[Cost-effectiveness analysis of fracture liaison services in Catalonia]. / Análisis de coste-efectividad de las Unidades de Coordinación de Fracturas en Cataluña.

OBJECTIVE: To assess the cost-effectiveness of Fracture Liaison Service (FLS) compared to the standard of care for secondary prevention of fragility fractures form the perspective of the Catalan Health Service. METHODS: Cost-utility assessment through a Markov model that simulated disease progression of a patients' cohort candidates to initiate antiosteoporotic treatment after a fragility fracture. A time horizon of 10 years and a 6-month duration per cycle was established. Clinical, economics and quality of life parameters were obtained from the literature and derived from four Catalan FLS. The Catalan Health Service perspective was adopted, considering direct health costs expressed in 2022 euros. A 3% discount rate was applied on costs and outcomes. Uncertainty was assessed through multiple sensitivity analyses. RESULTS: Compared to the standard of care, FLS would promote antiosteoporotic initiation and persistence, reducing the incidence and mortality associated with subsequent fragility fractures. This incremental clinical benefit was estimated at 0.055 years and 0.112 quality-adjusted life years (QALYs) per patient. A higher cost (€1,073.79 per patient) was estimated, resulting into an incremental cost-utility ratio of €9,602.72 per QALYs gained. The sensitivity analyses performed were consistent, corroborating the robustness and conservative approach of the base-case. CONCLUSIONS: The introduction of FLS for the secondary prevention of FF would represent a cost-effective strategy from the Catalan Health Service perspective.

Best Practice Framework of Fracture Liaison Services in Spain and their coordination with Primary Care.

The coordination of Fracture Liaison Services (FLS) with Primary Care (PC) is necessary for the continuity of care of patients with fragility fractures. This study proposes a Best Practice Framework (BPF) and performance indicators for the implementation and follow-up of FLS-PC coordination in clinical practice in Spain. PURPOSE: To develop a BPF for the coordination of FLS with PC in Spain and to improve the continuity of care for patients with fragility fractures. METHODS: A Steering Committee selected experts from seven Spanish FLS and related PC doctors and nurses to participate in a best practice workshop. Selection criteria were an active FLS with an identified champion and prior contact with PC centres linked to the hospital. The main aim of the workshop was to review current FLS practices in Spain and their integration with PC. A BPF document with processes, tools, roles, and metrics was then generated. RESULTS: Spanish FLS consists of a multidisciplinary team of physicians/nurses but with low participation of other professionals and PC staff. Evaluation and treatment strategies are widely variable. Four desired standards were agreed upon: (1) Effective channels for FLS-PC communication; (2) minimum contents of an FLS clinical report and its delivery to PC; (3) adherence monitoring 3 months after FLS baseline visit; and (4) follow-up by PC. Proposed key performance indicators are (a) number of FLS-PC communications, including consensus protocols; (b) confirmation FLS report received by PC; (c) medical/nursing PC appointment after FLS report received; and (d) number of training sessions in PC. CONCLUSIONS: The BPF provides a comprehensive approach for FLS-PC coordination in Spain, to promote the continuity of care in patients with fragility fractures and improve secondary prevention. The implementation of BPF recommendations and performance indicator tracking will benchmark best FLS practices in the future.

Factores pronósticos de buena funcionalidad a los 12 meses, de una fractura de cadera. Estudio Maluc Anoia / Pronostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study

