Profile and 3-month evolution of geriatric patients after a hip fracture followed-up at a Fracture Liaison Service (FLS) / Perfil y evolución a 3 meses de pacientes con fractura de cadera evaluados en una unidad de coordinación de fracturas (Fracture Liaison Service [FLS])

Introduction: There are few studies on Fracture Liaison Service (FLS) that evaluate older patients after a hip fracture (HF) through comprehensive geriatric assessment. We aim to determine these patients’ characteristics, outcomes, and prescribed treatments.Methods: A retrospective observational study of a cohort of patients older than 65 years admitted with HFs to an orthogeriatric unit between February 25th (2013) and December 16th (2016). After hospitalization, those patients with a good baseline social, functional, and cognitive situation were referred to the FLS. A comprehensive geriatric assessment and treatment adjustment were conducted. A comparison between FLS patients and HF patients non-referred was made.Results: From 1887 patients admitted to the orthogeriatric unit, 469 (23%) were referred to the FLS. Of those, 335 were women (77.2%) and 337 (77.6%) lived in the community. The FLS patients had a better functional status (97.1% of the patients with independent gait versus 79.2%) than non-FLS patients (p<0.001). After 3 months in the FLS, 356 (82%) patients had independent gait and had improved their analytical values. Antiosteoporotic treatment was prescribed to 322 patients (74%), vitamin D supplements to 397 (91.5%), calcium to 321 (74%), and physical exercise to 421 (97%).Conclusions: Patients referred to an FLS were younger, with a better functional and cognitive situation. At hospital discharge, they frequently presented gait impairment and laboratory abnormalities (anemia, hypoproteinemia, vitamin D deficiency) that presented good recovery due to the patient's previous baseline. These patients benefit from comprehensive treatment (pharmacological and non-pharmacological). (AU)

Introducción: Hay pocos estudios sobre las unidades de coordinación de fracturas (Fracture Liaison Services [FLS]) que evalúen a pacientes mayores tras una fractura de cadera (FC) a través de una valoración geriátrica integral. Nuestro objetivo es determinar las características de estos pacientes, los resultados y los tratamientos prescritos.Métodos: Estudio observacional retrospectivo de una cohorte de mayores de 65años ingresados tras fractura de cadera (FC) entre el 25 de febrero de 2013 y el 31 de diciembre de 2016 en una unidad de ortogeriatría. Tras el alta hospitalaria, los pacientes con buen soporte social y buena situación funcional y cognitiva fueron citados en la FLS. Se realizó una evaluación geriátrica integral y un ajuste del tratamiento. Dichos pacientes se compararon con pacientes con fractura de cadera no derivados a esta unidad.Resultados: Un total de 1.887 pacientes ingresaron en la unidad de ortogeriatría, y 469 (23%) fueron derivados a la FLS. De ellos, 335 fueron mujeres (77,2%) y 337 (77,6%) vivían en el domicilio. Los atendidos en la FLS tuvieron mejor funcionalidad (97,1% de pacientes con deambulación independiente versus 79,2%) que los no incluidos (p<0,001). A los 3meses en la FLS, 356 (82%) pacientes presentaban deambulación independiente y habían mejorado sus valores analíticos. Se prescribieron antiosteoporóticos a 332 pacientes (74%), suplementos de vitaminaD a 397 (91,5%), calcio a 321 (74%) y ejercicio físico a 421 (97%).Conclusiones: Los pacientes atendidos en una FLS fueron más jóvenes, con mejor situación funcional y cognitiva. Al alta hospitalaria, frecuentemente presentaron inestabilidad de la marcha y alteraciones analíticas (anemia, hipoproteinemia, déficit de vitamina D) que tuvieron buena evolución dado el estado previo del paciente. Estos pacientes se benefician de un tratamiento integral (farmacológico y no farmacológico). (AU)

Prehabilitation and perioperative geriatric care in patients aged over 80 years with colorectal cancer: Results of a cross-speciality geriatrics program.

