Impacto de un programa de atención domiciliaria al enfermo crónico en ancianos: calidad de vida y reingresos hospitalarios Impact of the program home care for the chronically ill for elderly: quality of life and hospital readmissions

OBJETIVO: Evaluar el impacto del programa Atención Domiciliaria al Enfermo Crónico (ADEC) comparado con la atención habitual (AH) a ancianos con dependencia funcional, derechohabientes del Instituto Mexicano del Seguro Social (IMSS). MATERIAL Y MÉTODOS: Cohorte prospectiva a tres meses a partir del egreso hospitalario en dos hospitales de la Ciudad de México. Se ingresaron 130 ancianos con dependencia funcional, 70 insertados al programa ADEC y 60 con atención habitual. Se midió impacto en reingresos hospitalarios y calidad de vida a partir de la escala Perfil de Impacto de la Enfermedad (SIP, por sus siglas en inglés). RESULTADOS: La edad promedio de los ancianos fue de 74 años (61/103) y 60% fueron mujeres. El principal diagnóstico fue enfermedad vascular cerebral (EVC) (30.77%). El grupo de ADEC mejoró la calidad de vida en la dimensión psicosocial [46.26 (±13.85) comparado con 29.45 (±16.48) vs. 47.03 (±16.47) a 42.36 (±16.35) p<0.05 en grupo habitual]. No se presentaron diferencias en los reingresos (p>0.05). CONCLUSIONES: El programa mejoró la dimensión psicosocial de calidad de vida.<br>OBJECTIVE: To evaluate the impact of the ADEC program (acronym in Spanish) as compared with the typical care provided to disabled elderly affiliated with the Mexican Institute of Social Security (IMSS). MATERIAL AND METHODS: Prospective cohort at three months after discharge from two general hospitals in Mexico City. A total of 130 patients with functional dependency were studied, 70 in the ADEC program and 60 with typical care. Impact was measured using hospital readmissions and quality of life based on the Sickness Impact Profile (SIP). RESULTS: Average age was 74 (61/103) years and 60% were women. The main diagnosis was cerebrovascular disease (30.77%). The quality of life in the psychosocial dimension improved for the ADEC group (from 46.26 (±13.85) to 29.45(±16.48) as compared with 47.03 (±16.47) to 42.36 (±16.35) for those receiving typical care (p<0.05). No differences were found regarding hospital readmissions. (p>0.05). CONCLUSIONS: HC program improved the psychosocial dimension of quality of life

Síntomas depresivos en personas adultas mayores con ideación suicida

Introduction: Depression is a mood disorder of higher incidence in older adults, it has been diagnosed that this population is more likely to present suicidal ideation. A detailed detection of depressive symptoms will allow the establishment of appropriate preventive actions and understanding of this disorder associated with suicidal ideation. Methods: We evaluated 93 adults over 60 years old, using the Yesavage geriatric depression scale, Beck suicidal ideation scale and a checklist of depressive symptomatology. Results: The prevalence of older adults with suicidal ideation was 40.9% (n = 38), and in relation to depression 57.0% (n = 53), the association of depression with suicidal ideation was 76.3% (n = 29), depressive symptoms with a greater impact of p <0.001 in older adults with suicidal ideation were: same emotional state during the day and changes between days, concentration, depression as punishment and feeling of suicide. Conclusions: The timely detection of depressive symptomatology in normal aging will allow to identify the predictors of suicide, to implement strategies to prevent fatal outcomes.Introducción: La depresión es el trastorno de ánimo de mayor incidencia en las personas adultas mayores, se ha diagnosticado que esta población es más propensa a presentar ideación suicida. Una detallada detección de los síntomas depresivos permitirá establecer acciones adecuadas de prevención y comprensión de este trastorno asociado a la ideación suicida. Métodos: Se evaluó a 93 personas adultas mayores de 60 años, mediante la escala de depresión geriátrica de Yesavage, la escala de ideación suicida de Beck y una checklist de sintomatología depresiva. Resultados: La prevalencia de personas adultas mayores con ideación suicida fue de 40.9% (n=38) y, en relación con la depresión de 57.0% (n=53), la asociación de depresión con ideación suicida fue de 76.3% (n=29). Los síntomas depresivos de mayor impacto de p< 0.001 en las personas adultas mayores con ideación suicida fueron: mismo estado emocional durante el día y cambio entre días, concentración, depresión como castigo y sentimiento de suicidio. Conclusiones: La detección oportuna de la sintomatología depresiva en el envejecimiento normal permitirá identificar los predictores del suicido, para implementar estrategias de prevención a desenlaces fatales