ANTECEDENTES: La fractura de cadera suele ocurrir en pacientes frágiles de edad avanzada y va asociada a una importante morbimortalidad al al primer año. El objetivo del estudio es describir los factores pronósticos que permitirían mantener la funcionalidad a los 12 meses. MÉTODO: Desde el 1 de junio de 2010 hasta el 31 de mayo de 2013 se han incluido a todos los pacientes mayores de 69 años con fractura de cadera por fragilidad ósea ingresados en la Unidad Geriátrica de Agudos de nuestro hospital. Definimos como mantenimiento funcional a aquellos pacientes que han perdido entre 0-15 puntos en el índice de Barthel respecto al previo a la fractura. Estudio prospectivo de análisis de datos bivariado para los factores pronósticos relacionados y multivariado para los factores pronósticos predictores. RESULTADOS: Se incluyen 271 pacientes, de ellos, 146 (54,8%), mantienen funcionalidad a los 12 meses y 122 (45,2%) no. Los pacientes que mantienen el estado funcional son más jóvenes: edad media 83,4 vs. 85,80 años (p = 0,002); con mejores puntaciones en los índices de: Lawton previo a la fractura 4,42 vs. 2,40 (p < 0,001) y Barthel al alta 34,2 vs. 27,1 (p = 0,002). También hay diferencias en la puntuación de la «Geriatric Dementia Scale» 2,59 vs. 3,13 (p = 0,009), en la puntuación de la «American Society Anesthesiologist»

BACKGROUND: Hip fracture usually occurs in frail elderly patients and is associated with an important morbi-mortality in the first year. The objective of the study is to describe the prognostic factors that would allow maintaining functionality at 12 months. METHOD: From June 1, 2010 to May 31, 2013, all patients older than 69 years with hip fracture due to bone fragility admitted to the Geriatric Acute Unit of our hospital were included. We define as functional maintenance those patients who have lost between 0-15 points in the Barthel Index with respect to the previous to the fracture. Prospective study of bivariate data analysis for related and multivariate prognostic factors for predictive predictors. RESULTS: 271 patients were included, of them, 146 (54.8%), maintained functionality at 12 months and 122 (45.2%) no. Patients who maintain functional status are younger: average age 83.4 vs 85.80 years (P=.002); with better scores in the indexes of: Lawton prior to fracture 4.42 vs 2.40 (P<.001) and Barthel at discharge 34.2 vs. 27.1 (P=.002). There are also differences in the score of the "Geriatric Dementia Scale" 2.59 vs. 3.13 (P=.009), in the score of the "American Society Anesthesiologist"

Pronostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study. / Factores pronósticos de buena funcionalidad a los 12 meses, de una fractura de cadera. Estudio Maluc Anoia.

BACKGROUND: Hip fracture usually occurs in frail elderly patients and is associated with an important morbi-mortality in the first year. The objective of the study is to describe the prognostic factors that would allow maintaining functionality at 12 months. METHOD: From June 1, 2010 to May 31, 2013, all patients older than 69 years with hip fracture due to bone fragility admitted to the Geriatric Acute Unit of our hospital were included. We define as functional maintenance those patients who have lost between 0-15 points in the Barthel Index with respect to the previous to the fracture. Prospective study of bivariate data analysis for related and multivariate prognostic factors for predictive predictors. RESULTS: 271 patients were included, of them, 146 (54.8%), maintained functionality at 12 months and 122 (45.2%) no. Patients who maintain functional status are younger: average age 83.4 vs 85.80 years (P=.002); with better scores in the indexes of: Lawton prior to fracture 4.42 vs 2.40 (P<.001) and Barthel at discharge 34.2 vs. 27.1 (P=.002). There are also differences in the score of the "Geriatric Dementia Scale" 2.59 vs. 3.13 (P=.009), in the score of the "American Society Anesthesiologist"

Oral bisphosphonate prescription and non-adherence at 12 months in patients with hip fractures treated in an acute geriatric unit.

