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Rodríguez-García R, González-Lamuño L, Santullano M, Martín-Carro B, Fernández-Martín JL, Cienfuegos Basanta MDC, Forcelledo L, Palomo Antequera C. Clinical features and disease progression of elderly patients at the ICU setting. Med Intensiva 2024; 48:254-262. [PMID: 38519374 DOI: 10.1016/j.medine.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/28/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE To describe and characterize a cohort of octogenarian patients admitted to the ICU of the University Central Hospital of Asturias (HUCA). DESIGN Retrospective, observational and descriptive study of 14 months' duration. SETTING Cardiac and Medical intensive care units (ICU) of the HUCA (Oviedo). PARTICIPANTS Patients over 80 years old who were admitted to the ICU for more than 24 h. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Age, sex, comorbidity, functional dependence, treatment, complications, evolution, mortality. RESULTS The most frequent reasons for admission were cardiac surgery and pneumonia. The average admission stay was significantly longer in patients under 85 years of age (p = 0,037). 84,3% of the latter benefited from invasive mechanical ventilation compared to 46,2% of older patients (p = <0,001). Patients over 85 years of age presented greater fragility. Admission for cardiac surgery was associated with a lower risk of mortality (HR = 0,18; 95% CI (0,062-0,527; p = 0,002). CONCLUSIONS The results have shown an association between the reason for admission to the ICU and the risk of mortality in octogenarian patients. Cardiac surgery was associated with a better prognosis compared to medical pathology, where pneumonia was associated with a higher risk of mortality. Furthermore, a significant positive association was observed between age and frailty.
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Affiliation(s)
- Raquel Rodríguez-García
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | | | | | - Beatriz Martín-Carro
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), RICORS2040 (Enfermedad renal), Instituto de Salud Carlos III, Oviedo, Spain
| | - Jose Luis Fernández-Martín
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS), RICORS2040 (Enfermedad renal), Instituto de Salud Carlos III, Oviedo, Spain
| | | | - Lorena Forcelledo
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carmen Palomo Antequera
- Universidad de Oviedo, Oviedo, Spain; Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain
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Fernández-Castro I, Casar-Cocheteux C, Pernas-Pardavila H, Losada-Arias E, Antela A. Cross-sectional analysis of a cohort of people over 65 years of age living with HIV. Enferm Infecc Microbiol Clin (Engl Ed) 2024:S2529-993X(24)00104-7. [PMID: 38688820 DOI: 10.1016/j.eimce.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/16/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION This study aims to describe and analyze the characteristics of aged people who are living with HIV (APHIV) and evaluate their association on the comorbidities they currently have. METHODS Cross-sectional analysis of APHIV under active follow-up at the Infectious Diseases Unit of the University Clinical Hospital of Santiago de Compostela. Demographic and clinical data were analyzed, along with their association with the development of comorbidities in this population. A correlation and multiple linear regression analysis were performed for this purpose. RESULTS Eighty-five APHIV, 65 males and 20 females, with an average age of 69 years (IQR 8) and a duration of living with HIV of 17 years (SD 7), were studied. 41% of them had their initial diagnosis with AIDS. The most common comorbidities are hypertension and dyslipidemia in 55% and 52%, respectively. 40% of APHIV take at least 5 medications. 35% have received more than 5 lines of antiretroviral treatment. At the time of analysis, all APHIV have an undetectable viral load. No significant association was observed between the number of comorbidities and various characteristics of APHIV; however, a weak correlation was noted among age, the cumulative number of antiretroviral treatments received throughout their lives, and the number of comorbidities. CONCLUSIONS This analysis highlights the substantial burden of comorbidities and polypharmacy experienced by APHIV. Further studies are needed to better understand the characteristics and variables influencing their development.
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Affiliation(s)
- Iván Fernández-Castro
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - Clara Casar-Cocheteux
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Hadrian Pernas-Pardavila
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Elena Losada-Arias
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Antonio Antela
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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de Miguel-Palacio M, González-Castillo AM, Martín-Ramos M, Membrilla-Fernández E, Pelegrina-Manzano A, Pons-Fragero MJ, Grande-Posa L, Sancho-Insenser JJ. Microbiological etiology and current resistance patterns in acute calculous cholecystitis. Cir Esp 2024:S2173-5077(24)00099-1. [PMID: 38663468 DOI: 10.1016/j.cireng.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/15/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The current treatment for acute calculous cholecystitis (ACC) is early laparoscopic cholecystectomy, in association with appropriate empiric antibiotic therapy. In our country, the evolution of the prevalence of the germs involved and their resistance patterns have been scarcely described. The aim of the study was to analyze the bacterial etiology and the antibiotic resistance patterns in ACC. METHODS We conducted a single-center, retrospective, observational study of consecutive patients diagnosed with ACC between 01/2012 and 09/2019. Patients with a concomitant diagnosis of pancreatitis, cholangitis, postoperative cholecystitis, histology of chronic cholecystitis or carcinoma were excluded. Demographic, clinical, therapeutic and microbiological variables were collected, including preoperative blood cultures, bile and peritoneal fluid cultures. RESULTS A total of 1104 ACC were identified, and samples were taken from 830 patients: bile in 89%, peritoneal fluid and/or blood cultures in 25%. Half of the bile cultures and less than one-third of the blood and/or peritoneum samples were positive. Escherichia coli (36%), Enterococcus spp (25%), Klebsiella spp (21%), Streptococcus spp (17%), Enterobacter spp (14%) and Citrobacter spp (7%) were isolated. Anaerobes were identified in 7% of patients and Candida spp in 1%. Nearly 37% of patients received inadequate empirical antibiotic therapy. Resistance patterns were scrutinized for each bacterial species. The main causes of inappropriateness were extended-spectrum beta-lactamase-producing bacteria (34%) and Enterococcus spp (45%), especially in patients older than 80 years. CONCLUSIONS Updated knowledge of microbiology and resistance patterns in our setting is essential to readjust empirical antibiotic therapy and ACC treatment protocols.
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Affiliation(s)
- Maite de Miguel-Palacio
- Servicio de Cirugía General, Hospital del Mar. Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | - Ana-María González-Castillo
- Servicio de Cirugía General, Hospital del Mar. Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina y Ciencias de la Vida, Universidad Pompeu Fabra, Barcelona, Spain
| | - María Martín-Ramos
- Servicio de Cirugía General, Hospital del Mar. Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Estela Membrilla-Fernández
- Servicio de Cirugía General, Hospital del Mar. Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina y Ciencias de la Vida, Universidad Pompeu Fabra, Barcelona, Spain
| | - Amalia Pelegrina-Manzano
- Servicio de Cirugía General, Hospital del Mar. Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Medicina y Ciencias de la Vida, Universidad Pompeu Fabra, Barcelona, Spain
| | - María-José Pons-Fragero
- Servicio de Cirugía General, Hospital del Mar. Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
| | - Luis Grande-Posa
- Servicio de Cirugía General, Hospital del Mar. Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Juan-José Sancho-Insenser
- Servicio de Cirugía General, Hospital del Mar. Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Departamento de Cirugía, Universidad Autónoma de Barcelona, Barcelona, Spain
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García-Prieto AM, Verdalles Ú, de José AP, Arroyo D, Aragoncillo I, Barbieri D, Camacho RE, Goicoechea M. Renin-angiotensin-aldosterone system blockers effect in chronic kidney disease progression in hypertensive elderly patients without proteinuria: PROERCAN trial. Hipertens Riesgo Vasc 2024; 41:95-103. [PMID: 38508877 DOI: 10.1016/j.hipert.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Evidence about nefroprotective effect with RAAS blockers in elderly patients with chronic kidney disease (CKD) without proteinuria is lacking. The primary outcome of our study is to evaluate the impact of RAAS blockers in CKD progression in elderly patients without proteinuria. MATERIALS AND METHODS Multicenter open-label, randomized controlled clinical trial including patients over 65 year-old with hypertension and CKD stages 3-4 without proteinuria. Patients were randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs and were followed up for three years. Primary outcome is estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcome measures include BP control, renal and cardiovascular events and mortality. RESULTS 88 patients were included with a mean age of 77.9±6.1 years and a follow up period of 3 years: 40 were randomized to RAAS group and 48 to standard treatment. Ethiology of CKD was: 53 vascular, 16 interstitial and 19 of unknown ethiology. In the RAAS group eGFR slope during follow up was -4.3±1.1ml/min, whereas in the standard treatment group an increase on eGFR was observed after 3 years (+4.6±0.4ml/min), p=0.024. We found no differences in blood pressure control, number of antihypertensive drugs, albuminuria, potassium serum levels, incidence of cardiovascular events nor mortality during the follow up period. CONCLUSIONS In elderly patients without diabetes nor cardiopathy and with non proteinuric CKD the use of RAAS blockers does not show a reduction in CKD progression. The PROERCAN (PROgresión de Enfermedad Renal Crónica en ANcianos) trial (trial registration: NCT03195023).
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Affiliation(s)
- A M García-Prieto
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Ú Verdalles
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A P de José
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - D Arroyo
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - I Aragoncillo
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - D Barbieri
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R E Camacho
- Servicio de Nefrología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - M Goicoechea
- RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Fernández-Torres J, Ilizaliturri-Sánchez V, Martínez-Flores K, Lozada-Pérez CA, Espinosa-Morales R, Zamudio-Cuevas Y. An update on the study of synovial fluid in the geriatric patient. Reumatol Clin (Engl Ed) 2024; 20:193-198. [PMID: 38644030 DOI: 10.1016/j.reumae.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/18/2023] [Accepted: 12/23/2023] [Indexed: 04/23/2024]
Abstract
BACKGROUND The characteristics of synovial fluid (SF) in geriatric patients differ from those in younger patients. In Mexico, epidemiologic data on the incidence of different rheumatic diseases in geriatric patients are scarce. OBJECTIVE To describe the physical characteristics of geriatric SF and the prevalence of crystals in knee and other joint aspirates from patients with previously diagnosed joint disease. MATERIALS AND METHODS A retrospective study was performed with a baseline of 517 SF samples between 2011 and 2023. White blood cell count was performed by Neubauer chamber and crystals were identified by polarized light microscopy. Descriptive statistical analysis was performed and prevalence was reported as a percentage. RESULTS The mean age of the adults was 73.5±5.0 years, 54.4% were women and 45.6% were men. The mean SF volume was 6.3±9.5mL in older adults and 15.3±24.9mL in those younger than 65 years. The mean viscosity in older adults was 9.5±4.5mm and the mean leukocyte count was 7352±16,402leukocytes/mm3. Seventy percent of the older adults' SFs were referred to the laboratory for osteoarthritis (OA), with lower proportions for rheumatoid arthritis (RA) (14.6%) and gout (5.1%). Of the crystals observed in the geriatric population, 14.6% corresponded to monosodium urate crystals (CUM) and 18.9% to calcium pyrophosphate crystals (CPP). CONCLUSIONS The characteristics of LS in older adults were smaller volume, increased viscosity, and non-inflammatory. The main diagnoses were OA, RA, and gout. The crystal content of the SF of the geriatric population corresponded mainly to CPP.
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Affiliation(s)
- Javier Fernández-Torres
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra-Ibarra, Mexico City 14389, Mexico
| | - Víctor Ilizaliturri-Sánchez
- Servicio de Reemplazo Articular Cadera-Rodilla, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra-Ibarra, Mexico City 14389, Mexico
| | - Karina Martínez-Flores
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra-Ibarra, Mexico City 14389, Mexico
| | - Carlos Alberto Lozada-Pérez
- División de Reumatología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra-Ibarra, Mexico City 14389, Mexico
| | - Rolando Espinosa-Morales
- División de Reumatología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra-Ibarra, Mexico City 14389, Mexico
| | - Yessica Zamudio-Cuevas
- Laboratorio de Líquido Sinovial, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra-Ibarra, Mexico City 14389, Mexico.
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Moreno-Carmona R, Serra-Prat M, Serra-Colomer J, Ferro T, Lavado À. [Effect of frailty in health resource use in aged cancer patients]. Gac Sanit 2024; 38:102360. [PMID: 38460206 DOI: 10.1016/j.gaceta.2024.102360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/03/2023] [Accepted: 11/28/2023] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To evaluate the effect of frailty on health resource use in aged population with cancer. METHOD Population-based cohort study with retrospective data collection and follow-up from January 2018 to December 2019 in people ≥65 years with cancer. RESULTS Overall, 996 individuals were included, with a prevalence of frailty of 22.1%. Mortality at 2 years was 14.1% in the frail and 9.0% in the non-frail (p=0.028). Independently of age and sex, frailty increased the number of urgent hospitalizations (168%) and planned hospitalizations (64%), visits to the emergency room (111%), outpatient consultations (59%), day hospital sessions (30%) and visits to primary care (114%). CONCLUSIONS Frailty is more prevalent, determines a poorer prognostic and is associated with higher health resource use in aged population with cancer.
