Oral health and self-rated health in community-dwelling older adults in Colombia.

BACKGROUND: The relationship between oral health and specific health conditions, such as cardiovascular disease or cognitive impairment, has been extensively studied. However, the effect of oral health status on self-rated health has not been assessed. This could be relevant in older people considering that poor self-rated health status and oral diseases are highly prevalent in this population. The aim of this study was to determine the association between different parameters of oral health and self-rated health status (SRHS) in Colombian community-dwelling older adults. METHODS: This is a secondary analysis of the SABE-Colombia study performed in 2015. The dependent variable was defined as the SRHS status assessed by the question "Compared with other people, your age: Do you consider your health status to be better, equal, or worse?" We considered four independent variables: total edentulism considering the high prevalence in older people, the GOHAI score to assess self-rated oral health, and the use of fixed and removable dental prostheses as potential modifiers of oral health. An adjusted ordinal logistic regression was performed by each independent variable. RESULTS: After the exclusion of missing data, 17,945 persons were included in the final analysis. A total of 10.6% reported worse SRHS, 37.6% reported equal SRHS, and 51.6% reported better SRHS. The worse SRHS group was older and had a higher proportion of dependence, cognitive impairment, and depressive symptoms. The frequency of total edentulism and the lower mean score of GOHAI were significant in the worse SHRS group. An ordinal logistic regression for each independent variable was performed, finding that edentulism increases the probability of worse SHRS, while the GOHAI and use of removable or fixed dental prostheses increase the probability of better SRHS. CONCLUSION: We found an association between total edentulism, GOHAI Index, the use of dental prostheses (both removable and fixed), and self-rated health status, showing the relevance of oral health status to self-rated health status independent of comorbidities and geriatric syndromes. This result supports the inclusion of oral health evaluation in comprehensive geriatric assessment.

Effect of physical activity on cognitive domains in dementia and mild cognitive impairment: overview of systematic reviews and meta-analyses.

OBJECTIVE: To assess the effect of physical activity on cognitive domains in persons with dementia or mild cognitive impairment. DESIGN: An overview of systematic reviews and meta-analyses of randomized controlled trials were performed. METHODS: A literature search was performed in PubMed, Scopus, and Cochrane Database of Systematic Reviews databases up to February 2020. Data about the change in cognitive domains after physical activity intervention was extracted and plotted. RESULTS: We included 11 meta-analyses in this overview. The most frequent type of physical activity for the intervention group was the aerobic exercise with a duration between 6 and 78 weeks. Global cognition was the most common form of assessing the cognitive function, follow of executive function, delayed recall, attention, and verbal fluency. We found a positive effect of physical activity on global cognition, executive function, and delayed recall, but no effect on verbal fluency, attention, and immediate recall. CONCLUSION: Physical activity shows a positive effect on cognition in people with dementia and mild cognitive impairment, especially when it was assessed as global cognition. Positive effects on executive function and memory were also shown. This result confirms the relevance of physical activity in the treatment of persons with cognitive impairment.

[Characterization of older adult patients admitted to an acute unit of a high complexity hospital in Bogotá, Colombia]. / Caracterización de los pacientes adultos mayores ingresados a una unidad de agudos de un hospital de alta complejidad en Bogotá, Colombia.

BACKGROUND AND OBJECTIVES: The objective is to describe the demographic, clinical, functional characteristics and outcomes of older adult patients hospitalized in the acute unit of the San Ignacio University Hospital (HUSI). METHODS: Descriptive, cross-sectional observational study, based on the review of the medical records of patients hospitalized in the Geriatrics Unit of the HUSI during the period 2019-2021. VARIABLES: Demographics, comorbidities, baseline situation, main cause of entry and outcomes. The diagnosis of geriatric syndromes was made through the Barthel index, the Lawton and Brody scale, FRAIL scale, mini nutritional assessment short form and Confusion Assessment Method criteria. RESULTS: A total of 4601 patients were analyzed, whose average age was 83years (56.2% women). 72.4% had some degree of dependency for basic activities of daily living, 90.8% had some degree of dependency for instrumental activities of daily living, 32.2% had malnutrition, 15. 7% falls, 9.9% oropharyngeal dysphagia, 32.2% frailty, 28.1% delirium, 54.1% previous dementia. The main comorbidities presented were arterial hypertension, chronic obstructive pulmonary disease and diabetes. 2.9% had some complication during their hospitalization, 10.8% died, and the hospital stay was 5days. CONCLUSION: Older adult patients admitted to the acute unit of the HUSI have a high frequency of dependency, dementia and nutritional disturbances.

Assessing Neutrophil-to-Lymphocyte Ratio as a Nutritional Indicator in Community-Dwelling Older Adults.

BACKGROUND: In an aging population, there is an increasing need for easily accessible nutritional markers. AIMS: To determine whether the neutrophil-to-lymphocyte ratio (NLR) can serve as an effective nutritional indicator compared to the Mini-Nutritional Assessment Short Form (MNA-SF) or other common markers such as albumin and body mass index (BMI). METHODS: Data were obtained from the SABE study in Ecuador, which included participants aged 60 years or older. This cross-sectional study collected comprehensive data, including demographics, health-related factors, and physical assessments. Neutrophil and lymphocyte counts were measured by complete blood count. Nutritional status was assessed by MNA-SF, and BMI was calculated. Several physical tests were performed to evaluate the participants' functional status. Confounding variables such as age, sex, and comorbidities were considered. RESULTS: The final sample consisted of 1790 subjects (48.9% male). The overall median age was 68 years (IQR 64,76). BMI and lymphocytes were higher in females, while NLR was higher in males. MNA-SF showed a negative association with NLR. Similarly, lymphocyte count shows a positive association with MNA-SF. Physical tests, such as the Romberg test and the Five Times Sit-to-Stand test, also showed correlations with NLR and lymphocyte count, respectively. CONCLUSION: The study results suggest a significant relationship between NLR and lymphocytes, and nutritional status. The correlation with albumin is stronger with NLR than with BMI. The simplicity and affordability of NLR may make it suitable for routine use in several medical fields, improving our understanding of the complex relationship between nutrition, inflammation, and overall health.

