Usability, User Experience, and Acceptance Evaluation of CAPACITY: A Technological Ecosystem for Remote Follow-Up of Frailty.

Frailty predisposes older persons to adverse events, and information and communication technologies can play a crucial role to prevent them. CAPACITY provides a means to remotely monitor variables with high predictive power for adverse events, enabling preventative personalized early interventions. This study aims at evaluating the usability, user experience, and acceptance of a novel mobile system to prevent disability. Usability was assessed using the system usability scale (SUS); user experience using the user experience questionnaire (UEQ); and acceptance with the technology acceptance model (TAM) and a customized quantitative questionnaire. Data were collected at baseline (recruitment), and after three and six months of use. Forty-six participants used CAPACITY for six months; nine dropped out, leaving a final sample of 37 subjects. SUS reached a maximum averaged value of 83.68 after six months of use; no statistically significant values have been found to demonstrate that usability improves with use, probably because of a ceiling effect. UEQ, obtained averages scores higher or very close to 2 in all categories. TAM reached a maximum of 51.54 points, showing an improvement trend. Results indicate the success of the participatory methodology, and support user centered design as a key methodology to design technologies for frail older persons. Involving potential end users and giving them voice during the design stage maximizes usability and acceptance.

Development of Continuous Assessment of Muscle Quality and Frailty in Older Patients Using Multiparametric Combinations of Ultrasound and Blood Biomarkers: Protocol for the ECOFRAIL Study.

BACKGROUND: Frailty resulting from the loss of muscle quality can potentially be delayed through early detection and physical exercise interventions. There is a demand for cost-effective tools for the objective evaluation of muscle quality, in both cross-sectional and longitudinal assessments. Literature suggests that quantitative analysis of ultrasound data captures morphometric, compositional, and microstructural muscle properties, while biological assays derived from blood samples are associated with functional information. OBJECTIVE: This study aims to assess multiparametric combinations of ultrasound and blood-based biomarkers to offer a cross-sectional evaluation of the patient frailty phenotype and to track changes in muscle quality associated with supervised exercise programs. METHODS: This prospective observational multicenter study will include patients aged 70 years and older who are capable of providing informed consent. We aim to recruit 100 patients from hospital environments and 100 from primary care facilities. Each patient will undergo at least two examinations (baseline and follow-up), totaling a minimum of 400 examinations. In hospital environments, 50 patients will be measured before/after a 16-week individualized and supervised exercise program, while another 50 patients will be followed up after the same period without intervention. Primary care patients will undergo a 1-year follow-up evaluation. The primary objective is to compare cross-sectional evaluations of physical performance, functional capacity, body composition, and derived scales of sarcopenia and frailty with biomarker combinations obtained from muscle ultrasound and blood-based assays. We will analyze ultrasound raw data obtained with a point-of-care device, along with a set of biomarkers previously associated with frailty, using quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Additionally, we will examine the sensitivity of these biomarkers to detect short-term muscle quality changes and functional improvement after a supervised exercise intervention compared with usual care. RESULTS: At the time of manuscript submission, the enrollment of volunteers is ongoing. Recruitment started on March 1, 2022, and ends on June 30, 2024. CONCLUSIONS: The outlined study protocol will integrate portable technologies, using quantitative muscle ultrasound and blood biomarkers, to facilitate an objective cross-sectional assessment of muscle quality in both hospital and primary care settings. The primary objective is to generate data that can be used to explore associations between biomarker combinations and the cross-sectional clinical assessment of frailty and sarcopenia. Additionally, the study aims to investigate musculoskeletal changes following multicomponent physical exercise programs. TRIAL REGISTRATION: ClinicalTrials.gov NCT05294757; https://clinicaltrials.gov/ct2/show/NCT05294757. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/50325.

Medical help-seeking intentions among patients with early Alzheimer's disease.

