Cambios en la salud de la población mayor pluripatológica en el entorno comunitario del Área III de Salud de Lorca (Murcia)

Resumen

Background: There is a growing interest in knowing the health of the elderly in Primary Care and management strategies to improve it, highlighting the relationship between the elderly population, multimorbidity and inadequate use of health resources, as well as negative health outcomes. Knowing the baseline situation of the pluripathological elderly in a health area and the changes observed over time is key to identifying areas for improvement in their care. Objective: To evaluate the changes in the health of the elderly population with multiple chronic conditions in the community setting of Health Area III after one year of follow-up. Methods: Longitudinal observational prospective follow-up study of a cohort of patients aged 65 years or older, attended in the portfolio of Home Care Services for Immobilized Patients of the Health Centers of Area III of Lorca (Murcia), from June 2019 to December 2020. The RANGECOM platform was used for data collection, which measures patient sociodemographic characteristics, social context, clinical characteristics, adverse events, nursing interventions and service utilization. Longitudinal statistical tests were performed using McNemar and Cochran's Q for qualitative variables, t-Student and repeated measures ANOVA for quantitative variables. Significant results were considered with p<0.05 using SPSS 25.0. Results: We present initial data on 97 patients with a mean age of 83,6 years (DE:6,7), predominantly female (71,1%) and with no or primary education (94,8%). The 86,6% live in company and 72% have a family caregiver, with a mean age of 59,1 years (DE:11,6), 68,9% are children, mainly women (82,9%). The caregiver overload evaluated with the IEC is 4,90; DE:3,52 for T4. The most prevalent chronic pathologies are: Arterial Hypertension (71,1%), Diabetes Mellitus (45,4%) and Arthrosis (41,2%). The Charlson index is 3,21; DE:2,39 for T4. The elderly show a significant worsening of functional capacity as measured with the Barthel index (56,28; DE:32,41 for T0 and 50,91; DE:33,46 for T4) and of cognitive capacity as measured with the Pfeiffer test (3,38; DE:3,33 for T0 and 3,82; DE:3,22 for T4). In addition, they tend to have a higher perception of loneliness according to the UCLA scale (30.99; SD: 6.96 for T0 and 30.03; SD: 7.05 for T4). The identified nursing diagnoses of grouped into four main functional health patterns: "Perception Health Management", related to Risk of falls (68% T0 and 69,5% T4); "Activity Exercise" with Impaired physical mobility (49,5% T0 and 65,9% T4) and Impaired ambulation (46,4% T0 and 57,3% T4); "Nutritional Metabolic" with Risk of skin integrity impairment (33% T0 and T4); "Cognitive Perceptual" with Memory impairment (19,6% T0 and 24,4% T4). And nursing interventions applied are grouped into four domains: "Safety", related to Fall Prevention (74,2% T0 and 72% T4); "Complex Physiological" with Skin Surveillance (50,5% T0 and 61% T4) and Pressure Ulcer Prevention (45,4% T0 and 47,6% T4); "Family" with Primary caregiver support (54,6% T0 and 56,1% T4); "Behavioral" with Health education (69,1% T0 and 74,4% T4) and Active listening (48,5% T0 and 54,9% T4). The pandemic reduces the number of nursing contacts (6 contacts T0 and 3,6 T4). The number of adverse events such as UPP (2,6% decrease), falls (12% decrease), emergency room visits (11,2% decrease) and admissions (8,4% decrease), although admissions due to exacerbation of a chronic process increased by 52,4%. The 13% use some type of assistive device (increasing oxygen therapy and aerosol therapy) and 75% use some type of technical aid. Conclusion: The health of the population aged 65 years and older, with multiple chronic conditions in the community setting of the Health Area III, shows a worsening of functional, cognitive and relational capacity and self-perception; it is necessary to apply nursing interventions focused on these areas, since the healt