共查询到20条相似文献,搜索用时 31 毫秒
1.
María Pilar Córcoles-Jiménez Ascensión Villada-MuneraMónica Moreno-Moreno María Delirio Jiménez-SánchezEduardo Candel-Parra María Ángeles del Egido FernándezAntonio Javier Piña-Martínez 《Revista espa?ola de geriatría y gerontología》2011,46(6):289
Recurrent falls affect between 14.8% and 19% of the elderly population, and are associated with an increased risk of fracture. We know little about the influence the history of recurrent falls may have on recovery after hip fracture.
Methods
Cohort study. The patients included were, over 65 years admitted during a 1 year period to the General University Hospital of Albacete with a hip fracture due to a fall. Recurrent falls were defined as a history of two or more falls within the 6 months prior to the fracture. Variables: demographic data, circumstances of fall, number of falls in the previous 6 months, type of fracture and its repair, comorbidity and drug treatment, cognitive status at admission (Pfeiffer test) and independence for activities of daily living (Barthel Index - BI) were collected. A subsample of patients with pre-fracture BI≥60 and Pfeiffer at admission≤4 was followed up at 3, 6 and 12 months.Results
A total of 335 patients were admitted. Data were collected on 279 of them, 19.4% of whom had previously suffered two or more falls. The recurrent fallers had a worse mental status on admission, a higher number of associated diseases, a lower percentage of independence in dressing and in bed-chair transferring than patients without history of recurrent falls, all statistically significant. In the 201 patients followed up, the impairment on the BI after 12 months compared to the BI previous to fracture was higher in recurrent fallers (-20.8 ± 31.54 vs -10.73 ± 20.21, P = .04), focusing more on independence in eating (76% vs 91.9%, P < .05), grooming (72% vs 91,9%, P < .01), faecal continence (60% vs 78.7%, p < .05) and walking indoors (80% vs 93.3%, P < .05).Conclusions
The recovery of independence after hip fracture is significantly lower in the group of recurrent fallers in patients without moderate or severe functional impairment previous to fracture and cognitively stable. 相似文献2.
Paula Martínez María Pilar Sáez José Amador Rubio Ester Cánovas Elena Esteban Javier Botas 《Revista espa?ola de geriatría y gerontología》2014
Objective
To review our experience on using an implantable loop recorder (ILR) in patients with recurrent falls, when an arrhythmogenic cause is suspected.Material and methods
This is a retrospective, observational study of patients with repetitive unexplained falls, suspected syncope, or electrocardiographic abnormalities. All of them had been evaluated by a cardiologist, who decided to implant a loop recorder (ILR) for an accurate diagnosis.Results
A total of 13 patients received an ILR. The average falls rate for the sample was 3.3. The mean age was 78 years, and 46% were female, with a mean follow-up period of 24 months. During this time, three patients did not suffer from a new fall. An arrhythmogenic diagnosis was obtained in 5 patients: bradycardia was identified in 4 cases, and tachycardia in one of them. The symptoms did not coincide with a documented arrhythmia in the rest of the patients.Conclusion
ILR is a helpful tool to establish an arrhythmogenic cause of unexplained and recurrent falls, in this selected sample of older adults. 相似文献3.
Pilar Pérez-Ros Francisco Martínez-Arnau Immaculada Tormos Miñana Aranzazu López Aracil M. Carmen Oltra Sanchis Leidy E. Pechene Mera Francisco José Tarazona-Santabalbina 《Revista espa?ola de geriatría y gerontología》2014
Objective
To evaluate the results of a fall prevention programme designed to be applied to the elderly living in the community.Material and methods
The sample consisted of 249 participants ≥70 years of age, who were randomly assigned to one of three groups. The monthly intervention group (GIM): instructions on fall prevention and healthy exercises to improve physical function and balance at beginning of the study, and a monthly theoretical and practical refresher session. The quarterly intervention group (GIT), with the same beginning intervention and a refresher session every three months. The control group (GC), the same beginning intervention but no refresher sessions.Results
The mean age of the sample was 74.47 years (SD 5.33), with 64% women. The incidence of falls was reduced from 0.64 per patient year in the previous year to 0.39 in the post-intervention year in GIM, from 0.49 to 0.47 in GIT, and in the GC it remained at 0.47 before and twelve months after, but with no significant differences in the reduction between groups (P=.062). At the end of the study there was a decrease in Rizzo scale of 0.72 points (95% CI: 0.57-0.88, P<.001).Conclusion
An interdisciplinary community intervention programme can contribute to reducing the incidence of falls. Further studies are required to continue research into the incidence of falls in the elderly living in the community. 相似文献4.