Background: Limited information is available on the active process of seeking medical help in patients with Alzheimer's disease (AD) at early stages. The aim of this study was to assess the phenomenon of medical help-seeking in early AD and to identify associated factors. Methods: A multicenter, non-interventional study was conducted including patients of 50-90 years of age with prodromal or mild AD (National Institute on Aging/Alzheimer's Association criteria), a Mini-Mental State Examination (MMSE) score ≥ 22, and a Clinical Dementia Rating-Global score (CDR-GS) of 0.5-1.0. A multivariate logistic regression analysis was conducted. Results: A total of 149 patients were included. Mean age (SD) was 72.3 (7.0) years, 50.3% were female, and 87.2% had a CDR-GS score of 0.5. Mean disease duration was 1.4 (1.8) years. Ninety-four (63.1%) patients sought medical help, mostly from neurologists. Patients with help-seeking intentions were mostly female (60.6%) with a CDR-GS score of 0.5 (91.5%) and had a greater awareness of diagnosis, poorer quality of life, more depressive symptoms, and a more severe perception of their condition than their counterparts. Lack of help-seeking intentions was associated with male sex (p = 0.003), fewer years of education (p = 0.005), a low awareness of diagnosis (p = 0.005), and a low emotional consequence of the condition (p = 0.016). Conclusion: Understanding the phenomenon of active medical help-seeking may facilitate the design of specific strategies to improve the detection of cognitive impairment, especially in patients with a lower level of educational attainment and poor awareness of their condition.

[Normal data of functional assessment tools of the elderly in Spain: the FRADEA study]. / Valores normativos de instrumentos de valoración funcional en ancianos españoles: estudio FRADEA.

OBJECTIVE: To determine the normal values of some of the functional assessment tools most used in Spain. DESIGN: Cross-sectional study of the first cut of a concurrent population based cohort. SETTING: Albacete city Health Area. PARTICIPANTS: A total of 993 subjects aged 70 years or over and participants in the FRADEA (Frailty and dependence in Albacete, Spain) cohort. MAIN MEASUREMENTS: An analysis was made of disability and function questionnaires, which included, Barthel, Lawton and Short Form of the Late-Life Function and Disability Instrument (SF-LLFDI), Holden's Functional Ambulation Category (FAC), and functional tests: walking speed (m/s), Timed Up and Go (TUG) (sec), one-leg balance time (sec), timed 5 Times Sit to Stand Test (5STS) (seg), Short Physical Performance Battery (SPPB), grip strength (kg), and elbow flexion strength (kg). The means, quartiles and percentiles are described, in the global cohort and in the male and female sub-groups aged between 70 and 79 years or aged 80 years or over. RESULTS: The quartiles of the different instruments were as follow: Barthel (80, 95, 100), Lawton (3, 6,8), SF-LLFDI (70, 111, 131), FAC (4, 5, 5), walking speed (0.51, 0.79, 1.00), TUG (13.8, 11.4, 9.8), one-leg balance time (3, 7, 15), 5STS (16.3, 13.0, 10.7), SPPB (7, 9, 11), grip strength (15, 20, 29), and elbow flexion strength (11, 20, 32). The younger ones, males and those living within the community showed a better performance in all the instruments. CONCLUSIONS: The normal values of a cohort of the elderly population based in Albacete using different functional assessment instruments are presented. These could be useful in clinical practice or research.

Awareness of Diagnosis in Persons with Early-Stage Alzheimer's Disease: An Observational Study in Spain.

INTRODUCTION: Limited information is available on people's experiences of living with Alzheimer's disease (AD) at earlier stages. This study assessed awareness of diagnosis among people with early-stage AD and its impact on different person-centered outcome measures. METHODS: We conducted an observational, cross-sectional study in 21 memory clinics in Spain. Persons aged 50-90 years, diagnosed with prodromal or mild AD (NIA/AA criteria), a Mini Mental State Examination (MMSE) score ≥ 22, and a Clinical Dementia Rating-Global score (CDR-GS) of 0.5 or 1.0 were recruited. The Representations and Adjustment to Dementia Index (RADIX) was used to assess participants' beliefs about their condition and its consequences. RESULTS: A total of 149 persons with early-stage AD were studied. Mean (SD) age was 72.3 (7.0) years and 50.3% were female. Mean duration of AD was 1.4 (1.8) years. Mean MMSE score was 24.6 (2.1) and 87.2% had a CDR-GS score of 0.5. Most participants (n = 84, 57.5%) used a descriptive term related to specific AD symptoms (e.g., memory difficulties) when asked what they called their condition. Participants aware of their diagnosis using the term AD (n = 66, 45.2%) were younger, had more depressive symptoms, and poorer life satisfaction and quality of life compared to those without awareness of their specific diagnosis. Practical and emotional consequences RADIX scores showed a significant negative correlation with Quality of Life in Alzheimer's Disease score (rho = - 0.389 and - 0.413, respectively; p < 0.0001). Years of education was the only predictor of awareness of AD diagnosis [OR = 1.04 (95% CI 1.00-1.08); p = 0.029]. CONCLUSIONS: Awareness of diagnosis was a common phenomenon in persons with early-stage AD negatively impacting their quality of life. Understanding illness representations in earlier stages may facilitate implementing optimized care that supports improved quality of life and well-being.

