[Cross-speciality geriatrics: A health-care challenge for the 21st century]. / Geriatría transversal. Un reto asistencial para el siglo xxi.

Increasing numbers of older persons are being treated by specialties other than Geriatric Medicine. Specialists turn to Geriatric Teams when they need to accurately stratify their patients' risk and prognosis, predict the potential impact of their, often, invasive interventions, optimise their clinical status, and contribute to discharge planning. Oncology and Haematology, Cardiology, General Surgery, and other surgical departments are examples where such collaborative working is already established, to a varying extent. The use of the term "Cross-speciality Geriatrics" is suggested when geriatric care is provided in clinical areas traditionally outside the reach of Geriatric Teams. The core principles of Geriatric Medicine (comprehensive geriatric assessment, patient-centred multidisciplinary targeted interventions, and input at point-of-care) are adapted to the specifics of each specialty and applied to frail older patients in order to deliver a holistic assessment/treatment, better patient/carer experience, and improved clinical outcomes. Using Comprehensive Geriatric Assessment methodology and Frailty scoring in such patients provides invaluable prognostic information, helps in decision making, and enables personalised treatment strategies. There is evidence that such an approach improves the efficiency of health care systems and patient outcomes. This article includes a review of these concepts, describes existing models of care, presents the most commonly used clinical tools, and offers examples of excellence in this new era of geriatric care. In an ever ageing population it is likely that teams will be asked to provide Cross-specialty Geriatrics across different Health Care systems. The fundamentals for its implementation are in place, but further evidence is required to guide future development and consolidation, making it one of the most important challenges for Geriatrics in the coming years.

[Characteristics of emergency poisoning cases in elderly versus younger patients]. / Características diferenciales de las intoxicaciones en los pacientes ancianos atendidos en un servicio de urgencias.

OBJECTIVES: To compare cases of poisoning according to age to detect differences in frequency of visits to the emergency department, patient characteristics, case management, and immediate outcome in terms of related mortality. MATERIAL AND METHODS: Descriptive study of a retrospective series of patients who visited a university hospital emergency department for treatment of poisoning between 2009 and 2014. We collected patient characteristics and data related to the event, case management, and poisoning-related death. Patients were grouped according to age (cut-off 65 y). RESULTS: Of a total of 3847 poisoning episodes, 341 (8.9%) were in patients aged 65 years or older. The percentage of women among these older patients (61.3%) was greater than among younger patients (36.3%; P<.001). Poisoning was accidental in older patients more often than younger ones (64.4% vs 9.5%, respectively; P<.001), occurred more often in the home (82.1% vs 37%, P<.001), and more often required active treatment (73.3% vs 57.4%; P<.001) and admission to hospital (21.4% vs 7.3%, P<.001). The related mortality rate was also higher in the older patients (2.1% vs 0.1% in younger patients, P<.001). CONCLUSION: The percentage of poisonings in patients aged 65 years or older is not negligible. Poisoning in patients of advanced age tends to be accidental and take place in the home. Older patients more often require active treatment and hospital admission; poisoning-related death is more common in older patients than younger ones.

OBJETIVO: Evaluar si existen diferencias, en función de la edad, en la frecuencia, las características, el manejo y el resultado inmediato en los episodios con diagnóstico de intoxicación en un servicio de urgencias (SU). METODO: Estudio descriptivo de una serie de casos retrospectivo de las visitas por intoxicaciones atendidas en el SU de un hospital universitario entre 2009 y 2014. Se recogieron datos demográficos, referentes a la intoxicación y su manejo y la mortalidad inmediata relacionada con el episodio. La serie se dividió en función de la edad (punto de corte: 65 años). RESULTADOS: De total de 3.847 episodios de intoxicación, 341 (8,9%) casos fueron en los pacientes de 65 o más años. La mayoría de estos casos, en comparación con los más jóvenes, fueron mujeres (61,3% vs 36,3%; p 0,001), de causa accidental (64,4% vs 9,5%; p < 0,001), ocurrieron en el domicilio (82,1% vs 37%; p < 0,001), precisaron más frecuentemente tratamiento activo (73,3% vs 57,4%; p < 0,001) e ingreso (21,4% vs 7,3%; p < 0,001) y tuvieron mayor mortalidad inmediata (2,1% vs 0,1%; p < 0,001). CONCLUSIONES: El porcentaje de intoxicaciones en pacientes de 65 años o más no es despreciable, suelen ser accidentales y en domicilio, y tienen mayor necesidad de tratamiento activo, hospitalización y mortalidad inmediata.