Odontoid fractures are the most common cervical spine fracture in elderly patients, with falls being the most common mechanism of fracture in these patients. The clinical symptoms range from mild neck pain to quadriplegia, or even death. Treatment options include surgical and non surgical therapies, such as cervical collar or halo vest. 相似文献
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Sandra Gómez-Talavera Iván Núñez-Gil David Vivas Borja Ruiz-Mateos Ana Viana-Tejedor Agustín Martín-García Javier Higueras-Nafría Carlos Macaya Antonio Fernández-Ortiz 《Revista espa?ola de geriatría y gerontología》2014
Introduction
Several risk scores regarding the probability of death/complications in the acute setting and during the follow-up of patients admitted with acute coronary syndromes (ACS) have been published, such as the GRACE, TIMI and ZWOLLE risk score. Our objective was to assess the prognosis of nonagenarians admitted to a coronary care unit with an ACS, as well as the usefulness of each of these scores.Material and methods
A retrospective analysis was performed on nonagenarians with an ACS admitted between 2003 and 2011. Vital status was determined at 14, 30 days, and 6 months after the ACS, and later during the follow-up. The risk scores were evaluated by area under the curve ROC (AUC).Results
A total of 45 patients with an ACS, 26 (57.8%) with ST-segment elevation and 19 (42.2%) with non-ST elevation. The GRACE- AUC for in-hospital mortality was excellent, 0.91, (95% CI: 0.82-1; P<.001), and for the combined event (in-hospital mortality and re-infarction) was 0.83 (95% CI: 0.66-1.0; P<.01). However, the GRACE-AUC at 6 months for mortality was 0.34 (95% CI: 0.09-0.58; P=.45), and for the combined event it was 0.51 (95% CI: 0.26-0.77; P=.95). The TIMI-AUC and ZWOLLE-AUC did not reach statistical significance.Conclusions
It is useful calculate the GRACE risk score in order to estimate risk and survival in the acute phase of ACS in nonagenarians. This can help appropriate in making invasive or conservative treatment decisions. 相似文献7.
Falls are one of the main causes of lesions, disability and even death in elderly patients. In all patients who fall, the repercussions and risk factors for falls and their recurrence should be evaluated. Evaluation of risk factors for falls should include the following: thorough medical history, exhaustive geriatric evaluation, general physical examination, examination of sense organs, balance and gait, evaluation of the environment, and complementary examinations (posturography). Evaluation protocols allow a greater number of risk factors to be identified. Numerous clinical tests (Tinetti, timed and go) allow the risk of new falls and of severe consequences to be assessed.The creation of falls units with multidisciplinary teams specifically designated to evaluate the elderly with recurrent falls and the prevention of falls is highly important. 相似文献
8.
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9.
Javier Mar Arantzazu ArrospideJosé María Begiristain Isabel LarrañagaAitor Sanz-Guinea Ignacio Quemada 《Revista espa?ola de geriatría y gerontología》2011,46(4):200
Introduction
The health impact of acquired brain injury (ABI) is not only apparent in the patient, but also in the loss of health related quality of life (HRQol) of their carers. The objectives of this study were to measure the loss of HRQol as well as the burden of the carers of patients with ABI.Material and methods
A retrospective study was conducted with 76 carers of patients with ABI. A questionnaire was used to collect information on the sociodemographic aspects, carer burden (Zarit Scale) and the HRQol (EuroQol Questionnaire) of the carers. A multiple linear regression model was constructed to analyse the effect of the different variables.Results
The carers were predominantly women over 50 years, retired or dedicated to domestic tasks and who cared for their husband or one of their parents. One third showed a high risk of claudication. The mean HRQol obtained with the EuroQol went from a similar score to that of the general population (0.9) in the group without burden, to 0.67 in the group with risk of claudication. The regression models explained the burden better than the loss in quality of life.Conclusions
Carers of patients with brain injury suffer a significant loss in HRQol compared to the general population. The deterioration arises from the mental dimensions and depends on the level of burden. 相似文献10.
