Fractura de cadera en el paciente anciano: factores pronóstico de mortalidad y recuperación funcional al año

Objective

The aim of this study is to identify the risks factors for mortality and functional recovery in elderly patients admitted to hospital with a hip fracture.

Impacto funcional de la fractura de pelvis por fragilidad. Descripción de una serie de casos consultados al servicio de Geriatría

Introduction

The prevalence of pelvic fracture (PF) due to frailty is increasing, leading to an increase in functional impairment in the patient, as well as increasing morbidity and mortality. The aim of the present study is to gain knowledge about the sociodemographic characteristics, as well as the functional features, of patients admitted to hospital with PF and evaluated by a Geriatrics department. The functional burden of PF and the potential influence of geriatric interventions are also assessed.

Autopercepción de la salud en ancianos y mortalidad a los 5 años. Estudio en una comunidad rural

IntroductionTo investigate the relationship between self-rated health and mortality at 5 years of follow-up among the elderly in a rural community.DesignSurvival study with a 5-year follow-up.ParticipantsRepresentative sample of 408 individuals aged more than 65 years living in a rural municipality in the north-west of Spain.ResultsSurvival was significantly lower among individuals who reported «poor» or «very poor» health (relative risk [RR] = 1.56; 95% confidence interval [95% CI], 1.04-2.33). However, after adjusting for other variables (age, sex, education, severe disease, toxic habits, and mobility) the probability of survival among these individuals reporting «poor» or «very poor» health was similar to that among participants who rated their health as «average», «good » or «very good» (RR = 1.15; 95% CI, 0.71-1.87). In the multivariate analysis, only age, regular smoking, and mobility remained as significant predictive factors of mortality.ConclusionsAfter adjusting for demographic and socioeconomic factors and for objective health status, self-rated health does not have a direct effect on mortality. The degree of mobility does seem to be useful in predicting mortality.     

Factores de riesgo de mortalidad en pacientes mayores de 65 años hospitalizados por COVID-19

Background and objectiveCOVID-19 is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has caused a global pandemic that we are currently suffering from.Objectiveto identify factors associated with the death of patients aged 65 years or older hospitalized for COVID-19.Materials and methodsRetrospective cohort study. We included patients aged 65 years or older who were hospitalized for COVID-19 and dead o discharged between March 5 and 25, 2020. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death.Results277 patients were included in this study. The bivariate analysis showed significant differences (p < 0.05) between survivors and non survivors: age, increased dependence and comorbidity, history of ischemic heart disease, renal failure and non-hematological neoplasms, heart failure during admission, leukocytosis, elevated creatinine, PCR, GOT and troponin Ic values, lymphopenia, and decreased blood pH and SatO2. Multivariate logistic regression revealed that age ≥ 65 years (OR: 4.23 (95% CI: 1.43-12.52; p = 0.009), lymphopenia < 1000/μL (OR: 2.36 (95% CI: 1.07-5.20; p = 0.033), creatinine > 1.2 mg/dL (OR: 3.08 (95% CI: 1.37-6.92; p = 0.006), SatO₂ < 90% (OR: 2.29 (95% CI: 1.01-5.21; p = 0.049) and troponin Ic > 11 ng/mL (OR: 2.32 (95% CI: 1.04-5.16; p = 0.040) were independently associated with higher hospital mortality.ConclusionsOlder age, lymphopenia, SatO₂ < 90%, elevated creatinine and troponin Ic values were independently associated with higher mortality in hospitalized patients with COVID-19, these factors could help clinicians to identify patients with poor prognosis.     

Factores pronósticos de remisión a largo plazo tras cirugía transesfenoidal en la enfermedad de Cushing

There is no consensus on the remission criteria for Cushing's disease or on the definition of disease recurrence after transsphenoidal surgery, and comparison of the different published series is therefore difficult. A long-term recurrence rate of Cushing's disease ranging from 2%-25% has been reported. Predictors of long-term remission reported include: 1) adenoma–related factors (aggressiveness, size, preoperative identification in MRI), 2) surgery-related factors, mainly neurosurgeon experience, 3) clinical factors, of which dependence on and duration of glucocorticoid treatment are most important, and 4) biochemical factors. Among the latter, low postoperative cortisol levels, less than 2 mcg/dL predict for disease remission. However, even when undetectable plasma cortisol levels are present, long-term recurrence may still occur and lifetime follow-up is required. We report the preliminary results of the first 20 patients with Cushing's disease operated on at our hospital using nadir cortisol levels less than 2 mcg/dl as remission criterion.     