Characterization in end-of-life care of older people attended by geriatricians.

BACKGROUND AND OBJECTIVE: Symptom control at the end of life is essential, and palliative sedation is a viable intervention option for the care of terminally ill patients. This study aims to characterize the elderly population receiving end-of-life care plans and their management with palliative sedation in a geriatric unit at a high complexity hospital. MATERIALS AND METHODS: A cross-sectional study was conducted, and a descriptive analysis was performed. Medical records of 163 patients admitted to a high complexity hospital in Bogota, Colombia between January 2016 and December 2019 were reviewed. RESULTS: From 163, 141 patients received an end-of-life care plan, and 22 were managed with palliative sedation. The mean age was 84 years, the most frequent cause of death was respiratory infections and 44% of patients had a history of cancer. Prior to admission, functional decline and the presence of moderate to severe dementia were frequently found. About one in ten persons required palliative sedation, which lasted an average of 2.22±5 days. The most common refractory symptom was dyspnea (45.45%), followed by pain (36.36%). CONCLUSIONS: Palliative sedation is prevalent in the elderly population and characterizing this population can provide increased knowledge to improve end-of-life care.

Clinical value of Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales to predict hospital-associated functional decline in an acute geriatric unit in Colombia.

Background: Older adults admitted to a hospital for acute illness are at higher risk of hospital-associated functional decline during stays and after discharge. Objective: This study aimed to assess the calibration and discriminative abilities of the Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales as predictors of hospital-associated functional decline at discharge in a cohort of patients older than age 65 receiving management in an acute geriatric care unit in Colombia. Methods: This study is an external validation of ISAR and HARP prediction models in a cohort of patients over 65 years managed in an acute geriatric care unit. The study included patients with Barthel index measured at admission and discharge. The evaluation discriminate ability and calibration, two fundamental aspects of the scales. Results: Of 833 patients evaluated, 363 (43.6%) presented hospital-associated functional decline at discharge. The HARP underestimated the risk of hospital-associated functional decline for patients in low- and intermediate-risk categories (relation between observed/expected events (ROE) 1.82 and 1.51, respectively). The HARP overestimated the risk of hospital-associated functional decline for patients in the high-risk category (ROE 0.91). The ISAR underestimated the risk of hospital-associated functional decline for patients in low- and high-risk categories (ROE 1.59 and 1.11). Both scales showed poor discriminative ability, with an area under the curve (AUC) between 0.55 and 0.60. Conclusions: This study found that HARP and ISAR scales have limited discriminative ability to predict HAFD at discharge. The HARP and ISAR scales should be used cautiously in the Colombian population since they underestimate the risk of hospital-associated functional decline and have low discriminative ability.

Antecedentes: los adultos mayores ingresados en un hospital por una enfermedad aguda tienen un mayor riesgo de deterioro functional hospitalario durante su estancia y después del alta. Objetivo: este estudio tuvo como objetivo evaluar las capacidades de calibración y discriminación de las escalas Hospital Admission Risk Profile (HARP) e Identification of Seniors at Risk (ISAR) como predictores de deterioro funcional hospitalario al alta en una cohorte de pacientes mayores de 65 años que recibieron manejo en una unidad geriátrica de agudos en Colombia. Métodos: este estudio es una validación externa de los modelos de predicción ISAR y HARP en una cohorte de pacientes mayores de 65 años atendidos en una unidad geriátrica de agudos. El estudio incluyó pacientes con índice de Barthel medido al ingreso y al alta y la evaluación de la capacidad de discriminación y calibración, dos aspectos fundamentales para esta medición. Resultados: de 833 pacientes evaluados, 363 (43.6%) presentaron deterioro funcional hospitalario al momento del alta. La escala HARP subestimó el riesgo de deterioro funcional hospitalario para los pacientes en las categorías de riesgo bajo e intermedio (relación entre eventos observados /esperados (ROE) 1.82 y 1.51, respectivamente). El HARP sobrestimó el riesgo de deterioro funcional hospitalario para pacientes en la categoría de alto riesgo (ROE 0.91). El ISAR subestimó el riesgo de deterioro hospitalario para pacientes en categorías de bajo y alto riesgo (ROE 1.59 y 1.11). Ambas escalas mostraron una pobre capacidad de discriminación, con un área bajo la curva (AUC) entre 0.55 y 0.60. Conclusiones: este estudio encontró que las escalas HARP e ISAR tienen una capacidad de discriminación limitada para predecir deterioro funcional hospitalario al alta. Las escalas HARP e ISAR deben usarse con cautela en la población colombiana ya que subestiman el riesgo de deterioro funcional hospitalario y tienen baja capacidad de discriminación.

Use of a nutrition-focused quality improvement program for community-living older adults at malnutrition risk is associated with better nutritional outcomes.

BACKGROUND & AIMS: Among older adults, malnutrition or its risk is common and is associated with increased morbidity and mortality plus increased need for healthcare utilization. We aimed to identify and treat malnutrition risk among older adults who received care at an outpatient clinic after a recent hospitalization and/or for management of a chronic disease. METHODS: From the outpatient clinic of Hospital Universitario San Ignacio, Bogotá, Colombia, we recruited older adults (>60 years) with malnutrition or its risk according to the Mini Nutritional Assessment-Short Form (MNA-SF). Patients were excluded if they had dementia or were not expected to live 90 days or more. Intervention was a nutrition-focused quality improvement program (QIP) including: i) education of patients and caregivers about the health importance of complete and balanced macro- and micronutrient intake plus physical exercise; and ii) nutritional intervention with dietary counseling and provision of oral nutritional supplements (ONS) for daily intake. To assess the effect of our intervention, we collected nutritional outcome data pre- and post-participation of patients in the nutrition-focused QIP. For pre-post comparisons, we used MNA-SF scores and calf circumference (a proxy for leg muscle mass) measures along with nutrition-related anthropometric determinations of body weight and body mass index (BMI). The ONS treatment phase was 60 days, with follow-up measurements up to 30 days after ONS treatment ended (90 days after intervention start). RESULTS: Of 677 enrolled patients, 618 completed the QIP, while 565 had complete anthropometric data. Patients had a mean age of 74.1 ± 8.7 years, an average of 2.6 comorbidities, included a high proportion of females (69.4%), with medium socioeconomic status (76%). After QIP intervention, 324 (52.4%) patients had improvement in nutritional outcomes; improvement was significant in all four measures (P-values < 0.001). Higher ONS adherence was associated with the highest improvement in nutritional status. CONCLUSIONS: For community-living older adults receiving outpatient care, comprehensive nutritional care offered via a nutrition-focused QIP was associated with significant improvements in indicators of nutritional status (MNA-SF scores and calf circumference) and maintenance or improvements in nutrition-related anthropometric measures (body weight and BMI). GOV IDENTIFIER: NCT04042987.

