Palabras clave
Anciano frágil
Disfunción cognitiva
Sistemas de apoyo psicosocial Aging
Fragile elderly
Cognitive dysfunction
Psychosocial support systems
Cómo citar
Resumen
Introducción: El adulto mayor es una persona vulnerable clínicamente, biológica, emocional y socialmente. El objetivo de este trabajo es identificar la prevalencia de riesgo de deterioro funcional, pérdida de autonomía y vulnerabilidad sociofamiliar en personas mayores hospitalizadas en una institución de salud. Metodología: Diseño de corte transversal con pacientes >65 años hospitalizados en institución de alta complejidad. Se excluyeron hospitalizados en unidad de cuidados intensivos, patología quirúrgica, oncológica y psiquiátrica. Los instrumentos de medición fueron aplicados mediante entrevista por trabajadoras sociales de la institución previo entrenamiento y estandarización en la técnica de entrevista. Se utilizó la escala de riesgo de deterioro funcional (HARP) y la versión abreviada y simplificada de la escala de valoración sociofamiliar de GIJÓN. Resultados: Evaluamos consecutivamente 981 pacientes durante un periodo de nueve meses en el servicio de hospitalización de adultos. Edad promedio del grupo 78 años, mayor prevalencia de mujeres (63%), alta frecuencia de casados (71%) y trabajadores jubilados o pensionados (82%). El 7,5% de los pacientes egresaron al programa de hospitalización domiciliaria. La prevalencia de riesgo deterioro funcional (HARP) fue del 50% con mayor compromiso en grupo de 85+ años (74%). La valoración de GIJÓN identificó limitación de recursos sociofamiliares en 4%. Discusión: La escala HARP y GIJÓN son instrumentos de fácil aplicación y complementan la valoración clínica del adulto mayor hospitalizado. Para los departamentos de atención al usuario y de asistencia social hospitalaria constituyen un estándar de calidad, dado que permiten conocer otras dimensiones como el entorno social, familiar, neuropsicológico y en algunos casos medio-ambientales en procura del cuidado integral.
Citas
World report on ageing and health.World Health Organization. 2015. [citado 1 de marzo de 2019]. Disponible en:
Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet (London, England). 2016;387(10033):2145-54. https://doi.org/10.1016/S0140-6736(15)00516-4
Multisectoral action for a life course approach to healthy ageing: Draft global strategy and plan of action on ageing and health. World Health Organization. 2016. [citado 1 de marzo de 2019]. Disponible en:
Fedesarrollo y Fundación Saldarriaga Concha. Misión Colombia Envejece: cifras, retos y recomendaciones. Editorial Fundación Saldarriaga Concha. Bogotá, D.C. Colombia. 2015. 706 p.
Colon-Emeric CS, Whitson HE, Pavon J, Hoenig H. Functional decline in older adults. American family physician. 2013;88(6):388-94.
Gill TM, Allore HG, Holford TR, Guo Z. Hospitalization, restricted activity, and the development of disability among older persons. Jama. 2004;292(17):2115-24. https://doi.org/10.1001/jama.292.17.2115
Avelino-Silva TJ, Farfel JM, Curiati JA, Amaral JR, Campora F, Jacob-Filho W. Comprehensive geriatric assessment predicts mortality and adverse outcomes in hospitalized older adults. BMC geriatrics. 2014;14:129.
Buurman BM, van Munster BC, Korevaar JC, de Haan RJ, de Rooij SE. Variability in measuring (instrumental) activities of daily living functioning and functional decline in hospitalized older medical patients: a systematic review. Journal of clinical epidemiology. 2011;64(6):619-27. https://doi.org/10.1016/j.jclinepi.2010.07.005
Kleinpell RM, Fletcher K, Jennings BM. Chapter 11. Reducing Functional Decline in Hospitalized Elderly. En: Hughes RG. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville MD; 2008:251-265.
