Cognitive Profile and Cardiovascular Risk Factors in Older Adults with Mild Cognitive Impairment.

The prevalence of cardiovascular risk factors (CVRFs) in the older adults population and their specific impact on their cognitive profiles still requires further research. For this purpose, a cross-sectional study was carried out to describe the presence of CVRFs and their association with cognitive performance in a sample of older adults (65-85 years old) with Mild Cognitive Impairment (MCI). Participants (n = 185) were divided into three groups concerning their cardiovascular risk level determined by the presence of different CVRFs, including Type 2 Diabetes (T2D), dyslipidemia, hypertension, and obesity. The primary outcome measures were the participant's scores in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Sociodemographic, clinical, and psychosocial data were collected. Non-parametrical statistical analyses and effect sizes were calculated. Findings revealed that a greater presence of CVRFs was not associated with a worse overall cognitive performance. High-risk patients were more likely to have significantly worse performance in the attentional domain compared to medium-risk (p = 0.029, r = 0.42) and compared to low-risk (p = 0.041, r = 0.35), specifically in the digits repetition subtest (p = 0.042). T2D alone was the CVRF associated with cognitive differences (p = 0.037, r = 0.32), possibly mediated by the duration of the condition. Consequently, a higher presence of CVRFs did not lead to a worse overall cognitive performance. However, high-risk individuals were more likely to experience cognitive impairment, particularly in the attentional domain. T2D played a significant role in these cognitive profile differences, possibly influenced by its duration.

Transplante fecal en geriatría / Faecal transplantation in geriatrics

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Communicating the Risk of MRSA: The Role of Clinical Practice, Regulation and Other Policies in Five European Countries.

BACKGROUND: The threat posed by Meticillin-resistant Staphylococcus aureus (MRSA) has taken on an increasingly pan-European dimension. This article aims to provide an overview of the different approaches to the control of MRSA adopted in five European countries (Austria, Germany, Netherlands, Spain, and the UK) and discusses data and reporting mechanisms, regulations, guidelines, and health policy approaches with a focus on risk communication. Our hypothesis is that current infection control practices in different European countries are implicit messages that contribute to the health-related risk communication and subsequently to the public perception of risk posed by MRSA. A reporting template was used to systematically collect information from each country. DISCUSSION: Large variation in approaches was observed between countries. However, there were a number of consistent themes relevant to the communication of key information regarding MRSA, including misleading messages, inconsistencies in content and application of published guidelines, and frictions between the official communication and their adoption on provider level. SUMMARY: The variability of recommendations within, and across, countries could be contributing to the perception of inconsistency. Having inconsistent guidelines and practices in place may also be affecting the level at which recommended behaviors are adopted. The discrepancy between the official, explicit health messages around MRSA and the implicit messages stemming from the performance of infection control measures should, therefore, be a key target for those wishing to improve risk communication.

Reducing Fall Risk with Combined Motor and Cognitive Training in Elderly Fallers.

BACKGROUND: Falling is a major clinical problem in elderly people, demanding effective solutions. At present, the only effective intervention is motor training of balance and strength. Executive function-based training (EFt) might be effective at preventing falls according to evidence showing a relationship between executive functions and gait abnormalities. The aim was to assess the effectiveness of a motor and a cognitive treatment developed within the EU co-funded project I-DONT-FALL. METHODS: In a sample of 481 elderly people at risk of falls recruited in this multicenter randomised controlled trial, the effectiveness of a motor treatment (pure motor or mixed with EFt) of 24 one-hour sessions delivered through an i-Walker with a non-motor treatment (pure EFt or control condition) was evaluated. Similarly, a 24 one-hour session cognitive treatment (pure EFt or mixed with motor training), delivered through a touch-screen computer was compared with a non-cognitive treatment (pure motor or control condition). RESULTS: Motor treatment, particularly when mixed with EFt, reduced significantly fear of falling (F(1,478) = 6.786, p = 0.009) although to a limited extent (ES -0.25) restricted to the period after intervention. CONCLUSIONS: This study suggests the effectiveness of motor treatment empowered by EFt in reducing fear of falling.