Nutrition-Focused Care for Community-Living Adults: Healthcare Utilization and Economic Benefits.

OBJECTIVES: We assessed the impact of a recently reported nutritional quality improvement program (QIP) on healthcare resource utilization and costs for older, community-living adults in Bogotá, Colombia. METHODS: The study included 618 community-dwelling, older adults (> 60 years) who were at risk or malnourished and receiving outpatient clinical care. The intervention was a QIP that emphasized nutritional screening, dietary education, lifestyle counseling, 60-day consumption of oral nutritional supplements, and 90-day follow-up. For economic modeling, we performed 90-day budget impact and cost-effectiveness analyses from a Colombian third-party payer perspective. The base-case analysis quantified mean healthcare resource use in the QIP study population. Analysis was based on mean input values (deterministic) and distributions of input parameters (probabilistic). As the deterministic analysis provided a simple point estimate, the cost-effectiveness analysis focused on the probabilistic results informed by 1000 iterations of a Monte-Carlo simulation. RESULTS: Results showed that the total use of healthcare resources over 90 days was significantly reduced by > 40% (hospitalizations were reduced by approximately 80%, emergency department visits by > 60%, and outpatient clinical visits by nearly 40%; P < .001). Based on economic modeling, total cost savings of $129 740 or per-patient cost savings of $210 over 90 days could be attributed to the use of nutritional QIP strategies. Total cost savings equated to nearly twice the initial investment for QIP intervention; that is, the per-dollar return on investment was $1.82. CONCLUSIONS: For older adults living in the community in Colombia, the use of our nutritional QIP improved health outcomes while lowering costs of healthcare and was thus cost-effective.

In-hospital complications in an acute care geriatric unit / [Complicaciones intrahospitalarias en una unidad geriátrica de agudos].

Introduction: In-hospital complications frequently occur in hospitalized people over 65 worsening their clinical outcomes. There are, however, few studies on the factors associated with in-hospital complications in elderly patient care. Objective: To evaluate factors associated with in-hospital complications in a geriatric acute care unit in Bogotá, Colombia. Materials and methods: We conducted an analytical, observational, retrospective study in a cohort of 1,657 patients over 65 years of age who received care in the geriatric unit of a high complexity hospital in Bogotá, Colombia. The dependent variable was in-hospital complications and the independent variables, the degree of functional dependence on admission, dementia, nutritional status, social support, comorbidity, and polypharmacy. We used Poisson's linear regression model to identify associated variables. Results: The bivariate analysis showed that functional dependence (PR=2.092, p≤0.001) and malnutrition (PR=2.850, p≤0.001) were associated with a higher rate of hospital-acquired infection. In the multivariate analysis, functional dependence (PR=1.931, p=0.003) and malnutrition (PR=2.502, p=0.002) remained independent factors for in-hospital complications. Conclusion: In acute care centers, integral assessment at admission to identify functional dependence and malnutrition predicts in-hospital complications.

Introducción. Las complicaciones hospitalarias ocurren con gran frecuencia en personas mayores de 65 años hospitalizadas y conllevan peores resultados clínicos. Son pocos los estudios sobre los factores asociados con las complicaciones hospitalarias en la atención de adultos mayores. Objetivo. Evaluar los factores asociados con las complicaciones hospitalarias en una unidad geriátrica de agudos en Bogotá, Colombia. Materiales y métodos. Se hizo un estudio observacional analítico basado en una cohorte retrospectiva que incluyó 1.657 pacientes mayores de 65 años atendidos en una unidad de hospitalización en Bogotá, Colombia. La variable dependiente fueron las complicaciones hospitalarias y, las independientes, la dependencia funcional, la demencia, el estado nutricional, el soporte social, las comorbilidades y la polifarmacia. Se utilizó el modelo de regresión lineal de Poisson para determinar las variables asociadas. Resultados. En el análisis bivariado se encontró que la dependencia funcional (razón de prevalencia, RP=2,092; p≤0,001) y la malnutrición (RP=2,850; p≤0,001) eran factores asociados con una mayor tasa de complicaciones hospitalarias. En el análisis multivariado aparecían como factores independientes (dependencia funcional: RP=1,931 y p=0,003; malnutrición: RP=2,502 y p=0,002). Conclusión. El hacer una evaluación integral que permita determinar la dependencia funcional y la malnutrición en el momento de ingreso en las unidades de hospitalización, permitiría predecir complicaciones hospitalarias.

Delirium prevalence in a Colombian hospital, association with geriatric syndromes and complications during hospitalization.