Usefulness of two instruments in assessing depression among elderly Mexicans in population studies and for primary care Utilidad de dos instrumentos para valorar depresión entre adultos mayores de México en estudios poblacionales y para la atención en el primer nivel de salud

OBJECTIVE: To determine the psychometric qualities of the CES-DR and GDS scales in the elderly and compare them to clinical psychiatric diagnoses. MATERIAL AND METHODS: The first phase consisted of home interviews for determining the psychometric qualities of the GDS and CES-DR scales. In the second phase, psychiatrists conducted diagnostic interviews. The sample consisted of 534 participants older than 60 years of age insured by the Mexican Institute of Social Security. RESULTS: First phase: Cronbach's alpha for the GDS was 0.87 and 0.86 for CES-DR. The GDS factorial analysis found eight factors that could explain 53.5% of the total variance and nine factors that explained 57.9% in the CES-DR. Second phase: Compared to the psychiatric diagnoses, CES-DR reported a sensitivity of 82% and a specificity of 49.2%; GDS reported 53.8% sensitivity and 78.9% specificity. CONCLUSIONS: CES-DR and GDS scales have high reliability and adequate validity but the CES-DR reports higher sensitivity.RESUMEN OBJETIVO: Determinar las propiedades psicométricas de las escalas CES-DR y GDS para depresión en población anciana y compararlas con el diagnóstico clínico psiquiátrico. MATERIAL Y MÉTODOS: La primera fase consistió en entrevistas en casa para determinar las propiedades psicométricas. En la segunda fase, los psiquiatras condujeron entrevistas diagnósticas. La muestra consistió en 534 participantes de 60 años y más asegurados por el Instituto Mexicano del Seguro Social. RESULTADOS: Primera fase: Alfa de Cronbach para el GDS y CES-DR fue de 0.87 y 0.86, respectivamente. El análisis factorial del GDS reportó ocho factores que explicaron 53.5% de la varianza, comparado con nueve del CESDR que explicaron 57.9%. Segunda fase: Comparado con el diagnóstico psiquiátrico, el CES-DR reportó una sensibilidad de 82% y una especificidad de 49.2% comparado con 53.8% y 78.9%, respectivamente del GDS. CONCLUSIONES: Las escalas CES-DR y GDS tienen consistencia y adecuada validez pero el CES-DR reporta más alta sensibilidad

Patterns of Muscle-Related Risk Factors for Sarcopenia in Older Mexican Women

Early detriment in the muscle mass quantity, quality, and functionality, determined by calf circumference (CC), phase angle (PA), gait time (GT), and grip strength (GSt), may be considered a risk factor for sarcopenia. Patterns derived from these parameters could timely identify an early stage of this disease. Thus, the present work aims to identify those patterns of muscle-related parameters and their association with sarcopenia in a cohort of older Mexican women with neural network analysis. Methods: Information from the functional decline patterns at the end of life, related factors, and associated costs study was used. A self-organizing map was used to analyze the information. A SOM is an unsupervised machine learning technique that projects input variables on a low-dimensional hexagonal grid that can be effectively utilized to visualize and explore properties of the data allowing to cluster individuals with similar age, GT, GSt, CC, and PA. An unadjusted logistic regression model assessed the probability of having sarcopenia given a particular cluster. Results: 250 women were evaluated. Mean age was 68.54 &plusmn; 5.99, sarcopenia was present in 31 (12.4%). Clusters 1 and 2 had similar GT, GSt, and CC values. Moreover, in cluster 1, women were older with higher PA values (p &lt; 0.001). From cluster 3 upward, there is a trend of worse scores for every variable. Moreover, 100% of the participants in cluster 6 have sarcopenia (p &lt; 0.001). Women in clusters 4 and 5 were 19.29 and 90 respectively, times more likely to develop sarcopenia than those from cluster 2 (p &lt; 0.01). Conclusions: The joint use of age, GSt, GT, CC, and PA is strongly associated with the probability women have of presenting sarcopenia

