Evaluación del estado funcional de pacientes ingresados en una enfermería de clínica médica: un estudio transversal

Autores/as

DOI:

https://doi.org/10.18554/refacs.v12i3.7589

Palabras clave:

Estado functional, Actividades cotidianas, Tiempo de Internación, Admisión del Paciente, Pacientes Internos

Resumen

Objetivo: caracterizar el estado funcional de los pacientes ingresados en una enfermería de clínica médica y comparar las variables clínicas según el nivel funcional, y comprobar si un nivel funcional bajo se asociaba a peores resultados clínicos. Método: estudio transversal, descriptivo y cuantitativo realizado con pacientes adultos ingresados en un hospital universitario de mayo a julio de 2019. La independencia funcional se evaluó mediante el Índice de Barthel. Los pacientes se agruparon según su puntuación en el Índice de Barthel: dependencia grave (<60 puntos), dependencia moderada (entre 60 y 80 puntos) e independiente (>85). Las variables entre los grupos se analizaron mediante la prueba de Chi-cuadrado y ANOVA. Las variables asociadas a la duración de la estancia hospitalaria se analizaron mediante regresión lineal múltiple. Resultados: Se incluyeron 97 pacientes. De ellos, el 52,5% eran mujeres, con una edad media de 63,3(17,7) años y 86 (88,7%) tenían comorbilidades. La mayoría de los pacientes (85,6%) fueron remitidos desde la Unidad de Cuidados de Urgencias. Las enfermedades respiratorias fueron la principal causa de hospitalización (33%). Sólo el 19,1% eran funcionalmente independientes. Los pacientes con dependencia funcional de moderada a grave tenían mayor necesidad de reingreso hospitalario (p=0,040). La duración de la estancia hasta la derivación a un hospital de referencia (p=0,011) fue un factor independiente asociado a una estancia hospitalaria más larga. Conclusión: Se observó que los pacientes ingresados en la enfermería en las primeras 24 horas tenían un nivel funcional bajo. Los pacientes con dependencia funcional, en comparación con los pacientes independientes, presentaron una mayor tasa de reingresos.

Citas

High KP, Zieman S, Gurwitz J, Hill C, Lai J, Robinson T, et al. Use of Functional Assessment to Define Therapeutic Goals and Treatment. J Am Geriatr Soc. [Internet]. 2019 [citado em 14 jun 2024]; 67(9):1782-90. DOI: https://doi.org/10.1111/jgs.15975

Agrawal S, Luc M, Winkowski F, Lindner K, Agrawal AK, Wozniak M, et al. Predictors of mortality in older patients admitted to a geriatric hospital. Geriatr Gerontol Int. [Internet]. 2019. [citado em 14 jun 2024]. 19(1):70-5. DOI: https://doi.org/10.1111/ggi.13573

Patrizio E, Calvani R, Marzetti E, Cesari M. Physical functional assessment in older adults. J Frailty Aging [Internet]. 2020 [citado em 14 jun 2024]; 10:141-9. DOI: https://doi.org/10.14283/jfa.2020.61

Werner C, Sturm M, Heldmann P, Fleiner T, Bauer JM, Hauer K. Predictors of 2-year post-discharge mortality in hospitalized older patients. J Clin Med. [Internet]. 2024 [citado em 16 jul 2024]; 13(5):1352. DOI: https://doi.org/10.3390/jcm13051352

So C, Lage DE, Slocum CS, Zafonte RD, Schneider JC. Utility of functional metrics assessed during acute care on hospital outcomes: a systematic review. PM & R. [Internet]. 2019 [citado em 14 jun 2024]; 11(5):522–532. DOI: https://doi.org/10.1002/pmrj.12013

Mudge AM, O’Rourke P, Denaro CP. Timing and risk factors for functional changes associated with medical hospitalization in older patients. J Gerontol A Biol Sci Med Sci. [Internet]. 2010 [citado em 14 jun 2024]; 65A(8):866-72. DOI: https://doi.org/10.1093/gerona/glq069

Koch D, Kutz A, Haubitz S, Baechli C, Gregoriano C, Conca A, et al. Association of functional status and hospital-acquired functional decline with 30-day outcomes in medical inpatients: A prospective cohort study. Appl Nurs Res. [Internet]. 2020 [citado em 14 jun 2024]; 54:151274. DOI: https://doi.org/10.1016/j.apnr.2020.151274

Formiga F, Chivite D, Solé A, Manito N, Ramon JM, Pujol R. Functional outcomes of elderly patients after the first hospital admission for decompensated heart failure (HF): a prospective study. Arch Gerontol Geriatr. [Internet]. 2006 [citado em 14 jun 2024]; 43(2):175-85. DOI: https://doi.org/10.1016/j.archger.2005.10.010

Torres OH, Muñoz J, Ruiz D, Ris J, Gich I, Coma E, et al. Outcome predictors of pneumonia in elderly patients: importance of functional assessment. J Am Geriatr Soc. [Internet]. 2004 [citado em 14 jun 2024]; 52(10):1603-9. DOI: https://doi.org/10.1111/j.1532-5415.2004.52492.x