BACKGROUND: The aim of this paper is to describe the prevalence of Delirium and the factors associated with its presentation and complications identified in a geriatric unit in Colombia. MATERIAL AND METHODS: This is a retrospective observational study that included all patients admitted consecutively for two years in a geriatric unit of a hospital in Bogotá, Colombia. We assessed delirium prevalence with the Confusion Assessment Method (CAM). The independent variables were age, sex, functional impairment (Barthel<90), malnutrition (MNA<12), pressure ulcers at admission, state of the social support network, number of comorbidities, polypharmacy (5 or more drugs), complications such as ICU requirement, hospital stay, in-hospital functional impairment and mortality were also evaluated. As an exclusion criterion: not having CAM registered in the medical record, all the patients had this information. RESULTS: We studied 1599 subjects with a mean age of 86 years (IQR 9). Delirium prevalence was 51.03%. Delirium was associated with a higher rate of: pressure ulcers on admission [OR 3.76 (CI 2.60-5.43 p<0.001)], functional impairment [OR 2.38 (CI 1.79-3.16 p<0.001)], malnutrition [OR 2.06 (CI 1.56-2.73 p<0.001)], and infection [OR 1.46 (CI 1.17-1.82 p<0.001)]. Moreover delirium has a higher association with mortality [OR 2.80 (1.03-7.54 p=0.042)], in-hospital functional decline [OR 1.82 (1.41-2.36 p<0.001)], and longer hospital stay [OR 1.04 (1.04-1.09 p=0.006)]; independently of age, sex, pressure ulcers on admission, functional impairment, malnutrition, dementia, infection and limited social network. CONCLUSION: Our study suggests that infectious diseases and geriatric syndromes such as, functional dependence, pressure ulcers, malnutrition or major cognitive impairment are independently associated with the presence of delirium on admission. Additionally, the presence of delirium is independently associated during hospitalization with complications, longer hospital stay, functional impairment and mortality.

Association of Malnutrition with Functional and Cognitive Trajectories in People Living with Dementia: A Five-Year Follow-Up Study.

BACKGROUND: In dementia, functional status depends on multiple factors in addition to cognition. Nutritional status is a potentially modifiable factor related to homeostasis and proper functioning of body systems and may contribute to cognitive and functional decline. OBJECTIVE: This paper aims to analyze the association of malnutrition with the course of cognitive and functional decline in people living with dementia. METHODS: This is an analysis of a longitudinal cohort study, the Dementia Study of Western Norway. Data of 202 patients diagnosed with mild dementia were analyzed; Alzheimer's disease (AD) (n = 103), Lewy body dementia (LBD) (n = 74), and other dementias (OD) (n = 25). Cognition was assessed with the Mini-Mental State Examination and functional decline through the activities of daily living included in the Rapid Disability Rating Scale. The Global Leadership Initiative on Malnutrition Index was used to determine nutritional status. Associations of nutritional status with cognitive and functional decline were evaluated through adjusted linear mixed models. RESULTS: At baseline, the prevalence of general malnutrition was 28.7%; 17.3% were classified as moderate malnutrition and 11.38% as severe malnutrition (there were no significant differences between AD and LBD). Malnutrition at diagnosis and over follow-up was a significant predictor of functional-decline, but not of cognitive decline. CONCLUSION: According to our results malnutrition was associated with faster functional loss but, not cognitive decline in older adults with dementia. A more comprehensive dementia approach including nutritional assessments could improve prognosis.

Behavioural Disturbances in Patients with Diagnosis of Neurocognitive Disorder in Bogotá (Colombia). / Alteraciones del comportamiento de pacientes con diagnóstico de trastorno neurocognoscitivo en Bogotá (Colombia).

INTRODUCTION: The main aim of this study is to determine the prevalence of behavioural disturbances (BD) in a group of patients with diagnosis of neurocognitive disorders assessed by a memory clinic in a referral assessment centre in Bogotá, Colombia, in 2015. MATERIAL AND METHODS: This is an observational, retrospective descriptive study of 507 patients with a diagnosis of neurocognitive disorder (according to DSM-5 criteria) evaluated in a referral centre in Bogotá, Colombia, in 2015. RESULTS: Among the group of patients assessed, analyses reveal mean age for minor neurocognitive disorders of 71.04 years, and 75.32 years for major neurocognitive disorder (P <0.001). A total of 62.72% of the sample were female. The most prevalent aetiology of the neurocognitive disorders was Alzheimer's disease, followed by behavioural variant frontotemporal dementia and neurocognitive disorders due to multiple aetiologies. BD occur more frequently in neurocognitive disorder due to behavioural variant frontotemporal dementia (100%), Alzheimer's disease (77.29%) and vascular disease (76.19%). The most prevalent BD in the group assessed were apathy (50.75%), irritability (48.45%), aggression (16.6%), and emotional lability (14.76%). CONCLUSIONS: BD are highly prevalent in patients with diagnosis of major neurocognitive disorder. BD are more prevalent in behavioural variant frontotemporal dementia than any other group. Apathy, irritability, emotional lability and aggression are the BD that occur with greater prevalence in our sample. We discuss the importance of BD in the clinical progression of neurocognitive disorders.

Prevalence of self-reported swallowing difficulties and associated factors among older Colombians / Prevalência de dificuldades de deglutição autorreferidas e fatores associados entre idosos colombianos

Objective: We aimed to determine the prevalence of self-reported swallowing difficulty (dysphagia) among older Colombians and to explore the factors associated with this condition. Methods: This study presents a secondary analysis of the SABE-Colombia survey, a crosssectional study of community-dwelling older adults. The dependent variable was self reported swallowing difficulty, assessed through the question: "How often do you have difficulty or discomfort swallowing?" Descriptive and bivariate analyses of the sample were performed, followed by multivariate analysis, adjusting for confounding variables. Results: The final sample included 19 004 older Colombians, whose mean age was 69 years (56% women). The overall prevalence of swallowing difficulty was 12.2%. In the multivariate analysis, significant associations were observed between swallowing difficulty and several factors, including male sex (OR 1.14, 95%CI 1.03 ­ 1.26), age > 80 years (OR 1.26, 95%CI 1.08 ­ 1.47), dependence in activities of daily living (OR 1.62, 95%CI 1.23 ­ 2.13), cognitive impairment (OR 1.49, 95%CI 1.30 ­ 1.70), depressive symptoms (OR 1.38, 95%CI 1.15 ­ 1.65), sarcopenia (OR 1.32, 95%CI 1.02 ­ 1.69), malnutrition (OR 1.35, 95%CI 1.23 ­ 1.49), and osteoarticular disease (OR 1.18, 95%CI 1.07 ­ 1.38). Conclusion: There was a high prevalence of swallowing difficulty among older community-dwelling Colombians. Our results showed a strong correlation between swallowing difficulty and risk factors such as cognitive impairment, depressive symptoms, osteoarticular disease, and dependence in activities of daily living, but not with malnutrition or sarcopenia. (AU)

Gait speed as a mediator of the effect of sarcopenia on dependency in activities of daily living.

