Medication Assessment in an Older Population during Acute Care Hospitalization and Its Effect on the Anticholinergic Burden: A Prospective Cohort Study.

(1) Background: Anticholinergic and sedative drugs (ASDs) contribute to negative health outcomes, especially in the frail population. In this study, we aimed to assess whether frailty increases with anticholinergic burden and to evaluate the effects of medication reviews (MRs) on ASD regimens among patients attending an acute care for the elderly (ACE) unit. (2) Methods: A cohort study was conducted between June 2019 and October 2020 with 150 consecutive patients admitted to our ACE unit. Demographic, clinical, and pharmacological data were assessed. Frailty score was determined using the Frail-VIG index (FI-VIG), and ASD burden was quantified using the drug burden index (DBI). In addition, the MR was performed using the patient-centered prescription (PCP) model. We used a paired T-test to compare the DBI pre- and post-MR and univariate and multivariate regression to identify the factors associated with frailty. (3) Results: Overall, 85.6% (n = 128) of participants showed some degree of frailty (FI-VIG > 0.20) and 84% (n = 126) of patients received treatment with ASDs upon admission (pre-MR). As the degree of frailty increased, so did the DBI (p < 0.001). After the implementation of the MR through the application of the PCP model, a reduction in the DBI was noted (1.06 ± 0.8 versus 0.95 ± 0.7) (p < 0.001). After adjusting for covariates, the association between frailty and the DBI was apparent (OR: 11.42, 95% (CI: 2.77-47.15)). (4) Conclusions: A higher DBI was positively associated with frailty. The DBI decreased significantly in frail patients after a personalized MR. Thus, MRs focusing on ASDs are crucial for frail older patients.

[3D/3D+ as a tool for rapid geriatric assessment and adequacy of the care resource at discharge from the Emergency Department]. / Las 3D/3D+ como herramienta de valoración geriátrica rápida y de adecuación del recurso asistencial al alta de los Servicios de Urgencias.

OBJECTIVE: Assess the 3D/3D+ rapid geriatric assessment tool for the early detection of frailty, its usefulness to identify the effects of the acute process on the functional, physical, cognitive and socioenvironmental dimensions, as well as the medications that may have triggered the patient's reason for visit. Finally, assess the usefulness of 3D/3D+ together with the clinical diagnosis to adequate care resource at discharge from the emergency department (ED). METHOD: Retrospective observational cohort study. Patients ≥75 years old, with clinical complexity visited at the ED were included. Basal frailty status was assessed using 3D (basal component), and the multidimensional impact of the acute process using 3D+ (current component). The main dependent variable was adequacy of the care resource at ED discharge. RESULTS: 278 patients were included, mean age 86 years (interquartile range: 83-90), 59.7% were women. According to the basal component (3D), 83.1% (95%CI: 78.2-87.3) presented some degree of frailty. The current component (3D+) was altered in 60.1% (95%CI: 54.1-65.9). The adequacy of ED discharge was correct in 96.4% (95%CI: 93.0-98.0). One out of 4patients was admitted to a medicine ward. CONCLUSIONS: 3D/3D+ facilitates an optimal model of emergency care adapted to patients ≥ 75 years old treated in EDs. It stratifies the level of frailty (3D), detects the severity of patients' acute problems (3D+) and contributes to decision-making regarding the most appropriate care resource at ED discharge.

Assessment of frailty in elderly patients attending a multidisciplinary wound care centre: a cohort study.

BACKGROUND: The incidence of frailty and non-healing wounds increases with patients' age. Knowledge of the relationship between frailty and wound healing progress is greatly lacking. METHODS: The aim of this study is to characterize the degree of frailty in elderly patients attending a multidisciplinary wound care centres (MWCC). Additionally, we seek to assess the impact of frailty on the wound healing rate and wound healing time. An open cohort study was conducted on 51 consecutive patients aged > 70 years treated for wounds at an MWCC of an intermediate care hospital. The frailty score was determined according to the Frail-VIG index. Data were collected through patient questionnaires at the beginning of the study, and at 6 months or upon wound healing. Wounds were followed up every 2 weeks. To analyse the relationship between two variables was used the Chi-square test and Student's or the ANOVA model. The t-test for paired data was used to analyse the evolution of the frailty index during follow-up. RESULTS: A total of 51 consecutive patients were included (aged 81.1 ± 6.1 years). Frailty prevalence was 74.5% according to the Frail-VIG index (47.1% mildly frail, 19.6% moderately frail, and 7.8% severely frail). Wounds healed in 69.6% of cases at 6 months. The frailty index (FI) was higher in patients with non-healing wounds in comparison with patients with healing wounds (IF 0.31 ± 0.15 vs IF 0.24 ± 0.11, p = 0.043). A strong correlation between FI and wound healing results was observed in patients with non-venous ulcers (FI 0.37 ± 0.13 vs FI 0.27 ± 0.10, p = 0.015). However, no correlation was observed in patients with venous ulcers (FI 0.17 ± 0.09 vs FI 0.19 ± 0.09, p = 0.637). Wound healing rate is statically significantly higher in non-frail patients (8.9% wound reduction/day, P25-P75 3.34-18.3%/day;AQ6 p = 0.044) in comparison with frail patients (3.26% wound reduction/day, P25-P75 0.8-8.8%/day). CONCLUSION: Frailty is prevalent in elderly patients treated at an MWCC. Frailty degree is correlated with wound healing results and wound healing time.