Quality of Life and the Experience of Living with Early-Stage Alzheimer's Disease.

BACKGROUND: There is a need to better understand the experience of patients living with Alzheimer's disease (AD) in the early stages. OBJECTIVE: The aim of the study was to evaluate the perception of quality of life in patients with early-stage AD. METHODS: A multicenter, non-interventional study was conducted including patients of 50-90 years of age with prodromal or mild AD, a Mini-Mental State Examination (MMSE) score ≥22, and a Clinical Dementia Rating-Global score (CDR-GS) of 0.5.-1.0. The Quality of Life in Alzheimer 's Disease (QoL-AD) questionnaire was used to assess health-related quality of life. A battery of self-report instruments was used to evaluate different psychological and behavioral domains. Associations between the QoL-AD and other outcome measures were analyzed using Spearman's rank correlations. RESULTS: A total of 149 patients were included. Mean age (SD) was 72.3 (7.0) years and mean disease duration was 1.4 (1.8) years. Mean MMSE score was 24.6 (2.1). The mean QoL-AD score was 37.9 (4.5). Eighty-three percent (n = 124) of patients had moderate-to-severe hopelessness, 22.1% (n = 33) had depressive symptoms, and 36.9% (n = 55) felt stigmatized. The quality of life showed a significant positive correlation with self-efficacy and negative correlations with depression, emotional and practical consequences, stigma, and hopelessness. CONCLUSION: Stigma, depressive symptoms, and hopelessness are frequent scenarios in AD negatively impacting quality of life, even in a population with short disease duration and minimal cognitive impairment.

Generation and validation of in-hospital mortality prediction score in COVID-19 patients: Alba-score.

BACKGROUND: COVID-19 has a wide range of symptoms reported, which may vary from very mild cases (even asymptomatic) to deadly infections. Identifying high mortality risk individuals infected with the SARS-CoV-2 virus through a prediction instrument that uses simple clinical and analytical parameters at admission can help clinicians to focus on treatment efforts in this group of patients. METHODS: Data was obtained retrospectively from the electronic medical record of all COVID-19 patients hospitalized in the Albacete University Hospital Complex until July 2020. Patients were split into two: a generating and a validating cohort. Clinical, demographical and laboratory variables were included. A multivariate logistic regression model was used to select variables associated with in-hospital mortality in the generating cohort. A numerical and subsequently a categorical score according to mortality were constructed (A: mortality from 0% to 5%; B: from 5% to 15%; C: from 15% to 30%; D: from 30% to 50%; E: greater than 50%). These scores were validated with the validation cohort. RESULTS: Variables independently related to mortality during hospitalization were age, diabetes mellitus, confusion, SaFiO2, heart rate and lactate dehydrogenase (LDH) at admission. The numerical score defined ranges from 0 to 13 points. Scores included are: age ≥71 years (3 points), diabetes mellitus (1 point), confusion (2 points), onco-hematologic disease (1 point), SaFiO2 ≤ 419 (3 points), heart rate ≥ 100 bpm (1 point) and LDH ≥ 390 IU/L (2 points). The area under the curve (AUC) for the numerical and categorical scores from the generating cohort were 0.8625 and 0.848, respectively. In the validating cohort, AUCs were 0.8505 for the numerical score and 0.8313 for the categorical score. CONCLUSIONS: Data analysis found a correlation between clinical admission parameters and in-hospital mortality for COVID-19 patients. This correlation is used to develop a model to assist physicians in the emergency department in the COVID-19 treatment decision-making process.

[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).

[Comorbidity in the elderly: utility and validity of assessment tools]. / Evaluación de la comorbilidad en la población anciana: utilidad y validez de los instrumentos de medida.

