Factores favorecedores de la aparición de cuadro confusional agudo en pacientes mayores de 84 años con fractura de fémur

[Delirium in nursing homes. Prevalence and risk factors]

OBJECTIVES

To study the prevalence of delirium in the residential environment and to analyse the associated clinical, functional and mental factors.

MATERIAL AND METHODS

A cross-sectional epidemic study was conducted on a population of elderly persons institutionalised in 2011 in 6 nursing homes in Asturias. Socio-demographic, clinical, functional (Barthel Index [BI]) and mental (Mini-Mental State Examination [MMSE]) variables were collected. Delirium was defined by the Confusion Assessment Method.

RESULTS

A total of 505 elderly were included in the study (age 83.30 ± 7.33 years, with 67.70% women), and scores on the MMSE of 17.19 ± 10.35 and a BI score of 55.11 ± 35.82. The prevalence of delirium was 11.70%. On examining the risk of delirium among the studied variables, there was statistical significance when considering: BI, MMSE, dementia, pressure ulcers, or urinary catheter, and the prescribing of clomethiazole, ACTH-I or trazodone. In the analysis of the variables in the logistic regression with BI, diagnosis of dementia, the prescribing of clomethiazole or trazodone, in the equation, there was a statistical significance associated with delirium.

CONCLUSIONS

The prevalence of delirium in a residential environment in our study population was 11.7%. The results show that BI, diagnosis of dementia, and prescribing of clomethiazole or trazodone were associated with risk of delirium in institutionalised patients.

[Delirium prevention and treatment in elderly hip fracture]

The fracture of the proximal femur or hip fracture in the elderly usually happens after a fall and carries a high morbidity and mortality. One of the most common complications during hospitalization for hip fracture is the onset of delirium or acute confusional state that in elderly patients has a negative impact on the hospital stay, and prognosis, worsening functional ability, cognitive status and mortality. Also the development of delirium during hospitalization increases health care costs. Strategies to prevent and treat delirium during hospitalization for hip fracture have been less studied. In this context, this paper aims to conduct a review of the literature on strategies that exist in the prevention and treatment of delirium in elderly patients with hip fracture.

Comprehensive care program for elderly patients over 65 years with hip fracture

OBJECTIVES

To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture.

PATIENTS AND METHODS

We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated.

RESULTS

One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients.

CONCLUSIONS

This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery.

[Risk factors for the development of medical complications in patients with hip fracture]

OBJECTIVE

To evaluate the clinical features and outcome of inpatients with hip fracture and to investigate the clinical variables associated with the risk of medical complications.

METHODS

Prospective study of hip fracture patients aged 65 or more, admitted to the Department of Orthopaedic Surgery of the Xeral-Calde Hospital, in Lugo, Spain, in 2008. The different clinical and biochemical variables as regards the baseline health status and presentation features of the hip fracture and its complications were all recorded. The factors associated with the development of medical inpatient complications, including death, were determined, using univariate and multivariate analyses.

RESULTS

A total of 258 patients were studied. The mean age was 82.2 (9.5) years, and 76% were women. The fracture was osteoporotic in 96.8%, and 92.6% were treated surgically. The mean Barthel index was 72.9 (25.7) and the age adjusted Charlson comorbidity index was 5.2 (1.5). A total of 63.9% patients had a major medical complication during their hospital stay. Mortality was 5.8%. The following variables were associated with the development of medical inpatient complications: Barthel index (OR=2.21; 95% CI, 1.1-4.25; p=0,01), age (OR=1.09; 95% CI, 1.02-1.12; p=0.006), haemoglobin at admission (OR=0.76; 95% CI, 0.62-0.93; p=0.01).

CONCLUSIONS

Patients with hip fracture are fragile elderly with a high degree of functional dependence and comorbidity. Those with a high risk of developing medical inpatient complications can be identified at admission.

[Delirium risk assessment in elderly hospitalized patients]

Delirium is a major geriatric syndrome that affects a significant percentage of elderly hospitalized patients. It involves major negative consequences for users and professionals and can be prevented. The aim of this paper is to identify and describe the tools for predicting delirium in hospitalized patients. Lastly, the work analyzes the sources of heterogeneity and the scarcity of such instruments, as well as the reasons why their use is not widespread in clinical practice.

[Acute orthogeriatric care (II). Clinical aspects]

The present article reviews the clinical principles of acute orthogeriatric care. The application of geriatric medicine to patients with hip fracture is explained. The principal stages of geriatric intervention in this process are mentioned, as are the interventions to be carried out by the geriatric team. Subsequently, we discuss the management of several frequent problems in these patients, such as high surgical risk, pain management, anaemia, delirium, malnutrition, and discharge planning. Lastly, the characteristics of several kinds of patients with special characteristics are mentioned, such as those diagnosed with dementia, nursing home residents or the oldest-old. Areas of improvement in the acute phase are also reviewed, such as mortality reduction, functional outcome improvement and the need for more efficient resource use in patients in the acute phase of hip fracture.

[Delirium in patients aged more the 94 years with femur fracture]

OBJECTIVE

Delirium is a frequent problem during hospital admission in the elderly. The aim of the present study was to evaluate the occurrence of delirium in patients aged more than 94 years admitted to hospital for femur fracture. A further aim was to analyze the possible existence of differences in length of hospital stay or in-hospital mortality according to the presence or absence of delirium.

MATERIAL AND METHODS

A total of 25 patients (mean age 96.8 years) admitted for femur fracture were included. Functional status was determined through the Barthel index and comorbidity through Charlson's index. Diagnosis of delirium was based on the Confusional Assessment Method.

RESULTS

There were 13 women (52%) and 12 men. The mean Barthel score before admission was 64.6 +/- 22 and the mean Charlson Index was 1.4 +/- 1. The mean length of hospital stay was 15.2 +/- 1.4 days. Five patients (20%) died during admission. Twelve patients (48%) developed delirium. Mortality (25% vs 15.4%) and the mean number of days of hospital stay (17.5 vs 13 days) were higher in patients with delirium, although these differences were not statistically significant.

CONCLUSIONS

Practically half the patients aged more than 94 years with fracture of the femur had an episode of delirium during admission.

Síndrome confusional agudo en pacientes ancianos ingresados por patología médica

INTRODUCTION

Delirium or acute confusional syndrome (ACS) is a frequent problem during hospitalization of elderly patients. We study the appearance of delirium and its characteristics in patients admitted to an internal medicine service.

METHODS

Prospective study of 148 patients over 64 years admitted due to medical condition (non-surgical) in the internal medicine service of the University Hospital of Bellvitge. Functionality was quantified with the Barthel index (BI) and comorbidity with the Charlson index (CI). The Confusional Assessment Method was used for the diagnosis of the ACS.

RESULTS

Seventy-seven (77) (52%) of the 148 patients were women, with a mean age of 78.5 years. The CI was 2.2. Mean of previous BI was 81.7. Mortality during admission was 8% (12 patients). A total of 42.5% of the patients (63) had ACS (30% prevalent). It was hyperactive in 68%, hypoactive in 16% and mixed in 16%. In 38% of the patients, the ACS had morning predominance and 62% it appeared after the evening. Advanced age was the only significant differences between patients with or without ACS (p < 0.001). There were no significant differences in the ACS percentage between patients who survived or who died (p = 0.36).

CONCLUSIONS

Frequency of appearance of the confusional picture is high in patients admitted to acute hospitals, it being more frequent in the elderly. Measures to prevent the confusional picture in elderly patients who are hospitalized should be increased.