Guía de consenso para el abordaje de la neumonía adquirida en la comunidad en el paciente anciano

The incidence of community-acquired pneumonia increases with age and is associated with an elevated morbidity and mortality due to the physiological changes associated with aging and a greater presence of chronic disease. Taking into account the importance of this disease from an epidemiological and prognostic point of view, and the enormous heterogeneity described in the clinical management of the elderly, we believe a specific consensus document regarding this patient profile is necessary. The purpose of the present work was to perform a review of the evidence related to the risk factors for the etiology, the clinical presentation, the management and the treatment of community-acquired pneumonia in elderly patients with the aim of producing a series of specific recommendations based on critical analysis of the literature. This document is the result of the collaboration of different specialists representing the Spanish Society of Emergency Medicine and Emergency Care (SEMES), the Spanish Society of Geriatrics and Gerontology (SEGG), the Spanish Society of Chemotherapy (SEQ), the Spanish Society of Internal Medicine (SEMI), the Spanish Society of Respiratory Medicine and Thoracic Surgery (SEPAR), Spanish Society of Home Hospitalization (SEHAD) and the Spanish Society of Infectious Disease and Clinical Microbiology (SEIMC).     

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.     

Relación entre el rendimiento en la prueba de estación unipodal y la velocidad del centro de presión en adultos mayores

Introduction

Frequent falls are one of the most important health problems in the elderly population. The unipedal stance test (UPST), asses postural stability and is used in fall risk measures. Despite this, there is little information about its relationship with posturographic parameters (PP) that characterizes postural stability. Center of pressure velocity (CoPV) is one of the best PP that describes postural stability. The aim of this study was to analyze the relation between UST score and CoPV in elderly population.

Materials and methods

A sample of 38 healthy elderly subjects where divided in two groups according to their UPST score, low performance (LP, n = 11) and high performance (HP, n = 27). The correlation between UPST score and COP mean velocity (CoPmV), recorded from a posturographic test, was analyzed between both groups.

Results

An inverse correlation between UPST score and CoPmV was found in both groups. However, this was higher in the LP group (r = −0.69, P = .02) compared to the HP (r = −0.39, P = .04).

Conclusions

Based on the results of this investigation, it may be concluded that the achievement on UPST has an inverse relationship with CoPmV, especially in subjects with low performance in the UPST.     

Propuesta de una batería neuropsicológica para la exploración del síndrome de Capgras

Capgras syndrome is the most prevalent of the delusional misidentification syndromes. It appears in both psychiatric illness and organic brain damage. Cognitive and neuropsychiatric models (lateralization and disconnection) have been proposed to explain the syndrome. From a neuropsychological point of view Capgras syndrome seems to be due to damage of bifrontal and right limbic and temporal regions. Memory, feeling of familiarity, monitoring of self and reality would be altered. All of these cause a failure to adequately integrate the information about emotions and facial recognition. Relative preservation of the left frontal lobe may be necessary for the development of delusional response. There does not seem to be a differential pattern as regards the aetiology, but there is a common underlying neuropsychiatric mechanism. Based on theoretic models, and clinics features, we propose a neuropsychological battery to assess the Capgras syndrome, that should be sensitive to the main expected deficits.     

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.     

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.     

Síndrome de la bolsa de orina púrpura en dos pacientes institucionalizados

Purple urine bag syndrome (PUBS) is an uncommon but particularly striking phenomenon characterised by a chemical reaction involving the urine, plastic and certain enzymes from some sulphatase- and phosphatase-producing bacteria, including Proteus mirabilis, Escherichia coli and Morganella morganii, amongst others. Following this reaction, the catheter and the bag may be stained red, blue or purple. This phenomenon tends to occur in patients with multiple pathology and with urinary catheters, as part of a urinary tract infection. We describe two clinical cases of PUBS in institutionalised patients with permanent urinary catheters.     

Efectos de un programa de intervención neuropsicológica basado en mindfulness sobre la enfermedad de Alzheimer: ensayo clínico aleatorizado a doble ciego

Introduction

The purpose of this research was to assess effects of a mindfulness based neuropsychological intervention on the clinical course of Alzheimer's disease.

