Collection: Revista Chilena de Medicina Familiar

Mobility and gait disorders are frequent problems in the elderly population and are rarely evaluated in outpatient medical consultation. Gait speed has been described as the main indicator of morbidity and mortality in this group of patients and for this reason it is considered essential to assess the degree of mobility limitation, sarcopenia and frailty. There are different batteries of tests that can be applied in the outpatient clinic and allow to quickly and easily assess the degree of mobility limitation. The following article reviews mobility disorders, their impact on the health of the elderly population and the way in which these can be evaluated by the clinician in the primary health care centers.

It is estimated that the older adult population could reach 30% of the total by 2050, and being the age group that concentrates the greatest burden of disease, it is important to have tools for prevention and early diagnosis of these diseases. In Chile, ministerial guidelines for mass screening of this population date from 2013, with little evidence to support them. The objective of this publication is to contribute to an adequate use of tests that allow screening and prevention of metabolic and neoplastic diseases in the elderly. Through a non-exhaustive bibliographic review of the literature, different national and international recommendations were compiled. Based on this, a profile of tests to be requested together with the ¨Examen de medicina Preventiva del Adulto mayor (EMPAM)/Examen Funcional del Adulto Mayor (EFAM)¨ is proposed. As a result, considering the evidence reviewed, it seems reasonable to include 8 examinations to the EMPAM/EFAM, including some that were already proposed by the Ministry of Health. It seems relevant to contrast the examinations currently requested in primary care in order to reach a consensus at national level, based on evidence and adapted to our local reality.

It is estimated that the older adult population could reach 30% of the total by 2050, and being the age group that concentrates the greatest burden of disease, it is important to have tools for prevention and early diagnosis of these diseases. In Chile, ministerial guidelines for mass screening of this population date from 2013, with little evidence to support them. The objective of this publication is to contribute to an adequate use of tests that allow screening and prevention of metabolic and neoplastic diseases in the elderly. Through a non-exhaustive bibliographic review of the literature, different national and international recommendations were compiled. Based on this, a profile of tests to be requested together with the “Examen de medicina Preventiva del Adulto mayor (EMPAM)/Examen Funcional del Adulto Mayor (EFAM)” is proposed. As a result, considering the evidence reviewed, it seems reasonable to include 8 examinations to the EMPAM/EFAM, including some that were already proposed by the Ministry of Health. It seems relevant to contrast the examinations currently requested in primary care in order to reach a consensus at national level, based on evidence and adapted to our local reality.

The cognitive problems have a high prevalence, a high social economic and public health impact, being an important cause of morbimortality and dependence and causing an important psycosocial impact in patients and their families/caregivers. Because of these reasons, it was created in Chile the National Programme of Dementia, which is in a pilot phase from 2017 and the inclusion of the Alzheimer and other Dementia to the Explicit Health Guarantees in October 2019, in which primary care plays a leading role. Is of vital importance that the physician who works in primary care, have the necessary skills to deal with patients living with dementia, in a comprehensive manner with an appropriate technical medicine based approach, under the principles of the comprehensive health care model. The objectives of this article is to review the epidemiology and impact of the cognitive impairment as a great public health problem, identify the main cognitive tests and their usefulness in the clinic evaluation, know the diagnostic study process and integral management in the context of Primary Care of a patient with suspicion and/or confirmation of cognitive impairment.

Falls represent an important public health problem due to their high frequency of occurrence, morbimortality, disability and associated costs. This article is aiming to deliver an up-to-date, friendly document for primary care physicians, offering summarized information about risk factors for falls in older people, and measures that have shown to be effective in fall prevention. Among the most effective interventions to reduce the incidence of falls in the elderly are exercise, orthotics, clinic-level improvement strategies, and the combination of these. Also, evidence-based tools for a comprehensive fall risk assessment in older adults are suggested. According to patient evaluation and clinical judgment, 3 risk groups are proposed (low, moderate, and high risk), aiming to assist the provider in selecting measures to be executed and suggest a management plan for preventing future falls. A summary of orthotics, technical aids and prevention programs available in Chilean primary care is incorporated as well, including motor kinesthetic therapy. The goal of this article is to encourage healthcare teams to include the suggested measures in their treatment plans, with the hope of improving the quality of life in older people and reduce healthcare costs in Chile.