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Affiliation(s)
- Rosario Moreno-Carmona
- Servicio de Oncología, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró (Barcelona), España
| | - Mateu Serra-Prat
- Unidad de Investigación, Fundació Salut del Consorci Sanitari del Maresme, Mataró (Barcelona), España; CIBER de Enfermedades Hepáticas y Digestivas (CIBEREHD), España.
| | - Júlia Serra-Colomer
- Unidad de Investigación Clínica, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España
| | - Társila Ferro
- Servicio de Oncología, Hospital Duran i Reynals, Institut Català d'Oncologia, L'Hospitalet de Llobregat (Barcelona), España
| | - Àngel Lavado
- Unidad de Gestión de la Información, Consorci Sanitari del Maresme, Mataró (Barcelona), España
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Yeverino Gutiérrez ML, González González MDR, González Santiago O. Trends in Parkinson's mortality in Mexico 2000-2020. Gac Sanit 2024; 38:102361. [PMID: 38422946 DOI: 10.1016/j.gaceta.2024.102361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To describe the recent trends in Parkinson's disease mortality in Mexico during 2000-2020. METHOD The adjusted mortality rate per 100,000 inhabitants was calculated using the direct method and the world standard population. Trend analysis was performed with the Joinpoint software. RESULTS The average mortality rate was 1.26/100,000 inhabitants (SD: 0.09), and males showed higher mortality than females (M/F ratio=1.60). Older individuals ≥70 years old showed higher mortality rates than the rest of the age groups. During the period of study, a significant increase in mortality was observed from 2000 to 2005, while from 2005 to 2020 no significant trend was observed in all the studied groups. CONCLUSIONS In Mexico, males and older individuals showed the highest mortality rates. The socioeconomic regions with high levels of wellness showed the highest mortality rates levels. Parkinson's mortality rate has remained constant since 2005 in Mexico.
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Affiliation(s)
- Myrna L Yeverino Gutiérrez
- Laboratory of Pharmacology, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Nuevo León, México
| | | | - Omar González Santiago
- Postgraduate Coordination in Pharmacy, Facultad de Ciencias Químicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Nuevo León, México.
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Verdu-Rotellar JM, Calero E, Duran J, Navas E, Alonso S, Argemí N, Casademunt M, Furió P, Casajuana E, Vinyoles E, Muñoz MA. Impact of malnutrition on the quality of life in older patients with advanced heart failure: a cohort study. Rev Clin Esp 2024; 224:105-113. [PMID: 38280424 DOI: 10.1016/j.rceng.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
OBJECTIVES The aim of this study was to assess the prevalence of malnutrition, the clinical characteristics associated with malnutrition and the impact of nutritional status on mortality, quality of life, self-care abilities, and activities of daily living in the older patients with advanced heart failure. METHODS A prospective multicentre cohort study including 260 community-dwelling elderly patients with advanced HF was conducted between June 2017 and December 2019. The study was carried out in 22 primary healthcare centres, three university hospitals, one acute-care hospital, and one geriatric rehabilitation unit in the city of Barcelona (Spain). Nutritional status was assessed at baseline using the Mini Nutritional Assessment questionnaire. Patient-reported outcome measures included quality of life (EQ-5D-3L), self-care behaviour (European Heart Failure Self-care Behaviour Scale) and impact on activities of daily living (Barthel Index). RESULTS Using the MNA-SF, 126 (48.5%) patients were identified as being at risk of malnutrition and 33 (12.7%) patients as having confirmed malnutrition. Compared to HF patients with normal nutritional status, patients with confirmed malnutrition were significantly older, with a lower BMI, and with reduced haemoglobin levels. During follow-up (median 14.9 months, Interquartile Range; 4.9-26.9), 133 (51.2%) of the included participants died, and mortality was significantly higher among patients identified as having malnutrition (p < 0.001). Better Barthel index and quality of life scores were inversely related to the risk of malnutrition, [Odds Ratio (OR) 0.97 (95% Confidence interval 0.96; 0.98) and OR 0.98 (95% Confidence interval, 0.96; 0.99)], respectively. Higher scores in the European Heart Failure Self-care Behaviour Scale, which implies worse self care, were related to higher malnutrition risk, OR 1.05 (95% Confidence interval, 1.02; 1.09. Adjusted multivariate logistic model found that malnutrition was significantly associated with poor quality of life, and adverse impacts on daily activities and self-care. CONCLUSIONS In community-dwelling older patients with advanced HF, malnutrition was associated with worse patient reported outcome measures related to poor quality of life, and adverse impacts on self-care and daily activities. Nutritional status must be systematically addressed by primary care nurses and family doctors to improve survival rates in these patients. It would be helpful the incorporation of expert professionals in nutrition in the primary health care centres.
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Affiliation(s)
- J-M Verdu-Rotellar
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, School of Medicine, Universitat Pompeu Fabra, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - E Calero
- Bellvitge University Hospital, Institut Català de la Salut, Barcelona, Spain
| | - J Duran
- Clinica Sant Antoni (Institut Medic i de Rehabilitació), Barcelona, Spain
| | - E Navas
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - S Alonso
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain
| | - N Argemí
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain
| | - M Casademunt
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain
| | - P Furió
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain
| | - E Casajuana
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain
| | - E Vinyoles
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; Departament de Medicina (School of Medicine, Universitat de Barcelona), Barcelona, Spain
| | - M A Muñoz
- Gerencia Territorial de Barcelona (Primary Healthcare), Institut Català de la Salut, Barcelona, Spain; Departament de Ciències Experimentals i de la Salut, School of Medicine, Universitat Pompeu Fabra, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
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Javier Afonso-Argilés F, Comas Serrano M, Castells Oliveres X, Cirera Lorenzo I, García Pérez D, Pujadas Lafarga T, Ichart Tomás X, Puig-Campmany M, Vena Martínez AB, Renom-Guiteras A. Emergency department admissions and economic costs burden related to ambulatory care sensitive conditions in older adults living in care homes. Rev Clin Esp 2023; 223:585-595. [PMID: 37838224 DOI: 10.1016/j.rceng.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/10/2023] [Accepted: 09/27/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES To assess the frequency of emergency department admissions (EDA) for ambulatory care sensitive conditions (ACSC) and non-ACSC among older adults living in care homes (CH), to describe and compare their demographic and clinical characteristics, the outcomes of the hospitalisation process and the associated costs. METHOD This multicenter, retrospective and observational study evaluated 2444 EDAs of older adults ≥ 65 years old living in care homes in 5 emergency departments in Catalonia (Spain) by ACSC and non-ACSC, in 2017. Sociodemographic variables, prior functional and cognitive status, and information on diagnosis and hospitalisation were collected. Additionally, the costs related with the EDAs were calculated, as well as a sensitivity analysis using different assumptions of decreased admissions due to ACSC. RESULTS A total of 2444 ED admissions were analysed. The patients' mean (SD) age was 85.9 (7.2) years. The frequency of ACSC-EDA and non-ACSC-EDA was 56.6% and 43.4%, respectively. Severe dependency and cognitive impairment were present in 56.6% and 78%, respectively, with no differences between the two groups. The three most frequent ACSC were falls/trauma (13.8%), chronic obstructive pulmonary disease/asthma (11.4%) and urinary tract infection (7.4%). The average cost per ACSC-EDA was є1,408.24. Assuming a 60% reduction of ACSC-EDA, the estimated cost savings would be є1.2 million. CONCLUSIONS Emergency admissions for ACSC from care homes have a significant impact on both frequency and costs. Reducing these conditions through targeted interventions could redirect the avoided costs towards improving care support in residential settings.
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Affiliation(s)
- F Javier Afonso-Argilés
- Servicio de Geriatría, Fundació Sanitària Mollet, Barcelona, Spain; Estudiante de doctorado de la Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - M Comas Serrano
- Servicio de Epidemiología y Evaluación, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, Barcelona, Spain; Miembro de la Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - X Castells Oliveres
- Servicio de Epidemiología y Evaluación, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Hospital del Mar, Barcelona, Spain; Miembro de la Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | | | - D García Pérez
- Servicio de Urgencias, Fundació Althaia, Xarxa Assistencial Universitaria de Manresa, Barcelona, Spain
| | - T Pujadas Lafarga
- Servicio de Geriatría y Cuidados Paliativos, Badalona Serveis Assistencials, Barcelona, Spain
| | - X Ichart Tomás
- Servicio de Urgencias, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Puig-Campmany
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A B Vena Martínez
- Servicio de Geriatría, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - A Renom-Guiteras
- Miembro de la Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain; Servicio de Geriatría, Hospital del Mar, Barcelona, Spain
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10
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Cristofori G, González Becerra M, Sánchez Osorio LM, Gómez Pavón J. [Utility and safety of direct admission to acute geriatric unit after Nursing Home Geriatric Team assessment]. Rev Esp Geriatr Gerontol 2023; 58:101388. [PMID: 37611364 DOI: 10.1016/j.regg.2023.101388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/31/2023] [Accepted: 07/11/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND OBJECTIVE More than half of institutionalized older people need a emergency department visit annually, with high resources consumption and higher risk of adverse events, due to high complexity. Direct admission to Acute Geriatric Unit (AGU), after geriatric consultant and nursing home medical team assessment, could be a safety and effective alternative to emergency department (ED) admission. METHODS Retrospective observational study of AGU patients admitted by Nursing Home Geriatric Team between January, 1st and December, 31st, 2021. Planned admissions and SARS-CoV-2 positive patients were excluded. Medical (sociodemographic, clinical, functional and cognitive) records and outcomes data (inpatient mortality, hospital and ED lenght of stay, transfer to ED and delirium within 48h after admission, hospital discharge location) were collected. RESULTS Two hundred and six patients directly admitted, 101 through ED (N 307). 62.5% with Barthel index <40, 65% with dementia, 56.4% with Charlson index ≥3. Inpatient mortality was 14.6% in direct admission, 20.8% in ED referral group, p=0.14. Hospital lenght of stay was 9.61±6.01 days in direct admission, 11.22±5.36 days in ED group, p=0.02. 27.7% of patients with delirium in direct admission and 36.6% in ED group; only one patient was transferred to ED, within 48h after admission. CONCLUSIONS Direct admission is a safety and effective alternative to ED referral in institutionalized older people after geriatric assessment, due to no increased mortality, shorter length of stay and hospital cost reduction.
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11
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Yu M, Lu L, Wu R. Perihilar cholangiocarcinoma resection: Is it beneficial for survival in elderly patients? Gastroenterol Hepatol 2023:S0210-5705(23)00441-7. [PMID: 37806347 DOI: 10.1016/j.gastrohep.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION As the population ages, surgeons are growing frequently faced with hard choices among a vast array of treatment options for the elderly. This study was to investigate safety and efficacy of resection in elderly patients with perihilar cholangiocarcinoma (PHCC). PATIENTS AND METHODS Literature reading and meta-analysis unveiled that elderly PHCC patients held a higher risk of death within 90 days after hepatectomy relative to younger patients, but their 5-year overall survival and disease-free survival were comparable. Among PHCC patients who underwent hepatectomy, the proportion of elderly patients with tumor classification Bismuth I-II and tumor stage pStage 1-3 was significantly higher than that of younger patients. RESULTS Curative resection R0 was more common in elderly patients than younger patients, but the difference was not statistically significant. Because of more comorbidities and less physiological reserve of elderly patients, they seemed to suffer more postoperative complications. CONCLUSION Considering improved life expectancy, it is crucial to treat elderly PHCC patients appropriately and attempts should be made to radical surgery based on comorbidities and functional status.
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Affiliation(s)
- Min Yu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
| | - Lina Lu
- Digestive Department, Jinhua Wenrong Hospital, Jinhua, China
| | - Rongjin Wu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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12
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Pérez Martínez P, Gómez-Huelgas R, Casado Escribano PP, Arévalo-Lorido JC, Pérez-Soto MI, Carretero Gómez J. Approach to obesity in the elderly population: a consensus report from the Diabetes, Obesity and Nutrition Working Group of SEMI (Spanish Society of Internal Medicine). Rev Clin Esp 2023; 223:493-498. [PMID: 37468094 DOI: 10.1016/j.rceng.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 07/21/2023]
Abstract
Obesity in the elderly not only impacts morbidity and mortality but their quality of life. This phenomenon has sparked extensive research and debate regarding treatment recommendations, primarly due to the lack evidence in this specific population. When addressing possible treatment recommendations for older adults with obesity, it is crucial to assess certain essential aspects such as functional status, sarcopenia, cognitive status, and others. Intentional weight loss in this population can be both effective and safe. The best weight loss plan for the elderly revolves around adopting a healthy lifestyle, which includes following a Mediterranean diet pattern and engaging in physical exercise, particularly strength training. Additionally, the use of weight loss medications, particularly glucagon-like peptide-1 receptor agonists (GLP-1 RA) and novel glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists, can provide an additional stage of treatment. In selective candidates, bariatric surgery may also be considered. The objective of this document is to propose a comprehensive algorithm of recommendations for the management of obesity in the elderly (above the age of 65), based on scientific evidence and the expertise of members from the Diabetes, Obesity, and Nutrition Workgroup of the Spanish Society of Internal Medicine.
