共查询到20条相似文献,搜索用时 359 毫秒
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Rafael Bielza Galindo Alejandro Ortiz Espada Estefanía Arias Muñana Rocío Velasco Guzmán de Lázaro Asunción Mora Casado Ricardo Moreno Martín Blanca Tapia Salinas Javier Escalera Alonso Jorge Gómez Cerezo 《Revista espa?ola de geriatría y gerontología》2013
Background
Patients with hip fracture (HF), due to their characteristics, require a specific support. The Acute Orthogeriatric Unit (OGU) has been shown to be one of the most beneficial.Objective
To evaluate the main variables of HF patients treated at an OGU and compare them with the previous referral model (RC).Material and methods
A prospective observational study with retrospective control was conducted on 169 patients, split into two groups. In the RC group, patients were admitted to conventional trauma ward. In the OGU group, an early geriatric assessment was performed, and patients were simultaneously attended daily by the orthopaedic surgeon, nurse and geriatrician, and the surgery times, work load, discharge and destination, were planned in a weekly meeting with the rest of professionals.Results
A total of 71 patients were included in the RC group and 96 in the OGU group. The preoperative characteristics were similar, except for a slightly higher comorbidity in the OGU group. The OGU patients were operated on earlier (3.82±2.08 vs 4.61±2.5 days; P<.32), and overall hospital stay was reduced by 28% (11.84±4.04 vs 16.46±8.4 days; P<.001). The functional efficiency (Barthel Index at discharge-Barthel Index at admission/overall stay - stay before surgery) was higher in the OGU group (1.56±0.7 vs 2.61±1.1; P<.05). There were no differences in functional status, mortality or discharge location.Conclusions
The OGU is a level of care that provides effective medical care in HF patients in general hospitals. 相似文献4.
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Sandra Gómez-Talavera Iván Núñez-Gil David Vivas Borja Ruiz-Mateos Ana Viana-Tejedor Agustín Martín-García Javier Higueras-Nafría Carlos Macaya Antonio Fernández-Ortiz 《Revista espa?ola de geriatría y gerontología》2014
Introduction
Several risk scores regarding the probability of death/complications in the acute setting and during the follow-up of patients admitted with acute coronary syndromes (ACS) have been published, such as the GRACE, TIMI and ZWOLLE risk score. Our objective was to assess the prognosis of nonagenarians admitted to a coronary care unit with an ACS, as well as the usefulness of each of these scores.Material and methods
A retrospective analysis was performed on nonagenarians with an ACS admitted between 2003 and 2011. Vital status was determined at 14, 30 days, and 6 months after the ACS, and later during the follow-up. The risk scores were evaluated by area under the curve ROC (AUC).Results
A total of 45 patients with an ACS, 26 (57.8%) with ST-segment elevation and 19 (42.2%) with non-ST elevation. The GRACE- AUC for in-hospital mortality was excellent, 0.91, (95% CI: 0.82-1; P<.001), and for the combined event (in-hospital mortality and re-infarction) was 0.83 (95% CI: 0.66-1.0; P<.01). However, the GRACE-AUC at 6 months for mortality was 0.34 (95% CI: 0.09-0.58; P=.45), and for the combined event it was 0.51 (95% CI: 0.26-0.77; P=.95). The TIMI-AUC and ZWOLLE-AUC did not reach statistical significance.Conclusions
It is useful calculate the GRACE risk score in order to estimate risk and survival in the acute phase of ACS in nonagenarians. This can help appropriate in making invasive or conservative treatment decisions. 相似文献6.
