Frailty and Fear of Falling: The FISTAC Study.

OBJECTIVE: To analyze the association between frailty and Fear of Falling (FoF) in a cohort of older adults with previous falls. DESIGN: Cross-sectional study (FISTAC). SETTING: Falls Unit, Complejo Hospitalario Universitario of Albacete (Spain). PARTICIPANTS: 183 adults older than 69 years, from the Falls Unit, with a history of a previous fall in the last year. MEASUREMENTS: FoF was assessed at baseline using the Falls Efficacy Scale International (FES-I) and three questions previously validated. Frailty was assessed with the frailty phenotype criteria. Age, gender, comorbidity, nutritional status, cognitive status and risk of depression were determined. RESULTS: Mean age 78.4, 80.3% women. FoF was present in 140 (76.5%) participants with the three questions and 102 (55.7%) presented high concern of falling with the FES-I. 88.8% of frail older adults presented FoF compared to 62.4% of those who were not frail, and only 37.8% of non frail had a high concern of falling, compared to 77.2% of those who were frail measured with the FES-I. Frail participants had an adjusted risk of FoF that was 3.18 (95% CI 1.32 to 7.65) higher compared to those who were not frail assessed with the three questions and 3.93 (95% CI 1.85 to 8.36) higher concern of falling when using the FES-I scale. Only female sex and depression risk were also associated to FoF in the final adjusted models. CONCLUSION: Frailty is independently associated with the FoF syndrome in older faller subjects.

Necesidad de la enseñanza de pregrado en geriatría: aportaciones de un nuevo modelo educativo / Need for undergraduate teaching in geriatrics: contribution of a new educational model

Introducción: analizar la adquisición de conocimientos en la especialidad de Geriatría en estudiantes de la Facultad de Medicina de la Universidad de Castilla-La Mancha (UCLM). Material y métodos: a 93 alumnos de quinto curso de la Facultad de Medicina de la UCLM se les realizó una encuesta antes y después de recibir la asignatura (6 semanas teoricoprácticas basadas en el aprendizaje por problemas). Resultados: después de recibir la asignatura de Geriatría, los alumnos mejoraron sus conocimientos sobre la especialidad, tanto en su utilidad como en la metodología y en la tipología de los principales beneficiarios. Al concluir, el 59,8% identificó al anciano con discapacidad reciente potencialmente recuperable como principal beneficiario de una unidad geriátrica de agudos. Los principales beneficiarios de una unidad de recuperación funcional fueron ancianos con ictus, fracturas de cadera y pérdida de funcionalidad. Las afecciones que más se benefician de la atención en consultas externas son el deterioro cognitivo, el síndrome confusional agudo, la pérdida funcional, las caídas y la pluripatología-polifarmacia. Tras la asignatura se produjo un cambio de opinión en los alumnos hacia que los geriatras son quienes deben abordar el síndrome confusional agudo, el trastorno depresivo, la incontinencia urinaria y las caídas. Tras la formación, hay una tendencia a que más ancianos en situación aguda, con buena función previa y con una enfermedad potencialmente recuperable, como el ictus, sean atendidos por un geriatra. Conclusiones: la enseñanza de pregrado de la Geriatría mejora el conocimiento de la especialidad, aclara cuál es el tipo de paciente que más se beneficia de su metodología de trabajo y prepara a los futuros médicos para prestar mayor calidad en la asistencia a pacientes ancianos

Introduction: to analyse knowledge of geriatrics among students of the Medical Faculty of Castilla-La Mancha University (UCLM) in Spain. Matherial and methods: we performed a survey of 93 fifth-year medical students at the UCLM Medical Faculty before and after they attended a 6-week problem-based training program in geriatrics. Results: after the learning period, the students had a better knowledge of geriatrics, including its utility, methods, and patient characteristics. At the end of the program, 59.8% were able to identify elderly individuals with potentially reversible, recent-onset disability as the principal users of acute geriatric units; those with stroke, hip fracture or functional decline as the main users of geriatric rehabilitation units and those with cognitive or functional decline, confusion, falls or multiple disorders/medications as the main users of outpatient clinics. Students changed their belief that confusion, depression, urinary incontinence and falls have to be managed by geriatricians. After the program students believed that geriatricians managed more elderly people with good functional status and acute, potentially treatable diseases such as stroke. Conclusions: education in geriatrics gives medical students a better understanding of the principal users of geriatric medicine and the methodology used, and prepares them to provide better care to the elderly

[Sensory demyelinating polyneuropathology as a manifestation of paraneoplastic encephalomyelitis associated to adenocarcinoma of the prostate]. / Polineuropatia sensitiva desmielinizante como manifestación de encefalomielitis paraneoplásica asociada al adenocarcinoma de próstata.

