RESUMEN
Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed.
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Calidad de Vida , Vacunación , Anciano , Humanos , España/epidemiologíaRESUMEN
BACKGROUND: Studies validating indirect methods to identify nonadherence in chronic patients who visit pharmacies are lacking. The aim of this study was to validate self-reported adherence and assess the variables associated with both overestimation and underestimation of good adherence when using this method. MATERIALS AND METHODS: An observational, cross-sectional study was undertaken to validate self-reported adherence in 132 community pharmacies throughout Spain in 6237 chronic patients. The Morisky-Green test was used as the validation method and through a 2 × 2 table, the validity indicators, predictive values, and likelihood ratios were calculated. To assess the variables associated with both overestimation and underestimation of good adherence, multivariate logistic regression analysis and calculation of the area under the ROC curve were used to evaluate discriminatory capacity. RESULTS: Sensitivity was 27.8% (95% CI: 26.2-29.4) and specificity was 93.9% (95% CI: 93.1-94.7). Discrepancy analysis obtained a significant overestimation of good adherence (p < 0.001). The factors associated with overestimating good adherence were performing a mnemonic trick (p < 0.001), not self-medicating (p < 0.001), a high level of physical activity (p < 0.001), and an older age (p = 0.014). Factors associated with underestimation were self-medication (p < 0.001), desiring more information (p < 0.001), smoking (p = 0.014), not engaging in physical activity in the low (p = 0.006) or high (p < 0.001) categories, having a younger mean age (p = 0.007), and taking two to three (p = 0.029) or four or more (p < 0.001) chronic treatments. CONCLUSION: Self-reported adherence has good specificity but poor sensitivity. The associated profiles of the discrepancies were obtained to identify both good and poor adherence.
Asunto(s)
Cumplimiento de la Medicación , Autoinforme , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Estudios Transversales , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , FarmaciasRESUMEN
The clinical progression of Alzheimer disease (AD) was studied in European subjects under treatment with AChE inhibitors (AChE-I) in relation to geographical location over a 2-years period. One thousand three hundred and six subjects from 11 European countries were clustered into 3 regions (North, South, West) and investigated with biannual follow-up over 2 years. Primary outcomes were cognitive, functional and behavioral measures. Caregiver burden, hospital admission and admission to nursing home were also recorded. Participant cognitive function declined non-linearly over time (MMSE: -1.5 pts/first year, -2.5 pts/second year; ADAScog: + 3.5 pts/first year, + 4.8 pts/second year), while the progression of behavioral disturbances (NPI scale) was linear. Neither scale showed regional differences, and progression of the disease was similar across Europe despite different health care systems. Functional decline (ADL, IADL) tended to progress more rapidly in Southern Europe (p=0.09), while progression of caregiver burden (Zarit Burden Interview) was most rapid in Northern Europe (5.6 pts/y, p=0.04). Incidences of hospital admission (10.44, 95%CI: 8.13-12.75, p < 0.001) and admission to nursing home (2.97, 95%CI: 1.83-4.11, p < 0.001) were lowest in Southern Europe. In general cognitive and functional decline was slower than in former cohorts. European geographical location reflecting differences in culture and in health care system does not impact on the progression of AD but does influence the management of AD subjects and caregiver burden.
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Enfermedad de Alzheimer/epidemiología , Progresión de la Enfermedad , Anciano , Enfermedad de Alzheimer/diagnóstico , Europa (Continente) , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Factores SocioeconómicosRESUMEN
This paper aims to define the role of the primary care physician (PCP) in the management of Alzheimer's disease (AD) and to propose a model for a work plan. The proposals in this position paper stem from a collaborative work of experts involved in the care of AD patients. It combines evidence from a literature review and expert's opinions who met in Paris, France, on July 2009 during the International Association of Geriatrics and Gerontology (IAGG) World Congress. The PCP's intervention appears essential at many levels: detection of the onset of dementia, diagnostic management, treatment and follow-up. The key role of the PCP in the management of AD, as care providers and care planners, is consolidated by the family caregiver's confidence in their skills. In primary care practice the first step is to identify dementia. The group proposes a "case finding" strategy, in target situations in which dementia should be detected to allow, secondarily, a diagnosis of AD, in certain cases. We propose that the PCP identifies 'typical' cases. In typical cases, among older subjects, the diagnosis of "probable AD" can be done by the PCP and then confirm by the specialist. While under-diagnosis of AD exists, so does under-disclosure. Disclosure to patient and family should be done by both specialist and PCP. Then, the PCP has a central role in management of the disease with the general objectives to detect, prevent and treat, when possible, the complications of the disease (falls, malnutrition, behavioural and psychological symptoms of dementia). The PCP needs to give basic information to the caregiver on respite care and home support services in order to prevent crisis situations such as unplanned institutionalisation and "emergency" hospital admission. Finally, therapeutic research must be integrated in the daily practice of PCP. It is a matter of patients' right to benefit from access to innovation and clinical research whatever his age or diseases, while of course fully respecting the rules and protective measures that are in force.