Ferran Roca Carbonell Erwin Martin Hernandez Ocampo Jose Maria Aragonès Pascual Eulalia Soler Fina Clapera Joan Espaulella Panicot 《Revista espa?ola de geriatría y gerontología》2014
Introduction
The aim of this study is to determine clinical features and interventions in patients attended in our hospital falls prevention unit.Material and methods
Medical records and evaluation protocols from October 2010 to June 2012 were reviewed. Results are expressed in means and standard deviation.Results
We studied 68 patients: 53 came due to falls (77.9%), and 15 (22%) due to gait disorders. The mean age was 77.6±7.9. Number of women: 63 (92.6%). Previous Barthel Index was 94/100, cognitive impairment 23 (33.8%), polypharmacy 69.1%, orthostatic hypotension 18 (26.4%). Walking speed 0.66± 0.19 m/s and Time up and go to (TUG) 16.6±4.5 s. Post-urography detected vestibular dysfunction in 34 patients (77%). Clinical cause of fall and/or gait disorder was multifactorial in 33 (48.5%), Parkinsonism 19 (27.9%), chronic pain/arthropathy 8 (11.4%), and vestibular syndrome 8 (11.4%). Two-thirds (45; 66.1%) of the patients began Physical therapy, and vitamin D was given to 47 (69.1%). Phone calls were made to patients and/or their relatives and noted that after 3 months of the treatment: 48 (70.5%) had no fall; 59 (86.7%) patients followed the recommendations, and 57 (83.8%) were satisfied.Conclusions
In this sample of older patients, mostly female with a good functional and cognitive condition, the causes of the falls were multifactorial in the half of the cases, and the post-urography detected vestibular changes in the half of the patients. 相似文献11.
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12.
Begoña Prado Villanueva Cornelia Bischoffberger ValdésEmiliana Valderrama Gama Carlos Verdejo BravoJavier Damián 《Revista espa?ola de geriatría y gerontología》2011,46(1):7
Introduction
Urinary incontinence (UI) has been poorly studied in Spanish nursing homes. The objective is to determine the prevalence and related factors of UI in institutionalized older people in Madrid, Spain.Methods
A probabilistic sample of 754 subjects 65 years of age and older living in public and private institutions in Madrid was randomly selected through stratified cluster sampling. Residents, caregivers and physicians were interviewed. UI was defined as any leakage in the previous 14 days. We asked about the frequency (occasional, nocturnal, frequent and total), quantity (drops or small quantities, very much), and types (urge, stress, due to cognitive impairment, and due to walking difficulty). To determine the factors associated with UI, we built logistic regression models that adjusted for age, sex, functional dependency (Barthel index) and cognitive status (Pfeiffer's test).Results
The prevalence of UI was 53.6%. Of all residents 35.8% had frequent or total UI. Among those incontinent 60.1% had a very large quantity of urine loss and the most common presentation was mixed (54.1%). The most frequent type in the population was urgent UI (26.8%) followed by UI due to walking difficulty (21.4%). UI was associated (odds ratios [95% CI]) with moderate (3.51 [1.56-7.89]) and severe functional disability (44.71 [10.99-181.94]), faecal incontinence (4.97 [2.04-12.16]), stroke (4.59 [1.06-19.87]), physical restraints (4.03 [1.02-17.87]), and falls (2.10 [1.16-3.81]). The mean (95% CI) number of pads used per person per day was 3.0 (2.4-3.6).Conclusions
The prevalence of UI was somewhat higher than that of other comparable populations. Mixed forms, including functional types, were common. 相似文献13.
Antoni Salvà Àlex Domingo Marta Roqué i Figuls José Antonio Serra-Rexach 《Revista espa?ola de geriatría y gerontología》2013
Data is presented from the survey conducted by the Sociedad Española de Geriatría y Gerontología (SEGG) (Spanish Society of Geriatrics and Gerontology) among its members in order to assess their scientific production between 2006 and 2011, specifically articles in journals that are indexed in the Science Citation Index. The scientific quality of the publications was quantified using the number of times every article was cited and the journal's impact factor. A total of 162 out of the 2450 members responded (6.6%), reporting a total of 903 individual articles, 335 (37%) of them in geriatrics-specific journals, and 568 (63%) in other journals of other specialties. The number of publications increased yearly from 128 in 2006 to 201 in 2010. The scientific quality could be calculated for 530 articles. On average, publications have been cited 8.2 times (median: 2), with the range of citations being from 0 to 242. The average impact factor was 3.1 (median 2.4), ranging from 0 to 53.5. A number of articles have been published in some of the largest impact factor journals, in those of general-interest, as well as geriatrics-specific and basic science journals. 相似文献
14.
