An update on the study of synovial fluid in the geriatric patient.

BACKGROUND: The characteristics of synovial fluid (SF) in geriatric patients differ from those in younger patients. In Mexico, epidemiologic data on the incidence of different rheumatic diseases in geriatric patients are scarce. OBJECTIVE: To describe the physical characteristics of geriatric SF and the prevalence of crystals in knee and other joint aspirates from patients with previously diagnosed joint disease. MATERIALS AND METHODS: A retrospective study was performed with a baseline of 517 SF samples between 2011 and 2023. White blood cell count was performed by Neubauer chamber and crystals were identified by polarized light microscopy. Descriptive statistical analysis was performed and prevalence was reported as a percentage. RESULTS: The mean age of the adults was 73.5±5.0 years, 54.4% were women and 45.6% were men. The mean SF volume was 6.3±9.5mL in older adults and 15.3±24.9mL in those younger than 65 years. The mean viscosity in older adults was 9.5±4.5mm and the mean leukocyte count was 7352±16,402leukocytes/mm3. Seventy percent of the older adults' SFs were referred to the laboratory for osteoarthritis (OA), with lower proportions for rheumatoid arthritis (RA) (14.6%) and gout (5.1%). Of the crystals observed in the geriatric population, 14.6% corresponded to monosodium urate crystals (CUM) and 18.9% to calcium pyrophosphate crystals (CPP). CONCLUSIONS: The characteristics of LS in older adults were smaller volume, increased viscosity, and non-inflammatory. The main diagnoses were OA, RA, and gout. The crystal content of the SF of the geriatric population corresponded mainly to CPP.

An update on the study of synovial fluid in the geriatric patient / Panorama actual del estudio de líquido sinovial en el paciente geriátrico

Background: The characteristics of synovial fluid (SF) in geriatric patients differ from those in younger patients. In Mexico, epidemiologic data on the incidence of different rheumatic diseases in geriatric patients are scarce. Objective: To describe the physical characteristics of geriatric SF and the prevalence of crystals in knee and other joint aspirates from patients with previously diagnosed joint disease. Materials and methods: A retrospective study was performed with a baseline of 517 SF samples between 2011 and 2023. White blood cell count was performed by Neubauer chamber and crystals were identified by polarized light microscopy. Descriptive statistical analysis was performed and prevalence was reported as a percentage. Results: The mean age of the adults was 73.5±5.0 years, 54.4% were women and 45.6% were men. The mean SF volume was 6.3±9.5mL in older adults and 15.3±24.9mL in those younger than 65 years. The mean viscosity in older adults was 9.5±4.5mm and the mean leukocyte count was 7352±16,402leukocytes/mm3. Seventy percent of the older adults’ SFs were referred to the laboratory for osteoarthritis (OA), with lower proportions for rheumatoid arthritis (RA) (14.6%) and gout (5.1%). Of the crystals observed in the geriatric population, 14.6% corresponded to monosodium urate crystals (CUM) and 18.9% to calcium pyrophosphate crystals (CPP). Conclusions: The characteristics of LS in older adults were smaller volume, increased viscosity, and non-inflammatory. The main diagnoses were OA, RA, and gout. The crystal content of the SF of the geriatric population corresponded mainly to CPP.(AU)

Antecedentes: Las características del líquido sinovial (LS) en pacientes geriátricos varían en comparación con pacientes más jóvenes. En México, los datos epidemiológicos sobre la incidencia de diversas enfermedades reumáticas en el paciente geriátrico son escasos. Objetivo: Describir las características físicas del LS geriátrico y la prevalencia de cristales en aspirados de rodilla y otras articulaciones de pacientes con enfermedades articulares previamente diagnosticadas.Materiales y métodos: Se realizó un estudio retrospectivo con una base de 517 muestras de LS entre 2011 y 2023. El recuento de glóbulos blancos se realizó con cámara de Neubauer, y los cristales se identificaron por microscopia de luz polarizada. Se realizó un análisis estadístico descriptivo y la prevalencia se reportó como porcentaje. Resultados: La edad promedio en los adultos fue de 73,5±5,0 años; el 54,4% fueron mujeres y el 45,6%, hombres. El volumen promedio del LS en adultos mayores fue de 6,3±9,5ml, mientras que en menores de 65 años fue de 15,3±24,9ml. La viscosidad promedio fue de 9,5±4,5mm en los adultos mayores, y una cuenta de 7.352±16.402 leucocitos/mm3. El 70% de los LS de los adultos mayores fueron remitidos a laboratorio por osteoartritis (OA), u una proporción más baja, por artritis reumatoide (AR) (14,6%) y gota (5,1%). En cuanto a los cristales observados en los LS de la población geriátrica, el 14,6% correspondieron a cristales de urato monosódico (CUM) y el 18,9%, a cristales de pirofosfato de calcio (CPP). Conclusiones: Las características del LS en los adultos mayores fueron menor volumen, viscosidad incrementada y no inflamatorios. Los principales diagnósticos fueron OA, AR y gota. El contenido de los cristales en los LS de la población geriátrica correspondió principalmente a CPP.(AU)

Nivel de conocimientos sobre lesiones premalignas bucales en pacientes geriátricos

Fundamento: El nivel de conocimiento sobre lesiones premalignas en la población geriátrica es un factor significativo que incide en la prevención, evitando la progresión a un cáncer bucal. Objetivo: Identificar el nivel de conocimiento de los pacientes geriátricos sobre las lesiones premalignas bucales. Metodología: Entre septiembre de 2019 y junio de 2021 se realizó un estudio observacional descriptivo transversal en el Consultorio Médico de la Familia # 12 del municipio Cabaiguán, provincia Sancti Spíritus. La población estuvo constituida por 158 pacientes geriátricos y mediante un muestreo probabilístico aleatorio simple la muestra quedó conformada por 80. Se aplicaron métodos del nivel teórico, empírico, estadístico y matemático. Las variables utilizadas fueron edad, sexo, escolaridad, nivel de conocimiento sobre factores de riesgo y signos clínicos, conocimientos sobre el autoexamen bucal y la conducta a seguir. Resultados: Se constató que el nivel de conocimientos sobre factores de riesgo fue regular y sobre signos clínicos y forma y frecuencia del autoexamen bucal fue mal. La mayoría de la muestra en estudio conocía donde acudir y afirmó haber recibido información al respecto. Conclusiones: En su mayoría el nivel de conocimientos sobre lesiones premalignas se observó entre regular y mal con un descenso significativo del nivel de conocimientos en los pacientes de edades más avanzadas.