Comorbidity is common in the elderly and contributes to the complexity of this population subgroup. This problem is a risk factor for major adverse events such as functional decline, disability, dependency, poor quality-of-life, institutionalization, hospitalization and death, but is not the most important factor. Age and risk of functional decline rather than comorbidity (understood as a compilation of diseases) are the main characteristics defining the target population attended by geriatricians. Comorbidity indexes should not be interpreted independently in the elderly, but within a context of comprehensive geriatric assessment that includes age-related preclinical dysfunctions, frailty measures, and functional, mental and psychosocial issues. The clinical management of comorbidity in the elderly requires advanced knowledge of geriatrics because the treatment of one condition may worsen or lead to the development of others and because preclinical physiological dysfunctions modulate drug response. Recommending a specific comorbidity index is difficult and depends on multiple factors, due to their psychometric characteristics, applicability in the elderly and their construct. However, the Cumulative Illness Rating Scale, in the version adapted to the elderly, could be highly suitable. Other instruments, such as the Charlson index, the Index of CoExistent Disease and the Kaplan index are also valid and reproducible.

[Subclinial atherosclerosis as a predictor of functional limitation at one year in high-functioning older adults: the Albacete study]. / Aterosclerosis subclínica, un predictor de limitación funcional al año en ancianos con alto nivel funcional: estudio Albacete.

INTRODUCTION: Subclinical atherosclerosis is associated with cardiovascular morbidity and mortality, but its relationship with functional limitation as a precursor of disability has not been determined. MATERIAL AND METHODS: A longitudinal cohort study was performed in 171 high-functioning community-dwelling adults aged more than 64 years old (mean age 73.7 years, 110 women). All received a carotid ultrasound examination at the beginning of the study. Subclinical atherosclerosis was determined by the presence or absence of atherosclerotic plaques and the sum of the diameters of all the plaques (SDP) in the carotid bilateral tree. Subjects were followed-up at 12 months. The association between subclinical atherosclerosis and functional limitation was assessed with the Timed Up and Go test (TUG) at entry and at 1 year, adjusted by demographic, functional, affective, cognitive and cardiovascular risk factors as covariables. RESULTS: At 1 year after baseline, 37 subjects (21.6%) performed the TUG 20% more slowly: 30 with plaque (30.7%) and seven without plaque (9.5%) (p=0.001). Those with plaque had an adjusted increased risk of performing the TUG 20% more slowly than those without plaque [OR 5.5, 95% CI 2.2-15.8]. SDP was 1.48 mm greater in subjects with more than 20% slowing on the TUG [3.34 vs 1.85; 95% CI 0.52-2.44]. For each 2-mm increment in the SDP, subjects had a 1.9-fold greater adjusted risk of performing the TUG 20% more slowly at 1 year [95% CI 1.4-2.5]. CONCLUSION: Subclinical atherosclerosis is an independent predictor of functional limitation at 1 year in high-functioning older adults.

[Spanish tools of cognitive and behavior assessment of alzheimer´s disease in severe state.] / Escalas de valoración cognitiva y conductual en español para la demencia severa.

BACKGROUND: There are different scales in Spanish for cognitive and behavioral assessment of patients with severe dementia. The objective of this study was to select those scales that are more accessible, useful and with better psychometric properties, both for clinical practice and for research. METHODS: Literature review, by experts in the field, of scales of cognitive and behavioral assessment in dementia in the main scientific databases. Published in Spanish or English, excluding those not validated in Spanish. RESULTS: 11 bibliographical references were selected. Cognitive scales: Severe Impairment Battery was the one with the most cognitive areas, its abbreviated version (SIB-s) had the best internal consistency (α=0.96), Baylor Profound Mental Status Examination had very good psychometric properties with 0.99 reliability and excellent concurrent validity with Mini-Mental State Examination (r=-0.91). Severe Cognitive Impairment Profile was the only one that allowed establishing subgroups of cognitive impairment. Behavioral scales: Neuropsychiatric Inventory was the gold standard in dementias, but there was only one specific scale for severe Alzheimer's disease, the Baylor Profound Mental Status Examination behavioral subscale. CONCLUSIONS: In Spanish severe dementia, Severe Cognitive Impairment Profile and the Neuropsychiatric Inventory are the gold standard tool for cognitive assessment for research studies, and the Baylor Profound Mental Status Examination is the most useful for daily clinical practice.

