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1.
Carmen Mateo-Pascual Rosa Julián-Viñals Teresa Alarcón-Alarcón Maria Victoria Castell-Alcalá Jose Manuel Iturzaeta-Sánchez Angel Otero-Piume 《Revista espa?ola de geriatría y gerontología》2014
Introduction
Vitamin D deficiency is common in the elderly, especially among institutionalized and/or hip fracture patients. However, there are few population studies on the prevalence of this deficiency in the general population over 64 years in our environment. The aim of this study was to determine the prevalence of vitamin D deficiency in an urban population cohort of over 64 years, and analyze its relationship with sociodemographic, climatic, and health factors.Material and methods
Cross-sectional study from «Peñagrande cohort», a population-based cohort consisting of people over 64 years. We determined 25-hydroxyvitamin D levels, and recorded sociodemographic data (age, sex, marital status, education, socioeconomic status), season of measurement and health variables (comorbidity, obesity, malnutrition, renal failure, cognitive impairment, vitamin D supplements, and disability).Results
A total of 468 individuals with a mean age of 76.0 years (SD: 7.7) were included, of which 53.4% were women. The mean value of vitamin D was 20.3 ± 11.7 ng/mL. The large majority (86.3%, 95% CI: 83.0-89.5) had a vitamin insufficiency (≤ 30 ng/ml), and 35.2% (95% CI: 30.8-39.7) showed severe vitamin deficiency (≤ 15 ng/ml). Vitamin insufficiency increases linearly with age (OR 1.06; 95% CI: 1.01-1.11), and was associated with low socioeconomic status (OR 3.29; 95% CI: 1.55-6.95). Severe vitamin D deficiency increases with age (OR 1.06; 95% CI: 1.02-1.09), female gender (OR 1.80; 95% CI: 1.18-2.75) and with cognitive impairment (OR 1.71; 95% CI: 1.04-2.83).Conclusion
The prevalence of vitamin D deficiency in people over 65 years of age in our community is high. It would be advisable to determine the vitamin D values in the high risk elderly in order to introduce measures of pharmacological supplementation in those with inadequate levels. 相似文献2.
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Selene Soria Eva GallegoMaite Vidan Javier OrtizJosé Antonio Serra-Rexach 《Revista espa?ola de geriatría y gerontología》2014
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. 相似文献5.
Pilar Jürschik Maria Viladrosa Teresa Botigué Ana Lavedán Ana Belen Vena Teresa Noguera 《Revista espa?ola de geriatría y gerontología》2013
Objective
To know the prevalence of mistreatment and to identify the associated factors among elderly people without cognitive impairment, seen in the geriatric unit, located in the hospital emergency area.Methods
Cross-sectional study of a population of 65 years or older assessed by the geriatric Interdisciplinary Social Welfare Functional Unit (ISSFU) of the emergency area in the Arnau de Vilanova hospital of Lleida. We excluded participants with cognitive impairment. The total number of participants was 127. The suspicion of mistreatment was measured using the Questionnaire of the American Medical Association (AMA) and the Canadian Task Force (CTF). The variables studied were social demographic characteristics and functional dependency.Results
Prevalence of suspicion of mistreatment was 29.1% (95% CI: 0.21-0.37). The most frequent subtypes were neglect and psychological, and less frequent was negligence. Associated factors were being female, being in unpaid work, being a widow and living alone.Conclusions
Three out of ten elderly people were identified as possible victims of abuse. Due to the relative isolation of many of the elderly who were abused, an unexpected visit to the emergency area may be the only opportunity for detection. Geriatric units located in this area should include the suspicion of mistreatment of this population in their comprehensive assessment. For this, it is necessary to have tool with a high degree of sensitivity and specificity for detection of abuse in the elderly. 相似文献6.