Potentially inappropriate medication at hospital admission in patients with palliative care needs.

Background Potentially inappropriate medications (PIMs) are common in older patients with polypharmacy, and are related to negative clinical results. Little information is available on the characteristics and consequences of PIMs in patients with advanced chronic conditions and palliative care needs. Objective To evaluate, for this population: (i) the prevalence of PIMs; (ii) the possible risk factors associated with its onset; and (iii) the related clinical consequences. Setting Acute-hospital care Geriatric Unit (AGU) in County of Osona, Spain. Method Ten-month prospective cross-sectional study. Patients with palliative care needs were identified according to the NECPAL CCOMS-ICO® test. Upon hospital admission, a multidisciplinary team consisting of a pharmacist and two AGU physicians determined the PIMs of the routine chronic medication of the patients. Sociodemographic and pharmacological data were collected with the objective of determining possible risk factors related to the existence of PIMs. Main outcome measure Prevalence and type of PIMs according to STOPP version 2 and MAI criteria at the time of hospital admission. Furthermore, days of hospital admission, destination at hospital discharge and survival analysis at 12 months related to PIMs were evaluated. Results Two hundred thirty-five patients (mean age 86.80, SD 5.37; 65.50% women) were recruited. According to the STOPP criteria, 88.50% of patients had ≥1 criterion (mainly 'indication of medication', followed by those that affect the nervous system and psychotropic drugs and risk drugs in people suffering from falls), and according to the MAI tool, 97.40% of the patients had some criterion related to inappropriate medication (mainly, duration of therapy). The following conditions were identified as risk factors for the existence of PIMs: insomnia, anxiety-depressive disorder, falls, pain, excessive polypharmacy and therapeutic complexity. There were no differences among patients in days of hospital stay, discharge's destination or survival at 12 months, regardless of the tool used. Conclusion The presence of PIMs is high in patients requiring palliative care. Some potentially modifiable risk factors such as the pharmacological ones are associated with a greater presence of inappropriate medication. The presence of PIMs does not affect this population in terms of mortality.

[Frail-VIG index: Design and evaluation of a new frailty index based on the Comprehensive Geriatric Assessment]. / Índice frágil-VIG: diseño y evaluación de un índice de fragilidad basado en la Valoración Integral Geriátrica.

INTRODUCTION: Frailty is closely linked to health results. Frailty indexes (FI) and the Comprehensive Geriatric Assessment (CGA) are multidimensional tools. FI serve to quantitatively measure frailty levels. They have shown to have an excellent correlation with mortality. However, they are infrequently used in clinical practice. Given the need for new, more concise, and pragmatic FI, a new FI is proposed based on a CGA (Frail-VIG Index). MATERIAL AND METHODS: A prospective, observational, longitudinal study was conducted, with cohort follow up at 12 months or death. Participants were patients admitted in the Geriatric Unit of the University Hospital of Vic (Barcelona, Spain) during 2014. Contrast of hypothesis log-rank for survival curves according to Frail-VIG index, and analysis of ROC curves were performed to assess prognostic capacity. RESULTS: A total of 590 patients were included (mean age=86.39). Mortality rate at 12 months was 46.4%. The comparative analysis showed statistically significant differences (P<.05) for almost all variables included in the Frail-VIG index. Survival curves also show significant differences (X2=445, P<.001) for the different Frail-VIG index scores. The area under the ROC curve at 12 months was 0.9 (0.88-0.92). An administration time of the Index is estimated at less than 10minutes. CONCLUSIONS: Results endorse the Frail-VIG index as a simple (as for contents), rapid (for administration time) tool, with discriminative (for situational diagnosis) and predictive capacity (high correlation with mortality).

[Care assessment parameters in an intermediate care unit for patients with dementia]. / Resultados de los parámetros de evaluación asistenciales de una unidad de atención intermedia para pacientes con demencia.

OBJECTIVE: To evaluate the care outcomes of a psychogeriatric unit. MATERIAL AND METHODS: A prospective study of 46 patients with dementia consecutively admitted to Psychogeriatric Unit between May and August 2008. The parameters analysed were: a) median Neuropsychiatric Inventory (NPI) on admission, after one week and at discharge, b) percentage of patients coming from home or discharged from the acute hospital, c) percentage of patients coming from the acute hospital with an average stay equal or less than 7 days, d) percentages of falls and physical restraints, and e) destination at discharge. Comparisons between variables were performed using t-test and chi-squared. RESULTS: There were a statistically significant difference between the median NPI on admittance (37.7) and after a week (13.7) (p<0.001). Half of the patients came from home and the other half from acute hospital, 73.9% of whom had had an average hospital stay equal or less than 7 days. Falls were reported in 19.6% of patients. Physical restraints were used in 43.5% of patients. On admission there was a low level of prescription of long half-life benzodiazepines (6.5%) and typical neuroleptics (2.2%), and 6.7% of patients had no prescription of psychotropic drugs. At discharge psychotropic drugs were not prescribed in 33% of patients. The institutionalisation rate was 43.5%. CONCLUSIONS: Intermediate Psychogeriatric wards enable behavioural symptoms to be controlled (BPSD) and they probably optimize the use of acute hospitals.