Enfermos crónicos domiciliarios: valoración integral físico-cognitiva y caídas durante 3 años de seguimiento

ObjectiveTo assess the physical and cognitive capacity of chronically ill homebound patients, and the falls they suffered during three years of monitoring.DesignDescriptive, longitudinal study.Setting«Raval Nord» Health District, Barcelona.Patients and other participantsAll the 243 homebound chronic patients registered in the home care programme in May 1996 (67% women, average age 84).Measurements and main resultsAfter three years 16% had gone into an old people's home, 9% had moved house and 38% had died. The probability of not continuing in the programme after three years monitoring was related to less autonomy, presence of comorbidity, and worse cognitive capacity (p < 0.05). Of the 90 patients (37%) who remained active in May 1999, 41% showed disorders on the Short Portable Mental Status Questionnaire (SPMSQ), with a significant relationship to greater age, less autonomy and the presence of comorbidity. Numerous alterations in analysis (21.6%) and linked illnesses (18.9%) were found in the patients with cognitive deterioration. 42% of the patients active in May'99 had fallen during the monitoring period. 10% of the falls involved fractures. The number of falls was higher when there was visual-auditory loss, consumption of psychiatric drugs or absence of use of orthopaedic aids. There was also a greater probability of falls in patients who only had a part-time carer (p < 0.05).ConclusionsIt is important to assess the autonomy, cognitive capacity and comorbidity of homebound chronic patients when monitoring them. Likewise, cognitive disorders and falls must be properly weighed, as they are common in this class of patient

Enfermos crónicos domiciliarios y consumo de psicofármacos

ObjetivoValorar el consumo de psicofármacos en los pacientes crónicos domiciliarios.DiseñoEstudio longitudinal, descriptivo.EmplazamientoÁrea Básica de Salud Raval Nord de Barcelona.Pacientes u otros participantesTodos los 243 enfermos crónicos domiciliarios registrados en el programa de atención domiciliaria en mayo de 1996. A los 3 años un 16% ha ingresado en una residencia, un 9% se ha trasladado de domicilio, un 38% ha fallecido y un 37% permanecía activo.Mediciones y resultados principalesDe los 90 pacientes que seguían activos, un 40% había consumido algún psicofármaco en mayo de 1999. El 8% de los pacientes que refirió consumir psicofármacos lo hacía por automedicación. El grupo farmacológico más consumido entre los psicofármacos era las benzodiazepinas, en un 64%. El consumo de psicofármacos fue superior en el sexo femenino (45%) y en las personas que vivían solas o en estado de viudedad (50%). El porcentaje de pacientes con consumo de psicofármacos fue superior cuando había peor grado de autonomía según el índice de Katz (67%), déficit cognitivo en el Short Portable Mental Status Questionnaire (SPMSQ) de Pfeiffer (62%) y ante la presencia de comorbilidad (56%) (p < 0,01).ConclusionesExiste un elevado consumo de psicofármacos en los pacientes crónicos domiciliarios, especialmente cuando hay deterioro físico-cognitivo y presencia de comorbilidad.ObjectiveTo assess the consumption of psychiatric drugs by chronic homebound patients.DesignDescriptive, longitudinal study.SettingRaval Nord Health District, Barcelona.Patients and other participantsAll 243 chronically ill homebound patients registered on the home care programme in May 1996. After three years 16% had gone into a home, 9% had moved residence, 38% had died, and 37% remained active.Measurements and main resultsOf the 90 patients still active, 40% took some psychiatric drug in May 1999. 8% of the patients who said they had taken psychiatric drugs did so by self-medication. The most commonly consumed pharmocological group of the psychiatric drugs were benzodiazepines at 64%. Women took more psychiatric drugs (45%), as did persons living alone or who had been bereaved (50%). The proportion of patients taking psychiatric drugs was greater when there was worse autonomy according to the Katz index (67%), a cognitive deficit on the Short Portable Mental Status Questionnaire (SPMSQ) of Pfeiffer (62%), and in the presence of comorbidity (56%) (p < 0.01).ConclusionsThere is high consumption of psychiatric drugs by chronic homebound patients, especially when there is physical-cognitive deterioration and presence of comorbidity