Papers by Marcela Carrasco
Revista Española de Geriatría y Gerontología, 2021
In order to address the complexity of needs of dependent older people, multidimensional and perso... more In order to address the complexity of needs of dependent older people, multidimensional and person-centered needs assessment is required. The objective of this review is to describe met and unmet needs of dependent older people, living in the community or in institutions, and the factors associated with those needs. Selection criteria included papers about need asessment which employed the Camberwell Assesment of Need for the Elderly (CANE). A search through MEDLINE, SCOPUS, WOS and CINHAL databases was carried out. Twenty-one articles were finally included. Unmet needs were found more frequently in psychosocial areas (mainly in "company", "daytime activities" and "psychological distress") and in institutionalized population. In addition, unmet needs were often associated with depressive symptoms, dependency, and caregiver burden. Discrepancies between self-reported needs and needs perceived by formal and informal caregivers were identified. It is important that professionals and caregivers try to make visible the perspective of older people and their psychological and social needs, particularly when the person is dependent, depressed or cognitively impaired.
Revista médica de Chile (Impresa), Nov 26, 2010
Low grade systemic inflammation is commonly observed in chronic obstructive pulmonary disease (CO... more Low grade systemic inflammation is commonly observed in chronic obstructive pulmonary disease (COPD). To evaluate the extent of systemic inflammation in a group of ex-smokers with COPD in stable condition and its relation with pulmonary function and clinical manifestations. We studied 104 ex-smokers aged 69 ± 8 years (62 males) with mild to very severe COPD and 52 healthy non-smoker subjects aged 66 ± 11 years (13 males) as control group. High sensitivity serum C reactive protein (CRP), interleukin 6 (IL6), fibrinogen (F) and neutrophil count (Nc) were measured. Forced expiratory volume in the first minute (FEV1), inspiratory capacity (IC), arterial blood gases, six minutes walking test, dyspnea and body mass index (BMI) were measured, calculating the BODE index. Health status was assessed using the Saint George Respiratory Questionnaire (SGRQ), the chronic respiratory questionnaire (CRQ), registering the number of acute exacerbations (AE) during the previous year and inhaled steroi...
Medwave, Jan 20, 2018
Antipsychotics have been proposed as a pharmacological alternative to prevent postoperative delir... more Antipsychotics have been proposed as a pharmacological alternative to prevent postoperative delirium. Nonetheless, their actual clinical benefits and harms are a matter of debate. To answer this question, we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the chosen systematic reviews, reanalyzed the data from the primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We identified 16 systematic reviews that included eight primary studies, all were randomized trials. We concluded the use of prophylactic antipsychotics reduces the incidence of postoperative delirium, but has no effect on the duration of hospital stay and might increase mortality.
Revista medica de Chile, 2017
The number of osteoporotic fractures is increasing along with population aging. Most patients wit... more The number of osteoporotic fractures is increasing along with population aging. Most patients with these type of fractures are older than 65 years, with multiple chronic conditions and different degrees of disability. Hip fracture is the most relevant osteoporotic fracture due to its frequency, costs, severity and complications. Multidisciplinary management is of the utmost importance to obtain good therapeutic results. We herein review the management of this fracture. Orthogeriatric joint management should be incorporated in fragility fracture treatment. We contribute with general recommendations for the perioperative management, which can be homologated for the management of older patients with other type of fragility fractures.
Revista Médica Clínica Las Condes, 2017
El delirium es reconocido como un problema de alta relevancia, especialmente en personas mayores,... more El delirium es reconocido como un problema de alta relevancia, especialmente en personas mayores, desde el servicio de urgencia y durante toda la estadía hospitalaria. Se asocia a mayor riesgo de morbilidad, dependencia funcional, deterioro cognitivo y mortalidad, además de una mayor estadía hospitalaria y costos. Su presencia implica desafíos en el manejo, toma de decisiones, diagnóstico y terapéutica. Se recomienda su tamizaje desde el momento de la atención de urgencia y durante la hospitalización, así como la implementación de protocolos de prevención y manejo, que han demostrado beneficio mediante un abordaje integral multidimensional. A pesar de su impacto, aún persisten altas tasas de subdiagnóstico y los sistemas de salud han sido lentos en la implementación de las recomendaciones. Actualmente el manejo adecuado del delirium es un desafío para mejorar la calidad asistencial.
Revista medica de Chile
We report a 79-year-old male patient presenting with progressive memory loss associated with anxi... more We report a 79-year-old male patient presenting with progressive memory loss associated with anxiety and muscular pain. An extensive biochemical control revealed high serum calcium and parathormone levels, and normal thyroid hormones. Cognitive assessment prior to surgery was compatible with mild cognitive impairment, showing significant improvement two months after parathyroidectomy. Our case suggests that, although rare, primary hyperparathyroidism should be considered as a possible cause of cognitive decline in the elderly.