BACKGROUND: Sarcopenia in older adults is strongly associated with an increase in dependency in activities of daily living (ADL) and with a decline in gait speed. Interestingly, gait speed has been shown to independently predict mortality. In this context, our study aimed to explore the mediator role of gait speed on the relationship between sarcopenia and dependency in ADL. METHODS: A cross-sectional study was conducted in Colombia, 19 705 older adults with a mean age of 70 years, 55.6% women, 16.1% with sarcopenia, and 14.7% mild, moderate, or severe dependency in ADL, according to 'SABE Survey 2015'. Sarcopenia was assessed by calf circumference and ADL dependence through the Barthel Index. Gait speed was measured over a distance of 3 m. The association between sarcopenia condition and gait speed and dependency level was analysed by linear regression adjusted by covariates. To examine whether gait speed mediated the association between sarcopenia and dependence components of physical function, simple mediation models were generated using ordinary least squares with the macro PROCESS version 3.2, adjusted for age, sex, and body mass index (BMI). RESULTS: Significant differences (P < 0.05) were found in gait speed and dependency in ADL between the sarcopenia and non-sarcopenia groups after adjusting for age, sex, and BMI. BMI was significantly higher in the non-sarcopenia group whereas dependency was significantly higher in the sarcopenia group (19.6% vs. 13.8%). Results from mediation model regression analysis indicated a significant and direct detrimental effect of sarcopenia on dependency in ADL (ß = -0.05; P < 0.001), and a significant indirect effect of gait speed on the direct effect (-0.009 to -0.004). CONCLUSIONS: The negative effect of sarcopenia on functional dependence was mediated by the gait speed. Therefore, gait speed may positively influence the detrimental effect of sarcopenia for dependency, after adjusting for age, gender, and BMI. Consequently, physical exercise should be promoted and focused to circumvent the gait speed decline associated with age in older people with sarcopenia.

Factores asociados con la fragilidad en un servicio ambulatorio de geriatría de un hospital universitario en Bogotá (Colombia) / Factors Associated with Frailty in the Geriatric Outpatient Service of a University Hospital in Bogotá (Colombia) / Fatores associados à fragilidade no ambulatório de geriatria de um hospital universitário de Bogotá (Colômbia)

Introducción: la fragilidad, entendida como un estado previo a la discapacidad, confiere mayor vulnerabi-lidad a estresores externos y contribuye a desenlaces negativos como caídas, hospitalización, discapacidad y mortalidad. El objetivo de este estudio fue identificar su prevalencia y evaluar los factores asociados en los pacientes del Servicio Ambulatorio de Geriatría del Hospital Universitario San Ignacio (husi) en Bogotá (Colombia). Materiales y métodos: estudio de corte transversal con 689 pacientes atendidos en la consulta externa de geriatría del husi entre agosto de 2016 y marzo de 2020. Mediante regresiones logísticas se iden-tificaron los factores relacionados con la fragilidad. Resultados: la prevalencia fue del 35.4 %. En el análisis bivariado, las variables asociadas con la fragilidad fueron edad mayor de 80 años (or: 2.07; ic95 %: 1.40-3.20; p = 0.001), sexo femenino (or: 1.40; ic95 %: 0.99-2.02; p = 0.03), multimorbilidad (or: 2.13; ic95 %: 1.40-2.90; p < 0.001) y malnutrición (or: 2.23; ic95 %: 1.22-4.07; p = 0.009). En el análisis multivariado, la multimor-bilidad (or: 2.46; ic95 %: 1.62-3.75; p = 0.001), la velocidad de la marcha lenta (or: 5.15; ic95 %: 3.0-8.60; p = 0.001) y el perímetro de pantorrilla bajo (or: 1.60; ic95 %: 1.03-2.50; p = 0.06) se vincularon con la fragilidad. Conclusión: la prevalencia de fragilidad en el servicio de geriatría del husies mayor a la de los referentes nacionales; adicionalmente, las variables analizadas coinciden con las encontradas en la literatura; todo esto respecto a la gran complejidad clínica de los pacientes. Es clave la detección de los factores que se asocian con fragilidad, a fin de intervenirlos y prevenir desenlaces adversos

Introduction: Frailty, understood as a pre-disability state, increases vulnerability to external stressors and contributes to negative outcomes such as falls, hospitalization, disability, and mortality. This study aims to identify the prevalence of frailty and assess the associated factors in patients attending the geriatric outpatient service of the Hospital Universitario San Ignacio (husi). Materials and methods: A cross-sectional study involving 689 patients treated at the husigeriatric outpatient clinic between August 2016 and March 2020. Logistic regressions were conducted to identify factors associated with frailty. Results: The prevalence of frailty was 35.4 %. In bivariate analysis, variables associated with frailty included age over 80 years (or: 2.07; ci95 %: 1.40-3.20; p = 0.001), female sex (or: 1.40; ci95 %:0.99-2.02; p= 0.03), multimorbidity (or: 2.13; ci95 %:1.40-2.90; p < 0.001) and malnutrition (or: 2.23; ci95 %: 1.22-4.07; p = 0.009). In multivariate analysis, multimorbidity (or: 2.46; ci95 %: 1.62-3.75; p = 0.001), slow walking speed (or: 5.15; ci95 %: 3.0-8.60; p = 0.001) and low calf perimeter (or: 1.60; ci95 %: 1.03-2.50; p = 0.06) were associated with frailty. Conclusion: The prevalence of frailty in our center exceeds national references; and the identified variables align with those reported in the literature; reflecting the considerable clin-ical complexity of our patients. Detecting factors associated with frailty is crucial for intervention and prevention of adverse outcomes