Introduction: In Chile, access to palliative care (PC) are insured for patients with oncological pathologies by the explicit health garanties, however, in order to ensure dignity and quality of life, it should be extended also to patients with advanced chronic diseases.The objective of this article is to expose to primary health care physicians (PHC), an approachment to the clinical assessment and management of patients with non-oncological diseases who require PC and how to face the end of life in them.
Development of the theme: There are multiple chronic diseases that require access to PC, so it is vital to identify patients whith these needs, using instruments that target symptoms, degree of functional disability, quality of life, and prognosis. Among the most used instruments for this purpose we find the Palliative Needs Scale (NECPAL), the Scale Eastern Cooperative Oncology Group (ECOG), the Karnofsky Index, the Palliative Performance Scale (PPS) and the ZARIT Caregiver Overload Scale. Likewise, the elaboration of an individualized therapeutic plan with the necessary resources, the individual preferences and the anticipated wills of each patient, is crucial to alleviate the pain and suffering that are present throughout the disease, these being more pronounced in the end stage of life; therefore, it is important to know this process and handle it properly.
Conclusion: It is necessary and very important to expand access to PC for patients with non-oncological chronic diseases, this being a great challenge for Chile. For this reason, the authors recommend the creation of a PC program in PHC, which includes guarantees of access to medicines in the basket and training for first-level health teams to provide this care.

Introducción: La nueva enfermedad por Coronavirus 2019 (COVID-19) se ha instaurado como una amenaza grave y urgente a la salud pública. Los estudios han mostrado peores resultados y mayor tasa de mortalidad en adultos mayores, lo que se asociaría a procesos fisiológicos relacionados con el propio envejecimiento. Para mejor comprensión de esta asociación se realiza una síntesis de los factores relacionados con el proceso de envejecimiento que parecen contribuir a la mayor susceptibilidad y resultados adversos en pacientes de edad avanzada con COVID-19, así como también el impacto de esta pandemia en adultos mayores desde un enfoque integral, con el fin de identificar estrategias terapéuticas que mejoren su pronóstico de salud. Metodología: Se realizó una revisión bibliográfica mediante consultas en los motores de búsqueda PubMed y Google Scholar. Se consideraron artículos originales y artículos de revisión bibliográfica, priorizando los atingentes a los objetivos. Desarrollo: Como factores asociados al aumento de riesgo de adultos mayores identificamos disminución de ECA-2, envejecimiento inflamatorio, senescencia celular, disfunción del tejido adiposo, inmunosenescencia, comorbilidades, sarcopenia, déficits nutricionales y factores socioculturales. Como impactos en los adultos mayores asociado a la pandemia encontramos efectos de la soledad y aislamiento, violencia intrafamiliar, aumento de discriminación por edad, efectos en residentes de establecimientos de larga estadía, dificultad en el manejo de patologías crónicas y disminución del ejercicio físico. Conclusión: Es fundamental asegurar el acceso de los adultos mayores a las atenciones de salud física, psicológica y social según sus comorbilidades específicas y su contexto sociocultural. Se deben implementar estrategias para abordar el potencial impacto de la pandemia en los adultos mayores desde un enfoque integral y preventivo, fomentando el autocuidado y la conexión social con pertinencia cultural y de género. Se deben discutir las políticas de confinamiento por edad cronológica, considerando los riesgos particulares individuales, evitando la discriminación por edad.

A continuarción se presentan breves reseñas de algunas presentaciones realizadas en el pasado VI Congreso Iberoamericanode Medicina Familiar realizado en la ciudad de Tijuana, Baja California, al norte de Mexico desde el 1 hasta el 4 de Mayodel presente año en donde varios médicos Chilenos, algunos pertenecientes a la Sociedad Chilena de Medicina Familiar,presentaron sus trabajos científicos aportando al programa en cada una de las cuatro jornadas de Congreso.