INTRODUCTION: Different neurological disorders affecting different levels of the nervous system, both central and peripheral, are included among the paraneoplastic symptomologies of cancers, although their incidence is not well defined and varies according to the type of tumour. CASE REPORT: We report the case of a 73 year old male patient who was admitted with a suspected polyneuropathy that had been developing for one month. The diagnosis was confirmed by electromyography. The only probable aetiology found in the course of a specific exploration was an adenocarcinoma of the prostate, with a widespread distribution throughout the central ganglionic chains and bone metastases, which were observed by computerised tomography of the abdomino pelvic region and bone gammography, and had not previously been diagnosed. CONCLUSIONS: We reviewed the literature on the relation between neurological paraneoplastic syndromes and neoplasias that are not of a pulmonary origin and we found a low rate of association between the two processes. The relation between adenocarcinoma of the prostate and neurological paraneoplastic processes receives very little attention. These syndromes vary greatly in their neurological expression, and there is a link with different antibodies that could explain an etiopathogenic mechanism of an immunitary nature. No effective treatment exists in spite of its usually being aggressive and varied. The disease often progresses quickly and leads to death after a few months.

Polineuropatía sensitiva desmielinizante como manifestación de encefalomielitis paraneoplásica asociada al adenocarcinoma de próstata / Sensory demyelinating polyneuropathology as a manifestation of paraneoplastic encephalomyelitis associated to adenocarcinoma of the prostate

Introducción. Dentro de la sintomatología paraneoplásica de los cánceres se incluye la afectación neurológica a distintos niveles del sistema nervioso, tanto central como periférico, sin que esté bien definida su incidencia, variando la misma según el tipo de tumor. Caso clínico. Presentamos el caso de un varón de 73 años que ingresa por sospecha de polineuropatía de un mes de evolución. El diagnóstico se confirmó por electromiografía. Al efectuarse el estudio específico se encontró como única probable etiología un adenocarcinoma de próstata, con una amplia extensión en las cadenas ganglionares centrales y metástasis óseas, objetivadas por una tomografía computarizada abdominopélvica y gammagrafía ósea, no diagnosticado previamente. Conclusiones. Realizamos una revisión bibliográfica sobre la relación existente entre los síndromes paraneoplásicos neurológicos y las neoplasias de origen no pulmonar, en la que se ha encontrado una baja frecuencia de asociación entre ambos procesos, con escasas reseñas en la literatura sobre la asociación entre el adenocarcinoma de próstata y los procesos paraneoplásicos neurológicos. Existe una gran diversidad de expresión neurológica de estos síndromes, así como una asociación a distintos anticuerpos que podrían explicar un mecanismo etiopatogénico de carácter inmunitario. No existe un tratamiento efectivo a pesar de que éste suele ser agresivo y variado. El curso es con frecuencia rápidamente progresivo y conduce a la muerte en pocos meses (AU)

Introduction. Different neurological disorders affecting different levels of the nervous system, both central and peripheral, are included among the paraneoplastic symptomologies of cancers, although their incidence is not well defined and varies according to the type of tumour. Case report. We report the case of a 73-year-old male patient who was admitted with a suspected polyneuropathy that had been developing for one month. The diagnosis was confirmed by electromyography. The only probable aetiology found in the course of a specific exploration was an adenocarcinoma of the prostate, with a widespread distribution throughout the central ganglionic chains and bone metastases, which were observed by computerised tomography of the abdomino-pelvic region and bone gammography, and had not previously been diagnosed. Conclusions. We reviewed the literature on the relation between neurological paraneoplastic syndromes and neoplasias that are not of a pulmonary origin and we found a low rate of association between the two processes. The relation between adenocarcinoma of the prostate and neurological paraneoplastic processes receives very little attention. These syndromes vary greatly in their neurological expression, and there is a link with different antibodies that could explain an etiopathogenic mechanism of an immunitary nature. No effective treatment exists in spite of its usually being aggressive and varied. The disease often progresses quickly and leads to death after a few months (AU)

[The prevalence of dementia and its main subtypes in subjects older than 65 years: impact of occupation and education. The Toledo Study]. / Prevalencia de demencia y de sus subtipos principales en sujetos mayores de 65 años: efecto de la educación y ocupación. Estudio Toledo.