A poorer functional status at the time of fracture is a predictor of non-adherence to oral bisphosphonates initiated after a hip fracture, and suggests further opportunities for optimization of secondary fracture prevention in this high-risk population. INTRODUCTION: Low adherence to treatment is a problem in post-fracture secondary prevention. We aimed to analyze the prognostic factors (related and predictive) associated with non-adherence to oral bisphosphonate prescription for hip fracture due to bone fragility (HFBF) 12 months after discharge from an acute geriatric unit. METHODS: Prospective study of bivariate data analyzing related and multivariate factors predicting non-adherence of oral bisphosphonates at 12 months after treatment for HFBF. The statistical study was performed with SPSS 19.0.0. RESULTS: We attended 368 patients with HFBF. At discharge, oral bisphosphonates were prescribed to 226 (61.42%) patients. At 12 months, we followed up 160 (70.7%) patients, 104 (65%) of whom had non-adherence to oral bisphosphonates. Bivariate analysis (adherent vs. non-adherent): age (83.79 ± 5.82 vs. 85.78 ± 5.80, p = .029); Lawton and Brody Index (4.29 ± 3.40 vs. 2.67 ± 3.31, p = .004); baseline Barthel Index (BI) (85.89 ± 21.99 vs. 74.18 ± 26.70) (p = .004); BI at admission (18.84 ± 10.00 vs. 14.47 ± 11.71, p = .004); BI at discharge (34.20 ± 15.40 vs. 27.45 ± 16.71, p = .011); baseline Functional Ambulation Classification (5.66 ± 0.98 vs. 5.43 ± 0.99, p = .025). Multivariate analysis: BI 0.980 (0.965-0.995, p = .007). Discriminatory capacity of the AUC model (± 95% CI): 0.634 (0.545-0.722). CONCLUSIONS: At 12 months, there was low adherence to treatment with oral bisphosphonates in our model. A lower BI prior to treatment is a predictive factor for non-adherence treatment with oral bisphosphonate.

Spanish National Hip Fracture Registry (SNHFR): a description of its objectives, methodology and implementation / Registro Nacional Español de Fracturas de Cadera (RNFC): descripción de sus objetivos, metodología e implementación

Objective: To ascertain the current situation and clinical variability of the provision of care for Hip Fracture (HF) in Spain and the factors related to it by using a National Registry (NHFR) with high patient numbers and territorial representation NHFR, and to compare results on a national and international level and propose standards and criteria to improve healthcare quality. Design: Continuous registry for at least three years of a representative sample of patients admitted to Spanish hospitals due to HF using the Minimum Common Dataset - international Fragility Fracture Network (FFN) MCD, adapted for Spanish. Study scope and subjects: all patients over the age of 74 years who are hospitalized with a diagnosis of a fragility HF at the participating hospitals distributed throughout the Spanish territory. Initially 48 hospitals are included, and we expect to incorporate the highest number of sites possible. Results: It is expected to ascertain the current situation of provision of care for HF in Spain. Each hospital will be offered information regarding their results and their situation compared to the rest. The results from national hospitals will be compared to others included in the registry and to hospitals abroad, which use the same database. Variability will be studied, care standards will be established, and objectives will be proposed for the continuous improvement of the care process of this condition

Objetivo: Conocer la situación actual y la variabilidad clínica del proceso asistencial a la Fractura de Cadera (FC) en España y los factores relacionados con la misma mediante la utilización de un Registro Nacional (RNFC) con elevada casuística y representación territorial RNFC, así como comparar resultados en el ámbito nacional e internacional y proponer estándares y criterios para mejorar la calidad asistencial. Diseño: Registro continuo durante al menos tres años de una muestra representativa de los pacientes ingresados por FC en los hospitales españoles mediante el Minimum Common Dataset - MCD internacional de la Fragility Fracture Network (FFN) adaptado al castellano. Ámbito y sujetos del estudio: se incluirán todos los pacientes mayores de 74 años hospitalizados con el diagnóstico de FC por fragilidad en los hospitales participantes repartidos por el territorio español. Inicialmente están incluidos 48 hospitales, a los que se espera que se vayan incorporando el mayor número posible de centros. Resultados: Se pretende conocer la situación actual de la atención a este proceso en España Se ofrecerá a cada hospital la información de sus resultados y su situación en relación al resto, se compararán los resultados de los hospitales nacionales entre sí y con los hospitales extranjeros incluidos en registros que usan la misma base de datos. Se estudiará la variabilidad, se establecerán estándares asistenciales y se plantearán objetivos para la mejora continua del proceso en la atención a esta patología

Spanish National Hip Fracture Registry (SNHFR): a description of its objectives, methodology and implementation.