Psychosomatics, 2009
Background: Delirium is an important problem especially in older medical inpatients. Objective: T... more Background: Delirium is an important problem especially in older medical inpatients. Objective: The authors asked whether delirium and its duration are associated with higher mortality in a 3-month follow-up period. Method: In this prospective cohort study, inpatients age 65 and older were assessed every 48 hours with the Confusion Assessment Method. Results: Of 542 patients enrolled, 192 (35.4%) developed delirium. After 3 months, mortality in the delirium cohort was 25.9%, and in the nondelirium cohort was 5.8%. Delirium was independently associated with mortality, and increased by 11% for every 48 hours of delirium. Conclusion: Delirium and increased delirium durations are significantly associated with higher mortality.
Revista médica de Chile, 2012
Delirium in older medical inpatients. A one year follow up study Background: Delirium is an impor... more Delirium in older medical inpatients. A one year follow up study Background: Delirium is an important problem in older medical inpatients. Aim: To assess if delirium is associated with higher mortality, functional decline or higher rates of readmission or institutionalization in a one year follow-up period. Material and Methods: Prospective cohort study of consecutive patients 65 years and older, admitted to a general hospital medical ward. A psychogeriatric team assessed patients every 48 h using the Confusion Assessment Method (CAM), functionality, acute severity and comorbidity scores. Analysis of one year mortality and telephone functional assessment was performed. Results: Five hundred forty two patients were enrolled and 35.4% had delirium. After one year, mortality was 34.9 and 13% in delirium and non-delirium cohorts, respectively (p < 0.01). After adjustment for covariates, delirium was independently associated with higher mortality, and higher functional decline and institutionalization. No signifi cant differences were seen in readmission rates. Conclusions: Delirium was signifi cantly associated with higher mortality and functional decline over a one year follow up period in geriatric inpatients.
![Research paper thumbnail of [Assessment of 1497 Chilean nursing home residents, using the Resource Utilization Group method, RUG T-18]](https://images.weserv.nl/?url=https%3A%2F%2Fattachments.academia-assets.com%2F76660550%2Fthumbnails%2F1.jpg&q=12&output=webp&max-age=110)
Revista medica de Chile, 2004
BACKGROUND There is little information about Chilean elderly residents of long term care faciliti... more BACKGROUND There is little information about Chilean elderly residents of long term care facilities, regarding their characteristics and need for resources. AIM To describe main characteristics and resource utilization of residents of one of the largest nursing homes in Chile, Fundación Las Rosas de Ayuda Fraterna. MATERIAL AND METHODS In a cross sectional and descriptive study, all residents were evaluated using the RUG T-18 method, that assess activities of daily living and the complexity of their clinical situation. RESULTS We assessed 1497 subjects 60 years old and over (73% women), with an age range of 60-106 years. Thirty six percent had urinary incontinence, 19% required assistance for feeding, and 38% needed help for walking or moving. Fifty seven percent were in the lowest category of complexity, "Institutionalization". Very few residents were in the most demanding categories, no one classified as "Rehabilitation", and only 0.7% were in "Special Car...
![Research paper thumbnail of [A novel method for targeting and characterizing healthy older people]](https://images.weserv.nl/?url=https%3A%2F%2Fattachments.academia-assets.com%2F76660548%2Fthumbnails%2F1.jpg&q=12&output=webp&max-age=110)
Revista medica de Chile, 2010
BACKGROUND there is no established definition of healthy aging in clinical practice, although it ... more BACKGROUND there is no established definition of healthy aging in clinical practice, although it is a World Health Organization goal. AIM to develop a clinical protocol to identify healthy older people living in the community and study their clinical, laboratory and functional characteristics. MATERIAL AND METHODS healthy people aged 60 years or older, were invited to participate in the study, by newspapers and radio, if they selfperceived as healthy, lived in the community, were functionally independent and had low disease burden. Potential participants were initially screened by telephone, and those who met the inclusion criteria were included. They had a comprehensive geriatric assessment which included clinical, anthropometric, laboratory and functional assessments. RESULTS of 384 people who answered the call, 83 subjects aged 60 to 98 years (57% women) met the inclusion criteria of healthy older people. Seventy eight percent did not consume any medication, 100% were able to per...
