Evaluación del sufrimiento en pacientes ancianos ingresados por fractura de cadera. Dificultades en el uso de instrumentos

Abstract

Medicine, especially in the elderly, must not focus exclusively on biomedical problems. The detection and relief of suffering are goals of medicine. According to “the threat and resources model” –amenazas y recursos-, suffering appears when person perceives a threat to self’s integrity along with lack of coping capabilities. Hip fracture is a serious health problem. Its incidence is increasing, above all among the frailest elderly. This thesis includes the assessment of subacute hip fracture elderly patients’ suffering by using questionnaires and the qualitative analysis of interviews where these were applied. Hip fracture patients suffer and their idea of suffering is inseparable from their personal situation. Patients had been able to explain themselves better and in wider terms than those required by instruments. Suffering assessed by PRISM (Pictorial Representation of Illness Self Measurement) and DME questionnaire (Detección Malestar Emocional) relate to each other and to geriatric variables: previous function, comorbidity, geriatric syndromes, and to anxiety. The use of instruments entailed a low patient inclusion rate and also difficulties in comprehension and acceptance of the instruments, detected by the qualitative analysis of results. Inclusion and comprehension problems –especially of PRISM task- had been associated to variables related to geriatric frailty, mainly previous low functional status. No association was found between comprehension of PRISM task and educational level. DME questionnaire, including the categorical option of answer, has been applied without significant comprehension and acceptance problems. Mixed methodology –quantitative and qualitative- has been essential to approach suffering of the elderly hip fracture patient. We recommend this strategy for future research. Establishing an affective bond with patient, using flexible methods and appreciating used time-space, are all needed to detect and relieve suffering in clinical practice. And, above all, an individualized approach to each person.

Date of Award	6 Nov 2015
Original language	Spanish
Supervisor	Joaquín T. Limonero (Director)