Germán Diestre Ortín Vanessa González Sequero Núria Collell Domènech Francisca Pérez López Pablo Hernando Robles 《Revista espa?ola de geriatría y gerontología》2013
Introduction
Advanced care planning (ACP) helps in make decisions on the health problems of people who have lost the capacity for informed consent. It has proven particularly useful in addressing the end of life. The aim of this study was to determine the prevalence of ACP in patients with severe chronic diseases.Material and methods
Review of medical records of patients with dementia, amyotrophic lateral sclerosis, Parkinson's disease, chronic obstructive pulmonary disease or interstitial lung disease, heart failure, chronic kidney disease on dialysis and cancer, all in advanced stages. We collected data on living wills or registered prior decisions by the physician according to clinical planned.Results
A total of 135 patients were studied. There was a record of ACP in 22 patients (16.3%). In most of them it was planned not to start any vital treatment in the event of high risk of imminent death and lacking the ability to make decisions. Only two patients were had a legal living will.Conclusion
The registration of ACP is relatively low, and this can affect decision-making in accordance with the personal values of patients when they do not have the capacity to exercise informed consent. 相似文献7.
Background
Supplementation with B vitamins for stroke prevention has been evaluated over the years, but which combination of B vitamins is optimal for stroke prevention is unclear. We performed a network meta-analysis to assess the impact of different combinations of B vitamins on risk of stroke.Methods
A total of 17 trials (86 393 patients) comparing 7 treatment strategies and placebo were included. A network meta-analysis combined all available direct and indirect treatment comparisons to evaluate the efficacy of B vitamin supplementation for all interventions.Results
B vitamin supplementation was associated with reduced risk of stroke and cerebral hemorrhage. The risk of stroke was lower with folic acid plus vitamin B6 as compared with folic acid plus vitamin B12 and was lower with folic acid plus vitamin B6 plus vitamin B12 as compared with placebo or folic acid plus vitamin B12. The treatments ranked in order of efficacy for stroke, from higher to lower, were folic acid plus vitamin B6 > folic acid > folic acid plus vitamin B6 plus vitamin B12 > vitamin B6 plus vitamin B12 > niacin > vitamin B6 > placebo > folic acid plus vitamin B12.Conclusions
B vitamin supplementation was associated with reduced risk of stroke; different B vitamins and their combined treatments had different efficacy on stroke prevention. Folic acid plus vitamin B6 might be the optimal therapy for stroke prevention. Folic acid and vitamin B6 were both valuable for stroke prevention. The efficacy of vitamin B12 remains to be studied. 相似文献8.
María Isabel Ferrero López José Fermín García Gollarte José Jorge Botella Trelis Oscar Juan Vidal 《Revista espa?ola de geriatría y gerontología》2012
Objective
To determine the prevalence of dysphagia in a population of institutionalised elderly people, and the effectiveness of a clinical method for its detection.Methodology
A prospective study was conducted on a random sample of elderly residents. A clinical evaluation along with an assessment with different volumes and viscosities (MECVV) were used. Specific care and follow up was arranged following this assessment.Results
Forty residents were studied. The prevalence of unrecognised dysphagia was 42.5%. Following assessment by the MECVV, the prevalence rose from 22.5% to 65% (P=.012). Dysphagia detected by MECVV was related to nutritional risk, as measured by the Mini-Nutritional Assessment (MNA) (P=.007), and to the diagnosis of dementia (P=.028).Conclusions
The diagnosis of dysphagia in this sample of institutionalised elderly people increases when applying a clinical method for detection, reaching a prevalence similar to other studies. 相似文献9.
Carmen María Osuna-Pozo José Antonio Serra-Rexach José Viña María del Carmen Gómez-Cabrera Antoni Salvá Domingo Ruiz Ferrán Masanes Alfonso Lopez-Soto Francesc Formiga Federico Cuesta Alfonso Cruz-Jentoft 《Revista espa?ola de geriatría y gerontología》2014
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. 相似文献10.
