Impacto de la modalidad de terapia de reemplazo renal en adultos mayores frágiles

IntroductionEnd-stage renal disease prevalence is increasing in older adults. Frailty is highly prevalent in older adults with end-stage renal disease. However, there are no prospective studies comparing the performance of the different modalities of renal replacement therapy (RRT) in frail older adults.ObjectiveTo compare clinically relevant outcomes (hospital admission, falls, hip fractures, and mortality) in prefrail and frail older adults according to the modality of RRT: peritoneal dialysis or haemodialysis.MethodsA prospective observational study in prefrail and frail older adults (according to FRAIL scale) on peritoneal dialysis and haemodialysis was carried out. An evaluation was made using baseline characteristics (age, Charlson, body mass index, time on RRT, compliance with Kt/V dose, haemoglobin, and albumin). The patients were followed-up over 12 months, recording mortality, days and number of hospital admissions, falls, and hip fractures.ResultsA total of 54/65 (83%) older adults on RRT met criteria for prefrailty or frailty, and signed informed consent (27 in each modality). Baseline characteristics were similar, except for serum albumin and time on RRT, both of which were significantly lower in the peritoneal dialysis group. The FRAIL score was similar in both groups. Baseline FRAIL correlated with higher comorbidity, lower albumin levels, and non-compliance of Kt/V dose, while it was independent of age, body mass index, and time on RRT. Days and number of hospital admissions at 12 months were similar in patients on peritoneal dialysis and haemodialysis. Survival on peritoneal dialysis and haemodialysis was similar. There were no differences in falls or hip fractures.ConclusionsPre-frail and frail older adults on peritoneal dialysis and haemodialysis have similar clinical outcomes.     

Prevalencia de demencia en adultos mayores de América Latina: revisión sistemática

Background and objectiveDementia is a growing public health problem. It involves the impairment of several cognitive functions, generating mental and physical disability, and therefore greater functional dependence. There is limited epidemiological information which reveals an approximate prevalence in older adults from Latin America. The objective of this study was to determine the prevalence of dementia in the older adult population of Latin America, and its distribution according to geographic area and gender.Materials and methodsA systematic review was carried out in databases: PubMed, Ovid, Lilacs, Cochrane, Scielo and Google Scholar, in order to identify studies that estimate the prevalence of dementia in urban and / or rural population over 65 years of age.ResultsOn February 2018, the literature search yielded 357 publications. The overall prevalence of dementia in the older adult population of Latin America was found to be 11%, prevailing more in female gender and urban people.ConclusionThe prevalence of dementia in Latin America is higher than registered previously, and even than in other continents.     

Calidad de la alimentación de adultos mayores de Santiago de Chile

IntroductionWith the increase in the elderly population of Chile, it is very important to evaluate the quality of food of this age group using simple and quick tools.ObjectiveTo compare the food quality of the elderly, according to gender and age.Material and methodsA cross sectional study was conducted on 458 elderly subjects ≥ 60 years-old of Santiago de Chile. Each one of them were interviewed in their home using the Food Quality Survey for Elderly (FQSE). The objective of this survey is to measure the quality of the food and preparations considered healthy and/or unhealthy for elderly. Weight and height, was obtained from the control document of the elderly.ResultsMen consume a higher number of unhealthy foods compared to women (P = .01). On comparing ages, those over 80 years-old consumed less unhealthy foods (P = .01). The elderly obese showed a lower score in unhealthy eating habits and total intake score.ConclusionWomen eat healthier compared to men, and better eating habits are observed at an older age, especially in men. Finally, on comparing nutritional status, the elderly obese are those who eat in the most inadequate form.     