Plan de estudios universitarios en medicina geriátrica desarrollado utilizando una técnica internacional Delphi modificada / University studies plan in geriatric medicine developed using a modified Delphi technique

Introducción: El aumento en el número de ancianos en estado de fragilidad hace imperioso que todos los facultativos del futuro adquieran suficientes conocimientos del envejecimiento humano y habilidades en el manejo del paciente de edad avanzada y de las enfermedades relacionadas con el envejecimiento. Pocos países ofertan estudios de medicina geriátrica dentro de la formación de pregrado. El objetivo del presente proyecto fue obtener un consenso entre geriatras europeos sobre los requerimientos mínimos que un estudiante de medicina debe dominar al final de su carrera universitaria. Material y métodos: Se utilizó un proceso Delphi modificado. En primer lugar expertos en educación y geriatras propusieron un conjunto de objetivos de aprendizaje basados en una revisión de la bibliografía. En segundo lugar, se realizaron tres rondas Delphi en las que participó un panel de 49 expertos representando a 29 países afiliados a la Unión Europea de Especialistas Médicos, que permitió alcanzar consenso para un plan de estudios definitivo. Resultados: El número de desacuerdos tras las rondas Delphi 1 y 2 fue de 81 y 53, respectivamente. Se logró un acuerdo completo tras la tercera ronda. El plan de estudios definitivo consiste en objetivos detallados agrupados bajo 10 objetivos generales de formación. Conclusiones: Se ha alcanzado un consenso entre geriatras europeos que fija objetivos formativos específicos para los estudiantes de medicina. Serán necesarios grandes esfuerzos para la implantación de estos requisitos dada la variabilidad existente en la calidad de la enseñanza de la geriatría. Este plan de estudios es un primer paso para ayudar a mejorar la enseñanza de geriatría en las facultades de medicina, y servirá también como base para avanzar en la formación en geriatría de posgrado en toda Europa (AU)

Introduction: The increase in the number of frail elderly people has led to the necessity that all doctors of the future acquire sufficient knowledge on human ageing and the skills in the management of the patient of advanced age, as well as the diseases associated with ageing. Few countries offer geriatric medicine within undergraduate training. The purpose of the present project was to obtain a consensus between European geriatricians on the minimum requirements that medical students must achieve at the end of their university degree course. Material and methods: A modified Delphi process was used. Firstly, experts in education and geriatrics proposed a set of learning objectives based on a review of the literature. Three Delphi rounds were then performed, in which a panel of 49 experts representing 29 countries affiliated to the European Union of Medical Specialists took part. This enabled them to reach a consensus on a definitive study plan. Results: The number of disagreements after the Delphi rounds 1 and 2 were 81 and 53, respectively. Full agreement was reached after the third round. The definitive study plan consisted of detailed objectives grouped under 10 general training objectives. Conclusions: A consensus has been reached between European geriatricians that sets specific training objectives for medical students. Great efforts will be required for the introduction of these requirements, given the variability there is in the quality of teaching in geriatrics. This study plan is a first step in helping to improve geriatrics teaching in faculties of medicine, and will also serve as a basis to make advances in the training in post-graduate geriatrics throughout Europe (AU)

[University studies plan in geriatric medicine developed using a modified Delphi technique]. / Plan de estudios universitarios en medicina geriátrica desarrollado utilizando una técnica internacional Delphi modificada.

INTRODUCTION: The increase in the number of frail elderly people has led to the necessity that all doctors of the future acquire sufficient knowledge on human ageing and the skills in the management of the patient of advanced age, as well as the diseases associated with ageing. Few countries offer geriatric medicine within undergraduate training. The purpose of the present project was to obtain a consensus between European geriatricians on the minimum requirements that medical students must achieve at the end of their university degree course. MATERIAL AND METHODS: A modified Delphi process was used. Firstly, experts in education and geriatrics proposed a set of learning objectives based on a review of the literature. Three Delphi rounds were then performed, in which a panel of 49 experts representing 29 countries affiliated to the European Union of Medical Specialists took part. This enabled them to reach a consensus on a definitive study plan. RESULTS: The number of disagreements after the Delphi rounds 1 and 2 were 81 and 53, respectively. Full agreement was reached after the third round. The definitive study plan consisted of detailed objectives grouped under 10 general training objectives. CONCLUSIONS: A consensus has been reached between European geriatricians that sets specific training objectives for medical students. Great efforts will be required for the introduction of these requirements, given the variability there is in the quality of teaching in geriatrics. This study plan is a first step in helping to improve geriatrics teaching in faculties of medicine, and will also serve as a basis to make advances in the training in post-graduate geriatrics throughout Europe.