José Gutiérrez Rodríguez Marian Rodríguez Piñera Eloy Ortiz Cachero Anabel González Alonso Paloma Pérez Guillén Francisco Luis Jiménez Muela Arsenio Alonso Collada Juan José Solano Jaurrieta 《Revista espa?ola de geriatría y gerontología》2013
Objectives
To study the prevalence of delirium in the residential environment and to analyse the associated clinical, functional and mental factors.Material and methods
A cross-sectional epidemic study was conducted on a population of elderly persons institutionalised in 2011 in 6 nursing homes in Asturias. Socio-demographic, clinical, functional (Barthel Index [BI]) and mental (Mini-Mental State Examination [MMSE]) variables were collected. Delirium was defined by the Confusion Assessment Method.Results
A total of 505 elderly were included in the study (age 83.30 ± 7.33 years, with 67.70% women), and scores on the MMSE of 17.19 ± 10.35 and a BI score of 55.11 ± 35.82. The prevalence of delirium was 11.70%. On examining the risk of delirium among the studied variables, there was statistical significance when considering: BI, MMSE, dementia, pressure ulcers, or urinary catheter, and the prescribing of clomethiazole, ACTH-I or trazodone. In the analysis of the variables in the logistic regression with BI, diagnosis of dementia, the prescribing of clomethiazole or trazodone, in the equation, there was a statistical significance associated with delirium.Conclusions
The prevalence of delirium in a residential environment in our study population was 11.7%. The results show that BI, diagnosis of dementia, and prescribing of clomethiazole or trazodone were associated with risk of delirium in institutionalised patients. 相似文献11.
Rafael Bielza Galindo Alejandro Ortiz Espada Estefanía Arias Muñana Rocío Velasco Guzmán de Lázaro Asunción Mora Casado Ricardo Moreno Martín Blanca Tapia Salinas Javier Escalera Alonso Jorge Gómez Cerezo 《Revista espa?ola de geriatría y gerontología》2013
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. 相似文献12.
Background
Vitamin B12 (cobalamin) is a cobalt-containing compound synthesized by bacteria and an essential nutrient in mammals, which take it up from diet. The absorption and distribution of dietary vitamin B12 to the organism is a complex process involving several gene products including carrier proteins, plasma membrane receptors and transporters. Disturbed cellular entry, transit or egress of vitamin B12 may lead to low vitamin B12 status or deficiency and eventually hematological and neurological disorders.Objective
The aim of this review is to summarize the causes leading to vitamin B12 deficiency including decreased intake, impaired absorption and increased requirements. Under physiological conditions, vitamin B12 bound to the gastric intrinsic factor is internalized in the ileum by a highly specific receptor complex composed by Cubilin (Cubn) and Amnionless (Amn). Following exit of vitamin B12 from the ileum, general cellular uptake from the circulation requires the transcobalamin receptor CD320 whereas kidney reabsorption of cobalamin depends on Megalin (Lrp2).Whereas malabsorption of vitamin B12 is most commonly seen in the elderly, selective pediatric, nondietary-induced B12 deficiency is generally due to inherited disorders including the Imerslund-Gräsbeck syndrome and the much rarer intrinsic factor deficiency. Biochemical, clinical and genetic research on these disorders considerably improved our knowledge of vitamin B12 absorption.This review describes basic and recent findings on the intestinal handling of vitamin B12 and its importance in health and disease. 相似文献13.