Material and method

A two year randomized and double blind clinical trial was conducted on 127 probable Alzheimer's disease patients, according to NINCDS-ADRDA scale. Patients were grouped into three experimental groups (cognitive stimulation, progressive muscular relaxation, and mindfulness) plus a control group. All participants were receiving donepezil. Cognitive skills were assessed with CAMCOG and MMSE, functional area with RDRS-2, and NPI was used for psychopathology screening. Three treatment sessions per week were carried out for two years, and follow up measurements were taken every six months.

Results

The global cognitive function, functionality and behavioral disorders measurements indicated that patients from the experimental group based on mindfulness were stable during the two years, while patients from the control group, as well as the other experimental groups, showed a mild but significant worsening of their mental capacities.

Conclusion

The mindfulness based neuropsychological program showed better cognitive and functional stability, as well as significant improvement in the psychopathological condition of mild to moderate Alzheimer’ patients. These results support the idea that a mindfulness based intervention can produce a clinically relevant improvement in the treatment of dementia. More research is needed to confirm these data.     

Características de la fractura de cadera y posterior recuperación en pacientes mayores de 65 años con historia de caídas recurrentes

Recurrent falls affect between 14.8% and 19% of the elderly population, and are associated with an increased risk of fracture. We know little about the influence the history of recurrent falls may have on recovery after hip fracture.

Methods

Cohort study. The patients included were, over 65 years admitted during a 1 year period to the General University Hospital of Albacete with a hip fracture due to a fall. Recurrent falls were defined as a history of two or more falls within the 6 months prior to the fracture. Variables: demographic data, circumstances of fall, number of falls in the previous 6 months, type of fracture and its repair, comorbidity and drug treatment, cognitive status at admission (Pfeiffer test) and independence for activities of daily living (Barthel Index - BI) were collected. A subsample of patients with pre-fracture BI≥60 and Pfeiffer at admission≤4 was followed up at 3, 6 and 12 months.

Results

A total of 335 patients were admitted. Data were collected on 279 of them, 19.4% of whom had previously suffered two or more falls. The recurrent fallers had a worse mental status on admission, a higher number of associated diseases, a lower percentage of independence in dressing and in bed-chair transferring than patients without history of recurrent falls, all statistically significant. In the 201 patients followed up, the impairment on the BI after 12 months compared to the BI previous to fracture was higher in recurrent fallers (-20.8 ± 31.54 vs -10.73 ± 20.21, P = .04), focusing more on independence in eating (76% vs 91.9%, P < .05), grooming (72% vs 91,9%, P < .01), faecal continence (60% vs 78.7%, p < .05) and walking indoors (80% vs 93.3%, P < .05).

Conclusions

The recovery of independence after hip fracture is significantly lower in the group of recurrent fallers in patients without moderate or severe functional impairment previous to fracture and cognitively stable.     

Una nueva especie de Neuryurus Ameghino (Mammalia, Glyptodontidae) en el Pleistoceno tardío de la Mesopotamia de Argentina

Among the South American Pleistocene Glyptodontidae (Xenarthra, Cingulata), one of the most scarcely represented genus in the fossil record is Neuryurus Ameghino, in which the only well characterized species, until now, is Neuryurus rudis (Gervais), coming from the Ensenadan (early-middle Pleistocene) of the Pampean region, Argentina. In this contribution, we report and describe a new species of Neuryurus, coming from the Arroyo Feliciano Formation (early Lujanian; ca. 130 ka), Entre Ríos province, Argentina, in a particular palaebiogeographic context, more associated with the western sector of Uruguay and southern Brazil than the Pampean region. From a morphological perspective, this new taxon is characterized by: (a) the remarkable development of the foramina at the exposed surface of the osteoderms of the dorsal carapace, showing un aspect almost spongy; (b) the large diameter of the perforations observed in the ventral surface of the osteoderms, resembling to those present in the dorsal surface of the osteoderms of the Glyptodontidae Doedicurinae; (c) the evident thickness of the osteoderms, as in Glyptodon Owen; (d) area of contact and articulation of adjacent osteoderms very denticulate, with deep osseous interdigitating projections, as in Glyptodon and Glyptotherium Osborn, but here more evident; (e) larger osteoderms of the dorsal carapace showing, in the dorsal surface, many little conical tubercles, having some resemblance to Panochthus tuberculatus Burmeister. The presence of this new species in the early late Pleistocene of the Mesopotamic region is another element that adds to the biogeographical characterization of this particular area, especially evident during the warm and humid pulses of the late Pleistocene. In turn, this species represents the most complete record of the genus outside the Pampean region and partially complete the stratigraphic and geographic distribution of the genus.     

