Prevención de las caídas basada en la evidencia en Europa

ProFaNE (Prevention of Falls Network Europe) is a thematic network funded by the European Commission. This network brings together scientists, clinicians and other health professionals from across Europe to focus on four main topics (taxonomy and co-ordination of trials, clinical assessment and management of falls, assessment of balance function, and psychological aspects of falls). There are 24 members across Europe as well as Network Associates who contribute expertise at workshops and meetings. ProFa- NE, a 4-year project which started in January 2003, aims to improve and standardise healthcare processes by introducing and promoting good practice throughout Europe. ProFaNE has its own website (http://www.profane.eu.org) and undertakes workshops to bring together experts and observers involved in specific topics to exchange knowledge, expertise and resources on interventions to reduce falls. The present article discusses ProFaNE's achievements to date and the work in progress to achieve good clinical practice and research into the prevention of falls across Europe.     

Características y factores asociados a caídas en pacientes con enfermedad cerebrovascular

Objectiveto asses the characteristics and factors associated with falls during hospitalisation among elderly stroke patients.Material and methodswe studied 1,410 subjects (60.1% female), aged 65 years and older (80.6 ± 6.9 years), admitted to a geriatric stroke unit between 2000 and 2003. We recorded demographic, clinical and functional variables and evaluated the characteristics and management of falls. The variables showing an association with falls in bivariate analyses were subsequently included in a multivariate logistic regression analysis.Resultsthe incidence rate of falls was 10.49% in 115 patients. The variables showing statistical association (p < 0.05) with falls were age (78.7 vs 80.8) and gender (10.5% male vs 6.6% female), arm strength (2.8 vs 2.3), leg strength (3.2 vs 2.6) and being classified in the group with moderate stroke (47.8%) compared with patients without falls (29.3%). Falls were more frequent in patients with depression (13% vs 7%) and delirium (27% vs 6%). The variables that remained significant in the multivariate logistic regression model for falls were: delirium (OR = 4.691 [2.930-7.511]), mild stroke (OR: 0.347 [0.154-0.782]), age (OR = 0.958 [0.929-0.987]), depression (OR = 1.760[1.095-2.828]), arm strength (OR = 1.233 [1.058-1.438]), and Barthel Index prior to the fall (OR = 1.013 [1.002-1.024]).Conclusionspatients with falls are younger, with a higher previous functional status and with lesser neurological severity on admission. The presence of depression and delirium are frequently associated.     

Uso de sujeciones físicas en relación con el riesgo de caídas en una residencia de ancianos

Backgrounds and objectivesThe use of physical restraints (PR) is common in the care of the elderly. However, their efficacy and safety are not supported by scientific evidence. The aim of this study was to determine the role of PR in preventing falls.Materials and methodsA retrospective cohort study design was used, in which each fall incident (n = 575) was examined in the residents over 65 years of age who resided at the one nursing homes from February 2009 to September 2013. An analysis was made of the association between the use of PR and risk of falls using a multivariate logistic regression, adjusting for the characteristics of residents that were associated with the use of PR according to a bivariate analysis.ResultsRisk factors for falls after accounting for PR use, include: risk of falling (Tinetti test) (OR 4.57; 95% CI 1.76-11.75); ability to walk (OR 6.40; 95% CI 2.78-14.74); hearing impairment (OR 2.12; 95% CI 1.05-4.29); and history of a previous fall (OR 17.81; 95% CI 8.83-35.93). The risk of falls was greater in restrained, ambulatory residents with cognitive impairment (OR 18.95; 95% CI 7.06-50.85). No differences were found in injuries between falls that occurred with and without PR.ConclusionsRestraint use was not significantly associated with fewer falls and injuries. The risk of falls could increase in ambulatory residents with cognitive impairment. The study results suggest the need to consider whether restraints provide adequate protection against the risk of falls.     

