[Consensus statement on the use of acetaminophen/tramadol in patients with moderate-severe pain]. / Documento de consenso sobre el uso de la combinación paracetamol/tramadol en pacientes con dolor moderado-intenso.

OBJECTIVES: To present recommendations on the use of the paracetamol/tramadol (P/T) combination in patients with moderate-intense pain based on best evidence and experience. METHODS: The method of nominal groups and Delphi was followed, and supported by a systematic literature review (SLR). A multidisciplinary panel of 12 experts in pain management was selected. In the first nominal group meeting, the aim, scope, users, and sections of the consensus document, were defined, along with the preliminary general recommendations. For the SLR, the inclusion and exclusion criteria, as well as the search strategies, were defined. Two reviewers selected and analysed the articles. This evidence was discussed in a second nominal group meeting, and definitive recommendations were developed. For each recommendation, the evidence levels and grade of recommendation grades were classified according to the Oxford model, and the grade according to the Delphi technique. It was defined as an agreement if at least 70% of the participants scored ≥7 for each recommendation (1=total disagreement to 10=total agreement). RESULTS: A total of 20 recommendations were produced, which covered general aspects, such as the assessment of pain, and those specific to P/T management. These latter included the indications of the P/T combination (patient profile, dosing, prescription, formulations), risk management (contraindications, precautions, interactions, concomitant use with other medications, follow-up, special situations), and patient education. CONCLUSIONS: These recommendations attempt to resolve any of the routine clinical questions, and help in the making of decisions on the use of the P/T combination in patients with moderate-intense pain.

Clinical evidence of diabetes mellitus end-organ damage as risk factor for falls complicated by hip fracture: A multi-center study of 1225 patients.

AIMS: To identify the differential characteristics of patients with type 2 diabetes mellitus (T2DM) complicated by end-organ damage who experience a fall-related hip fracture. METHODS: We analyzed the socio-demographic data and index fall clinical characteristics of a group of patients with nephropathy, neuropathy or retinopathy related to T2DM consecutively admitted to six hospitals in Barcelona, Spain because of a fall-related hip fracture. RESULTS: Out of 1225 patients admitted because of a fall-related hip fracture, 107 (8.7%) had clinical evidence of end-organ damage related to T2DM. Among this cohort the mean number of falls during the year prior to the index admission was 2.6±3.2; and 29 of them (27.1%) had already experienced three or more falls. Most falls leading to the index admission took place at the patients' home, from a standing position, and during daylight time. An intrinsic cause of falling was identified in all but one of these patients. Multiple stepwise logistic regression analysis showed that, compared to patients without this diagnosis, patients with complicated T2DM were younger (odds ratio 0.762), had less prevalence of dementia (odds ratio 0.078), but had experienced a higher number of falls in the previous year (odds 1.183). CONCLUSIONS: A significant amount of patients with clinical evidence of end-organ damage due to T2DM who experience a fall-related hip fracture have a history of recurrent falling in the previous year. These patients should be identified and offered preventive actions aimed at reducing their risk of falling.

[Mortality-associated factors in nonagenarian. The Nona-Santfeliu Study. Two years of follow-up]. / Factores asociados a mortalidad en nonagenarios. Estudio NonaSantfeliu. Seguimiento a los dos años.