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Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/terapia , Servicios de Salud para Ancianos/normas , Rol del Médico , Atención Primaria de Salud/normas , Competencia Clínica , Diagnóstico Precoz , Humanos , Comunicación Interdisciplinaria , Manejo de Atención al Paciente , Grupo de Atención al Paciente , Calidad de la Atención de Salud , SociedadesRESUMEN
No disponible
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Humanos , Masculino , Femenino , Anciano , Accidentes por Caídas/prevención & control , Prevención Primaria , Prevención de AccidentesRESUMEN
El agua contenida en los alimentos junto con la que bebemos y el resto de los líquidos que ingerimos, tienen que garantizar nuestra correcta hidratación en todas las edades y circunstancias vitales. En consecuencia, es muy importante que su consumo tenga asegurada la calidad y la cantidad. La ingestión adecuada de agua total se ha establecido para prevenir los efectos deletéreos de la deshidratación que incluyen trastornos funcionales y metabólicos. Es conocido como el grado de hidratación puede influir sobre la salud y el bienestar de las personas. En la mujer embarazada, una parte importante del aumento de su peso se produce a expensas del incremento del volumen plasmático. En el caso de la lactancia, resulta obvia la importancia de mantener una ingesta hídrica adecuada si queremos preservar localidad y cantidad de la leche y, por lo tanto, el estado nutricional del niño y de la madre. En el caso del niño, su balance hídrico tiene que estar equilibrado a través de aportaciones cotidianas suficientes. Las necesidades basales de líquidos en los mayores se cifran en torno a 30-35 mL por Kilogramo de peso y día. Hay circunstancias que incrementan las necesidades de líquidos del organismo como el estrés, la actividad y el ejercicio físico, el aumento de la temperatura ambiental ,la fiebre, las pérdidas de líquidos por vómitos y/o diarreas, la diabetes descompensada, las quemaduras, etc. Los factores que condicionan el ejercicio en relación con la hidratación son: las características del ejercicio, las condiciones ambientales, las características individuales, el acostumbramiento a las condiciones climáticas externas, el entrenamiento, el umbral y la capacidad de sudoración. Todo ello hace que resulte muy conveniente instaurar unas Guías directrices que puedan orientar a los consumidores, así como a los distintos profesionales dela salud, sobre lo que resulta más adecuado beber o aconsejar beber en cada momento (AU)
Water is a natural resource essential to life and essential in our daily food. The water contained in food which along with liquids we drink and the rest we eat, we have to ensure proper hydration in all ages and life circumstances. It is very important that its consumption has ensured the quality and quantity. The adequate intake of total water has been established to prevent the deleterious effects of dehydration (especially acute effects) that include functional and metabolic disorders. It is known that the degree of hydration can influence the health and welfare of people, including his mental concentration and other cognitive aspects, their physical performance and heat tolerance. In pregnant women, an important part of its increasing weight occurs at the expense of the volume plasma increase. In the case of breastfeeding, if we consider that approximately 87-90% the composition of milk is water, it is obvious the importance of maintaining an adequate water intake if we want to preserve the quality and quantity of milk and, hence, the nutritional status of children and mothers. In the case of children, their water balance has to be balanced through sufficient contributions every day, especially in the early stages of life where they are most vulnerable to fluids and electrolytes imbalances. Children -especially infants and those who start walking-are at increased risk, even deadly, dehydration than adults. The factors that determine the exercise in relation to the hydration are the characteristics of the exercise, environmental conditions, individual characteristics, accustomed to external weather conditions, training, and capacity threshold of sweating. In recent years, besides the traditional beverages, a wide range of new drinks that often have a significant caloric value, have proliferated in the marketplace for. This makes it highly desirable to establish some guidelines (AU)