Background: The knowledge level about premalignant lesions in the geriatric population is a significant factor that influences on prevention, avoiding progression into mouth neoplasms. Objective: To diagnose the knowledge level in geriatric patients about buccal premalignant lesions. Methodology: A cross-sectional descriptive observational study was conducted between September 2019 and June 2021 at the Family Medical Office # 12 of Cabaiguán municipality, Sancti Spíritus province. The population was constituted by 158 geriatric patients and by means of a simple random probabilistic sampling, the sample was made up by 80. Theoretical, empirical, statistical and mathematical methods were applied. The used variables were age, sex, schooling, risk factors and clinical signs knowledge, knowledge of buccal self-examination and conduct to be followed. Results: The knowledge level about risk factors was found to be regular and on clinical signs and form and frequency of buccal self-examination was bad. The majority of the sample under study knew where to go and affirmed that they had received information about it. Conclusions: Mostly the knowledge level of premalignant lesions was observed to be regular to bad with a significant decrease in the knowledge level in more elderly patients.

Evaluación clínica y social de pacientes depresivos en un programa de Hospital de Día Psicogeriátrico / Clinical and social evaluation of depressed patients in a Psychogeriatric Day Hospital program

Fundamento. El objetivo de este estudio fue identificar los problemas de los pacientes con sintomatología depresiva grave (GDS >9) mediante la escala HoNOS65+, evaluar la efectividad de un programa de hospitalización parcial para reducir los síntomas depresivos graves a GDS ≤ 9, e identificar los predictores de respuesta. Material y métodos. Estudio pre-post de pacientes con sintomatología depresiva grave tratados en el Hospital de Día Psicogeriátrico (HDPG) de Pamplona (España) entre 2013 y 2020. Se compararon las puntuaciones obtenidas en las escalas HoNOS65+, MMSE, GDS, BARTHEL, ALSAR y COTE al ingreso y al alta, y se determinaron los factores pronósticos de no mejora. Resultados. El 75,3% de los 81 pacientes fueron mujeres, con edad media 69,9 años (rango: 57-88). Al alta, la sintomatología depresiva grave se mantuvo en el 25,9% de los pacientes, los cuales mejoraron significativamente en las escalas HoNOS65+ total y COTE, pero mantuvieron los problemas de deterioro físico e incrementaron los cognitivos. Los pacientes con GDS ≤ 9 al alta redujeron significativamente los problemas presentados al ingreso, excepto el nivel de dependencia (Barthel). Al ingreso, los pacientes que no mejorarán mostraron mayores puntuaciones en sintomatología depresiva (GDS) y en problemas conductuales y sociales (HoNOS65+); las tres variables fueron predictores independientes de no mejora de la sintomatología depresiva grave. Conclusiones. El programa del HDPG impactó positivamente en los pacientes mayores con sintomatología depresiva grave. La mejoría clínica y social alcanzada apoya el formato de HDPG como una alternativa adecuada para la atención de estos pacientes.(AU)

Background. The aim of this study was to identify the problems of patients with severe depressive symptoms (GDS>9) according to the HoNOS+65 scale, to evaluate the effectiveness of a partial hospitalization program to reduce severe depressive symptoms, and to identify independent predictors. Methods. Pre-post study of patients with depression treated at the psychogeriatric Day Hospital (HDPG) of Pamplona (Spain). The scores obtained on the HoNOS+65, MMSE, GDS, BARTHEL, ALSAR, and COTE scales were compared at admission and discharge, and the prognostic factors for no improvement of severe depressive symptoms were determined. Results. The 75.3% of the 81 patients were women, with a mean age of 69.9 years (range: 57-88). At discharge, severe depressive symptoms only remained for 25.9%, who significantly improved on the HoNOS+65 total and COTE scales while problems of physical deterioration were maintained and cognitive ones increased. Patients with GDS <9 at discharge showed significant reductions in all the problems presented at admisión, except for the level of dependency (Barthel). On admission, the patiens who did not improve showed more severe despressive symptoms and greater behavioral and social problems: the three variables were independent predictors for no improvement of severe depressive symptoms. Conclusions. The HDPG program had a positive impact on patients with severe depressive symptoms. The clinical and social improvement achieved supports the HDPG format as an adequate alternative for the care of elderly patients with severe depressive symptoms.(AU)

Cardiac complications in a geriatric population hospitalized with COVID-19: The OCTA-COVID cohort.