OBJECTIVE: To ascertain the current situation and clinical variability of the provision of care for Hip Fracture (HF) in Spain and the factors related to it by using a National Registry (NHFR) with high patient numbers and territorial representation NHFR, and to compare results on a national and international level and propose standards and criteria to improve healthcare quality. DESIGN: Continuous registry for at least three years of a representative sample of patients admitted to Spanish hospitals due to HF using the Minimum Common Dataset - international Fragility Fracture Network (FFN) MCD, adapted for Spanish. STUDY SCOPE AND SUBJECTS: all patients over the age of 74 years who are hospitalized with a diagnosis of a fragility HF at the participating hospitals distributed throughout the Spanish territory. Initially 48 hospitals are included, and we expect to incorporate the highest number of sites possible. RESULTS: It is expected to ascertain the current situation of provision of care for HF in Spain. Each hospital will be offered information regarding their results and their situation compared to the rest. The results from national hospitals will be compared to others included in the registry and to hospitals abroad, which use the same database. Variability will be studied, care standards will be established, and objectives will be proposed for the continuous improvement of the care process of this condition.

Valoración del paciente frágil en urgencias / Assessing frail patients in the emergency department

Los pacientes ancianos frágiles utilizan cada vez más y de forma adecuada los servicios de urgencias hospitalarios (SUH). No existen evidencias que demuestren la efectividad de un modelo concreto de valoración geriátrica aplicado en los servicios de urgencias. Sin embargo, la valoración del paciente frágil en los SUH se debería utilizar adecuándola al entorno y con unos objetivos claros que permitieran realizar un diagnóstico multidimensional y establecer prioridades terapéuticas. La valoración del estado funcional aporta beneficios en la continuidad de cuidados por parte de la atención primaria, cuando los pacientes son dados de alta del SUH (AU)

Frail, elderly patients appropriately use hospital emergency services with increasing frequency. An effective evidence based model for evaluating such patients in the emergency department has not been developed. Nonetheless, when assessing the frail elderly we are advised to establish clear objectives appropriate to their overall situation so that a multidimensional diagnosis can be made and treatment priorities set. An evaluation of functional status is useful for planning continuity of care to be provided by the primary care team after these patients are discharged (AU)

Characteristics of falls producing hip fractures in nonagenarians.

OBJECTIVES: To evaluate the characteristics associated with falls causing hip fracture in patients 90 years of age or older (nonagenarians). A second objective was to compare these characteristics with those present in younger patients (65-79 year-olds). DESIGN: Prospective, observational study. SETTING: Six hospitals in Barcelona (Spain) and its surrounding area. PARTICIPANTS: 105 nonagenarians diagnosed with hip fracture after a fall. Most patients were women (78; 74%), with a mean age of 92.2+/-2 years. All of them were living in the community, except for eight institutionalized patients. 221 patients aged 65 to 79 composed the younger patient's comparison group. MEASUREMENTS: Characteristics of falls causing hip fracture were analyzed: location, time and the risk factor for the fall, classified as intrinsic, extrinsic or combined. RESULTS: The mean number of falls in the previous year was 1.5 - 22% of the patients reported having fallen two or more times. Falls usually happened while at home (70%) and during the day (64%). An intrinsic risk factor was considered the most likely cause in 37% of the cases, an extrinsic risk factor in 35%, and a combination in 28%. Multiple stepwise logistic regression analysis showed that nonagenarians were characterized by lower BI scores, more falls happening during night time, a higher use of, benzodiazepines and diuretics, and a lower use of non-benzodiazepinic hypnotics. CONCLUSIONS: Most falls causing hip fracture in nonagenarians happen during the day and at home. Falls in nonagenarians happening more frequently during nighttime, and these oldest subjects had lower BI scores, and a higher use of benzodiazepines and diuretics and less use of non-benzodiazepines hypnotics compared with the younger patients.

[Circumstances associated to falls resulting in hip fracture in community-dwelling subjects older than 94 years old]. / Circunstancias asociadas a las caídas responsables de fractura de fémur en pacientes mayores de 94 años no institucionalizados.

