Impact of an interventional bundle on complications associated with peripheral venous catheters in elderly patients.

PURPOSE: Elderly patients admitted to geriatrics departments often require peripheral venous catheters (PVC), which should be inserted and maintained following a series of preventive recommendations. Our objective was to evaluate the impact of a training bundle comprising measures aimed at reducing complications associated with the use of PVC in elderly patients admitted to a tertiary teaching hospital. METHODS: We performed a prospective study of patients who received a PVC within 24 h of admission to a geriatrics department. After a 10-month pre-interventional period, we implemented an educational and interventional bundle over a 9-month period. Follow-up was until catheter withdrawal. We analyzed and compared clinical and microbiological data between both study periods. RESULTS: A total of 344 patients (475 PVC) were included (pre-intervention period, 204 patients (285 PVC); post-intervention period, 140 patients (190 PVC)). No statistically significant differences in demographic characteristics were observed between the study periods. The colonization and phlebitis rates per 1000 admissions in both periods were, respectively, 36.7 vs. 24.3 (p = 0.198) and 81.5 vs. 65.1 (p = 0.457). The main reason for catheter withdrawal was obstruction/malfunctioning (33.3%). Obstruction rate was higher for those inserted in the hand than for those inserted at other sites (55.7% vs. 44.3%, p = 0.045). CONCLUSIONS: We found no statistically significant differences regarding phlebitis and catheter tip colonization rates. It is necessary to carry out randomized studies assessing the most cost-effective measure to reduce complications associated with PVC.

An early intervention program for subacute physical disability related to musculoskeletal diseases in the elderly: a pilot study.

To evaluate the efficacy of a program for subacute physical disability due to musculoskeletal disorders (MSD) in the elderly. We carried out a randomized controlled evaluator-blinded intervention study in a health district (October 2005 to April 2008). Subjects older than 64, starting a subacute MSD episode of physical disability-defined as moderate disability or higher in the Rosser classification-and identified by general practitioners, were randomized into standard care or an early specific program. The program was carried out by rheumatologists following detailed proceedings. Efficacy was defined as the difference between groups in the duration of episodes-time from onset until an improvement larger than a point in the Rosser classification). Hazard ratios (HR) to recovery of the program over standard care were obtained from Cox regression analyses. One hundred and twenty-three patients were included, generating 244 episodes of subacute MSD. Mean duration of episodes was 5 months; 14.5 % of them were chronically disabled throughout follow-up. The program was associated with shorter duration of episodes compared with CG analyzing just the ended ones (p = 0.004). The HR to recovery between groups did not achieve statistical differences. Nevertheless, recovery rate at 12 months and HR from those with moderate physical disability at the inclusion period (Rosser disability level 4, n = 84) were superior in the IG (HR 1.9, p = 0.03; HR 1.93; p = 0.03 respectively). An early intervention program for subacute MSD-related disability in elderly has partial efficacy; the program benefited patients with moderate physical disability and after a year of follow-up.

An intergenerational programme delays health impairment in nursing home residents: the Duplo project.

PURPOSE: To analyse whether an intergenerational programme in which students interacted with institutionalised older persons had any impact on the older persons' functional status. METHODS: Each academic year, a group of older adults living in nursing homes were divided into two arms. For the next four months, the first group received daily visits from a group of students during which they followed a pre-established activity plan, whilst the other arm proceeded with their normal activity. After 4 months, the groups crossed over, and the second arm received the student visits, whilst the first group returned to their normal activity. A battery of tests was performed at inception, crossover and the end of the second period. The tests explored mobility (Timed Up-and-Go), cognition (Mini-Mental Examination), executive function (Frontal Assessment Battery) and mood (Geriatric Depression Scale). A dichotomous aggregate "significant impairment" variable was deemed to be present when there was at least a 20% loss of function (compared to the value at the beginning of the period) in any of the aforementioned tests. RESULTS: The study included 289 older adults who visited with 91 students. Subjects in the active phase had a lower incidence of significant impairment than those in the control phase (O.R. 0.90, p < 0.01). There were no significant differences in the individual variables. CONCLUSION: An intergenerational project with students visiting older adults in nursing homes had a protective effect, delaying functional decay in older adults.

[HIV Infection in the elderly]. / Infección por el virus de la inmunodeficiencia humana en el anciano.

HIV infection is increasingly common in the elderly. This population is a heterogeneous group with particular epidemiologic characteristics and often with associated comorbidities, which frequently delay diagnosis and lead to poor immunological status at the start of highly active antiretroviral therapy (HAART). There are no differences between elderly and young HIV infected patients in the recommended antiretroviral regimens. Tolerance to treatment is good and the virological and immunological response to HAART is positive, although immunological response is slower and lower than in younger patients. Treatment adherence, which has been shown to be the only protective independent factor related to virological failure, is better in the elderly.