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Juan Ignacio González Montalvo Pilar Gotor PérezAlberto Martín Vega Teresa Alarcón AlarcónJosé Luis Mauleón Álvarez de Linera Enrique Gil GarayEduardo García Cimbrelo Julián Alonso Biarge 《Revista espa?ola de geriatría y gerontología》2011,46(4):193
Objective
To study the effects of the management of hip fracture patients in an acute orthogeriatric unit shared between the departments of Orthopedic Surgery and Geriatrics compared with the usual hospital care, and to analyse financial differences in both systems of care.Method
Prospective quasy-experimental randomized intervention study in 506 patients admited to a terciary hospital with an osteoporotic hip fracture. The usual model of care was the admission to the orthopedic ward with a request to Geriatrics (RC) and the study model consisted of the admission to an orthogeriatric unit (OGU) for the shared co-management between orthopaedic surgeons and geriatricians. This model included the appointment of one spokesperson from each department, the specialist geriatric nurse management, early geriatric assessment, shared daily clinical care, weekly joint ward round and coordinated planning of the surgery schedule, the start of the ambulation and the time and setting of patient discharge.Results
Two hundred fifty five consecutive patients admitted to the OGU and 251 patients managed simultaneusly by the RC model were included. Except for a mean age slightly lower in the OGU group, there were no differences neither in the baseline patients characteristics nor in the surgical rates between the two groups. Among the OGU patients group it was more frequent to receive rehabilitation in the acute setting, to be able to walk at discharge and to be referred to a geriatric rehabilitation unit (all with P<.05). The OGU patients received geriatric assessment and were operated on earlier than the RC patients (P<.001). The length of stay in the acute ward was 34% shorter in the OGU patients (mean 12.48±5 vs 18.9±8.6 days, P<.001) (median 12 [9-14] vs 17 [13-23] days, P<.001). The whole hospital length of stay, including the days spent in the geriatric rehabilitation units, was 11% shorter in the OGU patients (mean 21.16 ±14.7 vs 23.9 ±13.8 days, P<0.05) (median 14 [10-31] vs 20 [14-30] days, P<.001). The OGU saved 1,207 € to 1,633 € per patient when estimated by the costs for process model, and 3,741 € when estimated by the costs for stay model.Conclusions
The OGU is a hospital setting that provides an improvement in the patients functional outcome and a reduction in the hospital length of stay. Therefore it saves health care resources. These findings show the OGU as an advisable setting for the acute care of hip fracture patients. 相似文献8.
Dolors Estrada Ester Pujol Lourdes Jiménez Manuel Salamero Alejandro de la Sierra 《Revista espa?ola de geriatría y gerontología》2012
Introduction
Hypertension is the most prevalent cardiovascular risk factor among people over the age 60. The aim of this study is to assess the effectiveness of an educational intervention tool, and its reliability.Material and methods
Experimental study, prospective, randomised, parallel-group in a sample of 120 patients, 62 in the intervention group and 58 in the control group. The intervention group received a written and oral educational program on hypertension and cardiovascular risk; the control group did not receive any intervention.Results
At the end of the intervention there was an increase in the percentage of correct responses, with statistically significant differences compared to the control group, as regards knowledge of hypertension, risk factors associated with the risks of having high blood pressure and control medication.Conclusion
The implementation of an educational intervention on hypertension and cardiovascular risk associated with the same care activity is capable of increasing the level of knowledge by elderly hypertensive patients admitted to hospital. 相似文献9.
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Carmen María Osuna-Pozo José Antonio Serra-Rexach José Viña María del Carmen Gómez-Cabrera Antoni Salvá Domingo Ruiz Ferrán Masanes Alfonso Lopez-Soto Francesc Formiga Federico Cuesta Alfonso Cruz-Jentoft 《Revista espa?ola de geriatría y gerontología》2014
Background
There are few systematic studies on the prevalence of sarcopenia using the new diagnostic criteria in different geriatric care settings.Objective
To estimate the prevalence of sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria in older subjects living in nursing homes and in those who attend geriatric outpatient clinics.Material and methods
A single country multicentre study in two samples of older subjects: patients cared for in outpatient geriatric clinics, and individuals living in nursing homes. Data collected will include demographic variables, medical history, medication, geriatric syndromes, functional status (assessment of basic and instrumental activities of daily living), mobility, cognitive status, comorbidity, quality of life, nutritional status, and laboratory parameters. For the diagnosis of sarcopenia, 4 m walking speed, handgrip strength, and body composition measured by bioelectrical impedance analysis will be assessed.Results
Using the EWGSOP algorithm, the prevalence of sarcopenia in an elderly Spanish population will be estimated. In addition, concordance and correlation between the three parameters included in the definition (muscle mass, muscle strength, and physical performance) will be analysed, using the different existing cut-off points, and examining the diagnostic accuracy of each. Finally, demographic, anthropometric and functional data that define subjects with sarcopenia will be investigated.Conclusions
The ELLI study should improve knowledge on the prevalence and characteristics of sarcopenia in older people in our population. 相似文献11.