ntrodução: a fragilidade, entendida como um estado anterior à incapacidade, confere maior vulnerabi-lidade a estressores externos e contribui para desfechos negativos como quedas, hospitalização, incapa-cidade e mortalidade. O objetivo deste estudo foi identificar a prevalência e avaliar os fatores associados à fragilidade em pacientes do ambulatório de geriatria do Hospital Universitário San Ignacio (husi) de Bogotá, Colômbia. Materiais e métodos: estudo transversal com 689 pacientes atendidos no ambulatório de geriatria do husi entre agosto de 2016 e março de 2020. Foram realizadas regressões logísticas para identificar fatores associados à fragilidade. Resultados: a prevalência de fragilidade foi de 35.4 %. Na análise bivariada, as variáveis associadas à fragilidade foram: idade acima de 80 anos (or:2.07; ic95 %:1.40-3,20; p = 0.001), gênero feminino (or:1.40; ic95 %:0.99-2.02; p = 0.03), multimorbidade (or: 2.13; ic95 %: 1.40-2.90; p < 0.001) e desnutrição (or:2.23; ic95 %:1.22-4.07; p = 0.009). Na análise multivariada, multimorbidade (or:2.46; ic95 %: 1.62-3.75; p = 0.001), velocidade lenta de caminhada (or:5.15; ic95 %:3.0-8.60; p = 0.001) e baixa circunferência da panturrilha (or: 1.60; ic95 %: 1.03-2.50; p = 0.06) foram associados à fragilidade. Conclusão: a prevalência de fragilidade no husi é superior à das referências nacionais; adicionalmente, as variáveis associadas coincidem com as encontradas na literatura; tudo isso em relação à grande complexidade clínica dos nossos pacientes. É fundamental detectar os fatores associados à fragilidade para intervir e prevenir resultados adversos

El sentimiento de soledad en la población adulta mayor participante en centros de día en Bogotá, Colombia

Objetivo: Identificar los factores asociados a las categorías de soledad en población adulta mayor en centros de día en Bogotá, Colombia. Materiales y métodos: Se realizó un estudio cuantitativo, transversal y analítico para medir la soledad en personas mayores que participan en un centro de día de la ciudad de Bogotá, mediante la escala ESTE en personas mayores, entre noviembre de 2020 y junio de 2021. Para cumplir con el objetivo, se realizó un análisis estadístico descriptivo univariado, de tal forma que, para las variables cuantitativas, se empleó media con desviación estándar o mediana con rangos intercuartílicos, de acuerdo con los criterios de normalidad utilizando la prueba Shapiro Wilk, y para las variables categóricas, frecuencias absolutas y proporciones. El análisis bivariado se realizó con las pruebas t de Student y chi cuadrado (p < 0,05), lo cual contribuyó a la construcción de un modelo de regresión logística, con las variables con significancia estadística. Resultados: Se incluyeron 215 personas adultas mayores con promedio de edad de 70,5 años; 72 % correspondían al sexo femenino, 56,5 % tenían educación primaria, 38,6 % eran solteros y 67,4 % presentaban antecedente de enfermedad crónica no transmisible. Según la escala ESTE, en soledad familiar registraron nivel bajo (67 %); en soledad conyugal, entre nivel alto y medio (79 %); en soledad social, nivel alto y medio (51 %); en crisis de adaptación, nivel alto y medio (43 %). Se encontraron asociaciones en soledad conyugal con sexo femenino (p = 0,001), en soledad social con clase baja (p = 0,027) y en crisis de adaptación con clase baja (p = 0,024). Conclusiones: Los factores que se asocian al sentimiento de soledad en población adulta mayor participante en centros de día son, en la categoría de soledad conyugal, ser mujer, y, en soledad social y crisis de adaptación, pertenecer a clase baja.

Objective: To identify the factors associated with the categories of loneliness among the elderly population attending day care centers in Bogotá, Colombia. Materials and methods: An analytical, cross-sectional and quantitative study was carried out to measure the loneliness among older people attending a day care center in the city of Bogotá between November 2020 and June 2021 using the ESTE scale. To meet the objective, a univariate descriptive statistical analysis was performed, such that, for the quantitative variables, the mean with standard deviation or median with interquartile ranges were used, in accordance with the Shapiro-Wilk test for normality, and for the categorical variables, absolute frequencies and proportions were used. The bivariate analysis was conducted using Student's t-test and chi-square test (p < 0.05), which contributed to build a logistic regression model with statistically significant variables. Results: A total of 215 elderly people with a mean age of 70.5 years were included in the study: 72 % were females, 56.5 % had primary education, 38.6 % were single and 67.4 % had a history of chronic non-communicable disease. According to the ESTE scale, the study subjects showed a low level of family loneliness (67 %), a high and medium level of marital loneliness (79 %), a high and medium level of social loneliness (51 %) and a high and medium level of adaptation crisis (43 %). It was found that marital loneliness was associated with females (p = 0.001), social loneliness with lower class (p = 0.027) and adaptation crisis with lower class (p = 0.024). Conclusions: The factors associated with the feeling of loneliness among the elderly population attending day care centers are, in the marital loneliness category, being a woman and, in the social loneliness and adaptation crisis categories, belonging to the lower class.

Clinical value of Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales to predict hospital-associated functional decline in an acute geriatric unit in Colombia

Background: Older adults admitted to a hospital for acute illness are at higher risk of hospital-associated functional decline during stays and after discharge. Objective: This study aimed to assess the calibration and discriminative abilities of the Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales as predictors of hospital-associated functional decline at discharge in a cohort of patients older than age 65 receiving management in an acute geriatric care unit in Colombia. Methods: This study is an external validation of ISAR and HARP prediction models in a cohort of patients over 65 years managed in an acute geriatric care unit. The study included patients with Barthel index measured at admission and discharge. The evaluation discriminate ability and calibration, two fundamental aspects of the scales. Results: Of 833 patients evaluated, 363 (43.6%) presented hospital-associated functional decline at discharge. The HARP underestimated the risk of hospital-associated functional decline for patients in low- and intermediate-risk categories (relation between observed/expected events (ROE) 1.82 and 1.51, respectively). The HARP overestimated the risk of hospital-associated functional decline for patients in the high-risk category (ROE 0.91). The ISAR underestimated the risk of hospital-associated functional decline for patients in low- and high-risk categories (ROE 1.59 and 1.11). Both scales showed poor discriminative ability, with an area under the curve (AUC) between 0.55 and 0.60. Conclusions: This study found that HARP and ISAR scales have limited discriminative ability to predict HAFD at discharge. The HARP and ISAR scales should be used cautiously in the Colombian population since they underestimate the risk of hospital-associated functional decline and have low discriminative ability.