OBJECTIVE: To evaluate the circumstances associated with falls resulting in hip fracture in the 95 years of age or older community-dwelling patients. MATERIAL AND METHODS: A prospective, observational study, was conducted in 6 hospitals in the Barcelona area on the characteristics associated with falls resulting in hip fracture in 30 patients aged > 94 years old. Location, time and the risk factor for the fall (classified as intrinsic, extrinsic or combined) were evaluated. RESULTS: Mean number of falls in the previous year was 1.6, 5 (16.7%) of the patients reporting having fallen two or more times. Falls usually occurred while at home, a high percentage (46.7%) of which occurred during the night. When the differences were evaluated by sex, there was a high percentage of uncorrected auditory loss in men and high number of chronic drugs and psychotropic drugs in women. CONCLUSIONS: Most falls causing hip fracture in community-dwelling very elderly subjects occur at home. Nearly half of the falls occur during the night.

Falls in nonagenarians living in their own homes: the Nonasantfeliu study.

OBJECTIVES: To evaluate the prevalence of falls and their circumstances in non-institutionalized people older than 89 years and living in an urban community. DESIGN: Cross-sectional cohort study. SETTING: Community-based study. PARTICIPANTS: 137 nonagenarians living at home. MEASUREMENTS: We evaluated sociodemographic data, capacity to perform basic activities according to the Barthel Index (BI) and instrumental activities on the Lawton-Brody Index (LI), cognition with the Spanish version of the Mini-Mental State Examination (MEC), near visual acuity by the Snellen test, and auditory acuity with the whisper test. RESULTS: Ninety-nine women (72%) and 38 men with an average age of 93.07 years (0.7) were included. 48.1% of them had suffered a fall during the last year, and in 20% of cases this had happened on more than one occasion. In 5.7% of cases, falls led to fractures. Factors associated with falls were a lower LI and a greater number of prescribed drugs. In the multivariate analysis the only factor related to falls was the number of drugs taken (p>0.001, odds ratio 0.785, 95% confidence interval 0.676-0.912). CONCLUSIONS: Measures to prevent falls among nonagenarians should be intensified due to their high frequency. In this age group the increase in the percentage of falls is mainly related to the higher number of drugs taken.

[Nonagenarian's risk profile for living in a nursing home. The NonaSantfeliu study]. / Diferencias entre nonagenarios según su lugar de residencia. Estudio NonaSantfeliu.

OBJECTIVE: By means of a cross-sectional study, describe the differential characteristics between a group of inhabitants of a same municipality over 89 years of age who are permanently institutionalized and those of the same age who continue to live in the community, trying to identify a profile of nonagenarians with high risk of living in a nursing home. MATERIAL AND METHODS: One hundred and eighty six nonagenarians were studied: 137 (74%) were living in their home and 49 (26%) in a nursing home. Sociodemographic data, ability to perform basic daily activities with Barthel Index (BI) or instrumental activities with Lawton and Brody Index (LI), cognition with the Spanish version of the Mini-Mental State Examination (MEC) and comorbidity (Charlson Index) were evaluated. Cardiovascular risk factors and other prevalent diseases were also studied. RESULTS: A total of 143 women (76.5%) and 43 men with a mean age of 93.06 years were studied. A predominance of women, single persons, worse IL, and greater consumption of drugs was observed in the bivariate analysis in the nonagenarians living in residences and widowers than in those living in the community. The multivariate analysis showed that the features of being single and having a lower IL were independent factors of living in a nursing home. CONCLUSIONS: The main difference between nonagenargian patients who live in the community and those in residences is that the latter are mainly single and have a low score on a scale that quantities instrumental activities of the daily life.

Diferencias entre nonagenarios según su lugar de residencia. Estudio NonaSantfeliu / Nonagenarian's risk profile for living in a nursing home. The NonaSantfeliu study

