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.     

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.     

Prevención cuaternaria en ancianos

Quaternary prevention is a group of measures taken to prevent, decrease and/or alleviate the harm caused by health activities.     

El fenómeno de las caídas en residencias e instituciones: revisión del Grupo de Trabajo de Osteoporosis,Caídas y Fracturas de la Sociedad Española de Geriatría y Gerontología (GCOF-SEGG)

The Workshop on Osteoporosis, Falls and Fractures (GCOF) of The Spanish Geriatrics and Gerontology Society (SEGG) formed a committee in order to review the state of the art on the detection, risk factors and assessment tools for falls, and intervention protocols when falls occurs in nursing homes, long-term hospitals or medium-stay units. The different patient profiles are described in order to make a comprehensive approach to this heterogeneous topic and population, offering a risk classification and specific advice according to these categories.     

Experiencia con el uso del registrador implantable de eventos en una serie de personas mayores con caídas y sospecha de síncopes de origen arrítmico

Objective

To review our experience on using an implantable loop recorder (ILR) in patients with recurrent falls, when an arrhythmogenic cause is suspected.

Material and methods

This is a retrospective, observational study of patients with repetitive unexplained falls, suspected syncope, or electrocardiographic abnormalities. All of them had been evaluated by a cardiologist, who decided to implant a loop recorder (ILR) for an accurate diagnosis.

Results

A total of 13 patients received an ILR. The average falls rate for the sample was 3.3. The mean age was 78 years, and 46% were female, with a mean follow-up period of 24 months. During this time, three patients did not suffer from a new fall. An arrhythmogenic diagnosis was obtained in 5 patients: bradycardia was identified in 4 cases, and tachycardia in one of them. The symptoms did not coincide with a documented arrhythmia in the rest of the patients.

Conclusion

ILR is a helpful tool to establish an arrhythmogenic cause of unexplained and recurrent falls, in this selected sample of older adults.     

Prevención de las úlceras de talón en un hospital de media estancia. Estudio comparativo de vendaje clásico almohadillado respecto a las taloneras hidrocelulares de poliuretano

Introduction

The aim of the study is to determine the incidence of heel pressure ulcers (UPPT) and to compare the two systems for UPPT prevention: classic padded bandage and polyurethane heel.

Material and methods

Prospective intervention study in a medium-long hospital stay of all people admitted that had no UPPT but had a risk of UPPT according to the Braden Scale or clinical judgment. The patients were randomized to prevention with classic padded bandage or polyurethane heel. The outcome variable was the incidence of UPPT for each study group, which was recorded every 15 days or when there were clinical changes.

Results

Of the 940 patients evaluated, 409 with a mean age of 80.5 years and 59.1% women,were included in the study. Of these, 78% had Barthel score ≤30; 28.6% dementia; delirium 37.6%; 27.6% diabetes; and 19.6% other UPP. The overall incidence was 2.9% UPPT; 2.49% in the classic padded bandage and 3.37% in the polyurethane heel group (p=0.82).

Conclusions

No statistically significant differences were observed between the group with the classical dressing and the group with the polyurethane heel dressing. The use of multiple measures to prevent UPPT achieved a low incidence of these.     

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.     

Implantación de una Unidad de Ortogeriatría de Agudos en un hospital de segundo nivel

Background

Patients with hip fracture (HF), due to their characteristics, require a specific support. The Acute Orthogeriatric Unit (OGU) has been shown to be one of the most beneficial.

Objective

To evaluate the main variables of HF patients treated at an OGU and compare them with the previous referral model (RC).

Material and methods

A prospective observational study with retrospective control was conducted on 169 patients, split into two groups. In the RC group, patients were admitted to conventional trauma ward. In the OGU group, an early geriatric assessment was performed, and patients were simultaneously attended daily by the orthopaedic surgeon, nurse and geriatrician, and the surgery times, work load, discharge and destination, were planned in a weekly meeting with the rest of professionals.

Results

A total of 71 patients were included in the RC group and 96 in the OGU group. The preoperative characteristics were similar, except for a slightly higher comorbidity in the OGU group. The OGU patients were operated on earlier (3.82±2.08 vs 4.61±2.5 days; P<.32), and overall hospital stay was reduced by 28% (11.84±4.04 vs 16.46±8.4 days; P<.001). The functional efficiency (Barthel Index at discharge-Barthel Index at admission/overall stay - stay before surgery) was higher in the OGU group (1.56±0.7 vs 2.61±1.1; P<.05). There were no differences in functional status, mortality or discharge location.

Conclusions

The OGU is a level of care that provides effective medical care in HF patients in general hospitals.     

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.     

Elaboración de una herramienta para la estimación del riesgo de mortalidad a corto y medio plazo tras el alta de una Unidad de Hospitalización de Agudos de Geriatría

Objectives

To identify predictive factors for 6 and 12-months mortality after discharge from a geriatric acute care unit, and from these, derive a mortality-risk index.

Methods and analysis

Prospective cohort study will be conducted on patients over 70 years-old admitted to a geriatric acute care unit and survived to hospital discharge. The main outcome measure will be mortality at 6 months and 12 months after discharge. Independent variables include sociodemographics, functional status, comorbidities, and clinical and laboratory characteristics. Risk factors associated with mortality will be constructed using multivariate logistic regression models. To build the mortality index, points will be assigned to each risk factor by dividing each beta coefficient in the logistic model by the lowest beta coefficient. A score will be assigned to each subject by adding up the points for each risk factor present in the model. The predictive accuracy of the model will be determined by comparing the predicted versus observed mortality in the study population and calculating the area under the ROC curves in both populations.

