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Patrones de deterioro funcional al final de la vida
June R Lunney1, Joanne Lynn, Daniel J Foley
1Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Md 20892-9205, USA. june_lunney@nih.gov
JAMA
|May 15, 2003
Resumen
El deterioro funcional al final de la vida varía significativamente según la trayectoria de la enfermedad. La fragilidad y la insuficiencia orgánica muestran el mayor descenso, mientras que la muerte súbita muestra el menor impacto en las necesidades de atención.
Área de la Ciencia:
- Gerontología Gerontología.
- Epidemiología La epidemiología.
- Salud Pública La salud pública.
Sus antecedentes:
- Los médicos observan patrones variados de deterioro funcional en la atención al final de la vida.
- Existen datos empíricos limitados sobre estos patrones en poblaciones grandes.
Objetivo del estudio:
- Investigar las diferencias en el deterioro funcional a través de cuatro trayectorias distintas de enfermedades al final de la vida.
- Estas trayectorias incluyen muerte súbita, muerte por cáncer, muerte por insuficiencia de órganos y fragilidad.
Principales métodos:
- Análisis de cohorte del estudio de poblaciones establecidas para estudios epidemiológicos de personas mayores (EPESE).
- Función física auto-o proxy-reportada examinada (Actividades de la Vida Diaria - ADLs) dentro de un año antes de la muerte para 4.190 fallecidos.
- Comparación de la dependencia de ADL en todas las trayectorias de la enfermedad, controlando los factores demográficos.
Principales resultados:
- Se observaron variaciones significativas en el deterioro funcional entre las cuatro trayectorias de la enfermedad.
- Los fallecidos por muerte súbita mantuvieron una alta función, mientras que los fallecidos frágiles mostraron la mayor dependencia.
- Los fallecidos por cáncer y insuficiencia orgánica exhibieron patrones intermedios de declive, con un aumento de la discapacidad más cerca de la muerte.
Conclusiones:
- Las trayectorias de declive funcional al final de la vida útil son muy variables.
- La identificación de estos patrones distintos es crucial para desarrollar estrategias de atención personalizadas y mejorar los programas de fin de vida.
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