Efecto conjunto de deterioro cognitivo y condición sociofamiliar sobre el estado funcional en adultos mayores hospitalizados

Joint effect of cognitive impairment and socio-family status on functional status in hospitalized older adults

José Mauricio Ocampo-Chaparro , Carlos A. Reyes-Ortiz
Revista Latinoamericana de Psicología, (2021), 53, pp. 20-29.
Recibido el 29 de abril de 2020
Aceptado el 8 de marzo de 2021

https://doi.org/10.14349/rlp.2021.v53.3

Resumen

Introducción: El objetivo de este estudio fue evaluar el efecto conjunto de deterioro cognitivo y condición sociofamiliar sobre el estado funcional en adultos mayores hospitalizados. Método: Se usó una cohorte retrospectiva, que incluyó 399 adultos mayores entre 2014 hasta 2015. El desenlace primario fue el estado funcional evaluado con la Escala de Lawton y Brody en cuatro tiempos. El deterioro cognitivo se evaluó con el Examen Mínimo Mental y la condición sociofamiliar con la Escala Sociofamiliar de Gijón. Resultados: Se encontró que el 54% tenían deterioro social y el 86% presentaban deterioro cognitivo. En análisis multivariados, la edad avanzada, la estancia hospitalaria prolongada, la albúmina baja, el deterioro cognitivo, el delirium y el deterioro social se asociaron significativamente con peor estado funcional. Conclusiones: Este estudio sugiere que el efecto conjunto entre deterioro cognitivo y deterioro social comprometen más el estado funcional que cada factor por separado.

Palabras clave:
Deterioro cognitivo, deterioro social, ancianos, hospitalización

Abstract

Introduction: The objective of this study was to evaluate the joint effect of cognitive impairment and socio-family condition on the functional status in hospitalized older adults. Method: A retrospective cohort included 399 older adults between 2014 and 2015. The primary outcome was functional status assessed by Lawton and Brody Scale in four times. Cognitive impairment was assessed with the MiniMental State examination and the socio-family condition with the Gijón Socio-family Scale. Results: It was found that 54% had social deterioration and 86% had cognitive impairment. In multivariate analyzes, advanced age, prolonged hospital stay, low albumin, cognitive impairment, delirium, and social deterioration were significantly associated with worse functional status. Conclusions: This study suggests that the joint effect between cognitive impairment and social deterioration compromises the functional status more than each factor separately.

Keywords:
Cognitive impairment, social deterioration, elderly, hospitalization

Artículo Completo
Bibliografía

Alarcón, T., Bárcena, A., González-Montalvo, J. I., Peñalosa, C., & Salgado, A. (1999). Factors predictive of outcome on admission to an acute geriatric ward. Age and Ageing, 28(5), 429-432. https://doi.org/10.1093/ageing/28.5.429

Alzheimer’s Association (2017). 2017 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 13(4), 325-373. https://doi.org/10.1016/j.jalz.2017.02.001

Bacca, A. M., González, A., & Rodríguez, A. F. U. (2005). Validación de la Escala de Depresión de Yesavage (versión reducida) en adultos mayores colombianos. Pensamiento Psicológico, 1(5), 53-64.

Baztán, J., Cáceres, L., Llanque, J., Gavidia, J., & Ruipérez, I. (2012). Predictors of functional recovery in older hospitalized adults. Journal of the American Geriatrics Society, 60(1), 187-189. https://doi.org/10.1111/j.1532-5415.2011.03716.x

Bentley, J., & Meyer, J. (2004). Repeat attendance by older people at accident and emergency departments. Journal of Advanced Nursing, 48(2), 149-156. https://doi.org/10.1111/j.1365-2648.2004.03182.x

Berkman, L. F., Leo-Summers, L., & Horwitz, R. I. (1992). Emotional support and survival after myocardial infarction. A prospective, population-based study of the elderly. Annals of Internal Medicine, 117(12), 1003-1009. https://doi.org/10.7326/0003-4819-117-12-1003

Bo, M., Fonte, G., Pivaro, F., Bonetto, M., Comi, C., Giorgis, V., Marchese, L., Isaia, G., Maggiani, G., Furno, E., & Falcone, Y., & Isaia, G. C. (2016). Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients. Geriatrics & Gerontology International, 16(3), 314-321. https://doi.org/10.1111/ggi.12471

Boltz, M., Chippendale, T., Resnick, B., & Galvin, J. E. (2015). Anxiety in family caregivers of hospitalized persons with dementia: contributing factors and responses. Alzheimer Disease and Associated Disorders, 29(3), 236. https://doi.org/10.1097/WAD.0000000000000072

