Subdiagnóstico de delirium en adultos mayores hospitalizados / Delirium in Chilean elderly inpatients: an overlooked problem

Background: Delirium is a common underdiagnosed and undertreated problem in elderly inpatients, associated to higher morbidity, mortality and health cost. Aim: To evaluate the prevalence of delirium at hospital admission in medically ill elderly patients and the attending physician's diagnosis and treatment of delirium. Patients and methods: In a prospective and descriptive study, consecutive patients aged 65 years or more, admitted to an internal medicine ward were evaluated by independent physicians, during the first 48 h of admission, to asses the presence of delirium. Diagnosis of delirium was based on the Confusion Assessment Method. Medical and nurse records were reviewed. Family was interviewed when necessary. Results: One hundred eight patients (52% women, age range 65-94 years) with an APACHE II score of 11.6±5, were evaluated. Fifty seven patients (53%) had delirium (32% hyperactive, 72% hypoactive and 5% mixed). Delirium prevalence was significantly higher in older patients (66% among those aged 75 years or older versus 30% in younger, p <0.05) and among patients with more severe conditions (88% among those with an APACHE score over 16 versus 47% below that value, p <0.05). Medical records of patients with delirium showed that this diagnosis was present only in 32% and cognitive deficit was described in 73%. Ten percent of patients with delirium received sedative medication and 38% were physically restricted. There were no environmental interventions to prevent or control delirium. Conclusions: Delirium in elderly inpatients at this unit is an extraordinarily prevalent problem, seriously under diagnosed (68%) and under treated. This study should alerts our medical community to improve the diagnosis and management of delirium in elderly inpatients.

Resultados al aplicar el sistema de clasificación de pacientes RUG-T18 en ancianos ingresados a un hospital universitario / Application of RUG-T18 classification to elderly patients admitted to an university hospital

Background: Among case mix classifications, the best for hospitalized elders is the Resource Utilization Groups (RUG) system, which allows a better location of patients, resource administration and the design of health care strategies for elderly people. Aim: To report the results of RUG-T18 classification of elderly patients admitted to an university hospital. Patients and methods: RUG-T18 classification was applied to 210 patients aged 75.2 ñ 7.2 years old, 108 male, admitted to the Clinical Hospital of the Catholic University of Chile. Results: The clinical classification of assessed patients was rehabilitation in 50.9 per cent of cases, special care in 10.5 per cent, clinically complex in 37.1 per cent and reduced physical functions in 0.5 per cent. None had behavioral alterations. There were no differences between subjects older or younger than 75 years old. Daily life activities showed that help was required for sphincter control in 46 per cent of patients, for feeding in 44 per cent and for mobilization in 64 per cent (28 per cent of patients required help from two or more people). Geriatric assessment showed that, since 1993, the proportion of elders with greater functional derangement increased from 18 to 28 per cent, and the proportion of those with mental disturbances from 4 to 12 per cent, specially among those over 75 years old. Conclusions: Most elders admitted to the hospital are classified in the superior categories of the RUG-T18 system and have severe mental and functional limitations. These patients require a multidisciplinary approach with a great emphasis in rehabilitation

Valoración geriátrica ambulatoria de 2116 adultos mayores pobres / Geriatric assessment of 2116 free living elders

Background: Geriatric assessment quantifies medical, functional, mental and social capabilities and alterations of elders and is the first step to initiate specific intervention programs. Aim: To report the initial geriatric assessment of a program aimed to help poor elders living in Metropolitan Santiago. Subjects and methods: Two thousand one hundred sixteen free living subjects aged 65 to 99 years old (711 males) were subjected to an assessment using a simple geriatric score validated abroad and used previously in Chile. The resulting score ranges from 0 (better) to 5 (worst). Results: Eighty eight percent of elders did not have problems in the functional evaluation. Subjects over 75 years old needed occasional support for the daily activities with higher frequency than younger subjects (12 and 5.4 per cent respectively, p< 0.001) and had a higher frequency of major functional limitations (7.8 and 3.2 per cent respectively, p< 0.001). Mental assessment was considered normal in 89.4 per cent of subjects. Those over 75 years old had a higher frequency of memory disturbances (11.4 and 6.5 per cent respectively) and cognitive alterations (4.6 and 1.8 per cent respectively). Indefinite social support could be received by 84 per cent of subjects, but 7.4 per cent did not have access to this resource. Conclusions: Geriatric assessment of poor elders gives useful information to identify those subjects that require community help

Estudio comparativo de nonagenarios que viven en sus propios hogares versus los institucionalizados / Comparative study of nonagenarians living at their own homes and institutionalized

Subjects and methods: During 24 months, 241 people of 90 years or older were interviewed. One hundred twenty seven (96 female) lived in their own homes and 114 (108 female) lived in institutions. The geriatric evaluation scale, validated in previous studies, was used as the assessment instrument. Results: Mean age of subjetcs was 94 years old (range 90 to 106). Eight percent of subjects were bedridden. No differences in general condition, fecal or urinary continence, nutritional status, blood pressure, cognition, sight and hearing acuity, were observed between free living and institutionalized subjetcs. Free living elders had a significantly higher number of bothers or offspring and 90 percent were happy with the place where they lived. Conclusions: Most nonagenarians in Santiago are in good general medical conditions. Probably, the decision to become institutionalized depends more on lack of family support than on worse medical, functional or mental conditions

Experiencia piloto en el uso de una ficha de evaluación geriátrica ambulatoria / Pilot experience with an ambulatory geriatric assessment questionnaire

Ten percent of the chilean population is over 60 years old and general practitioners need an instrument to assess the degree of disability and multiple ailments of elders. Aim: to develop and use an instrument to assess elders consulting in primary care outpatient clinics. An instrument to be used by general practitioners, aimed to assess bio-psico-social risk of elders was devised by the Geriatrics Program at the Faculty of Medicine of the Catholic University of Chile. The instrument was used in 100 elders (82 female) aged 71ñ8 years old consulting in a primary care outpatient clinic. The instrument took less than 5 minutes to be used. The most frequent risk factors found were living alone in 62 percent of subjects, falls in the last year in 47 percent, memory disturbances in 62 percent, overweight in 76 percent, visual impairment in 76 percent, urinary incontinence in 26 percent and depression in 76 percent. Thirty percent had difficulties to climb stairs and 4 percent had no support in case of severe disability. The applied instrument is fast to apply, easily understood by patients and detects problems associated with old age, that will help to plan primary care health programs

Evaluación geriátrica de adultos mayores en un hospital universitario / Geriatric assessment of elders at a university hospital

The aim of this work was to evaluate general aspects, medical diagnoses, degree of disability, mental status and social support of hospitalized elders, using a Geriatric Assessment Scale, devised at the Catholic University. Ninety eight hospitalized subjects (58 female, aged 60 to 74 years old) were surveyed before discharge. Results showed that 34 percent had serious handicaps in their daily living and required third party help, 14 percent had moderated cognitive impairment and that 12 percent lacked social of family support. We conclude that the scale is useful, easy to use and allows to obtain a thorough diagnosis of hospitalized elders