Revista espanola de geriatria y gerontologia, 2008
Delirium is defined as a syndrome characterized by an acute and fluctuating decline in higher cog... more Delirium is defined as a syndrome characterized by an acute and fluctuating decline in higher cognitive functions. The impact of this syndrome is often underestimated in the geriatric population both from the diagnostic and prognostic points of view. Many clinicians are unaware of the scale of the impact on outcomes of delirium. This review presents evidence that supports the view that delirium is independently associated with a worse overall outcome, assessed in terms of greater functional and cognitive deterioration, intrahospital complications, and a higher risk of mortality. Likewise, the impact of delirium on the health system (increases in hospital stay, referrals and costs) is discussed. Therefore, we propose that delirium be considered as a marker of health status, which would allow assessment of this syndrome to be broadened to include two fundamental considerations: firstly, that persons with delirium belong to a group with a higher risk of adverse events and secondly, tha...
![Research paper thumbnail of [Biomedical impact of traveling for Chilean elderly]](https://images.weserv.nl/?url=https%3A%2F%2Fattachments.academia-assets.com%2F76660547%2Fthumbnails%2F1.jpg&q=12&output=webp&max-age=110)
Revista medica de Chile, 2004
BACKGROUND In Chile there is a program named "Vacations for Elderly during Low Season".... more BACKGROUND In Chile there is a program named "Vacations for Elderly during Low Season". AIM To characterize participants of this program and to measure the impact of traveling in their health and wellbeing. MATERIAL AND METHODS Two anonymous and voluntary questionnaires were applied to 4200 participants, before and after a ten days vacation package. RESULTS Before traveling, questionnaires were answered by 802 subjects, and after traveling by 4057 (69% women, 22% older than 75 years old, 15.8% living alone). The presence and maintaining of good health were most appreciated at this age and 59% classified their health as good or excellent. Twenty five percent referred sensory problems (seeing or hearing), 12% reported urinary incontinence and 21% presented falls in the last three months; depression screening (GDS-5) was positive in 16%. Chronic disease prevalence was similar to the general Chilean elderly population. After traveling they reported significant improvements in ...
... Palabras clave Delirium. Geriatría. Pronóstico. González, Matías a ; Carrasco, Marcela b. a D... more ... Palabras clave Delirium. Geriatría. Pronóstico. González, Matías a ; Carrasco, Marcela b. a Departamento de Psiquiatría. Facultad de Medicina. Pontificia Universidad Católica de Chile. Santiago de Chile. Chile. b Departamento de Geriatría. Facultad de Medicina. ...
![Research paper thumbnail of [Delirium in Chilean elderly inpatients: an overlooked problem]](https://images.weserv.nl/?url=https%3A%2F%2Fattachments.academia-assets.com%2F76660546%2Fthumbnails%2F1.jpg&q=12&output=webp&max-age=110)
BACKGROUND Delirium is a common underdiagnosed and undertreated problem in elderly inpatients, as... more BACKGROUND Delirium is a common underdiagnosed and undertreated problem in elderly inpatients, associated to higher morbidity, mortality and health cost. AIM To evaluate the prevalence of delirium at hospital admission in medically ill elderly patients and the attending physician's diagnosis and treatment of delirium. PATIENTS AND METHODS In a prospective and descriptive study, consecutive patients aged 65 years or more, admitted to an internal medicine ward were evaluated by independent physicians, during the first 48 h of admission, to asses the presence of delirium. Diagnosis of delirium was based on the Confusion Assessment Method. Medical and nurse records were reviewed. Family was interviewed when necessary. RESULTS One hundred eight patients (52% women, age range 65-94 years) with an APACHE II score of 11.6+/-5, were evaluated. Fifty seven patients (53%) had delirium (32% hyperactive, 72% hypoactive and 5% mixed). Delirium prevalence was significantly higher in older pati...
International Journal of Mental Health Promotion
Loneliness is considered a public health problem that negatively affects wellbeing, especially in... more Loneliness is considered a public health problem that negatively affects wellbeing, especially in the older population. In Latin-American countries, most of the older population live with their family. Although this is thought to diminish feelings of loneliness, there is scarce data to support this. The objective of this study is to determine the prevalence of loneliness and evaluate its association with objective social networks, family functioning and perception of social support, in a sample of older people from Santiago, Chile. A survey was conducted of a representative sample of community older people (60-97 years) from Santiago, Chile, using the UCLA abbreviated scale of loneliness. Logistic regression was performed to test the variables related to the loneliness of older people. A total of 1,217 older people were interviewed. 88% were living with at least one person at home and 92% had living children. Using the UCLA abbreviated scale, 45% were found to perceive feelings of loneliness at least some of the time. Logistic regression showed significant association between loneliness and family dysfunction; depressive symptoms; living alone; not having a partner (widowed, separated or single); having little contact with relatives and friends; feeling a lack of social support; and sensation of poor self-efficacy. Loneliness is a prevalent public health problem in this older Latin-American community. Living accompanied does not protect against loneliness, particularly in vulnerable groups such as those with depression, or when there are family conflicts. The high prevalence of loneliness strongly conveys the need for public health policies to address loneliness in older people.