PURPOSE: The geriatric population is especially vulnerable to coronavirus disease (COVID-19) and its potential complications. We sought to analyze the incidence of cardiological complications in an elderly population hospitalized for COVID-19. METHODS: A prospective observational longitudinal that included patients ≥75 years of age with diagnosis of COVID-19 admitted to the Geriatric Department from March to May 2020. Epidemiological, geriatric, clinical and laboratory test variables were collected. Cardiovascular events, including de novo atrial fibrillation (AF), acute coronary syndrome (ACS), congestive heart failure (CHF), pulmonary embolism and in-hospital death, were documented. A follow-up was carried out at 12 months through a telephone interview as well as using electronic medical records, collecting cardiac events and mortality. RESULTS: 305 patients were included; 190 (62.3%) were female, with median age of 87 years (interquartile range (82-91)). More than half of the patients had a history of cardiac disease, with AF being the most common and affecting 85 (27.9%) patients. During hospitalization, 112 (36.7%) patients died. Eighty-nine (29.2%) patients presented cardiac complications. Acute heart failure was the most prevalent (46; 15.1%), followed by new-onset AF (20; 6.5%), pulmonary embolism (17; 5.6%), and ACS (5; 1.6%). Patients with cardiac complications had a longer hospital stay (p<0.001). During follow-up, 29 (15.1%) died, and 40 (20.8%) patients had a cardiovascular event being CHF the most prevalent complication (16.7%). CONCLUSION: The incidence of cardiovascular complications in geriatric patients is high and is associated with a longer hospital stay. CHF was the most frequent event, followed by AF.

Cardiac complications in a geriatric population hospitalized with COVID-19: The OCTA-COVID cohort / Complicaciones cardiacas en una población geritrica hospitalizada por COVID-19: La cohorte OCTA-COVID

Purpose: The geriatric population is especially vulnerable to coronavirus disease (COVID-19) and its potential complications. We sought to analyze the incidence of cardiological complications in an elderly population hospitalized for COVID-19.Methods: A prospective observational longitudinal that included patients ≥75 years of age with diagnosis of COVID-19 admitted to the Geriatric Department from March to May 2020. Epidemiological, geriatric, clinical and laboratory test variables were collected. Cardiovascular events, including de novo atrial fibrillation (AF), acute coronary syndrome (ACS), congestive heart failure (CHF), pulmonary embolism and in-hospital death, were documented. A follow-up was carried out at 12 months through a telephone interview as well as using electronic medical records, collecting cardiac events and mortality.Results:305 patients were included; 190 (62.3%) were female, with median age of 87 years (interquartile range (82–91)). More than half of the patients had a history of cardiac disease, with AF being the most common and affecting 85 (27.9%) patients. During hospitalization, 112 (36.7%) patients died. Eighty-nine (29.2%) patients presented cardiac complications. Acute heart failure was the most prevalent (46; 15.1%), followed by new-onset AF (20; 6.5%), pulmonary embolism (17; 5.6%), and ACS (5; 1.6%). Patients with cardiac complications had a longer hospital stay (p<0.001). During follow-up, 29 (15.1%) died, and 40 (20.8%) patients had a cardiovascular event being CHF the most prevalent complication (16.7%). (AU)

Introducción: La población geriátrica es especialmente vulnerable a la enfermedad por coronavirus (COVID-19) y sus posibles complicaciones. Nos propusimos analizar la incidencia de complicaciones cardiológicas en una población anciana hospitalizada por COVID-19.Métodos: Estudio longitudinal observacional prospectivo que incluyó a pacientes≥75 años con diagnóstico de COVID-19 ingresados en el Servicio de Geriatría de marzo a mayo de 2020. Se recogieron variables epidemiológicas, geriátricas, clínicas y de laboratorio. Se documentaron eventos cardiovasculares, que incluyen fibrilación auricular (FA) de novo, síndrome coronario agudo, insuficiencia cardíaca congestiva, embolia pulmonar y muerte intrahospitalaria. Se realizó un seguimiento a los 12 meses, mediante entrevista telefónica y accediendo a la historia clínica electrónica, recogiendo eventos cardíacos y mortalidad.Resultados: Se incluyeron 305 pacientes; 190 (62,3%) eran mujeres, con una mediana de edad de 87 años (rango intercuartílico: 82-91). Más de la mitad de los pacientes tenían antecedentes de enfermedad cardíaca, siendo la FA la más frecuente y afectando a 85 (27,9%) pacientes. Durante la hospitalización fallecieron 112 (36,7%) pacientes. Ochenta y nueve (29,2%) pacientes presentaron complicaciones cardíacas. La insuficiencia cardíaca congestiva aguda fue la más prevalente (46; 15,1%), seguida de la FA de nueva aparición (20; 6,5%), la embolia pulmonar (17; 5,6%) y el síndrome coronario agudo (5; 1,6%). Los pacientes con complicaciones cardíacas tuvieron una estancia hospitalaria más prolongada (p<0,001). Durante el seguimiento fallecieron 29 pacientes (15,1%) y 40 (20,8%) presentaron un evento cardiovascular, siendo la insuficiencia cardíaca congestiva la complicación más prevalente (16,7%). (AU)

[Nutritional status and associated factors in ambulatory elderly patients]. / Estado nutricional y factores asociados en pacientes ancianos ambulatorios.

OBJECTIVE: To analyze the nutritional status (NS) of patients older than 65 years and establish their relationship with sociodemographic and health variables. DESIGN: Cross-sectional observational study in patients older than 65 years. LOCATION: 3 health centers. PARTICIPANTS: 255 patients: ambulatory (AP), in domiciliary care (DP) or institutionalized (IP). They completed the study 243 (response rate 95.3%). MAIN MEASUREMENTS: The Chang method was applied to determine the NS. Sociodemographic, anthropometric variables, dependence, mood, cognitive and analytical parameters were collected. Associations were analyzed applying chi-square and analysis of variance. The prevalence ratio (PR) for malnutrition was calculated. A multivariate model was applied (binary logistic regression). Significance was considered for p<0.05. RESULTS: The average age was 81.3 years (SD=7.4) and 72.0% were women. 48.9% were AP, 26.8% DP and 24.2% IP. 29.6% (95% CI: 23.9-35.8) presented malnutrition. Greater malnutrition was established in relation to living in a residence or requiring home help (PR=5.3), age over 85 (PR=4.9), presenting a moderate or higher dependency for basic activities of daily living (PR=3.9) and instrumental (PR=3.3), need help for mobility (PR=2.9) and present moderate/severe cognitive impairment (PR=2.1). The determinants of malnutrition in the multivariate model were older than 85 years old and being IP or DP. CONCLUSIONS: Emphasis should be placed on evaluating NS in patients older than 85 years of age who live in a residence or require home care, since they are the groups at greatest risk of malnutrition.