Boltz, M., Kuzmik, A., Resnick, B., Trotta, R., Mogle, J., BeLue, R., Leslie, D., & Galvin, J. E. (2018). Reducing disability via a family centered intervention for acutely ill persons with Alzheimer´s disease and related dementias: protocol of a cluster-randomized controlled trial (Fam-FFC study). Trials, 19(1), 496. https://doi.org/10.1186/s13063-018-2875-1

Boltz, M., Lee, K. H., Chippendale, T., & Trotta, R. L. (2018). Pre-admission functional decline in hospitalized persons with dementia: the influence of family caregiver factors. Archives of Gerontology and Geriatrics, 74, 49-54. https://doi.org/10.1016/j.archger.2017.09.006

Boltz, M., Resnick, B., Chippendale, T., & Galvin, J. (2014). Testing a family-centered intervention to promote functional and cognitive recovery in hospitalized older adults. Journal of the American Geriatrics Society, 62(12), 2398-2407. https://doi.org/10.1111/jgs.13139

Calzada Gutiérrez, M. T., & Ocampo Chaparro, J. M. (2018). Conceptualización de cuidador institucional de persona mayor en Colombia. Revista de Salud Pública, 20, 511-517. https://doi.org/10.15446/rsap.v20n4.66544

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40(5), 373-383. https://doi.org/10.1016/0021-9681(87)90171-8

Covinsky, K. E., Palmer, R. M., Fortinsky, R. H., Counsell, S. R., Stewart, A. L., Kresevic, D., Burant, C. J., & Landefeld, C. S. (2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. Journal of the American Geriatrics Society, 51(4), 451-458. https://doi.org/10.1046/j.1532-5415.2003.51152.x

Feng, Z., Coots, L. A., Kaganova, Y., & Wiener, J. M. (2014). Hospital and ED use among Medicare beneficiaries with dementia varies by setting and proximity to death. Health Affairs, 33(4), 683-690. https://doi.org/10.1377/hlthaff.2013.1179

Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198. https://doi.org/10.1016/0022-3956(75)90026-6

Fox, M. T., Persaud, M., Maimets, I., O’Brien, K., Brooks, D., Tregunno, D., & Schraa, E. (2012). Effectiveness of acute geriatric unit care using acute care for elders’ components: a systematic review and meta-analysis. Journal of the American Geriatrics Society, 60(12), 2237-2245. https://doi.org/10.1111/jgs.12028

Garre-Olmo J. (2018). Epidemiología de la enfermedad de Alzheimer y otras demencias. Revista de Neurología, 66(11), 377-386. https://doi.org/10.33588/rn.6611.2017519

Graf, C. (2008). The Lawton instrumental activities of daily living scale. AJN The American Journal of Nursing, 108(4), 52-62. https://doi.org/10.1097/01.NAJ.0000314810.46029.74

Hartley, P., Gibbins, N., Saunders, A., Alexander, K., Conroy, E., Dixon, R., Lang, J., Luckett, J., Luddington, T., & Romero-Ortuno, R. (2017). The association between cognitive impairment and functional outcome in hospitalized older patients: a systematic review and meta-analysis. Age and Ageing, 46(4), 559-567. https://doi.org/10.1093/ageing/afx007

Inouye, S. K. (2006). Delirium in older persons. New England Journal of Medicine, 354(11), 1157-1165. https://doi.org/10.1056/NEJMra052321

Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P., & Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method: a new method for detection of delirium. Annals of Internal Medicine, 113(12), 941-948. https://doi.org/10.7326/0003-4819-113-12-941

Kitamura, K., Nakamura, K., Nishiwaki, T., Ueno, K., & Hasegawa, M. (2010). Low body mass index and low serum albumin are predictive factors for short-term mortality in elderly Japanese requiring home care. The Tohoku Journal of Experimental Medicine, 221(1), 29-34. https://doi.org/10.1620/tjem.221.29

Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9(3_Part_1), 179-186.

López-Álvarez, J., & Agüera-Ortiz, L. F. (2015). Nuevos criterios diagnósticos del deterioro cognitivo y la enfermedad de Alzheimer: una visión desde la psicogeriatría. Psicogeriatría, 5(1), 3-14.