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Humanos , Masculino , Femenino , Embarazo , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Agua Corporal/fisiología , Ingestión de Líquidos/fisiología , Equilibrio Hidroelectrolítico/fisiología , Política Nutricional , Valores de Referencia , EspañaRESUMEN
INTRODUCTION: Falls are a cause of disability and death in geriatric population. Third part of the elderly suffer at least one fall per year. Neurological illness are a very important risk factor in developing falls. AIM: To establish the differences between neurological and not neurological patients with recurrent falls. PATIENTS AND METHODS: We select 113 patients over 65 years-old with two or more falls in the last six months, collecting demographic and medical data, as well as a functional, mental and social evaluation, gait and balance tests and posturography. Complementary examinations were done to clarify the diagnosis in each case. RESULTS: Average age was 78 years-old. We define a group A, patients in which the main cause of falls is a neurological disease and group B with a non-neurological cause. Group A shows more number of falls (p < 0.053), worse functional (p < 0.002) and mental (p < 0.001) situation and more comorbility (p = 0.05), as well as worse scores in gait tests. CONCLUSIONS: Neurological illness are a very important risk factor in falls due to the disturbances in gait and balance that they produce. Dementia, parkinsonism and cerebrovascular diseases are frequently found in elderly patients with recurrent falls. Patients with falls due to neurological illness tend to fall oftener and have worse mental and functional situation. Evaluating neurological risk factors in geriatric patients with recurrent falls is essential to establish appropriate prevention strategies.
Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Enfermedades del Sistema Nervioso/complicaciones , Anciano , Femenino , Humanos , MasculinoRESUMEN
Las caídas son causa de discapacidad y muerte en la población geriátrica. Un tercio de los ancianossufre al menos una caída al año. Las patologías neurológicas son un importante factor de riesgo en la producción de caídas. Objetivo. Establecer las diferencias entre ancianos con caídas de repetición en función de que padezcan o no alguna patologíaneurológica. Pacientes y métodos. Se seleccionaron 113 pacientes mayores de 65 años con dos o más caídas en los últimos seis meses y se recogieron variables demográficas y médicas, valoración funcional, mental, social, de la marcha y el equilibrio, y posturografía. Se realizaron las pruebas complementarias en cada caso para aclarar el diagnóstico. Resultados.La edad media fue de 78 años. Se definió un grupo A, pacientes en los que la causa fundamental de la caída era neurológica, y un grupo B, con causa no neurológica. El grupo A presentó mayor número de caídas (p = 0,053), peor situación funcional (p = 0,002) y mental (p < 0,001) y mayor morbilidad (p = 0,05), así como peor puntuación en los test de valoración de lamarcha. Conclusiones. Las enfermedades neurológicas constituyen un importante factor de riesgo en la producción de caídas por las alteraciones de la marcha y el equilibrio que producen. Las demencias, los síndromes parkinsonianos y la enfermedadcerebrovascular se encuentran con frecuencia entre la población de ancianos con caídas de repetición. Los pacientes con caídas de causa neurológica presentan más caídas y peor situación funcional y mental. Identificar factores de riesgo neurológico en ancianos con caídas resulta fundamental para establecer estrategias de prevención adecuadas (AU)
Falls are a cause of disability and death in geriatric population. Third part of the elderly suffer at leastone fall per year. Neurological illness are a very important risk factor in developing falls. Aim. To establish the differences between neurological and not neurological patients with recurrent falls. Patients and methods. We select 113 patients over 65years-old with two or more falls in the last six months, collecting demographic and medical data, as well as a functional, mental and social evaluation, gait and balance tests and posturography. Complementary examinations were done to clarifythe diagnosis in each case. Results. Average age was 78 years-old. We define a group A, patients in which the main cause of falls is a neurological disease and group B with a non-neurological cause. Group A shows more number of falls (p < 0.053), worse functional (p < 0.002) and mental (p < 0.001) situation and more comorbility (p = 0.05), as well as worse scores in gaittests. Conclusions. Neurological illness are a very important risk factor in falls due to the disturbances in gait and balance that they produce. Dementia, parkinsonism and cerebrovascular diseases are frequently found in elderly patients with recurrent falls. Patients with falls due to neurological illness tend to fall oftener and have worse mental and functional situation. Evaluating neurological risk factors in geriatric patients with recurrent falls is essential to establish appropriate prevention strategies (AU)