Tendencias en las hospitalizaciones psiquiátricas de personas mayores de 65 años

BackgroundThe aim of this study was to analyse the trend in the percentages of elderly patients admitted to hospital for psychiatric reasons. An additional aim was to analyse the characteristics of the elderly population admitted to a psychiatric hospitalisation unit.Material an MethodsAn analysis was made of the trends in the percentages of discharges in elderly population at the national level and in the Mental Health Hospitalisation Unit (MHHU) of the Regional University Hospital of Malaga for a period of at least 18 years using segmented regression. For the study of the characteristics of the elderly population, all patients (N = 5,925) and consecutive episodes of admission (N = 15,418) were compared between 1999 and 2017 in the MHHU.ResultsAt the national level, there was an increase in hospital discharges in elderly patients with a significant mean annual percent change of 2.0%. In the study unit, the elderly population were more frequently female, involuntarily admitted, and had a longer hospital stay. They had been diagnosed more frequently with organic and depressive mental disorders, and less frequently with schizophrenia, substance use, and personality disorders.ConclusionsThere was a growing trend in the percentage of elderly psychiatric patients admitted to hospitals during the study period. These results point to the increase in elderly psychiatric admissions and thus the need to adapt psychiatric units to the characteristics of this population.     

Planificación anticipada de los cuidados y del uso de recursos hospitalarios en pacientes con COVID-19 en un programa de atención integrada para adultos mayores frágiles en residencias

ObjectivesTo estimate the magnitude and importance of a process of stratification and advance care planning and the use of health resources, among patients in an integrated health care program for frail elderls in nursing homes,that were referred to the hospital with COVID-19.Material and methodsProspective cohort study of patients > 64 years old with COVID-19 infection, in a health care program in nursing homes (from 3/15/2020 to 9/15/2020). The identification of patients with palliative needs, the performing and visible registration in electronic health records of the advance care planning and the use of intensive care were assessed.ResultsWe included 374 COVID-19 patients. 88% were women, the median age was 88 years old. The 79% were patients with palliative needs, of which 68% had the advance care planning (P<.001) registered in the electronic health record. Only 1% of patients with palliative needs and severity criteria were admitted to the intensive care unit. Overall mortality was 25%. Of those who died, 74% had severity criteria (P<.001) and 90% had palliative needs (P<.001).ConclusionsCarrying out a care process based on identification of patients with palliative needs and advance care planning and a central and visible registration of advance care planning in health records, could improve the quality and safety of care and optimize the use of intensive care health resources at all times and especially in public health emergencies.     

Evidencias psicométricas de una versión breve de la Coping Humor Scale en adultos mayores peruanos

IntroductionHumour plays an important role in promoting successful and healthy aging. However, its scientific study is still limited, partly due to the absence of validated tools for use in Latin America. The objective of this study was to translate the 5-item Coping with Humor Scale (CHS-5) from English to Spanish and examine the evidence of reliability and validity based on the internal, convergent, and discriminant structure of the Peruvian version of the scale.Materials and methodThe participants were 236 elderly Peruvian adults (78.4% A confirmatory factor analysis, analysis of correlation (r), and reliability (α, Cronbach's alpha and ω, omega) was performed.ResultsThe one-dimensional model presented an adequate fit of the data (χ² = 7.72, df =5, P=.17, χ² / df = 1.54, GFI = 0.988, CFI = 0.996, NFI = 0.988, RMSEA =0. 048 [95% CI; 0.000-0.111]; and SRMR = 0.016). The reliability indexes were adequate (α= 0.86 [95% CI: 0.82-0.89] and ω = 0.89 [95% CI: 0.87-0.91]). A positive correlation was observed between the mean score of CHS-5 and satisfaction with life, and was negative with depression.ConclusionsThe CHS-5 has excellent psychometric properties, being a measure that provides valid and reliable interpretations to be used in elderly Peruvians with depression.     

Asociación entre la longitud de los telómeros y deterioro cognitivo en adultos mayores

IntroductionCognitive impairment is a transition stage between normal aging and dementia, the prevalence of last one increases with age; the damage of the functions and physical integrity, places the older adult in a greater susceptibility to get sick. Telomere length is a hallmark of aging to characterize this phenotype, as well as a biomarker that reflects the underlying state of the cell. In this work, the relative length of telomeres in older adults with cognitive impairment was correlated.Material and methodsObservational-analytical study, in samples of adult patients older than 65 years with and without cognitive impairment, in whom the relative length of telomeres was measured.ResultsNinety samples of older adults were included in the study and in the association analysis according to multivariate logistic models, cognitive impairment showed almost five times more risk for telomere shortening in relation to the presence of the diagnosis of cognitive impairment (Odds ratio 4.88, p = 0.027).ConclusionsWhen correlating the relative length of telomeres in older adults diagnosed with cognitive impairment, this association was confirmed for shorter.     