Eficacia de la vía subcutánea frente a la hidratación intravenosa en el paciente anciano hospitalizado: estudio controlado aleatorizado / Efficacy of the subcutaneous route compared to intravenous hydration in the elderly hospitalised patient: A randomised controlled study

Introducción: La subcutánea (SC) ha resurgido recientemente como vía de hidratación con potenciales ventajas en población anciana, sin embargo poco se conoce de su aplicación en ambiente hospitalario. El objetivo de este estudio es evaluar la no inferioridad en eficacia de esta vía frente a la intravenosa (IV) en el paciente anciano con deshidratación. Material y métodos: Estudio prospectivo de intervención, controlado y aleatorizado sobre pacientes de 65 y más años ingresados en una Unidad Geriátrica de Agudos con deshidratación leve-moderada e intolerancia oral. Evaluamos la no inferioridad de la sueroterapia subcutánea frente a la intravenosa. La intervención consistió en la administración de hasta un máximo de 1,5 l/día por vía subcutánea vs. intravenosa durante 72 h evaluando variaciones de parámetros bioquímicos (urea, creatinina, osmolaridad), evolución clínica y complicaciones relacionadas con la vía. Resultados: Sesenta y siete pacientes completaron el estudio (34 SC, edad media: 86,4 ± 8,5 años, 41% mujeres, vs. 33 IV, 84,3 ± 6,6, 54,5% mujeres, sin diferencias significativas). La cantidad de líquido infundido al día por ambas vías fue de 1.320 ml ± 400 SC vs. 1.480 ml ± 340 IV, p = 0,092. Durante el seguimiento se objetivaron reducciones similares entre grupos sin significación estadística, con diferencias de medias pre-postintervención de urea (49,6 ± 52,3 SC vs. 50,3 ± 52,3 IV, p = 0,96); creatinina (0,68 ± 0,66 SC vs. 0,60 ± 0,49 IV, p = 0,58), y osmolaridad plasmática (15,6 ± 24,4 SC vs. 21,1 ± 31 IV, p = 0,43). Se objetivaron menos episodios de extracción de catéter en grupo SC con mayor tendencia de edema peri-clisis. Conclusiones: La eficacia de la rehidratación por vía subcutánea en pacientes ancianos hospitalizados con deshidratación leve-moderada no es inferior a la obtenida por vía intravenosa, pudiendo presentar ventajas adicionales (AU)

Introduction: The subcutaneous (SC) route has recently emerged as a rehydration method with potential advantages in the geriatric population. Nevertheless, little is known about its application during hospitalization. The objective of the present study is to evaluate the subcutaneous non-inferiority efficacy in hydration against the intravenous (IV) route in elderly patients with dehydration. Material and methods: A prospective, randomized and controlled interventional trial of patients 65 years and older admitted to an Acute Geriatric Unit with mild to moderate dehydration and oral intolerance, evaluating the non-inferiority of subcutaneous fluid therapy versus the intravenous route. The intervention consisted of the administration of up to 1.5 l/day/route for 72 hours subcutaneous vs. intravenous, evaluating the variations in biochemical parameters (urea, creatinine, osmolarity), clinical outcome, and route related complications. Results: Sixty seven patients completed the study (34 SC, age 86.4±8.5 years, 41% women, vs. 33 IV, 84.3±6.6, 54.5% women, with no significant differences). The amount of fluid administered per day by route was 1.320 ml±400 SC vs. 1.480 ml±340 IV, P=.092. During follow similar reductions were observed between groups without any statistical significance, with mean differences pre-postintervention of urea (49.6±52.3 SC vs. 50.3±52.3 IV, P=.96); creatinine (0.68±0.66 SC vs. 0.60±0.49 IV, P=.58), and osmolarity (15.6±24.4 SC vs. 21.1±31 IV, P=.43). Fewer catheter extraction episodes were observed in the SC group, which also was the group most prone to peri-clysis edema. Conclusions: The efficacy of subcutaneous rehydration in elderly hospitalized patients with mildmoderate dehydration is not inferior to that obtained intravenously, and may even have additional advantages (AU)

[Efficacy of the subcutaneous route compared to intravenous hydration in the elderly hospitalised patient: a randomised controlled study]. / Eficacia de la vía subcutánea frente a la hidratación intravenosa en el paciente anciano hospitalizado: estudio controlado aleatorizado.

