Estudio sociosanitario del paciente anciano con perfil de larga estancia y terminal atendido en una unidad médica de corta estancia

Abstract

Objective to describe the clinical, functional, health and social characteristics of the elderly population with chronic and/or terminal diseases (PALET profile) in a short-stay medical unit (SSMU) attached to an emergency department in relation to the remaining patients. Material and methods a descriptive study of all patients admitted to the SSMU during a 1-year period was performed. Data on age, sex, length of hospital stay, patient profile (PALET or oncological), functional status (Barthel index), cognitive status (Pfeiffer), nutritional status (MNA), depression (Yesavage), living arrangements, and destination after discharge were gathered. The statistical analysis consisted of descriptive study and bivariate analysis (Student’s ttest, chi-square test) with a significance level of p < 0.05 (95% confidence interval [CI]). Results there were 1,028 patients (51.0% men), with a mean age of 71.6 years [15-104] (median 77 years). There were 264 PALET patients (25.7%), 94 oncological patients (9.1%), and 770 patients with other diagnoses (65.2%). No significant differences were found between the groups in the mean length of stay. Overall mortality in the SSMU: 39 patients (76.9% PALET patients). PALET patients were older (OR = 8.16 [95% CI: 4.18-14.16], p < 0.001), had poorer functional and mental status (p < 0.001) and showed higher mortality (OR = 10.76 [95% CI: 5.03-22.98], p < 0.001) than the remaining patients. PALET patients required a higher proportion of domiciliary resources and were more likely to be referred to medium- or long-stay facilities at discharge (p < 0.001). Conclusions our SSMU attends a substantial proportion of elderly patients with chronic and/or terminal diseases (PALET). Because of the functional, mental, and nutritional status of these patients, as well as the presence of comorbidities and the high mortality rate, domiciliary, health and social resources should be developed to improve the quality of care provided to these patients.