Factores asociados a la calidad de vida en adultos mayores con insuficiencia orgánica crónica avanzada en un hospital de Lima-Perú: Factors associated with quality of life in older adults with advanced chronic organ failure in a hospital in Lima, Peru

Objective: To determine the factors associated with the quality of life in older adults with advanced chronic organ failure. Materials and methods: Observational, cross-sectional analytical research, whose population was made up of 100 older adults; then the data collection technique was the interview and the instrument the question through the application of Barthel and WHOQoL-Bref; then to answer the study objectives, the non-parametric Mann Whitney U, Kruskal Wallis, and Spearman's Rho tests were applied, considering significance at 5%. Results: (44) 44% of older adults were over 80 years old, (59) 59% were male, (31) 31% studied higher technical level, (57) 57% were holders in the Navy. , (74) 74% presented high blood pressure. The most frequent geriatric syndromes were visual or auditory deficit (82) 82%, insomnia (59) 59%, constipation (52) (52%) and malnutrition (47) 47%. (50) 50% of older adults presented severe functional dependence. (63) 63% presented quality of life at a medium level. The epidemiological factors associated with low quality of life were age over 80 years (p = 0.032, Rp = 1.818), female sex (p = 0.009, Rp = 2.056), the level of instruction given by illiterate, primary and high school (p = 0.025, Rp = 1.930) and the relationship with the navy as a relative (p = 0.022, Rp = 1.894). Associated geriatric syndromes were insomnia (p=0.034, Rp=1.930), constipation (p=0.000, Rp=3.560), pressure injury (p=0.000, Rp=2.788), and severe functional dependence (p= 0.000, Rp = 4.667). Conclusions: Age over 80 years, female sex, the level of instruction given by illiterate, primary and secondary, the relationship with the Navy as a family member, insomnia, constipation, pressure injury and severe functional dependence were Factors associated with quality of life in older adults with advanced chronic organ failure. Keywords: Risk factors, quality of life, older adults.Objetivo: Determinar los factores asociados a la calidad de vida en adultos mayores con insuficiencia orgánica crónica avanzada. Materiales y métodos: Investigación observacional, analítica transversal, cuya población la conformaron 100 adultos mayores, la técnica de recolección de datos fue la entrevista y el instrumento el cuestionario a través de la aplicación del índice de Barthel y WHOQoL-Bref, luego, para responder a los objetivos de estudio se aplicaron las pruebas no paramétricas U de Mann Whitney, Kruskal Wallis y Rho de Spearman, considerando la significancia del 5%. Resultados: El (44) 44% de adultos mayores tenían más de 80 años, el (59) 59% eran varones, el (31) 31% estudiaron nivel técnico superior, el (57) 57% eran titulares en la marina de guerra, el (74) 74% presentó hipertensión arterial. Los síndromes geriátricos más frecuentes fueron déficit visual o auditivo (82) 82%, insomnio (59) 59%, estreñimiento (52) (52%) y malnutrición (47) 47%. El (50)50% de los adultos mayores presentó dependencia funcional grave. El (63)63% presentó Calidad de vida a nivel medio. Los factores epidemiológicos asociados a la baja calidad de vida, fueron la edad mayor a 80 años (p = 0.032, Rp = 1.818), sexo femenino (p = 0.009, Rp = 2.056), el grado de instrucción dado por analfabeto, primaria y secundaria (p = 0.025, Rp = 1.930) y la relación con la Marina de Guerra como familiar (p = 0.022, Rp = 1.894). Los síndromes geriátricos asociados fueron el insomnio (p = 0.034, Rp = 1.930), el estreñimiento (p=0.000, Rp = 3.560), la lesión por presión (p=0.000, Rp = 2.788) y la dependencia funcional grave (p=0.000, Rp = 4.667). Conclusiones: La edad mayor a 80 años, sexo femenino, el grado de instrucción  analfabeto, primaria y secundaria, la relación con la Marina de Guerra como familiar, el insomnio, el estreñimiento, la lesión por presión y la dependencia funcional grave fueron factores asociados a la calidad de vida  baja en los adultos mayores con insuficiencia orgánica crónica avanzada. Palabras clave: Factores de riesgo, calidad de vida, adultos mayores

Características clínico epidemiológicas de pacientes con enfermedad crónica en fase terminal admitidos a un departamento de emergencia general