Antecedentes: los adultos mayores ingresados en un hospital por una enfermedad aguda tienen un mayor riesgo de deterioro functional hospitalario durante su estancia y después del alta. Objetivo: este estudio tuvo como objetivo evaluar las capacidades de calibración y discriminación de las escalas Hospital Admission Risk Profile (HARP) e Identification of Seniors at Risk (ISAR) como predictores de deterioro funcional hospitalario al alta en una cohorte de pacientes mayores de 65 años que recibieron manejo en una unidad geriátrica de agudos en Colombia. Métodos: este estudio es una validación externa de los modelos de predicción ISAR y HARP en una cohorte de pacientes mayores de 65 años atendidos en una unidad geriátrica de agudos. El estudio incluyó pacientes con índice de Barthel medido al ingreso y al alta y la evaluación de la capacidad de discriminación y calibración, dos aspectos fundamentales para esta medición. Resultados: de 833 pacientes evaluados, 363 (43.6%) presentaron deterioro funcional hospitalario al momento del alta. La escala HARP subestimó el riesgo de deterioro funcional hospitalario para los pacientes en las categorías de riesgo bajo e intermedio (relación entre eventos observados /esperados (ROE) 1.82 y 1.51, respectivamente). El HARP sobrestimó el riesgo de deterioro funcional hospitalario para pacientes en la categoría de alto riesgo (ROE 0.91). El ISAR subestimó el riesgo de deterioro hospitalario para pacientes en categorías de bajo y alto riesgo (ROE 1.59 y 1.11). Ambas escalas mostraron una pobre capacidad de discriminación, con un área bajo la curva (AUC) entre 0.55 y 0.60. Conclusiones: este estudio encontró que las escalas HARP e ISAR tienen una capacidad de discriminación limitada para predecir deterioro funcional hospitalario al alta. Las escalas HARP e ISAR deben usarse con cautela en la población colombiana ya que subestiman el riesgo de deterioro funcional hospitalario y tienen baja capacidad de discriminación.

Inter-University Network for Healthy Aging, Latin America and the Caribbean (RIES-LAC): a university contribution to the Decade of Healthy Aging / Rede interuniversitária para o envelhecimento saudável, América Latina e Caribe (RIES-ALC): uma contribuição universitária para a década do envelhecimento saudável / Red interuniversitaria de envejecimiento saludable, Latinoamérica y Caribe (RIES-LAC): un aporte universitario a la década del envejecimiento saludable

A população mundial está envelhecendo e a América Latina e o Caribe (ALC) não são exceção. Atualmente, 8% da população da ALC tem mais de 65 anos e prevê-se que esse número aumente para 30% até 2050. Sabe-se que o processo de envelhecimento envolve alterações moleculares, fisiológicas, funcionais, psicoafetivas e sociais. Todos envelhecemos, a questão é envelhecer com saúde. Como nem sempre é esse o caso, a Organização Mundial da Saúde (OMS) declarou esse período (2021-2030) como a Década do Envelhecimento Saudável. A Década é uma iniciativa global de colaboração de diferentes setores e partes interessadas (governos, sociedade civil, organizações internacionais, profissionais, instituições universitárias, meios de comunicação social e setor privado) para melhorar a vida de pessoas idosas, suas famílias e comunidades. A colaboração centra-se em quatro pilares de ação estreitamente interligados: mudar a forma como pensamos, sentimos e agimos em relação à idade e ao envelhecimento; garantir que as comunidades promovam as capacidades dos idosos; fornecer cuidados integrados e centrados nas pessoas e serviços de saúde primários que respondam às necessidades dos idosos; e fornecer acesso a cuidados de longo prazo para idosos que deles necessitem.

The world's population is aging, and the Latin America and the Caribbean (LAC) region is no exception. Currently, 8% of the LAC population is over 65 years old, and this number is estimated to increase to 30% by 2050. The aging process is known to involve molecular, physiological, functional, psychosocial, and social changes. We all age; the point is to age healthily. As this is not always the case, the World Health Organization (WHO) declared the period from 2021 to 2030 as the Decade of Healthy Aging. The Decade is a global collaboration involving diverse sectors and stakeholders (governments, civil society, international organizations, professionals, academic institutions, the media, and the private sector) to improve the lives of older people, their families, and communities. The collaboration is centered on four closely interconnected pillars of action: changing how we think, feel, and act towards age and aging; ensuring that communities foster the abilities of older people; providing person-centered integrated care and primary health services responsive to older people; and providing access to long-term care for older people who need it. In light of this situation, what can academics from universities in LAC do? If we organize ourselves and unite efforts, we can contribute to the Decade of Healthy Aging and, consequently, influence the quality of life of older people.

La población mundial está envejeciendo y Latinoamérica y Caribe (LAC) no son una excepción. Actualmente, el 8% de la población en LAC tiene sobre 65 años, y se proyecta un aumento al 30% para 2050. Es conocido que el proceso de envejecimiento implica cambios moleculares, fisiológicos, funcionales, psicoafectivos y sociales. Todos envejecemos, el punto es envejecer saludablemente. Como no siempre ocurre así, la Organización Mundial de la Salud(OMS) ha declarado a este período (2021­2030) como la Década del Envejecimiento Saludable. La Década es una iniciativa de colaboración mundial de distintos sectores y partes interesadas (gobiernos, sociedad civil, organizaciones internacionales, profesionales, instituciones universitarias, medios de comunicación y el sector privado) para mejorar la vida de las personas mayores, sus familias y comunidades. La colaboración se centra en cuatro pilares de actuación estrechamente interconectados: cambiar nuestra forma de pensar, sentir y actuar con respecto a la edad y el envejecimiento; asegurar que las comunidades fomenten las capacidades de las personas mayores; ofrecer una atención integrada y centrada en las personas, y servicios de salud primarios que respondan a las necesidades de las personas mayores; y proporcionar acceso a la atención a largo plazo para las personas mayores que lo necesiten.

