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Imamura T, Sudo T, Orihashi Y, Takahashi Y, Onishi Y, Onizuka M, Mikami K, Ueda Y, Yamamoto K. Psychosocial factors predicting symptoms of depression and anxiety in allogeneic hematopoietic stem cell transplant recipients in Japan. Int J Psychiatry Med 2024; 59:287-302. [PMID: 37507109 DOI: 10.1177/00912174231191672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
OBJECTIVE We explored whether a patient's psychosocial background before allogeneic hematopoietic stem cell transplantation (allo-HSCT) could predict the occurrence of psychiatric symptoms during treatment and after hospital discharge. METHOD Logistic regression analysis was performed using INTERMED, a scale that comprehensively evaluates psychological factors such as psychiatric history, current mental status, and coping skills, and social factors such as social participation status, relationships with others, and living environment, which were used as independent variables. The Center for Epidemiologic Studies Depression Scale was used to measure depression, while the Profile of Mood States was used to measure anxiety and other symptoms. Both measures were used as dependent variables and were administered upon clean room admission, during clean room stay, at clean room discharge, and at 3, 6, and 12 months after hospital discharge. RESULTS Participants included 70 patients (45 males and 25 females, mean age 53.3 ± 12.3 years). Thirty-eight patients participated in the program for the entire period, up to 12 months after hospital discharge. The total score on the Japanese version of the INTERMED and psychological factor scores assessed at baseline were significant predictors of depressed mood on discharge; however, there were no significant predictors of scores on the Profile of Mood States. CONCLUSIONS A comprehensive pretransplant evaluation of psychosocial background can help predict the appearance of psychiatric symptoms after allo-HSCT. In patients who are expected to develop psychiatric symptoms after allo-HSCT, it is important to consider early intervention by a specialist and close monitoring by a medical team.
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Affiliation(s)
- Takashi Imamura
- Department of Clinical Psychology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Sudo
- Student Services Center, Musashi University, Nerima-ku, Japan
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Japan
| | - Yasushi Orihashi
- Division of Clinical Research Center in Hiroshima, Hiroshima University Hospital, Minami-ku, Japan
| | - Yuki Takahashi
- Department of Palliative Care, Tokai University School of Medicine, Isehara, Japan
| | - Yuichi Onishi
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Japan
| | - Makoto Onizuka
- Department of Hematology, Tokai University School of Medicine, Isehara, Japan
| | - Katsunaka Mikami
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Japan
| | - Yasunori Ueda
- Department of Hematology/Oncology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenji Yamamoto
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Japan
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Fiore G, Ferrari S, Cutino A, Giorgino C, Valeo L, Galeazzi GM, Marchi M. Delirium in COVID-19 and post-liver transplant patients: an observational study. Int J Psychiatry Clin Pract 2022; 26:343-351. [PMID: 35061952 DOI: 10.1080/13651501.2022.2026403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Delirium is a major complication in hospitalised patients. This study aimed to compare the mortality trends of patients with delirium according to the underlying physical condition. METHODS Hospitalised patients diagnosed with delirium by the Modena Consultation-Liaison Psychiatry Service (Italy) during 2020 were enrolled. Three groups were identified: COVID; after orthotopic liver transplant (OLT); other conditions. The full medical records were screened to retrieve socio-demographic and clinical data. INTERMED score and Delirium Rating Scale were used to retrospectively rate bio-social-complexity and delirium severity. Early (20 days) and end of study (31st January 2021) mortality were ascertained for each subject. RESULTS A total of 103 patients were enrolled. Patients hospitalised for COVID showed higher INTERMED scores (two-tailed t-test, p = 0.019) and higher 20-day mortality (HR = 3.68, p = 0.014). When considering a 1-year follow-up, the main predictor of mortality was patients' age in all three subgroups (HR = 1.06; p = 0.003). CONCLUSION Our results suggest that patients hospitalised for COVID-19 with delirium showed higher bio-psycho-social complexity and higher short-term mortality, regardless of the severity of delirium. OLT patients showed lower mortality and bio-psycho-social complexity, despite being still considered as 'complex', according to the INTERMED score. Future research should focus on understanding the underlying mechanisms in the relationship between delirium and mortality.Key pointsPatients hospitalised for COVID-19 with delirium were found at risk of higher short-term mortality and higher bio-psycho-social complexity.OLT patients showed lower overall mortality and lower bio-psycho-social complexity than the other two groups, despite being still in the 'complex' range according to the INTERMED score.Future research should assess the areas of impact of delirium in patients affected by COVID-19, considering short- and long-term outcomes.