OBJECTIVES: To describe a perioperative cross-speciality geriatrics program for patients aged >80 years with colorectal cancer (CRC), aimed to detect and manage frailty and to understand its influence on clinical outcomes. MATERIALS AND METHODS: Patients aged >80 years with CRC and proposed for surgery were included from October 2018 to March 2020. Comprehensive geriatric assessments (CGA) were performed. Patients were classified according to the estimated physiological reserve, from fit, frail patients and even the disabled: CGA-1, CGA-2, CGA-3, and CGA-4. Individualised treatment was adapted to each patient's situation. Patients who underwent surgery were followed up by a geriatrician. The presence of complications, length of stay, hospital readmissions at 30 days, and short- and long-term mortality were recorded. RESULTS: Seventy-four patients were included. The mean age was 84.5 ± 4.5 years. 55.4% patients were classified as CGA-1, 24.3% as CGA-2, 16.2% as CGA-3, and 4.1% as CGA-4. No CGA-4 patient was operated on. Frail (CGA-2 and CGA-3) patients had higher medical complications (50% vs 21.2%, p < 0.05) and delirium (30% vs 9.1%, p < 0.05) than fit patients (CGA-1). They also had higher rates of surgical complications (20% vs 15.2%), longer hospital stay (10 ± 6.2 vs 8.4 ± 4.2 days), 30-day readmissions (15% vs 6.3%), and mortality at six (10% vs 3%) and twelve months (20% vs 6.1%), although it was not statistically significant. CONCLUSION: CGA and prehabilitation can classify patients according to their frailty status, support clinicians in decision-making to achieve tailored treatment, and detect clinical conditions for intervention in multiple domains of health in the perioperative period.

Factors affecting exercise program adherence in patients with acute hip fracture and impact on one-year survival.

OBJECTIVE: To study the adherence of an Early Inpatient Exercise Program in patients with acute hip fracture, identify variables associated with its performance, and its association to one-year survival. METHODS: Observational longitudinal study of a cohort of 509 patients, admitted consecutively with a hip fracture in La Paz University Hospital (Madrid, Spain). Data included sociodemographic variables, pre-fracture physical functioning, cognitive impairment, comorbidities, measure of exercise adherence (pre-surgery exercise, post-surgery exercise, and rehabilitation sessions) and vital status at follow-up. One year after the fracture, either patients or relatives were contacted by telephone to ascertain their vital status. Data were analyzed using logistic regressions and multivariate Cox proportional hazards regression. RESULTS: Three quarters of patients (76.0%) were able to comply with the Early Inpatient Exercise Program. Factors associated with adherence were: living at home (Odds Ratio (OR)=3.39; 95% Confidence Interval (CI): 2.03, 5.64), absence of pre-fracture disability (OR=3.78; 95% CI: 2.21, 6.47), absence of pre-fracture cognitive impairment (OR=2.36; 95% CI: 1.36, 4.07) and comorbidities (OR=1.66; 95% CI: 1.03, 2.67). Early Inpatient Exercise Program adherence was associated with one-year survival (HR=1.62; 95% CI: 1.06, 2.49). CONCLUSIONS: The adherence with an Early Inpatient Exercise Program is high and is associated with 1-year survival. It is important to make a stronger effort to encourage participation in Early Inpatient Exercise Program in the 24% currently non-compliant, and in those with cognitive and physical impairments.

Impacto funcional de la fractura de pelvis por fragilidad. Descripción de una serie de casos consultados al servicio de Geriatría / Functional consequences of fragile pelvis fracture. Description of several cases attended by a consultation Geriatrics team