OBJECTIVES: Few studies have prospectively evaluated predictors of mortality in the very elderly. This study has aimed to determine which factors could predict death in nonagenarians after two years of follow-up. PATIENTS AND METHOD: 176 nonagenarians were evaluated prospectively, 137 (74%) of whom lived in their own home and 49 (26%) of whom were institutionalized. Sociodemographic data were collected. Functional status was determined by the Lawton-Brody and the Barthel index, and cognition by the Spanish version of the Mental State Examination (MEC). The Charlson index was used to measure overall co-morbidity. RESULTS: The sample consisted of 135 women (76.3%) and 41 men. Mean age was 93 +/- 3.2 years. Mean Barthel index was 60.8 +/- 30, Lawton index 2.1 +/- 2.2 and MEC 21 +/- 11. The mean of Charlson index was 1.4 +/- 1.7. Six-four patients had died after two years of follow-up (36.3%). Charlson index (oR 1.370, 95% Ci 1.113-1.686, p < 0.003), Lawton index (OR 0.750, 95% CI 0.586-0.960, p < 0.02) and MEC (OR 0.964, 95% CI 0.932-0.997, p < 0.003) were variables independently associated with death after 24 months of follow-up. CONCLUSION: Higher comorbidity, incapacity to perform instrumental ADL at baseline and poor cognitive status are predictors of mortality after 2 years of follow-up in nonagenarians.

Factores asociados a mortalidad en nonagenarios. Estudio NonaSantfeliu. Seguimiento a los dos años / Mortality-associated factors in nonagenarian. The Nona-Santfeliu Study. Two years of follow-up

Objetivos. Pocos estudios han evaluado los factores predictores de mortalidad en las personas muy ancianas. El objetivo del presente estudio fue evaluar qué factores podían predecir la muerte en pacientes nonagenarios después de dos años de seguimiento. Pacientes y método. Se evaluaron 176 nonagenarios, de los que el 73% vivían en su domicilio y el resto en residencia. Se recogieron datos sociodemográficos, la capacidad para realizar actividades básicas con el índice de Barthel (IB) y para instrumentales con el índice de Lawton (IL). Se valoró la cognición con el miniexamen cognitivo de Lobo (MEC) y la comorbilidad con el índice de Charlson. Resultados. Se trataba de 135 mujeres (76,3%) y 41 varones, con una edad media de 93 ± 3 años. La media del IB fue 60,8 ± 30, la del IL 2,1 ± 2,2, la del MEC 21 ± 11 y la del índice de Charlson 1,4 ± 1,7. Sesenta y cuatro pacientes habían fallecido a los dos años de seguimiento (36,3%). El índice de Charlson (OR: 1,370; IC 95%: 1,113-1,686; p < 0,003), IL (OR: 0,750; IC 95%: 0,586-0,960; p < 0,02) y MEC (OR: 0,964; IC 95%: 0,932-0,997; p < 0,003), resultaron factores independientes de mortalidad a los 2 años de seguimiento. Conclusiones. Una mayor comorbilidad, la incapacidad para realizar actividades instrumentales y la disfunción cognitiva son predictores de mortalidad después de 2 años de seguimiento en las personas mayores de 89 años (AU)

Objectives. Few studies have prospectively evaluated predictors of mortality in the very elderly. This study has aimed to determine which factors could predict death in nonagenarians after two years of follow-up. Patients and method. 176 nonagenarians were evaluated prospectively, 137 (74%) of whom lived in their own home and 49 (26%) of whom were institutionalized. Sociodemographic data were collected. Functional status was determined by the Lawton-Brody and the Barthel index, and cognition by the Spanish version of the Mental State Examination (MEC). The Charlson index was used to measure overall co-morbidity. Results. The sample consisted of 135 women (76.3%) and 41 men. Mean age was 93 ± 3.2 years. Mean Barthel index was 60.8 ± 30, Lawton index 2.1 ± 2.2 and MEC 21 ± 11. The mean of Charlson index was 1.4 ± 1.7. Six-four patients had died after two years of follow-up (36.3%). Charlson index (oR 1.370, 95% Ci 1.113-1.686, p < 0.003), Lawton index (OR 0.750, 95% CI 0.586-0.960, p < 0.02) and MEC (OR 0.964, 95% CI 0.932-0.997, p < 0.003) were variables independently associated with death after 24 months of follow-up. Conclusion. Higher comorbidity, incapacity to perform instrumental ADL at baseline and poor cognitive status are predictors of mortality after 2 years of follow-up in nonagenarians (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.

[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.