Rehabilitación geriátrica multidisciplinar en el paciente con fractura de cadera y demencia

Hip fracture and dementia rates increase with age, and both groups of patients suffer increased morbidity and mortality and functional impairment. The management of these patients is a challenge for the orthogeriatric and rehabilitation team process, as despite the evidence on the benefit, the results analysed are still worse than in patients without cognitive impairment. For this reason, and due to the limitation in health resources, many of them have problems in accessibility to them, or are limited to a less intense rehabilitation. There are insufficient studies on the best rehabilitation interventions in this group of patients, but it is suggested: 1) to use a multidisciplinary rehabilitation model adapted to the patient with dementia, and 2) to redefine results of the rehabilitation of these patients not only in terms of functional improvement, without highlighting other concepts, such as quality of life, decrease in complications or improved social support.     

Fractura de cadera en el paciente anciano: factores pronóstico de mortalidad y recuperación funcional al año

Objective

The aim of this study is to identify the risks factors for mortality and functional recovery in elderly patients admitted to hospital with a hip fracture.

Evaluación de las complicaciones clínicas de los pacientes con fractura de cadera y sus factores asociados en una Unidad de Agudos de Ortogeriatría

Introduction

The incidence of clinical complications in hip fracture (HF) patients is high and variable due to their heterogeneous nature. The aim of the study was to assess the clinical complications and their associated factors in HF patients admitted to the Orthopaedic Geriatric Unit of a 283 bed University Hospital. An average of 200 HF patients is attended yearly.

Resultado de la actualización de la vía clínica de la fractura de cadera del anciano en un hospital universitario de Madrid

Background and objectivesOrthogeriatric management with clinical pathways (CP) in hip fracture (HF) has been shown to be superior to other models. We studied whether updating the CP, through prioritization of admission and surgery, improvement in the prevention and treatment of delirium, management of anticoagulants and antiplatelet agents and the use of perioperative peripheral nerve block, modifies surgical delay, stay, readmissions, mortality, suffering delirium and functional status at discharge.Material and methodA retrospective observational study of unicenter cohorts of 468 patients with HF, 220 from 2016 (old VC) and 248 from 2019 (new VC). The variables are: intervention in the first 48 hours, surgical delay (hours), stay (days), stay less than 15 days, delirium, functional loss at discharge (Barthel prefracture scale less Barthel scale at discharge), readmission at one month, and mortality at admission, month and year.ResultsMedian age: 87.0 [interquartile range 8.0], mostly women (76.7%). Significantly, with the new VC, there was a greater number of patients operated on in the first 48 hours (27,7% vs 36,8% p = 0.036), less surgical delay (72.5 [47,5-110,5] vs 64.0 [42,0-88,0] p < 0.001), shorter stay (10,0 [7,0-13,0] vs 8,0 [6,0-11,0] p < 0.001), greater number of discharges in 15 days (78,2% vs 91,5% p < 0.001), lower delirium (54,1% vs 43,5% p = 0.023). No significant changes in readmissions, functional loss at discharge, mortality at admission, 3 months or year.ConclusionsUpdating the VC brings benefits to the patient (less surgical delay, equal functional status at discharge with fewer days of admission) and benefits in management (lower admission) without modifying mortality.     

Etiología de la candidiasis en pediatría: análisis comparativo con el paciente adulto

BackgroundCandida spp. represents a group of commensal yeasts that can act as pathogens and cause candidiasis in different anatomical locations.AimsThe aim of this study was to perform an epidemiological and comparative analysis between the isolates of Candida spp. in clinical specimens during a three year-period (2010-2012) from children (0-14 years) and adults (15-99 years) in the Valencian Community (RedMIVA).MethodsThe microbiological surveillance network of Valencian Community was used as the information source.Results and conclusionsCandida was isolated in 52,436 patients (1,604 [3.1%] children and 50,832 [96.9%] adults). Candida albicans was significantly (p < 0.05) the predominant species in both age groups, and in almost every type of clinical specimen. The distribution of other species varied depending on the sample type and age group. In blood specimens, Candida parapsilosis followed by C. albicans, Candida famata and Candida lusitaniae were the main species found in children, whereas C. albicans followed by C. parapsilosis, Candida glabrata and Candida tropicalis were the predominant species in adults. In sterile fluids, urine and lower respiratory tract samples, C. parapsilosis was the second most prevalent species in the children group, while C. glabrata and C. tropicalis were the main second species in adults.     