Introducción. La fractura de pelvis (FP) por fragilidad presenta una incidencia creciente y tiene como consecuencias generar un importante deterioro funcional en el paciente e incrementar la morbimortalidad. El objetivo de este estudio fue conocer las características sociodemográficas y funcionales de los pacientes ingresados con FP consultados a un servicio de Geriatría, especialmente su impacto funcional y la posible influencia de la intervención geriátrica. Material y métodos. Estudio retrospectivo en el que se incluyó a todos los pacientes mayores de 65 años ingresados en el servicio de Traumatología con FP con tratamiento conservador consultados de forma consecutiva al servicio de Geriatría entre 1995 y 2015. Se recogieron variables demográficas (edad, sexo y procedencia), datos de la valoración geriátrica (basal y al ingreso), la estancia hospitalaria, la mortalidad intrahospitalaria y la derivación al alta. Resultados. Se incluyó a 271 pacientes de 81,1±7 años de edad media, predominantemente mujeres (81,2%). La mediana de la estancia global fue de 9 (IC: 5-14) días. La capacidad de deambular de forma autónoma disminuyó tras la FP del 72,3 al 3,6%. Aumentaron los casos de incapacidad severa en las actividades de la vida diaria del 7,9 al 79,5%. La mortalidad intrahospitalaria fue del 2,2%. En las interconsultas de seguimiento médico la estancia media se redujo de forma significativa frente a las interconsultas de valoración (10,0±7,8 vs. 16,1±12,0 días, p<0,001). Conclusión. Los pacientes con FP consultados a Geriatría fueron mayoritariamente mujeres de edad muy avanzada con un deterioro funcional severo secundario a la FP. La intervención de un geriatra podría contribuir a optimizar los recursos hospitalarios (AU)

Introduction. The prevalence of pelvic fracture (PF) due to frailty is increasing, leading to an increase in functional impairment in the patient, as well as increasing morbidity and mortality. The aim of the present study is to gain knowledge about the sociodemographic characteristics, as well as the functional features, of patients admitted to hospital with PF and evaluated by a Geriatrics department. The functional burden of PF and the potential influence of geriatric interventions are also assessed. Material and methods. A retrospective study conducted between 1995 and 2015 on all patients older than 65 years old with PF admitted to the Traumatology department, and then assessed in the Geriatrics Department. Sociodemographic information was also collected (age, gender and place of residence), as well as data from the geriatric assessment (baseline situation and at hospital admission), hospital stay, within hospital mortality, and discharge. Results. The study included 271 patients with a mean age of 81.1±7 years, and mainly women (81.2%). The median hospital stay was 9 days (interquartile range 5 to 14 days). The ability to walk independently decreased after PF from 72.3% to 3.6%. Severe disability cases increased in activities of daily living from 7.9% to 79.5%. Within hospital mortality was 2.2%. As regards medical follow-up consultations, the mean length of stay was significantly reduced compared to the assessment consultations (10.0±7.8 vs 16.1±12.0 days, P<.001). Conclusion. PF patients evaluated by the Geriatrics Department were mainly women, with advanced age, and a severe functional impairment secondary to PF. The intervention of a geriatrician could contribute to optimise hospital resources (AU)

[Functional consequences of fragile pelvis fracture. Description of several cases attended by a consultation Geriatrics team]. / Impacto funcional de la fractura de pelvis por fragilidad. Descripción de una serie de casos consultados al servicio de Geriatría.

INTRODUCTION: The prevalence of pelvic fracture (PF) due to frailty is increasing, leading to an increase in functional impairment in the patient, as well as increasing morbidity and mortality. The aim of the present study is to gain knowledge about the sociodemographic characteristics, as well as the functional features, of patients admitted to hospital with PF and evaluated by a Geriatrics department. The functional burden of PF and the potential influence of geriatric interventions are also assessed. MATERIAL AND METHODS: A retrospective study conducted between 1995 and 2015 on all patients older than 65 years old with PF admitted to the Traumatology department, and then assessed in the Geriatrics Department. Sociodemographic information was also collected (age, gender and place of residence), as well as data from the geriatric assessment (baseline situation and at hospital admission), hospital stay, within hospital mortality, and discharge. RESULTS: The study included 271 patients with a mean age of 81.1±7 years, and mainly women (81.2%). The median hospital stay was 9 days (interquartile range 5 to 14 days). The ability to walk independently decreased after PF from 72.3% to 3.6%. Severe disability cases increased in activities of daily living from 7.9% to 79.5%. Within hospital mortality was 2.2%. As regards medical follow-up consultations, the mean length of stay was significantly reduced compared to the assessment consultations (10.0±7.8 vs 16.1±12.0 days, P<.001) CONCLUSION: PF patients evaluated by the Geriatrics Department were mainly women, with advanced age, and a severe functional impairment secondary to PF. The intervention of a geriatrician could contribute to optimise hospital resources.