Characteristics of febrile urinary tract infections in older male adults.

BACKGROUND: Urinary tract infections (UTI) are among the most frequent bacterial infections in older adults. The aim of the study was to analyse the existence of differences in clinical features, microbiological data and risk of infection by multidrug-resistant organisms (MDRO) between older and non-older men with febrile UTI (FUTI). METHODS: This was an ambispective observational study involving older males with a FUTI attended in the Emergency Department. Variables collected included age, comorbidity, diagnostic of healthcare-associated (HCA)-FUTI, clinical manifestations, hospitalization, mortality, and microbiological data. RESULTS: Five hundred fifty-two males with a FUTI, 329 (59.6%) of whom were older adults, were included. Older males had a higher frequency of HCA-FUTI (p <  0.001), increased Charlson scores (p <  0.001), had received previous antimicrobial treatment more frequently (p <  0.001) and had less lower urinary tract symptoms (p <  0.001). Older patients showed a lower frequency of FUTI caused by E. coli (p <  0.001) and a higher rate of those due to Enterobacter spp. (p = 0.003) and P. aeruginosa (p = 0.033). Resistance rates to cefuroxime (p = 0.038), gentamicin (p = 0.043), and fluoroquinolones (p <  0.001) in E. coli isolates and the prevalence of extended-spectrum beta-lactamase and AmpC producing E. coli and Klebsiella spp. strains (p = 0.041) and MDRO (p <  0.001) were increased in older males. Inadequate empirical antimicrobial treatment (p = 0.004), frequency of hospitalization (p <  0.001), and all cause in-hospital mortality (p = 0.007) were higher among older patients. In the multivariate analysis, being admitted from an long term care facility (OR 2.4; 95% CI: 1.06-5.9), having a urinary tract abnormality (OR 2.2; 95% CI: 1.2-3.8) and previous antimicrobial treatment (OR 3.2; 95% CI: 1.9-5.4) were associated to FUTI caused by MDRO. CONCLUSIONS: Older male adults with a FUTI have different clinical characteristics, present specific microbiological features, and antimicrobial resistance rates. In the multivariate analysis being an older male was not associated with an increased risk of FUTI caused by MDRO.

La dislipemia en la población anciana / No disponible

Diversos estudios epidemiológicos y de intervención han establecido de forma clara la relación entre la hipercolesterolemia y el riesgo de padecer una enfermedad cardiovascular arteriosclerótica. De la misma manera, tratamiento con estatinas ha demostrado un beneficio en la prevención primaria y secundaria de enfermedad cardiovascular. Los ensayos clínicos que han incluido población de 65-80 años no son numerosos pero en este grupo de población también se establece una claro beneficio cardiovascular con el tratamiento con estatinas. De hecho, la arteriosclerosis es un fenómeno casi inseparable del envejecimiento y es lógico pensar que la hipercolesterolemia también es un factor de riesgo en la población anciana. En relación con la población de edad superior a 80 años no existen estudios disponibles en la actualidad y la información que se maneja en la práctica clínica se basa en la extrapolación de datos obtenidos en población más joven. El tratamiento hipolipemiante en la población anciana estaría justificado, al menos, hasta los 80 años. Obviamente, el planteamiento de inicio del tratamiento hipolipemiante estaría en función de su calidad de vida previa, de su esperanza de vida y de su situación de riesgo cardiovascular (AU)

Several epidemiological and clinical trials have well established the relationship between hypercholesterolemia and the risk of developing a cardiovascular disease. In the same way, statin therapy have shown a beneficial effect on primary and secondary cardiovascular prevention. There are a small number of elderly people, aged 65-80 years, included in clinical trials with statins but the results have shown the efficacy and usefulness of treating hypercholesterolemia in the elderly. With relation to very elderly people, aged >80, there are no data. The use of hypolipemic drug treatment in elderly people is justified at least until the 80 years. It is important to notice that the decision of treating hyperlipidemia depends on previous quality of life, life expentancy, and risk of cardiovascular disease (AU)

La hipertensión arterial en la población anciana / No disponible

Se estima que la prevalencia de hipertensión arterial (HTA) en la población española de edad>60 años es superior al 65%. Es conocido que la HTA es el factor de riesgo más importante para el desarrollo de una enfermedad cardiovascular, y que ésta sigue siendo la primera causa de muerte en la población occidental. La necesidad de tratamiento de la HTA en la población anciana es un hecho ya ampliamente demostrado y se asocia a una reducción del riesgo de presentar una complicación cardiovascular. Sin embargo, el tratamiento de la HTA en el anciano puede resultar una tarea complicada por la necesidad de tener presente en su manejo clínico una serie de características propias de este grupo de pacientes, como son una farmacocinética alterada, la comorbilidad, o la polifarmacia. Por otra parte, todavía no existen estudios suficientes en el caso de la población más anciana (>85 años) y, en este sentido, el tratamiento individualizado es el que debiera realizarse en nuestra práctica clínica habitual (AU)

The prevalence of essential hypertension in Spanish population elder than 60 years is about 65%. It is known that essential hypertension is the most important risk factor for developing a cardiovascular disease. Cardiovascular diseases continue to be the leading causes of illness and death among adults from developed countries. Several studies have demonstrated the beneficial effects of antihypertensive treatment in hypertensive elderly people. However, managing of high blood pressure in elderly population can be difficult since most of these people have comorbidities that could influence the therapy. On the other hand there are some issues that remainsunanswered in this group of population, such as how aggressively these patients should betreated, and also evidence enough for treating oldest old patients (AU)

Dying in hospital of terminal heart failure or severe dementia: the circumstances associated with death and the opinions of caregivers.

BACKGROUND: Improving the care provided to elderly patients affected by end-stage chronic diseases dying in acute hospitals is a health priority. We evaluated the circumstances related to death in end-stage non-cancer patients dying in two acute care hospitals, and their caregiver's opinions about the death. METHODS: Some 102 patients, over 64 years of age, with end-stage dementia (37%) or congestive heart failure (64%), were included in the study. Caregiver's opinions on the circumstances of death were obtained using a questionnaire. In addition, we collected data regarding written instructions on several items, including do not resuscitate (DNR) orders, decisions about care in terms of the level or intensity of interventions, information provided to relatives about the prognosis, total withdrawal of normal drug therapy, and provision of palliative care. RESULTS: Caregivers stated that the clinical information was accurate in 67.6% of cases, and the control of symptoms was good in 55%. However, the perception of pain persisted in 14% and uncontrolled dyspnoea in 45%. The end-of-life care was assessed as: excellent 30.5%, good 36%, fairly good 25.5%, bad 6%, and very bad 2%. DNR orders were specified in 89% of patients, decisions concerning the intensity of care in 64%, and 80% of relatives were aware of the prognosis. Drug therapy was withdrawn in 64% of cases, and terminal palliative care was initiated in 79.5%. CONCLUSION: Our results suggest that some aspects of the palliative care provided to elderly patients with end-stage chronic diseases, admitted to acute care hospitals, could be improved. Such aspects include the clinical information provided and the successful control of specific symptoms.