Intervenciones basadas en el ejercicio y el entorno para la prevención de caídas en personas con deterioro cognitivo que viven en centros de cuidado: revisión sistemática y metaanálisis

This systematic review aims to report the effectiveness of interventions based on exercise and/or physical environment for reducing falls in cognitively impaired older adults living in long-term care facilities.In July 2014, a literature search was conducted using main databases and specialised sources. Randomised controlled trials assessing the effectiveness of fall prevention interventions, which used exercise or physical environment among elderly people with cognitive impairment living in long-term care facilities, were selected. Two independent reviewers checked the eligibility of the studies, and evaluated their methodological quality. If it was adequate, data were gathered.Fourteen studies with 3,539 participants using exercise and/or physical environment by a single or combined approach were included. The data gathered from studies that used both interventions showed a significant reduction in fall rate.Further research is needed to demonstrate the effectiveness of those interventions for preventing falls in the elderly with cognitive impairment living in long-term care establishments.     

Revisión de la validez de las escalas de valoración del riesgo de caídas en pacientes hospitalizados

Falls in the hospital setting are a major health problem due to their high prevalence and their physical, functional, psychological or economic consequences. Since 1990s, different fall risk assessment scales have been developed to detect high-risk patients, which are also applied in the hospital setting. The aim of this review is to analyse the validity of different scales for assessing fall risk in adults in the hospital setting, especially in elderly patients. Following a literature search in April 2021, 36 primary studies were found that analysed the validity of the Downton, Morse, Hendrich II, Stratify and Tinetti scales. Meta-analyses of sensitivity and specificity showed a high heterogeneity that does not allow recommending a specific tool that can be considered as standard in acute inpatients.     

Ensayo clínico aleatorizado de una estrategia de prevención de caídas en ancianos institucionalizados basada en el Mini Falls Assessment Instrument

IntroductionThe Mini Falls Assessment Instrument (MFAI) identifies risk factors for falls in an individual and links them to specific interventions. This study evaluates the effectiveness of MFAI as the basis for a falls prevention strategy in institutionalized elderly.Material and methodsA cluster randomized clinical trial (identifier NCT00888953) was conducted in 16 nursing homes randomized to apply MFAI (intervention) or a modified version not linked to actions (control). The primary endpoint was the occurrence of falls during follow-up (12 months). Secondary variables were total number of falls, physical function, quality of life, functional status, and adverse effects.ResultsData from 330 participants (197 intervention, 137 control) were analyzed. Both groups had a similar number of risk factors: 7 in the intervention group (range 1-12) and 8 (1-13) in the control group. In the intervention group there were more fallers (49% vs. 38%), and higher number of falls (315 vs. 109), and fall rate per 100 person-years (192.5 vs. 179.8) than the control group. In the multivariate analysis, there were no significant differences in fall risk (odds ratio = 1.45; 95% confidence interval [CI]: .67 to 3.14; P = .350), but the incidence rate is significantly higher in the intervention group (Incidence rate ratio = 2.23; 95% CI: 1.43 to 3.48; P < .001).ConclusionsThe results on the efficacy of the MFAI as a fall prevention strategy are inconclusive. Additional studies are needed in order to provide good quality evidence.     