OBJETIVO: Existen diferentes escalas en español para la valoración cognitiva y conductual de los pacientes con demencia severa. El objetivo de este estudio fue seleccionar aquellas escalas más accesibles, útiles y con mejores propiedades psicométricas, tanto para la práctica clínica como para fines investigadores. METODOS: Se realizó una revisión bibliográfica, por expertos en la materia, de escalas de valoración cognitiva y conductual sobre demencia en las principales bases de datos científicas. Debían estar publicadas en español o inglés, excluyendo aquellas no validadas al español. RESULTADOS: Se seleccionaron 11 referencias bibliográficas. En cuanto a escalas cognitivas: la Severe Impairment Battery era la que más áreas cognitivas en-globaba; su versión abreviada (SIB-s) presentaba la mejor consistencia interna (α=0,96); el Baylor Profound Mental Status Examination presentaba muy buenas propiedades psicométricas, con fiabilidad 0,99 y excelente validez concurrente con el Mini-Mental State Examination (r=-0,91); el Severe Cognitive Impairment Profile era la única que permitía establecer subgrupos de deterioro cognitivo. En cuanto a escalas conductuales: el Neuropsychiatric Inventory era el gold standard en demencias. Solo había una escala específica para la enfermedad de Alzheimer, el Baylor Profound Mental Status Examination subescala conductual. CONCLUSIONES: En demencias severas, el Severe Cognitive Impairment Profile y el Neuropsychiatric Inventory son las herramientas más completas para estudios de investigación, y el Baylor Profound Mental Status Examination la más útil para la práctica clínica.

[Nutritional status in older adults admitted to an acute geriatric unit]. / Estado nutricional de ancianos hospitalizados en una unidad geriátrica de agudos.

INTRODUCTION: Objective: to describe the nutritional status of older adults hospitalized in an acute geriatric unit (AGU) and its association with mortality and days of hospitalization. Material and methods: a retrospective study in 1,084 adults older than 65 years, hospitalized in an AGU. The Mini Nutritional Assessment®-Short Form (MNA®-SF) and subjective global assessment (SGA) were used. The association between nutritional status, mortality, and long hospital stay (> 7 days) was analyzed using regression models and Cox hazard models. Results: mean age was 86.5 years: 58.7% were women. Mean MNA®-SF score was 8.9 (20.0%, well nourished; 48.2%, at nutritional risk, and 31.7% with malnutrition). Using the SGA, 22.1% were well nourished, 54.7% had moderate malnutrition, and 23.2% had severe malnutrition. Agreement between SGA and MNA®-SF was good (kappa, 0.654; p < 0.001), and correctly classified 78.5% of participants. Malnutrition was associated with poorer cognitive status, greater disability, worse ambulation, and lower levels of total protein, albumin, cholesterol, and transferrin. Patients with malnutrition in the MNA®-SF assessment had a higher adjusted mortality risk than those who were well nourished (HR, 1.80; 95% CI, 1.01-3.20), same as those with SGA C versus A (HR, 1.66; 95% CI, 0.96-2.86). Patients with SGA B and C presented a higher adjusted risk of long hospitalization as compared to well nourished subjects (OR, 1.42; 95% CI, 1.04-1.96 and OR, 1.73; 95% CI, 1.18-2.54, respectively. Patients with malnutrition per the MNA-SF® presented a higher adjusted risk of long hospitalization as compared to well nourished subjects (OR, 1.59; 95% CI, 1.09-2.33). Conclusions: nutritional risk and malnutrition are very common in older adults in AGUs, and are associated with higher mortality and longer hospital stay.

