ABSTRACT
Fundamento: Analizar las características epidemiológicas, clínicas y funcionales de los pacientes ingresados en el Hospital Universitario de Navarra por infección por SARS-CoV-2, así como los factores predictores de mortalidad, durante la primera ola de la pandemia provocada por este virus. Metodología: Estudio observacional y retrospectivo de todos los pacientes hospitalizados mayores de 75 años entre marzo y noviembre de 2020. Se ha obtenido información sobre múltiples variables, entre las que cabe destacar los síndromes geriátricos previos y que han aparecido durante la hospitalización, o los antecedentes médicos considerados relevantes en la infección por SARS-CoV-2. Se ha realizado un análisis descriptivo de los datos, comparaciones según diversos factores de interés y análisis multivariable para analizar los factores asociados a la mortalidad. Resultados: Se obtuvieron datos de un total de 426 pacientes cuya edad media fue de 83,2 años (52,6% varones). El 34,7% fallecieron en el hospital y el 4,5% antes de un mes tras el alta hospitalaria. Los factores relacionados con la mortalidad fueron: peor situación funcional basal, enfermedad renal crónica y fiebre o disnea como formas de presentación. Los síntomas típicos más frecuentes fueron: fiebre, disnea, tos, astenia e hiporexia. Hasta el 42,1% presentaron delirium como síntoma de inicio atípico. Se objetivó un deterioro funcional que no se recuperó al mes de seguimiento (índice de Barthel basal 81,12; 70,08 al alta; 75,55 al mes). Conclusiones: La infección por SARS-CoV-2 ha provocado elevadas tasas de mortalidad en las personas mayores. En este grupo etario, es frecuente la forma de presentación atípica de esta enfermedad y el deterioro funcional durante la hospitalización. En el presente estudio se ha identificado un peor estado funcional previo como predictor de mortalidad. Son necesarios más estudios que evalúen el impacto que la enfermedad y la hospitalización tienen en el paciente mayor...(AU)
Background: The objective of the present study is to analyze the epidemiological, clinical and functional characteristics of patients admitted to the University Hospital of Navarra due to SARS-CoV-2 infection, as well as the predictors of mortality, during the first wave of the pandemic caused by this virus. Methodology: An observational, retrospective study was performed, including all hospitalized patients older than 75 years. Information has been obtained on multiple variables, among which it is worth mentioning previous geriatric syndromes or those that have appeared during hospitalization, or past medical history considered relevant in SARS-CoV-2 infection. A descriptive analysis of the data, comparisons according to various factors of interest and multivariate analysis to analyze factors associated with mortality were carried out. Results: Data have been obtained from a total of 426 patients with a mean age of 83.2 years (52.6% men). 34.7% died in hospital and 4.5% within 1 month after hospital discharge. The factors related to mortality were: worse baseline functional status, chronic kidney disease, and fever or dyspnea as forms of presentation. The most frequent typical symptoms were: fever, dyspnea, cough, asthenia and hyporexia. Up to 42.1% presented delirium as a symptom of atypical onset. We observed a functional deterioration that was not recover after a month of follow-up (baseline Barthel index 81.12; 70.08 at discharge; 75.55 after a month). Conclusions: SARS-CoV-2 infection has caused high mortality rates in older adults. In this age group, the atypical presentation of this disease and functional deterioration during hospitalization are frequent. In the present study, a worse previous functional status has been identified as a predictor of mortality. More studies are needed to evaluate the impact that the disease and hospitalization have on the older patient...(AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , /epidemiology , Early Diagnosis , Hospitalization , Mortality , Geriatrics , Health of the Elderly , Retrospective Studies , /diagnosisABSTRACT
BACKGROUND: The objective of the present study is to analyze the epidemiological, clinical and functional characteristics of patients admitted to the University Hospital of Navarra due to SARS-CoV-2 infection, as well as the predictors of mortality, during the first wave of the pandemic caused by this virus. METHODOLOGY: An observational, retrospective study was performed, including all hospitalized patients older than 75 years. Information has been obtained on multiple variables, among which it is worth mentioning previous geriatric syndromes or those that have appeared during hospitalization, or past medical history considered relevant in SARS-CoV-2 infection. A descriptive analysis of the data, comparisons according to various factors of interest and multivariate analysis to analyze factors associated with mortality were carried out. RESULTS: Data have been obtained from a total of 426 patients with a mean age of 83.2 years (52.6% men). 34.7% died in hospital and 4.5% within 1 month after hospital discharge. The factors related to mortality were: worse baseline functional status, chronic kidney disease, and fever or dyspnea as forms of presentation. The most frequent typical symptoms were: fever, dyspnea, cough, asthenia and hyporexia. Up to 42.1% presented delirium as a symptom of atypical onset. We observed a functional deterioration that was not recover after a month of follow-up (baseline Barthel index 81.12; 70.08 at discharge; 75.55 after a month). CONCLUSIONS: SARS-CoV-2 infection has caused high mortality rates in older adults. In this age group, the atypical presentation of this disease and functional deterioration during hospitalization are frequent. In the present study, a worse previous functional status has been identified as a predictor of mortality. More studies are needed to evaluate the impact that the disease and hospitalization have on the older patient, with the aim of implementing preventive, diagnostic and therapeutic measures that are necessary to avoid functional deterioration and adverse health events related to it.