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Humanos , Masculino , Femenino , Anciano , Accidentes por Caídas/estadística & datos numéricos , Trastornos Neurológicos de la Marcha/epidemiología , Trastornos Neurológicos de la Marcha/complicaciones , Factores de Riesgo , Enfermedades del Sistema Nervioso/complicaciones , Enfermedades del Sistema Nervioso/epidemiología , PosturaAsunto(s)
Geriatría , Dolor , Anciano , Humanos , Dolor/epidemiología , Dolor/etiología , Manejo del DolorRESUMEN
No disponible
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Anciano , Anciano de 80 o más Años , Humanos , Insuficiencia Cardíaca/terapia , Hospitalización/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , EspañaAsunto(s)
Delirio , Geriatría , Enfermedad Aguda , Anciano , Delirio/epidemiología , Delirio/etiología , Humanos , SíndromeRESUMEN
No disponible
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Humanos , Geriatría/educación , Educación de Pregrado en Medicina/tendencias , Curriculum/tendencias , Facultades de Medicina/tendenciasRESUMEN
No disponible
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Humanos , Confusión/epidemiología , Delirio/epidemiología , Factores de Riesgo , Anciano Frágil , Antipsicóticos/uso terapéuticoRESUMEN
No disponible
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Anciano , Humanos , Geriatría , Hospitalización/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , España/epidemiologíaRESUMEN
No disponible
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Humanos , Sociedades Médicas/tendencias , Geriatría/tendencias , Acreditación/tendencias , Medicina/tendencias , Educación de Postgrado en Medicina/tendenciasRESUMEN
OBJECTIVES: a) establish the major immunological parameters for clinical use in a group of retirees; b) correlate its levels in relation to gender; c) assess the influence of some specific factors (substance abuse, diseases) on the analyzed parameters. MATERIAL AND METHODS: study period: 1990-1999; sample: 249; 102 men (M); 147 women (W). Median age: 67.03 (4.2) years. Analyzed immunological variables: total leukocytes, lymphocytes B, immunoglobulins (IgG, IgA and IgM), rheumatoid factor, lymphocytes subpopulations (CD4, CD8, ratio), natural killer, complement (C3 and C4) and delayed hypersensitivity tests. TECHNIQUES: flow cytometry (EPICS-Profile II) and Multitest IMC. STATISTICAL ANALYSIS: SPSS version 10.0.Results. Gender influence: leukocytes: M: 6,699.4 (1,615.0); W: 6,105.9 (1,470.5); p < 0,003; lymphocytes B (%): M: 9.4 (5.0); W: 11.3 (4.1); p < 0,003; IgG: M: 1,155.7 (320.0); W: 1,116.1 (257.8); p = 0,28, IgM: M: 112.7 (69.3); W: 136.8 (85.6); p < 0,01; IgA: M: 276.1 (114); W: 254.0 (122); p = 0,15; rheumatoid factor: M: 18.5 (6.6); W: 20.9 (18.8); p = 0,020; CD4 (%): M: 42.2 (9.7); W: 47.3 (9,1); p < 0.001; CD8 (%): M: 30.3 (10,8); W: 25.0 (10.2); p < 0,001; scores: M: 13.2 (7.4); 11m: 10.0 (7.2); p < 0,005. Influence of the substance abuse: smokers; lymphocytes B (%): 8.8 (3.4); No: 10.9 (4.7); p < 0.008; CD8 (%): smokers: 31.8 (13.2); No: 26.2 (9.9); p < 0.003; CD4/CD8 ratio: smokers: 1.6 (0.9); No: 2.0 (1.3); p < 0,05; scores: smokers: 14.3 (6.8); No: 10.8 (7.5); p < 0.02; alcoholism: lymphocytes B (%): 8.7 (2.5). No: 10.8 (4.7); p < 0.001; alcoholism: store: 16.9 (6.7); No: 10.7 (7.3); p < 0,001. Influence of the diseases: diabetes: CD4 (%): 49.4 (12.0); diabetics versus healthy: p = 0,05; CD4/CD8 ratio: 2.6 (2.5); diabetics versus healthy: p = 0,04; EPOC: CD8 (%): 32.9 (16,3); COPD versus healthy: p = 0,07; neoplasias NK (%): 17.1 (21.4); neoplasias versus healthy: p < 0,01. CONCLUSIONS. a) there are differences according to the gender in the parameters of normalcy of some variables; b) smoking and alcoholism alter the immunological test analyzed, and c) some chronic diseases influence the subpopulations of lymphocytes and the cutaneous test of delayed hypersensitivity.