Objetivo. Realizar un estudio transversal descriptivo de las características diferenciales entre un grupo de habitantes de un mismo municipio, mayores de 89 años y permanentemente institucionalizados, y los de la misma edad que siguen viviendo en la comunidad, para intentar identificar un perfil de nonagenario con alto riesgo de vivir en residencia. Material y métodos. Se evaluaron 186 nonagenarios, de los que 137 (74%) vivían en su domicilio mientras que 49 (26%), en residencia. Se recogieron los datos sociodemográficos, la capacidad para realizar actividades básicas se valoró con el índice de Barthel y para instrumentales con el índice Lawton y Brody (IL), la cognición con el miniexamen cognitivo de Lobo y la comorbilidad con el índice de Charlson. También se registró la existencia de enfermedades prevalentes, así como de algunos factores de riesgo cardiovascular. Resultados. Se trataba de 143 mujeres (76,5%) y 43 varones, con una edad media de 93,06 años. En el análisis bivariante se observa un predominio de mujeres, solteros, peor IL y un mayor consumo de fármacos en los nonagenarios de las residencias y de viudos en la comunidad. En el análisis multivariante se mantuvieron el ser soltero y el tener un menor IL como factores independientes de vivir en residencia. Conclusiones. La principal diferencia entre los pacientes nonagenarios que viven en la comunidad y los institucionalizados es que en estos últimos predomina el ser soltero y el tener una baja puntuación en una escala que cuantifica las actividades instrumentales de la vida diaria (AU)

Objective. By means of a cross-sectional study, describe the differential characteristics between a group of inhabitants of a same municipality over 89 years of age who are permanently institutionalized and those of the same age who continue to live in the community, trying to identify a profile of nonagenarians with high risk of living in a nursing home. Material and methods. One hundred and eighty six nonagenarians were studied: 137 (74%) were living in their home and 49 (26%) in a nursing home. Sociodemographic data, ability to perform basic daily activities with Barthel Index (BI) or instrumental activities with Lawton and Brody Index (LI), cognition with the Spanish version of the Mini-Mental State Examination (MEC) and comorbidity (Charlson Index) were evaluated. Cardiovascular risk factors and other prevalent diseases were also studied. Results. A total of 143 women (76.5%) and 43 men with a mean age of 93.06 years were studied. A predominance of women, single persons, worse IL, and greater consumption of drugs was observed in the bivariate analysis in the nonagenarians living in residences and widowers than in those living in the community. The multivariate analysis showed that the features of being single and having a lower IL were independent factors of living in a nursing home. Conclusions. The main difference between nonagenargian patients who live in the community and those in residences is that the latter are mainly single and have a low score on a scale that quantities instrumental activities of the daily life (AU)

Risperidona y acontecimientos adversos cerebrovasculares en los pacientes ancianos con demencia / Risperidone and cerebrovascular adverse in elderly patients with dementia

No disponible

[Characteristics of falls producing hip fracture in an elderly population. Differences according to age and gender]. / Circunstancias asociadas a las caídas responsables de fractura de fémur en pacientes ancianos. Diferencias por grupo de edad y género.

BACKGROUND: The majority of hip fractures are produced because of a fall. We examined the characteristics associated with falls causing hip fracture in elderly patients. MATERIAL AND METHODS: Characteristics of falls owing to hip fracture were analyzed in 410 consecutive patients admitted in 6 hospitals during the 2004. We evaluated the location, time and the possible cause of fall: intrinsic risk factor, extrinsic or combined. RESULTS: We evaluated 316 women (77%) and 94 men, mean age 81.9 years. Previous to the hip fracture, the mean BI was 77.5. The mean value of falls during the last year was 1.9. Previously to the fall that caused hip fracture, we found that 24% of the patients had fallen repeatedly (more than two falls). Usually falls were at home (68%) and during daytime (80%). In 45% of patients an intrinsic risk factor was considered the most likely cause, in 33% an extrinsic risk factor and in 22% a combination. CONCLUSIONS: The majority of falls owing to hip fracture in elderly people happen in daytime, at home and due to intrinsic risk factors. Efforts to identify elderly people at risk of fall should be stressed in order to establish preventive measures.