BACKGROUND: To assess the prevalence of dementia and its subtypes in a population with a low level of education, and to determine whether there is any association between occupation, education and dementia. SUBJECTS AND METHOD: Cross-section study of the population, with a sample of 3,214 individuals representative of the population of Toledo, Spain, aged 65 years and older. The Mini-Mental State Examination (MMSE) was used in the first phase of the study to detect those individuals with cognitive deterioration. The second phase consisted of a semi-structured clinical interview and neuropsychological evaluation. Dementia and sub-types of dementia were determined using well-established diagnostic criteria. The process was applied using an algorithm to optimise diagnostic agreement. RESULTS: The overall prevalence of dementia, Alzheimer's disease and vascular dementia amounted to 7.6, 4.6 and 1.8%, respectively. A direct relationship was detected between these three entities and age. The prevalence of dementia was greater in women, illiterate persons and occupations which require less skill. Once adjustment had been made for other socio-demographic variables, only age was associated with the presence of dementia. CONCLUSIONS: The overall prevalence of dementia, Alzheimer's type dementia and vascular dementia increases with age. No clear association was found between education, occupation and dementia.

Factores de riesgo de ingreso hospitalario en mayores de 64 años / Risk factors for hospitalization among the elderly

Objetivo: Determinar los factores asociados al ingreso hospitalario en una muestra representativa de la población mayor de 64 años. Diseño y participantes: Estudio de cohorte sobre una muestra de 3.214 sujetos representativa de la población de 65 y más años del partido judicial de Toledo (Castilla-La Mancha).Método: Entrevista personal en el domicilio del sujeto donde se recogen: datos sociodemográficos, carga de enfermedad, situación funcional en actividades de autocuidado e instrumentales, presencia de deterioro cognitivo y trastorno del ánimo, salud autopercibida y utilización previa de recursos sanitarios. Se analiza la presencia de ingreso hospitalario en los 12 meses que siguen a la entrevista en cualquiera de los tres hospitales que atienden el mencionado área. Resultados: 342 (10,6 por ciento) de los sujetos ingresaron en una ocasión al menos en el año siguiente a la realización de la entrevista. En el modelo logístico resultaron factores de riesgo de ingreso hospitalario: la edad avanzada (OR: 1,02), el sexo masculino (OR: 1,37), la presencia de cardiopatía (OR: 1,97) o broncopatía (OR: 1,57), el déficit visual incapacitante (OR: 1,88), la pobre salud autopercibida (OR: 1,37), la dependencia en actividades de autocuidado (OR: 1,45) y haber utilizado previamente el hospital (OR: 3,45). La ingesta de alcohol resultó un factor protector (OR: 0,70). Conclusiones: Las circunstancias asociadas a precisar ingreso hospitalario son multifactoriales. El ingreso anterior es el factor de riesgo de mayor magnitud a la hora de predecir una nueva admisión (AU)

[Risk factors for hospital admission in persons older than 64-years of age]. / Factores de riesgo de ingreso hospitalario en mayores de 64 años.

OBJECTIVE: To determine factors associated with hospitalization in a representative sample of population older than 64 years. DESIGN AND PARTICIPANTS: Cohort study on a sample of 3,214 representative subjects of the population 65 years and older from the judicial district of Toledo (Spain). METHOD: Personal home interview collecting data on: sociodemographic factors, comorbidity, basic and instrumental activities of daily life, conigitive decline and depressive disorder, self-rated health and previous use of health services. Hospital discharge in the 12-month period after the interview in anyone of the three hospitals in the study area were analyzed. RESULTS: 342 (10.6%) of the subjects spent at least one night in the hospital in the year after the accomplishment of the interview. Risk factors for hospitalization in the logistical model were: advanced age (OR: 1.02), male sex (OR: 1.37), presence of cardiopathy (OR: 1.97) or chronic obstruction to airflow (OR: 1.57), visual deficit (OR: 1.88), worse self-rated health (OR: 1.37) and having used the hospital previously (OR: 3.45). Alcohol consumption was a protective factor (OR: 0.70). CONCLUSIONS: Risk factors for hospitalization are of diverse origin. The previous admission is the strongest predictive factor for new hospitalization.