ABSTRACT
BACKGROUND: Hospitalization is a moment of extreme vulnerability for frail older adults. There is scarce evidence on the effectiveness of geriatric co-management or transitional care interventions in Latin America. AIMS: To assess whether geriatric co-management combined with an interdisciplinary transitional care intervention could reduce 30-day hospital readmission rate compared to usual care in hospitalized frail older patients in a tertiary hospital in Argentina. METHODS: Single-blinded randomized controlled trial. Usual care treatment arm: all procedures performed during hospitalization were overseen by a senior internal medicine specialist and complied with pre-defined protocols. Patients had access to specialist care if needed, as well as hospital-at-home or home-based primary care services after discharge. Intervention treatment arm: in addition to usual care, a geriatric co-management team performed a comprehensive geriatric assessment during hospitalization, provided tailored recommendations to minimize geriatric syndromes and planned transition of care. A health and social care counselor oversaw continuity of care in patients' homes after discharge. RESULTS: We included 120 participants in each of the intervention and usual care (control) arms. Thirty-day hospital readmissions were 47.7% lower in the intervention arm (18.3% vs 35.0%; P = 0.040); and emergency room visits within the first 6 months after discharge were 27.8% lower (43.3% vs 60.0%; P = 0.010). There was a non-statistically significant decrease in 6-month mortality in the intervention arm (25.0% vs 35.0%; P = 0.124). CONCLUSION: Geriatric co-management of frail older patients during hospitalization combined with an interdisciplinary transitional care intervention reduced 30-day hospital readmissions and emergency visits 6 months after discharge. TRIAL REGISTRATION NUMBER: Trial registration number: RENIS IS003081.
Subject(s)
Patient Readmission , Transitional Care , Aged , Argentina , Frail Elderly , Geriatric Assessment , Humans , Patient DischargeABSTRACT
BACKGROUND: Low socioeconomic status has been associated with individual health-related problems; however, no study has specifically investigated the impact of socioeconomic disparities on gait performance using an index that considers the population aggregation, as the Human Development Index (HDI). Thus, the aim of the present study was to assess gait parameters of older people living in cities with differences in socioeconomic conditions, identified by HDI. METHODS: Cross-sectional design study conducted with a sample of 233 older people from two Brazilians regions: Coari, state of Amazonas, Brazil (n= 124, low-HDI-Bra) and Ribeirão Preto, state of São Paulo, Brazil (n= 109, very high-HDI-Bra). The gait performance was assessed by an electronic walkway, and the interest variables were gait speed, cadence, stride time, step length and stride width. RESULTS: Low-HDI-Bra group presented worse gait performance as identified by slower gait speed (p = < .001), slower cadence (p = < .001), higher stride time (p = < .001), shorter step length (p = < .001), compared with the very high-HDI-Bra group. There was a positive association between HDI, and gait spend, cadence and step length, and there was a negative association between HDI and stride time and stride width. CONCLUSIONS: Long-term exposure to socioeconomic inequalities found in low HDI cities may impair gait performance in late life. Such information may be relevant to create public politics that use the gait parameter based on the region where the people live.
Subject(s)
Gait , Walking Speed , Aged , Brazil , Cross-Sectional Studies , Humans , Income , WalkingABSTRACT
BACKGROUND: Adverse drug reactions are a common cause of potentially avoidable harm, particularly in older adults. AIMS: To evaluate the feasibility and efficacy of a pilot multifactorial intervention to reduce potentially inappropriate medication (PIM) use in older adults. METHODS: We conducted a phase 2, feasibility, open-label study in the ambulatory setting of an integrated healthcare network in Buenos Aires, Argentina. We recruited primary care physicians (PCPs) and measured PIM use in a sample of their patients (65 years or older). Educational workshops for PCPs were organized with the involvement of clinician champions. Practical deprescribing algorithms were designed based on Beers criteria. Automatic email alerts based on specific PIMs recorded in each patient's electronic health record were used as a reminder tool. PCPs were responsible for deprescribing decisions. We randomly sampled 879 patients taking PIMs from eight of the most commonly used drug classes at our institution and compared basal (6 months prior to the intervention) and final (12 months after) prevalence of PIM use using a test of proportions. RESULTS: There was a significant reduction (p < 0.05) in all drug classes evaluated. Non-Steroidal Anti-Inflammatory Drugs (basal prevalence 5.92%; final 1.59%); benzodiazepines (10.13%; 6.94%); histamine antagonists (7.74%; 3.07%); opioids (2.16%; 1.25%); tricyclic antidepressants (8.08%; 4.10%); muscle relaxants (7.74%; 3.41%), anti-hypertensives (3.53%; 1.82%) and oxybutynin (2.96%; 1.82%). The absolute reduction in the overall prevalence was 8.5 percentage points (relative reduction of 51.4%). CONCLUSION: This multifactorial intervention is feasible and effective in reducing the use of potentially inappropriate medication in all drug classes evaluated.
