[PAPPS update on older people 2022]. / Actividades preventivas en el mayor. Actualización PAPPS 2022.

This article examines the latest available evidence on preventive activities in the elderly, including sleep disorders, physical exercise, deprescription, cognitive disorders and dementias, nutrition, social isolation and frailty.

Benzocarta: intervención mínima para la desprescripción de benzodiacepinas en pacientes con insomnio / Benzoletter: minimal intervention for deprescribing benzodiazepines in patients with insomnia

OBJETIVO: Averiguar si una intervención mediante carta dirigida a usuarios de benzodiacepinas consigue disminuir su consumo. MÉTODO: Estudio antes-después sin grupo control realizado en atención primaria en mayo de 2016. A 1.582 pacientes que tomaban una única dosis diaria de una benzodiacepina como hipnótico durante más de 3 meses se les envió una carta personalizada de su médico de familia con información sobre los efectos desfavorables de dicho consumo y la recomendación para retirarlo, con una pauta de descenso escalonada (Benzocarta). Se evaluó el porcentaje de pacientes que cesaron el consumo de benzodiacepinas, el porcentaje que las disminuyeron y la diferencia en la dosis total dispensada (miligramos equivalentes de diazepam dispensados en 3 meses) entre el periodo preintervención y postintervención (a los 6 y 12 meses). RESULTADOS: Se obtuvieron datos de dispensaciones de 1.561 pacientes (media de edad: 69,3 años; 74% mujeres). Al año de la intervención, el 22,0% (intervalo de confianza del 95% [IC95%]:19,9-24,0) habían abandonado el consumo de benzodiacepinas y el 18,8% (IC95%:16,9-20,8) lo habían disminuido. Se observó una reducción estadísticamente significativa de la dosis total dispensada (media de la diferencia: 89mg; IC95%: 72,2-105,7). CONCLUSIÓN: La Benzocarta se asocia a una disminución relevante en el consumo de hipnóticos. Es una intervención sencilla y factible que puede aplicarse en poblaciones amplias, e incluso de forma repetida en el tiempo. Se requieren estudios controlados para confirmar su eficacia

OBJECTIVE: To determine whether a letter-based intervention to patients taking benzodiazepines reduces their consumption. METHOD: A before-after study without control group performed in primary care in May 2016. 1582 patients who took a single daily dose of benzodiazepines as hypnotic for more than 3 months were sent a personalized letter from their family doctor. The letter contained information about the risks of long-term benzodiazepine consumption and the recommendation to discontinue them with a gradual drop protocol (Benzoletter). The percentage of patients who stopped or decreased the use of benzodiazepines, and the difference in the total dose dispensed (mg equivalents of diazepam dispensed in three months) between the pre- and post-intervention period (at 6 and 12 months) were evaluated. RESULTS: Dispensing data from 1561 patients were collected (average age: 69.3 years; 74% women). Twelve months after the intervention, 22.0% (95% confidence interval [95%CI]: 19.9-24.0) discontinued benzodiazepine consumption and 18.8% (95%CI: 16.9-20.8) reduced their consumption. A statistically significant reduction was observed in the total dose dispensed (mean difference: 89mg; 95%CI: 72.2-105.7). CONCLUSION: The Benzoletter is associated with a significant decrease in the consumption of hypnotics. It is a simple and feasible intervention that allows acting on large populations, and it could even be periodically repeated. Controlled studies are required to confirm its effectiveness

[PAPPS GdT Major 2020 Update]. / Actualización PAPPS GdT Mayor 2020.

In this update, we have introduced new topics that we believe are of vital importance in the major areas, such as the revision of walking aids, as well as recommendations on nutrition and social isolation. Recommendations on deprescribing, fragility, mild cognitive impairment, and dementia have already been presented in previous updates.

[Benzoletter: minimal intervention for deprescribing benzodiazepines in patients with insomnia]. / Benzocarta: intervención mínima para la desprescripción de benzodiacepinas en pacientes con insomnio.

OBJECTIVE: To determine whether a letter-based intervention to patients taking benzodiazepines reduces their consumption. METHOD: A before-after study without control group performed in primary care in May 2016. 1582 patients who took a single daily dose of benzodiazepines as hypnotic for more than 3 months were sent a personalized letter from their family doctor. The letter contained information about the risks of long-term benzodiazepine consumption and the recommendation to discontinue them with a gradual drop protocol (Benzoletter). The percentage of patients who stopped or decreased the use of benzodiazepines, and the difference in the total dose dispensed (mg equivalents of diazepam dispensed in three months) between the pre- and post-intervention period (at 6 and 12 months) were evaluated. RESULTS: Dispensing data from 1561 patients were collected (average age: 69.3 years; 74% women). Twelve months after the intervention, 22.0% (95% confidence interval [95%CI]: 19.9-24.0) discontinued benzodiazepine consumption and 18.8% (95%CI: 16.9-20.8) reduced their consumption. A statistically significant reduction was observed in the total dose dispensed (mean difference: 89mg; 95%CI: 72.2-105.7). CONCLUSION: The Benzoletter is associated with a significant decrease in the consumption of hypnotics. It is a simple and feasible intervention that allows acting on large populations, and it could even be periodically repeated. Controlled studies are required to confirm its effectiveness.

