Implantación de una Unidad de Ortogeriatría de Agudos en un hospital de segundo nivel

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.     

Elaboración de una herramienta para la estimación del riesgo de mortalidad a corto y medio plazo tras el alta de una Unidad de Hospitalización de Agudos de Geriatría

Objectives

To identify predictive factors for 6 and 12-months mortality after discharge from a geriatric acute care unit, and from these, derive a mortality-risk index.

Methods and analysis

Prospective cohort study will be conducted on patients over 70 years-old admitted to a geriatric acute care unit and survived to hospital discharge. The main outcome measure will be mortality at 6 months and 12 months after discharge. Independent variables include sociodemographics, functional status, comorbidities, and clinical and laboratory characteristics. Risk factors associated with mortality will be constructed using multivariate logistic regression models. To build the mortality index, points will be assigned to each risk factor by dividing each beta coefficient in the logistic model by the lowest beta coefficient. A score will be assigned to each subject by adding up the points for each risk factor present in the model. The predictive accuracy of the model will be determined by comparing the predicted versus observed mortality in the study population and calculating the area under the ROC curves in both populations.

Conclusions

The risk-mortality index developed would allow an easy estimate to be made of individual risk of death at 6 months and 12 months after discharge from a geriatric acute care unit, with the purpose of establishing care plans and individualising treatment, according to real objectives.     

Informe: análisis de las publicaciones de socios de la Sociedad Española de Geriatría y Gerontología del año 2006 al 2011

Data is presented from the survey conducted by the Sociedad Española de Geriatría y Gerontología (SEGG) (Spanish Society of Geriatrics and Gerontology) among its members in order to assess their scientific production between 2006 and 2011, specifically articles in journals that are indexed in the Science Citation Index. The scientific quality of the publications was quantified using the number of times every article was cited and the journal's impact factor. A total of 162 out of the 2450 members responded (6.6%), reporting a total of 903 individual articles, 335 (37%) of them in geriatrics-specific journals, and 568 (63%) in other journals of other specialties. The number of publications increased yearly from 128 in 2006 to 201 in 2010. The scientific quality could be calculated for 530 articles. On average, publications have been cited 8.2 times (median: 2), with the range of citations being from 0 to 242. The average impact factor was 3.1 (median 2.4), ranging from 0 to 53.5. A number of articles have been published in some of the largest impact factor journals, in those of general-interest, as well as geriatrics-specific and basic science journals.     

La eclosión de la sarcopenia: Informe preliminar del Observatorio de la Sarcopenia de la Sociedad Española de Geriatría y Gerontología

Sarcopenia is a common and prominent geriatric syndrome, of major interest for daily clinical practice of professionals working with older people. The number of affected individuals and its relation with disability, frailty, many chronic diseases, lifestyle and adverse outcomes are extremely relevant for geriatric care. Moreover, biological changes that lead to the loss of muscle mass and strength are intrinsically related to the mechanisms of aging. It is not therefore surprising that research in this field is growing exponentially in recent years, and sarcopenia has been placed in recent years in the forefront of research in geriatric medicine and gerontology.The Spanish Society of Geriatrics and Gerontology has recently created an Observatory of Sarcopenia, which aims to promote educational and research activities in this field. The first activity of the Observatory has been to offer the Spanish speaking scientific community a review of the current status of sarcopenia, that may allow unifying concepts and fostering interest in this promising field of geriatrics.     

La unidad de ortogeriatría de agudos. Evaluación de su efecto en el curso clínico de los pacientes con fractura de cadera y estimación de su impacto económico

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.     

Análisis de las defunciones de pacientes con demencia ingresados en una unidad de psicogeriatría

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.     

Tafonomía y contexto paleoambiental de los restos de un cetáceo del Mioceno medio de Tarragona (NE España)

A new finding of a marine mammal is documented from the middle Miocene of El Camp basin in Tarragona (NE Spain). The incomplete and disarticulated bone remains belong to the skeleton of a juvenile cetacean. These remains appear deposited above a transgression surface and included within a glauconitic calcisiltite layer. This unit constitutes the beginning of a shallowing-upwards sequence and was deposited under low-energy conditions and low sedimentation rates in a middle-outer platform setting. This context was responsible for the long exposure of the remains and, consequently, an extension of the biostratinomic stage. These conditions favored the natural decomposition and disarticulation of the carcass, allowing the action of different types of scavenging organisms. The interpretation of the paleoenvironmental setting is based in the combination of different datasets: taphonomic data of the bone remains, paleoecologic and taphonomic information provided by the fauna associated to the bones, and ichnologic and sedimentologic interpretation of the sediments where the fossils are included. Combination of such different proxies enables a very good characterization of the paleoenvironmental context of the studied fossils.     

El fenómeno de las caídas en residencias e instituciones: revisión del Grupo de Trabajo de Osteoporosis,Caídas y Fracturas de la Sociedad Española de Geriatría y Gerontología (GCOF-SEGG)

The Workshop on Osteoporosis, Falls and Fractures (GCOF) of The Spanish Geriatrics and Gerontology Society (SEGG) formed a committee in order to review the state of the art on the detection, risk factors and assessment tools for falls, and intervention protocols when falls occurs in nursing homes, long-term hospitals or medium-stay units. The different patient profiles are described in order to make a comprehensive approach to this heterogeneous topic and population, offering a risk classification and specific advice according to these categories.     

Tafonomía de bivalvos holocenos en la costa del estuario de Bahía Blanca, Argentina

In the Bahía Blanca Estuary (Argentina), Holocene deposits are fossiliferous sand ridges originated by the last transgressive-regressive marine event. By means of ternary taphograms applied on valves of Brachidontes rodriguezi a taphonomic analysis was carried out in two ridges, both in the external and internal estuary area. Six taphonomic attributes were considered. The disarticulation and the fragmentation are higher in the external ridge, whereas the bioerosion and incrustation, both barely manifested, are similar in the two environmental settings. In the outer deposit, as much the abrasions as the dissolution of the shells are more intense. Genetically, it is considered that these shell concentrations were originated by multiepisodic storm events. Based on the taphonomic analysis, it arises that in the generation of the internal ridge waves of moderate energy with different sorting degrees prevailed, whereas in the formation of the external deposits waves of greater energy with smaller sorting capacity prevailed.