Subject(s)
Antihypertensive Agents , Potentially Inappropriate Medication List , Aged , Argentina , Electronic Health Records , Humans , Inappropriate Prescribing/prevention & control , PrevalenceABSTRACT
BACKGROUND: Because gait performance is a marker of organic integrity, and the Human Development Index (HDI) of a region impacts the organism globally, this paper aims to investigate possible associations between both HDI and HDI dimensions at individual level (i.e. education, income, or life expectancy) with gait performance in older adults. METHODS: Searches were conducted on EMBASE and PubMed databases. Eligible studies included community-dwelling population aged ≥60years, analysis of at least one quantitative gait variable, observational studies, Human Development Index or its dimensions (i.e. education, income, or life expectancy). RESULTS: Thirty-five articles were included in this systematic review. No study directly used HDI as an independent variable, but all selected articles found relationships between gait performance and one or two HDI dimensions at individual-level in the same study. Gait speed was the most common dependent variable associated with all three HDI dimensions. Low education, poor income, and short life expectancy were associated with worse gait speed, in combination and/or independently. CONCLUSION: No studies were found using HDI as a main variable. Systematic evidence showed a strong relationship with all three HDI dimensions: education, income, and life expectancy, suggesting that social factors at individual level affect gait performance.
Subject(s)
Aging , Gait , Health Status Indicators , Human Development , Social Determinants of Health , Socioeconomic Factors , Age Factors , Aged , Aged, 80 and over , Educational Status , Female , Gait Analysis , Geriatric Assessment , Humans , Income , Life Expectancy , Male , Middle Aged , PovertySubject(s)
Influenza A Virus, H1N1 Subtype/genetics , Influenza, Human/mortality , Adult , Aged , Argentina/epidemiology , DNA, Viral/analysis , Female , Humans , Influenza, Human/virology , Male , Middle Aged , Prognosis , Reverse Transcriptase Polymerase Chain Reaction , Sex Distribution , Sex Factors , Survival Rate/trends , Young AdultABSTRACT
BACKGROUND: Diogenes syndrome (DS) is characterized by extreme self-neglect, domestic squalor, and social withdrawal. Despite having been described decades ago, it is still difficult to persue a correct diagnosis in primary care clinics. METHODS: This paper reports a case of an elderly man with extreme self neglect and an abnormal collecting pattern whose condition remained undetected for many years. His collectionism was manifested with a tendency to store items in an organized manner but without a clear purpose. CONCLUSION: The authors suggest that the presence of collectionism could be a helpful clue towards diagnosis of DS in similar cases.
Subject(s)
Compulsive Behavior/psychology , Mental Disorders/diagnosis , Aged , Humans , Hygiene , Male , Mental Disorders/psychology , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/psychology , Social Isolation/psychology , Syndrome , Treatment RefusalABSTRACT
Until recently, vitamin D was only considered as one of the calciotrophic hormones without major significance in other metabolic processes in the body. Several recent findings have demonstrated that vitamin D plays also a role as a factor for cell differentiation, function and survival. Two organs, muscle and bone, are significantly affected by the presence, or absence, of vitamin D. In bone, vitamin D stimulates bone turnover while protecting osteoblasts of dying by apoptosis whereas in muscle vitamin D maintains the function of type II fibers preserving muscle strength and preventing falls. Furthermore, two major changes associated to aging: osteoporosis and sarcopenia, have been also linked to the development of frailty in elderly patients. In both cases vitamin D plays an important role since the low levels of this vitamin seen in senior people may be associated to a deficit in bone formation and muscle function. In this review, the interaction between vitamin D and the musculoskeletal components of frailty are considered from the basic mechanisms to the potential therapeutic approach. We expect that these new considerations about the importance of vitamin D in the elderly will stimulate an innovative approach to the problem of falls and fractures which constitutes a significant burden to public health budgets worldwide.
Subject(s)
Aging/physiology , Musculoskeletal System/metabolism , Vitamin D/metabolism , Animals , Bone and Bones/metabolism , Humans , Musculoskeletal System/drug effects , Receptors, Calcitriol/metabolism , Vitamin D/pharmacologyABSTRACT
Argentina is a large country situated at the southern end of the Americas. It is highly urbanized, and almost one-third of the population lives in the capital city and its surrounding area (Buenos Aires). The population is composed of heterogeneous groups, formed primarily by descendants of European immigration who constitute 85% of the inhabitants. In the last 30 years, Argentina has witnessed a growth in the elderly population from less than 7% to nearly 10% of the total population. Additionally, in Buenos Aires City, more than 17% are aged 65 or older. The healthcare systems for the elderly lack nationwide coverage. The Programa de Atención Médica Integral (PAMI) is the largest program for elderly care. It is a state-run program for disabled and senior citizens. PAMI serves 65% of the approximately 3.6 million older people in Argentina. The quality of PAMI healthcare delivery has decreased in the last 2 decades and has largely declined since the Argentinean economic crisis of late 2001. The rehabilitation and long-term care services are relatively underdeveloped, and fewer than 2% of senior citizens live in residential or nursing homes. Recently, the government has proposed a system of care built up from the primary care resources of the community.