Actividades preventivas en los mayores. Actualización PAPPS 2018 / No disponible

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Actividades preventivas en los mayores / No disponible

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Conclusiones del XII Encuentro Nacional de Jefes de Estudio y Tutores de Formación Sanitaria Especializada, AREDA 2015 (Bilbao, 23-25 de septiembre de 2015) / Conclusions of the 12th National Meeting of Specialised Health Training Heads of Studies and Tutors, AREDA 2015 (Bilbao 23-25 September 2015)

No disponible

Actividades preventivas en los mayores / Preventive activities in older persons

No disponible

El anciano frágil. Detección y tratamiento en AP / The frail elderly. Detection and management in Primary Care

En el artículo se revisa el estado actual en la detección y directrices de tratamiento del anciano frágil desde la AP, que incluye las recomendaciones 2009 del Programa de Actividades Preventivas y de Promoción de la Salud de la Sociedad Española de Medicina Familiar y Comunitaria (PAPPS-semFYC) derivadas de éste, y delimita líneas futuras pertinentes de revisar.La falta de un límite preciso entre la fragilidad y la buena funcionalidad, y con la discapacidad y dependencia, dificulta su definición y delimitación. Las 2 maneras más extendidas en la actualidad para detectar ancianos frágiles son la selección sobre la base de factores de riesgo con consistente predicción de presentar episodios adversos y pérdida funcional (edad avanzada, hospitalización, caídas, alteración de la movilidad y equilibrio, debilidad muscular y poco ejercicio, comorbilidad, condicionantes sociales adversos, polifarmacia), o sobre la base de la pérdida de funcionalidad incipiente o precoz sin que exista todavía un grado ostensible de discapacidad o dependencia, y con posibilidades de reversibilidad o modificación con intervenciones adecuadas; otras opciones de detección, aunque menos empleadas o en fase experimental, son la detección de acuerdo con la existencia de un fenotipo (síndrome geriátrico) según criterios clínicos determinados por Fried, o por marcadores biológicos (estadio preclínico)(AU)

In this article the current state in the detection and management directives of the frail elderly from Primary Care are reviewed. These include the recommendations of the 2009 Preventive Activities Program and Health Promotion of the Spanish Society of Family and Community Medicine (PAPPS-semFYC) and define future lines worthy of review.The lack of defined limits between frailty and good functionality, and with disability and dependency, makes it difficult to diagnose. The two currently most widely methods for detecting the frail elderly are: screening based on risk factors with a sound prediction of suffering adverse events and functional loss (advanced age, hospitalisation, falls, changes in movement and balance, muscle weakness and little exercise, comorbidity, adverse social conditions, multiple medications, etc.) or based on the loss of incipient functionality or early loss if there is still no ostensible degree of incapacity or dependence, and with the possibilities of reversing or modifying it with suitable interventions. Other detection methods, although less used or in the experimental phase include, detection of a phenotype (geriatric syndrome) according to clinical criteria established by Fried, or by biological markers (pre-clinical stage)(AU)

[The frail elderly. Detection and management in Primary Care]. / El anciano frágil. Detección y tratamiento en AP.

In this article the current state in the detection and management directives of the frail elderly from Primary Care are reviewed. These include the recommendations of the 2009 Preventive Activities Program and Health Promotion of the Spanish Society of Family and Community Medicine (PAPPS-semFYC) and define future lines worthy of review. The lack of defined limits between frailty and good functionality, and with disability and dependency, makes it difficult to diagnose. The two currently most widely methods for detecting the frail elderly are: screening based on risk factors with a sound prediction of suffering adverse events and functional loss (advanced age, hospitalisation, falls, changes in movement and balance, muscle weakness and little exercise, comorbidity, adverse social conditions, multiple medications, etc.) or based on the loss of incipient functionality or early loss if there is still no ostensible degree of incapacity or dependence, and with the possibilities of reversing or modifying it with suitable interventions. Other detection methods, although less used or in the experimental phase include, detection of a phenotype (geriatric syndrome) according to clinical criteria established by Fried, or by biological markers (pre-clinical stage).