Fitzpatrick JJ, Stier L, Eichorn A, Dlugacz YD, O'Connor LJ, Salinas TK, et al. Hospitalized elders: changes in functional and mental status. Outcomes management. 2004;8(1):52-6.
Thomas DR. Focus on functional decline in hospitalized older adults. The journals of gerontology Series A, Biological sciences and medical sciences. 2002;57(9):M567-8. https://doi.org/10.1093/gerona/57.9.M567
Beaton K, Grimmer K. Tools that assess functional decline: systematic literature review update. Clinical interventions in aging. 2013;8:485-94. https://doi.org/10.2147/CIA.S42528
Sager MA, Rudberg MA, Jalaluddin M, Franke T, Inouye SK, Landefeld CS, et al. Hospital admission risk profile (HARP): identifying older patients at risk for functional decline following acute medical illness and hospitalization. Journal of the American Geriatrics Society. 1996;44(3):251-7. https://doi.org/10.1111/j.1532-5415.1996.tb00910.x
González JG, Palacios E, García AS, González DC, Caicoya AM, Sánchez AF, et al. Evaluación de la fiabilidad y validez de una escala de valoración social en el anciano. Aten Primaria. 1999;23:434-40.
Liu SK, Montgomery J, Yan Y, Mecchella JN, Bartels SJ, Masutani R, et al. Association Between Hospital Admission Risk Profile Score and Skilled Nursing or Acute Rehabilitation Facility Discharges in Hospitalized Older Adults. Journal of the American Geriatrics Society. 2016;64(10):2095-100. https://doi.org/10.1111/jgs.14345
Graf CL. The hospital admission risk profile: the HARP helps to determine a patient's risk of functional decline. The American journal of nursing. 2008;108(8):62-71. https://doi.org/10.1097/01.NAJ.0000327832.59406.26
Graf C. The Hospital Admission Risk Profile (HARP). Medsurg nursing : official journal of the Academy of Medical-Surgical Nurses. 2010;19(2):133-4.
Mehta KM, Yaffe K, Covinsky KE. Cognitive impairment, depressive symptoms, and functional decline in older people. Journal of the American Geriatrics Society. 2002;50(6):1045-50. https://doi.org/10.1046/j.1532-5415.2002.50259.x
Corrales D, Palomo L, Magarino Bravo MJ, Alonso G, Torrico P, Barroso A, et al. [Functional ability and social-care problems of the elderly in the Caceres health area]. Aten Primaria. 2004;33(8):426-33. https://doi.org/10.1016/S0212-6567(04)79428-7
Ashby-Mitchell K, Jagger C, Fouweather T, Anstey KJ. Life expectancy with and without cognitive impairment in seven Latin American and Caribbean countries. PloS one. 2015;10(3):e0121867. https://doi.org/10.1371/journal.pone.0121867
Johnson S, Bacsu J, Abeykoon H, McIntosh T, Jeffery B, Novik N. No Place Like Home: A Systematic Review of Home Care for Older Adults in Canada. Canadian journal on aging = La revue canadienne du vieillissement. 2018:1-20. https://doi.org/10.1017/S0714980818000375
Lenaghan NA. Transitional care and empowerment of the older adult. Geriatric nursing. 2018; 1-6.
