Spanish list of potentially inappropriate drugs in the elderly (ES-PIA project).

PURPOSE: In the last decades, different criteria have been developed for detecting inappropriate prescription in older patients. In Spain, translations and adaptations of international lists are available but it would be necessary a national list which could cope with the peculiarities of our health system, existing pharmaceutical market, and prescription habits. We propose in this project the creation of a Spanish potentially inappropriate drugs list which could be applicable in our clinical scenario. METHODS: We use a Delphi method involving 25 experts from different backgrounds (Clinical Pharmacology, Geriatrics, Rational Use of Drugs and Pharmacy, Primary Care and Pharmacoepidemiology, and Pharmacovigilance) that were asked to participate in two-round questionnaires. For analysis, current recommendations of Worth and Pigni were applied, and every statement was classified into one of three groups: strong, moderate, or low agreement. Statements with strong agreement were accepted to be part of the inadequate prescription list. Moderate agreement statements were selected to enter the second questionnaire, and statements with low agreement were further analyzed to determine if it was due to heterogeneity or due to dispersion in the answers. RESULTS: The first questionnaire consisted of 160 proposed sentences, of which 106 reached a high agreement, 32 a moderate agreement, and 22 a low agreement. All sentences proposed in the second questionnaire reached a strong agreement. The total accepted sentences were 138. CONCLUSIONS: We offer a list of inadequate prescription in older patients adapted to the Spanish pharmacopeia and according to the prescription habits in our environment.

Effect of strength exercise with elastic bands and aerobic exercise in the treatment of frailty of the elderly patient with type 2 diabetes mellitus. / Efecto del ejercicio de fuerza muscular mediante bandas elásticas combinado con ejercicio aeróbico en el tratamiento de la fragilidad del paciente anciano con diabetes mellitus tipo 2.

AIM: To evaluate in the elderly diabetic patient the probability of improving the frailty after performing strength exercises with an elastic band and aerobic exercise. METHODS: Prospective study of diabetic patients older than 70 years, with Barthel >80 points and Global Deterioration Scale -Functional Assessment Staging <3 points. Strength exercises with an elastic band 3 days a week and walk 30min a day 5 days a week were recommended. Adherence to the exercises was assessed using the Haynes-Sacket test. Frailty was assessed by the Fried criteria and functional capacity by the Short Physical Performance Battery at baseline and at 6 months. RESULTS: 44 patients completed 6 months of follow-up. There was non-adherence to aerobic exercises in 38.6% of cases and to exercises with elastic bands in 47.7%. The prevalence of frailty decreased from an initial 34.1% to 25% at 6 months (p=0.043) and the percentage of patients with a moderate-severe functional limitation was reduced from 26.2% to 21.4% (p=0.007). Adherence to aerobic exercises (p=0.034) and absence of coronary ischemic heart disease (p=0.043) predisposed to improve frailty. CONCLUSIONS: Performing 6-month strength exercises with an elastic band and aerobic exercise reduces the prevalence of frailty in elderly diabetic patients. The probability of improving frailty decreases in case of coronary ischemic heart disease and increases with adherence to aerobic exercises.