INTRODUCCIÓN: Objetivo: describir el estado nutricional de los mayores hospitalizados en una unidad geriátrica de agudos (UGA) y su asociación con la mortalidad y la estancia hospitalaria. Material y métodos: estudio retrospectivo de 1084 personas mayores de 65 años en una UGA. Se emplearon el Mini Nutritional Assessment®-Short Form (MNA®-SF) y la valoración global subjetiva (VGS). La asociación entre estado nutricional, mortalidad y estancia hospitalaria prolongada (> 7 días) se analizó mediante un modelo de regresión y el análisis de riesgos de Cox. Resultados: edad media de 86,5 años: 58,7% de mujeres. La puntuación media del MNA®-SF fue de 8,9, estando el 20,0% sin riesgo nutricional, el 48,2% en riesgo nutricional y el 31,7% con malnutrición. Mediante la VGS, el 22,1% estaban bien nutridos, el 54,7% moderadamente desnutridos y el 23,2% gravemente desnutridos. El acuerdo entre VGS y MNA®-SF fue bueno (kappa = 0,654; p < 0,001), clasificando correctamente al 78,5% de los participantes. La malnutrición se asoció a peor estado cognitivo, mayor discapacidad, peor deambulación y niveles menores de proteínas totales, albúmina, colesterol y transferrina. Los pacientes con malnutrición según el MNA®-SF presentaron una mortalidad ajustada mayor que la de los bien nutridos (HR: 1,80; IC 95%: 1,01-3,20), igual que aquellos con VGS de C frente a los de A (HR: 1,66; IC 95%: 0,96-2,86). Los pacientes con VGS de B (OR: 1,42; IC 95%: 1,04-1,96) y C (OR: 1,73; IC 95%: 1,18-2,54) presentaron mayor riesgo ajustado de estancia hospitalaria prolongada frente a los bien nutridos. Los pacientes con malnutrición según el MNA®-SF presentaron mayor riesgo ajustado de estancia hospitalaria prolongada (OR: 1,59; IC 95%: 1,09-2,33) frente a los bien nutridos. Conclusiones: el riesgo nutricional y la malnutrición son muy frecuentes en los mayores hospitalizados en una UGA y se asocian con mayor mortalidad y estancias más prolongadas.

[Polyneuropathies in the elderly. Classification and thematic review]. / Polineuropatías en la población anciana. Clasificación y revisión temática.

The term polyneuropathy (PNP) is used to describe a group of entities affecting the peripheral nerves, due to external trauma or internal pathology. The prevalence of PNP in the elderly is between 5 and 10%. Despite the multiplicity of causes, the most common etiological factor is diabetes. PNP is characterized by a wide variety of symptoms, due to the multiple functions of nerves. Clinical manifestations range from sensory or motor deficit to inability to maintain gait and stability. Diagnosis is difficult in the elderly, and can be a challenge to the geriatrician in patients with functional impairment. The gold standard for diagnosis is electrophysiology testing. The present article describes the main PNP in the elderly based on the physiopathology of these diseases and provides a practical proposal for clinical classification.

[Comprehensive Care Home Unit: reduction of hospital resources during influenza outbreaks]. / Unidad domiciliaria de atención integral: Reducción de recursos hospitalarios durante brotes de gripe.

OBJECTIVE: The Comprehensive Care Home Unit of the General Hospital of Villarrobledo is a unit formed by a geriatrician who sees people in nursing homes to improve their quality of care. The activity of the Unit has been analyzed, mainly with the objective of avoiding referral to the emergency room, avoiding hospital admissions, avoiding hospital readmissions and reducing the number of hospital admission days. METHODS: We retrospectively described the clinical activity of the Unit during the influenza outbreak of 2017 and 2018. We selected sociodemographical variables, functional assessment scales (Katz index, Barthel index and the Functional Ambulation Classification), and the Global Deterioration Scale. We registered mortality, type of treatment, oncological patients and patients with supplementary tests. The population was divided into four subgroups: hospital admission avoided, hospital re-admission avoided, referral to the emergency department avoided and reduction of admission days. The demographic characteristics were described, including the mode or mean of the variables. An economic report was made, and an analysis of cost per process according to the subgroups, means of Related Groups for the Diagnosis and degree of dependency measured by the Barthel index. RESULTS: We selected 112 patients, they had a mean age of 82.2 years, Katz G (34.8%), IB 28.8 (DE 34.9), FAC 0 (63.4%) and GDS 7 (22.3%). The most frequent disease seen was respiratory infection (63.2%), 71.4% received active treatment, 10.7% complementary tests were performed, 17.9% oncological and 17% mortality. Cost analysis: hospital readmission avoided (€ 4,128 per patient) and patients with total disability (BI 0-20, € 3,623 per patient) presented more economic saving. The economic savings were more than € 230,000. CONCLUSIONS: The contribution of the Unit during periods of influenza outbreak is cost saving because of reduced numbers of admissions, numbers of readmissions, days of admission and emergency room visits.