Utilidad de la estación unipodal en la valoración del riesgo de caídas

Aimsto compare posturographic test with One-Leg Balance test in the elderly.Methodswe studied 59 healthy men and women living in the community who were at least 65 years of age. All of them were evaluated with One–Leg Balance (defined as the ability to stand on one leg unsupported for 5 seconds) and Modifies Clinical Test for the Sensory Interaction on Balance by the Balance Master (Neurocom®). We distributed the patients in two groups. Group A included those who couldn’t perform one-leg balance and group B those who could perform it.Results62.6% of subjects could perform one-leg balance and 37.2% could not perform it. On a firm surface with opened eyes, the A group made a variation of 0.4 deg/s (0.28-0.6) in the gravity center position and the B group 0,2 deg/s (0.1-0.3) (p = 0.010). On a firm surface with closed eyes, the A group made a variation of 0.5 deg/s (0.3-0.8) and the B group 0.3 deg/s (0.1- 0.4) (p = 0.002). On a foam surface with open eyes, the A group made a variation of their gravity center position of 1.10 deg/s (0.90-1.60) and the B group 0.9 deg/s (0.73-1.30) (p = 0.045). On a foam surface with closed eyes the A group made a variation of their gravity center position of 6 deg/s (4-6) and the B group 2.3 deg/s (1.63-3.08) (p < 0.001).Conclusionselderly patients who can perform one-leg balance, make less variations of their gravity centre. The results are the same when visual and propioceptive afferences are suppressed.     

Incidencia de la hiponatremia y de sus causas en pacientes neurológicos

IntroductionHyponatremia is considered the most frequent electrolyte disorder found in hospitalized patients and seems to be a prognostic factor during hospitalization.MethodsA prospective observational study was carried out in consecutive neurological patients admitted to our hospital over a 3-month period. Blood and urinary ionogram and osmolality were determined at entry and 3–5 days after admission in all patients with hyponatremia.ResultsOf the 130 patients admitted, 19 (14.6%) had hyponatremia. The causes of hyponatremia were as follows: inappropriate fluid replacement in 4 patients (21%), antihypertensive drugs in 4 (21%), syndrome of inappropriate secretion of antidiuretic hormone in 4 (21%), cerebral salt wasting syndrome in 2 (10%), and edematous status caused by liver disease in one and digestive loss in one (5%) each. Mortality was one (5%) and 0 (0%) among patients with and without hyponatremia, respectively.ConclusionHyponatremia is common in hospitalized neurological patients and can be misdiagnosed as a worsening of the main illness.     

Factores de riesgo asociados a desnutrición en personas mayores que viven en la comunidad: una revisión rápida

The aim of this review was to determine the most important risk factors (RF) in the development of malnutrition in people over 65 years living in the community. A rapid review has been conducted by applying the PRISMA methodology (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) and using the Medline database (PubMed). A search strategy was drawn up, up to 13 January 2020. A total of 24 articles published in the last 5 years were included in this review. Assuming the methodological limitations of the present review, it is possible to conclude that undernutrition is a multifactorial problem whose most significant RF are: age, economic status, alterations in the digestive system, comorbidity, polymedication, dependence on the performance of daily life activities, physical inactivity, food insecurity, depression, social isolation, and the field of self-perceptions. Early identification of geriatric patients exposed to these RF can allow a preventive approach in the development of malnutrition from primary care.     

Papel de la genética en la etiología de las sinucleinopatías

The protein family known as synucleins is composed of α-, β- and γ-synuclein. The most widely studied is the α-synuclein protein due to its participation in essential processes of the central nervous system. Neurotoxicity of this protein is related to the presence of multiplications (duplications and triplications) and point mutations in the gene sequence of the α-synuclein gene (SNCA), differential expression of its isoforms and variations in post-transductional modifications. Neurotoxicity is also related to cytoplasmic inclusions known as Lewy bodies (LBs) and Lewy neurites (LNs), which are also present in α-synucleinopathies. In general, the β-synuclein protein, codified by the SNCB gene, acts as a regulator of processes triggered by α-synuclein and its function is altered by variations in the gene sequence, while γ-synuclein, codified by the SNCG gene, seems to play a major role in certain tumoral processes.     

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.     

Evaluación de las complicaciones clínicas de los pacientes con fractura de cadera y sus factores asociados en una Unidad de Agudos de Ortogeriatría

Introduction

The incidence of clinical complications in hip fracture (HF) patients is high and variable due to their heterogeneous nature. The aim of the study was to assess the clinical complications and their associated factors in HF patients admitted to the Orthopaedic Geriatric Unit of a 283 bed University Hospital. An average of 200 HF patients is attended yearly.