Necesidad de atención paliativa a residentes institucionalizados con enfermedades crónicas evolutivas con pronóstico de vida limitado

Abstract

ObjectivesTo identify and describe the palliative care needs of patients with advanced chronic diseases by all causes and who are institutionalized in a nursing home using NECPAL CCOMS-ICO® tool and other variables. Material and methodsCross-sectional descriptive study of institutionalized patients diagnosed with advanced progressive chronic diseases in the nursing home «Paseo de la Cuba» in Albacete, from May 1, 2013 to November 1, 2013. The variables were: sex, age, advanced chronic disease, time in the nursing home, existence of advance care directives, incapacity of the patient, do-not-resuscitate order, concomitant diseases, treatment, Charlson and Karnofsky indexes, and all variables contained in the NECPAL CCOMS-ICO®. ResultsThe sample size included 130 residents (65% of the total population) that met criteria of multiple morbidity or chronic diseases and to whom the «surprise question» of the NECPAL CCOMS-ICO® instrument was applied. The mean age of the patients was 84.43 years, with 72.3% women, who had a higher mean age than the men. The most prevalent chronic disease was advanced dementia with 86.9%. Advanced directives had been made by 3.8%, and 17.7% were legally incapacitated. There was 70.8% comorbidity according to the Charlson index. The entire sample had a score below 50 on the Karnofsky Index. Comorbidity and multiple medications were characteristic of the sample. The criterion of a negative answer to the surprise question was fulfilled by 64.5%, and all of them obtained a positive NECPAL rating. ConclusionsImplementing the NECPAL CCOMS-ICO® tool in those health services that attend to high proportions of chronically ill, such as nursing homes, accompanied by training and adaptation of resources measures can lead to a very significant qualitative and quantitative change in our system.