Circunstancias asociadas a las caídas responsables de fractura de fémur en pacientes ancianos. Diferencias por grupo de edad y género / Characteristics of falls producing hip fracture in an elderly population. Differences according to age and gender

Objetivo. La mayoría de fracturas de fémur acontecen tras una caída. El objetivo de este estudio es identificar las circunstancias asociadas a las caídas que provocan fractura de fémur en una población anciana. Pacientes y métodos. Se estudiaron las características de las caídas responsables de la fractura de fémur en 410 pacientes ingresados de forma consecutiva en 6 centros durante el año 2004. Se valoró el lugar, la hora y la posible causa de la caída, ya fuese causa intrínseca, extrínseca o combinada. Resultados. Se incluyeron 316 (77%) mujeres y 94 varones con una edad media de 81,9 años. La media del índice de Barthel previo fue de 77,5. El promedio de caídas durante los 12 meses previos fue de 1,9. En el 24% de los casos se documentaron caídas de repetición (más de dos caídas) previamente a la caída que provocó la fractura de fémur. La caída aconteció en el domicilio en el 68% de los casos y en el 80% de los casos fue diurna (8-20 horas). En el 45% de los pacientes se consideró que la caída tuvo una causa intrínseca, en el 33% extrínseca y en el 22% combinada. Conclusiones. La mayoría de las caídas responsables de fractura de fémur en el anciano son diurnas, en el domicilio y de causa intrínseca. Se debe intensificar la identificación de los pacientes con riesgo elevado de caídas para establecer medidas de prevención de los factores de riesgo evitables

Background. The majority of hip fractures are produced because of a fall. We examined the characteristics associated with falls causing hip fracture in elderly patients. Material and methods. Characteristics of falls owing to hip fracture were analyzed in 410 consecutive patients admitted in 6 hospitals during the 2004. We evaluated the location, time and the possible cause of fall: intrinsic risk factor, extrinsic or combined. Results. We evaluated 316 women (77%) and 94 men, mean age 81.9 years. Previous to the hip fracture, the mean BI was 77.5. The mean value of falls during the last year was 1.9. Previously to the fall that caused hip fracture, we found that 24% of the patients had fallen repeatedly (more than two falls). Usually falls were at home (68%) and during daytime (80%). In 45% of patients an intrinsic risk factor was considered the most likely cause, in 33% an extrinsic risk factor and in 22% a combination. Conclusions. The majority of falls owing to hip fracture in elderly people happen in daytime, at home and due to intrinsic risk factors. Efforts to identify elderly people at risk of fall should be stressed in order to establish preventive measures

Identificación desde un servicio de urgencias de la población anciana con riesgo de caída que motiva ingreso hospitalario / Identification of geriatric population at risk of fall from an emergency outpatient service causing hospital admission

Objetivos: Establecer un método de detección precoz de aquellos ancianos con riesgo de caídas que requerirán ingreso hospitalario. Métodos: Estudio prospectivo en pacientes >= 65 años que ingresaron en el Área de Observación del Servicio de Urgencias (AOSU) por cualquier tipo de patología aguda, recogiéndose si la caída era motivo de acudir a urgencias y los antecedentes previos de caídas. Se estableció además una valoración orgánica (mediante el Índice de Comorbilidad de Charlson), cognitiva-afectiva (mediante examen cognitivo SPMSQ de Pfeiffer, la escala de depresión geriátrica de Yessavage, el índice de Reisberg previo al ingreso y el Confussion Assesment Method -CAM-), funcional (mediante el índice de Barthel), el estado nutricional mediante la escala Mini Nutricional Assesment (MNA) y el riesgo de ulceración cutánea por la escala de Norton. Resultados: Se analizaron 1315 pacientes. Ingresaron por caída 127 (9,7 por ciento) con una edad media de 79,9 años (ñ7,6). La caída se asoció al sexo femenino (p<0,014), ancianos de mayor edad (p< 0,001), antecedentes de caídas previas (p<0,001), mayor comorbilidad (p< 0,004), presencia de un estado confusional agudo (p=0,00015) y a mayor deterioro cognitivo (p< 0,001) y funcional (p< 0,042). Mediante análisis estadístico multivariable se identificaron como factores predictores independientes de caída a los antecedentes de caída previa, la escala de Norton, Charlson y Pfeiffer. Conclusiones: Creemos que es posible detectar desde el servicio de urgencias la población anciana con riesgo a sufrir caídas que requerirán ingreso hospitalario, siendo el paciente anciano frágil el más susceptible a nuevas caídas (AU)