INTRODUCTION: The subcutaneous (SC) route has recently emerged as a rehydration method with potential advantages in the geriatric population. Nevertheless, little is known about its application during hospitalization. The objective of the present study is to evaluate the subcutaneous non-inferiority efficacy in hydration against the intravenous (IV) route in elderly patients with dehydration. MATERIAL AND METHODS: A prospective, randomized and controlled interventional trial of patients 65 years and older admitted to an Acute Geriatric Unit with mild to moderate dehydration and oral intolerance, evaluating the non-inferiority of subcutaneous fluid therapy versus the intravenous route. The intervention consisted of the administration of up to 1.5 l/day/route for 72 hours subcutaneous vs. intravenous, evaluating the variations in biochemical parameters (urea, creatinine, osmolarity), clinical outcome, and route related complications. RESULTS: Sixty seven patients completed the study (34 SC, age 86.4 ± 8.5 years, 41% women, vs. 33 IV, 84.3 ± 6.6, 54.5% women, with no significant differences). The amount of fluid administered per day by route was 1.320 ml ± 400 SC vs. 1.480 ml ± 340 IV, P = .092. During follow similar reductions were observed between groups without any statistical significance, with mean differences pre-postintervention of urea (49.6 ± 52.3 SC vs. 50.3 ± 52.3 IV, P=.96); creatinine (0.68 ± 0.66 SC vs. 0.60 ± 0.49 IV, P=.58), and osmolarity (15.6 ± 24.4 SC vs. 21.1 ± 31 IV, P=.43). Fewer catheter extraction episodes were observed in the SC group, which also was the group most prone to peri-clysis edema. CONCLUSIONS: The efficacy of subcutaneous rehydration in elderly hospitalized patients with mild-moderate dehydration is not inferior to that obtained intravenously, and may even have additional advantages.

Standardizing assessment of elderly people in acute care: the interRAI Acute Care instrument.

OBJECTIVES: To examine the frequency distributions and interrater reliability of individual items of the interRAI Acute Care instrument. DESIGN: Observational study of a representative sample of older inpatients; duplicate assessments conducted on a subsample by independent assessors to examine interrater reliability. SETTING: Acute medical, acute geriatric and orthopedic units in 13 hospitals in nine countries. PARTICIPANTS: Five hundred thirty-three patients aged 70 and older (mean age 82.4, range 70-102) with an anticipated stay of 48 hours or longer of whom 161 received duplicate assessments. MEASUREMENTS: Sixty-two clinical items across 11 domains. Premorbid (3-day observation period before onset of the acute illness) and admission (the first 24 hours of hospital stay) assessments were conducted. RESULTS: The frequency of deficits exceeded 30% for most items, ranging from 1% for physically abusive behavior to 86% for the need for support in activities of daily living after discharge. Common deficits were in cognitive skills for daily decision-making (38% premorbid, 54% at admission), personal hygiene (37%, 65%), and walking (39%, 71%). Interrater reliability was substantial in the premorbid period (average kappa=0.61) and admission period (average kappa=0.66). Of the 69 items tested, less than moderate agreement (kappa<0.4) was recorded for six (9%), moderate agreement (kappa=0.41-0.6) for 14 (20%), substantial agreement (kappa=0.61-0.8) for 40 (58%), and almost perfect agreement (kappa>0.8) for nine (13%). CONCLUSION: Initial assessment of the psychometric properties of the interRAI Acute Care instrument provided evidence that item selection and interrater reliability are appropriate for clinical application. Further studies are required to examine the validity of embedded scales, diagnostic algorithms, and clinical protocols.