Abstract
Objetivo
Estimar la proporción de casos de demencia detectados en personas mayores de 70 años que residen en sus domicilios y describir la utilización de los servicios sanitarios y sociales que hacen las personas con demencia.
Material y métodos
Encuesta poblacional de los supervivientes de la cohorte «Envejecer en Leganés» iniciada en 1993. En el tercer seguimiento de 1999–2000 se incorporó el diagnóstico clínico de la demencia realizado según el examen neurológico y una extensa batería neuropsicológica. Se preguntó también sobre la utilización de servicios sanitarios y sociales y sobre diagnósticos previos.
Resultados
En la muestra de supervivientes (n = 527), la prevalencia de demencia fue de 12,1%. Sólo el 30% de los dementes había sido previamente diagnosticado por los servicios sanitarios. La proporción de demencia no detectada está significativamente asociada con su gravedad (leve, 95%; moderada, 69%; grave, 36%). Comparados con las personas mayores no dementes, los dementes utilizan con mayor frecuencia los servicios hospitalarios, la consulta médica y de enfermería a domicilio y la consulta por terceros, y con menos frecuencia, los servicios preventivos y de rehabilitación. Esta tendencia se acentúa en los pacientes con demencia grave. La utilización de los servicios sociales comunitarios es muy baja (inferior al 8% en los casos más graves).
Conclusiones
La detección de la demencia en los ancianos es muy baja y deben incrementarse los esfuerzos de detección en la atención primaria. También deben aumentar los recursos sociosanitarios específicos para esta población y cambiar las pautas asistenciales del equipo de atención primaria y de los profesionales sanitarios en general.
Palabras clave: Demencia, Diagnóstico, Atención primaria, Utilización de servicios, Detección
Abstract
Objectives
To calculate the proportion of cases of dementia detected in people over 70 living in their homes and to describe the use made by people with dementia of the health and social services.
Material and methods
Population survey of the survivors of the cohort «Growing old in Leganés», started in 1993. In the third monitoring (1999–2000), the clinical diagnosis of dementia on the basis of a neurological examination and an extensive neuro-psychological battery was included. Their use of health and social services and prior diagnoses were also asked.
Results
In the sample of survivors (n = 527), there was 12.1% prevalence of dementia. Only 30% of the demented had previously been diagnosed by the health services. The proportion of undetected dementia was significantly associated with its seriousness (light 95%, moderate 69%, severe 36%). Compared with older persons who were not demented, the demented used more often hospital services, medical and nursing consultations at home and consultations through third parties; and less often, preventive and rehabilitation services. This trend was accentuated in patients with grave dementia. The use of community social services was very low (below 8% in the most serious cases).
Conclusions
The detection of dementia in the elderly is very low and efforts to detect it in primary care need to be stepped up. Specific social-health resources for this population also need to be increased and the attendance guide-lines for primary care teams, and for health professionals in general, need to be changed.
Key words: Dementia, Diagnosis, Primary care, Use of services, Differential diagnosis
Footnotes
Este estudio ha sido parcialmente financiado por la Fundación La Caixa.
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