Resultados preliminares de un programa comunitario de prevención de caídas: estudio Precari (prevención de caídas en La Ribera)

Objective

To evaluate the results of a fall prevention programme designed to be applied to the elderly living in the community.

Material and methods

The sample consisted of 249 participants ≥70 years of age, who were randomly assigned to one of three groups. The monthly intervention group (GIM): instructions on fall prevention and healthy exercises to improve physical function and balance at beginning of the study, and a monthly theoretical and practical refresher session. The quarterly intervention group (GIT), with the same beginning intervention and a refresher session every three months. The control group (GC), the same beginning intervention but no refresher sessions.

Results

The mean age of the sample was 74.47 years (SD 5.33), with 64% women. The incidence of falls was reduced from 0.64 per patient year in the previous year to 0.39 in the post-intervention year in GIM, from 0.49 to 0.47 in GIT, and in the GC it remained at 0.47 before and twelve months after, but with no significant differences in the reduction between groups (P=.062). At the end of the study there was a decrease in Rizzo scale of 0.72 points (95% CI: 0.57-0.88, P<.001).

Conclusion

An interdisciplinary community intervention programme can contribute to reducing the incidence of falls. Further studies are required to continue research into the incidence of falls in the elderly living in the community.     

Efecto de 24 semanas de entrenamiento de fuerza a moderada-alta intensidad en ancianos

Introduction

Strength programs have been seen to be useful in minimizing the effects of sarcopenia, although intervention protocols may vary in their content and characteristics. The aim of this study was to demonstrate the influence of a particular strength protocol for the elderly.

Material ans methods

A total of 35 individuals took part in the study, with 18 in the exercise group (4 men and 14 women), and 17 in the control group (4 men and 13 women). The average age was 73. The exercise group carried out a strength training program at moderate to high intensity over 24 weeks. Strength was evaluated using the chair stand test, 2-minute step and 2 vertical jumps-squat jump (SJ), and countermovement jump (CMJ). Falls in both groups were also compared before and after the intervention, as well as their relationship with the chair stand variable.

Results

A tendency towards improvement was observed in all tests, with the exception of CMJ; while the control group showed a tendency in the opposite direction. Contrast between the two groups at the end of the intervention was notable in all the tests. An inverse relationship between the chair stand strength variable and the number of falls was evident.

Conclusions

According to the results achieved, the training was perceived to exercise a positive influence on both the strength of the elderly people and a reduction of the number of falls. The gap between the two groups widened towards the end of the intervention.     

Delirium subsindrómico en pacientes ancianos: revisión sistemática

In this systemic review, the articles published between1990 and November 2012 on subsyndromal delirium (SSD), and specifically those with reference to geriatric patients, were analysed. In SSD, symptoms from the three nuclear domains of delirium (cognitive, circadian and higher order thinking) are simultaneously present, with mild to moderate severity. Although the search for these clinical characteristics is a useful guide, there are no universally accepted diagnostic criteria for SSD. Regardless of the criteria used for diagnosis, SSD is persistently associated with poor functional and cognitive outcome, longer hospital stay, institutionalisation, and increased mortality. Studies are needed on the physiopathology, treatment and prevention in the field of SSD, which is a particularly important clinical condition in geriatric patients.     

La acción tafonómica de mamíferos carnívoros en el sitio arqueológico Inca Cueva-cueva 4, borde oriental de la Puna argentina

In this paper, a model of carnivore taphonomic action in the Argentinean Puna is applied to archaeological site Inca Cueva-cueva 4, on the Eastern Fringe of the Puna East of the Andes cordillera, which contains hunter-gatherer occupations dating to the early and middle Holocene. Different indicators, such as the low levels of bone modifications (ca. 2 to 8% NISP), consisting mainly in subtle marks, suggest a low intensity of the intervention of carnivores during the formation of these deposits. Variables such as the frequency of carnivore scats attest to repeated carnivore visits to the cave, but the “dilution effect” upon the small faunal assemblages these carnivores tend to accumulate in a context of larger zooarchaeological assemblages would have faded their traces away.