Valor pronóstico del diagnóstico principal en ancianos ingresados en una unidad geriátrica de agudos al alta y al año

ObjectiveTo analyse the relationship between the primary diagnosis on admission to an Acute Geriatric Unit (AGU) and the risk of hospital mortality and one year after dischargeMaterial and methodsA longitudinal study was conducted on patients admitted to the Central Hospital AGU Red Cross in Madrid in 2009. The admission diagnosis was grouped by Diagnosis Related Groups (DRGs). The date of death was collected from the medical charts and the National Death Index Ministry of Health report. The main outcome of study was the association between diagnoses on admission and functional impairment at discharge (measured as a loss of 10 or more points between the Barthel Index at discharge and that on admission), mortality during hospitalization, at 3 months and one year after discharge. The multivariate analysis was adjusted for age, sex, comorbidity, functional and cognitive status, and serum albumin.ResultsThe study included1147 patients, with a mean age of 86.7 years (SD ± 6.7), and 66% were women. During admission, 10.1% of patients died and 36.6% had functional impairment at discharge. After discharge, 25.5% died at 3 months, and 42.2% at one year. The distribution of the primary diagnoses at admission (between parentheses hospital mortality and at year) were heart failure, 21.4% (8.1% and 37.4%), pneumonia,13.3% (12.3% and 46.4%), and aspiration pneumonia, 4.7% (27.5%, y 71%), respiratory diseases,13.3% (6.6% and 38.2%), urinary infection,10.2% (5.1% and 42.7%), and stroke (excluding AIT), 9.9% (13.3% and 46.9%). In the multivariate analysis, only admissions due to aspiration pneumonia were independently associated with increased risk of hospital mortality (odds ratio, 2.23; 95% CI = 1.13 to 44.42), and stroke with increased risk of functional impairment at discharge (odds ratio, 6.01; 95% CI = 3.42-10.57). No diagnosis was independently associated with increased risk of death at 3 months and at yearConclusionsAdmission from aspiration pneumonia carries an increased risk of death in elderly patients hospitalised for acute medical conditions. After discharge, the risk of death must be attributed to factors other than the admission diagnosis     

Evaluación funcional y cognitiva en una población urbana de mayores de 89 años. Estudio NonaSantFeliu

Introductionthe increase in life expectancy should be characterized by an increase in disability-free life. We assessed functional and cognitive capacity in an urban population older than 89 years, as well as possible gender variations.Material and methodsthe NonaSantFeliu study is a longitudinal, observational, population-based study. We present the first crosssectional survey of 186 inhabitants older than 89 years in a city. Sociodemographic data were gathered. We assessed basic activities of daily living with the Barthel Index (BI), instrumental activities with the Lawton Index (LI), cognitive status with the Mini-Mental State Examination (MMSE) and comorbidity with the Charlson Index (CI).Resultsof 186 examined nonagenarians, 143 (76.5%) were women. The mean age SD was 93.1 ± 3.1 years. One-hundred forty nine (80.2%) were widowed and 26% were institutionalized. The mean BI was 60.8 ± 30; 56% were functionally independent or had slight dependence. The mean LI was 2.1 ± 2.8. The mean MMSE score was 21 ± 11; 56% had an MMSE score higher than 23. The mean CI was 1.4 ± 1.7. No significant differences were found by gender.Conclusionsdespite their advanced age, most of the nonagenarians showed mild functional and cognitive impairment with low comorbidity. No significant differences were observed by gender. Future studies should help to detect nonagenarians at high risk of rapid impairment to allow early initiation of interventions to delay the development of further incapacity.     

Impacto de la pandemia por COVID-19 y el confinamiento estricto de la población en la incidencia de fractura de cadera en España. Una revisión sistemática

Background and objectiveDuring the COVID-19 pandemic, a strict population confinement was decreed in Spain. In a situation of health crisis and health system saturation, knowledge of pathologies whose treatment cannot be delayed is of great importance for the correct management of resources and processes. The objective was to determine the influence of the COVID-19 pandemic and the strict population confinement on hip fracture incidence in Spain.Material and methodSystematic review following the PRISMA guidelines. Search in Pubmed and Chocrane Library on 11/11/2022: hip fracture and COVID-19 and Spain.ResultsSix studies met the inclusion criteria, 50% showed a decrease in the hip fractures incidence during strict population confinement (all in Comunidad de Madrid hospitals), and in the other 50% there were no differences (all in other region hospitals). It was constant that hip fractures, either did not decrease, or decreased much less than the rest of fractures during the period of strict population confinement, increasing their relative number with respect to the total admissions in orthopedic surgery and traumatology.ConclusionsThe behavior of the hip fractures number during the strict population confinement decreed by the COVID-19 pandemic has not been symmetrical in all regions. To design and implement contingency plans in the event of a pandemic situation, these data must be taken into account in order to properly plan material and human resources.     