Conclusions

The risk-mortality index developed would allow an easy estimate to be made of individual risk of death at 6 months and 12 months after discharge from a geriatric acute care unit, with the purpose of establishing care plans and individualising treatment, according to real objectives.     

Problemas de seguridad relacionados con la aplicación de dispositivos de restricción física en personas mayores

The use of physical restraint devices on frail elderly could have significant negative consequences on their health. Apart from complications due to prolonged immobility, the use of this procedure is associated with other serious adverse effects which occur when a person is restricted in a position which carries a risk of asphyxiation. The devices most implicated in these incidents are bedrails, vests and restraining belts. Physical restraint could also be associated as much with the sudden death of patients, due to the stress that it causes, as with injuries from falling. This article presents the recommendations which experts, manufacturers and institutions dealing with the quality of health care have issued for the safest use of this procedure. It stresses the need for better training of professionals, as well as the importance of investigating the factors which can lead to accidents with the aim of preventing them.     

Utilización del servicio de urgencia de un hospital universitario por los adultos mayores en Santiago de Chile

Introduction

An increase in visits to Emergency Departments by older adults has been reported, but there are no data available on this in countries in the early phases of demographic and epidemiological transition. This paper describes the characteristics of people over 60 years-old (AM) who visited the Emergency Department of the Hospital Clínico Universitario de la Pontificia Universidad Católica, Chile (SU-PUC), compared to those less than 60 years-old (AJ).

Material and methods

Demographic data and reasons for admission and re-admission were collected retrospectively from the SU-PUC monthly statistics report. Obstetrics, paediatrics and «scheduled admissions» were excluded. The frequencies were compared using Chi-squared (significance: P < .05).

Results

A total of 37,660 visits to the SU-PUC were recorded (81% AJ; 19% AM; with 8% being older than 75 years). No statistical differences were found in the visit time (70% daytime), or by season between the groups.A total of 7,414 (19.6%) of those who visited were hospitalised, with differences being detected between groups (AM: 48.9% vs 12.9% AJ; P < .001), particularly in those over 75 years (59%). The primary cause of admission was cardiopulmonary in AM (22%) and gastrointestinal in AJ (31%). Re-admissions were 10% in AM and 6% in AJ (P < .001).

Conclusion

The use of SU by AM and some characteristics of their care process (hospitalisation) are similar to those found in countries in more advanced phases of demographic transition.     

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.     

Efectividad de una intervención educativa sobre hipertensión arterial dirigida a pacientes hipertensos de edad avanzada

Introduction

Hypertension is the most prevalent cardiovascular risk factor among people over the age 60. The aim of this study is to assess the effectiveness of an educational intervention tool, and its reliability.

Material and methods

Experimental study, prospective, randomised, parallel-group in a sample of 120 patients, 62 in the intervention group and 58 in the control group. The intervention group received a written and oral educational program on hypertension and cardiovascular risk; the control group did not receive any intervention.

Results

At the end of the intervention there was an increase in the percentage of correct responses, with statistically significant differences compared to the control group, as regards knowledge of hypertension, risk factors associated with the risks of having high blood pressure and control medication.

Conclusion

The implementation of an educational intervention on hypertension and cardiovascular risk associated with the same care activity is capable of increasing the level of knowledge by elderly hypertensive patients admitted to hospital.     

Trasplante renal en mayores de 60 años en un hospital de Colombia

Introduction

Kidney transplantation is the treatment of choice in patients with end- stage renal disease. Renal transplantation in without fear of ethical conflicts is the best treatment option in the elderly. The objective is to describe the demographic and clinical characteristics of patients over 60 years old with at least one year of renal transplantation in a single center of Colombia.

Methods

This is a cohort study of patients over 60 years old from a single center in Bogota, Colombia. About 28 patients were analyzed between June 2004 and March 2012.

Results

The mean age was 65 years old, with 89% males. The main cause of chronic kidney disease was diabetic nephropathy, followed by hypertensive nephrosclerosis. Most of them (96.4%) were deceased donor transplants with a mean age of 40 years old, cold ischemia time was 12 hours and there was a mismatch of 3.25 (±1.29). Major comorbidities were hypertension, diabetes, dyslipidemia, and coronary arterial disease. Almost 17% had delayed graft dysfunction. Serum creatinine at 6 and 12 months was 1.27 mg/dl (±0.31) and 1.25 mg/dl (±0.33), respectively. Only 10% of patients had acute cellular rejection. Humoral rejections were not documented. The patient survival at 1 year was 89.7%, and death-censored graft survival was 96.4%. The most frequent cause of death was acute myocardial infarction.

Conclusions

Proper selection of kidney transplant recipients shows satisfactory results in survival, with low morbidity in patients older than 60 years.     

Síndrome del miembro fantasma: aproximación terapéutica mediante el tratamiento espejo. Experiencia de un Servicio de Geriatría

The clinical use of mirror visual feedback was initially introduced to alleviate phantom pain by restoring motor function through plastic changes in the human primary motor cortex. It is a promising novel technique that gives a new perspective to neurological rehabilitation. Using this therapy, the mirror neuron system is activated and decrease the activity of those systems that perceive protopathic pain, making somatosensory cortex reorganization possible. This paper reports the results of the mirror therapy in three patients with phantom limb pain after recent lower limb amputation, showing its analgesic effects and its benefits as a comprehensive rehabilitation instrument for lower limb amputee geriatric patients.     

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.