Browsing by Author "Marin, PP"
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- ItemDelirium in Chilean elderly inpatients: an overlooked problem(SOC MEDICA SANTIAGO, 2005) Carrasco, M; Hoyl, T; Marin, PP; Hidalgo, J; Lagos, C; Longton, C; Chavez, P; Valenzuela, E; Arriagada, DBackground: Delirium is a common underdiagnosed and undertreated problem in elderly inpatients, associated to higher morbidity, mortality and health cost. Aim: To evaluate the prevalence of delirium as hospital admission in medically ill elderly patients and the attending physician's diagnosis and treatment of delirium. Patients and methods: In a prospective and descriptive study, consecutive patients aged 65 years or more, admitted to an internal medicine ward were evaluated by independent physicians, during the first 48 h of admission, to asses the presence of delirium. Diagnosis of delirium was based on the Confusion Assessment Method. Medical and nurse records were reviewed. Family was interviewed when necessary. Results: One hundred eight patients (52% women, age range 65-94 years) with an APACHE II score of 11.6+/-5, were evaluated. Fifty seven patients (52% women, age range 65-94 years) with an APACHE II score of 5% mixed). Delirium prevalence was significantly higher in older patients (66% among those aged 75 years or older versus 30% in younger; p <0.05) and among patients with more severe conditions (88% among those with an APACHE score over 16 versus 47% below that value, p <0.05). Medical records of patients with delirium showed that this diagnosis was present only in 32% and cognitive deficit was described in 73%. Ten percent of patients with delirium received sedative medication and 38% were physically restricted. There were no environmental interventions to prevent or control delirium. Conclusions: Delirium in elderly inpatients at this until is an extraordinarily prevalent problem, seriously under diagnosed (68%) and under treated. This study should alerts our medical community to improve the diagnosis and management of delirium in elderly inpatients.
- ItemEstimation of the number of institutionalized elderly in Chile(SOC MEDICA SANTIAGO, 2004) Marin, PP; Guzman, JM; Araya, ABackground: Elderly people (>60 years) in Chile represented 11.4% (n = 1,717,478) of the total population in 2002. The group with disabilities or mental problems is increasing and there is no reliable information about the number of institutionalized elderly subjects. Aim: To estimate the number of elderly people living in residences for long term care and their and main characteristics. Patients and methods: Chilean Census does not provide: exact information about institutional care, therefore; we developed "proxy" indicator of the: percentage of institutionalized elderly (those living in "collective residences with more than 5 elderly persons and in which they represent more than 25% of the residents". This proxy has a R2=0.9859 with the true value of institutionalized persons for those Latin-American countries with exact value in census data at CELADE. Results: Using the proxy we found that institutionalized elderly population had increased,from. 14,114 (1992) to 26,854 (2002) and is projected to reach 83,500 (2025). In 2002, there were 1,668 institutions (37.4% informal care). In the Metropolitan Area, there were 804 institutions (14,178 elderly persons) and 40.3% of these were registered at the Ministry of Health. The proportion of institutionalized elderly subjects was 1.56% of the total elderly population; this proportion increased from 0.87% in subjects 60-74 years old to 2.5% among subjects aged 75-84 years and 6.1% in subjects 85 years old and over. Among subjects living in institutions, 60.9 were women, 21% were married, 35% were single, approximately 50% receive a pension and around 15% were handicapped. Conclusions: Institutional care affects a small percentage of elderly population, but it will increase to the near future. The main characteristics of institutionalized elderly subjects are not well known. We propose to create a formal Registry of these institutions and to include Nursing Homes and hospitals in type of housing of future Censuses.
- ItemProposed minimum contents for medical school programs in geriatric medicine in Latin America(PAN AMER HEALTH ORGANIZATION, 2005) Cano, C; Gutierrez, LM; Marin, PP; Martinez, FM; Pelaez, M; Manas, LR; Vega, E; Zuniga, CIn the developing countries of the world, an aging of the population in general is occurring at the same time that the life expectancy of older adults is increasing. The results of this double aging process are especially striking for health care services because of the concurrent epidemiologic transition, which has led to infectious diseases being replaced by noninfectious, habitually chronic diseases that occur predominantly in older age. In these circumstances, older adults begin to predominate among the patients whom physicians in Latin America now serve and in the near future, older adults will constitute the immense majority of those patients. To respond to this situation, the training of professionals responsible for providing care to older adults should be improved, and the preparation of specialists in geriatric medicine should be enhanced both quantitatively and qualitatively. Future doctors should have the knowledge, abilities, and attitudes to enable them to appropriately serve this population segment. With these aims in mind, structures and procedures should be established that make it possible to impart the specific contents of geriatric medicine during medical school not only as a part of the traditional vertical teaching of the core curriculum of geriatric medicine, but also through the horizontal teaching of some of the material in other subjects. This article discusses why, with what objectives, with what contents, with what procedures, and with what staffing and materials the training of professionals in geriatric medicine should be carried out, and why it is time to give priority to this undertaking. Putting into place the measures proposed in this article should facilitate the incorporation of this subject-matter into the curricula of the medical schools of Latin America.
- ItemResults of the INTRA-WHO survey in Chile(SOC MEDICA SANTIAGO, 2005) Marin, PP; Villalobos, A; Carrasco, M; Kalache, ABackground: The aging speed in developing countries has been faster than predicted. Thus, health care systems must adapt to face Ibis new scenario efficiently. The WHO designed the INTRA study to assess health promotion anal protection actions in primary care, for people over 50 years of age. Material and methods: Questionnaries designed by WHO were applied to 1,167 subjects (aged 50-94 years, 68% fernale) and 117 health care professionals attending and working respectively, at 33 health care centers of the Vina-Quillota Health Service. Results: Twenty percent of subjects were illiterate and 25% bad less than 6 years of instruction. Forty three percent could reache the health centre by public transportation and 92% did not need to be accompanied; 39% spended snore than one hour to be attended and 71% considered that the service in the centre was good. Sixty seven percent attended regular appointments, 63% did not perform any physical activity and only half of them were advised to start stick activity. Weight loss was recommended to 55% bat only ore third has achieved such goal. Only one third of patients admitted being interrogated about their drinking habits. Among subjects in whom blood pressure was measured, one fourth bad abnormal values. Conclusions: Primary, health care in Chile, although having health care programs for the elderly, is loosing opportunities to improve health status and quality of life of this age group.