Subject(s)
COVID-19 , SARS-CoV-2 , Male , Humans , Aged , Aged, 80 and over , Female , COVID-19/epidemiology , Tertiary Care Centers , Pandemics , Retrospective Studies , Hospitalization , DyspneaABSTRACT
Background Polypharmacy is a common condition among older adults and is associated with adverse drug reactions and health outcomes, including falls, functional and cognitive impairment, and frailty. Methods A prospective observational study will be conducted on older adults with polypharmacy. The aim is to assess the impact of a specialized outpatient clinic focused on pharmacotherapy optimization recently integrated into daily clinical practice in a Spanish public tertiary teaching hospital on patients functional and cognitive abilities. Patients who attend a first consultation and meet inclusion criteria (≥75 years old, have a life expectancy≥3 months, and polypharmacy (≥5 prescribed medications) will be invited to participate in the study, until reach a calculated sample size of 104 participants. Patients will be excluded if they are enrolled in a clinical trial related to medication or in the event of a no-show or cancellation of the appointment at the first visit. Participants will receive usual care: a first consultation including multidisciplinary pharmacological optimization in the context of a CGA and subsequent face-to-face and/or telephone follow-up (∼3 and ∼6 months). The primary endpoint will be the functional (Barthel index) and cognitive change in capacities (IPCR Índice de Incapacidad psíquica de la Cruz Roja). Secondary endpoints include medication changes, changes in patients quality of life, rate of falling, and use of healthcare resources. Discussion We expect that the close collaboration between professionals from different disciplines working together will be an effective strategy to improve the functional and cognitive abilities of older adults. Trial registration ClinicalTrials.gov: NCT05408598 (March 1, 2022) (AU)
Antecedentes La polifarmacia es una condición común entre los adultos mayores, y se asocia a reacciones adversas a medicamentos y a resultados negativos en la salud como caídas, deterioro funcional y cognitivo, y fragilidad. Métodos Se realizará un estudio observacional prospectivo en adultos mayores con polifarmacia. El objetivo es evaluar el impacto de una consulta especializada ambulatoria centrada en la optimización farmacológica y recientemente integrada en la práctica clínica habitual en un hospital universitario público español, sobre las capacidades funcionales y cognitivas de los pacientes. Los pacientes que acudan a una primera consulta y cumplan los criterios de inclusión (≥75 años, tengan una esperanza de vida ≥3 meses, y polifarmacia (≥5 medicamentos prescritos) serán invitados a participar en el estudio, hasta alcanzar un tamaño muestral calculado de 104 participantes. Los pacientes serán excluidos si ya participan en un ensayo clínico relacionado con medicación o en caso de no presentarse o cancelar la consulta inicial. Los participantes recibirán la atención habitual: una primera consulta que incluirá la optimización farmacológica en el contexto de una valoración geriátrica integral (VGI) y un seguimiento posterior presencial y/o telefónico (∼3 y ∼6 meses). La variable principal será el cambio en las capacidades funcionales (índice de Barthel) y cognitivas (Índice de Incapacidad Psíquica de la Cruz Roja [IPCR]) medidas al inicio y durante el seguimiento. Las variables secundarias incluyen cambios en la medicación, en la calidad de vida de los pacientes, en la tasa de caídas y en el uso de recursos sanitarios. Discusión Esperamos que esta estrecha colaboración entre profesionales de diferentes disciplinas que trabajan conjuntamente sea una estrategia eficaz para mejorar las capacidades funcionales y cognitivas de los adultos mayores. Registro del ensayo ClinicalTrials.gov: NCT05408598 (1 de marzo de 2022) (AU)
Subject(s)
Humans , Cognitive Dysfunction/drug therapy , Outpatients , Polypharmacy , Patient Care Team , Prospective StudiesABSTRACT
BACKGROUND: Polypharmacy is a common condition among older adults and is associated with adverse drug reactions and health outcomes, including falls, functional and cognitive impairment, and frailty. METHODS: A prospective observational study will be conducted on older adults with polypharmacy. The aim is to assess the impact of a specialized outpatient clinic focused on pharmacotherapy optimization recently integrated into daily clinical practice in a Spanish public tertiary teaching hospital on patients' functional and cognitive abilities. Patients who attend a first consultation and meet inclusion criteria (≥75 years old, have a life expectancy≥3 months, and polypharmacy (≥5 prescribed medications) will be invited to participate in the study, until reach a calculated sample size of 104 participants. Patients will be excluded if they are enrolled in a clinical trial related to medication or in the event of a no-show or cancellation of the appointment at the first visit. Participants will receive usual care: a first consultation including multidisciplinary pharmacological optimization in the context of a CGA and subsequent face-to-face and/or telephone follow-up (â¼3 and â¼6 months). The primary endpoint will be the functional (Barthel index) and cognitive change in capacities (IPCR - Índice de Incapacidad psíquica de la Cruz Roja). Secondary endpoints include medication changes, changes in patients' quality of life, rate of falling, and use of healthcare resources. DISCUSSION: We expect that the close collaboration between professionals from different disciplines working together will be an effective strategy to improve the functional and cognitive abilities of older adults. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05408598 (March 1, 2022).