Epidemiology of hip fracture in the elderly in Spain.

OBJECTIVE: To describe the incidence and epidemiological characteristics of hip fracture (HF) in patients aged 65 years or over in the various autonomous regions (AR) of Spain from the year 2000 to 2002 and to determine which factors affect in-hospital mortality. METHODS: Retrospective, observational study including all patients aged >65 years with acute hip fracture in the 19 AR of Spain from 2000 to 2002. Data were obtained from the National Record of the Minimum Basic Data Set of the Ministry of Health. We analyzed the following: incidence rates (crude and age- and gender-adjusted rates) and incidence of hospital admission by season, length of hospital stay and in-hospital mortality. We used regression analysis to identify the factors that influenced in-hospital mortality. RESULTS: There were 107,718 cases of HF in patients aged >65 years; of these, 74% were women, with a mean age of 79 years (SD 14). The crude incidence rate for HF was 511 cases per 100,000 >65-year-old patients per year (265 cases per 100,000 men and 688 per 100,000 women and year). Incidence adjusted for age and gender was 503 cases per 100,000 inhabitants per year. Catalonia had the highest age-adjusted incidence and Galicia the lowest (623 and 317 cases per 100,000 inhabitants per year, respectively). Incidence rates increased from spring (24.1%) to winter (25.8%). The mean length of hospital stay was 15 days (SD 13). Seasonal influence and length of stay varied greatly between autonomous regions. While the overall in-hospital mortality rate was 5.3%, the rate for males was double that of females (8.9% and 4.8%, respectively), and in-hospital mortality increased with comorbidity (each point on the Charlson index increased mortality by 34.5%) was higher in winter (11% more risk compared to warmer seasons) and in cold climate regions (15% more risk compared to regions with a warm climate, i.e.: Catalonia, Valencia, Murcia, Andalusia, Balearic Islands and Canary Islands). CONCLUSIONS: Hip fracture mainly affects elderly women and presents great variability in incidence, seasonality, length of hospital stay and mortality between the different autonomous regions in Spain. Elderly male patients with severe comorbid conditions, who are admitted in winter and in cold climate regions are more at risk of in-hospital mortality.

Aging in HIV-Infected Subjects: A New Scenario and a New View.

The prevalence of HIV-infected people aged 50 years or older is increasing rapidly; the proportion will increase from 28% to 73% in 2030. In addition, HIV-infected individuals may be more vulnerable to age-related condition. There is growing evidence that the prevalence of comorbidities and other age-related conditions (geriatric syndromes, functional or neurocognitive/mental problems, polypharmacy, and social difficulties) is higher in the HIV-infected population than in their uninfected counterparts. However, despite the potential impact of this situation on health care, little information exists about the optimal clinical management of older HIV-infected people. Here we examine the age-related conditions in older HIV-infected persons and address clinical management according to author expertise and published literature. Our aim is to advance the debate about the most appropriate management of this population, including less well-studied aspects, such as frequency of screening for psychological/mental and social and functional capabilities.

Psychotropic medications and falls in nursing homes: a cross-sectional study.

BACKGROUND: Psychotropic medications are very frequently used in nursing homes and have been associated with falls. Little is known on the potential differences between types and subtypes of these medications, and also regarding different prescription patterns. METHODS: Data from 4502 residents living in 41 nursing homes belonging to a Spanish private chain were collected during a study period of 1 month and analyzed. Frequency of injurious and noninjurious falls were investigated for the following groups of psychotropic medications: typical neuroleptics; atypical neuroleptics; antidepressants; short and middle half-life benzodiazepines (BZD); long half-life BZD; BZD (of any type) administered only if needed; other hypnotic, sedative or anxiolytic drugs; cholinesterase inhibitors, and memantine. OR (95% CI) were calculated using regression analysis adjusted for age, sex, number of medications, physical restraint, and cognitive performance. RESULTS: Mean age (SD) was 84.3 (8.6) and 73.4% of the subjects were female. Psychotropic medication was prescribed to 2987 residents (66.3%), and there were 490 falls. Total falls were associated with use of atypical neuroleptics (OR 1.50, CI 1.17‒1.94), antidepressants (OR 1.36, CI 1.03‒1.78), short and middle half-life BZD (OR 1.27, CI 1.00‒1.60), long half-life BZD (OR 1.65, CI 1.14‒2.38), cholinesterase inhibitors (OR 1.42, CI 1.05‒1.92), and memantine (OR 1.90, CI 1.32‒2.74). Injurious falls were associated with typical neuroleptics (OR 1.77, CI 0.99‒3.17), atypical neuroleptics (OR 1.64, CI 1.11‒2.44), and long half-life BZD (OR 2.57, CI 1.56‒4.25). The use of 2 or more psychotropics in combination was also associated with a significant increase of total falls and injurious falls. CONCLUSIONS: Psychotropic medications were highly prescribed in the studied sample and were associated with falls. The most unsafe profile was detected for long half-life BZD, neuroleptics, and psychotropics in combination.