Enfermedades bucales y factores de riesgo en la población geriátrica perteneciente a un consultorio médico / Oral diseases and risk factors in the geriatric population of a family doctor's office

Se realizó un estudio descriptivo y transversal, desde noviembre de 2016 hasta abril de 2017, de los 166 adultos mayores pertenecientes al consultorio médico No 20 del Policlínico Carlos Juan Finlay del municipio de Santiago de Cuba, para evaluar la presencia de enfermedades bucodentales y los factores de riesgo. Para la recolección de la información se utilizó la encuesta de salud bucal de la Organización Mundial de la Salud y la historia de salud bucal familiar. Los hábitos nocivos como la deficiente higiene bucal y la dieta cariogénica, además de las enfermedades crónicas no transmisibles, fueron los factores de riesgo más comunes en esta población, en quienes la disfunción masticatoria y la caries dental constituyeron los problemas principales

A descriptive and cross-sectional study of 166 elderly belonging to the family doctor office No 20 of Carlos J Finlay Polyclinic in the municipality of Santiago de Cuba, was carried out from November, 2016 to April, 2017, to evaluate the presence of oral-dental diseases and risk factors. The survey of oral health from the World Health Organization and the medical record of family oral health were used for gathering the information. Harmful habits as poor oral hygiene and a cariogenic diet, besides non communicable chronic diseases, were the most common risk factors in this population, for whom masticatory dysfuntion and dental decay constituted the main problems

[Usefulness of scoring risk for adverse outcomes in older patients with the Identification of Seniors at Risk scale and the Triage Risk Screening Tool: a meta-analysis]. / Valor de los instrumentos ISAR y TRST para predecir resultados adversos en población general geriátrica asistida en los servicios de urgencias: metanálisis.

OBJECTIVES: A considerable proportion of the geriatric population experiences unfavorable outcomes of hospital emergency department care. An assessment of risk for adverse outcomes would facilitate making changes in clinical management by adjusting available resources to needs according to an individual patient's risk. Risk assessment tools are available, but their prognostic precision varies. This systematic review sought to quantify the prognostic precision of 2 geriatric screening and risk assessment tools commonly used in emergency settings for patients at high risk of adverse outcomes (revisits, functional deterioration, readmissions, or death): the Identification of Seniors at Risk (ISAR) scale and the Triage Risk Screening Tool (TRST). We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and SCOPUS, with no date limits, to find relevant studies. Quality was assessed with the QUADAS-2 checklist (for quality assessment of diagnostic accuracy studies). We pooled data for prognostic yield reported for the ISAR and TRST scores for each short- and medium-term outcome using bivariate random-effects modeling. The sensitivity of the ISAR scoring system as a whole ranged between 67% and 99%; specificity fell between 21% and 41%. TRST sensitivity ranged between 52% and 75% and specificity between 39% and 51%.We conclude that the tools currently used to assess risk of adverse outcomes in patients of advanced age attended in hospital emergency departments do not have adequate prognostic precision to be clinically useful.

OBJETIVO: Una importante proporción de la población geriátrica presenta resultados de salud desfavorables tras ser asistida en servicios de urgencia hospitalaria (SUH). La valoración del riesgo de resultados adversos permitiría modificar el manejo clí- nico, ajustando los recursos disponibles a las necesidades y riesgos de cada paciente. Existen instrumentos de valoración del riesgo, pero su precisión pronóstica varía. Esta revisión sistemática pretende cuantificar la precisión pronóstica de los dos instrumentos de cribado/estratificación de riesgo más empleados, el Identification of Seniors at Risk (ISAR) y Triage Risk Screening Tool (TRST), para identificar la población geriátrica, asistida en los SUH, con alto riesgo de resultados adversos (nuevas visitas a los SUH, deterioro funcional, reingresos hospitalarios y/o muerte). Para ello se realizaron búsquedas en PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) y SCOPUS, sin límite de fechas. La calidad de los estudios se evaluó mediante el instrumento QUADAS-2. Se llevaron a cabo metanálisis sobre el rendimiento pronóstico de los instumentos ISAR y TRST para cada variable de resultado a corto o medio plazo, siguiendo un modelo de efectos aleatorios bivariante. La sensibilidad y la especificidad globales del instrumento ISAR estuvieron comprendidas entre 67-99% y 21-41%, respectivamente; mientras que las estimaciones globales para la sensibilidad y especificidad del TSRT estuvieron comprendidas entre 52-75% y 39-51%, respectivamente. Se concluye que las herramientas evaluadas para determinar el riesgo de eventos adversos en adultos geriátricos atendidos en los SUH no cuentan en la actualidad con la suficiente precisión diagnóstica para ser de utilidad clínica.