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Affiliation(s)
- Pablo Pérez Martínez
- Servicio de Medicina Interna, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Ricardo Gómez-Huelgas
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Medicina Interna, Instituto de Investigación Biomédica de Málaga (IBIMA)/Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
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13
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Pérez Reyes M, Sánchez Pérez B, León Díaz FJ, Pérez Daga JA, Mirón Fernández I, Santoyo Santoyo J. Implementation of an ERAS protocol on elderly patients in liver resection. Cir Esp 2023; 101:274-282. [PMID: 35918049 DOI: 10.1016/j.cireng.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/08/2021] [Indexed: 04/21/2023]
Abstract
BACKGROUND The increase of quality of life, the improvement in the perioperative care programs, the use of the frailty index, and the surgical innovation has allowed to access of complex abdominal surgery for elderly patients like liver resection. Despite of this, in patients aged 70 or older there is a limitation for the implementation ERAS protocolos. The aim of this study is to evaluate the implementation ERAS protocol on elderly patients (≥70 years) undergoing liver resection. METHODS A prospective cohort study of patients who underwent liver resection from December 2017 to December 2019 with an ERAS program. We compare the outcomes in patients ≥70 years (G ≥ 70) versus <70 years (G < 70). The frailty was measured with the Physical Frailty Phenotype score. RESULTS A total of 101 patients were included. 32 of these (31.6%) were patients ≥70 years. 90% of the both groups had performed >70% of the ERAS. Oral diet tolerance and mobilization on the first postoperative day were quicker in <70 years group. The hospital stay was similar in both groups (3.07days/2.7days). Morbidity and mortality were similar; Clavien I-II(G ≥ 70:41% vs G < 70:30,5%) and Clavien ≥ III (G ≥ 70:6% vs G < 70:8.5%), like hospital readmissions. Mortality was <1%. ERAS protocol compliance was associated with a decrease in complications (ERAS < 70%:80% vs ERAS > 90%:20%; p = 0.02) and decrease in severity of complications in both study groups. Frailty was found in 6% of the elderly group; the only patient who died had a frailty index of 4. CONCLUSION Implementation of ERAS protocol for elderly patients is possible, with major improvements in perioperative outcomes, without an increase in morbidity, mortality neither readmissions.
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Affiliation(s)
- María Pérez Reyes
- Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain.
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14
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Asadi SE, Khademi M, Yarahmadi S, Ebrahimzadeh F, Mohammadi E. A comparison of nurses and elderly patients' perceptions of caring behaviors in intensive care units. Enferm Intensiva (Engl Ed) 2023; 34:80-89. [PMID: 37295921 DOI: 10.1016/j.enfie.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/05/2022] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Differences in patients and nurses' perceptions of caring behaviors arouse patient dissatisfaction. Continuous monitoring and assessment of caring behaviors has revealed its problems, and this in turn would promote care services by planning rational interventions and removing the problems. The present study aimed to compare nurses and elderly patients' perceptions of nurses' caring behaviors in intensive care units in accordance with Watson's transpersonal caring theory. METHODS In this descriptive-analytical study, 70 nurses were selected using the census method, and 70 elderly patients over 60 years old were also selected using purposive sampling method from the intensive care units of Lorestan University of Medical Sciences during 2012-2013. Caring Behavior Inventory for Elders (CBI-E) was adopted in this research to detect the nurses and elderly patients' perceptions of caring behaviors. In the data analysis phase, Kruskal-Wallis, Mann-Whitney U, and Pearson correlation tests were used. RESULTS The research findings revealed no statistically significant difference between the total scores of nurses' 83.80 (22.93), 95% CI [78.40, 89.20] and elderly patients' 80.09 (26.00), 95% CI [74, 86.20] perception of nurses' caring behaviors (P=0.379). From the viewpoint of the nurses and elderly patients, responding quickly to a patient's call 100.00 (0.00), 95% CI [100.00, 100.00] had the highest mean scores and patient participation in caring process had the lowest mean scores among nurses 22.86 (33.71), 95% CI [15.00, 30.80] and elderly patients 14.29 (28.41), 95% CI [7.63, 20.90]. CONCLUSION This study indicated the elderlies and nurses' similar perceptions of caring behaviors in intensive care units. This finding would help nurses to recognize and prioritize the elderly patients' care needs, thereby promoting the quality of care services.
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Affiliation(s)
- S E Asadi
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - M Khademi
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - S Yarahmadi
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran; Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - F Ebrahimzadeh
- Nutritional Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - E Mohammadi
- Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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15
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Manrique MJ, Batuecas Á, Cenjor C, Ferrán S, Gómez JR, Lorenzo AI, Marco J, Matiñó E, Morant A, Morera C, Pérez N, Polo R, Ramos Á, Sánchez S, Nuñez F. Presbycusis and balance disorders in the elderly. Bibliographical review of ethiopathogenic aspects, consequences on quality of life and positive effects of its treatment. Acta Otorrinolaringol Esp (Engl Ed) 2023:S2173-5735(23)00031-5. [PMID: 36906066 DOI: 10.1016/j.otoeng.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/15/2022] [Indexed: 03/11/2023]
Abstract
At this time, we still do not have adequate knowledge and awareness of the consequences of hearing loss in the elderly on quality of life. Similarly, there is also insufficient information on the relationship of presbycusis and balance disorders with other comorbidities. Such knowledge can contribute to improve both prevention and treatment of these pathologies, to reduce their impact on other areas such as cognition or autonomy, as well as to have more accurate information on the economic impact they generate in society and in the health system. Therefore, with this review article we aim to update the information on the type of hearing loss and balance disorders in people over 55 years of age, and their associated factors; to analyze the impact on the quality of life of these people and the one which can be generated at a personal and population level (both sociological and economic) if an early intervention in these patients is pursued.
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Castilla-Guerra L, Fernández-Moreno MC, González-Iglesias ML, Boceta-Osuna J, Gutiérrez-Gutiérrez B, Jiménez-Hernández MD. Pharmacological therapy in the secondary prevention of ischemic stroke in the oldest-old patients: has it improved in recent decades? Rev Clin Esp 2023; 223:202-208. [PMID: 36842658 DOI: 10.1016/j.rceng.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Population aging has caused an increase in strokes in very elderly patients (VEP). We assess how secondary prevention of ischemic stroke has changed in VEP in recent decades. METHOD Retrospective study of discharges due to ischemic stroke in the Virgen Macarena, Virgen del Rocio and Valme hospitals in Seville (Spain), during the periods 1999-2001, 2014-16 and 2019-2020. VEP were considered those with ≥80 years. RESULT We studied 1806 patients, 349 (19.3%) were VEP. Over the years, VEPs have doubled (13.5% vs. 25.9% and 28% p = 0.0001) and age has increased (83.3 ± 3 vs. 84.1 ± 3 vs. 85.2 ± 4 p = 0.001). Comparing the periods, the VEPs have more hypertension (69.9% vs. 84.8% vs. 84.6%; p = 0.0001) and dyslipidemia (12% vs. 41.7% vs. 52.3%; p = 0.0001) and have prescribed more antihypertensives (69.1% vs. 86.7% vs. 92.3%; p = 0.0001), statins (5.3% vs. 78% vs. 81.5%; p = 0.0001) and anticoagulants (16.5% vs. 19.4% vs. 53.1%; p = 0.001), increasing the number of antihypertensives (1 ± 0.9 vs. 1.6 ± 0, 9 vs. 1.9 ± 0.8 drugs p = 0.0001), and high-intensity statins (2.3% vs. 42.7 vs. 69.2% p = 0.0001). Comparing the VEPs with the younger ones, there were no differences in antihypertensive treatment in any period, there were differences in antithrombotic treatment in the first period, and with statins the differences were maintained until the end. CONCLUSIONS In the last 20 years the number of VEPs has doubled, exceeding a quarter of the discharges. Although there is improvement in secondary stroke prevention in VEPs, there is room for improvement.
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Affiliation(s)
- L Castilla-Guerra
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain.
| | - M C Fernández-Moreno
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - M L González-Iglesias
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J Boceta-Osuna
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - B Gutiérrez-Gutiérrez
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M D Jiménez-Hernández
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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17
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Ersoy İ, Ersoy P. Impact of drug interactions with direct oral anticoagulants on mortality in elderly with atrial fibrillation during the COVID-19 pandemic. Med Clin (Barc) 2023; 160:71-77. [PMID: 35931571 PMCID: PMC9283695 DOI: 10.1016/j.medcli.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the effect of drug interactions with chronic direct oral anticoagulants (DOAC) on mortality in older atrial fibrillation (AF) patients during the Coronavirus disease 2019(COVID-19) pandemic. METHODS We followed a total of 601 elderly patients (65 years of age) from the NOEL-Drug Registry cohort who were referred to a tertiary outpatient clinic between 9 March 2020 and 1 March 2021. We recorded clinical characteristics and medications for the last 3 months. In addition, all drug interactions were identified using Lexicomp®. Finally, we recorded retrospectively all death events, COVID-19 diagnosis, and relevant deaths from the database at the end of the study. According to logistic regression, we performed propensity score (PS) matching to reduce potential bias. Factors associated with total mortality in the 12 months were analyzed using multivariable Cox proportion hazard analysis. RESULTS The mean age [standard deviation (SD)] was 74.5 (±6.9), and the male/female ratio was 337/264. The prevalence of total mortality was 16.9% (n=102). A total of 4472 drugs were analyzed for DOAC interaction. 81.8% of older AF patients were not at risk in terms of potential interaction. In the Cox proportional hazard model after PS-matching, previous DOAC use with class X interaction was associated with significantly higher mortality risk (adjusted hazard ratio: 2.745, 95% confidence interval: 1.465-5.172, p=0.004). CONCLUSIONS Our study showed that while most co-medications do not have significant interactions with DOACs, few serious drug interactions contribute to mortality in elderly patients with AF during the pandemic.
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Affiliation(s)
- İbrahim Ersoy
- Afyonkarahisar Health Sciences University, Department of Cardiology, Afyonkarahisar, Turkey,Corresponding author
| | - Pınar Ersoy
- Provincial Directorate of Health, Department of Public Health, Afyonkarahisar, Turkey,Public Health Specialist, Afyonkarahisar, Turkey
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Mostaza JM, Salinero-Fort MA, Cardenas-Valladolid J, Rodríguez-Artalejo F, Díaz-Almirón M, Vich-Pérez P, San Andrés-Rebollo FJ, Vicente I, Lahoz C. Factors associated with mortality due to SARS-CoV-2 in the population over 75 years of age in the Community of Madrid. Rev Clin Esp 2022; 222:468-478. [PMID: 35970758 PMCID: PMC9372797 DOI: 10.1016/j.rceng.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/04/2022] [Indexed: 11/30/2022]
Abstract
Objective Various studies have identified factors associated with risk of mortality in patients with SARS-CoV-2 infection. However, their sample size has often been limited and their results partially contradictory. This study evaluated factors associated with COVID-19 mortality in the population of Madrid over 75 years of age, in infected patients, and in hospitalized patients up to January 2021. Patients and Methods This population-based cohort study analyzed all residents of the Community of Madrid born before January 1, 1945 who were alive as of December 31, 2019. Demographic and clinical data were obtained from primary care electronic medical records (PC-Madrid), data on hospital admissions from the Conjunto Mínimo Básico de Datos (CMBD, Minimum Data Set), and data on mortality from the Índice Nacional de Defunciones (INDEF, National Death Index). Data on SARS-CoV-2 infection, hospitalization, and death were collected from March 1, 2020 to January 31, 2021. Results A total of 587,603 subjects were included in the cohort. Of them, 41,603 (7.1%) had confirmed SARS-CoV-2 infection, of which 22,362 (53.7% of the infected individuals) were hospitalized and 11,251 (27%) died. Male sex and age were the factors most closely associated with mortality, though many comorbidities also had an influence. The associations were stronger in the analysis of the total population than in the analysis of infected or hospitalized patients. Mortality among hospitalized patients was lower during the second wave (33.4%) than during the first wave (41.2%) of the pandemic. Conclusion Age, sex, and numerous comorbidities are associated with risk of death due to COVID-19. Mortality in hospitalized patients declined notably after the first wave of the pandemic.
