La unidad de ortogeriatría de agudos. Evaluación de su efecto en el curso clínico de los pacientes con fractura de cadera y estimación de su impacto económico

Objective

To study the effects of the management of hip fracture patients in an acute orthogeriatric unit shared between the departments of Orthopedic Surgery and Geriatrics compared with the usual hospital care, and to analyse financial differences in both systems of care.

Method

Prospective quasy-experimental randomized intervention study in 506 patients admited to a terciary hospital with an osteoporotic hip fracture. The usual model of care was the admission to the orthopedic ward with a request to Geriatrics (RC) and the study model consisted of the admission to an orthogeriatric unit (OGU) for the shared co-management between orthopaedic surgeons and geriatricians. This model included the appointment of one spokesperson from each department, the specialist geriatric nurse management, early geriatric assessment, shared daily clinical care, weekly joint ward round and coordinated planning of the surgery schedule, the start of the ambulation and the time and setting of patient discharge.

Results

Two hundred fifty five consecutive patients admitted to the OGU and 251 patients managed simultaneusly by the RC model were included. Except for a mean age slightly lower in the OGU group, there were no differences neither in the baseline patients characteristics nor in the surgical rates between the two groups. Among the OGU patients group it was more frequent to receive rehabilitation in the acute setting, to be able to walk at discharge and to be referred to a geriatric rehabilitation unit (all with P<.05). The OGU patients received geriatric assessment and were operated on earlier than the RC patients (P<.001). The length of stay in the acute ward was 34% shorter in the OGU patients (mean 12.48±5 vs 18.9±8.6 days, P<.001) (median 12 [9-14] vs 17 [13-23] days, P<.001). The whole hospital length of stay, including the days spent in the geriatric rehabilitation units, was 11% shorter in the OGU patients (mean 21.16 ±14.7 vs 23.9 ±13.8 days, P<0.05) (median 14 [10-31] vs 20 [14-30] days, P<.001). The OGU saved 1,207 € to 1,633 € per patient when estimated by the costs for process model, and 3,741 € when estimated by the costs for stay model.

Conclusions

The OGU is a hospital setting that provides an improvement in the patients functional outcome and a reduction in the hospital length of stay. Therefore it saves health care resources. These findings show the OGU as an advisable setting for the acute care of hip fracture patients.     

Prevalencia de sarcopenia en consultas de geriatría y residencias. Estudio ELLI

Background

There are few systematic studies on the prevalence of sarcopenia using the new diagnostic criteria in different geriatric care settings.

Objective

To estimate the prevalence of sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria in older subjects living in nursing homes and in those who attend geriatric outpatient clinics.

Material and methods

A single country multicentre study in two samples of older subjects: patients cared for in outpatient geriatric clinics, and individuals living in nursing homes. Data collected will include demographic variables, medical history, medication, geriatric syndromes, functional status (assessment of basic and instrumental activities of daily living), mobility, cognitive status, comorbidity, quality of life, nutritional status, and laboratory parameters. For the diagnosis of sarcopenia, 4 m walking speed, handgrip strength, and body composition measured by bioelectrical impedance analysis will be assessed.

Results

Using the EWGSOP algorithm, the prevalence of sarcopenia in an elderly Spanish population will be estimated. In addition, concordance and correlation between the three parameters included in the definition (muscle mass, muscle strength, and physical performance) will be analysed, using the different existing cut-off points, and examining the diagnostic accuracy of each. Finally, demographic, anthropometric and functional data that define subjects with sarcopenia will be investigated.

Conclusions

The ELLI study should improve knowledge on the prevalence and characteristics of sarcopenia in older people in our population.     

1. Reunión Nacional de Trabajo Multidisciplinar en Oncogeriatría: documento de consenso

On 2nd of June 2011 the Institut Català d’ Oncologia l’Hospitalet--Hospital Duran i Reynals hosted the first Meeting of Multidisciplinary Work in Oncogeriatrics. The reason for the meeting, which follows on from an initiative of the Medical Societies of Radiotherapy, Oncology, Geriatrics and Gerontology and Palliative Care and Medical Oncology, was to initiate a joint line of work among the different specialties that generally take part in the handling of the elderly patient suffering from oncologic pathologies. This document summarises the different subjects covered during the Meeting.     

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.     

Calidad de vida percibida por las personas mayores. Consecuencias de un programa de estimulación cognitiva a través de la motricidad «Memoria en movimiento»

Introduction

This article presents the results of evaluation of health related quality of life in a group of elderly people who were engaged in the program of cognitive stimulation «Memory in movement».

Materials and methods

A content analysis was conducted to determine the type of experience that the subjects stated in the context of an interview. The statements were classified into categories created ad hoc. The sample consisted of 32 participants with a mean age of 69.92 ± 4.98 years. The software QSR NVivo-8 was used for data processing.

Results

The results show that the 48% of the elderly perceive some improvements in their memorisation abilities, 47% in attention and concentration, and 10% in the satisfaction with life after being in the program. They are especially worried about the loss of memory -stated by the 65.62%- and they came to the cognitive stimulation program with the aim of improving this capacity. The feelings that participants reported having experienced during the program have to do with fun, vitality and energy.

Conclusions

Programs on cognitive stimulation that incorporate some physical activities, together with a clear playful and social component, improve the psychic and social capacities and they open an important line of intervention due to their good acceptance by the elderly.     

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.     

Guías clínicas de fractura de cadera. Comparación de sus principales recomendaciones

Hip fracture is the most severe complication of osteoporosis, and despite being a frequent health problem, there is a wide variability in both the health care provided to these patients and the results achieved after their treatment. Clinical guidelines are a tool that helps to reduce this variability. The authors of this review try to give a panoramic and comparative view of the key recommendations proposed by the main guidelines for the hospital care of hip fracture patients. Recommendations on the care in the acute phase are reviewed, particularly the initial hospital management, use of tools, preventive measures to avoid medical complications, surgery related aspects, treatment of usual clinical problems, and shared orthopaedic and geriatric care. Circulating and putting into practice the main recommendations will help to improve the health care provided to these patients and obtain better outcomes.