Confort térmico de adultos mayores: una revisión sistemática de la literatura científica

By 2050, people over 65 years old will represent 66% of the world's population. Thermal comfort both indoors and outdoors is one of the most influential factors to improve their quality of life in cities. The aim of this paper is to present a systematic review of the literature that identifies differences in thermal comfort temperature between older adults and other age groups, as well as to determine the factors that influence them. The review focused on studies published between 2000 and 2018. The results show that, for physiological, psychological, and physical reasons, there were differences between 0.2 and 4 °C. However, the published studies were heterogeneous in terms of methodologies and sample size. Likewise, few determine the comfort temperature range for older people in a given climate, demonstrating the opportunity for future lines of research.     

Confort térmico y el riesgo de infecciones respiratorias en los adultos mayores en la sierra rural del Perú

The objective is to evaluate thermal comfort in the rural highlands of Peru and determine if thermal conditions influence the risk of respiratory infections. The probit regression model is used for this, with the unit of analysis being adults over 60 years of age. The information source is the data from the National Household Survey and the National Service of Meteorology and Hydrology of Peru. In addition, it was possible to monitor the temperature and the interior relative humidity of 4 types of bedrooms with a thermo-hygrometer and compared it with the desired thermal comfort index criterion. The results show that if the air temperature drops on average by one degree (1° C) in the area of residence, the probability of risk of respiratory infections in older adults increases by 0.18, although the relative humidity and the wind speed were not statistically significant at 1% significance level. Finally, the 4 types of bedrooms evaluated lacked the desired thermal comfort and increased the risk of acquiring respiratory infections.     

Determinantes sociales,clínicos y psicosociales asociados a hipertensión arterial no controlada en adultos mayores. Encuesta SABE Colombia 2016

ObjectiveTo evaluate sociodemographic, clinical and psychosocial characteristics that are associated with uncontrolled arterial hypertension (HANC) in older adults in Colombia.MethodsSecondary analysis of data from the National Survey of Health, Welfare and Aging (SABE Colombia 2016), in which men and women aged 60 years or older in the country who were not institutionalized were interviewed. The dependent variable was uncontrolled hypertension (HANC) (≥140/90 mm Hg). The SABE survey surveyed 23694 older adults; 11264 had a diagnosis of arterial hypertension (HTA) and were taking antihypertensive medication. On the other hand, 5106 older adults, randomly selected, had their blood pressure taken. Participants previously diagnosed with HTA under medical management with antihypertensives and who had had their blood pressure taken at the same time were included, resulting in a sample of 2656 participants. Sociodemographic, clinical and psychosocial characteristics were evaluated. Univariate, bivariate, and multivariate analyzes with logistic regression were performed.ResultsOne thousand one hundred eighty-eight (44.7%) participants presented HANC. A higher prevalence of HANC was observed in adults older than 74 years (OR 1.31; 95% CI 1.09-1.57) and lower prevalence in residents of urban areas (OR 0.55; 95% CI 0.42–0.71).ConclusionsAge over 74 years and living in a rural area were identified as variables associated with inadequate blood pressure control in non-institutionalized older adults in Colombia.     

