Don Carléone Sanama B1*, Montasser Ibrahim D1, EL Kabbaj D1 and Mrini S2
1Mohamed V Military Training Hospital in Rabat, Morocco
2 Université Cheik Anta Diop of Dakar, Senegal
*Corresponding Author: Don Carléone Sanama B, Mohamed V Military Training Hospital in Rabat, Morocco.
Received: December 01, 2021; Published: February 11, 2022
Introduction: The Measure of autonomy loss has required special attention since the sixties: initially with the Katz scale based on activities of daily living (ADL), and the Lawton scale based on activities of domestic life still called instrumental activities of daily living (IADL). It evolved in the eighties with the WHO classification, which served as the basis for developing the SMAF (Functional Autonomy Measurement System) score used in Canada. It has 29 functions divided into 5 areas (ADL, IADL, mobility, communication, mental functions), with a total score varying from 0 to 87. In France, it is the AGGIR grid that is used and includes 06 GIR.
Objective: To evaluate autonomy in chronic hemodialysis, to improve its overall management.
Material and Methods: Prospective observational study carried out from 12 to 26 December 2019, at the Hemodialysis Center of Mohamed V Military Training Hospital in Rabat, Morocco, which included all chronic hemodialysis of both sexes. The SMAF evaluation grid was completed based on information collected from the patient, his entourage, and completed with the data of his medical file. The grade rating scale used ranged from 0 to 3: 0=Total autonomy, 0.5=Difficulty, 1=Stimulation/Supervision, 2=Partial help, 3= Total dependence. The data processing was done with Microsoft Excel 2013.
Results: We had 47% men and 53% women (sex ratio M/F: 0.9); of which 39% were aged 65 and over. The average age was 59 years ± 18.9. 10% were totally dependent for at least one IADL, and 26% had full autonomy in all areas. 15% used help for at least one IADL; 26% were supervised to manage their budget. 32% had memory difficulties, 40% had motor impairment and 26% mental impairment. 5% of patients aged 65 and over needed help with at least one ADL. 47% of men aged 65 and over needed help with at least one ADL, compared with 53% of women in the same age group. The total SMAF score ranged from 0 to 41.5.
Discussion: We chose the SMAF score because it allows for a comprehensive and multidimensional assessment of patient autonomy from other scores. In Quebec, Choinière in 2010 had 6% of patients aged 65 and over who required help for at least one ADL (2); which is consistent with the data from our study. In France, a study done in 2016 by P. Gervais., et al. on 207 residents of an EHPAD in the Dordogne, comparing SMAF and AGGIR scores, found the following results: 24% had a disability for IADL; 22% mental disability, and 24% motor disability. This data is less than ours.
Conclusion: Evaluation of autonomy in chronic hemodialysis is essential, for adequate and comprehensive management to improve quality of life. In our series, 26% had total autonomy in all areas. Dialysis itself would decrease autonomy over the years, it’s the interest in establishing an autonomy score before dialysis and reassessing it regularly.
Keywords: SMAF; Autonomy; Hemodialysis; ADL; IADL
Citation: Don Carléone Sanama B., et al. “Evaluation Of Autonomy in Chronic Hemodialysis, at the Military Hospital of Rabat in Morocco: About 38 Cases". Acta Scientific Medical Sciences 6.3 (2022): 36-38.
Copyright: © 2022 Don Carléone Sanama B., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.