La salud bucal en una población geriátrica / Oral health in a geriatric population

Fundamento: el conocimiento del estado de salud bucal de la población geriátrica permite identificar los problemas de salud y factores de riesgo que los propician, premisa para mejorar la calidad de vida de estos pacientes.Objetivo: describir el estado de salud bucal de la población geriátrica del consultorio médico 16-01, de la Clínica Estomatológica “Héroes de Bolivia”, de junio a septiembre de 2015.Métodos: se realizó un estudio descriptivo transversal, en el consultorio y período de tiempo ya definidos. La población de estudio estuvo conformada por 60 pacientes. Se midieron las variables: edad, clasificación epidemiológica, factores de riesgo asociados, las enfermedades bucodentales y el índice de cariados - perdidos-obturados en dentición permanente (CPOD) y sus componentes, según la edad de los mismos.Resultados: el grupo de 60 a 74 años de edad, con un 50 por ciento, fue el más representativo. De los factores de riesgo asociados se observó que la higiene bucal deficiente (68,3 por ciento), la ingestión de alimentos calientes (38,3 por ciento) y la dieta cariogénica (25,0 por ciento) fueron los predominantes. De acuerdo a la clasificación epidemiológica no hubo pacientes sanos y el 68,3 por ciento se clasificó enfermo, estando el 60 por ciento afectado por caries dental. El índice de COPD se observó alto con predominio de los dientes perdidos en el grupo de edad de 60-74 años.Conclusiones: se describió el estado de salud bucal de la población geriátrica estudiada (AU)

Background: knowing the state of the oral health of the elderly population permits to identify the health problems and risk factors that cause them, premise to improve the quality of life of those patients.Objective: to describe the state of the oral health of the geriatric population from the family doctors office 16-01 of "Heroes de Bolivia" stomatology clinic from June to September, 2015.Methods: a descriptive and cross-sectional study was carried out in the office and time period mentioned above. The study population consisted of 60 patients. The variables: age, epidemiological classification, associated risk factors, oral diseases and index of decayed-missed-filled teeth (DMFT) in permanent dentition and its components, according to their ages were measured.Results: the group of 60 to 74 years old, with 50 percent, was the most representative one. The predominant associated risk factors were: poor oral hygiene (68,3 percent), ingestion of hot foods (38,3 percent) and cariogenic diet (25 percent). According to the epidemiological classification there were no healthy patients and 68,3 percent were classified as sick, 60 percent was affected by tooth decay. The rate of DMFT was high, with prevalence of missing teeth in the age group of 60 to 74 years.Conclusions: the state of the oral health of the studied elderly population was described (AU)

La atención al Adulto mayor: un reto para la medicina contemporánea / Senior Adult Care: A Challenge For Contemporary Medicine

Introducción: en Cuba, como parte del Programa de Atención al Adulto Mayor, la atención comunitaria desarrolla acciones encaminadas a la atención integral al anciano, con el fin de mantenerlos activos en el seno de la comunidad e integrarlos a esta. Para ello es imprescindible concebir esta etapa de la vida como un período de desarrollo y crecimiento, rico en experiencias y conocimientos, lo que se revertiría en acciones preventivas que contribuyan a que los ancianos lleven una vida más plena, sintiéndose útiles y satisfechos a pesar de su avanzada edad, con una percepción positiva de la vejez, responsabilidad que debe asumir el personal de la salud de su comunidad por mantener una estrecha relación con ellos. Objetivos: caracterizar a la población geriátrica y, posteriormente, trabajar con ella en un proyecto comunitario. Métodos: estudio observacional, descriptivo y transversal en el Consultorio 6 del Policlínico Pedro Díaz Coello durante los meses enero-febrero de 2013. Se integraron al estudio todos los pacientes mayores de 60 años, escogiéndose la muestra de forma aleatoria simple, teniendo en cuenta los criterios de exclusión. Para la caracterización se revisaron las historias clínicas individuales, se aplicó la Escala de Depresión Yesavage y el test para determinar deterioro cognitivo en el anciano, Mini Mental. Resultados: predominaron los viejos jóvenes, funcionales con un mayor por ciento en el sexo femenino y sin deterioro cognitivo; la depresión estaba presente en la mayoría de ellos. Conclusiones: predominaron los viejos jóvenes, funcionales y sin deterioro cognitivo, con un mayor por ciento en el sexo femenino, la depresión estuvo presente en la mayoría de ellos(AU)

Introduction: In Cuba, as part of the Care Program for the Elderly, community care develops actions to provide comprehensive care to the elderly, in order to keep them active within the community and integrate them in it. This requires designing this stage of life as a period of development and growth, rich in experience and knowledge, which would be reversed in preventive actions that help the elderly lead a fuller life, feeling useful and satisfied despite their advanced age, with a positive perception of old age. This responsibility must assume by the health personnel in their community by maintaining a close relationship with them. Objectives: Characterize the geriatric population and then work with it in a community project. Methods: An observational, descriptive study was carried out at Doctor's Office 6 in Pedro Diaz Coello Polyclinic from January to February 2013. All patients older than 60 years joined the study. The sample was chosen at simple random, taking into account the exclusion criteria. Individual medical histories were reviewed to characterize the subjects in this study. Yesavage Depression Scale was applied as well as tests to determine cognitive impairment in the elderly. Results: Old youth predominated, with greater functional percent in women without cognitive impairment; depression was present in most of them. Conclusions: Old youth predominated, functional and without cognitive impairment, with a higher percent in women, depression was present in most of them(AU)

Tubeless versus standard PCNL in geriatric population.