McCusker, J., Kakuma, R., & Abrahamowicz, M. (2002). Predictors of functional decline in hospitalized elderly patients: a systematic review. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 57(9), M569–M577. https://doi.org/10.1093/gerona/57.9.m569

Mecocci, P., von Strauss, E., Cherubini, A., Ercolani, S., Mariani, E., Senin, U., Winblad, B., & Fratiglioni, L. (2005). Cognitive impairment is the major risk factor for development of geriatric syndromes during hospitalization: results from the GIFA study. Dementia and Geriatric Cognitive Disorders, 20(4), 262-269. https://doi.org/10.1159/000087440

Miralles, R., Sabartés, O., Ferrer, M., Esperanza, A., Llorach, I., García-Palleiro, P., & Cervera, A.-M. (2003). Development and validation of an instrument to predict probability of home discharge from a geriatric convalescence unit in Spain. Journal of the American Geriatrics Society, 51(2), 252-257. https://doi.org/10.1046/j.1532-5415.2003.51066.x

Norris, S. L., High, K., Gill, T. M., Hennessy, S., Kutner, J. S., Reuben, D. B., Unützer, J.,  & Landefeld, C. S. (2008). Health care for older Americans with multiple chronic conditions: a research agenda. Journal of the American Geriatrics Society, 56(1), 149-159. https://doi.org/10.1111/j.1532-5415.2007.01530.x

Ocampo-Chaparro, J. M., Mosquera-Jiménez, J. I., Davis, A. S., & Reyes-Ortiz, C. A. (2018). Deterioro funcional asociado al deterioro cognitivo en el anciano hospitalizado. Revista Española de Geriatría y Gerontología, 53(1), 19-22. https://doi.org/10.1016/j.regg.2017.05.007

Ocampo, J. M., & Reyes-Ortiz, C. A. (2016). Revisión sistemática de literatura. Declinación funcional en ancianos hospitalizados. Revista Médica de Risaralda, 22(1), 49-57. https://doi.org/10.22517/25395203.13681

Okamura, T., Hayakawa, T., Hozawa, A., Kadowaki, T., Murakami, Y., Kita, Y., Abbott, R.D.,  Okayama, A., & Ueshima, H. (2008). Lower levels of serum albumin and total cholesterol associated with decline in activities of daily living and excess mortality in a 12-year cohort study of elderly Japanese. Journal of the American Geriatrics Society, 56(3), 529-535. https://doi.org/10.1111/j.1532-5415.2007.01549.x

Osuna-Pozo, C. M., Ortiz-Alonso, J., Vidán, M., Ferreira, G., & Serra-Rexach, J. A. (2014). Review of functional impairment associated with acute illness in the elderly. Revista Española de Geriatría y Gerontología, 49(2), 77-89. https://doi.org/10.1016/j.regg.2013.08.001

Phelan, E. A., Borson, S., Grothaus, L., Balch, S., & Larson, E. B. (2012). Association of incident dementia with hospitalizations. JAMA, 307(2), 165-172. https://doi.org/10.1001/jama.2011.1964

Rudberg, M. A., Sager, M. A., & Zhang, J. (1996). Risk factors for nursing home use after hospitalization for medical illness. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 51(5), M189-M194. https://doi.org/10.1093/gerona/51a.5.m189

Sands, L. P., Yaffe, K., Covinsky, K., Chren, M.-M., Counsell, S., Palmer, R., Fortinsky, R., & Landefeld, C. S. (2003). Cognitive screening predicts magnitude of functional recovery from admission to 3 months after discharge in hospitalized elders. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 58(1), M37-M45. https://doi.org/10.1093/gerona/58.1.m37

Slaets, J. P., Kauffmann, R. H., Duivenvoorden, H. J., Pelemans, W., & Schudel, W. J. (1997). A randomized trial of geriatric liaison intervention in elderly medical inpatients. Psychosomatic Medicine, 59(6), 585-591. https://doi.org/10.1097/00006842-199711000-00005

Sleiman, I., Rozzini, R., Barbisoni, P., Morandi, A., Ricci, A., Giordano, A., & Trabucchi, M. (2009). Functional trajectories during hospitalization: a prognostic sign for elderly patients. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 64(6), 659-663. https://doi.org/10.1093/gerona/glp015

Takizawa, C., Thompson, P. L., Walsem, A. van, Faure, C., & Maier, W. C. (2015). Epidemiological and economic burden of Alzheimer’s disease: a systematic literature review of data across Europe and the United States of America. Journal of Alzheimer’s Disease, 43(4), 1271-1284. https://doi.org/10.3233/JAD-141134

Young, J., & Inouye, S. K. (2007). Delirium in older people. BMJ, 334(7598), 842-846. https://doi.org/10.1136/bmj.39169.706574.AD

Zhao, Y., Kuo, T.-C., Weir, S., Kramer, M. S., & Ash, A. S. (2008). Healthcare costs and utilization for Medicare beneficiaries with Alzheimer’s. BMC Health Services Research, 8(1), 108. https://doi.org/10.1186/1472-6963-8-108

PDF