Ranieri P, Bianchetti A, Margiotta A, Virgillo A, Clini EM, Trabucchi M. Predictors of 6-month mortality in elderly patients with mild chronic obstructive pulmonary disease discharged from a medical ward after acute nonacidotic exacerbation. J Am Geriatr Soc. [Internet]. 2008 [citado em 14 jun 2024]; 56(5):909-13. DOI: https://doi.org/10.1111/j.1532-5415.2008.01683.x

Loyd C, Markland AD, Zhang Y, Fowler M, Harper S, Wright NC, et al. Prevalence of hospital-associated disability in older adults: a meta-analysis. J Am Med Dir Assoc. [Internet]. 2020 [citado em 14 jun 2024]; 21(4):455-61. DOI: https://doi.org/10.1016/j.jamda.2019.09.015

Roussel M, Teissandier D, Yordanov Y, Balen F, Noizet M, Tazarourte K, et al. Overnight stay in the emergency department and mortality in older patients. JAMA Intern Med. [Internet]. 2023 [citado em 16 jun 2024]; 183(12):1378-85. DOI: 10.1001/jamainternmed.2023.5961

Naseri C, Haines TP, Morris ME, McPhail SM, Etherton-Beer C, Shorr R, et al. Factors affecting engagement of older adults in exercise following hospitalization. J Geriatr Phys Ther. [Internet]. 2022 [citado em 16 jul 2024]; 45(4):197-206. DOI:

https://doi.org/10.1519/jpt.0000000000000355

Carmona-Torres JM, Rodríguez-Borrego MA, Laredo-Aguilera JA, López-Soto PJ, Santacruz-Salas E, Cobo-Cuenca AI. Disability for basic and instrumental activities of daily living in older individuals. PLoS ONE [Internet]. 2019 [citado em 16 jul 2024]; 14(7):e0220157. DOI: https://doi.org/10.1371/journal.pone.0220157

Tonkikh O, Shadmi E, Flaks-Manov N, Hoshen M, Balicer RD, Zisberg A. Functional status before and during acute hospitalization and readmission risk identification. J Hosp Med. [Internet]. 2016 [citado em 14 jun 2024]; 11(9):636-41. DOI: https://doi.org/10.1002/jhm.2595

Rodrigues C, Mendonça D, Martins MM. Functional trajectories of older acute medical inpatients. Enferm Clín. [Internet]. 2020. [citado em 16 jul 2024]; 30(4):260-8. DOI: https://doi.org/10.1016/j.enfcli.2019.03.001

Cano-Escalera G, Graña M, Irazusta J, Labayen I, Gonzalez-Pinto A, Besga A. Mortality risks after two years in frail and pre-frail older adults admitted to hospital. J Clin Med. [Internet]. 2023 [citado em 16 jul 2024]; 12(9):3103. DOI: https://doi.org/10.3390/jcm12093103

Greysen SR, Covinsky KE. Functional status – an important but overlooked variable in the readmissions equation. J Hosp Med. [Internet]. 2014 [citado em 14 jun 2024]; 9(5):330-1. DOI: https://doi.org/10.1002/jhm.2170

Ryg J, Anru PL, Engberg H, Jorgensen MG, Masud T, Christensen K, et al. Association of body mass index with all-cause mortality in acutely hospitalized older patients. J Am Med Dir Assoc. [Internet]. 2022 [citado em 14 jul 2024]; 23(3):507-13. DOI: https://doi.org/10.1016/j.jamda.2021.07.015

Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J. [Internet]. 1965 [citado em 14 jun 2024]; 14:61-5. Disponível em: https://pubmed.ncbi.nlm.nih.gov/14258950/

Granger CV, Dewis LS, Peters NC, Sherwood CC, Barrett JE. Stroke rehabilitation: analysis of repeated Barthel index measures. Arch Phys Med Rehabil. [Internet]. 1979 [citado em 14 jun 2024]; 60(1):14-17. Disponível em: https://pubmed.ncbi.nlm.nih.gov/420565/

Sulter G, Steen C, Jacques DK. Use of the Barthel index and modified rankin scale in acute stroke trials. Stroke [Internet]. 1999 [citado em 14 jun 2024]; 30(8):1538-41. DOI: https://doi.org/10.1161/01.STR.30.8.1538

Borges PRT, Fontes DE, Gaudêncio DL, Sampaio RF. Perfil dos pacientes internados em hospitais universitários de grande porte: conhecer para potencializar a assistência. Saúde (Santa Maria) [Internet]. 2020 [citado em 14 jun 2024]; 46(2):e43662. DOI: https://doi.org/10.5902/2236583443662

