[PAPPS update on older people 2022]. / Actividades preventivas en el mayor. Actualización PAPPS 2022.

This article examines the latest available evidence on preventive activities in the elderly, including sleep disorders, physical exercise, deprescription, cognitive disorders and dementias, nutrition, social isolation and frailty.

[PAPPS GdT Major 2020 Update]. / Actualización PAPPS GdT Mayor 2020.

In this update, we have introduced new topics that we believe are of vital importance in the major areas, such as the revision of walking aids, as well as recommendations on nutrition and social isolation. Recommendations on deprescribing, fragility, mild cognitive impairment, and dementia have already been presented in previous updates.

[The frail elderly. Detection and management in Primary Care]. / El anciano frágil. Detección y tratamiento en AP.

In this article the current state in the detection and management directives of the frail elderly from Primary Care are reviewed. These include the recommendations of the 2009 Preventive Activities Program and Health Promotion of the Spanish Society of Family and Community Medicine (PAPPS-semFYC) and define future lines worthy of review. The lack of defined limits between frailty and good functionality, and with disability and dependency, makes it difficult to diagnose. The two currently most widely methods for detecting the frail elderly are: screening based on risk factors with a sound prediction of suffering adverse events and functional loss (advanced age, hospitalisation, falls, changes in movement and balance, muscle weakness and little exercise, comorbidity, adverse social conditions, multiple medications, etc.) or based on the loss of incipient functionality or early loss if there is still no ostensible degree of incapacity or dependence, and with the possibilities of reversing or modifying it with suitable interventions. Other detection methods, although less used or in the experimental phase include, detection of a phenotype (geriatric syndrome) according to clinical criteria established by Fried, or by biological markers (pre-clinical stage).

[Benzoletter: minimal intervention for deprescribing benzodiazepines in patients with insomnia]. / Benzocarta: intervención mínima para la desprescripción de benzodiacepinas en pacientes con insomnio.

OBJECTIVE: To determine whether a letter-based intervention to patients taking benzodiazepines reduces their consumption. METHOD: A before-after study without control group performed in primary care in May 2016. 1582 patients who took a single daily dose of benzodiazepines as hypnotic for more than 3 months were sent a personalized letter from their family doctor. The letter contained information about the risks of long-term benzodiazepine consumption and the recommendation to discontinue them with a gradual drop protocol (Benzoletter). The percentage of patients who stopped or decreased the use of benzodiazepines, and the difference in the total dose dispensed (mg equivalents of diazepam dispensed in three months) between the pre- and post-intervention period (at 6 and 12 months) were evaluated. RESULTS: Dispensing data from 1561 patients were collected (average age: 69.3 years; 74% women). Twelve months after the intervention, 22.0% (95% confidence interval [95%CI]: 19.9-24.0) discontinued benzodiazepine consumption and 18.8% (95%CI: 16.9-20.8) reduced their consumption. A statistically significant reduction was observed in the total dose dispensed (mean difference: 89mg; 95%CI: 72.2-105.7). CONCLUSION: The Benzoletter is associated with a significant decrease in the consumption of hypnotics. It is a simple and feasible intervention that allows acting on large populations, and it could even be periodically repeated. Controlled studies are required to confirm its effectiveness.