Mortalidad, calidad de vida y atención domiciliariadiferencias entre pacientes institucionalizados y atención domiciliaria

Laburpena

Society’s ageing is a fact. Life expectancy has dramatically increased in Spain during twentieth century, being one of the highest in Europe. This lead to an increase in comorbidities, pluripathology, disability, fragility, physical and mental limitations and elderly patients’ deterioration and it means a greater dependence which sometimes implies the necessity of a long-term assistance. That is how home care programs and institutionalization emerged. Despite the increase in the number of nursing homes in our country, there are still not enough when facing the demand. Nursing homes or home care can be decisive when designing a socio-sanitary approach to this so vulnerable social sector. There lies the importance of this PhD thesis. It studies these patients’ characteristics, analyzing the differences between institutionalized patients and those who live at home, mortality, quality of life and health resources use. An analytical observational longitudinal prospective cohort study was performed in Seville. The total number of patients in the study was 1314. 80,7% (1061 patients) were institutionalized and 19,3% (253 patients) were in a home care situation. Both groups are homogeneous according to their clinical characteristics. However, presence of psychiatric diseases and cognitive impairment is associated with institutionalization. An example of this is the high presence of E3 category (according to pluripathologies criteria) in patients in nursing homes. On the other hand, patients in home care situation have a greater comorbidity. Frequency of visits and family support were also studied, being lower in institutionalized patients than in those living at home. A higher percentage of patients who lived at home had a spouse. Patients in home care situation had a greater presence of polypharmacy. Concerning degree of dependence and cognitive impairment, after studying the Barthel, Lawton-Brody and Pfeiffer scales, it was concluded that institutionalization is associated with greater dependence and degree of cognitive impairment. Both groups were homogeneous regarding the number of falls sustained. On the contrary, statistical differences were found regarding benzodiazepines intake. No differences were found between both groups regarding mortality during the year of study. The main mortality cause was cardiovascular system diseases, followed by respiratory diseases, After the studies carried out, the key mortality determinants are: age, degree of dependence and hospital admissions. Statistical differences were not found in relation to the perceived quality of life in both groups. The EuroQol scale values were lower in patients with anxiety and depression and higher in those patients with more independency and less cognitive impairment. Use of health resources was studied, understood as the number of primary care calls, emergencies and hospital admissions. Patients in home care situation needed a greater number of home visits by their primary care physician, ambulance interventions and emergency attendances. These results invite us to reflect on the importance of enhancing the patients’ autonomy and a longitudinally follow-up, both in institutionalized and home care situations.