Siqueira AB, Cordeiro RC, Perracini MR, Ramos LR. Impacto funcional da internação hospitalar de pacientes idosos. Rev Saúde Pública [Internet]. 2004 [citado em 14 jun 2024]; 38(5):687-94. DOI: https://doi.org/10.1590/S0034-89102004000500011

Romanholi-Cória V, Grigolo IH, Mutter VM, Defende GS, Moras LL, Morales ST, et al. Caracterização dos idosos internados por doença respiratória aguda em um hospital escola terciário. Rev Med (São Paulo) [Internet]. 2017 [citado em 14 jun 2024]; 96(2):94-102. DOI:

https://doi.org/10.11606/issn.1679-9836.v96i2p94-102

Gomes LL, Volpe FM. The profile of clinical and surgical admissions to the general hospitals of the FHEMIG network. Rev Méd Minas Gerais [Internet]. 2018 [citado em 14 jun 2024]; 28(Suppl 5):e-S280513. DOI: https://dx.doi.org/10.5935/2238-3182.20180125

Gallego-González E, Mayordomo-Cava J, Vidán MT, Valadés-Malagón M, Serra-Rexach JA, Ortiz-Alonso J. Functional trajectories associated with acute illness and hospitalization in oldest old patients: Impact on mortality. Front Physiol. [Internet]. 2022 [citado em 14 jul 2024]; 13:937115. DOI: https://doi.org/10.3389/fphys.2022.937115

Boucher EL, Gan JM, Rothwell PM, Shepperd S, Pendlebury ST. Prevalence and outcomes of frailty in unplanned hospital admissions: a systematic review and meta-analysis of hospital-wide and general (internal) medicine cohorts. EClinicalMedicine [Internet]. 2023 [citado em 14 jul 2024]; 59:101947.DOI: https://doi.org/10.1016/j.eclinm.2023.101947

Cunha AIL, Veronese N, Melo BS, Ricci NA. Frailty as a predictor of adverse outcomes in hospitalized older adults: A systematic review and meta-analysis. Ageing Res Rev. [Internet]. 2019 [citado em 14 jun 2024]; 56:100960. DOI: https://doi.org/10.1016/j.arr.2019.100960

Koch D, Kutz A, Haubitz S, Baechli C, Gregoriano C, Conca A, et al. Association of functional status and hospital-acquired functional decline with 30-day outcomes in medical inpatients: A prospective cohort study. Appl Nurs Res. [Internet]. 2020 citado em 14 jun 2024]; 54:151274. DOI: https://doi.org/10.1016/j.apnr.2020.151274

Ryg J, Engberg H, Mariadas P, Pedersen SH, Jorgensen MG, Vinding KL, et al. Barthel Index at hospital admission is associated with mortality in geriatric patients: a Danish nationwide population-based cohort study. Clin Epidemiol. [Internet]. 2018 [citado em 14 jun 2024]; 10:1789-800. DOI: https://doi.org/10.2147/CLEP.S176035

Garcia-Perez L, Linertova R, Lorenzo-Riera A, Vazquez-Diaz JR, Duque-Gonzalez B, Sarria-Santamera A. Risk factors for hospital readmissions in elderly patients: a systematic review. QJM [Internet]. 2011 [citado em 14 jun 2024]; 104(8):639-51. DOI: https://doi.org/10.1093/qjmed/hcr070

Smith DM, Giobbie-Hurder A, Weinberger M, Oddone EZ, Henderson WG, Asch DA, et al. Predicting non-elective hospital readmissions. J Clin Epidemiol. [Internet]. 2000 [citado em 14 jun 2024]; 53(11):1113-8. DOI: https://doi.org/10.1016/S0895-4356(00)00236-5

Soley-Bori M, Soria-Saucedo R, Ryan CM, Schneider JC, Haynes AB, Gerrard P, et al. Functional status and hospital readmissions using the medical expenditure panel survey. J Gen Intern Med. [Internet]. 2015 [citado em 14 jun 2024]; 30(7):965-72. DOI: https://doi.org/10.1007/s11606-014-3170-9

Hoyer EH, Needham DM, Miller J, Deutschendorf A, Friedman M, Brotman DJ. Functional status impairment is associated with unplanned readmissions. Arch Phys Med Rehabil. [Internet]. 2013 [citado em 14 jun 2024]; 94(10):1951-8. DOI: https://doi.org/10.1016/j.apmr.2013.05.028

Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare Fee-for-Service Program. New Engl J Med. [Internet]. 2009 [citado em 14 jun 2024]; 360:1418-28. DOI: https://doi.org/10.1056/nejmsa0803563

Publicado

2024-11-19

Cómo citar

Paula, E. da S., Bueno Paranhos, D., Martins Junior, A., & Moraes, F. R. de. (2024). Evaluación del estado funcional de pacientes ingresados en una enfermería de clínica médica: un estudio transversal. REVISTA FAMILIA, CICLOS DE VIDA Y SALUD EN EL CONTEXTO SOCIAL, 12(3), e7589. https://doi.org/10.18554/refacs.v12i3.7589

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