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Affiliation(s)
- Gianluca Fiore
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Ferrari
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Section of Clinical Neurosciences, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Cutino
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Giorgino
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Valeo
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian M Galeazzi
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Section of Clinical Neurosciences, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mattia Marchi
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Onghena L, Berrevoet F, Vanlander A, Van Vlierberghe H, Verhelst X, Hoste E, Poppe C. Illness cognitions and health-related quality of life in liver transplant patients related to length of stay, comorbidities and complications. Qual Life Res 2022; 31:2493-2504. [DOI: 10.1007/s11136-022-03083-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 10/19/2022]
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Assessment of Biopsychosocial Complexity and Health Care Needs: Measurement Properties of the INTERMED Self-Assessment Version. Psychosom Med 2017; 79:485-492. [PMID: 28033198 DOI: 10.1097/psy.0000000000000446] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The INTERMED Self-Assessment questionnaire (IMSA) was developed as an alternative to the observer-rated INTERMED (IM) to assess biopsychosocial complexity and health care needs. We studied feasibility, reliability, and validity of the IMSA within a large and heterogeneous international sample of adult hospital inpatients and outpatients as well as its predictive value for health care use (HCU) and quality of life (QoL). METHODS A total of 850 participants aged 17 to 90 years from five countries completed the IMSA and were evaluated with the IM. The following measurement properties were determined: feasibility by percentages of missing values; reliability by Cronbach α; interrater agreement by intraclass correlation coefficients; convergent validity of IMSA scores with mental health (Short Form 36 emotional well-being subscale and Hospital Anxiety and Depression Scale), medical health (Cumulative Illness Rating Scale) and QoL (Euroqol-5D) by Spearman rank correlations; and predictive validity of IMSA scores with HCU and QoL by (generalized) linear mixed models. RESULTS Feasibility, face validity, and reliability (Cronbach α = 0.80) were satisfactory. Intraclass correlation coefficient between IMSA and IM total scores was .78 (95% CI = .75-.81). Correlations of the IMSA with the Short Form 36, Hospital Anxiety and Depression Scale, Cumulative Illness Rating Scale, and Euroqol-5D (convergent validity) were -.65, .15, .28, and -.59, respectively. The IMSA significantly predicted QoL and also HCU (emergency department visits, hospitalization, outpatient visits, and diagnostic examinations) after 3- and 6-month follow-up. Results were comparable between hospital sites, inpatients and outpatients, as well as age groups. CONCLUSIONS The IMSA is a generic and time-efficient method to assess biopsychosocial complexity and to provide guidance for multidisciplinary care trajectories in adult patients, with good reliability and validity across different cultures.
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van Eck van der Sluijs JF, de Vroege L, van Manen AS, Rijnders CAT, van der Feltz-Cornelis CM. Complexity Assessed by the INTERMED in Patients With Somatic Symptom Disorder Visiting a Specialized Outpatient Mental Health Care Setting: A Cross-sectional Study. PSYCHOSOMATICS 2017; 58:427-436. [PMID: 28347505 DOI: 10.1016/j.psym.2017.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Somatic symptom disorders (SSD), a new classification in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition is associated with problematic diagnostic procedures and treatment that lead to complex care. In somatic health care, the INTERMED has been used to assess levels of complexity; however, in SSD this instrument has not yet been applied. OBJECTIVE This study aims to explore complexity in patients with SSD using the INTERMED, hereby contributing to an increased comprehension of this new patient group. METHOD In this cross-sectional study, the INTERMED was used to assess complexity in outpatients with SSD at the Clinical Centre of Excellence for Body, Mind, and Health (The Netherlands), along biologic, psychologic, social, and health care domains. This was done retrospectively with patient files from consecutive patients from 2011 until 2015. RESULTS In the total SSD sample (N = 187), 63% was female, the mean age (standard deviation) was 42 (±12.4) years, with an average educational level. The mean INTERMED score was 23.5 indicating high overall complexity in this population. A high proportion of our sample (69%) scored as highly complex (>20). High complexity was associated with higher depression and anxiety scores, but not with a higher number of physical symptoms. CONCLUSIONS This study demonstrates that patients with SSD form a high-complex group, with higher scores compared with literature about multiple sclerosis, rheumatoid arthritis, or patient waiting for a liver transplant. INTERMED outcomes indicate a need for extensive diagnostic procedures and integrated multidisciplinary care for patients with SSD. Attention should especially be paid to mental disorders (depression and anxiety), given their association with high complexity.