Subject(s)
Delivery of Health Care/statistics & numerical data , Health Services for the Aged/statistics & numerical data , Aged , Argentina , Delivery of Health Care/economics , Female , Health Services for the Aged/economics , Humans , Male , Population DynamicsABSTRACT
La presente es una guía de práctica clínica para la prevención de caídas en el paciente mayor. Se evalúa el impacto del problema, los factores de riesgo por caídas, y principalmente la evidencia y el grado de recomendación existente hasta el momento acerca de la efectividad de las distintas intervenciones, tanto en ancianos de la comunidad como institucionalizados. La efectividad del ejercicio individualizado y cómo prescribirlo. Intervenciones multidisciplinarias. Protectores de cadera. La prueba del levántate y anda para el diagnóstico del paciente vulnerable
Subject(s)
Humans , Male , Female , Aged , Accidental Falls/statistics & numerical data , Accidental Falls/prevention & control , Aged , Evidence-Based Medicine , Risk FactorsABSTRACT
La presente es una guía de práctica clínica para la prevención de caídas en el paciente mayor. Se evalúa el impacto del problema, los factores de riesgo por caídas, y principalmente la evidencia y el grado de recomendación existente hasta el momento acerca de la efectividad de las distintas intervenciones, tanto en ancianos de la comunidad como institucionalizados. La efectividad del ejercicio individualizado y cómo prescribirlo. Intervenciones multidisciplinarias. Protectores de cadera. La prueba del levántate y anda para el diagnóstico del paciente vulnerable
Subject(s)
Humans , Male , Female , Aged , Accidental Falls/prevention & control , Accidental Falls/statistics & numerical data , Evidence-Based Medicine , Risk Factors , AgedABSTRACT
La evaluación prequirúrgica cuidadosa e individualizada en el anciano es esencial para maximizar los beneficios y disminuir los riesgos. La frecuencia de las cirugías en los ancianos supera un 60 por ciento comparada con la de los menores de 65 años y por otro lado conlleva hasta el 75 por ciento de los fallecimientos postquirúrgicos. Históricamente la edad per se ha sido un factor determinante en la evaluación prequirúrgica, no obstante la evidencia sugiere que los factores de riesgo individuales, como el estado general y la comorbilidad son mejores predictores. Existen diferentes herramientas para evaluar los riesgos individuales en el paciente mayor, pero la mayoría de las veces solamente se hace hincapié en el riesgo cardiovascular, que si bien es importante, existen otros de similar jerarquía en relación al tipo de cirugía que nos enfrentemos. Para evaluar los riesgos individuales, el médico consultor debe sistemáticamente revisar el estado general, funcional, nutricional y mental del paciente mayor; y también los sistemas cardiopulmonar y renal. Por otro lado es útil recordar que el tipo de cirugía determinará el estrés quirúrgico y anestésico, es así como existen situaciones donde una buena historia clínica podrá ser el "test prequirúrgico" más importante (vgr: cirugía de cataratas)
Subject(s)
Aged , Humans , Preoperative Care , Risk Assessment , Aged , Risk FactorsABSTRACT
La evaluación prequirúrgica cuidadosa e individualizada en el anciano es esencial para maximizar los beneficios y disminuir los riesgos. La frecuencia de las cirugías en los ancianos supera un 60 por ciento comparada con la de los menores de 65 años y por otro lado conlleva hasta el 75 por ciento de los fallecimientos postquirúrgicos. Históricamente la edad per se ha sido un factor determinante en la evaluación prequirúrgica, no obstante la evidencia sugiere que los factores de riesgo individuales, como el estado general y la comorbilidad son mejores predictores. Existen diferentes herramientas para evaluar los riesgos individuales en el paciente mayor, pero la mayoría de las veces solamente se hace hincapié en el riesgo cardiovascular, que si bien es importante, existen otros de similar jerarquía en relación al tipo de cirugía que nos enfrentemos. Para evaluar los riesgos individuales, el médico consultor debe sistemáticamente revisar el estado general, funcional, nutricional y mental del paciente mayor; y también los sistemas cardiopulmonar y renal. Por otro lado es útil recordar que el tipo de cirugía determinará el estrés quirúrgico y anestésico, es así como existen situaciones donde una buena historia clínica podrá ser el "test prequirúrgico" más importante (vgr: cirugía de cataratas)