Aplicación clínica del test «Detenerse al andar mientras se habla» (Stop walking while talking test). Relación con parámetros funcionales y otras pruebas de marcha y equilibrio / Clinical application of the 'Stop walking while talking test'. Relationship with geriatric assessment parameters and other tests of balance and gait

Objetivo. Estudiar la relación entre el test Stop walking while talking (SWWT) y los parámetros de valoración geriátrica y otras pruebas de equilibrio y marcha. Pacientes y métodos. Estudio prospectivo, observacional y transversal de 108 pacientes (62% mujeres), edad media: 80,5±8,4. Veintitrés vivían en el domicilio, 24 en una residencia y 61 estaban ingresados en una unidad de convalecencia. Se registró: índice de Barthel, Mini-mental state examination of Folstein (MMSE), comorbilidad (Charlson), la presencia de caída previa y miedo a caer. Se les aplicó a todos ellos el test Timed up and go (TUG), el test de Tinetti y el test SWWT. Según el SWWT los pacientes se dividieron en 2 grupos: stoppers y non-stoppers. Todos tenían capacidad de deambulación (con o sin ayudas). Resultados. Los del grupo de stoppers presentaron medias de edad 82,2±8,7; Barthel 64,6±20,7; MMSE 21,6±5,1; Charlson 1,8±1,7 y los non-stoppers de 78,5±7,6 (p=0,024), 86,0±18,1 (p<0,001), 24,3±4,0 (p=0,004) y 1,3±1,6 (p=0,130), respectivamente. De los 58 stoppers 39 (67,2%) tuvieron caída previa y 19 (32,8%) no (p=0,002); 43 (74,1%) miedo a caer y 15 (25,9%) no (p<0,009). De los 63 pacientes con TUG>20seg, 52 (82,5%) eran stoppers y 11 (17,5%) non-stoppers; de los 31 con TUG entre 10-20seg, 5 (16,1%) y 26 (83,9%); de los 14 con TUG<10, uno (7,1%) y 13 (92,9%) (p<0,0001), respectivamente. La puntuación en el test de Tinetti fue 15,4±5,1 y 23,9±4,6 (p<0,001), respectivamente. Conclusiones. El grupo de stoppers presentaba mayor edad, dependencia, deterioro cognitivo, caída previa, miedo a caer, puntuaciones inferiores en el test de Tinetti y tiempos más prolongados en el TUG (AU)

Objective. To assess the relationship between the Stop Walking While Talking (SWWT) test and some parameters of the geriatric assessment, as well as other tests of balance and gait. Patients and methods. A prospective, observational and cross-sectional study conducted on 108 patients (62% women), with a mean age of 80.5±8.4 years. Twenty-three of them were living at home, 24 in a nursing home, and 61 in an intermediate care unit. A record was made of the Barthel index, Mini-Mental State Examination of Folstein (MMSE), comorbidity (Charlson index), the presence of previous falls, and fear of falling. Timed Up and Go (TUG), Tinetti test, and Stop Walking While Talking (SWWT) test, were performed on all the patients. Based on the results of the SWWT test patients were divided in two groups: "stoppers" and "non-stoppers". All patients were able to walk (with or without walking aids). Results. The stoppers group of patients had a mean age 82.2±8.7; Barthel index 64.6±20.7; MMSE 21.6±5.1; Charlson index 1.8±1.7, and the non-stoppers 78.5±7.6 (P=.024), 86.0±18.1 (P<.001), 24.3±4.0 (P=.004), and 1.3±1.6 (P=.130), respectively. Of the 58 stoppers patients, 39 (67.2%) had a previous fall, and 19 (32.8%) had not (P=.002); 43 (74.1%) had fear of falling, and 15 (25.9%) had not (P<0.009). Of the 63 patients with TUG>20seconds, 52 (82.5%) were stoppers and 11 (17.5%) non-stoppers. Of the 31 with TUG between 10-20seconds, 5 (16.1%) were stoppers and 26 (83.9%) non-stoppers. Of the 14 with TUG<10 seconds, 1 (7.1%) were stoppers, and 13 (92.9%) non-stoppers (P<0.0001). The score of Tinetti test in the stoppers group was 15.4±5.2, and in non-stoppers 23.9±4.6 (P<0.001). Conclusions. Those in the stopper group were significantly older, were more dependent in activities of daily living, had greater cognitive impairment, more previous falls, had greater fear of falling, lower scores on the Tinetti test, and longer times in the TUG (AU)

