Hunter Mellado R F, Negron J, Gomez M A
Internal Medicine Department, Universidad Central del Caribe, Bayamon, Puerto Rico 00960-6032.
Bol Asoc Med P R. 1997 Jul-Sep;89(7-9):102-10.
To introduce the ASSUME study with the presentation of a clinical, socio-demographic, preventive and psychological profile of a geriatric population of patients who receive their health care in the General Internal Medicine Ambulatory Sector of our institution.
The Assume study is a prospective, randomized trial which is directed at increasing the participation of patients in preventive health care strategies at a primary, secondary and tertiary level. In this paper we focus on the initial stage of the process which aims to define and synthesize predisposing risk factors in the geriatric patient which would be amenable to primary, secondary and tertiary preventive strategies. Through a process of patient interview profiles of a physical, social and psychological nature are have been constructed. With the availability of this profile a clearer definition of the potential benefit of preventive strategies could be established. In this paper we present the initial profile of patients of all patients randomized to the study as of Sept. 01, 1997.
A total of 123 patients have been enrolled with 48(39%) males and 75(61%) females. The mean age of patients is 70 years with a median of 68 years. Cardiovascular disorders establish the leading disease events in our population of patients with Hypertension in 85%, Ischemic heart disease in 50%, Myocardial Infarction in 19% and 40% with a history of Congestive Heart failure. Diabetes and Heart Failure were seen in 40%. An average of 4.4 prescribed drugs per patient was documented. A minority of patients took more than 7 drugs and none took more than 9 medications. Most patients (67 or 55%) had not required hospitalizations in the preceding 12 months and none of the patients required more than 4 hospitalizations. The average LOS was 8.60 days. The Preventive Medicine profile reveals a large number of un-vaccinated adults. Regular cigarette smoking was seen in 12%. We have used the body mass index as a measure of adequacy of weight. We highlight the number of patients who have a BMI equivalent to an obese, severely obese or morbidly obese category (41%). The number of patients who follow a prescribed diet was found to be 54 patients for 44% of the study group. With regards to the interventions primarily designed for early cancer detecting, approximately half of the patients undergo the recommended annual screening interventions. The screening of visual accuracy was reported in 54%, dental screen (24%) and auditory screening (15%). Nearly a quarter of patients have severe depression. The CAPE testing reveal that in the information and orientation section most patients presented none or light dysfunction(87%). In the conductual phase marked or severe impairment was detected in 12% of patients. In the mental ability section 22% of patients presented marked or severe impairment.
The geriatric population studied would benefit from modalities which would increment the modern modalities for primary and secondary prevention of disease. Follow-up studies will allow the evaluation of the effectiveness of the conceptual model proposed, which would increment the patient participation in these preventive modalities.
介绍ASSUME研究，展示在我院普通内科门诊接受医疗服务的老年患者群体的临床、社会人口学、预防和心理特征。
ASSUME研究是一项前瞻性随机试验，旨在提高患者在一级、二级和三级预防保健策略中的参与度。在本文中，我们关注该过程的初始阶段，旨在定义和综合老年患者中适合一级、二级和三级预防策略的易患风险因素。通过患者访谈过程，构建了身体、社会和心理方面的特征。有了这些特征，就能更清晰地确定预防策略的潜在益处。在本文中，我们展示了截至1997年9月1日随机纳入该研究的所有患者的初始特征。
共纳入123例患者，其中男性48例（39%），女性75例（61%）。患者的平均年龄为70岁，中位数为68岁。心血管疾病是我们患者群体中的主要疾病事件，85%患有高血压，50%患有缺血性心脏病，19%患有心肌梗死，40%有充血性心力衰竭病史。40%的患者患有糖尿病和心力衰竭。记录显示每位患者平均开具4.4种处方药。少数患者服用超过7种药物，无人服用超过9种药物。大多数患者（67例或55%）在过去12个月内未住院，且无患者住院超过4次。平均住院时间为8.60天。预防医学特征显示大量成年人未接种疫苗。12%的患者经常吸烟。我们使用体重指数来衡量体重是否合适。我们强调体重指数相当于肥胖、重度肥胖或病态肥胖类别的患者数量（41%）。发现遵循规定饮食的患者有54例，占研究组的44%。关于主要用于早期癌症检测的干预措施，约一半患者接受了推荐的年度筛查干预。54%的患者进行了视力准确性筛查，24%进行了牙科筛查，15%进行了听力筛查。近四分之一的患者患有严重抑郁症。CAPE测试显示，在信息和指导部分，大多数患者无功能障碍或仅有轻度功能障碍（87%）。在行为阶段，12%的患者检测到明显或严重受损。在智力能力部分，22%的患者表现出明显或严重受损。
所研究的老年人群体将受益于能够增加疾病一级和二级预防现代模式的方法。后续研究将评估所提出概念模型的有效性，这将提高患者对这些预防模式的参与度。