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Affiliation(s)
- J M Mostaza
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna. Hospital La Paz-Carlos III, Madrid, Spain.
| | - M A Salinero-Fort
- Fundación de Investigación Biosanitaria y de Innovación de Atención Primaria (FIIBAP), Instituto de Investigación del Hospital La Paz (IdIPAZ), Red de Investigación en pacientes crónicos (REDISSEC), Subdirección general de Investigación en Salud, Ministerios de Sanidad, Madrid, Spain
| | - J Cardenas-Valladolid
- Dirección Técnica de Sistemas de Información Sanitaria, Gerencia Adjunta de Procesos Asistenciales, Gerencia Asistencial de Atención Primaria, Madrid. Spain
| | - F Rodríguez-Artalejo
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid-IdIPAZ, CIBER de Epidemiología y Salud Pública (CIBERESP) e IMDEA-Alimentación, CEI UAM + CSIC, Madrid, Spain
| | - M Díaz-Almirón
- Unidad de Investigación, Instituto de Investigación Hospital La Paz, IdiPAZ, Madrid, Spain
| | - P Vich-Pérez
- Fundación de Investigación Biosanitaria y de Innovación de Atención Primaria (FIIBAP), Centro de Salud Los Alpes, Madrid, Spain
| | - F J San Andrés-Rebollo
- Fundación de Investigación Biosanitaria y de Innovación de Atención Primaria (FIIBAP), Centro de Salud Las Calesas, Madrid, Spain
| | - I Vicente
- Centro de Salud Monovar, Madrid, Spain
| | - C Lahoz
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna. Hospital La Paz-Carlos III, Madrid, Spain
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Gil-Romero V, Puertas-Molina L, Lleixà-Méndez N, Ibarra-Rubio M. Prevalence and factors associated with malnutrition in hospitalized patients with proximal femur fracture: Experience at Hospital Universitari Mutua Terrassa. Enferm Clin (Engl Ed) 2022; 32:234-238. [PMID: 35216950 DOI: 10.1016/j.enfcle.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/01/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Malnutrition is commonly associated with elderly patients with femoral fractures. Approximately 50% of hospitalized patients with a femoral fracture are malnourished or at risk of malnourishment. This situation may have a negative impact on outcomes and results for these patients. Malnourishment has been associated with an increased risk of complications, mortality, poor recovery, and delayed length of stay. METHOD A retrospective observational study was conducted at our institution to evaluate the prevalence of malnutrition or risk of malnourishment in 766 hospitalized patients from January 2016 to December 2019. Furthermore, we identified factors that are associated with malnutrition. We also compared length of stay and mortality according to the degree of malnutrition. RESULTS The mean age for patients included was 84.6 years and 75% of patients were female. The Mini Nutritional Assessment test results showed 7.9% of patients were malnourished and 31.5% at risk of malnourishment. CONCLUSIONS Our study results indicate a high prevalence of malnutrition and risk of malnourishment in hospitalized elderly patients with a femoral fracture.
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Affiliation(s)
- Verónica Gil-Romero
- Unidad Funcional Interdisciplinaria Sociosanitaria, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Laura Puertas-Molina
- Unidad de Traumatología Geriátrica, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, Spain.
| | - Núria Lleixà-Méndez
- Servicio de Nutrición y Dietética, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Montserrat Ibarra-Rubio
- Servicio de Nutrición y Dietética, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, Spain
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San Martín Arrieta EJ, Jiménez Álvarez G, Quesada Bellver B, Baeza Monedero ME, Fernández Muñoz I, López Cuenca S. [Analysis of the factors involved in the evolution of patients over 80 years of age admitted to the intensive care unit: Should we change our procedure?]. Rev Esp Geriatr Gerontol 2022; 57:182-185. [PMID: 35618527 DOI: 10.1016/j.regg.2022.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/06/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES The care of older patients in intensive care units (ICU) is becoming more frequent. To describe characteristics of elderly patients admitted to the ICU and to analyze the factors associated with mortality. PATIENTS AND METHODS Retrospective cross-sectional study, with patients ≥80 years, admitted to the ICU of the Rey Juan Carlos University Hospital, from March 2012 to December 2018. Demographic variables, comorbidities and mortality in the ICU, in hospital and at one year were collected, analyzed by univariate analysis and binary logistic regression. RESULTS Six hundred twenty patients, mean age 83.6 years (SD: 3.25), 31% required invasive mechanical ventilation (IMV), 25% vasopressors and 29% renal replacement therapy (RRT) due to acute renal failure (ARF). The 60% were admissions of medical origin. In-hospital mortality was 156 patients (25%), 91 died in the ICU and 65 on the ward, with shorter ICU stays for the survivors (2.72; SD: 0.22) compared to the deceased (3.74; SD: 0.38), with statistically significant differences. 63% remained alive one year after ICU discharge. An explanatory model of ICU mortality was obtained by logistic regression that included the following factors: IMV (OR: 5.78, 95% CI 2.73-12.22), vasopressors (OR: 2.54, 95% CI 1.24-5.19), AKI/TRS (OR: 2.69, 95% CI 1.35-5.35), medical admission (OR: 2.88, 95% CI 1.40-5.92), urgent admission (OR: 2.33, 95% CI 1.30-4.18) and limitation of life support (LTSV) (OR: 47.35, 95% CI 22.96-97.68). The days in the ICU (OR: 0.93, 95% CI 0.87-0.99) would be inversely related to mortality. CONCLUSIONS In older patients, there is no increase in mortality, with a 1-year survival >63%. The need for IMV, the use of vasopressor drugs and ARF/RTS were factors associated with mortality in the multivariate analysis.
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Affiliation(s)
| | | | - Belén Quesada Bellver
- Servicio de Medicina Intensiva, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España
| | | | - Irene Fernández Muñoz
- Servicio de Medicina Intensiva, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España
| | - Sonia López Cuenca
- Servicio de Medicina Intensiva, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España
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Rosas C, Oliveira HC, Neri AL, Ceolim MF. Depressive symptoms, symptoms of insomnia and stressful events in hypertensive older adults: Cross-sectional study. Enferm Clin (Engl Ed) 2022; 32:195-202. [PMID: 35690430 DOI: 10.1016/j.enfcle.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/18/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES the aim of this study was to determine whether symptoms of insomnia and intensity of stressful life events are independently associated with depressive symptoms in community-dwelling hypertensive older adults. METHODS this was an observational cross-sectional study. Participants were 438 older adults with arterial hypertension who completed questionnaires about depressive symptoms, stressful events, self-reported symptoms of insomnia and socio-demographic characteristics. Cluster analysis was performed to obtain groups according to insomnia symptoms. The following groups were identified: Poor Sleep Quality, Early Waking and Good Sleep Quality. Associations were tested using linear regression analysis and multiple Poisson regression analysis. RESULTS The factors that independently contributed to the increase of depressive symptoms were belonging to the Poor Sleep Quality group (p<.001) and Early Waking group (p=.005), reporting higher intensity of stressful life events (p<.001) and having less schooling (p=.003). CONCLUSION older adults with hypertension need a comprehensive approach to their health care that considers depressive symptoms and their relationship with intensity of stressful events, insomnia symptoms and schooling.
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Affiliation(s)
- Carola Rosas
- Facultad de Enfermería, Universidade Estadual de Campinas, Campinas, SP, Brazil; Instituto de Enfermería, Universidad Austral de Chile, Valdivia, Los Ríos, Chile.
| | | | - Anita Liberalesso Neri
- Departamento de Psicología y Psiquiatría Médica, Universidade Estadual de Campinas, Campinas, SP, Brazil
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22
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Cáceres Santana E, Bermúdez Moreno C, Ramírez Suarez J, Bahamonde Román C, Murie-Fernández M. Incidence of falls in long-stay hospitals: risk factors and strategies for prevention. Neurologia (Engl Ed) 2022; 37:165-170. [PMID: 35465909 DOI: 10.1016/j.nrleng.2019.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 03/03/2019] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Falls are a major health problem in elderly institutionalised patients, due to the associated high morbidity and mortality rates and the impact on future quality of life. OBJECTIVE To analyse the incidence and patient profile for falls, and to identify potential causes and effects. We also assess the efficacy of intervention in selected patients in preventing further falls. METHODS We performed a prospective study at a long-term care centre for 12 months. Data were collected via fall reports. The falls committee drafted a monthly data collection form. RESULTS A total of 155 falls were recorded in 80 patients, with 40% presenting more than one fall. Patients aged over 70 years accounted for 84.5% of falls; 42.7% of patients are able to walk independently; 55.5% of falls occurred in the bedroom; 74.8% of patients had been prescribed sedatives or psychoactive, or antihypertensive drugs; 27.7% of falls were due to loss of balance and 22.5% were due to patients performing an activity for which they did not have the capacity. Fractures occurred in 1.9% of patients. CONCLUSIONS Patients aged over 70 years, walking independently, receiving sedatives or psychoactive or antihypertensive drugs, and with history of falls were at greatest risk. The majority of falls occurred in the bedroom. Physiotherapy interventions were highly effective in cases selected by the falls committee.
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Affiliation(s)
- E Cáceres Santana
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), Spain
| | - C Bermúdez Moreno
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), Spain
| | - J Ramírez Suarez
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), Spain
| | - C Bahamonde Román
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), Spain
| | - M Murie-Fernández
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), Spain.
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Cáceres Santana E, Bermúdez Moreno C, Ramírez Suarez J, Bahamonde Román C, Murie-Fernández M. Incidence of falls in long-stay hospitals: risk factors and strategies for prevention. Neurologia 2022; 37:165-170. [PMID: 31056217 DOI: 10.1016/j.nrl.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 02/13/2019] [Accepted: 03/03/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Falls are a major health problem in elderly institutionalised patients, due to the associated high morbidity and mortality rates and the impact on future quality of life. OBJECTIVE To analyse the incidence and patient profile for falls, and to identify potential causes and effects. We also assess the efficacy of intervention in selected patients in preventing further falls. METHODS We performed a prospective study at a long-term care centre for 12 months. Data were collected via fall reports. The falls committee drafted a monthly data collection form. RESULTS A total of 155 falls were recorded in 80 patients, with 40% presenting more than one fall. Patients aged over 70 years accounted for 84.5% of falls; 42.7% of patients are able to walk independently; 74.8% of patients had been prescribed sedatives or psychoactive, or antihypertensive drugs; 55.5% of falls occurred in the bedroom; 27.7% of falls were due to loss of balance and 22.5% were due to patients performing an activity for which they did not have the capacity. Fractures occurred in 1.9% of patients. CONCLUSIONS Patients aged over 70 years, walking independently, receiving sedatives or psychoactive or antihypertensive drugs, and with history of falls were at greatest risk. The majority of falls occurred in the bedroom. Physiotherapy interventions were highly effective in cases selected by the falls committee.
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Affiliation(s)
- E Cáceres Santana
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), España
| | - C Bermúdez Moreno
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), España
| | - J Ramírez Suarez
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), España
| | - C Bahamonde Román
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), España
| | - M Murie-Fernández
- Unidad de Neurorrehabilitación, Hospital ICOT Ciudad de Telde, Telde (Las Palmas), España.
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Fuertes Abardía C, Ballesta Juan P, Cruz Esteve I, Galindo Ortego G, Marsal Mora JR, Gómez-Arbonés X. [Potentially inappropriate prescribing: Usefulness of STOPP/START criteria version 2 in Catalonian elderly population]. Semergen 2022; 48:163-173. [PMID: 35151557 DOI: 10.1016/j.semerg.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/03/2021] [Accepted: 09/11/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To measure the prevalence of potentially inappropriate prescribing (PIP) among the elderly population in Catalonia using criteria Screening Tool of Older Person's Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) version 2. In addition, to evaluate the association between PIP and several factors (polypharmacy, gender, age and sociodemographic conditions). MATERIALS AND METHODS Design: Retrospective cross sectional population study. SETTINGS Primary Health Care, Catalonia, Spain. PARTICIPANTS The study population comprised of participants 70 years old and over, who attended primary health care centres in Catalonia in 2014 (700.058 patients). MAIN ANALYSIS 55 STOPP and 19 START criteria are applied to analyse PIP prevalence. Logistic regression models are adjusted to determine PIP association with several factors. RESULTS The mean age is 79. 2±6.5. 58.5% being female. 38.7% of patients have 7 or more prescribed drugs, whereas 50% go to a primary care centre 10 or more times during one year. The most frequent PIP among STOPP criteria are related to nonsteroidal anti-inflammatory drug intake, antiplatelet and anticoagulants use, and benzodiazepines. According to START, the most frequent omissions are vitamin D and calcium supplements, antidepressants, and cardiovascular medications. Factors that increase PIP are: female gender, living in a nursing home, receiving home health care, polypharmacy and frequent visits to primary care centres. CONCLUSIONS The overall prevalence of PIP is 89.6%. PPI is significantly related to certain drugs and patient's conditions. The knowledge of this association is important for the implementation of security measures for medical prescription.
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Affiliation(s)
- C Fuertes Abardía
- Centro de Atención Primaria Primer de Maig, Institut Català de la Salut, Lleida, España.
| | - P Ballesta Juan
- Centro de Salud Elx Carrús Este, Departamento de Salud del Vinalopó, Elche, España
| | - I Cruz Esteve
- Centro de Atención Primaria Primer de Maig, Institut Català de la Salut, Lleida, España
| | - G Galindo Ortego
- Centro de Atención Primaria Primer de Maig, Institut Català de la Salut, Lleida, España
| | - J R Marsal Mora
- Unitat de Suport a la Recerca Lleida-Pirineus, Institut d'Investigació en Atenció Primària J Gol (IDIAP J Gol), Lleida, España
| | - X Gómez-Arbonés
- Departamento de Medicina, Universitat de Lleida, Lleida, España; Institut de Recerca Biomèdica de Lleida (IRB Lleida), Lleida, España
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25
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Pineño-Flores C, Ambrona-Zafra D, Rodríguez-Pino JC, Soldevila-Verdeguer C, Palma-Zamora E, Molina-Romero FX, Morón-Canis JM, González-Argente FX, Morales-Soriano R. Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely? Cir Esp 2022; 100:125-132. [PMID: 35221240 DOI: 10.1016/j.cireng.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/17/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population. METHODS Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018. The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients ≥75 years (elderly). RESULTS 79 patients were included, 21 of them older than 75 years (27%); within this group, 23'9% were over 80 years old. The ASA of both groups was similar. Patients ≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P = .037). Morbidity was higher in the elderly (61.9% vs. 46.6%), although without differences. Patients aged ≥75 years had more non-surgical complications (33.3%, P = .050), being pneumonia the most frequent. Postoperative mortality was higher in the ≥75 years (9 vs. 0%; P = .017). The overall survival and disease-free survival did not show significant differences in both groups. CONCLUSIONS Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC.