[Clinical application of the "Stop walking while talking test". Relationship with geriatric assessment parameters and other tests of balance and gait]. / Aplicación clínica del test «Detenerse al andar mientras se habla¼ (Stop walking while talking test). Relación con parámetros funcionales y otras pruebas de marcha y equilibrio.

OBJECTIVE: To assess the relationship between the Stop Walking While Talking (SWWT) test and some parameters of the geriatric assessment, as well as other tests of balance and gait. PATIENTS AND METHODS: A prospective, observational and cross-sectional study conducted on 108 patients (62% women), with a mean age of 80.5±8.4 years. Twenty-three of them were living at home, 24 in a nursing home, and 61 in an intermediate care unit. A record was made of the Barthel index, Mini-Mental State Examination of Folstein (MMSE), comorbidity (Charlson index), the presence of previous falls, and fear of falling. Timed Up and Go (TUG), Tinetti test, and Stop Walking While Talking (SWWT) test, were performed on all the patients. Based on the results of the SWWT test patients were divided in two groups: "stoppers" and "non-stoppers". All patients were able to walk (with or without walking aids). RESULTS: The stoppers group of patients had a mean age 82.2±8.7; Barthel index 64.6±20.7; MMSE 21.6±5.1; Charlson index 1.8±1.7, and the non-stoppers 78.5±7.6 (P=.024), 86.0±18.1 (P<.001), 24.3±4.0 (P=.004), and 1.3±1.6 (P=.130), respectively. Of the 58 stoppers patients, 39 (67.2%) had a previous fall, and 19 (32.8%) had not (P=.002); 43 (74.1%) had fear of falling, and 15 (25.9%) had not (P<0.009). Of the 63 patients with TUG>20seconds, 52 (82.5%) were stoppers and 11 (17.5%) non-stoppers. Of the 31 with TUG between 10-20seconds, 5 (16.1%) were stoppers and 26 (83.9%) non-stoppers. Of the 14 with TUG<10 seconds, 1 (7.1%) were stoppers, and 13 (92.9%) non-stoppers (P<0.0001). The score of Tinetti test in the stoppers group was 15.4±5.2, and in non-stoppers 23.9±4.6 (P<0.001). CONCLUSIONS: Those in the stopper group were significantly older, were more dependent in activities of daily living, had greater cognitive impairment, more previous falls, had greater fear of falling, lower scores on the Tinetti test, and longer times in the TUG.

Evolución de la incidencia de caídas en un centro hospitalario de media y larga estancia / Changes in the incidence of falls in an intermediate and long-term care center

IntroducciónEl objetivo de este estudio es analizar características de caídas en los ancianos institucionalizados durante 2 períodos de estudio.Material y métodosRegistro prospectivo de caídas en un centro sociosanitario. Las variables recogidas fueron: edad, sexo, índice de Barthel, diagnósticos principales, fármacos en el momento de la caída, lugar, turno en el que aconteció, iluminación, características del suelo, uso de ayudas técnicas y/o sujeción, calzado y actividad al caer. En el primer período de estudio de dos años (período A) había 332 camas (convalecencia, larga estancia, paliativos, psicogeriatría y residencia asistida). En el segundo período, también de dos años (período B), las unidades de cuidados paliativos y de convalecencia fueron trasladadas a otro centro (quedando 255 camas).ResultadosPeríodo A: 647 caídas en 227 pacientes; número total de pacientes ingresados: 1.387 (incidencia acumulada de caídas del 46,6%). Período B: 539 caídas en 191 pacientes; número total de pacientes ingresados: 908 (incidencia acumulada de caídas del 59,3%). Diferencias significativas entre períodos: edad (79,8±10,6 frente a 81,3±10,2) (p<0,02); porcentaje de mujeres (el 55,2 frente al 66,4%) (p<0,001); diagnóstico neurológico (el 26,7 frente al 36,1%) (p<0,001); fármacos: antidepresivos (el 12,6 frente al 16,4%) y neurolépticos (el 10,3 frente al 15,2%) (p<0,001); caída en la habitación (el 39,7 frente al 41,6%) (p<0,001); transferencias (el 41,3 frente al 30,8%) (p<0,001), y uso de ayuda técnica (el 65,8 frente al 40,5%) (p<0,001).Conclusionesa) la incidencia de caídas se incrementó en el segundo período del estudio; b) en el período A predominaron factores de riesgo relacionados con la actividad rehabilitadora (transferencias o uso de ayudas técnicas)...(AU)

