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.     

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.     

¿Cuál es el papel de la valoración geriátrica integral en Oncogeriatría?

The growing increase in world population and generalised aging have been accompanied by an increase in the prevalence of cancer in the elderly. Aging is associated with certain physiological changes, some of which are enhanced by the neoplasm itself. Along with this, the elderly oncology patient usually has more problems than the rest of the elderly, and has a multitude of deficits. These characteristics require a special handling of the older patient with cancer, by using the main tool used in Geriatrics, the comprehensive geriatric assessment. This article analyses the importance of the comprehensive geriatric assessment in this population group, paying special attention to its ability to predict the toxicity of chemotherapy and the survival of the elderly oncology, as well as its ability to classify these patients into groups that help in the decision making process.     

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.     

Repercusión de un sistema centralizado de ingresos sobre la eficacia y eficiencia de una unidad geriátrica de recuperación funcional

ObjectiveTo evaluate the influence of a change in the management of admissions on the activity and care outcomes of a Geriatric Functional Recovery Unit (GFRU).Material and methodsA retrospective observational study was conducted. Since 2000, the Hospital Central Cruz Roja GFRU has been collecting data grouped into periods of 4 years, except for the centralised admissions (September 2016-December 2018). The data collected on admission included the Red Cross Functional and Mental scales, the Barthel index, the main diagnosis of the functional decline (grouped into stroke, orthopaedic problem, and multifactorial immobility episodes), and comorbidity evaluated by the Charlson index. The following outcome variables were analysed: the overall and relative functional gain at discharge; length of hospital stay; the functional efficiency, discharges to nursing homes, and transfers to acute care units. An analysis was made of the relationship between the admissions from the centralised unit and the previous period (directly admission managed by GFRU), using multivariate analysis (linear regression for continuous outcome variables and logistic regression for the dichotomous ones), adjusted for admission variables.ResultsPatients admitted from the centralised unit showed a greater overall and relative functional gain (difference between both means: 3.49 points, 95% CI; 1.65-5.33, and 12.41%, 95% CI; 0.74-24.08, respectively), longer stay (12.92 days, 95% CI; 11.54-14.30) and lower efficiency (−0.36, 95% CI; −0.16 to −0.57), higher risk of institutionalisation (OR 1.61, 95% CI; 1.19-2.16), and transfers to acute care units (OR 3.16, 95% CI; 2.24-4.47).ConclusionsA centralised admissions system had an influence on the improvement of functional parameters in the patients, but with a longer length of hospital stay, and lower efficiency. Increases in institutionalisation at discharge and transfers to acute care units were also observed.     

Impacto de la pandemia por COVID-19 y el confinamiento estricto de la población en la incidencia de fractura de cadera en España. Una revisión sistemática

Background and objectiveDuring the COVID-19 pandemic, a strict population confinement was decreed in Spain. In a situation of health crisis and health system saturation, knowledge of pathologies whose treatment cannot be delayed is of great importance for the correct management of resources and processes. The objective was to determine the influence of the COVID-19 pandemic and the strict population confinement on hip fracture incidence in Spain.Material and methodSystematic review following the PRISMA guidelines. Search in Pubmed and Chocrane Library on 11/11/2022: hip fracture and COVID-19 and Spain.ResultsSix studies met the inclusion criteria, 50% showed a decrease in the hip fractures incidence during strict population confinement (all in Comunidad de Madrid hospitals), and in the other 50% there were no differences (all in other region hospitals). It was constant that hip fractures, either did not decrease, or decreased much less than the rest of fractures during the period of strict population confinement, increasing their relative number with respect to the total admissions in orthopedic surgery and traumatology.ConclusionsThe behavior of the hip fractures number during the strict population confinement decreed by the COVID-19 pandemic has not been symmetrical in all regions. To design and implement contingency plans in the event of a pandemic situation, these data must be taken into account in order to properly plan material and human resources.     

Influencia de la enfermedad psiquiátrica previa en la evolución de los pacientes sometidos a cirugía bariátrica

IntroductionPresurgical evaluation of patients undergoing bariatric surgery includes, among others, a psychological/psychiatric evaluation. Psychiatric disorders that did not contraindicate surgery may persist and influence on weight loss and postoperative clinical course, hindering the success of the procedure. The aim of our study was to analyze the postoperative evolution of our series of patients with and without psychiatric symptoms before surgery.Patients and methodsRetrospective analysis of 109 patients undergoing bariatric surgery with duodenal switch from 2003 to 2008 (follow up > 6 months). We studied weight changes, immediate and delayed complications of surgery and nutritional deficiencies in post-surgical follow-up in patients with previous psychiatric disorders (group 1, n = 17) compared with patients without psychiatric disorders (group 2, n = 92).ResultsPatients in group 1 showed a greater tendency for weight gain. They regained a 9,4% of the initial excess weight lost between 18 months after surgery and 36 months after surgery, while patients in group 2 regained only 0.2% in the same period (p < 0.05). There was no difference in immediate surgical complications (5/17 vs 25/92 patients). The mean incidence of late surgical complications was 0.71 per patient in group 1 and 0.22 complications per patient in group 2 (p = 0.02). 52.9% of patients in group 1 had at least one late complication compared to 19,6% of patients in group 2 (p = 0.003). The three most common complications in patients with previous psychiatric disorders were chronic diarrhea, vomits and malnutrition. The presence of nutritional deficiencies were common in both groups, mainly soluble vitamins, iron and zinc. During postoperative follow-up, we found 3.1 ± 1.6 nutritional deficiencies per patient in group 1 and 2.5 ± 1.7 in group 2 (p = 0.04). More than three nutritional deficiencies were found in 8 patients in group 1 (52.9%) compared to 23 patients in group 2 (25%) (p = 0.03).ConclusionsThe presence of previous psychiatric disorders may be a predictor of a less positive outcome in morbidly obese patients who undergo bariatric surgery.