consecutiva, de enero de 2010 a diciembre de 2011. Se evaluó el impacto de la presencia de PrU en el momento del ingreso en relación a los siguientes resultados de salud: destino final, estado funcional, mortalidad y duración de la estancia en la unidad de rehabilitación. Resultados: la prevalencia de PrU en el momento del ingreso fue del 16%. Los pacientes con PrU tenían mayor edad, más presencia de discapacidad y tenían una mayor prevalencia de condiciones complejas, incluyendo desnutrición y deterioro cognitivo. En el análisis bivariado se encontró que los pacientes con PrU al ingreso presentaron un peor resultado final (%): alta a domicilio (69,2 vs. 82,5), ingreso en unidades de larga estancia (14 vs. 6,4), reingreso hospitalario (8,4 vs. 6,2) y fallecimiento (8,4 vs. 4,8); p < 0,001, y un peor índice de Barthel al momento del alta (57 frente a 83); p < 0,001, con mayor duración de la estancia en la unidad (61 frente a 53 días); p 0,004. En el análisis multivariante, la presencia de PrU en el momento del ingreso, se asoció como variable predictora negativa de retorno a domicilio, así como predictora negativa respecto a la ganancia funcional al alta de la unidad postagudos. Conclusiones: las PrUs fueron prevalentes y tuvieron un impacto negativo en los resultados clínicos de nuestra unidad geriátrica, como destino de alta, ganancia funcional y duración de la estancia, en pacientes vulnerables (AU)


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Lesão por Pressão/dietoterapia , Lesão por Pressão/epidemiologia , Doença Aguda/epidemiologia , Lesão por Pressão/prevenção & controle , Lesão por Pressão/reabilitação , Estudos Retrospectivos , Estudos de Coortes , Doença Aguda/reabilitação , Análise Multivariada , Tempo de Internação , Análise de Dados/métodos
10.
Maturitas ; 88: 65-9, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27105701

RESUMO

OBJECTIVE: Older citizens with orthopaedic conditions need specialised care for the facilitation of early community reintegration and restitution of physical function. We introduced a new community care programme as an alternative to usual hospital rehabilitation for orthopaedic patients. STUDY DESIGN: This was an observational study of a cohort of older orthopaedic patients attending a hospital-at-home integrated care programme (HHU), compared with a contemporary cohort of users of a geriatric rehabilitation unit (GRU) in the urban area of Badalona, Catalonia, Spain. MAIN OUTCOMES MEASURES: Functional gain at discharge was measured using the Barthel Index (BI). Other outcomes were: length of intervention (days), rehabilitation efficiency and discharge destination. RESULTS: Over the 2 years of the study we assessed 270 patients (69 at HHU; 201 at GRU). We found no significant differences in baseline characteristics between HHU and GRU groups-mean (IQR) or % age 83 (79-87) vs. 84 (79-88), cognitive impairment 27.5% vs. 24.9%, functional decline 40 (31-48) vs. 43 (32-58). Overall, we found no statistically significant differences between HHU and GRU groups on functional gain: 35 (22-45) vs. 32 (18-46), and discharge home 85.5% vs. 86.1%. Length of intervention was shorter in the HHU group, 43 (32-56) vs. 57 (44-81); p<0.01, for hip fracture patients. In a multivariate analysis, the adjusted mean difference in rehabilitation efficiency between HHU and GRU groups in the hip fracture subgroup was 0.27 (0.09 to 0.46); p=0.004. CONCLUSIONS: This hospital-at-home service obtained similar clinical results to the usual hospital-based rehabilitation care, and for hip fracture patients attending that service, rehabilitation efficiency was better.


Assuntos
Transtornos Cognitivos , Prestação Integrada de Cuidados de Saúde , Fraturas do Quadril/reabilitação , Hospitais , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Ortopedia , Espanha
11.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 50(1): 26-34, ene.-feb. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-130653

RESUMO

Presentamos una scoping review sobre el interés que puede tener desarrollar en nuestro sistema sanitario nuevos esquemas de hospitalización domiciliaria en pacientes ancianos con condiciones complejas asociadas a procesos agudos de salud. Se realizó una búsqueda bibliográfica de ensayos clínicos aleatorizados, revisiones sistemáticas y metaanálisis de los mismos en Pubmed y Cochrane Library, desde enero de 1990 a julio de 2013. La búsqueda incluyó los términos hospital-at-home, Early Supported Discharge, hospital in the home y home hospitalization. Se analizaron: modelo de intervención (sustitutivo del ingreso o facilitador del alta), edad, diagnóstico principal, perfiles de pacientes incluidos y tipo de intervención (disciplinas implicadas, duración de la intervención y principales objetivos y resultados). Concluimos que hay diversos modelos de hospitalización domiciliaria con resultados clínicos favorables. Aparte de esquemas sanitarios centrados en agudizaciones de enfermedades crónicas en ancianos más jóvenes, mayoritarios en nuestro país, destacan otros esquemas integrales basados en equipos interdisciplinares de base geriátrica orientados a intervenciones complejas. El desarrollo de esquemas de hospitalización domiciliaria integral, con equipos liderados por geriatras, es una oportunidad como alternativa a la hospitalización convencional adaptada a pacientes ancianos en nuestro entorno asistencial (AU)