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Affiliation(s)
- Cristina Pineño-Flores
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain.
| | - David Ambrona-Zafra
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain
| | - Jose Carlos Rodríguez-Pino
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Carla Soldevila-Verdeguer
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain
| | - Elias Palma-Zamora
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Francesc Xavier Molina-Romero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Balearic Islands, Spain
| | - Jose Miguel Morón-Canis
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Francesc Xavier González-Argente
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Balearic Islands, Spain
| | - Rafael Morales-Soriano
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Balearic Islands, Spain
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Llàcer P, Núñez J, Manzano L, Cepeda Rodrigo JM, Salamanca Bautista P, Guzmán García M, Trullás Vila JC, Quirós López R, López Reboiro ML, Montero-Pérez-Barquero M. Carbohydrate antigen 125 (CA125) as a prognostic marker in the elderly with acute heart failure and preserved ejection fraction. Med Clin (Barc) 2021; 159:164-170. [PMID: 34895749 DOI: 10.1016/j.medcli.2021.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Carbohydrate antigen 125 (CA125) has emerged as a new biomarker in heart failure. The objective of the study is to determine whether serum CA125 levels predict total mortality and readmissions at one year in patients >70 years old with acute heart failure (AHF) and preserved ejection fraction (PEF). METHODS Multicenter prospective observational study, which included 359 patients (mean age 81.5 years). The primary endpoint was total all-cause mortality and total readmissions for AHF at 1 year. A negative binomial regression technique was used to evaluate the association between CA125 and both endpoints. RESULTS At one year of follow-up, 87 deaths (24.2%) were registered. The patients in the lower quartile of CA125 had a lower crude mortality rate (14.4%, 26.7, 26.7, 29.2; p=0.09). After multivariate analysis, the CA125 value was positively associated with a higher risk (p=0.009). Such association was also positive but borderline significant for the risk of readmissions (p=0.089). CONCLUSIONS In a population older than 70 years hospitalized for AHF with PEF, elevated levels of CA125 are associated with an increased risk of death at one year of follow-up. The association with readmission for AHF was more uncertain. Low levels of CA125 identifies a subgroup at low-risk.
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Affiliation(s)
- Pau Llàcer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España.
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valéncia, INCLIVA, Valencia, España; CIBER Cardiovascular, Madrid, España
| | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España; Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, España
| | | | | | | | - Joan Carles Trullás Vila
- Servicio de Medicina Interna, Hospital d'Olot i comarcal de la Garrtoxa, Girona, Universitat de Vic - Universitat Central de Catalunya, Barcelona, España
| | - Raúl Quirós López
- Servicio de Medicina Interna, Hospital de la Costa del Sol, Marbella, Málaga, España
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Velarde-Mayol C, de la Hoz-García B, Angulo-Sevilla D, Torres-Barriga C. [Health consequences (mortality and institutionalization) of hip fracture among the elderly people: Population cohort study in Segovia]. Aten Primaria 2021; 53:102129. [PMID: 34157660 PMCID: PMC8220413 DOI: 10.1016/j.aprim.2021.102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE In order to know the social and health consequences of hip fractures (HF). DESIGN A retrospective cohort study of an entire health area was carried out in patients aged 75 or more, over a period of 5 years. SITE: Segovia Health Area. PARTICIPANTS All patients older than 75 years with a diagnosis of HF, excluding displaced and passerby. INTERVENTIONS The socio-sanitary changes that occur after the HF in respect to their baseline situation (family situation, comorbidities, dependence and mental situation) and the variables which most influence mortality and institutionalization after the HF were analyzed. MAIN MEASUREMENTS One thousand one hundred fifty-nine HF were recorded, with a constant annual incidence of 10.7‰. The prevalence was higher in women: 7.4% versus 3.7%. RESULTS The baseline profile is a pluripatological, non-institutionalized, 87-year-old woman, who retains her independent in her daily life and suffers from a HF due to an accidental fall in her home. At the end of the study period 51% were permanently institutionalized, negatively influencing having worse mental deterioration, worse dependence and subsequent readmissions and in addition, 45.5% died, 25.5% during the first year. The most unfavorable conditions were being previously dependent, having severe mental deterioration, male and within the comorbidities the most influential was previously having an anemia. CONCLUSIONS Our data confirms the deterioration of the autonomy-functional capacity after a HF, in line with what has been published, and has allowed to identify which elderly people are at the greatest risk of complications in the short and medium term (institutionalization and death).
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Affiliation(s)
| | | | - David Angulo-Sevilla
- Medicina de Familia y Comunitaria, Centro de Salud Segovia 1 y Unidad Docente Multiprofesional de Atención Familiar y Comunitaria de Segovia, Segovia, España
| | - Corina Torres-Barriga
- Medicina de Familia y Comunitaria, Centro de Salud Segovia 1 y Unidad Docente Multiprofesional de Atención Familiar y Comunitaria de Segovia, Segovia, España
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González-Franco Á, Cerqueiro González JM, Arévalo-Lorido JC, Álvarez-Rocha P, Carrascosa-García S, Armengou A, Guzmán-García M, Trullàs JC, Montero-Pérez-Barquero M, Manzano L. Morbidity and mortality in elderly patients with heart failure managed with a comprehensive care model vs. usual care: The UMIPIC program. Rev Clin Esp 2021; 222:123-130. [PMID: 34615617 DOI: 10.1016/j.rceng.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Elderly patients with heart failure (HF) have a high degree of comorbidity which leads to fragmented care, with frequent hospitalizations and high mortality. This study evaluated the benefit of a comprehensive continuous care model (UMIPIC program) in elderly HF patients. METHODS AND RESULTS We prospectively analyzed data from the RICA registry on 2862 patients with HF treated in internal medicine departments. They were divided into two groups: one monitored in the UMIPIC program (UMIPIC group, n: 809) and another which received conventional care (RICA group, n: 2.053). We evaluated HF readmissions during 12 months of follow-up and total mortality after episodes of HF hospitalization. UMIPIC patients were older with higher rates of comorbidity and preserved ejection fraction than the RICA group. However, the UMIPIC group had a lower rate of HF readmissions (17% vs. 26%, p < .001) and mortality (16% vs. 27%, respectively; p < .001). In addition, we selected 370 propensity score-matched patients from each group and the differences in HF readmissions (15% UMIPIC vs. 30% RICA; hazard ratio [HR] = 0.44; 95% confidence interval [CI] 0.32-0.60; p < .001) and mortality (17% UMIPIC vs. 28% RICA; hazard ratio = 0.58; 95% CI 0.42-0.79; p = .001) were maintained. CONCLUSIONS The implementation of the UMIPIC program, based on comprehensive continuous care of elderly patients with HF and high comorbidity, markedly reduce HF readmissions and total mortality.
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Affiliation(s)
- Á González-Franco
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | - J C Arévalo-Lorido
- Servicio de Medicina Interna, Hospital Comarcal de Zafra, Zafra, Badajoz, Spain
| | - P Álvarez-Rocha
- Servicio de Medicina Interna y Cardiología, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - S Carrascosa-García
- Servicio de Medicina Interna, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - A Armengou
- Servicio de Medicina Interna, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - M Guzmán-García
- Servicio de Medicina Interna, Hospital San Juan de la Cruz, Jaén, Spain
| | - J C Trullàs
- Servicio de Medicina Interna, Hospital d'Olot i comarcal de la Garrotxa, Girona, Spain; Laboratori de Reparació i Regeneració Tissular (TR2Lab), Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya, Vic, Barcelona, Spain
| | - M Montero-Pérez-Barquero
- Servicio de Medicina Interna, IMIBIC/Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - L Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain
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Abad-Corpa E, Lidón-Cerezuela B, Meseguer Liza C, Arredondo-Gónzalez CP, de la Cuesta-Benjumea C. [The care in the prevention of falls in elderly people: Meta-summary of qualitative articles]. Aten Primaria 2021; 53:102067. [PMID: 33940462 PMCID: PMC8111575 DOI: 10.1016/j.aprim.2021.102067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/23/2020] [Accepted: 03/01/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To summarize the qualitative evidence on the role of care providers in the prevention of falls of persons over 65 years of age in centres and in the community. DESIGN Meta-summary of qualitative evidence following the aggregation method. DATA SOURCES Extensive manual search of 16 databases (CINAHL, Pubmed/Medline, Embase, PsycInfo, Cochrane Library, PeDRO, Opengrey (Reports), Cuiden, Cuidatge, Enfispo, Medes, Lilacs, Teseo, Dissertation and Thesis Global and Ibecs), in English, French, Spanish and Portuguese; no time limit. SELECTION OF STUDIES Selection and blind critical appraisal by pairs. A first relevance and relevance screening and a second critical appraisal screening were carried out. A total of 4170 articles were located; 41 qualitative articles were critically appraised and 31 were selected. DATA EXTRACTION Data regarding author, year, study design, location, participants (number, age, sex and occupation), study methods and findings were extracted. RESULTS The analysis revealed four major themes: precipitating factors, preventive models, feelings and decision-making process. It also highlights the difficult act of ethical balance, the role of the institution in prevention and the fragmentation of care, as keys to successful implementation. CONCLUSIONS The findings show the complexity of fall prevention and the need to incorporate care providers' opinions in preventive models.
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Affiliation(s)
- Eva Abad-Corpa
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Murcia, Murcia, España; Hospital Reina Sofía, Servicio Murciano de Salud, Murcia, España; Instituto Murciano de Investigación Biosanitaria, IMIB-Arrixaca, El Palmar, Murcia, España; Unidad de Investigación en Cuidados y Servicios de Salud, Investén-isciii. Instituto de Salud Carlos III, Madrid, España; Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable, CIBERFES. Instituto de Salud Carlos III, Madrid, España
| | - Beatriz Lidón-Cerezuela
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Murcia, Murcia, España; Instituto Murciano de Investigación Biosanitaria, IMIB-Arrixaca, El Palmar, Murcia, España.
| | - Cristóbal Meseguer Liza
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Murcia, Murcia, España; Gerencia de Urgencias y Emergencias 061, Servicio Murciano de Salud, Murcia, España
| | | | - Carmen de la Cuesta-Benjumea
- Departamento de Psicología de la Salud, Universidad de Alicante, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
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30
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Vallejo Maroto I, Cubo Romano P, Mafé Nogueroles MC, Matesanz-Fernández M, Pérez-Belmonte LM, Said Criado I, Gómez-Huelgas R, Díez Manglano J. Recommendations on the comprehensive, multidimensional assessment of hospitalized elderly people. Position of the Spanish Society of Internal Medicine. Rev Clin Esp 2021; 221:347-358. [PMID: 38108495 DOI: 10.1016/j.rce.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
This position paper describes the most relevant and essential aspects of a comprehensive, multidimensional assessment of hospitalized elderly people. The change in demographic patterns and the epidemiological profiles of diseases makes it necessary for internal medicine departments to adapt in order to take into account the vulnerabilities of the elderly in this context. A comprehensive, multidimensional assessment and the multidisciplinary development of a care plan during hospitalization can have an impact in terms of preventing mortality, disability, and institutionalization at discharge. It is necessary for all internists to acquire skills to improve the hospitalization experience in the elderly and obtain better health outcomes in our patients. This document has been developed by the Focus Group on Aging and the Polypathological and Advanced Age Working Group and endorsed by the Spanish Society of Internal Medicine.
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Affiliation(s)
- I Vallejo Maroto
- Unidad de Continuidad Asistencial de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - P Cubo Romano
- Unidad del Paciente Crónico Complejo, Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Madrid, España
| | - M C Mafé Nogueroles
- Servicio de Medicina Interna, Hospital de Crónicos y Larga Estancia La Pedrera, Alicante, España
| | - M Matesanz-Fernández
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti de Lugo, Lugo, España
| | - L M Pérez-Belmonte
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, España
| | - I Said Criado
- Servicio de Urgencias, Hospital Álvaro Cunqueiro, Vigo, España
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, España
| | - J Díez Manglano
- Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, España
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Vallejo Maroto I, Cubo Romano P, Mafé Nogueroles MC, Matesanz-Fernández M, Pérez-Belmonte LM, Said Criado I, Gómez-Huelgas R, Díez Manglano J. Recommendations on the comprehensive, multidimensional assessment of hospitalized elderly people. Position of the Spanish Society of Internal Medicine. Rev Clin Esp 2021; 221:347-358. [PMID: 34059234 DOI: 10.1016/j.rceng.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022]
Abstract
This position paper describes the most relevant and essential aspects of a comprehensive, multidimensional assessment of hospitalized elderly people. The change in demographic patterns and the epidemiological profiles of diseases makes it necessary for internal medicine departments to adapt in order to take into account the vulnerabilities of the elderly in this context. A comprehensive, multidimensional assessment and the multidisciplinary development of a care plan during hospitalization can have an impact in terms of preventing mortality, disability, and institutionalization at discharge. It is necessary for all internists to acquire skills to improve the hospitalization experience in the elderly and obtain better health outcomes in our patients. This document has been developed by the Focus Group on Aging and the Polypathological and Advanced Age Working Group and endorsed by the Spanish Society of Internal Medicine.