Perfil de paciente geriátrico y factores asociados a mortalidad en población mayor de 80 años con infección por COVID-19: experiencia de un hospital universitario en Bogotá

Objetivo: Caracterizar el perfil del paciente e identificar los factores asociados a mortalidad de población mayor de 80 años hospitalizada por infección por COVID-19, a cargo del Servicio de Geriatría en un hospital universitario de la ciudad de Bogotá. Materiales y métodos: Se llevó a cabo un estudio observacional analítico, basado en la revisión de historias clínicas de una cohorte retrospectiva, en el que se incluyeron pacientes de 80 años o más con infección confirmada por COVID-19, en el período del 1 de marzo de 2020 al 28 de febrero de 2021. La variable dependiente fue mortalidad; las variables independientes, edad, factores clínicos, situación basal y paraclínicos. Resultados: Se identificaron 280 pacientes, con mediana de edad de 84 años, y la mayoría de perfil robusto. El síntoma más frecuente fue tos, seguido por disnea. El 60,3 % de los pacientes presentaron linfopenia, además de elevación de dímero D (> 1000 ug/L), y en la mayoría de los casos se describieron patrones radiológicos típicos de COVID-19. La mortalidad fue del 41,4 %, principalmente asociada a mayor edad, proteína C reactiva elevada, dependencia para actividades básicas de la vida diaria, antecedente de trastorno neurocognitivo mayor, comorbilidad y los pacientes con perfiles dependiente y frágil. Conclusiones: La población geriátrica presenta un alto riesgo de mortalidad por infección por COVID-19. El presente estudio permitió evidenciar qué perfiles de paciente dependientes y frágiles, así como presencia de comorbilidades como trastorno neurocognitivo mayor, enfermedad pulmonar obstructiva crónica y polifarmacia previa al ingreso podrían influir en el desenlace.

Objective: To characterize the geriatric patient profile and identify the mortality-associated factors in a population over 80 years hospitalized with COVID-19 infection in the geriatric ward of a university hospital in the city of Bogotá. Materials and methods: An analytical observational retrospective cohort study based on chart reviews was conducted. The study included patients over 80 years with confirmed COVID-19 infection from March 1, 2020 to February 28, 2021. The dependent variable was mortality and the independent variables were age, clinical factors, baseline characteristics and paraclinical status. Results: Two hundred eighty (280) patients with a median age of 84 years, most of whom were overweight, were identified. The most frequent symptom was cough followed by dyspnea. Out of all patients, 60.3 % presented lymphopenia and elevated D-dimer levels (> 1,000 μg/L), and most of them showed typical imaging patterns of COVID-19. Mortality accounted for 41.4 % and was mainly associated with older age, elevated C-reactive protein, activities of daily living impairment, history of major neurocognitive disorder, comorbidity, and dependent and frail patient profiles. Conclusions: The geriatric population has an increased risk of mortality from COVID-19 infection. The present study showed that dependent and frail patient profiles, as well as the presence of comorbidities such as major neurocognitive disorder, chronic obstructive pulmonary disease and polypharmacy prior to admission, could influence the outcome.

Complicaciones hospitalarias en una unidad geriátrica de agudos / In-hospital complications in an acute care geriatric unit

Resumen | Introducción. Las complicaciones hospitalarias ocurren con gran frecuencia en personas mayores de 65 años hospitalizadas y conllevan peores resultados clínicos. Son pocos los estudios sobre los factores asociados con las complicaciones hospitalarias en la atención de adultos mayores. Objetivo. Evaluar los factores asociados con las complicaciones hospitalarias en una unidad geriátrica de agudos en Bogotá, Colombia. Materiales y métodos. Se hizo un estudio observacional analítico basado en una cohorte retrospectiva que incluyó 1.657 pacientes mayores de 65 años atendidos en una unidad de hospitalización en Bogotá, Colombia. La variable dependiente fueron las complicaciones hospitalarias y, las independientes, la dependencia funcional, la demencia, el estado nutricional, el soporte social, las comorbilidades y la polifarmacia. Se utilizó el modelo de regresión lineal de Poisson para determinar las variables asociadas. Resultados. En el análisis bivariado se encontró que la dependencia funcional (razón de prevalencia, RP=2,092; p≤0,001) y la malnutrición (RP=2,850; p≤0,001) eran factores asociados con una mayor tasa de complicaciones hospitalarias. En el análisis multivariado aparecían como factores independientes (dependencia funcional: RP=1,931 y p=0,003; malnutrición: RP=2,502 y p=0,002). Conclusión. El hacer una evaluación integral que permita determinar la dependencia funcional y la malnutrición en el momento de ingreso en las unidades de hospitalización, permitiría predecir complicaciones hospitalarias.

Abstract | Introduction: In-hospital complications frequently occur in hospitalized people over 65 worsening their clinical outcomes. There are, however, few studies on the factors associated with in-hospital complications in elderly patient care. Objective: To evaluate factors associated with in-hospital complications in a geriatric acute care unit in Bogotá, Colombia. Materials and methods: We conducted an analytical, observational, retrospective study in a cohort of 1,657 patients over 65 years of age who received care in the geriatric unit of a high complexity hospital in Bogotá, Colombia. The dependent variable was in-hospital complications and the independent variables, the degree of functional dependence on admission, dementia, nutritional status, social support, comorbidity, and polypharmacy. We used Poisson's linear regression model to identify associated variables. Results: The bivariate analysis showed that functional dependence (PR=2.092, p≤0.001) and malnutrition (PR=2.850, p≤0.001) were associated with a higher rate of hospital-acquired infection. In the multivariate analysis, functional dependence (PR=1.931, p=0.003) and malnutrition (PR=2.502, p=0.002) remained independent factors for in-hospital complications. Conclusion: In acute care centers, integral assessment at admission to identify functional dependence and malnutrition predicts in-hospital complications.