Subject(s)
Frailty , Outpatients , Humans , Aged , Quality of Life , Prospective Studies , Cognition , Observational Studies as TopicABSTRACT
INTRODUCTION: The World Health Organisation recently defined the construct of intrinsic capacity (IC), a function-based marker of older adult's health encompassing all mental and physical capacities of the individual. Multicomponent physical exercise (MCE) is a potential intervention capable to maintain/increase IC at older age; however, evidence is scarce on the effects of MCE on IC in cognitively impaired pre-frail/frail older adults. METHODS: Secondary analyses of a randomised clinical trial. One hundred and eighty-eight older outpatients (age = 84.06 ± 4.77, 70.2% women) presenting with pre-frailty/frailty (according to Fried Criteria) and mild cognitive impairment (MCI)/mild dementia were recruited in the Geriatric clinics of three tertiary hospitals in Spain. Subjects were randomised to participate in the 12-week home-based individualised Vivifrail MCE or usual care. An IC index was created based on the z-score of the locomotion (Short Physical Performance Battery), cognitive (Montreal Cognitive Assessment), psychology (15-item Geriatric Depression Scale Yesavage) and vitality (handgrip strength) domains. RESULTS: After the 3-month intervention, linear mixed models showed significant between-group differences in the evolution of the IC composite score (ß=0.48; 95% confidence interval [CI] = 0.24, 0.74; P < 0.001), IC Locomotion (ß = 0.42; 95% CI = 0.10, 0.74; P < 0.001), IC Cognition (ß = 0.45; 95% CI = 0.03, 0.87; P < 0.05) and IC Vitality domains (ß = 0.50; 95% CI = 0.25, 0.74 at 3-month) favouring the MCE group. CONCLUSIONS: The 12-week Vivifrail multicomponent exercise program is an effective strategy to enhance IC, especially in terms of locomotion, cognition and vitality IC domains in community-dwelling older adults with pre-frailty/frailty and MCI/mild dementia, compared to usual care.
Subject(s)
Dementia , Frailty , Humans , Female , Aged , Male , Frail Elderly/psychology , Independent Living , Frailty/diagnosis , Hand Strength , Exercise , Exercise Therapy , Dementia/diagnosis , Dementia/therapyABSTRACT
No disponible
Subject(s)
Humans , Aged , Aged, 80 and over , Coronavirus Infections , Epidemiology , Pandemics , Hospitalization , Mortality , Quality of LifeSubject(s)
Diabetes Mellitus, Type 1 , Aged, 80 and over , Diabetes Mellitus, Type 1/diagnosis , Humans , MaleABSTRACT
OBJECTIVE: The ability to control postural balance is essential to perform most of the activities of daily life, allowing you to maintain an active lifestyle, avoiding falls. However, aging-related changes in sensory systems, neural processing, information conduction, and musculoskeletal mechanics make postural control difficult in older adults. In the evaluation of posturo-graphic parameters, alterations are observed after physical exercise. The objective of this study focused on analyzing the possible influence of age on postural control in an adult population and comparing the differences in postural control due to the regular practice of aerobic physical activity. METHODS: A cross-sectional study was carried out in 116 healthy adults, differentiating them between sedentary and sportsmen (cyclists and runners) and in two age groups (< and ≥ 65 years). Data were collected on the RMS amplitude (root-mean-square) in AP (antero-posterior) and ML (medio-lateral) and the RMS velocity obtained through a force platform in different support and vision conditions. SPSS 15.0 Software was used for the statistical treatment with a significance level of 5%. To compare the dependent variables between the different activity gropus, the t-test and the Mann-Witney were applied (p<0,05), while correlation análisys was applied to study the relationship of age in the postural parameters using p Pearson and Spearman test depending on the distribution of the data. RESULTS: The results reaffirmed the negative influence of physiological aging on postural control mechanisms in the sedentary group, as well as a positive influence of the practice of aerobic exercise regardless of age, with an improvement in balance. More than half of the posturagraphic parameters (PP) were altered in sedentary subjects compared to athletes, who did not show alterations (p<0,05). The RMS-Velocity (mm/s) or distribution of displacement in standing over time, is the parameter with the greatest alteration in all the conditions analyzed (p<0,01), among sedentary subjects regardless of age, not suffering variations among athletes. In relation to the type of sport, we observed better results in cyclists compared to the sedentary group, with less alterations in all PP (RMS-ROM in AP, ML and RMS-Velocity) mainly for single-leg support on a hard surface and with eyes open as well as closed. CONCLUSIONS: We can conclude that the practice of regular aerial exercise is a beneficial activity to improve postural control, preserve the deterioration of balance and prevent falls.