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Linfocitos B/inmunología , Jubilación , Anciano , Antígenos CD/inmunología , Femenino , Humanos , Inmunoglobulina A/inmunología , Inmunoglobulina G/inmunología , Inmunoglobulina M/inmunología , Células Asesinas Naturales/inmunología , Masculino , Estudios RetrospectivosRESUMEN
Objetivos. a) valorar los principales parámetros inmunológicos de uso clínico en un grupo de jubilados; b) correlacionar sus niveles en función del género, y c) valorar la influencia sobre los parámetros analizados de determinados factores (hábitos tóxicos, enfermedades).Material y métodos. Período de estudio: 1990-1999; muestra: 249; 102 hombres (H); 147 mujeres (M). Edad media: 67,03 ñ 4,2 años. Variables inmunológicas analizadas: leucocitos totales, linfocitos B, inmunoglobulinas (IgG, A y M), factor reumatoide, subpoblaciones de linfocitos (CD4, CD8, ratio), natural killer (NK), complemento (C3 y C4) y pruebas de hipersensibilidad retardada. Técnicas: citometría de flujo (EPICS-Profile II) y Multitest IMC. Análisis estadístico: SPSS versión 10.0.Resultados. Influencia del género: leucocitos: H: 6.699,4 (1.615,0); M: 6.105,9 (1.470,5); p< 0,003; linfocitos B ( por ciento); H: 9,4 (5,0); M: 11,3 (4,1); p < 0,003; IgG; H: 1.155,7; (320,0) M: 1.116,1 (257,8); p = 0,28; IgM; H: 112,7 (69,3); M: 136,8 (85,6); p < 0,01; IgA; H: 276,1 (114); M: 254,0 (122); p = 0,15; factor reumatoide: H: 18,5 (6,6); M: 20,9 (18,8); p = 0,20; CD4 ( por ciento); H: 42,2 (9,7); M: 47,3 (9,1); p < 0,001; CD8 ( por ciento); H: 30,3 (10,8); M: 25,0 (10,2); p < 0,001; score; H: 13,2 (7,4); M: 10,0 (7,2); p < 0,005. Influencia de los hábitos tóxicos: fumadores: linfocitos B ( por ciento): 8,8 (3,4); No: 10,9 (4,7); p < 0,008; CD8 ( por ciento); fumadores: 31,8 (13,2); No: 26,2 (9,9); p < 0,003; cociente CD4/CD8: fumadores: 1,6 (0,9); No: 2,0 (1,3); p < 0,05; score: fumadores: 14,3 (6,8); No: 10,8 (7,5); p < 0,02; hábito enólico, linfocitos B ( por ciento): 8,7 (2,5); No: 10,8 (4,7); p < 0,001; hábito enólico, score: 16,9 (6,7); No: 10,7 (7,3); p < 0,001. Influencia de las enfermedades: diabetes; CD4 ( por ciento): 49,4 (12,0); diabéticos frente a sanos: p = 0,05; cociente CD4/CD8: 2,6 (2,5); diabéticos frente a sanos: p = 0,04; enfermedad pulmonar obstructiva crónica (EPOC): CD8 ( por ciento), 32,9 (16,3); EPOC frente a sanos: p = 0,07; neoplasias: NK ( por ciento): 17,1 (21,4); neoplasias frente a sanos: p < 0,01. Conclusiones. a) existen diferencias en función del género en los parámetros de normalidad de algunas variables; b) el tabaquismo y el hábito enólico alteran las pruebas inmunológicas analizadas, y c) determinadas enfermedades crónicas influyen en las subpoblaciones de linfocitos y en las pruebas cutáneas de hipersensibilidad retardada (AU)