INTRODUCTION AND OBJECTIVES: Percutaneous nephrolithotomy (PCNL) is a standard, safe, and efficient method for large-volume renal calculi for all age groups. Nephrostomy tube constitutes an invaluable part of the nephrolithotomy operation. However, the nephrostomy tube has been recently replaced with ureteral catheter or double J-stent thanks to advances in urotechnology and operation equipment. The aim of the current article was to evaluate the safety and reliability of tubeless percutaneous nephrolithotomy in the geriatric population. METHODS: Between January 2009 and September 2013, a total of 52 patients aged 65 years or elder with renal calculi bigger than 2cm underwent PCNL operation. The first group of 25 patients (48%) with a mean age of 70.0 years (std:±3,8) underwent tubeless PCNL whereas the second group consisting of 27 (52%) patients with a mean age of 71.3 years (std: ±4,0) underwent standard PCNL. The patients were randomly compared retrospectively in terms of burden of calculus, analgesic requirement, creatinine value, renal parenchymal thickness, Body-mass index (BMI), clavien score, length of hospitalization, and being calculus-free. RESULTS: The groups were found to be similar in age, BMI, and gender (P>.05). Burden of calculus, duration of operation, and rate of narcotic analgesic use were found to be statistically significantly higher in the group of Standard PCNL group than in the Tubeless PCNL group (P<.05). Length of hospital stay was 1.7 days in the group of tubeless PCNL and 2.6 days in the standard PCNL group (P<.05). No significant difference was found between the groups in terms of fall in hemoglobin, creatinine, values of parenchymal thickness, and clavien score, preoperative blood transfusion, previous SWL, location of calculi, number of access, and rate of success (P>.05). Burden of calculus was 900 mm2 (304-4232) in the standard PCNL group and 600mm(2) (220-2660) in the tubeless PCNL group with the difference being statistically significant (P=.014). Overall success was achieved in 96.0 and 96.3% of tubeless PCNL and standard PCNL patients after one session of PCNL, respectively. CONCLUSIONS: Tubeless percutaneous nephrolithotomy was found to be as safe and effective as standard PCNL in the geriatric population. It is recommended especially in this group of patients because of its advantages such as shorter length of hospitalization, less analgesic requirement, and earlier mobilization.

Health related quality of life in rheumatoid arthritis, osteoarthritis, diabetes mellitus, end stage renal disease and geriatric subjects. Experience from a General Hospital in Mexico.

INTRODUCTION: Chronic diseases have a great impact in the morbidity and mortality and in the health-related quality of life (HRQoL) of patients around the world. The impact of rheumatic diseases has not been fully recognized. We conducted a comparative study to evaluate the HRQoL in different chronic diseases. OBJECTIVES: The aim of the present study was to assess the HRQoL and identify specific areas affected in patients with rheumatoid arthritis (RA), osteoarthritis (OA), diabetes mellitus, end-stage renal disease, geriatric subjects and a control group. PATIENTS AND METHODS: We conducted a cross-sectional study, in a General Hospital in Morelia, Mexico. All patients met classification criteria for RA, OA, diabetes mellitus, end-stage renal disease; the geriatric subjects group was≥65 years, and the control group≥30 years. Demographic characteristics were recorded, different instruments were applied: SF-36, visual analogue scale for pain, patient's and physician's global assessments, Beck Depression Inventory and specific instruments (DAS-28, HAQ-Di, WOMAC, Diabetes Quality of Life [DQOL] and Kidney Disease Questionnaire of Life [KDQOL]). Biochemical measures: erythrocyte sedimentation rate, blood count, glucose, HbA1C, serum creatinine and urea. RESULTS: We evaluated 290 subjects (control group: 100; geriatric subjects: 30 and 160 for the rest of groups). Differences were detected in baseline characteristics (P<.0001). The SF-36 scores were different between control group and others groups (P=0.007). The worst HRQoL was in end-stage renal disease group (±SD: 48.06±18.84 x/SD). The general health was the principal affected area in RA. The pain was higher in rheumatic diseases: OA (5.2±2.4) and RA (5.1±3). HAQ was higher in OA compared to RA (1.12±0.76 vs 0.82±0.82, respectively; P=.001). Forty five percent of all subjects had depression. CONCLUSIONS: The HRQoL in RA patients is poor and comparable to other chronic diseases (end-stage renal disease and diabetes mellitus). Rheumatic diseases should be considered high impact diseases and therefore should receive more attention.

[Analysis of the medical prescription in institutionalised patients]. / Analisis de la prescripción farmacológica en pacientes institucionalizados.

OBJECTIVES: To evaluate/assess the therapeutic concordance/agreement with prescribed medication in patients institutionalized diagnoses in two periods of time as well as the characteristics of this prescription. MATERIAL AND METHODS: Observational and descriptive study. Prescribing and clinical diagnoses of institutionalized patients were analyzed. These patients were treated by the same physicians during the period of time with a one-year interval (2010-2011), offering prescribing information in this period. RESULTS: A total of 81 patients (78% women), mean age 84±7 years, and 5±2 diagnoses per patient. The number of drugs per patient was more than 8 in the 2 periods, being higher in 2011 compared to 2010. From all the prescription, we found that 8.88% in 2010 and 9.3% in 2011 are included as "limited clinical value" drugs. In 2010, it sees a concordance of 86.71±13.75 against 87.17±14.58 in 2011, it means, 87% of patients are treated with drugs in agreement with their diagnoses, representing an increase of 0.47 in 2011 regarding 2010. No statistically significant differences between the 2 years. CONCLUSIONS: The prescriptions in institutionalized patients are very high and the number of drugs per patient increased after information. When we analyzed prescriptions we underline a high percentage of drugs included in the group of limited clinical value (citicoline). A significant percentage of prescriptions don't correspond with diagnoses avaiable in their clinical history.