Lorena Bajo Peñas Joan Espaulella Panicot Núria Dalmau Paniagua Matilde Barneto Soto Jacint Altimiras Roset 《Revista espa?ola de geriatría y gerontología》2013
Aim
To determine the characteristics of patients with dementia who died in a psychogeriatric unit, and to describe the conditions that led to their death.Material and methods
Observational study of patients who died in the Psychogeriatric unit of Hospital de la Santa Creu de Vic during a three and a half year period.Results
Of the 554 patients admitted during the study period, we recorded a mortality of 14.6% (81 patients). The analysis of those who died showed that 67.9% were women, with a mean age of 85.8 years, with the most frequent cause being Alzheimer type dementia (37%) and being in an advanced stage (CDR3, GDS 6-7) in 72.8% of cases. On admission the following characteristics were recorded: Mini Mental State Examination (MMSE) 9.5, Barthel Index (BI) prior to entry 50.1, BI on admission 17.4, and Neuropsychiatric Inventory (NPI) 31.4. A therapeutic limitation treatment was determined for 84% of patients on admission. From the analysis of the conditions that lead to death it was noted that: In 74.1% of the patients the death was a direct result of a triggering event (the most frequent being respiratory infection), in 17.3% the death occurred by a gradual decline, with no clear precipitating factor, and in 8.6% of patients palliative sedation was required due to poorly controlled symptoms.Conclusions
Intercurrent problems were the most common factors related to the death of the patients. Most patients died in the stages prior to the established criteria for terminal dementia. In some cases patients may experience disorder behavior as a refractory symptom. 相似文献14.
Francisco Javier Alonso-Renedo Leire González-Ercilla Itziar Iráizoz-Apezteguía 《Revista espa?ola de geriatría y gerontología》2014
Objective
To analyze the literature as regards the knowledge, skills and attitudes that these disciplines can provide in improving technical, ethical and human quality health care in the elderly with advanced organ failure, multimorbidity, frailty and progressive dementia.Material and methods
A comprehensive review focused on available references on the interrelationship between geriatric medicine and palliative medicine, education in bioethics, prognostic tools, functional status, and the humanization of health care.Results
Advance care planning, comprehensive geriatric assessment, the study of the values of the patient and their introduction in decision-making process, as well as the need to promote moral, care, and healthcare organizational ethics, are essential elements to achieve this objective.Conclusions
Practitioners and healthcare organizations should seek excellence as a moral requirement. To achieve this, there is a priority to acquire virtues of care and fundamental concepts of geriatric and palliative medicine, assessing functional status, advance care planning and patient/family needs as essential issues to protect, care for and promote them in all care settings. 相似文献15.
Ingrid Kvestad Sunita Taneja Tivendra Kumar Mari Hysing Helga Refsum Chittaranjan S. Yajnik Nita Bhandari Tor A. Strand Folate Vitamin B Study Group 《PloS one》2015,10(6)
Objectives
Deficiencies of vitamin B12 and folate are associated with delayed development and neurological manifestations. The objective of this study was to measure the effect of daily supplementation of vitamin B12 and/or folic acid on development in young North Indian children.Methods
In a randomized, double blind trial, children aged six to 30 months, received supplement with placebo or vitamin B12 and/or folic acid for six months. Children were allocated in a 1:1:1:1 ratio in a factorial design and in blocks of 16. We measured development in 422 children by the Ages and Stages Questionnaire 3rd ed. at the end of the intervention.Results
Compared to placebo, children who received both vitamin B12 and folic acid had 0.45 (95% CI 0.19, 0.73) and 0.28 (95% CI 0.02, 0.54) higher SD-units in the domains of gross motor and problem solving functioning, respectively. The effect was highest in susceptible subgroups consisting of stunted children, those with high plasma homocysteine (> 10 μmol/L) or in those who were younger than 24 at end study. With the exception of a significant improvement on gross motor scores by vitamin B12 alone, supplementation of either vitamin alone had no effect on any of the outcomes.Conclusion
Our findings suggest that supplementation of vitamin B12 and folic acid benefit development in North Indian Children.Trial Registration
ClinicalTrials.gov NCT00717730 相似文献16.