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Affiliation(s)
- Jonna F van Eck van der Sluijs
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands; Tranzo Department, Tilburg University, Tilburg, The Netherlands.
| | - Lars de Vroege
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands; Tranzo Department, Tilburg University, Tilburg, The Netherlands
| | - Annick S van Manen
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands
| | | | - Christina M van der Feltz-Cornelis
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands; Tranzo Department, Tilburg University, Tilburg, The Netherlands
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Michaud L, Ludwig G, Berney S, Rodrigues S, Niquille A, Santschi V, Favre AS, Lange AC, Michels AA, Vrijens B, Bugnon O, Pilon N, Pascual M, Venetz JP, Stiefel F, Schneider MP. Immunosuppressive therapy after solid-organ transplantation: does the INTERMED identify patients at risk of poor adherence? Pharm Pract (Granada) 2016; 14:822. [PMID: 28042353 PMCID: PMC5184375 DOI: 10.18549/pharmpract.2016.04.822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/26/2016] [Indexed: 12/23/2022] Open
Abstract
Background: Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients. Objective: This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal post-transplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED>20) might have lower medication adherence than noncomplex patients (INTERMED≤20). Methods: Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (>20 or ≤20). Results: Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up: one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study. Conclusion: Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics.
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Affiliation(s)
- Laurent Michaud
- Psychiatric Liaison Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
| | - Gundula Ludwig
- Psychiatric Liaison Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
| | - Sylvie Berney
- General Psychiatry Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
| | | | - Anne Niquille
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne . Lausanne ( Switzerland ).
| | - Valérie Santschi
- Professor, La Source School of Nursing Sciences, University of Applied Sciences Western Switzerland . Lausanne ( Switzerland ).
| | - Anne-Sophie Favre
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne . Lausanne ( Switzerland ).
| | | | - Annemieke A Michels
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne . Lausanne ( Switzerland ).
| | - Bernard Vrijens
- University of Liège , Belgium and Chief Science Officer, Westrock Healthcare. Visé ( Belgium ).
| | - Olivier Bugnon
- School of pharmaceutical sciences, University of Geneva, University of Lausanne , Switzerland and Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne. Lausanne ( Switzerland ).
| | - Nathalie Pilon
- Transplantation Centre, University Hospital of Lausanne (CHUV) . Lausanne ( Switzerland ).
| | - Manuel Pascual
- Transplantation Centre, University Hospital of Lausanne (CHUV) . Lausanne ( Switzerland ).
| | - Jean-Pierre Venetz
- Transplantation Centre, University Hospital of Lausanne (CHUV) . Lausanne ( Switzerland ).
| | - Friedrich Stiefel
- Psychiatric Liaison Service, University Hospital of Lausanne (CHUV). Lausanne ( Switzerland ).
| | - Marie-Paule Schneider
- Community Pharmacy, Department of Ambulatory Care & Community Medicine, University of Lausanne , Switzerland and Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne . Lausanne ( Switzerland ).