IntroductionThe characteristics of falls in older patients admitted to an institution in 2 different periods.Material and methodsWe performed a prospective study of falls among inpatients admitted to an intermediate and long-term care center. Age, sex, Barthel index, main diagnoses, medication at the time of the fall, place, the shift when the fall occurred, lighting, characteristics of the floor, the use of walking aids and/or restraints, the kind of shoes worn, and activity at the moment of the fall were registered. During the first 2-year study period (period A), there were 332 beds (intermediate care and rehabilitation unit, long-term care unit, palliative care unit, psychogeriatric unit and assisted residential home). During the second 2-year period (period B), the palliative and intermediate care units were moved to another center (255 beds remaining).ResultsPeriod A: there were 647 falls in 227 patients; the total number of patients admitted was 1387 (accumulated incidence of falls: 46.6%). Period B: there were 539 falls in 191 patients; the total number of patients admitted was 908 (accumulated incidence of falls: 59.3%). Significant differences between the two periods were found in age (79.8±10.6 versus 81.3 10.2) (p<0.02), the percentage of women (55.2% versus 66.4%) (p<0.001), neurological diagnoses (26.7% versus 36.1%) (p< 0.001), antidepressants (12.6% versus 16.4%), neuroleptics (10.3% versus 15.2%) (p<0.001), falls in the bedroom (39.7% versus 41.6%) (p<0.001), falls when moving from bed to chair (41.3% versus 30.8%) (p<0.001), and the use of walking aids (65.8% versus 40.5%) (p<0.001).Conclusionsa) the incidence of falls increased in the second period of the study; b) in period A, risk factors for falls related to rehabilitation (moving from bed to chair, use of walking aids) were more frequent...(AU)

[Changes in the incidence of falls in an intermediate and long-term care center]. / Evolución de la incidencia de caídas en un centro hospitalario de media y larga estancia.

INTRODUCTION: The characteristics of falls in older patients admitted to an institution in 2 different periods. MATERIAL AND METHODS: We performed a prospective study of falls among inpatients admitted to an intermediate and long-term care center. Age, sex, Barthel index, main diagnoses, medication at the time of the fall, place, the shift when the fall occurred, lighting, characteristics of the floor, the use of walking aids and/or restraints, the kind of shoes worn, and activity at the moment of the fall were registered. During the first 2-year study period (period A), there were 332 beds (intermediate care and rehabilitation unit, long-term care unit, palliative care unit, psychogeriatric unit and assisted residential home). During the second 2-year period (period B), the palliative and intermediate care units were moved to another center (255 beds remaining). RESULTS: Period A: there were 647 falls in 227 patients; the total number of patients admitted was 1387 (accumulated incidence of falls: 46.6%). Period B: there were 539 falls in 191 patients; the total number of patients admitted was 908 (accumulated incidence of falls: 59.3%). Significant differences between the two periods were found in age (79.8+/-10.6 versus 81.3 10.2) (p<0.02), the percentage of women (55.2% versus 66.4%) (p<0.001), neurological diagnoses (26.7% versus 36.1%) (p< 0.001), antidepressants (12.6% versus 16.4%), neuroleptics (10.3% versus 15.2%) (p<0.001), falls in the bedroom (39.7% versus 41.6%) (p<0.001), falls when moving from bed to chair (41.3% versus 30.8%) (p<0.001), and the use of walking aids (65.8% versus 40.5%) (p<0.001). CONCLUSIONS: a) the incidence of falls increased in the second period of the study; b) in period A, risk factors for falls related to rehabilitation (moving from bed to chair, use of walking aids) were more frequent. In period B, risk factors related to the characteristics of psychogeriatric patients were predominant (neurological illness, use of psychotropic drugs, and c) the difference in the incidence of falls between the two study periods may be related to the distinct characteristics of the patients (case mix).