Julie Robertson Francesco Iemolo Sally P. Stabler Robert H. Allen J. David Spence 《CMAJ》2005,172(12):1569-1573
Background
Carotid plaque area is a strong predictor of cardiovascular events. High homocysteine levels, which are associated with plaque formation, can result from inadequate intake of folate and vitamin B12. Now that folic acid fortification is widespread in North America, vitamin B12 has become an important determinant of homocysteine levels. We sought to determine the prevalence of low serum levels of vitamin B12, and their relation to homocysteine levels and carotid plaque area among patients referred for treatment of vascular disease since folic acid fortification of enriched grain products.Methods
We evaluated 421 consecutive new patients with complete data whom we saw in our vascular disease prevention clinics between January 1998 and January 2002. We measured total carotid plaque area by ultrasound and determined homocysteine and serum vitamin B12 levels in all patients.Results
The patients, 215 men and 206 women, ranged in age from 37 to 90 years (mean 66 years). Most were taking medications for hypertension (67%) and dyslipidemia (62%). Seventy-three patients (17%) had vitamin B12 deficiency (vitamin B12 level < 258 pmol/L with homocysteine level > 14 μmol/L or methylmalonic acid level > 271 nmol/L). The mean area of carotid plaque was significantly larger among the group of patients whose vitamin B12 level was below the median of 253 pmol/L than among those whose vitamin B12 level was above the median: 1.36 (standard deviation [SD] 1.27) cm2 v. 1.09 (SD 1.0) cm2; p = 0.016.Conclusions
Vitamin B12 deficiency is surprisingly common among patients with vascular disease, and, in the setting of folic acid fortification, low serum vitamin B12 levels are a major determinant of elevated homocysteine levels and increased carotid plaque area.Elevated plasma total homocysteine levels are a strong, graded independent risk factor for stroke and myocardial infarction.1,2 Mechanisms by which homocysteine may cause vascular disease include a propensity for thrombosis and impaired thrombolysis, increased production of hydrogen peroxide, endothelial dysfunction and increased oxidation of low-density lipoproteins and Lp(a) lipoproteins.3 Folic acid fortification of enriched cereal grain products began in North America in March 1996 and was made mandatory in 1998. Fortification has reduced the number of neural tube defects by half,4 which is clearly a beneficial outcome, but so far it has had little impact on cardiovascular mortality.5Carotid plaque area is a strong predictor of cardiovascular events.6 High homocysteine levels, which are associated with plaque formation, can result from inadequate intake of folate and vitamin B12. Now that folic acid fortification is widespread, vitamin B12 has become an important determinant of homocysteine levels.7 We sought to determine the prevalence of low serum levels of vitamin B12, and their relation to homocysteine levels and carotid plaque area among patients referred for treatment of vascular disease since folic acid fortification of enriched grain products. 相似文献17.
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Jhon Fredy Ramírez Villada Henry Humberto León Ariza 《Revista espa?ola de geriatría y gerontología》2012
Objective
To analyze the relationship between different test measuring explosive strength and functionality of active women participating in a leisure sport program in order to describe the caracteristics of health status and look for tools for diagnosing and monitoring degenerative process.Methods
This study was conducted on 102 women physically active and without risk factors. Anthropometric, functional independence and explosive strength tests were applied.Results
Mean age 60.08±5.35 years; body mass index: 26.81±3.91; percentage of fat: 52.45±4.75; percentage of muscle mass: 37.24±6.77; tests of functional independence: maximum speed (30 meters): 9.39±1.92 s; speed-agility (30 meters): 12.93±1.59 s, and dynamic balance (6 meters): 21.9±8.01 s. Explosive Strength (Bosco test): Squat Jump: 12.23±3.05 cm, Countermovement Jump: 13.18±3.04 cm and Countermovement Jump Arm swing: 14.80±4.01 cm.Conclusion
The statistical relationships found between body composition, explosive strength and functionality tests, are important tools for diagnosing and monitoring, and could improve the intervention models on the elderly. 相似文献19.
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Aida Robles Castiñeiras Gabriel J. Díaz Grávalos Santiago Reinoso Hermida Ana López González Carmen Vázquez Gil Alejandro A. García Caballero 《Revista espa?ola de geriatría y gerontología》2012