Componentes de la valoración geriátrica y adherencia terapéutica en el paciente anciano con infarto agudo de miocardio

Background and objectivePoor therapeutic adherence after acute myocardial infarction (AMI) can lead to early serious complications. Information on the impact of geriatric assessment on adherence is scarce. The objective of this study was to analyze, in older patients with AMI, the impact of geriatric assessment on therapeutic adherence 12 months after admission.Materials and methodsA previous study randomized patients aged >75 years who had presented an AMI to a nursing health education program versus conventional management, evaluating the impact of this intervention on therapeutic adherence after 12 months. In-hospital geriatric assessment was performed. For this substudy, the adherence predictors were analyzed using binary logistic regression. Those patients who obtained adherence in the 4 tools were considered adherent: the Morisky-Green, Haynes-Sackett test, attendance at visits and correct withdrawal of drugs from the pharmacy.ResultsA total of 119 patients with a mean age of 82.2 years were included. At one year, a total of 42 patients (35.3%) were adherent. The predictors of poor adherence in the final model were male sex, worse glomerular filtration rate, cognitive impairment, nutritional risk, not living alone and not belonging to the intervention group.ConclusionsThe data of this series show a low therapeutic adherence in the elderly after an AMI. Cognitive impairment or nutritional risk was significantly associated with poorer adherence, contrary to a nursing intervention, which highlights the importance of health education and supervision in high-risk patients.     

Íleo biliar como causa de dolor abdominal en el paciente anciano

Gallstone ileus is a rare and potentially serious complication of cholelithiasis. It is defined as a mechanical intestinal obstruction secondary to the presence of a gallstone in the intestinal luz. The most frequent cause is impaction of the calculus in the ileum after passing through a bilioenteric fístula. It has a high morbidity and mortality rate, mainly due to the difficulty and delay in its diagnosis. A retrospective study is presented of 4 cases of gallstone ileus treated between 2013 and 2017 in the Hospital Nuestra Señora del Prado. An analysis was performed on the clinical characteristics, diagnostic tests, and surgical treatment.     

Estimación del filtrado glomerular en el paciente anciano. Implicaciones clínicas en el uso de antibióticos

IntroductionIn elderly, impaired kidney function may lead to relevant clinical implications, especially in drug dosage. There is no consensus on the best formula to estimate glomerular filtration rate (GFR) in this context. While the Cockcroft–Gault (CG) equation is the most used one in drug development, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is the most employed by clinical laboratories. The objective of this study is to analyze the differences and implications of using one or another equation when adjusting the dose of antibiotics.Material and methodsCross-sectional study performed in patients older than 80 years admitted to an acute geriatric unit for infectious disease. Socio-demographic, functional, clinic, assistance and laboratory variables were gathered, calculating GFR according to CG and CKD-EPI. A concordance study between both equations, bivariate analysis and multiple linear regression were carried out.Results100 patients were recruited, with mean age 88.5 ± 4.2 years, and 54% women. A relative overestimation of 13.63 mL/min was observed in GFR according to CKD-EPI, with a low-moderate concordance between both formulas. Greater need for dose adjustment of antibiotics with GC than with CKD-EPI was detected (38% vs. 23%; P < .001), as well as dosage discrepancies, especially with levofloxacin.ConclusionsBoth equations are not interchangeable in the elderly. When used to adjust antibiotic dose, CKD-EPI may overestimate GFR and may cause an increase in adverse reactions. Further studies should be carried out with the aim of reaching a consensus on the most appropriate equation for the elderly patient.     

El anciano en la unidad de geriatría de agudos

Although the implementation of acute geriatric units (AGUs) in general hospitals has a grade A of evidency, in Spain, only 12% of them have this resource. The estimation of geriatric especializad beds for the care of acute frail elderly people is of 2.6/1000 inhabitants older than 75 years. AGUs have demonstrated to reduce the functional loss associated with the hospitalization and to increase the percentage of older people that can return home, without increases in mortality nor costs. In this review we present the characteristics of patients who benefit from AGUs, the services offered, the structure and functioning of the unit, the role of the professionals that work in it and the quality indicators that must be acomplished.     

Utilidad clínica de la micafungina en el tratamiento de las candidiasis invasoras en el paciente crítico

BackgroundOver the last 30 years a significant increase of Candida spp. invasive disease has been observed in non-neutropenic critical ill patients. Both fluconazole and amphotericin B have been considered first line treatment for invasive (proven and probable) Candida spp. disease, although the mortality rate is still high.ObjectivesTo review the current data on the use of micafungin for the treatment of Candida invasive disease in critical ill patients.MethodsThe pharmacologic, mycological and clinical properties of micafungin are reviewed based on current published data. The use and efficacy of micafungin for the treatment of Candida invasive disease in critical ill patients is discussed.Results and conclusionsTo reduce the rate of mortality more effective antifungals and pre-emptive treatment strategies are currently warranted. Candins achieve better results for the treatment of invasive Candida disease in non-neutropenic critical ill patients. Micafungin has a good safety profile (similar to fluconazole). Micafungin is a first line drug for the treatment of invasive Candida disease and may be used as a pre- emptive approach followed by a de-escalating strategy with azoles.