Juan Ignacio González Montalvo Pilar Gotor PérezAlberto Martín Vega Teresa Alarcón AlarcónJosé Luis Mauleón Álvarez de Linera Enrique Gil GarayEduardo García Cimbrelo Julián Alonso Biarge 《Revista espa?ola de geriatría y gerontología》2011,46(4):193
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. 相似文献15.
The benefits of the collaboration between orthopaedics and geriatrics in the management and care of elderly patients admitted with hip fracture have been widely demonstrated. A questionnaire was sent to all hospital geriatricians of Castilla y León in order to determine the characteristics this collaboration between orthopaedics and geriatrics in the public hospitals of Castilla y León. They were asked about the type of collaboration with orthopaedics in the care of the elderly patient admitted with hip fracture and details of the treatment of the complications. Most of the hospitals maintain a high level of orthogeriatric collaboration with geriatricians, and the geriatrician attends to most of the medical complications of these patients. The average hospital stay is 10 days, with a surgical delay of 3 days. Management of the most frequent clinical problems in hospitals of Castilla y León are detailed in this article, comparing them with the latest articles and current recommendations from clinical practice guides. 相似文献
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Álvaro Casas Herrero Nicolás Martínez VelillaFrancisco Javier Alonso Renedo 《Revista espa?ola de geriatría y gerontología》2011,46(6):311
Risk of fall is significantly increased in old people with cognitive decline due to specific associations between gait parameters and cognition. This association has recently been demonstrated, there being increasing evidence that cognitive domains such as attention, executive function and types of memory are critical for the correct regulation of gait. Gait disturbances can appear as early predictors of dementia in elderly patients. In the assessment of the fall risk, the use of dual tasks is novel, simple and relevant, especially in cognitive decline. Evidence for interventions in this population is limited, with vitamin D and physical exercise being the most encouraging, for decreasing the risk of fall in dementia. 相似文献
17.
Several epidemiological studies have analyzed the association between frailty status and adverse geriatric health outcomes, with there being a clear relationship being demonstrated in mortality, disability, mobility loss, institutionalization and falls. However, different studies have evaluated different number of these adverse events, with different criteria, and with different follow-up periods. As a result of this relationship, the objective of geriatric medicine must not only be the prevention, diagnosis and treatment of diseases based on multidisciplinary team work and use of geriatric units according to functional status of patients, but the detection, prevention and treatment of frailty. Frailty must be considered as a pre-disability state that can be prevented and treated to delay its progression towards disability, institutionalization, and death. The characterization of frailty status can also help other medical specialties to stratify the risk of adverse health outcomes in oncology treatments, surgical interventions, or diagnostic procedures. 相似文献
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Elena Muñoz-Hellín Roberto Cano-de-la-CuerdaJuan Carlos Miangolarra-Page 《Revista espa?ola de geriatría y gerontología》2013
Sensory stimuli or sensory cues are being used as a therapeutic tool for improving gait disorders in Parkinson's disease patients, but most studies seem to focus on auditory stimuli. The aim of this study was to conduct a systematic review regarding the use of visual cues over gait disorders, dual tasks during gait, freezing and the incidence of falls in patients with Parkinson to obtain therapeutic implications. We conducted a systematic review in main databases such as Cochrane Database of Systematic Reviews, TripDataBase, PubMed, Ovid MEDLINE, Ovid EMBASE and Physiotherapy Evidence Database, during 2005 to 2012, according to the recommendations of the Consolidated Standards of Reporting Trials, evaluating the quality of the papers included with the Downs & Black Quality Index. 21 articles were finally included in this systematic review (with a total of 892 participants) with variable methodological quality, achieving an average of 17.27 points in the Downs and Black Quality Index (range: 11-21). Visual cues produce improvements over temporal-spatial parameters in gait, turning execution, reducing the appearance of freezing and falls in Parkinson's disease patients. Visual cues appear to benefit dual tasks during gait, reducing the interference of the second task. Further studies are needed to determine the preferred type of stimuli for each stage of the disease. 相似文献
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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