Introduction. Patients with advanced chronic disease (cancer and non-cancer) often go to emergency services. Objectives. To determine terminal chronic disease in those admitted to emergency, reason for admission, treatment and destination, comparing cancer with non-cancer. Methods. Observational study in people over 18 year old admitted to the emergency department of a tertiary hospital. Instrument: Supportive and Palliative Care Indicators Tool. Statistical analysis: Chi-square and U Mann-Whitney tests, considering p <0.05. Results. Of 4925 admissions, 271 (5,5%) met criteria. 233 patients were analyzed, median age 77 years [28-99], female sex 59%. Cancer diagnosis 42%, dementia 23%, neurological sequelae 15%, liver cirrhosis 12% and another 8%. Reason for admission was 48% infection, 9% uncontrolled pain and 7% bleeding. Antibiotics were used in 48% of patients, opioids 12% (morphine and tramadol) and transfusions 9%; 8.6% of these patients received advanced life support (mechanical ventilation 5,6%, inotropic 4,7% and hemodialysis 0,8%). The median stay in the emergency room was 6 days [1-62]; 27% died, 32% were discharged and 42% were referred to another hospital department. The stay and reason for admission were similar in cancer and non-cancer (p>0,05), presenting older age and disease time in non-cancer patients (p<0,01). Conclusions. One of every 20 admissions to the emergency department evaluated corresponds to a chronic disease in the terminal phase (more frequent non-cancer), being the reasons for admission infections, pain and bleeding.Introducción. Los pacientes con enfermedad crónica terminal (oncológica y no oncológica) acuden con frecuencia a servicios de urgencias. Objetivos. Identificar enfermedad terminal en pacientes admitidos a emergencia, motivo de ingreso, tratamiento y destino, comparando oncológicos y no oncológicos. Métodos. Estudio observacional en mayores de 18 años admitidos al departamento de emergencia de un hospital terciario. Intrumento: Supportive and Palliative Care Indicators Tool. Análisis estadístico: pruebas de Chi-cuadrado y U Mann-Whitney, considerando significancia p <0,05. Resultados. De 4925 admisiones, 271 (5,5%) cumplieron criterios de enfermedad terminal. Se analizaron 233 pacientes, mediana de edad 77 años [28-99], sexo femenino 59%. Diagnóstico de cáncer 42%, demencia 23%, secuela neurológica 15%, cirrosis hepática 12% y otros 8%. Los motivos de ingreso fueroninfección 48%, dolor no controlado 9% y sangrado 7%. Se usó antibióticos en 48% de pacientes, opioides 12%(morfina y tramadol) y transfusiones en el 9%. El 8,6% recibió soporte vital avanzado (ventilación mecánica 5,6%, inotrópicos 4,7% y hemodiálisis 0,8%). La mediana de estancia en urgencias fue 6 días [1-62]; falleció 27%, salió de alta 32% y 42% fue derivado a otro servicio hospitalario. La estancia en emergencia y el destino fueron similares en oncológicos y no oncológicos (p>0,05), presentándose mayor edad y tiempo de enfermedad en pacientes no oncológicos (p<0,01). Conclusiones: Una de cada 20 admisiones al departamento de emergencia evaluado corresponden a enfermedad crónica en fase terminal (más frecuentes no oncológicas), siendo los motivos de ingreso infecciones, dolor y hemorragia

An International Consensus Definition of the Wish to Hasten Death and Its Related Factors

Background: The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD. Methods: Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy. Findings: All 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD. Conclusions: This international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention

An International Consensus Definition of the Wish to Hasten Death and Its Related Factors

Abstract Backgroun

What Lies behind the Wish to Hasten Death? A Systematic Review and Meta-Ethnography from the Perspective of Patients

BACKGROUND: There is a need for an in-depth approach to the meaning of the wish to hasten death (WTHD). This study aims to understand the experience of patients with serious or incurable illness who express such a wish. METHODS AND FINDINGS: Systematic review and meta-ethnography of qualitative studies from the patient's perspective. Studies were identified through six databases (ISI, PubMed, PsycINFO, CINAHL, CUIDEN and the Cochrane Register of Controlled Trials), together with citation searches and consultation with experts. Finally, seven studies reporting the experiences of 155 patients were included. The seven-stage Noblit and Hare approach was applied, using reciprocal translation and line-of-argument synthesis. Six main themes emerged giving meaning to the WTHD: WTHD in response to physical/psychological/spiritual suffering, loss of self, fear of dying, the desire to live but not in this way, WTHD as a way of ending suffering, and WTHD as a kind of control over one's life ('having an ace up one's sleeve just in case'). An explanatory model was developed which showed the WTHD to be a reactive phenomenon: a response to multidimensional suffering, rather than only one aspect of the despair that may accompany this suffering. According to this model the factors that lead to the emergence of WTHD are total suffering, loss of self and fear, which together produce an overwhelming emotional distress that generates the WTHD as a way out, i.e. to cease living in this way and to put an end to suffering while maintaining some control over the situation. CONCLUSIONS: The expression of the WTHD in these patients is a response to overwhelming emotional distress and has different meanings, which do not necessarily imply a genuine wish to hasten one's death. These meanings, which have a causal relationship to the phenomenon, should be taken into account when drawing up care plans