[1st National Meeting of Multidisciplinary Work in Oncogeriatrics: expert consensus document]. / 1.(a) Reunión Nacional de Trabajo Multidisciplinar en Oncogeriatría: documento de consenso.

On 2nd of June 2011 the Institut Català d' Oncologia l'Hospitalet--Hospital Duran i Reynals hosted the first Meeting of Multidisciplinary Work in Oncogeriatrics. The reason for the meeting, which follows on from an initiative of the Medical Societies of Radiotherapy, Oncology, Geriatrics and Gerontology and Palliative Care and Medical Oncology, was to initiate a joint line of work among the different specialties that generally take part in the handling of the elderly patient suffering from oncologic pathologies. This document summarises the different subjects covered during the Meeting.

[Vitamin D and fractures in the elderly]. / Vitamina D y fracturas en el anciano.

Osteoporosis and the subsequent fractures caused by this are a source of morbidity and mortality in the elderly population. It is also often the start of the cascade that culminates in frailty and dependence. Vitamin D has a direct relationship with the appearance of osteoporosis and with the risk of fractures. Receptors of this vitamin have also recently been described in other organs and systems of the body that are associated with muscle strength, cancer and overall mortality. Deficiency of this vitamin in the elderly population in Spain is very prevalent, both in the community and the hospitalised elderly. The diagnosis and treatment are straightforward and cheap. Its efficacy in the prevention of osteoporosis and in the appearance of fractures is perfectly demonstrated. In this review, we will look at the physiology and actions of this vitamin, as well as the principal studies that have demonstrated its effectiveness in the elderly population.

Nutritional assessment of residents in long-term care facilities (LTCFs): recommendations of the task force on nutrition and ageing of the IAGG European region and the IANA.

Unintentional weight loss and Undernutrition are major problems among older people living in Long-Term Care Facilities (LTCF). Undernutrition manifests in LTCF particularly as weight loss and low Body Mass Index (BMI) and is associated with increased morbidity and mortality as well as with functional decline. There are many factors associated with poor nutritional status and affecting protein-energy intake and/or energy expenditure. These include age of 85 years or older, low nutrient intake, loss of ability to eat independently, swallowing and chewing difficulties, becoming bed-ridden, pressure ulcers, history of hip fracture, dementia, depressive symptoms and suffering from two or more chronic illnesses. Nutritional evaluation is an essential part of the Comprehensive Geriatric Assessment (CGA). This evaluation ranges from methods such as BMI to several validated tools such as Mini-Nutritional Assessment (MNA). After diagnosis, the management of undernutrition in LTCF requires a multidisciplinary approach which may involve dietary and environmental improvements and managing multiple co-morbidities, while avoiding polypharmacy as far as possible. Finally, the need for supplementation or artificial (tube) feeding may be considered taking into account the CGA and individual needs. This document presents a succinct review and recommendations of evaluation and treatment of undernutrition.

The eldest of older adults living with HIV: response and adherence to highly active antiretroviral therapy.

OBJECTIVE: The study objective was to analyze the characteristics and the response to therapy in the eldest of the older adults living with human immunodeficiency virus. METHODS: The study included a cohort of patients with human immunodeficiency virus aged 55 years or more on initiating highly active antiretroviral therapy (HAART). Immunologic and virologic response, morbidity, and mortality were assessed. Patients were categorized as aged less than 65 years and 65 years or more. RESULTS: A total of 112 patients were included (82 patients aged<65 years and 30 patients aged> or =65 years). There were no differences between the age groups in baseline characteristics, survival, and virologic response. There was a trend toward better adherence and a lower CD4+ cell increase after HAART in the older group. CONCLUSION: A relationship was found between lower CD4+ cell increase after HAART and advanced age. We found the best adherence to treatment in the eldest of the older adults, and this has been shown to be the only protective independent factor related to virologic failure.

[General coordination of hospital activity]. / Coordinación general de las actuaciones en el hospital.

The present article describes the organizational and general coordination measures taken by the hospital management to attend the 325 victims who arrived at our hospital after the terrorist attack on the morning of 11 March. Firstly, we summarize the activity performed by the extra-hospital emergency services and the distribution of the victims in centers. Secondly, we describe in greater detail the interventions performed to initiate the External Emergency Action Plan in our hospital, the triage system and identification of patients who used it, as well as the resources in terms of beds, operating rooms and personnel that were used on that day. Lastly, by way of discussion, we provide a critical analysis of our interventions.