Estudio de cohorte retrospectivo de pacientes diagnosticados de cáncer de tiroides del área suroeste de Madrid. Factores pronósticos en el cáncer diferenciado de tiroides

ObjectivesTo analyze the clinical and histopathological features of patients with thyroid cancer in the southwest Madrid area and to identify poor prognostic factors in the subgroup with differentiated thyroid carcinoma (DTC) of the follicular epitelium.Patients and methodsA retrospective cohort study of patients diagnosed with thyroid cancer at our hospital from 1998 to 2009. Significant clinical, surgical, and histopathological variables were included in Cox proportional hazard and logistic regression models to identify baseline factors predicting for death, recurrence, and persistent disease in DTC.ResultsA total of 150 patients with a median age of 49 years and a median follow-up of 5.4 years were enrolled. Histological subtypes were: papillary carcinoma (86%), follicular carcinoma (6.6%), medullary carcinoma (4%), poorly differentiated carcinoma (2.7%), and anaplastic carcinoma (0.7%). At the end of the study, 68% of patients were cured, 3.3% had died (disease-specific mortality, 1.3%), 1.3% were lost to follow-up, 6.7% had persistent biochemical disease, and 2.7% persistent clinical disease, while 18% of patients were pending assessment. The best prognostic model for DTC recurrence was TNM staging (stage II-IV vs. I: HR 5.9, 95% CI 1.3-26.6), while the best model for persistent disease or death was ETA clinical staging (high risk vs. low or very low risk: OR 9.2, 95% CI 2.6-33.2).ConclusionsIn our study, disease-specific mortality and persistent clinical disease were low. Classification of DTC patients based on ETA staging after initial treatment was a good predictor of persistent disease or death.     

Diabetes mellitus y riesgo de fractura de cadera. Revisión sistemática

Background and objectivesIt has been reported that the risk of fracture is increased in patients with diabetes mellitus (DM). The aim of this study was to investigate the possible relationship between DM and hip fracture, as well as any associated risk factors, by means of a systemic review of the literature.MethodsPubMed and SCOPUS databases were used to search for relevant studies published from January 2001 to August 2018. Retrospective and prospective cohort studies were selected in which the estimated risk of hip fracture was demonstrated by comparing groups of diabetic patients with non-diabetics. A search was also made for risk factors independent from the association between DM and hip fracture.ResultsA total of 27 articles that fulfilled the inclusion criteria were included. A clear association was observed in diabetic patients (women and men) compared to non-diabetics patients. Among the risk factors, the most important ones were the fact that diabetes was type 1, probably associated with greater risk to a longer duration of DM, and being a female.ConclusionsThere is an increased risk of hip fracture in patients diagnosed with DM. This association is more significant in diabetes type 1 and women.     

El peor año de mi vida. Agotamiento emocional y burnout por la COVID-19 en profesionales de residencias. Estudio RESICOVID

IntroductionThe COVID-19 pandemic has led to major changes in the day-to-day operations of residential care facilities. Little is known about the impact it has had on professionals working in nursing homes in Spain. This research arose from the need to explore the situation experienced during the pandemic and to delve into the experiences as narrated by professionals working in nursing homes. The aim of the RESICOVID study was to analyze the effects on professionals of the measures taken in response to the COVID-19 pandemic in nursing homes.Material and method31 professionals (mean age: 32.9 years; 83.8% women, in various areas of care) were interviewed. Seventy-one percent of the sample presented a diagnosis of COVID-19. The analysis was performed with the Atlas-ti v8 program.ResultsFrom the analysis of the interviews, 128 quotations were extracted, coded in the following dimensions: 1. experience of confinement; 2. perception of changes; 3. health problems; 4. cognitive and functional changes; 5. loneliness.ConclusionsBurnout, overload, lack of resources and uncertainty caused by the COVID-19 pandemic have generated feelings of fear, exhaustion, anxiety, frustration and sadness in professionals who continue to this day without sufficient resources to face the situation. The design of contingency plans for future health crises should take into account this impact on care professionals.