Deseo de adelantar la muerte en pacientes con cáncer avanzado

El deseo de adelantar la muerte (DAM) es un fenómeno complejo y multifactorial, en el que subyace el sufrimiento que experimentan algunos pacientes al final de su vida, ante situaciones presentes o previsibles que el enfermo percibe como insalvables. Una de las dificultades con la que se enfrentan los estudios clínicos entorno al DAM ha sido su pobre conceptualización y la ambigüedad de la terminología usada para referirse a él, lo cual se ha identificado como uno de los principales escollos cuando se ha intentado comparar los resultados de diferentes estudios. Adicionalmente a la imprecisión conceptual del DAM, su naturaleza fluctuante, puesta de manifiesto por diferentes autores, sin duda influencia los resultados de los estudios epidemiológicos al respecto. Esta fluctuación del DAM se ha relacionado no sólo con los cambios en la mejora o empeoramiento de algunos síntomas, sino también con factores psicosociales y espirituales, incluida la percepción de la atención recibida y el sentido de la vida de los propios pacientes. En conclusión, los diferentes estudios tanto cuantitativos como cualitativos nos informan que el DAM es una respuesta a un origen multifactorial relacionada con el sufrimiento, y que esta respuesta es variable dependiendo de las poblaciones estudiadas y los instrumentos utilizados

Uso de metadona en el anciano con dolor oncológico: una revisión sistemática

Objetivo: Identificar el uso clínico de la metadona como analgésico en el manejo del dolor oncológico enancianos.Material y métodos: Se realizó una revisión sistemática de la literatura sobre el uso específico de la meta-dona en ancianos con dolor oncológico en las bases de datos MEDLINE, COCHRANE DATABASE y SCOPUS.Se llevó a cabo una segunda búsqueda en MEDLINE de estudios clínicos y revisiones sistemáticas del usode metadona en dolor oncológico, seleccionando aquellos en los que la edad media de los pacientes fuese≥ 65 a˜nos.Resultados: En la primera búsqueda se obtuvieron 4 artículos y de la segunda 7 estudios, ninguno de ellosespecíficos del uso de la metadona en ancianos con cáncer.Conclusiones: No existen datos suficientes del uso de la metadona como analgésico en el anciano con cán-cer. Dadas sus peculiaridades características farmacológicas es necesario su uso por personal experto. Seproponen unas recomendaciones para su empleo como analgésico en el tratamiento del dolor oncológicoen el anciano.Objective: To identify the clinical use of methadone as an analgesic in the management of cancer pain inelderly patients.Material and methods: We performed a systemic review of the literature on the specific use of metha-done in elderly with cancer pain in MEDLINE, COCHRANE DATABASE and SCOPUS. A second search wasconducted in MEDLINE to look for clinical trials and systematic review of the use of methadone in cancerpain, selecting only those in which the mean age of patients was ≥ 65 years old.Results: Four articles were obtained in the first search, and from the second 7 clinical trials, none of themspecific to methadone use in elderly patients with cancer.Conclusions: There are insufficient data on the use of methadone as an analgesic in the elderly with cancer.Given its pharmacological characteristics it must be used by trained personnel. Several recommendationsare proposed for its use as an analgesic in the treatment of cancer pain in the elderly

Características clínico epidemiológicas de pacientes con enfermedad crónica en fase terminal admitidos a un departamento de emergencia general

Introduction. Patients with advanced chronic disease (cancer and non-cancer) often go to emergency services. Objectives. To determine terminal chronic disease in those admitted to emergency, reason for admission, treatment and destination, comparing cancer with non-cancer. Methods. Observational study in people over 18 year old admitted to the emergency department of a tertiary hospital. Instrument: Supportive and Palliative Care Indicators Tool. Statistical analysis: Chi-square and U Mann-Whitney tests, considering p 0,05), presenting older age and disease time in non-cancer patients (p0,05), presentándose mayor edad y tiempo de enfermedad en pacientes no oncológicos (p<0,01). Conclusiones: Una de cada 20 admisiones al departamento de emergencia evaluado corresponden a enfermedad crónica en fase terminal (más frecuentes no oncológicas), siendo los motivos de ingreso infecciones, dolor y hemorragia

Line of argument: Explanatory model of WTHD.

<p>Line of argument: Explanatory model of WTHD.</p

Methodological Quality of included studies assessed with CASP (1999): qualitative research checklist.

<p>Methodological Quality of included studies assessed with CASP (1999): qualitative research checklist.</p