OBJETIVO: La capacidad de controlar el equilibrio postural es fundamental para realizar la mayoría de las actividades de la vida diaria, permitiendo mantener un estilo de vida activo y evitando las caídas. No obstante, los cambios relacionados con el envejecimiento en los sistemas sensoriales, en el procesamiento neuronal, en la conducción de la información y en la mecánica musculo-esquelética dificultan el control postural en los adultos mayores. En la evaluación de los parámetros posturo-gráficos se observan alteraciones tras la realización de ejercicio físico. El objetivo de este estudio se centró en analizar la posible influencia de la edad en el control postural de una población de adultos y comparar las diferencias en el control postural debidas a la práctica regular de actividad física aérobica. METODOS: Se realizó un estudio transversal en 116 adultos sanos, diferenciándolos entre sedentarios y deportistas (ciclistas y corredores), así como en dos grupos de edad (con edad menor y mayor o igual a 65 años). Se recogieron los datos de la amplitud RMS (root-mean-square o media cuadrática del centro de presión) en AP (antero-posterior) y ML (medio-lateral), y de la velocidad RMS, obtenidos a través de una plataforma de fuerza en diferentes condiciones de apoyo y visión. El tratamiento estadístico se realizó con el software SPSS 15.0 con un nivel de significación del 5%. Para comparar las variables dependientes entre los diferentes grupos de actividad se aplicó la prueba t-test y la Mann-Witney (p<0,05), mientras que para estudiar la relación de la edad en los parámetros posturales se aplicó el análisis de correlación mediante la p de Pearson y la prueba de Spearman dependiendo de la distribución de los datos. RESULTADOS: Los valores obtenidos reafirmaron la influencia negativa del envejecimiento fisiológico sobre los mecanismos de control postural en el grupo de sedentarios, así como una influencia positiva de la práctica de ejercicio aeróbico con independencia de la edad, con una mejora del equilibrio. Más de la mitad de los parámetros posturo-gráficos (PP) estaban alterados en los sujetos sedentarios frente a los deportistas, que no mostraron alteraciones (p<0,05). El RMS-Velocity (mm/s) o distribución de desplazamientos en bipedestación a lo largo del tiempo, es el parámetro con mayor alteración en todas las condiciones analizadas (p<0,01) en sujetos sedentarios independientemente de la edad, no sufriendo variaciones en los deportistas. En relación con el tipo de deporte, observamos mejores resultados en los ciclistas frente al grupo de sedentarios, con una menor alteración de los PP (RMS-ROM en AP, ML y RMS-Velocity), en apoyo monopodal en superficie dura tanto con los ojos abiertos como cerrados. CONCLUSIONES: Podemos concluir que la práctica de ejercicio aérobico regular es una actividad beneficiosa para mejorar el control postural, preservar el deterioro del equilibrio y prevenir las caídas.
Subject(s)
Aging/physiology , Exercise/physiology , Postural Balance/physiology , Accidental Falls/prevention & control , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , SpainABSTRACT
The aim of this article is to present the research protocol for a study that will evaluate the feasibility of implementation of Health Arcade prototype multidomain intervention based on physical and cognitive training using gamification technologies at improving care for older people hospitalized with an acute illness. A total of 40 older people will be recruited in a tertiary public hospital at Pamplona, Spain. The intervention duration will be four to nine consecutive days. Additionally, the patients will receive encouragement for maintaining active during hospital stay and for reducing sedentary time. Primary implementation-related outcomes will be the adherence to treatment (i.e., number of games and days completed during the intervention period), reaction or response time, and number of success and failures in each game per day. Secondary implementation-related outcomes will be self-perceived grade of difficulty, satisfaction, enjoyment per game and session, and self-perceived difficulties in handling the prototype hardware. Other health-related outcomes will also be assessed such as functional capacity in activities of daily living, mood status, quality of life, handgrip strength, physical activity levels, and mobility. The current study will provide additional evidence to support the implementation of multidomain interventions designed to target older persons with an acute illness based on friendly technology. The proposed intervention will increase accessibility of in-clinical geriatrics services, improve function, promote recovery of the health, and reduce economic costs.
