Enfermos crónicos domiciliarios: valoración integral físico-cognitiva y caídas durante 3 años de seguimiento

OBJECTIVE: To assess the physical and cognitive capacity of chronically ill homebound patients, and the falls they suffered during three years of monitoring. DESIGN: Descriptive, longitudinal study. SETTING: «Raval Nord» Health District, Barcelona. PATIENTS AND OTHER PARTICIPANTS: All the 243 homebound chronic patients registered in the home care programme in May 1996 (67% women, average age 84). MEASUREMENTS AND MAIN RESULTS: After three years 16% had gone into an old people's home, 9% had moved house and 38% had died. The probability of not continuing in the programme after three years monitoring was related to less autonomy, presence of comorbidity, and worse cognitive capacity (p < 0.05). Of the 90 patients (37%) who remained active in May 1999, 41% showed disorders on the Short Portable Mental Status Questionnaire (SPMSQ), with a significant relationship to greater age, less autonomy and the presence of comorbidity. Numerous alterations in analysis (21.6%) and linked illnesses (18.9%) were found in the patients with cognitive deterioration. 42% of the patients active in May'99 had fallen during the monitoring period. 10% of the falls involved fractures. The number of falls was higher when there was visual-auditory loss, consumption of psychiatric drugs or absence of use of orthopaedic aids. There was also a greater probability of falls in patients who only had a part-time carer (p < 0.05). CONCLUSIONS: It is important to assess the autonomy, cognitive capacity and comorbidity of homebound chronic patients when monitoring them. Likewise, cognitive disorders and falls must be properly weighed, as they are common in this class of patient.