Condiciones sociodemográficas ambientales asociadas a perfiles de salud-alimentación entre personas adultas mayores,Córdoba-Argentina

IntroductionDemographic trends indicate that population aging is not exclusive to developed countries. Argentina reaches 15.5% of the elderly population. The Covid-19 pandemic has brought to the forefront the public health situation of this population, challenging health systems, with disproportionate impacts on this group, which has suffered more than 80% of the deaths in the country, mainly in those with comorbidities.ObjectiveTo analyze the sociodemographic and environmental conditions involved in the process of development of health and nutrition profiles of the elderly people of Córdoba, Argentina 2020.MethodologyEpidemiological, cross-sectional, population-based study that included 221 elderly people (≥60 years old), through random sampling. Data on sociodemographic and environmental conditions, health and dietary profiles were collected through structured interviews.ResultsThe average age of the participants was 68 years. Eighty-five percent recognized neighborhood contamination, 38% of them being garbage dumps close to their homes. Eighty-nine percent reported at least one non-communicable disease (NCD) or associated risk factor and 66% were overweight (BMI≥25 kg/m²). The presence of obesity (BMI≥30 kg/m²) was associated (OR = 2.05; CI 1.007–3.922) with the development of NCDs. Only 4% of the population complied with the daily fruit and vegetable consumption recommendation.ConclusionThe predominant characteristics of the health and dietary profiles associated with NCDs identified suggest the need to study in depth the social determinants that condition the aging process.     

Análisis de la sedación paliativa en pacientes mayores hospitalizados: efectividad de un protocolo

ObjectiveTo measure changes in the practice of palliative sedation during agony in hospitalised elderly patients before and after the implementation of a palliative sedation protocol.Material and methodsA retrospective before-after study was performed in hospitalised patients over 65 years old who received midazolam during hospital admission and died in the hospital in two 3-month periods, before and after the implementation of the protocol. Non-sedative uses of midazolam and patients in intensive care were excluded. Patient and admission characteristics, the consent process, withdrawal of life-sustaining treatments, and the sedation process (refractory symptom treated, drug doses, assessment and use of other drugs) were recorded. Association was analysed using the Chi² and Student t tests.ResultsA total of 143 patients were included, with no significant differences between groups in demographic characteristics or symptoms. Do not resuscitate (DNR) orders were recorded in approximately 70% of the subjects of each group, and informed consent for sedation was recorded in 91% before vs. 84% after the protocol. Induction and maintenance doses of midazolam followed protocol recommendations in 1.3% before vs 10.4% after the protocol was implemented (P=.02) and adequate rescue doses were used in 1.3% vs 11.9% respectively (P=.01). Midazolam doses were significantly lower (9.86 mg vs 18.67 mg, P<.001) when the protocol was used than when it was not used. Ramsay sedation score was used in 8% vs. 12% and the Palliative Care Team was involved in 35.5% and 16.4% of the cases (P=.008) before and after the protocol, respectively.ConclusionsUse of midazolam slightly improved after the implementation of a hospital protocol on palliative sedation. The percentage of adequate sedations and the general process of sedation were mostly unchanged by the protocol. More education and further assessment is needed to gauge the effect of these measures in the future.     

Relación entre el perfil oxidativo y el índice de diversidad de la dieta en adultos mayores de una zona urbano-marginal de Costa Rica

Background and objectiveThe older we get, the greater the production of reactive oxygen species and therefore the greater the oxidative stress, which is related to the deterioration of the health of older adults. This study analyzed the relationship between the oxidative profile and the dietary diversity index in an urban-marginal population of older adults in Costa Rica.MethodsEighty-eight older adults were studied and various markers of oxidative stress, serum glucose levels, lipid profile, and some micronutrients were determined. In addition, the body mass index (BMI) was calculated and the dietary diversity index (DDI) was determined.ResultsLipid peroxidation and DNA oxidation, a mean plasma antioxidant capacity percentage of 39.54 ± 10.67%, which decreased with age, were evidenced. 67% of the participants had alterations in glycemia, 73% had one or more alterations in blood lipid levels, 55% had insufficient vitamin D levels, and 68.6% were overweight. The average IDD was 4.91 points, indicating that the diet was not very diverse. No relationship was found between IDD and nutritional status, between nutritional status and oxidative stress, nor between biochemical variables and oxidative stress.ConclusionThe adults studied presented high oxidative stress, a high percentage of overweight, and a low IDD. A higher IDD was associated with a lower blood concentration of MDA and a higher % PAC.