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Affiliation(s)
- I Vallejo Maroto
- Unidad de Continuidad Asistencial de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - P Cubo Romano
- Unidad del Paciente Crónico Complejo, Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Madrid, Spain
| | - M C Mafé Nogueroles
- Servicio de Medicina Interna, Hospital de Crónicos y Larga Estancia La Pedrera, Alicante, Spain
| | - M Matesanz-Fernández
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti de Lugo, Lugo, Spain
| | - L M Pérez-Belmonte
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - I Said Criado
- Servicio de Urgencias, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - J Díez Manglano
- Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain
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Crespo-Fresno A, Vidal-Guitart X, Sánchez-Raya J, Pagès-Bolíbar E, Cuxart-Fina A. Predictive validity of the functional capacity of the CUPAX questionnaire in older adults with hip fracture. Med Clin (Barc) 2021; 158:111-117. [PMID: 33846003 DOI: 10.1016/j.medcli.2020.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Osteoporotic hip fracture is a relevant pathology due to its prevalence and social and health impact. The aim of this study is to explore the predictive validity of the CUPAX questionnaire on mortality, place of residence and post-fracture functionality. MATERIALS AND METHODS Prospective observational study. Two hundred and six patients older than 65 years were included, admitted after a hip fracture. The CUPAX questionnaire score was collected before fracture and one year later, and the place of residence and survival at hospital discharge, and after 6 and 12 months. The statistical analysis was carried out with the SAS® 9.4 and Stata® 13.1 programmes. RESULTS The median age of the sample was 87.0 years (80.1% women). The in-hospital and one-year mortality rate were 5.8% and 19.1%, respectively. Most of the patients were admitted from home (71.4%), and the most frequent discharge destination was a social health centre (48.2%). The percentage of retention of previous functional level in the total sample was 50%, being higher in the younger patients. The area under the curve ROC for mortality one year later was .697 (95% CI .626-.760) and .659 (95% CI .576-.741) for the discharge destination of patients admitted from home. Evaluation of functional retention one year after the fracture, identified three groups of patients based on the pre-fracture CUPAX value. CONCLUSIONS These findings support the clinical utility of the CUPAX questionnaire as a predictive functional tool in elderly patients with hip fracture.
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Affiliation(s)
- Almudena Crespo-Fresno
- Servicio de Medicina Física y Rehabilitación, Hospital Vall d'Hebron, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España.
| | - Xavier Vidal-Guitart
- Universidad Autónoma de Barcelona, Barcelona, España; Servicio de Farmacología Clínica, Hospital Vall d'Hebron, Barcelona, España
| | - Judith Sánchez-Raya
- Servicio de Medicina Física y Rehabilitación, Hospital Vall d'Hebron, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España
| | - Esther Pagès-Bolíbar
- Servicio de Medicina Física y Rehabilitación, Hospital Nostra Senyora de Meritxell, Andorra la Vella, Andorra
| | - Ampar Cuxart-Fina
- Servicio de Medicina Física y Rehabilitación, Hospital Vall d'Hebron, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España
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Pineño-Flores C, Ambrona-Zafra D, Rodríguez-Pino JC, Soldevila-Verdeguer C, Palma-Zamora E, Molina-Romero FX, Morón-Canis JM, González-Argente FX, Morales-Soriano R. Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely? Cir Esp 2021; 100:S0009-739X(21)00029-4. [PMID: 33714556 DOI: 10.1016/j.ciresp.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/03/2021] [Accepted: 01/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population. METHODS Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018.The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients≥75 years (elderly). RESULTS 79 patients were included, 21 of them older than 75 years (27%); within this group, 23.9% were over 80 years old. The ASA of both groups was similar. Patients≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P=.037). Morbidity was higher in the elderly (61.9 vs. 46.6%), although without differences. Patients aged≥75 years had more non-surgical complications (33.3%, P=.050), being pneumonia the most frequent. Postoperative mortality was higher in the≥75 years (9 vs. 0%; P=.017). The overall survival and disease-free survival did not show significant differences in both groups. CONCLUSIONS Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC.
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Affiliation(s)
- Cristina Pineño-Flores
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España.
| | - David Ambrona-Zafra
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Cataluña, España
| | - Jose Carlos Rodríguez-Pino
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | - Carla Soldevila-Verdeguer
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España
| | - Elias Palma-Zamora
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | - Francesc Xavier Molina-Romero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Baleares, España
| | - Jose Miguel Morón-Canis
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España
| | - Francesc Xavier González-Argente
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España; Facultad de Medicina, Universidad de las Islas Baleares, Palma de Mallorca, Baleares, España
| | - Rafael Morales-Soriano
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Son Espases, Palma de Mallorca, Baleares, España; Instituto de Investigación Sanitaria de Islas Baleares (IdISBa), Hospital Universitari Arnau de Villanova, Palma de Mallorca, Baleares, España
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Sánchez-Ortiz M, García-Simón E, Mateo-Abad A, Soguero-Pérez MDM, Castro-Vilela ME. [Bladder catheterization in the hospitalized elderly people]. Rev Esp Geriatr Gerontol 2021; 56:96-99. [PMID: 33303258 DOI: 10.1016/j.regg.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/27/2020] [Accepted: 09/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To determine the prevalence of patients with bladder catheterization in a geriatrics service and to analyze the factors associated with the use of urinary catheterization in hospitalized elderly people. MATERIAL AND METHOD This descriptive and retrospective study (January to December 2019) included all the patients admitted to a geriatric service, with bladder catheterization during their hospital admission. Sociodemographic and clinical data were collected. RESULTS In 2019, 10.20% of the patients admitted required urinary catheters. Most of these patients were males (60.6%), with an average age of 86.5 years (SD: 8.65). 43.4% of the urinary catheters that were placed temporarily were indicated in the geriatric unit, 28.9% in another medical service and 26.3% in the emergency department. The median of days with a urinary catheter was 7.5 days. The most common reason to indicate a urinary catheter was acute urinary retention (AUR) (67.7%). At hospital discharge, 22.3% of the patients needed to continue with a urinary catheter at home, without needing it prior to admission. CONCLUSIONS In our study, a high percentage of bladder catheterization was needed during the hospitalization, the most common cause being AUR. The average use (in days) of urinary catheters is high, with the consequent risk of nosocomial urinary tract infections. It is necessary to improve the prescribing habits of urinary catheterization and its early withdrawal through specific educational efforts and avoiding their inappropriate use.
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Affiliation(s)
| | | | - Ana Mateo-Abad
- Servicio de Geriatría, Hospital San José, Teruel, España
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Eroles-Busquets M, García-Cerdán MR, Mejías-Serrano MT, Giner-Nogueras R, Vázquez-González I, Reinoso-Iñiguez JI. Study of the prevalence of the risk of malnutrition in the non-institutionalized population over 65 years old attended in a health center in Barcelona. Enferm Clin (Engl Ed) 2021; 31:71-81. [PMID: 33358680 DOI: 10.1016/j.enfcli.2020.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 10/02/2020] [Accepted: 10/25/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To know the prevalence of risk of malnutrition in community-dwelling elderly (defined as aged >65) attended in a Primary Care Center, to find the main factors associated to malnutrition risk and to evaluate the Mini Nutritional Assessment Questionnaire (MNA) MNA Short Form vs. MNA Full Test. METHOD Design: Cross-Sectional study. SETTING Primary Care Center. SUBJECTS 337 participants visited in the Community Care Center. Mini Nutritional Assessment Questionnaire (MNA) was applied; sociodemographic and Health variables were collected as well as functional evaluation tests (Short Portable Mental Status Questionnaire and Lawton & Brody Instrumental Activities of Daily Living Scale). Clinical history information was taken from the Medical Records. Using MNA Full Test (MNA-FT) as the gold standard, sensitivity, specificity and predictive values of MNA Short Form (MNA-SF) were evaluated. RESULTS prevalence according MNA-FT was 0.6% for malnutrition and 7.7% for malnutrition risk. No gender differences were found. The average age was higher in the population with malnutrition or at risk for malnutrition (p=0.016). Significant association of malnutrition with having carer (p<0.0001) or being more dependent (p<0.0001) was found. MNA-SF showed an acceptable sensitivity (67.9%) and good specificity (92.6%). CONCLUSIONS Compared with other studies this data showed a low prevalence of malnutrition risk in community-living elderly using the MNA test. It is recommended to use the MNA-FT in order to avoid under diagnosing malnutrition with MNA-SF.
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Affiliation(s)
- Montserrat Eroles-Busquets
- Equipo de Atención Primaria (EAP) Camps Blancs, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España.
| | - M Rosa García-Cerdán
- Equipo de Atención Primaria (EAP) Camps Blancs, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - M Trinidad Mejías-Serrano
- Equipo de Atención Primaria (EAP) Camps Blancs, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - Roser Giner-Nogueras
- Equipo de Atención Primaria (EAP) Camps Blancs, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - Inés Vázquez-González
- Equipo de Atención Primaria (EAP) Camps Blancs, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - Jana Isabel Reinoso-Iñiguez
- Equipo de Atención Primaria (EAP) Camps Blancs, Institut Català de la Salut, Sant Boi de Llobregat, Barcelona, España; Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
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Martínez Valero AP, Amo-Saus E, Pardo-García I, Escribano-Sotos F. [Diet quality in a population aged over 65 and related socioeconomic factors]. Aten Primaria 2021; 53:27-35. [PMID: 32143973 PMCID: PMC7752958 DOI: 10.1016/j.aprim.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/19/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The consumption of certain foods and healthy eating habits are related to preventing and suffering from a number of chronic diseases. These foods tend to be included in food pyramids, such as that proposed by the Spanish Society for Community Nutrition. One method of analysing diet quality is the use of indices that assess the frequency of consumption of different food groups. AIM To analyse diet quality in a Spanish population of persons aged over 65years using the Healthy Eating Index and to determine how sociodemographic factors affect scores on the index. DESIGN A cross-sectional, descriptive study was conducted on the diet followed at home by Spanish population aged over 65years, using the Healthy Eating Index and taking information from the 2014 European Health Interview Survey in Spain. Multiple linear regression analysis was used to determine the socioeconomic factors associated with diet quality. RESULTS Of the study population, 89.6% need to make changes in their diet, while only 8.2% follow a healthy diet. Suffering from chronic diseases, overweight and occasional physical exercise were associated with higher scores on the Healthy Eating Index. CONCLUSION Most of the population aged 65years or over need to make changes in their dietary patterns. Those with potential health risks are more careful about their diet. These findings confirm the need to promote guidelines for healthy eating in the non-clinical population.
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Affiliation(s)
- Ana Pilar Martínez Valero
- Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha (UCLM), Cuenca, España; Servicios de Salud de Castilla-La Mancha (SESCAM), Albacete, España
| | - Elisa Amo-Saus
- Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha (UCLM), Albacete, España.
| | - Isabel Pardo-García
- Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha (UCLM), Cuenca, España; Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha (UCLM), Albacete, España
| | - Francisco Escribano-Sotos
- Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha (UCLM), Cuenca, España; Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha (UCLM), Albacete, España
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Rivera-Chávez JG, Torres-Gutiérrez JL, Regalado-Villalobos A, Moreno-Cervantes CA, Luna-Torres S. Association between falls and cardiovascular diseases in the geriatric population. Arch Cardiol Mex 2021; 91:66-72. [PMID: 33661879 PMCID: PMC8258912 DOI: 10.24875/acm.20000024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/25/2020] [Indexed: 12/30/2022] Open
Abstract
Objective To determine the association of cardiovascular diseases with falls in the geriatric population. Methods Original, Transversal and analytical study. Elderly patients who attend the external consultation of the Geriatrics service, older than 65 years, with falls history, perform comprehensive geriatric assessment to indentify causes of falls in the period from March 2018 to June 2019. We perform measures of central tendency, chi-square test X2 for qualitative variables, we performed linear regression model. Results A total of 669 patients were included, the analysis shows association with frailty [OR 1.65 (95% CI 1.37-3.77), p <0.05], Heart Failure [OR 1.02, (95% CI, 0.68 - 1.54), p < 0.05 ], the logistic regression analysis with the variables (Fragility, SAH, es: DM2, AMI, Stroke, AF, postural hypotensive syncope, Hypothyroidism, Dyslipidemia, and HF) shows that the probability of falling is 57%. Conclusion Cardiovascular diseases have a high prevalence in the population studied and increase the risk of falls. Individually analyzed cardiovascular diseases do not show an association with the syndrome of falls in the elderly, except for frailty, which proved to be an independent factor that increases the risk of falls with an OR 1.65. When analyzing them together, the risk of falling increases up to 57%. It is necessary to correctly identify and treat cardiovascular diseases in the elderly.