OBJETIVO: La Unidad Domiciliaria de Atención Integral (UDAI) del Hospital General de Villarrobledo está formada por un geriatra que atiende a las personas institucionalizadas para mejorar su calidad asistencial. Se analizó la actividad de la UDAI, principalmente en el objetivo de evitar ingresos y reingresos hospitalarios, evitar visitas a urgencias y facilitar el alta hospitalaria prematura. METODOS: Describimos de forma retrospectiva la actividad de la UDAI durante los brotes de gripe del 2017 y 2018. Aportamos variables sociodemográficas, escalas de valoración funcional (índice de Katz, índice de Barthel y la Escala de Valoración Funcional de la Marcha), y la Escala de Deterioro Global. Registramos mortalidad, tipo de tratamiento, pacientes oncológicos y pruebas complementarias. Se dividió la población en cuatro subgrupos: ingreso hospitalario evitado, reingreso hospitalario evitado, derivación a urgencias evitada y reducción días de ingreso. Se describieron las características demográficas, incluido la moda o media de las variables. Se realizó una memoria económica, y un análisis de coste por proceso según los subgrupos, medias de Grupos Relacionados por el Diagnóstico y grado de dependencia medido por el Índice de Barthel. RESULTADOS: Se seleccionaron 112 pacientes, presentaban una edad media de 82,2 años, Katz G (34,8%), IB 28,8 (DE 34,9), FAC 0 (63,4%) y GDS 7 (22,3%). La enfermedad más frecuente fue la infección respiratoria (63,4%), recibieron tratamiento activo un 71,4%, se realizaron pruebas complementarias en un 10,7%, oncológico 17,9% y exitus 17%. Análisis de costes: el reingreso hospitalario evitado (4.128 € por paciente) y los pacientes con discapacidad total (IB 0 ­ 20, 3.623 € por paciente) presentaron un mayor ahorro de costes. El ahorro económico fue de más de 230.000€. CONCLUSIONES: La contribución de la UDAI durante los periodos de brote de gripe supone un ahorro de costes basado en disminuciones de hospitalizaciones, disminución de reingresos, acortamiento de estancias hospitalarias y reducción de derivaciones a urgencias.

[Oral anticoagulation therapy in the elderly population with atrial fibrillation. A review article]. / Anticoagulación en población anciana con fibrilación auricular no valvular. Artículo de revisión.

Aging is an important risk factor for patients with atrial fibrillation. The estimated prevalence of atrial fibrillation in patients aged ≥80 years is 9-10%, and is associated with a four to five fold increased risk of embolic stroke, and with an estimated increased stroke risk of 1.45-fold per decade in aging. Older age is also associated with an increased risk of major bleeding with oral anticoagulant therapy. This review will focus on the role of oral anticoagulation with new oral anticoagulants, non-vitamin K antagonist in populations with common comorbid conditions, including age, chronic kidney disease, coronary artery disease, on multiple medication, and frailty. In patients 75 years and older, randomised trials have shown new oral anticoagulants to be as effective as warfarin, or in some cases superior, with an overall better safety profile, consistently reducing rates of intracranial haemorrhages. Prior to considering oral anticoagulant therapy in an elderly frail patient, a comprehensive assessment should be performed to include the risks and benefits, stroke risk, baseline kidney function, cognitive status, mobility and fall risk, multiple medication, nutritional status assessment, and life expectancy.

[Preventing dependency in the elderly.]. / Prevención de la dependencia en las personas mayores.

INTRODUCTION: dependency, i.e. the need to depend on another person to perform activities of daily living, is the main concern and cause of suffering and poor quality of life in the elderly. The prevalence of dependency increases with age and is related to the presence of prior disease and fragility. Dependency is associated with increased morbidity, mortality and institutionalization, as well as with greater health and social resource utilization, all of which increases health costs. OBJECTIVE: to create a consensus document on the main health recommendations for the prevention of dependency in the elderly, based on the scientific evidence available to date, with the collaboration of scientific societies and public health administrations (the Spanish Ministry of Health, Autonomous Communities and Cities). METHODS: a) a preliminary consensus document was drafted by an expert group composed of representatives of various scientific societies and health administrations. This document was based on a review of the recommendations and guidelines published by the main organizations involved in health promotion and the prevention of disease, functional deterioration and dependency in the elderly; b) the consensus document was reviewed by the remaining experts assigned by the scientific societies and central and autonomous administrations; c) the final document was approved after a session in which the text was discussed and reviewed by all the experts participating in the working group (including the academic committee); d) the document was presented and discussed in the First National Conference on Prevention and Health Promotion in Clinical Practice in Spain. All participating experts signed a conflicts of interest statement. RESULTS: the document provides recommendations, with their grades of evidence, grouped in the following three categories: a) health promotion and disease prevention, with specific preventive activities for the elderly, including prevention of geriatric syndromes; b) prevention of functional deterioration, with clinical recommendations that can be applied in primary and specialized care; c) prevention of iatrogeny (drug prescription, inappropriate use of diagnostic and therapeutic modalities and healthcare). These recommendations were tailored to the characteristics of the older person (OP), categorized in five groups: healthy OP, OP with chronic disease, fragile or at risk OP, dependent OP, and OP at the end of life. CONCLUSION: these recommendations should be implemented by public health administrations to improve strategies for the prevention of dependency in the elderly in the XXI century.