The Hypertriglyceridemic Waist Phenotype Is Associated with Several Cardiovascular Risk Factors in Women with Rheumatoid Arthritis

Rheumatoid arthritis (RA) associates with cardiovascular risk factors (CVRF) such as dyslipidemias and systemic inflammation. Cardiovascular Disease (CVD) is the leading cause of mortality. The hypertriglyceridemic waist phenotype (HTWP) identifies increased CVRF; however, information about HTWP on RA is scarce. Objective: To evaluate the association of HTWP with CVRF in RA. Material and methods: Cross-sectional study. Women (125) with RA were included (ACR, 1987). Anthropometry, bioimpedance, body mass index (BMI), disease activity score 28 (DAS28), and health assessment questionnaire disability index (HAQ-Di) were determined. The lipid profile determination includes the atherogenic index (AI) (TC/HDL) and Framingham Risk Score. HTWP is defined as a waist circumference &ge;88 cm and triglycerides &ge; 150 mg/dL. Chi-squared and Student&rsquo;s t-tests were applied for comparisons. Results: HTWP was found in 38 (30.4%) patients. The subgroup with HTWP had a greater frequency of arterial hypertension (AHT) (57.9 vs. 37.9, p = 0.04), Type 2 DM (23.7 vs. 8.0, p= 0.02), BMI (29.7 &plusmn; 3.2, vs. 26.8 &plusmn; 4.3, p &lt; 0.001), fat mass (39.3 &plusmn; 4.8 vs. 34.7 &plusmn; 6.8, p &lt; 0.001), and AI (4.7 &plusmn; 1.2 vs. 3.7 &plusmn; 1.0, p &lt; 0.001). No differences between DAS28 and HAQ-Di were found. HTWP was associated with the presence of MetS and CVR (p &lt; 0.001 and p = 0.012, respectively). Conclusion: The HTWP in RA is associated with CVRF, and its potential predictive role should be evaluated in longitudinal studies

The Hypertriglyceridemic Waist Phenotype Is Associated with Several Cardiovascular Risk Factors in Women with Rheumatoid Arthritis

Rheumatoid arthritis (RA) associates with cardiovascular risk factors (CVRF) such as dyslipidemias and systemic inflammation. Cardiovascular Disease (CVD) is the leading cause of mortality. The hypertriglyceridemic waist phenotype (HTWP) identifies increased CVRF; however, information about HTWP on RA is scarce. Objective: To evaluate the association of HTWP with CVRF in RA. Material and methods: Cross-sectional study. Women (125) with RA were included (ACR, 1987). Anthropometry, bioimpedance, body mass index (BMI), disease activity score 28 (DAS28), and health assessment questionnaire disability index (HAQ-Di) were determined. The lipid profile determination includes the atherogenic index (AI) (TC/HDL) and Framingham Risk Score. HTWP is defined as a waist circumference ≥88 cm and triglycerides ≥ 150 mg/dL. Chi-squared and Student’s t-tests were applied for comparisons. Results: HTWP was found in 38 (30.4%) patients. The subgroup with HTWP had a greater frequency of arterial hypertension (AHT) (57.9 vs. 37.9, p = 0.04), Type 2 DM (23.7 vs. 8.0, p= 0.02), BMI (29.7 ± 3.2, vs. 26.8 ± 4.3, p p p p p = 0.012, respectively). Conclusion: The HTWP in RA is associated with CVRF, and its potential predictive role should be evaluated in longitudinal studies