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Affiliation(s)
- José G. Rivera-Chávez
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
| | - Jorge L. Torres-Gutiérrez
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
| | - Alejandra Regalado-Villalobos
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
| | - César A. Moreno-Cervantes
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
| | - Sara Luna-Torres
- Geriatrics Service, Regional Hospital of the Institute of Social Security and Services of State Workers (ISSSTE), Regional Hospital, Health Sciences Division, Leon Campus, University of Guanajuato (UG). León, Guanajuato, Mexico
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Lopez Cuenca S, Oteiza L, Lazaro Martín N, Ibarz M, Irazabal M, Artigas A, Lorente JA. [ISAR Score (Identification of Seniors At Risk) predicts mortality in patients older than 75 years admitted in Intensive Care]. Rev Esp Geriatr Gerontol 2020; 56:5-10. [PMID: 33309421 DOI: 10.1016/j.regg.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/16/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Currently, the patient's baseline situation is a more important prognostic factor than age. The purpose of this study is to estimate the prognostic value of the ISAR score (Identification of Senior at Risk) in patients ≥75 years admitted to intensive care (ICU). PATIENTS AND METHODS Prospective multicenter study including patients ≥75 years admitted to the ICU > 24hours. On admission, 28 days and 6 months after discharge from the ICU, mortality and baseline were evaluated using the ISAR score, the Lawton and Brody scale (LB) and the Barthel index (BI), the Frail fragility scale. scale (FS), the Charlson comorbidity index (ICC), Dementia rating score (DRC). RESULTS 38 of 94 patients (40%) were high risk (ISAR ≥ 3) and were characterized by BI 90 (65-100), LB 4 (3-5), and CDR 1 (0-2), ICC 7.5 (6-10). 58% had FS ≥ 3. In the long term, they were in a situation of dependency [BI 50 (2.5-77.5), LB 3 (0-4), CDR 1 (0-1.5)]. The ICU mortality at 28 days and 6 months was 18.4%, 25.7% and 35.3%, respectively, being statistically significant. The area under the ISAR score ROC curve was 0.749 to 0.797, in all the mortality periods studied, although the difference with other predictive variables was not significant, but the p value was the lowest. CONCLUSIONS The ISAR score predicts mortality in critically elderly patients with a discriminative capacity comparable to other predictive variables.
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Affiliation(s)
- Sonia Lopez Cuenca
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | - Lorena Oteiza
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Noelia Lazaro Martín
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - Mercedes Ibarz
- Servicio de Medicina Intensiva, Hospital Universitario Sagrat Cor, Barcelona, España
| | - Marian Irazabal
- Servicio de Medicina Intensiva, Hospital Universitario General de Cataluña, Barcelona, España
| | - Antonio Artigas
- Corporación Universitaria Parc Taulí, CIBER de Enfermedades Respiratorias, Universidad Autónoma de Barcelona, Sabadell, Barcelona, España; Departamento de Medicina Intensiva, Hospitales Universitarios Sagrado Corazón, General de Cataluña, Quirón Salud, Barcelona-San Cugat del Vallès, España
| | - José A Lorente
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid, España; CIBER de Enfermedades Respiratorias, Madrid, Universidad Europea, Madrid, España
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Martinez-Peromingo J, Castañeda A, Muñana A, Baeza ME, de Peralta P, Fuentes C, Barba R. Acute care for elderly patients in a functional impairment prevention unit. Rev Clin Esp 2020; 220:548-552. [PMID: 31780072 DOI: 10.1016/j.rce.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/30/2022]
Abstract
AIM To determine whether the care of patients with moderate dependency who were hospitalised in a functional impairment prevention unit (FIPU) was superior to that of a conventional unit (CU) in terms of functional impairment and mean stay. METHODS We conducted a single-centre, retrospective, controlled intervention study that compared acute treatment in an FIPU and in conventional wards. The study included 466 elderly patients with moderate dependence (Barthel index, 30-70) and older than 75 years. Of these, 280 were included in the intervention group and 186 in the control group. The primary outcomes were loss of functionality attributable to the hospitalisation (measured by the loss of ambulation and urinary continence) and differences in the length of stay. RESULTS The patients hospitalised in the FIPU showed less functional impairment as determined by the loss of urinary continence (2.1% of the FIPU patients vs. 9.7% of the CU patients; p<.01) and the loss of walking ability (2.1% vs. 25.3%; p<.01). The patients hospitalised in the FIPU had a shorter mean stay (7.4 vs. 8.5 days; p<.05), with 1 day less of stay than the CU patients. CONCLUSION The acute care of elderly patients with moderate dependency in an FIPU was independently associated with less functional decline and shorter stays.
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Affiliation(s)
| | - A Castañeda
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - A Muñana
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - M E Baeza
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - P de Peralta
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - C Fuentes
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España
| | - R Barba
- Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, España.
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de la Cuesta-Benjumea C, Arredondo-González CP, Lidón-Cerezuela B, Abad-Corpa E. [Fall prevention in older people and their families: a qualitative synthesis]. Gac Sanit 2020; 35:186-192. [PMID: 33268110 DOI: 10.1016/j.gaceta.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyse and synthesize the evidence on fall prevention of people older than 65 years and their family care providers METHOD: Qualitative synthesis, which is a part of a convergent systematic integrative review. Forty-one qualitative studies were retained for full text scrutiny. Nine studies on family care providers were selected for this synthesis. RESULTS Care providing, and kinship relationships mediated family care providers' interventions to prevent falls in older people. The fall of the dependent relative constitutes a turning point in these relationships. Family care providers are vulnerable to having a fall themselves and therefore receivers of preventive interventions. CONCLUSIONS Taking into account the context of care and family relations will improve the effectiveness of preventive interventions and will facilitate adherence. Fall prevention policy and programmes must pay better attention to the health and wellbeing of family care providers.
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Affiliation(s)
- Carmen de la Cuesta-Benjumea
- Departamento de Psicología de la Salud, Universidad de Alicante, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, España
| | | | | | - Eva Abad-Corpa
- Departamento de Enfermería, Universidad de Murcia, Murcia, España; Hospital Reina Sofía, Servicio Murciano de Salud, Murcia, España; IMIB-Arrixaca; Investén-iscii, Murcia, España; CIBERFES, Murcia, España
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García-Prieto AM, Verdalles Ú, de José AP, Verde E, Arroyo D, Aragoncillo I, Linares T, Barbieri D, Goicoechea M. The effect of renin-angiotensin-aldosterone system blockers on the progression of chronic kidney disease in hypertensive elderly patients without proteinuria: PROERCAN study. Rationale and design. Hipertens Riesgo Vasc 2020; 37:101-107. [PMID: 32156479 DOI: 10.1016/j.hipert.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Blood pressure (BP) control is fundamental to the care of patients with chronic kidney disease (CKD), and is relevant at all stages of CKD. Renin-angiotensin-aldosterone system (RAAS) blockers have shown to be effective, not only in BP control but also in reducing proteinuria and slowing CKD progression. However, there is a lack of evidence for recommending RAAS blockers in elderly patients with CKD without proteinuria. The primary outcome of the present study is to evaluate the impact of RAAS blockers on CKD progression in elderly patients without proteinuria. MATERIALS AND METHODS The PROERCAN trial (trial registration, NCT03195023) is a multicentre open-label, randomized controlled clinical trial with 110 participants over 65 years-old with hypertension and CKD stages 3-4 without proteinuria. Patients will be randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs, and will be followed up for three years. Primary outcome is the estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcomes include BP control, renal and cardiovascular events, and mortality. RESULTS AND CONCLUSIONS The design of this trial is presented here. The results will show if antihypertensive treatment with RAAS blockers has an impact on CKD progression in elderly patients without proteinuria. Any differences in BP control, cardiovascular events, and mortality with each antihypertensive treatment will be also clarified.
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Affiliation(s)
- A M García-Prieto
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain.
| | - Ú Verdalles
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - A P de José
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - E Verde
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - D Arroyo
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - I Aragoncillo
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - T Linares
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - D Barbieri
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - M Goicoechea
- Servicio Nefrología Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain; Spanish Research Network (REDINREN), Madrid, Spain
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Abstract
Rest homes for the elderly have been particularly hit during the crisis due the current COVID-19 pandemic. At the time of writing this article, more than 17,500 elderly people that lived in Care Homes have died due to coronavirus, more than 66% of the deaths. The infection and mortality rates in the institutionalised population are high. This is due to the advanced age, immune system deficit, and the presence of comorbidities, as well as because there are frail, because they live with other residents and carers in a closed institution, and transmission is easy in the context of a highly contagious and virulent virus. The elderly often have more severe forms of the disease. Atypical presentations are more frequent in the elderly and can delay the diagnosis. The Polymer Chain Reaction (PCR) test in the first 7 days for the detection of SARS-CoV-2 viral RNA is considered the test of reference ('Gold standard'). The criteria for referring to a hospital site from Care Homes should take into account an assessment of comorbidity, the severity, the presence of severe cognitive impairment, and the dependency or necessity of ventilatory support in seriously ill patients. The social-health centres should have contingency plans available in order to offer a response when cases of COVID-19 appear. Isolation during pandemics may have important physical and psychosocial consequences in the residents. It is necessary to reflect and claim a new residential model from a person-centered care approach that seeks the integration of health and social services.
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Affiliation(s)
- E Blanco-Tarrio
- Especialista en Medicina Familiar y Comunitaria, Centro de Salud de Periurbana Norte, Salamanca, España.
| | - G Blanco Sánchez
- Especialista en Farmacia Hospitalaria, Adjunto, Hospital del Henares, Coslada, Madrid, España
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Zelada Rodríguez MA, Cerdà Mas G, García Ortiz de Uriarte L, Martí Company FX, Ronquillo Moreno N, Rodríguez González D. Arterial hypertension treatment in octogenarians with dementia according to ESC/ESH-2018: Three-year follow-up. Med Clin (Barc) 2020; 154:301-4. [PMID: 31558281 DOI: 10.1016/j.medcli.2019.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/19/2019] [Accepted: 06/27/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the control of systolic blood pressure (SBP) retrospectively according to the recommendations of the ESC/ESH-2018 guideline and its relationship with mortality in octogenarian patients with dementia. PATIENTS AND METHODS Preliminary, longitudinal, observational, retrospective study, including 65 patients ≥80 years with diagnosis of dementia and arterial hypertension admitted to a psychogeriatric unit during 2015. The main variables were SBP control according to the recommendations of the ESC/ESH-2018 guideline, considering desirable SBP (130-139mmHg), undesirable SBP (suboptimal <130mmHg and elevated SBP ≥140mmHg) and mortality at 3 years in patients with antihypertensive treatment at discharge (n = 53). RESULTS Mean age, 86.7±4.31 years (63% women); severe functional dependence (Barthel index <40): 67.7%; severe cognitive impairment (GDS-Riesberg ≥6): 86.3%; high comorbidity: 49%; mortality at 3 years: 41 (63.1%). Patients with arterial hypertension and cardiovascular comorbidity had a higher prescription of antihypertensive drugs (2.07 vs. 1.18, p=.002). Three years mortality was lower in patients with desirable SBP (44.4%) versus undesirable SBP (72.7%) groups, although it was not statistically significant. CONCLUSIONS The percentage of patients in treatment with suboptimal SBP was elevated especially in hypertensive patients without cardiovascular comorbidity. We found a trend for higher mortality in undesirable SBP groups compared to desirable SBP.
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Sánchez Acedo P, Eguaras Córdoba I, Zazpe Ripa C, Herrera Cabezón J, Tarifa Castilla A. Prospective Study of Factors Associated With Postoperative Delirium After Urgent Abdominal Surgery. Cir Esp 2020; 98:450-455. [PMID: 32248983 DOI: 10.1016/j.ciresp.2020.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Delirium is a frequent complication in elderly patients after urgent abdominal surgery. METHODS Prospective study of consecutive patients aged ≥65years who had undergone urgent abdominal surgery from 2017-2019. The following variables were recorded: age, sex, ASA, physiological state, cognitive impairment, frailty (FRAIL Scale), functional dependence (Barthel Scale), quality of life (Euroqol-5D-VAS), nutritional status (MNA-SF), preoperative diagnosis, type of surgery (BUPA Classification), approach and diagnosis of postoperative delirium (Confusion Assessment Method). Univariate and multivariate analyses were performed to analyze the correlation of these variables with delirium. RESULTS The study includes 446 patients with a median age of 78years, 63.6% were ASA ≥III and 8% had prior cognitive impairment. 13.2% were frail and 5.4% of the patients had a severe or total degree of dependence. 13.6% developed delirium in the postoperative period. In the univariate analysis, all the variables were statistically significant except for sex, type of surgery (BUPA) and duration. In the multivariate analysis the associated factors were: age (P<.001; OR: 1,08; 95%CI: 1,038-1,139), ASA (P=.026; OR: 3.15; 95%CI: 1.149-8.668), physiological state (P<.001; OR: 5.8; 95%CI: 2.176-15.457), diagnosis (P=.006) and cognitive impairment (P<.001; OR: 5.8; 95%CI: 2.391-14.069). CONCLUSION The factors associated with delirium are age, ASA, physiological state in the emergency room, preoperative diagnosis and prior cognitive impairment.
