[Cross-speciality geriatrics: A health-care challenge for the 21st century]. / Geriatría transversal. Un reto asistencial para el siglo xxi.

Increasing numbers of older persons are being treated by specialties other than Geriatric Medicine. Specialists turn to Geriatric Teams when they need to accurately stratify their patients' risk and prognosis, predict the potential impact of their, often, invasive interventions, optimise their clinical status, and contribute to discharge planning. Oncology and Haematology, Cardiology, General Surgery, and other surgical departments are examples where such collaborative working is already established, to a varying extent. The use of the term "Cross-speciality Geriatrics" is suggested when geriatric care is provided in clinical areas traditionally outside the reach of Geriatric Teams. The core principles of Geriatric Medicine (comprehensive geriatric assessment, patient-centred multidisciplinary targeted interventions, and input at point-of-care) are adapted to the specifics of each specialty and applied to frail older patients in order to deliver a holistic assessment/treatment, better patient/carer experience, and improved clinical outcomes. Using Comprehensive Geriatric Assessment methodology and Frailty scoring in such patients provides invaluable prognostic information, helps in decision making, and enables personalised treatment strategies. There is evidence that such an approach improves the efficiency of health care systems and patient outcomes. This article includes a review of these concepts, describes existing models of care, presents the most commonly used clinical tools, and offers examples of excellence in this new era of geriatric care. In an ever ageing population it is likely that teams will be asked to provide Cross-specialty Geriatrics across different Health Care systems. The fundamentals for its implementation are in place, but further evidence is required to guide future development and consolidation, making it one of the most important challenges for Geriatrics in the coming years.

Fiabilidad interobservador de los 4 índices de comorbilidad más utilizados en pacientes ancianos / The interrater reliability of four common comorbidity indexes used in elderly patients

Objetivo. Conocer la fiabilidad interobservador de los 4 índices de comorbilidad más utilizados en ancianos: índice de Charlson (ICh), Cumulative Illness Rating Scale for Geriatrics (CIRS-G), índice de Kaplan-Feinstein (IKF), e índice de coexistencia de enfermedad (ICED). Material y métodos. Cuatro médicos, previamente entrenados, revisaron de forma independiente 40 historias clínicas de pacientes mayores de 75 años, ingresados por patología médica aguda, realizando los 4 índices y cronometrando el tiempo. Se analizó el coeficiente de correlación intraclase (CCI) para los índices cuantitativos (ICh y CIRS-G) y el coeficiente Kappa para índices cualitativos (IKF e ICED), las concordancias <0,4 se consideraron deficientes; 0,4-0,75 aceptable, y >0,75 excelente. Resultados. Los pacientes de las historias evaluadas tenían una edad media de 85,93 (±5,35) años, siendo el 72,5% mujeres. El CCI global de los 4 evaluadores para el ICh fue 0,78 (IC del 95%:0,67-0,86) y para el CIRS-G (score):0,66 (IC del 95%:0,53-0,78). Los valores del coeficiente Kappa para el IKF oscilaron entre 0,51-0,76 y para el ICED entre 0,44-0,66. El tiempo de aplicación fue menor para el ICh (mediana de 39 segundos [30-45]) e IKF (42 segundos [35-52]) y mayor para el CIRS-G (score) (128 segundos [110-160]) e ICED (102 segundos [80-124]). Conclusiones. De los 4 índices valorados, el ICh y el índice CIRS-G (score), son los que presentan una mejor fiabilidad interobservador. El ICh y el IKF, presentan menor tiempo de aplicación(AU)

Objective. To report on the interrater reliability of four common comorbidity indexes used in the hospitalised elderly: Charlson Index (CI), Geriatric Cumulative Illness Rating Scale (CIRS-G), Index of Co-existent Disease (CoD) and Kaplan-Feinstein Index (KFI). Method. Four trained observers, independently reviewed the same 40 medical charts of hospitalised geriatric patients. Scores for the four indexes were calculated, along with the intraclass correlations coefficient (ICC) (quantitative index: CI and CIRS-G) and Kappa coefficient (qualitative index: CoD and KFI). The agreement <0.4 was considered deficient, 0-4-0.75 acceptable and >0.75 excellent. Results. A total of 40 patients (29 women) of 85.93 (±5.35) years were analysed. Intraclass correlations coefficient: CI: 0.78 (95% CI: 0.67-0.86); CIRS-G (score): 0.66 (95% CI: 0.53-0.78). Kappa coefficient: KFI: 0.51 to 0.76; CoD: 0.44-0.66. The application time was lower for the Charlson index (median of 39seconds [30-45]) and the KFI (42seconds [35-52]) and higher for CIRS-G (score) (128seconds [110-160]) and CoD (102seconds [80-124]). Conclusions. Of the four comorbidity indexes used in a hospitalised elderly population, the CI, and CIRS-G (score), are those that have better interrater reliability. The Charlson index and KFI show a lower application time than the CIRS-G (score)(AU)