Publication: Detección del anciano de alto riesgo en la unidad de corta estancia de urgencias de un hospital terciario
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2017-08-16
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Universidad Complutense de Madrid
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Abstract
El envejecimiento poblacional afecta sobre todo a países desarrollados como el nuestro. Se empieza a distinguir diferentes tipos de ancianos, desde sanos o robustos a pacientes geriátricos con mayor comorbilidad, discapacidad y dependencia. No existe una definición de fragilidad que sea práctica y universal. El anciano frágil es un paciente muy vulnerable que “no está ni muy bien ni muy mal”, mayoritariamente independiente y ante la presencia de un proceso intercurrente está en riesgo de sufrir deterioro funcional y otros resultados adversos. El anciano es cada vez más frecuente (15-35%) y complejo en los SUH. Se identifica anciano frágil con anciano en riesgo de presentar eventos adversos (muerte, refrecuentación, reingreso, dependencia y mala calidad de vida). El papel actual de los Servicios de Urgencias hospitalarios (SUH) en el sistema de salud ha cambiado. Ejercen un papel central en la atención del paciente anciano y en la transición de cuidados entre la atención primaria y especializada en el hospital. En las últimas décadas han vivido situaciones de saturación y colapso asistencial. Para paliar este problema se han ido desarrollando alternativas a la hospitalización convencional vinculadas frecuentemente al SUH como las Unidades de Corta Estancia (UCE). Hasta la fecha, la Valoración convencional del paciente en los SUH y en las UCE es unidimensional, centrada en el episodio médico actual sin tener en consideración otros aspectos clínicos, funcionales, mentales y sociales asociados a malos resultados. La Valoración Geriátrica Integral (VGI) incluye los dominios anteriores pero hasta la fecha no se ha adaptado convenientemente en las UCE ni SUH...
Population aging affects all countries. It is very important to distinguish different types of elders, from healthy elderly to geriatric patient with greater comorbidity, disability and dependence. There is no practical and universal definition of frailty. The frail elderly is a very vulnerable patient ("not to bad but not very good") mostly independently and with at risk of functional decline and other adverse outcomes after a trigger process. The elderly is frequent visitor of Emergency Department (ED). Frail elderly is identified as a patient at risk for adverse events (death, revisit, readmission, dependency and poor quality of life). The current role of ED has changed in the health system. ED is a central role in the care of elderly patients and in the transition between primary care and hospital care. In recent decades, EDs have experienced situations of overcrowding. ED have developed alternatives to conventional hospitalization often linked ED as Short Stay Unit (SSU) for solving this situation. Currently, conventional management of the patient in the ED and the SSU is one-dimensional, focusing on actual medical episode without considering other clinical, functional, mental and social aspects associated with poor results. Comprehensive Geriatric Assessment (CGA) includes the above domains but to date has not been properly applied or adapted in ED and SSU...
Population aging affects all countries. It is very important to distinguish different types of elders, from healthy elderly to geriatric patient with greater comorbidity, disability and dependence. There is no practical and universal definition of frailty. The frail elderly is a very vulnerable patient ("not to bad but not very good") mostly independently and with at risk of functional decline and other adverse outcomes after a trigger process. The elderly is frequent visitor of Emergency Department (ED). Frail elderly is identified as a patient at risk for adverse events (death, revisit, readmission, dependency and poor quality of life). The current role of ED has changed in the health system. ED is a central role in the care of elderly patients and in the transition between primary care and hospital care. In recent decades, EDs have experienced situations of overcrowding. ED have developed alternatives to conventional hospitalization often linked ED as Short Stay Unit (SSU) for solving this situation. Currently, conventional management of the patient in the ED and the SSU is one-dimensional, focusing on actual medical episode without considering other clinical, functional, mental and social aspects associated with poor results. Comprehensive Geriatric Assessment (CGA) includes the above domains but to date has not been properly applied or adapted in ED and SSU...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 12-01-2016