Uso de metadona en el anciano con dolor oncológico: una revisión sistemática

Objective

To identify the clinical use of methadone as an analgesic in the management of cancer pain in elderly patients.

Material and methods

We performed a systemic review of the literature on the specific use of methadone in elderly with cancer pain in MEDLINE, COCHRANE DATABASE and SCOPUS. A second search was conducted in MEDLINE to look for clinical trials and systematic review of the use of methadone in cancer pain, selecting only those in which the mean age of patients was ≥ 65 years old.

Results

Four articles were obtained in the first search, and from the second 7 clinical trials, none of them specific to methadone use in elderly patients with cancer.

Conclusions

There are insufficient data on the use of methadone as an analgesic in the elderly with cancer. Given its pharmacological characteristics it must be used by trained personnel. Several recommendations are proposed for its use as an analgesic in the treatment of cancer pain in the elderly.     

Actualización de la neumonía en el anciano

The incidence of pneumonia increases with age and contributes to morbidity and mortality in the elderly. In our setting, pneumonia is the sixth leading cause of death and the fourth most common diagnosis at discharge from acute hospitals. This article reviews current concepts in management of pneumonia in the elderly: healthcare-associated pneumonia, aspiration and oropharyngeal dysphagia, risk stratification, and indications of radiological, microbiological and biological markers. We present current evidence on antibiotic treatment (when to start, empirical coverage, duration, new drugs and combinations) and adjuvant treatment (steroids, early mobilization, oral hygiene, prevention and treatment of aspiration and cardiac complications). We emphasize preventive aspects and considerations regarding palliative treatment.     

Prevención primaria del ictus en el anciano: evidencias actuales en el tratamiento de la hipertensión arterial

After age, arterial hypertension (AHT) is the most significant risk factor associated with stroke, and accounts for more than 25% of all strokes. The prevalence of AHT in the elderly in Spain is approximately 70%, which means that there are more than 5 million people over 65 years-old with hypertension in our country. There are currently numerous trials and meta-analyses that demonstrate that antihypertensive treatment clearly reduces the risk of stroke in elderly, and very elderly (≥80 years) subjects. However there are many areas of uncertainty such as, for example, when to start antihypertensive treatment, to what level should the blood pressure be lowered, or what is the best antihypertensive in the prevention of stroke in this population. In this article we present a review of the current evidence in the prevention of stroke in the elderly patient by means of treatment of the AHT.     

La transición hacia el retiro: adaptación en una muestra de prejubilados españoles de la escala Retirement Satisfaction Inventory

Objectives

This study provides psychometric data for the Spanish adaptation of the scale of Retirement Satisfaction Inventory (RSI). We explore the factor structure and psychometric properties a sample of Spanish early retirees. RSI measures the motivation to retirement, satisfaction with life in retirement and leisure activities.

Material and methods

The RSI scale (Floyd et al, 1992) was applied to a sample of 638 Spanish early-pensioners with a mean age of 61.28 (SD: 5.77) years and a mean age at early retirement of 53.89 years (SD: 2.71). An exploratory factorial analysis was performed using the SPSS statistics package, and a confirmatory factorial using the AMOS 6.0 module. The data collection process was carried out by means of the questionnaires by post method.

Results

The adaptation of the RSI to Spanish showed a three-scale structure:: the reasons for retirement, satisfaction with life in retirement, and leisure activities. These scales showed a structure with four, two and three main factors, respectively, which differ slightly from those reported in the original instrument.The confirmatory factorial analysis demonstrated the optimum fit of the model for the three scales.

Conclusions

The RSI adaptation to Spanish provides a tool that could asses the motivation towards retirement during the leaving work process, satisfaction with retirement life, and the leisure sources in the Spanish early retired population.     

Descripción de los resultados y costes de una intervención preventiva a nivel respiratorio en el anciano institucionalizado: ensayo controlado aleatorizado

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.     

Revisión sobre el deterioro funcional en el anciano asociado al ingreso por enfermedad aguda

Hospitalization is a risk for elderly population, with a high probability of having adverse events. The most important one is functional impairment, due to its high prevalence and the serious impact it has on the quality of life. The main risk factors for functional decline associated with hospitalization are, age, immobility, cognitive impairment, and functional status prior to admission. It is necessary to detect patients at risk in order to implement the necessary actions to prevent this deterioration, with physical exercise and multidisciplinary geriatric care being the most important.     

Lupus eritematoso sistémico en el anciano

Late-onset systemic lupus erythematosus (SLE) usually appears in patients older than 65 years and has clinical features different from the classical form observed in younger patients. In the elderly, SLE represents 10-20% of all SLE cases, shows a different and less aggressive clinical evolution and the first manifestations are non-specific. A significantly higher incidence of late-onset SLE in males, and the fact that postmenopausal women have a more benign disease, suggests that the estrogenic status may influence the activity of the disease. Owing to the insidious onset and the non-specific clinical manifestations on presentation, there is commonly a delayed diagnosis of late-onset SLE. Furthermore, the presence of comorbidities and concomitant therapies in elderly patients may limit the therapeutic options for SLE. The treatment of choice of joint symptoms and serositis includes non-steroidal anti-inflammatory drugs and low-dose steroids for short periods. In addition to the need for adopting a multidisciplinary approach, it is fundamental to obtain information about the functional, cognitive and social status of these patients in order to make appropriate healthcare decisions.     

La neurólisis del nervio mediano en el paciente anciano: evaluación a largo plazo

Purpose

Carpal tunnel release by opening the flexor retinaculum is considered a satisfactory treatment. However, several factors, like ageing, may influence postoperative results. We present the long term outcomes in elderly patients.

Methods

This is an historical prospective long term study of 52 patients who received surgical treatment of carpal tunnel syndrome when they were 65 or older. We have carried out a clinical-functional (with the Levine questionnaire), electromyographic and dynamometric valuation of the patients studied, up to ten years from the surgery.

Results

The results of Levine's questionnaire, revealed favourable data for a mean follow-up of 10.35 years, with a mean improvement in the clinical score of 1.93 points (95% confidence interval [CI]: 1.72-2.17) and in the functional score of 0.83 points (95% CI: 0.68-0.99). Similarly, the electromyographic values showed a significant improvement compared to preoperative ones (mean difference of sensory velocity of 8.43 m/s, 95% CI: 8.17-11.63; mean difference of motor latency of 1.65 ms, 95% CI: 1.24-2.25). The data on grip strength did not reach statistical significance.

Conclusions

In elderly patients, complete section of the carpal transverse ligament, allows maintaining favourable differences in most of the parameters studied, ten years after surgery, making the surgical treatment a recommendable option.     

Vitamina D y fracturas en el anciano

Osteoporosis and the subsequent fractures caused by this are a source of morbidity and mortality in the elderly population. It is also often the start of the cascade that culminates in frailty and dependence. Vitamin D has a direct relationship with the appearance of osteoporosis and with the risk of fractures. Receptors of this vitamin have also recently been described in other organs and systems of the body that are associated with muscle strength, cancer and overall mortality. Deficiency of this vitamin in the elderly population in Spain is very prevalent, both in the community and the hospitalised elderly. The diagnosis and treatment are straightforward and cheap. Its efficacy in the prevention of osteoporosis and in the appearance of fractures is perfectly demonstrated. In this review, we will look at the physiology and actions of this vitamin, as well as the principal studies that have demonstrated its effectiveness in the elderly population.