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Onghena L, Develtere W, Poppe C, Geerts A, Troisi R, Vanlander A, Berrevoet F, Rogiers X, Van Vlierberghe H, Verhelst X. Quality of life after liver transplantation: State of the art. World J Hepatol 2016; 8:749-756. [PMID: 27366301 PMCID: PMC4921796 DOI: 10.4254/wjh.v8.i18.749] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/04/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
Quality of life (QoL) after deceased donor liver transplantation is increasingly recognized as a major outcome parameter. We reviewed recent publications in this rapidly evolving field in order to summarize recent achievements in the field and to define opportunities and perspectives for research and improvement of patient care. QoL does improve after liver transplantation according to a typical pattern. During the first year, there is a significant improvement in QoL. After one year, the improvement does stabilise and tends to decline slightly. In addition to the physical condition, different psychological parameters (such as depression, anxiety, sexual function) and sociodemographic elements (professional state, sex, marital state) seem to impact QoL. Opportunities for further research are the use of dedicated questionnaires and identification of influencing factors for QoL.
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Chong HJ, Kim HK, Kim SR, Lee S. Waiting for a kidney transplant: the experience of patients with end-stage renal disease in South Korea. J Clin Nurs 2016; 25:930-9. [PMID: 26994991 DOI: 10.1111/jocn.13107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
AIMS AND OBJECTIVES To explore the experiences of Korean patients with end-stage renal disease awaiting kidney transplantation. BACKGROUND The need for kidney transplantation has increased worldwide, while the number of kidney donors has not increased commensurately. This mismatch is a serious issue in South Korea. Prolonged waits for transplantation may cause physical and psychosocial issues and lead to poor outcomes. Nevertheless, the experience of waiting for kidney transplantation in South Korea has never been explored in depth. DESIGN A qualitative descriptive design was used. METHODS The participants were eight patients diagnosed with end-stage renal disease on the waiting list for kidney transplantation in South Korea. Data were collected through individual in-depth interviews. All conversations during interviews were recorded and transcribed verbatim. Transcribed data were analysed using conventional content analysis. RESULTS The experience of waiting for kidney transplantation consisted of six categories: (1) the light at the end of the tunnel, (2) being on call without any promise, (3) a tough tug of war between excitement and frustration, (4) doubts in the complexity, (5) A companion on the hard journey and (6) getting ready for D-day. CONCLUSIONS Kidney transplantation candidates experience psychosocial difficulties and concerns while waiting for long periods of time without any assurance of resolution. Systematic education and psychosocial support from health care professionals and family members help patients get through what they describe as a difficult journey. Comprehensive management programs for kidney transplantation candidates are needed. RELEVANCE TO CLINICAL PRACTICE Health care professionals need to recognise the psychosocial concerns of patients awaiting kidney transplantation. Clinicians should provide patients with information and support throughout the waiting period.
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Affiliation(s)
- Hye Jin Chong
- Organ Transplant Center, Chonbuk National University Hospital, Jeonju, Korea
| | - Hyun Kyung Kim
- College of Nursing, Chonbuk Research Institute of Nursing Science, Chonbuk National University, Jeonju, Korea
| | - Sung Reul Kim
- College of Nursing, Chonbuk Research Institute of Nursing Science, Chonbuk National University, Jeonju, Korea
| | - Sik Lee
- Division of Nephrology, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
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Lobo A. Psychosomatic and liaison psychiatry in Zaragoza: philosophy, objectives and results in a four decade experience: the 2014 EAPM 'Frits Huyse Award' lecture. J Psychosom Res 2014; 77:435-7. [PMID: 25281168 DOI: 10.1016/j.jpsychores.2014.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 08/22/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Antonio Lobo
- Department of Medicine and Psychiatry, University of Zaragoza, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Spain.
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Gutierrez BAO, Silva HSD, Shimizu HE. Biopsychosocial aspects and the complexity of care of hospitalized elderly. ACTA PAUL ENFERM 2014. [DOI: 10.1590/19820194201400071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate the biopsychosocial aspects and aspects of the health system of hospitalized elderly and to classify their degree of care complexity. Methods This was a quantitative study whose convenience sample consisted of 279 elderly. The Interdisciplinary Medicine Instrument (INTERMED) method was used, a tool that identified biopsychosocial aspects and conditions of the health system and classified the complexity of the patient. The data were submitted to descriptive analysis. Results The prevailing profile was of elderly women, retired, white, with low educational levels, married and satisfied with their life conditions. The mean age was 72.3 years. The biological domain was the most compromised. As for the complexity of care, 34.8% of the patients required multiprofessional care. Conclusion The elderly had high care complexity, with the biological and health system domains being the most compromised.
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