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Affiliation(s)
| | | | - Cruz Zazpe Ripa
- Cirugía General, Complejo Hospitalario de Navarra, Navarra, España
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Benchimol JA, Elizondo CM, Giunta DH, Schapira MC, Pollan JA, Barla JD, Carabelli GS, Boietti BR. Survival and functionality in the elderly over 85 years of age with hip fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:265-271. [PMID: 32247622 DOI: 10.1016/j.recot.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/09/2020] [Accepted: 02/02/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND There is a tendency for the aging population to fracture their hips. Our aim was to compare survival and functionality at one year, among elderly and very elderly patients with hip fracture. MATERIAL AND METHODS A prospective cohort of patients included in the Institutional Registry of Elderly Patients with Hip Fracture between 2014 and 2017. We classified patients as elderly patients (EP) <65 and <85 years and very elderly patients (VEP) ≥85 years. RESULTS We included 952 patients, 43% were EP and 57% were VEP. The proportion of women was 84% and 86% (P=.33) and with 2 or more points in the Charlson comorbidities index (28 and 31%, P= .36), respectively. The VEP were more dependent according to the Barthel score (34% and 62%, P<.01) and frailer according to the Edmonton score (30% and 61%, P<.01). One-year survival was 91% (95% CI 86-93) in the EP and 76% (95% CI 70-89) in the VEP. In-hospital complications were more frequent in the VEP 12% (7% in the EP, P<.01). Age is an independent risk factor for one-year survival (HR 2.11; 95% CI 1.36-3.29, P<.001). CONCLUSIONS Age is a risk factor for the VEP group survival despite fragility and comorbidities. Because of their vulnerability, an appropriate care plan should be considered for VEP.
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Affiliation(s)
- J A Benchimol
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Sección de Geriatría, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.
| | - C M Elizondo
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Área de Investigación en Medicina Interna, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - D H Giunta
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Área de Investigación en Medicina Interna, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - M C Schapira
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Sección de Geriatría, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - J A Pollan
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - J D Barla
- Servicio de Ortopedia, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - G S Carabelli
- Servicio de Ortopedia, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - B R Boietti
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Área de Investigación en Medicina Interna, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina; Sección de Geriatría, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Esteban-Fernández A, Díez-Villanueva P, Vicent L, Bover R, Gómez-Bueno M, De Juan J, Iniesta ÁM, García-Aguado M, Martínez-Sellés M. Sacubitril/Valsartan is useful and safe in elderly people with heart failure and reduced ejection fraction. Data from a real-word cohort. Rev Esp Geriatr Gerontol 2020; 55:65-69. [PMID: 31892433 DOI: 10.1016/j.regg.2019.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND HF elderly patients are underrepresented in Sacubitril/Valsartan HF trials, and the effect of S/V in real-life patients with advanced age is unknown. The aim of this study was to evaluate the use and safety of S/V in a real-word cohort of elderly patients. METHODS We performed a prospective registry of patients who started S/V in clinical practice. We compared baseline characteristics, adverse events during follow-up and causes of S/V withdrawal according to age. RESULTS A total of 427 patients started treatment with S/V: 222 (52.0%)<70 years old, 140 (32.8%) between 70 and 79 and 65 (15.2%)≥80. During a mean follow-up of 7.0±0.1months S/V was well tolerated, with no age-related differences in adverse events (26.8%, 25.9%, 23.1% respectively; p=0.83). Symptomatic hypotension tended to be more frequent in the elderly (19.8%, 25.6%, 33.3% respectively; p=0.17). The withdrawal of S/V was more frequent in younger patients (14.4%, 10.0%, 4.6% respectively; p=0.05) and related to poor prognosis (HR 13.51, 95% CI 3.22-56.13, p<0.001). CONCLUSIONS Sacubitril/Valsartan is useful and safe in elderly people with HF-rEF in real-life clinical practice, and withdrawal is associated to poor prognosis. The doses achieved are lower in elderly people.
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Affiliation(s)
- Alberto Esteban-Fernández
- Servicio de Cardiología, Hospital Universitario de Móstoles, Madrid, Spain; Universidad Rey Juan Carlos, Madrid, Spain.
| | | | - Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Ramón Bover
- Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Manuel Gómez-Bueno
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Javier De Juan
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain; Universidad Complutense, Universidad Europea, Madrid, Spain
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González-Guerrero JL, Paredes-Galán E, Ferrero-Martínez AI, Galán MC, Hornillos-Calvo M, Menéndez-Colino R, Torres-Torres I, Rodríguez-Artalejo F, Rodríguez-Pascual C. [Characteristics and one-year outcomes in elderly patients hospitalised with heart failure and preserved, mid-range and reduced ejection fraction]. Rev Esp Geriatr Gerontol 2020; 55:195-200. [PMID: 32081386 DOI: 10.1016/j.regg.2019.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/10/2019] [Accepted: 12/09/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The latest European Society of Cardiology Heart Failure (HF) guidelines define three types of HF according to the ejection fraction (EF): HF with reduced EF (HFrEF) when EF<40%, HF with mid-range EF (HFmrEF), when EF 40-49%, and HF with preserved EF (HFpEF) when EF≥50%. The objective of this study was to analyse the characteristics and results of elderly patients hospitalised with HF according to the new classification using EF. METHODS A prospective study was carried out with 531 HF patients aged ≥75 years classified according to EF, and admitted in the geriatric wards of 6 hospitals in Spain. An analysis was performed on the demographic and clinical characteristics, as well as well as the morbidity and mortality at one year of follow-up. RESULTS As regards EF, 17.1% had HFrEF, 10% had HFmrEF, and 72.9% had HFpEF. Patients with HFmrEF were more similar to those with HFrEF in terms of a younger age, predominance of men, and previous admission due to HF. This was also the case with the use of drugs for neurohormonal blockade. Patients with HFrEF (compared to those with HFmrEF and HFpEF), had higher mortality (35.2%, 24.5%, and 25.6%, respectively), more readmissions for HF (17.6%, 15.1%, and 14.5%, respectively), and more events (61.5%, 45.3%, and 52.5%, respectively), although there were no significant differences. There were also no differences observed in the survival analysis between the EF groups and the time-dependent outcome variables. CONCLUSIONS In elderly patients hospitalised with HF, those classified as HFmrEF did not show any clear differences with respect to those with HFrEF or HFpEF. There were no differences in terms of morbidity and mortality.
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Affiliation(s)
| | - Emilio Paredes-Galán
- Servicio de Cardiología, Complejo Hospitalario Universitario de Vigo, Vigo, España
| | | | | | | | | | | | - Fernando Rodríguez-Artalejo
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid/Idipaz y CIBERESP, Madrid, España
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Ramos M, Quezada M, Ayala R, Gómez-Pavón FJ, Jaramillo J, Calderón-Domínguez M, Toro R. Asymptomatic aortic stenosis in a geriatric population. The role of frailty and comorbidity in mortality. Rev Esp Cardiol (Engl Ed) 2019; 74:167-174. [PMID: 31882390 DOI: 10.1016/j.rec.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES The prognosis of asymptomatic severe aortic stenosis (AS) has not been widely documented in elderly patients who are frequently frail and have comorbidities. We sought to analyze the factors that influence early mortality in geriatric patients with asymptomatic severe AS. METHODS This ambispective cohort study included 104 patients aged 70 years or older with asymptomatic severe AS. Epidemiological, geriatric, clinical and echocardiographic variables were collected and compared between frail and nonfrail patients. During follow-up, the time from diagnosis to mortality and the causes of death were recorded. RESULTS Overall, 59.6% of the patients were frail. During follow-up, 69.4% of the frail patients died, with a median time to mortality of 2.52 years (95%CI, 1.36-3.69). The overall 1-year survival rate in frail patients was 76%. On multivariate analysis, age (HR, 2.47; 95%CI, 1.00-6.12), a Charlson comorbidity index ≥ 5 (HR, 3.75; 95%CI, 1.47-9.52) and frailty (HR, 6.67; 95%CI, 1.43-9.52) were independently related to mortality. In total, 8.7% of the patients had a Charlson comorbidity index ≥ 5, and all these patients died during follow-up, with a median survival of 1.01 years (95%CI, 0.36-1.67). The area under the receiver operating characteristic curve of the Charlson index was 0.739 (95%CI, 0.646-0.832). In this population, values ≥ 5 showed high specificity (100%) but low sensitivity. CONCLUSIONS A high prevalence of frailty was present in geriatric patients with asymptomatic severe AS. Age, a Charlson index ≥ 5 and frailty were independent factors for mortality, conferring an unfavorable short-term prognosis.
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Affiliation(s)
- Mónica Ramos
- Unidad de Cardiología, Hospital Central de la Cruz Roja, Madrid, Spain; Facultad de Medicina, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Madrid, Spain.
| | - Maribel Quezada
- Unidad de Cardiología, Hospital Central de la Cruz Roja, Madrid, Spain; Facultad de Medicina, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Madrid, Spain
| | - Rocío Ayala
- Unidad de Cardiología, Hospital Central de la Cruz Roja, Madrid, Spain; Facultad de Medicina, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Madrid, Spain
| | - Francisco Javier Gómez-Pavón
- Facultad de Medicina, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Madrid, Spain; Servicio de Geriatría, Hospital Central de la Cruz Roja, Madrid, Spain
| | - Javier Jaramillo
- Facultad de Medicina, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Madrid, Spain; Servicio de Geriatría, Hospital Central de la Cruz Roja, Madrid, Spain
| | - María Calderón-Domínguez
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Departamento de Medicina, Facultad de Medicina, Cádiz, Spain
| | - Rocío Toro
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain; Departamento de Medicina, Facultad de Medicina, Cádiz, Spain
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49
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Martín-Fortea MP, Lambán Ibor E, Cebollada Sánchez R, Monforte Cirac ML. [Bacteraemia due to L. monocytogenes: Description of cases and review of literature]. Rev Esp Geriatr Gerontol 2019; 55:50-53. [PMID: 31521408 DOI: 10.1016/j.regg.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
Abstract
Bacteraemia due to L. monocytogenes is a sporadic disease related to advanced age or neoplasms, and mortality associated with this disease is high. This study aims to describe the epidemiological, clinical, and therapeutics characteristics of this specific disease, through a retrospective descriptive analysis of cases with positive blood cultures from Calatayud Hospital, from 2008 to 2018. Four cases were detected, all of them occurred in the last 3 years analysed, and the age was greater than the age published in other papers. However, risk factors and mortality were similar. Prevention and early detection are essential to control the increase in this pathology.
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Affiliation(s)
| | - Elena Lambán Ibor
- Servicio de Medicina Interna, Hospital Ernest Lluch de Calatayud, Zaragoza, España
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50
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Rincón Gómez M, Hernández Quiles C, García Gutiérrez M, Galindo Ocaña J, Parra Alcaraz R, Alfaro Lara V, González León R, Bernabeu Wittel M, Ollero Baturone M. Hip fracture co-management in the elderly in a tertiary referral hospital: A cohorts study. Rev Clin Esp 2019; 220:1-7. [PMID: 31279498 DOI: 10.1016/j.rce.2019.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hip fracture in the elderly is one of the most prevalent diagnoses in Orthopedic Surgery Departments. It has a great impact in medical, economic and social terms. Our objective is to analyze clinical impact of a co-management care model between orthopedic surgery and internal medicine departments for elderly patients admitted with hip fracture in a tertiary referral hospital. MATERIAL AND METHODS Retrospective cohort study of patients older than 65 years old admitted with hip fracture between January 2005-August 2006 (HIST cohort) without a co-management care model, and between January 2008-August 2010 (COFRAC cohort) with a co-manEdadment care model. Analysis of demographic, clinical and surgery characteristics, complications incidence and mortality and re-admissions at 30 days was made. RESULTS A total of 701 patients were included (471 HIST, 230 COFRAC). There were no differences in sex, gender, time to surgery, type of anesthesia and surgery, length of stay, ambulation at discharge and 30-days emergency room consultation, readmissions or mortality at 30 days. There were differences in identification of polypatological patients (16.8 vs. 24.4%, P=0.02), presence of osteoporosis (3.9 vs. 7.6%, P=0.03), motor deficit (3.5 vs. 8.8%, P=0.03), number of chronic drugs (3.7±2.5 vs. 4.3±3.2, P<0.01), diagnosis of delirium (15.6 vs. 20.9%, P=0.048), constipation (80.3 vs. 74.7%, p<0.001), monitoring of anemia (83.3 vs. 97.1%, P>0.01) and renal failure at discharge (44.5 vs. 97.3%, P<0.01) and hospital mortality (4.6 vs. 1.3%, P=0.02). CONCLUSIONS Co-management for elderly patients admitted with hip fracture provides a better information about previously chronic conditions, a higher control of hospital complications and decreases hospital mortality.
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Affiliation(s)
- M Rincón Gómez
- Departamento de Medicina Interna, Hospitales Universitarios Virgen del Rocío, Sevilla, España.
| | - C Hernández Quiles
- Departamento de Medicina Interna, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - M García Gutiérrez
- Departamento de Medicina Interna, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - J Galindo Ocaña
- Departamento de Medicina Interna, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - R Parra Alcaraz
- Departamento de Medicina Interna, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - V Alfaro Lara
- Departamento de Medicina Interna, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - R González León
- Departamento de Medicina Interna, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - M Bernabeu Wittel
- Departamento de Medicina Interna, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - M Ollero Baturone
- Departamento de Medicina Interna, Hospitales Universitarios Virgen del Rocío, Sevilla, España
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