Cognition, functionality and symptoms in patients under home palliative care.

Maria Aparecida Scottini,José Eduardo De Siqueira,Rachel Duarte Moritz

doi:10.1590/1806-9282.64.10.922

Abstract

Evaluating the degree of cognition, functionality, presence of symptoms and medications prescribed for patients under palliative home care. Descriptive, cross-sectional study where 55 patients under palliative home care were interviewed. Cognition was evaluated using the Mini-Mental state examination (MM), with patients being separated into two groups: with preserved cognitive ability (MM>24), or altered (MM <24). The functionality was verified by the Palliative Performance Scale (PPS) and the patients were divided into two groups: PPS≤50 and PPS≥60. The symptoms presence was evaluated by ESAS (Edmonton Symptom Assessment System) being considered as mild (ESAS 1-3), moderate (ESAS 4-6) or severe (ESAS 7-10) symptoms. Medications prescribed to control the symptoms were registered. Statistical analysis used Student's t test (p <0.05). Most of the 55 patients were women (63.6%), 70.9% of these had MM> 24, 83.6% had PPS <50 and 78.2% presented chronic non-neoplastic degenerative disease. There was a significant relationship between PPS≤50 and MM≤24. Symptoms were present in 98% of patients. Asthenia was more frequently reported and was not treated in 67% of the cases. Severe pain was present in 27.3%: 46% without medication and 13% with medication, if necessary. Most patients with severe dyspnea used oxygen. Most of the analysed patients had their cognition preserved, presented low functionality and 98% reported the presence of symptoms. Severe pain was present in almost 1/3 of the patients without effective treatment. Re-evaluate palliative home care is suggested to optimize patient's quality of life.

Highlights

Population aging associated with increased control of chronic-degenerative diseases leads to a systemic commitment of the patient, with greater dependence and consequent loss of quality of life, which leads to an increase in hospital admissions and a high financial expense on healthcare[1].The hospital is not the place for such patients because it increases the risk of infection, causes isolation from the family, and exposure to technological resources that do not bring them benefits[1]
Cognition was evaluated using the Mini-Mental state examination (MM), with patients being separated into two groups: with preserved cognitive ability (MM≥24), or altered (MM
The functionality was verified by the Palliative Performance Scale (PPS) and the patients were divided into two groups: PPS≤50 and PPS≥60

Summary

Introduction

The hospital is not the place for such patients because it increases the risk of infection, causes isolation from the family, and exposure to technological resources that do not bring them benefits[1]. In this reality, palliative care (PC) is inserted as a necessary measure that provides humanized medical care directed to the sick person and to the disease, and whose main goal is the quality of life. Patients with chronic degenerative diseases are often submitted to unnecessary examinations and treatment, with loss of quality of life.

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