La atención al adulto mayor: un reto para la medicina contemporánea / Senior Adult Care: A Challenge For Contemporary Medicine

Introducción: en Cuba, como parte del Programa de Atención al Adulto Mayor, la atención comunitaria desarrolla acciones encaminadas a la atención integral al anciano, con el fin de mantenerlos activos en el seno de la comunidad e integrarlos a esta. Para ello es imprescindible concebir esta etapa de la vida como un período de desarrollo y crecimiento, rico en experiencias y conocimientos, lo que se revertiría en acciones preventivas que contribuyan a que los ancianos lleven una vida más plena, sintiéndose útiles y satisfechos a pesar de su avanzada edad, con una percepción positiva de la vejez, responsabilidad que debe asumir el personal de la salud de su comunidad por mantener una estrecha relación con ellos. Objetivos: caracterizar a la población geriátrica y, posteriormente, trabajar con ella en un proyecto comunitario. Métodos: estudio observacional, descriptivo y transversal en el Consultorio 6 del Policlínico Pedro Díaz Coello durante los meses enero-febrero de 2013. Se integraron al estudio todos los pacientes mayores de 60 años, escogiéndose la muestra de forma aleatoria simple, teniendo en cuenta los criterios de exclusión. Para la caracterización se revisaron las historias clínicas individuales, se aplicó la Escala de Depresión Yesavage y el test para determinar deterioro cognitivo en el anciano, Mini Mental. Resultados: predominaron los viejos jóvenes, funcionales con un mayor por ciento en el sexo femenino y sin deterioro cognitivo; la depresión estaba presente en la mayoría de ellos. Conclusiones: predominaron los viejos jóvenes, funcionales y sin deterioro cognitivo, con un mayor por ciento en el sexo femenino, la depresión estuvo presente en la mayoría de ellos(AU)

Introduction: In Cuba, as part of the Care Program for the Elderly, community care develops actions to provide comprehensive care to the elderly, in order to keep them active within the community and integrate them in it. This requires designing this stage of life as a period of development and growth, rich in experience and knowledge, which would be reversed in preventive actions that help the elderly lead a fuller life, feeling useful and satisfied despite their advanced age, with a positive perception of old age. This responsibility must assume by the health personnel in their community by maintaining a close relationship with them. Objectives: Characterize the geriatric population and then work with it in a community project. Methods: An observational, descriptive study was carried out at Doctor's Office 6 in Pedro Diaz Coello Polyclinic from January to February 2013. All patients older than 60 years joined the study. The sample was chosen at simple random, taking into account the exclusion criteria. Individual medical histories were reviewed to characterize the subjects in this study. Yesavage Depression Scale was applied as well as tests to determine cognitive impairment in the elderly. Results: Old youth predominated, with greater functional percent in women without cognitive impairment; depression was present in most of them. Conclusions: Old youth predominated, functional and without cognitive impairment, with a higher percent in women, depression was present in most of them(AU)

Enfermedad renal crónica en el adulto mayor / Chronic renal disease in elder people

Fundamento: la insuficiencia renal crónica se define como el daño estructural o funcional del riñón, evidenciado por marcadores de daño (orina, sangre o imágenes) por un período igual o mayor a tres meses. Entre el 8 al 10 % de la población general adulta tiene algún daño renal. Objetivos: conocer la incidencia y prevalencia de la enfermedad renal crónica en el adulto mayor, en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández. Métodos: se realizó un estudio de tipo, longitudinal, descriptivo, retrospectivo. La muestra la constituyó 274 pacientes que cumplieron los criterios de inclusión. Las variables utilizadas fueron: edad, sexo, color de la piel, peso, antecedentes patológicos personales, las causas de ingreso, los factores de progresión de la enfermedad renal crónica, hábitos tóxicos y valor de la creatinina. Para organizar los indicadores obtenidos se aplicó el método estadístico descriptivo, analizando la información mediante tablas de distribución de frecuencia, gráficos y las medidas de resumen como la media y la moda para las variables cuantitativas, y los números absolutos y el porcentaje para las variables cualitativa. Resultados: alta prevalencia hospitalaria de la enfermedad renal crónica en el adulto mayor, más frecuente en el sexo femenino y la raza blanca, coexisten muchos factores de riesgo, predominando hipertensión arterial, cardiopatías, diabetes mellitus, edad y hábito de fumar. Los factores de progresión más frecuentes encontrados fueron hipertensión arterial descompensada, hipoperfusión renal y sepsis. Conclusiones: existe una alta prevalencia hospitalaria de la enfermedad renal crónica en el adulto mayor, con un subdiagnóstico de la misma.

Founding principle: chronic renal insufficiency is defined as the kidney structural or functional damage, evidenced by markers of damage (urine, blood or images) for a period of three months or more. Between 8 and 10 % of the general adult population has some renal damage. Objective: to know the incidence and prevalence of the chronic renal disease in elder people, in the Teaching Clinic Surgical Hospital Comandante Faustino Pérez Hernández. Methods: a retrospective descriptive longitudinal study was carried out. The sample was formed by 274 patients fulfilling the inclusion criteria. The used variables were: age, sex, skin color, weight, personal pathological antecedents, entering cause, chronic renal disease´s progression factors, toxic habits and creatinine value. For organizing the obtained indicators we applied the descriptive statistic method, analyzing the information through frequency distribution tables, graphics resuming measures as average and mode for the quantitative variables, and absolute numbers and percentage for the qualitative variables. Results: high nosocomial prevalence of the chronic renal disease in elder people, more frequent in the female sex and white people; coexistence of many risk factors, predominating arterial hypertension, cardiopathies, diabetes mellitus, age and smoking. The most frequently found progression factors were de decompensated arterial hypertension, renal hypoperfusion and sepsis. Conclusions:there is high nosocomial prevalence of the chronic renal disease in elder people.

