Asociación de la fragilidad con el uso de servicios de salud en adultos mayores. Un análisis secundario del Estudio Nacional sobre Salud y Envejecimiento en México

Antecedentes: La fragilidad se ha relacionado con desenlaces adversos, pero aún es escasa la evidencia sobre su asociación con el uso de servicios de salud. Objetivo: Evidenciar la asociación de la fragilidad con el uso de servicios de salud en adultos mexicanos mayores de 60 años. Material y métodos: Análisis del Estudio Nacional sobre Salud y Envejecimiento en México para 2015 (basal) y 2018 (seguimiento). La fragilidad se definió con el índice de fragilidad. Fueron incluidos los siguientes desenlaces: hospitalización, visitas médicas, cirugía mayor, procedimientos quirúrgicos menores y visitas al dentista. Se utilizaron modelos de riesgos competitivos y de número de eventos (regresión negativa binomial). Resultados: Se incluyeron 8526 individuos, cuya edad promedio fue de 70.8 %; 55.8 % correspondió al sexo femenino. De acuerdo con los resultados, los días de hospitalización y el número de procedimientos menores se asociaron a fragilidad. Conclusiones: La fragilidad podría ser un parámetro útil en la planeación de los servicios de salud para los adultos mayores. Por otro lado, su evaluación permitiría priorizar la atención a quienes presenten mayor riesgo de desenlaces adversos

Multiple Logistic Regression Models for SPPB as Dependent Variable (<8 points) and Self-rated Health in Three Categories (Good/Very Good, Fair [reference], and Poor/Very Poor) as Independent Variable Stratified by Sex.

<p>Multiple Logistic Regression Models for SPPB as Dependent Variable (<8 points) and Self-rated Health in Three Categories (Good/Very Good, Fair [reference], and Poor/Very Poor) as Independent Variable Stratified by Sex.</p

Handgrip strength predicts functional decline at discharge in hospitalized male elderly: a hospital cohort study.

Functional decline after hospitalization is a common adverse outcome in elderly. An easy to use, reproducible and accurate tool to identify those at risk would aid focusing interventions in those at higher risk. Handgrip strength has been shown to predict adverse outcomes in other settings. The aim of this study was to determine if handgrip strength measured upon admission to an acute care facility would predict functional decline (either incident or worsening of preexisting) at discharge among older Mexican, stratified by gender. In addition, cutoff points as a function of specificity would be determined. A cohort study was conducted in two hospitals in Mexico City. The primary endpoint was functional decline on discharge, defined as a 30-point reduction in the Barthel Index score from that of the baseline score. Handgrip strength along with other variables was measured at initial assessment, including: instrumental activities of daily living, cognition, depressive symptoms, delirium, hospitalization length and quality of life. All analyses were stratified by gender. Logistic regression to test independent association between handgrip strength and functional decline was performed, along with estimation of handgrip strength test values (specificity, sensitivity, area under the curve, etc.). A total of 223 patients admitted to an acute care facility between 2007 and 2009 were recruited. A total of 55 patients (24.7%) had functional decline, 23.46% in male and 25.6% in women. Multivariate analysis showed that only males with low handgrip strength had an increased risk of functional decline at discharge (OR 0.88, 95% CI 0.79-0.98, p = 0.01), with a specificity of 91.3% and a cutoff point of 20.65 kg for handgrip strength. Females had not a significant association between handgrip strength and functional decline. Measurement of handgrip strength on admission to acute care facilities may identify male elderly patients at risk of having functional decline, and intervene consequently

Mean (SD) of SPPB^† According to Self-Rated Health (Four Categories) at Each Site and Stratified by Sex^†.

<p>Mean (SD) of SPPB<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0153855#t002fn002" target="_blank">^†</a> According to Self-Rated Health (Four Categories) at Each Site and Stratified by Sex<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0153855#t002fn002" target="_blank">^†</a>.</p

General Characteristics of the Sample According to Site and Stratified by Sex.

<p>General Characteristics of the Sample According to Site and Stratified by Sex.</p

Multiple logistic regression models for functional decline stratified by gender.

<p><i>Notes:</i> OR = odds ratio, HS = handgrip strength, CI = confidence interval, GEMU = Geriatric Evaluation and Management Unit, EuroQoL VAS = European Quality of Life Visual Analog Scale, LBI = Lawton and Brody Index, GDS 30 = Geriatric Depression Scale of 30 items, MMSE = Mini-Mental Status Examination, APACHE II = Acute Physiology and Chronic Health Evaluation II, Ci = Charlson index.</p><p>Model 1: fully adjusted model: HS, age, years of education, hospitalization in the GEMU, EuroQoL VAS, LBI score, GDS 30 score, MMSE score, pressure sores, delirium, APACHE II score and Ci score.</p><p>Model 2: only significant variables (stepwise).</p

Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for handgrip strength, with cut-off points of 20.65 kg for male subjects.

<p><i>Notes:</i> AUC = area under the curve.</p

General patient characteristics.

<p><i>Notes:</i> n = number of subjects, SD = standard deviation, GEMU = Geriatric Evaluation and Management Unit, COPD = chronic obstructive pulmonary disease, EuroQoL VAS = European Quality of Life Visual Analog Scale, LBI = Lawton and Brody Index, BI = Barthel index, GDS 30 = Geriatric Depression Scale of 30 items, MMSE = Mini-Mental Status Examination, APACHE II = Acute Physiology and Chronic Health Evaluation II, Ci = Charlson Index, HS = handgrip strength.</p>†<p>p<0.05.</p

A 2×2 table with a cut-off point of 20.65 kg for male subjects, showing absolute frequencies; next table shows values derived from this table.

<p>HS = handgrip strength.</p

ROC curves for functional decline in function of different cut points of handgrip strength of male subjects.

<p>ROC curves for functional decline in function of different cut points of handgrip strength of male subjects.</p