[Rationale, design and methodology of physical attributes identification of the fear of falling syndrome (FISTAC study)]. / Razonamiento, diseño y metodología del estudio de identificación de los atributos físicos del síndrome de temor a caerse en ancianos (FISTAC).

INTRODUCTION: The aim of this study was to identify the physical determining factors of the Fear of Falling Syndrome (FoF) in older adults with a history of falls. METHODS: An observational study was conducted on 183 subjects older than 64 years with a fall in the previous year, with data collected from the geriatrics outpatient clinic of the Complejo Hospitalario Universitario from Albacete, Spain. Sociodemographic and anthropometric data, as well as comorbidity, drugs usually taken, functional status, physical function, frailty, cognitive and affective status were collected. Muscle mass was measured using bioimpedancy meter (BIA), and densitometry (DXA), strength with digital hand-held JAMAR dynamometer and with a Leg-press machine, muscle potency with a T-Force instrument, gait variability with the Gait-Rite instrument, and postural stability with the Neurocom Balance Master posturograph were also determined. An analysis was performed to determine if the FoF is associated with physical impairments adjusted for the study covariates. RESULTS: The study included 140 subjects with FoF, and 43 without it. The mean age was 78.4 years, and 147 were women. Posturography could be measured in 182 participants, DXA in 117, BIA in 165, and muscle potency in 146. FoF was associated with female sex, frailty, depressed mood, social risk, muscle strength and power, physical function, number of drugs used, and orthostatic hypotension in the overall sample. After adjusting for sex, only frailty, depressed mood, and number of drugs remained associated. CONCLUSIONS: Rationale, design, and methods of the FISTAC study are presented.

[Frailty and long term mortality, disability and hospitalisation in Spanish older adults. The FRADEA Study]. / Fragilidad como predictor de mortalidad, discapacidad incidente y hospitalización a largo plazo en ancianos españoles. Estudio FRADEA.

INTRODUCTION: The objective of this study was to analyse whether frailty is related to long-term mortality, incident disability in basic activities of daily living (BADL), and hospitalisation. MATERIAL AND METHODS: A concurrent cohort study conducted on 993 participants over age 70 from the FRADEA Study. Frailty was determined with Fried frailty phenotype. Data was collected on mortality, hospitalisation and incident disability in BADL (bathing, grooming, dressing, toileting, eating or transferring) during the follow-up period. The risk of adverse events was determined by logistic regression, Kaplan-Meier analysis, and Cox proportional hazard analysis adjusted for age, sex, Barthel index, comorbidity and institutionalization. RESULTS: Mean follow-up was 952 days (SD 408), during which 182 participants (18.4%) died. Frail participants had an increased adjusted risk of death (HR 4.5, 95%CI: 1.8-11.1), incident disability in BADL (OR 2.7, 95%CI: 1.3-5.9) and the combined event mortality or incident disability (OR 3.0, 95%CI: 1.5-6.1). Pre-frail subjects had an increased adjusted risk of death (HR 2.9, 95%CI: 1.2-6.5), incident disability in BADL (OR 2.1, 95%CI: 1.2-3.6), and the combined event mortality or incident disability (OR 2.2, 95%CI: 1.3-3.6). There was a positive association between frailty and hospitalisation, which almost reached statistical significance (OR 1.7, 95%CI: 1.0-3.0). CONCLUSIONS: Frailty is long-term associated with mortality and incident disability in BADL in a Spanish cohort of older adults.