Enfermedad renal crónica en el adulto mayor / Chronic renal disease in elder people

Fundamento: la insuficiencia renal crónica se define como el daño estructural o funcional del riñón, evidenciado por marcadores de daño (orina, sangre o imágenes) por un período igual o mayor a tres meses. Entre el 8 al 10 % de la población general adulta tiene algún daño renal.Objetivos: conocer la incidencia y prevalencía de la enfermedad renal crónica en el adulto mayor, en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández. Métodos: se realizó un estudio de tipo, longitudinal, descriptivo, retrospectivo. La muestra la constituyó 274 pacientes que cumplieron los criterios de inclusión. Las variables utilizadas fueron: edad, sexo, color de la piel, peso, antecedentes patológicos personales, las causas de ingreso, los factores de progresión de la enfermedad renal crónica, hábitos tóxicos y valor de la creatinina. Para organizar los indicadores obtenidos se aplicó el método estadístico descriptivo, analizando la información mediante tablas de distribución de frecuencia, gráficos y las medidas de resumen como la media y la moda para las variables cuantitativas, y los números absolutos y el porcentaje para las variables cualitativa. Resultados: alta prevalencia hospitalaria de la enfermedad renal crónica en el adulto mayor, más frecuente en el sexo femenino y la raza blanca, coexisten muchos factores de riesgo, predominando hipertensión arterial, cardiopatías, diabetes mellitus, edad y hábito de fumar. Los factores de progresión más frecuentes encontrados fueron hipertensión arterial descompensada, hipoperfusión renal y sepsis. Conclusiones: existe una alta prevalencia hospitalaria de la enfermedad renal crónica en el adulto mayor, con un subdiagnóstico de la misma(AU)

Founding principle: chronic renal insufficiency is defined as the kidney structural or functional damage, evidenced by markers of damage (urine, blood or images) for a period of three months or more. Between 8 and 10 % of the general adult population has some renal damage. Objective: to know the incidence and prevalence of the chronic renal disease in elder people, in the Teaching Clinic Surgical Hospital Comandante Faustino Pérez Hernández. Methods: a retrospective descriptive longitudinal study was carried out. The sample was formed by 274 patients fulfilling the inclusion criteria. The used variables were: age, sex, skin color, weight, personal pathological antecedents, entering cause, chronic renal disease's progression factors, toxic habits and creatinine value. For organizing the obtained indicators we applied the descriptive statistic method, analyzing the information through frequency distribution tables, graphics resuming measures as average and mode for the quantitative variables, and absolute numbers and percentage for the qualitative variables. Results: high nosocomial prevalence of the chronic renal disease in elder people, more frequent in the female sex and white people; coexistence of many risk factors, predominating arterial hypertension, cardiopathies, diabetes mellitus, age and smoking. The most frequently found progression factors were de decompensated arterial hypertension, renal hypoperfusion and sepsis. Conclusions: there is high nosocomial prevalence of the chronic renal disease in elder people(AU)

Defectos refractivos y patologías oculares relevantes en los adultos mayores de los hogares de la Secretaría de Integración Social de Bogotá DC / Relevant refractive error and ocular patologies in geriatrics houses of Secretría de Integración Social of Bogotá DC

Objetivo: determinar la prevalencia de defectos refractivos y patologías oculares en pacientes geriátricos de Bogotá, atendidos entre octubre de 2007 y septiembre de 2008. Metodología: con el apoyo de la Clínica de Optometría de la Universidad de La Salle, se estudiaron 596 pacientes pertenecientes al Hogar de Ancianos Casa Nostra, Hogar Santa Teresa de Jornet, Hogar Sagrado Corazón, Despertar Balcanes, Bosque Popular y Bello Horizonte, de la Secretaría de Integración Social del Distrito Capital. A todos los pacientes se les realizó examen clínico optométrico: agudeza visual en V.L., agudeza visual en V.P., toma de distancia pupilar, examen externo, oftalmoscopia sin dilatación, presión intraocular, rejilla de Amsler, queratometría y retinoscopía. Para la determinación de retinopatía hipertensiva, se utilizó la clasificaciónde Keith-Wagener-Berker, y de acuerdo al ETDRS se diferenció la retinopatía diabética, previa estandarización de la prueba y consentimiento informado.La información se recolectó en el formato de historia clínica HCIIO01 VERSIÓN 006-2007. Se utilizó la base de datos en el programa EPI INFO 6.4 y se realizó análisis estadístico descriptivo. Resultados: el defecto refractivo con mayor prevalencia fue el astigmatismo, con 36,4%, y la patología más prevalente fue el pterigio, con 44,79%. Conclusiones: tanto el astigmatismo como el pterigio son las alteraciones visuales y oculares más prevalentes en las personas adultas de los hogares estudiados. Con los datos anteriores es importante sugerir la creación de un modelo de atención primaria que contemple aspectos educativos, promocionales y asistenciales para este grupo de pacientes, con el ánimo de intervenir las causas de morbilidad visual y ocular, mejorando la calidad de vida de esta población.

Objective: to determine the prevalence of refractive error and ocular pathologies in geriatric patients of Bogota, taken care of between October of 2007 and September of 2008. Methods: with the support of the Optometry Clinic - University of the Salle, 596 patients, pertaining to Hogar Casa Nostra, Hogar Santa Teresa de Jornet, Hogar Sagrado Corazón, Despertar Balcanes, Bosque Popular and Bello Horizonte of Secretaría de Integración Social of Distrito Capital. To all the patients’ optometric clinical examination was made to them: Visual acuity in L.V., visual acuity in N.V., taking of distance to pupilar, external examination, oftalmoscopy without expansion, intraocular pressure, grid of Amsler, queratometry and retinoscopy. For determination of hypertensive retinopaty, the classification of Keith-Wagener-Berker was used, and according to the ETDRS was differentthe diabetic retinopaty; previous standardization of the test and informed consent. The information was collected in the format of clinical history: HCIIO01 VERSION 006-2007 and in base of EPI INFO 6.4, and descriptive statistical analysis was made. Results: the refractive error with greater prevalence was the Astigmatism with 36,4% and the prevalent pathology was pterigium with 44,79%. Conclusions: As much the astigmatism as pterigium are the visual and ocularalterations more prevalents in the adult people, it is important to suggest the creation of a model of primary attention with educative aspects, promotional and welfare for this patients, for take part the causes of visual and ocular morbidity, improving the quality of life of this one population.