Revista médica de Chile
Prevalencia de pacientes con alto riesgo de caídas en un servicio médico-quirúrgico de un hospita... more Prevalencia de pacientes con alto riesgo de caídas en un servicio médico-quirúrgico de un hospital universitario BraUlio aliaga a , natalia molina a , matías nogUera a , PaUla esPinoza a , seBastián sánchez a , BárBara lara 1 , marcela carrasco 1,2 , gonzalo eymin 1,3 Risk of falls among patients admitted to a medical-surgical ward. Analysis of 376 medical records Background: Detecting patients at risk of falls during hospital stay is of utmost importance to implement preventive measures. Aim: To determine the frequency of patients with a high risk of falls admitted to a medical-surgical ward. To assess the preventive measures implemented. Materials and Methods: Review of medical records of 376 patients aged 20 to 97 years (28% older than 70 years) admitted to a clinical hospital in a period of four months. Results: Eleven percent of patients had a history of falls, 50% had a sensory deficit, 68% had unstable gait, 8% had a neurological risk condition, 8% had drowsiness or disorientation, 4% had psychomotor agitation or delirium, 86 % used high risk medications, 73% used 2 or more high risk drugs and 72% were using devices that decrease mobility. One hundred forty-one patients (38%) had a high risk of falling. The mean age of the latter was 77 years, 89% had a sensory deficit, 96% had unstable gait, 4% had psychomotor agitation or delirium and 98% used high risk drugs. Less than 1% had a medical prescription of a caregiver, physical restraints or antipsychotics, however, 21% of patients had a caregiver. Conclusions: The percentage of patients with a high risk of falling is important. The main risk factors were sensory deficit, unstable gait and the use of high risk medications. The low frequency of preventive measures prescriptions is striking.
Revista Española de Geriatría y Gerontología
Resumen Introduccion La enfermedad renal cronica terminal esta aumentando en los adultos mayores.... more Resumen Introduccion La enfermedad renal cronica terminal esta aumentando en los adultos mayores. La fragilidad es altamente prevalente en los adultos mayores con enfermedad renal cronica terminal. Sin embargo, no existen estudios prospectivos que comparen el rendimiento de las diferentes modalidades de terapia de reemplazo renal (TRR) en adultos mayores fragiles. Objetivo Comparar la ocurrencia de resultados clinicamente relevantes (hospitalizaciones, caidas, fracturas de caderas y mortalidad) en adultos mayores prefragiles y fragiles segun modalidad de TRR: hemodialisis o dialisis peritoneal. Metodo Estudio observacional prospectivo en adultos mayores prefragiles y fragiles (segun escala FRAIL) en hemodialisis y dialisis peritoneal en las unidades correspondientes de la Red de Salud UC-Christus. Se evaluaron caracteristicas basales (edad, Charlson, indice de masa corporal, tiempo en TRR, cumplimiento de Kt/V, hemoglobina y albumina) y se siguieron a 12 meses, registrando mortalidad, dias y numero de hospitalizaciones, caidas y fracturas de cadera. Resultados Cumplieron criterios de ingreso 27 pacientes por grupo. Sus caracteristicas basales fueron similares, a excepcion de la albuminemia y del tiempo en TRR, ambas menores en el grupo en dialisis peritoneal. La escala FRAIL fue similar. La escala FRAIL se correlaciono basalmente con mayor comorbilidad, menor albuminemia y no cumplimiento del Kt/V, mientras que fue independiente de la edad, indice de masa corporal y tiempo en TRR. Los dias y numero de hospitalizaciones a 12 meses fueron similares para ambas modalidades de TRR. La supervivencia de ambos grupos fue similar. No hubo diferencias en caidas y ningun paciente tuvo fracturas de cadera. Conclusiones En adultos mayores prefragiles y fragiles la modalidad de TRR no influyo en la ocurrencia de hospitalizacion, mortalidad, caidas ni fracturas de cadera.
Medwave, Jan 26, 2016
Falls in elderly people are common and come with important effects on morbidity and mortality, de... more Falls in elderly people are common and come with important effects on morbidity and mortality, dependence and institutionalization. It has been proposed that supplementation of vitamin D could prevent the occurrence of this event. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified 18 systematic reviews including 31 randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded the use of vitamin D probably leads to little or no difference in the risk of falling in elderly people.
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Papers by Marcela Carrasco