Experiencia en la evaluación del riesgo de caídas. Comparación entre el test de Tinetti y el Timed Up & Go / Experience in the evaluation of risk of falls. Comparison between the Tinetti and Timed-Up & Go tests

Objetivo: comparar los test de Tinetti y Timed Up & Go, las características de cada uno de ellos y su relación con el antecedente de caída en el último año. Pacientes y métodos: se realizaron los test de Tinetti y Timed Up & Go a un grupo de pacientes ingresados en un centro sociosanitario. Se registraron la edad, índice masa corporal, diagnóstico principal, tiempo empleado para realización de ambos test, presencia de caída en el último año, capacidad funcional (índice de Barthel), función cognitiva (Mini-Mental de Folstein) y comorbilidad (índice de Charlson). Resultados: N: 70. Edad media: 75,2 (DE: 13,4) años; índice Barthel: 75,1 (15,7) puntos; Mini-mental de Folstein: 22,5 (5,3) puntos; índice de Charlson: 1,9 (1,7) puntos. La media de los test Tinetti y Timed Up & Go fue de 18,5 (5,0) puntos y 32,2 (18,6) s respectivamente. Existió buena correlación entre ambos test (r = ­0,80; p < 0,001). El tiempo empleado en la realización del test de Tinetti y del Timed Up & Go fue de 204,4 (73,9) y 65,8 s (27,1), respectivamente (p < 0,001). Treinta y tres pacientes habían presentado caída en último año y el área bajo la curva ROC para el test de Timed Up & Go y de Tinetti en la predicción de dicha caída fue 0,626 y 0,582, respectivamente. Conclusiones: a) existió muy buena correlación entre ambos test; b) La realización del test de Timed Up & Go requirió menos tiempo por parte del examinador, y c) para ambos test, parece difícil establecer un punto de corte con una sensibilidad y especificidad óptimas en la predicción de caída en el último año

Objective: to compare the Tinetti and Timed Up & Go tests, the characteristics of each of these tests, and their relation with falls in the previous year. Patients and methods: the Tinetti and Timed Up & Go tests were performed by patients in a medium- and long-term care center. Age, body mass index, main diagnosis, the time employed to perform both tests, the presence of a fall in the previous year, functional status (Barthel index), cognitive function (Folstein's mini-mental test) and comorbidity (Charlson index) were also registered. Results: N: 70. Mean age 75.2 (SD, 13.4); Barthel index score 75.1 (15.7); Folstein's mini-mental test 22.5 (5.3); Charlson comorbidity index 1.9 (1.7). The mean Tinetti and Timed Up & Go scores were 18.5 (5.0) points and 32.2 (18.6) seconds, respectively. Both tests showed good correlation (r = ­0.80; p < 0.001). The time employed to perform the Tinetti and Timed Up & Go tests was 204.4 (73.9) and 65.8 (27.1) seconds, respectively (p < 0.001). Thirty-three patients had had a fall in the previous year. The area under the ROC curve of the Timed Up & Go and Tinetti tests was 0.626 and 0.582, respectively. Conclusions: a) a good correlation between the two tests was found; b) less time was required by the examiner to administer the Timed Up & Go test, and c) for both tests, it is difficult to establish a cut-off point, with acceptable sensitivity and specificity, for the prediction of fall in the previous year