Braet A, Weltens C, Sermeus W. Effectiveness of discharge interventions from hospital to home on hospital readmissions: a systematic review. JBI database of systematic reviews and implementation reports. 2016;14(2):106-73. https://doi.org/10.11124/jbisrir-2016-2381
Grimmer K, Milanese S, Beaton K, Atlas A. Additional measures do not improve the diagnostic accuracy of the Hospital Admission Risk Profile for detecting downstream quality of life in community-dwelling older people presenting to a hospital emergency department. Clinical interventions in aging. 2014;9:233. https://doi.org/10.2147/CIA.S56086
Hoogerduijn JG, Schuurmans MJ, Duijnstee MS, de Rooij SE, Grypdonck MF. A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline. Journal of clinical nursing. 2007;16(1):46-57. https://doi.org/10.1111/j.1365-2702.2006.01579.x
De Saint-Hubert M, Schoevaerdts D, Cornette P, D'Hoore W, Boland B, Swine C. Predicting functional adverse outcomes in hospitalized older patients: a systematic review of screening tools. The journal of nutrition, health & aging. 2010;14(5):394-9. https://doi.org/10.1007/s12603-010-0086-x
Hoogerduijn JG, Schuurmans MJ, Korevaar JC, Buurman BM, de Rooij SE. Identification of older hospitalised patients at risk for functional decline, a study to compare the predictive values of three screening instruments. Journal of clinical nursing. 2010;19(9-10):1219-25. https://doi.org/10.1111/j.1365-2702.2009.03035.x
de Saint-Hubert M, Jamart J, Boland B, Swine C, Cornette P. Comparison of three tools predicting functional decline after hospitalization of older patients. Journal of the American Geriatrics Society. 2010;58(5):1003-5. https://doi.org/10.1111/j.1532-5415.2010.02839.x
Gregorevic K, Peel NM, Lim WK, Hubbard RE. Do Health Assets have a Protective Effect for Hospitalised Frail Older Adults?. QJM:monthly journal of the Association of Physicians. 2018;111(11):785-789
Dent E, Perez-Zepeda M. Comparison of five indices for prediction of adverse outcomes in hospitalised Mexican older adults: a cohort study. Archives of gerontology and geriatrics. 2015;60(1):89-95. https://doi.org/10.1016/j.archger.2014.09.011
Fox MT, Sidani S, Persaud M, Tregunno D, Maimets I, Brooks D, et al. Acute care for elders components of acute geriatric unit care: systematic descriptive review. Journal of the American Geriatrics Society. 2013;61(6):939-46. https://doi.org/10.1111/jgs.12282
Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. The New England journal of medicine. 1995;332(20):1338-44. https://doi.org/10.1056/NEJM199505183322006
Hung WW, Ross JS, Farber J, Siu AL. Evaluation of the Mobile Acute Care of the Elderly (MACE) service. JAMA internal medicine. 2013;173(11):990-6. https://doi.org/10.1001/jamainternmed.2013.478
Miralles R, Esperanza A, Vázquez O, Basseda RM. Valoración geriátrica en el hospital: unidades de postagudos. Rev Mult Gerontol. 2005;15(1):30-5.
Loren Guerrero L, Gascon Catalan A. Biopsychosocial factors related to the length of hospital stay in older people. Revista latino-americana de enfermagem. 2011;19(6):1377-84. https://doi.org/10.1590/S0104-11692011000600014
Bowling A, Browne PD. Social networks, health, and emotional well-being among the oldest old in London. Journal of gerontology. 1991;46(1):S20-32. https://doi.org/10.1093/geronj/46.1.S20
Bernabeu-Wittel M, Baron-Franco B, Murcia-Zaragoza J, Fuertes-Martin A, Ramos-Cantos C, Fernandez-Moyano A, et al. A multi-institutional, hospital-based assessment of clinical, functional, sociofamilial and health-care characteristics of polypathological patients (PP). Archives of gerontology and geriatrics. 2011;53(3):284-91. https://doi.org/10.1016/j.archger.2010.12.006
Villarreal Amarís G, Month Arrieta E. Condición sociofamiliar, asistencial y de funcionalidad del adulto mayor de 65 años en dos comunas de Sincelejo (Colombia). Salud Uninorte. 2012;28(1):75-87.
Ruiz-Dioses L, Campos-León M, Peña N. Situación sociofamiliar, valoración funcional y enfermedades prevalentes del adulto mayor que acude a establecimientos del primer nivel de atención, Callao 2006. Revista peruana de medicina experimental y salud pública. 2008;25(4):374-9