Trinidad Lorenzo José Carlos Millán-CalentiLaura Lorenzo-López Alba SánchezAna Maseda 《Revista espa?ola de geriatría y gerontología》2013
Introduction
Self-Rated Health is part of the comprehensive concept of Quality of Life and is a valid measurement of health status. The main objective of this study was to test the predictive value of some different variables on the poor Self-Rated Health among elders.Material and methods
We performed a cross-sectional study on a sample consisting of 140 participants. Measurements: age, gender, level of education, environment, cognitive status, physical impairment, diseases, health perception and social support. The influence of the studied variables on the poor Self-Rated Health was performed with a logistic regression analysis and a ROC curve to establish the cut-off values for these variables with the best sensitivity and specificity to predict the poor Self-Rated Health.Results
A poor Self-Rated Health was significantly associated with age, comorbidity, and the perception of poor functional social support, whereas no association was found with gender, environment and educational level.Conclusions
Old age, the number of diagnosed diseases, and functional social support are Self-Rated Health risk factors, while the characteristics and repercussions of the diseases should not be considered. 相似文献12.
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Ferran Roca Carbonell Erwin Martin Hernandez Ocampo Jose Maria Aragonès Pascual Eulalia Soler Fina Clapera Joan Espaulella Panicot 《Revista espa?ola de geriatría y gerontología》2014
Introduction
The aim of this study is to determine clinical features and interventions in patients attended in our hospital falls prevention unit.Material and methods
Medical records and evaluation protocols from October 2010 to June 2012 were reviewed. Results are expressed in means and standard deviation.Results
We studied 68 patients: 53 came due to falls (77.9%), and 15 (22%) due to gait disorders. The mean age was 77.6±7.9. Number of women: 63 (92.6%). Previous Barthel Index was 94/100, cognitive impairment 23 (33.8%), polypharmacy 69.1%, orthostatic hypotension 18 (26.4%). Walking speed 0.66± 0.19 m/s and Time up and go to (TUG) 16.6±4.5 s. Post-urography detected vestibular dysfunction in 34 patients (77%). Clinical cause of fall and/or gait disorder was multifactorial in 33 (48.5%), Parkinsonism 19 (27.9%), chronic pain/arthropathy 8 (11.4%), and vestibular syndrome 8 (11.4%). Two-thirds (45; 66.1%) of the patients began Physical therapy, and vitamin D was given to 47 (69.1%). Phone calls were made to patients and/or their relatives and noted that after 3 months of the treatment: 48 (70.5%) had no fall; 59 (86.7%) patients followed the recommendations, and 57 (83.8%) were satisfied.Conclusions
In this sample of older patients, mostly female with a good functional and cognitive condition, the causes of the falls were multifactorial in the half of the cases, and the post-urography detected vestibular changes in the half of the patients. 相似文献14.
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Francisco Javier Alonso-Renedo Leire González-Ercilla Itziar Iráizoz-Apezteguía 《Revista espa?ola de geriatría y gerontología》2014
Objective
To analyze the literature as regards the knowledge, skills and attitudes that these disciplines can provide in improving technical, ethical and human quality health care in the elderly with advanced organ failure, multimorbidity, frailty and progressive dementia.Material and methods
A comprehensive review focused on available references on the interrelationship between geriatric medicine and palliative medicine, education in bioethics, prognostic tools, functional status, and the humanization of health care.Results
Advance care planning, comprehensive geriatric assessment, the study of the values of the patient and their introduction in decision-making process, as well as the need to promote moral, care, and healthcare organizational ethics, are essential elements to achieve this objective.Conclusions
Practitioners and healthcare organizations should seek excellence as a moral requirement. To achieve this, there is a priority to acquire virtues of care and fundamental concepts of geriatric and palliative medicine, assessing functional status, advance care planning and patient/family needs as essential issues to protect, care for and promote them in all care settings. 相似文献16.
David Jos Coca Sandra Milena Castelblanco Diego Andrs Chavarro-Carvajal Luis Carlos Venegas-Sanabria 《Biomédica : revista del Instituto Nacional de Salud》2021,41(2):293
Introduction:
In-hospital complications frequently occur in hospitalized people over 65 worsening their clinical outcomes. There are, however, few studies on the factors associated with in-hospital complications in elderly patient care.Objective:
To evaluate factors associated with in-hospital complications in a geriatric acute care unit in Bogotá, ColombiaMaterials and methods:
We conducted an analytical, observational, retrospective study in a cohort of 1,657 patients over 65 years of age who received care in the geriatric unit of a high complexity hospital in Bogotá, Colombia. The dependent variable was in-hospital complications and the independent variables, the degree of functional dependence on admission, dementia, nutritional status, social support, comorbidity, and polypharmacy. We used Poisson’s linear regression model to identify associated variables.Results:
The bivariate analysis showed that functional dependence (PR=2.092, p≤0.001) and malnutrition (PR=2.850, p≤0.001) were associated with a higher rate of hospital-acquired infection. In the multivariate analysis, functional dependence (PR=1.931, p=0.003) and malnutrition (PR=2.502, p=0.002) remained independent factors for in-hospital complications.Conclusion:
In acute care centers, integral assessment at admission to identify functional dependence and malnutrition predicts in-hospital complications. 相似文献17.
