Escalas de valoración del dolor en pacientes con demencia. Instrumentos de ayuda para el fisioterapeuta,el médico,el enfermero y el terapeuta ocupacional

The purpose of this study was to determine which scales are being used to evaluate pain in old people suffering from dementia.     

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.     

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.     

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).     

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.     

Life cycle assessment of 3D printing geo‐polymer concrete: An ex‐ante study

Three‐dimensional (3D) printing and geo‐polymers are two environmentally oriented innovations in concrete manufacturing. The 3D printing of concrete components aims to reduce raw material consumption and waste generation. Geo‐polymer is being developed to replace ordinary Portland cement and reduce the carbon footprint of the binder in the concrete. The environmental performance of the combined use of the two innovations is evaluated through an ex‐ante life cycle assessment (LCA). First, an attributional LCA was implemented, using data collected from the manufacturer to identify the hotspots for environmental improvements. Then, scaled‐up scenarios were built in collaboration with the company stakeholder. These scenarios were compared with the existing production system to understand the potential advantages/disadvantages of the innovative system and to identify the potential directions for improvement. The results indicate that 3D printing can potentially lead to waste reduction. However, depending on its recipe, geo‐polymer likely has higher environmental impacts than ordinary concrete. The ex‐ante LCA suggests that after step‐by‐step improvements in the production and transportation of raw materials, 3D printing geo‐polymer concrete is able to reduce the carbon footprint of concrete components, while it does still perform worse on impact categories, such as depletion of abiotic resources and stratospheric ozone depletion. We found that the most effective way to lower the environmental impacts of 3D concrete is to reduce silicate in the recipe of the geo‐polymer. This approach is, however, challenging to realize by the company due to the locked‐in effect of the previous innovation investment. The case study shows that to support technological innovation ex‐ante LCA has to be implemented as early as possible in innovation to allow for maintaining technical flexibility and improving on the identified hotspots.