This scoping review focused on the opportunity of developing new hospital-at-home schemes in our health systems adapted to older patients with complex conditions due to acute illness. A review was conducted on articles including, randomized controlled trials, systematic reviews and meta-analysis in PubMed and Cochrane Library, from January 1990 to July 2013. Search terms were: hospital-at-home, Early Supported Discharge, hospital in the home and home hospitalization. An analysis was performed to include: the intervention model (admission avoidance or early discharge), age, diagnosis, main inclusion criteria and intervention characteristics (disciplines involved, duration of intervention, main outcomes and objectives). It is concluded that there are several models of hospital-at-home care, with favorable clinical outcomes. The majority of teams in our country focused on acute health care in the less elderly with chronic diseases. Other schemes based on comprehensive geriatric assessment and interdisciplinary teams specialized in complex interventions are also highlighted. The development of comprehensive geriatric assessment based hospital-at-home care by teams led by geriatricians is an opportunity to develop alternatives to conventional hospitalization interventions tailored to older patients (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Hospitalização/tendências , Serviços Hospitalares de Assistência Domiciliar/tendências , Tempo de Internação/tendências , Colaboração Intersetorial , Qualidade de Vida , Serviços de Assistência Domiciliar/organização & administração , Serviços de Assistência Domiciliar/tendências , Avaliação de Resultado de Intervenções Terapêuticas , Avaliação de Eficácia-Efetividade de Intervenções
12.
Int J Stroke ; 10(1): 7-12, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23227916

RESUMO

After an acute stroke, a multidimensional approach based on multidisciplinary work and rehabilitation is required in order to promote functional independence and social reinsertion and to maintain medical stability. These activities are usually developed in the hospital setting as a continuum of the acute phase, but hospitalization is resource consuming and resources are limited. Early Support Discharge strategies base postacute care and rehabilitation at home after an early discharge planning and represent possible alternatives to conventional hospitalization. Recent evidence suggests that Early Supported Discharge might be superior to hospitalization from both the clinical-functional and the economic viewpoints. Moreover, home-based rehabilitation might potentiate important determinants of effectiveness, such as patient's motivation and goal-directed rehabilitation. However, hitherto produced evidence and recommendations show a number of limitations related to the organization models, the inclusion/exclusion criteria, and the questionable applicability of results to any healthcare setting worldwide. In this article, we critically review different methodological and organizational aspects of the available studies. For example in the definition of the target population, based mainly on residual disability and medical stability, we suggest that other relevant aspects, such as premorbid functional status, cognitive function, and previous institutionalization, should be better defined. Focusing on the outcomes, we suggest that, besides strong outcomes such as global functioning, surrogate outcomes, such as physical function, could help to refine the specific interventions. Finally, considering that the majority of studies were conducted in northern Europe, further studies are needed to test the implementation of Early Supported Discharge in different regions.


Assuntos
Alta do Paciente , Reabilitação do Acidente Vascular Cerebral , Humanos
13.
Rev Esp Geriatr Gerontol ; 50(1): 26-34, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-24948521

RESUMO

This scoping review focused on the opportunity of developing new hospital-at-home schemes in our health systems adapted to older patients with complex conditions due to acute illness. A review was conducted on articles including, randomized controlled trials, systematic reviews and meta-analysis in PubMed and Cochrane Library, from January 1990 to July 2013. Search terms were: hospital-at-home, Early Supported Discharge, hospital in the home and home hospitalization. An analysis was performed to include: the intervention model (admission avoidance or early discharge), age, diagnosis, main inclusion criteria and intervention characteristics (disciplines involved, duration of intervention, main outcomes and objectives). It is concluded that there are several models of hospital-at-home care, with favorable clinical outcomes. The majority of teams in our country focused on acute health care in the less elderly with chronic diseases. Other schemes based on comprehensive geriatric assessment and interdisciplinary teams specialized in complex interventions are also highlighted. The development of comprehensive geriatric assessment based hospital-at-home care by teams led by geriatricians is an opportunity to develop alternatives to conventional hospitalization interventions tailored to older patients.


Assuntos
Avaliação Geriátrica , Serviços de Saúde para Idosos/organização & administração , Serviços de Assistência Domiciliar/organização & administração , Idoso , Humanos , Modelos Organizacionais
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