Lorena Bajo Peñas Joan Espaulella Panicot Núria Dalmau Paniagua Matilde Barneto Soto Jacint Altimiras Roset 《Revista espa?ola de geriatría y gerontología》2013
Aim
To determine the characteristics of patients with dementia who died in a psychogeriatric unit, and to describe the conditions that led to their death.Material and methods
Observational study of patients who died in the Psychogeriatric unit of Hospital de la Santa Creu de Vic during a three and a half year period.Results
Of the 554 patients admitted during the study period, we recorded a mortality of 14.6% (81 patients). The analysis of those who died showed that 67.9% were women, with a mean age of 85.8 years, with the most frequent cause being Alzheimer type dementia (37%) and being in an advanced stage (CDR3, GDS 6-7) in 72.8% of cases. On admission the following characteristics were recorded: Mini Mental State Examination (MMSE) 9.5, Barthel Index (BI) prior to entry 50.1, BI on admission 17.4, and Neuropsychiatric Inventory (NPI) 31.4. A therapeutic limitation treatment was determined for 84% of patients on admission. From the analysis of the conditions that lead to death it was noted that: In 74.1% of the patients the death was a direct result of a triggering event (the most frequent being respiratory infection), in 17.3% the death occurred by a gradual decline, with no clear precipitating factor, and in 8.6% of patients palliative sedation was required due to poorly controlled symptoms.Conclusions
Intercurrent problems were the most common factors related to the death of the patients. Most patients died in the stages prior to the established criteria for terminal dementia. In some cases patients may experience disorder behavior as a refractory symptom. 相似文献18.
Feliciano Villar Josep FabàMontserrat Celdrán Rodrigo Serrat 《Revista espa?ola de geriatría y gerontología》2014
Introduction
The purpose of this study is to determine the opinion of professionals working in residential aged care facilities on the regulation of sexuality in these settings.Materials and methods
Fifty-three professionals from five residential aged care facilities located in the metropolitan area of Barcelona answered several questions regarding the advisability of establishing measures for the regulation of sexuality in RACFs, the elements that could contribute to this, and the aspects that such regulations should consider.Results
Around 50% of the participants recognized the advisability of having some type of measures for sexuality regulation in residential aged care facilities. According to their responses this should be developed taking into account professional opinions, but also the points of view of the residents and their relatives. The most frequently mentioned regulations were those that ensured that any kind of sexually charged situation occurred in a private environment. The development of strategies are suggested to distinguish those people with dementia that are competent to consent to sexual acts from those who are not.Conclusions
The opinion of professionals working in RACFs regarding the advisability of establishing measures for sexuality regulation seems to be considerably divided. Thus, whilst around 50% of them recognize their potential usefulness, the other half consider them unnecessary or even counterproductive for the sexual freedom of residents. Associating regulation with prohibition and sexuality with sexual activity was not uncommon among the responses of the participants. 相似文献19.
Maria dels Àngels Cebrià i Iranzo M. Ángeles Tortosa-Chuliá Celedonia Igual-Camacho Patricia Sancho Laura Galiana José Manuel Tomás 《Revista espa?ola de geriatría y gerontología》2014
Introduction
The institutionalized elderly with functional impairment show a greater decline in respiratory muscle (RM) function. The aims of the study are to evaluate outcomes and costs of RM training using Pranayama in institutionalized elderly people with functional impairment.Material and methods
A randomized controlled trial was conducted on institutionalized elderly people with walking limitation (n = 54). The intervention consisted of 6 weeks of Pranayama RM training (5 times/week). The outcomes were measured at 4 time points, and were related to RM function: the maximum respiratory pressures and the maximum voluntary ventilation. Perceived satisfaction in the experimental group (EG) was assessed by means of an ad hoc questionnaire. Direct and indirect costs were estimated from the social perspective.Results
The GE showed a significant improvement related with strength (maximum respiratory pressures) and endurance (maximum voluntary ventilation) of RM. Moreover, 92% of the EG reported a high satisfaction. The total social costs, direct and indirect, amounted to €21,678.Conclusions
This evaluation reveals that RM function improvement is significant, that intervention is well tolerated and appreciated by patients, and the intervention costs are moderate. 相似文献20.
María Isabel Ferrero López José Fermín García Gollarte José Jorge Botella Trelis Oscar Juan Vidal 《Revista espa?ola de geriatría y gerontología》2012