Efecto del ejercicio de fuerza muscular mediante bandas elásticas combinado con ejercicio aeróbico en el tratamiento de la fragilidad del paciente anciano con diabetes mellitus tipo 2 / Effect of strength exercise with elastic bands and aerobic exercise in the treatment of frailty of the elderly patient with type 2 diabetes mellitus

Objetivo: Evaluar en el paciente diabético anciano la probabilidad de mejorar la fragilidad tras realizar ejercicios de fuerza con una banda elástica y ejercicio aeróbico. Métodos: Estudio prospectivo de pacientes diabéticos mayores de 70 años, con Barthel > 80 puntos y Global Deterioration Scale-Functional Assessment Staging < 3 puntos. Se recomendaron ejercicios de fuerza con una banda elástica 3 días a la semana y caminar 30 min al día 5 días a la semana. Se revisó la adherencia a los ejercicios mediante la pregunta de Haynes-Sacket. En el momento basal y a los 6 meses se evaluaron la fragilidad según los criterios de Fried y la capacidad funcional mediante el Short Physical Performance Battery. Resultados: Un total de 44 pacientes completaron los 6 meses de seguimiento. Se produjo falta de adherencia a los ejercicios aeróbicos en el 38,6% de los casos y a los ejercicios con bandas elásticas en el 47,7%. La prevalencia de fragilidad disminuyó del 34,1% inicial al 25% a los 6 meses (p = 0,043), y el porcentaje de sujetos con una limitación funcional moderada-grave se redujo del 26,2 al 21,4% (p = 0,007). La adherencia a los ejercicios aeróbicos (p = 0,034) y la ausencia de cardiopatía isquémica coronaria (p = 0,043) predispusieron a mejorar la fragilidad. Conclusiones: Realizar durante 6 meses ejercicios de fuerza con una banda elástica y ejercicio aeróbico reduce la prevalencia de fragilidad en pacientes diabéticos ancianos. La probabilidad de mejorar la fragilidad disminuye en caso de cardiopatía isquémica coronaria y aumenta con la adherencia a los ejercicios aeróbicos

Aim: To evaluate in the elderly diabetic patient the probability of improving the frailty after performing strength exercises with an elastic band and aerobic exercise. Methods: Prospective study of diabetic patients older than 70 years, with Barthel > 80 points and Global Deterioration Scale -Functional Assessment Staging < 3 points. Strength exercises with an elastic band 3 days a week and walk 30 min a day 5 days a week were recommended. Adherence to the exercises was assessed using the Haynes-Sacket test. Frailty was assessed by the Fried criteria and functional capacity by the Short Physical Performance Battery at baseline and at 6 months. Results: 44 patients completed 6 months of follow-up. There was non-adherence to aerobic exercises in 38.6% of cases and to exercises with elastic bands in 47.7%. The prevalence of frailty decreased from an initial 34.1% to 25% at 6 months (p = 0.043) and the percentage of patients with a moderate-severe functional limitation was reduced from 26.2% to 21.4% (p = 0.007). Adherence to aerobic exercises (p = 0.034) and absence of coronary ischemic heart disease (p = 0.043) predisposed to improve frailty. Conclusions: Performing 6-month strength exercises with an elastic band and aerobic exercise reduces the prevalence of frailty in elderly diabetic patients. The probability of improving frailty decreases in case of coronary ischemic heart disease and increases with adherence to aerobic exercises

Spanish list of potentially inappropriate drugs in the elderly (ES-PIA project).

PURPOSE: In the last decades, different criteria have been developed for detecting inappropriate prescription in older patients. In Spain, translations and adaptations of international lists are available but it would be necessary a national list which could cope with the peculiarities of our health system, existing pharmaceutical market, and prescription habits. We propose in this project the creation of a Spanish potentially inappropriate drugs list which could be applicable in our clinical scenario. METHODS: We use a Delphi method involving 25 experts from different backgrounds (Clinical Pharmacology, Geriatrics, Rational Use of Drugs and Pharmacy, Primary Care and Pharmacoepidemiology, and Pharmacovigilance) that were asked to participate in two-round questionnaires. For analysis, current recommendations of Worth and Pigni were applied, and every statement was classified into one of three groups: strong, moderate, or low agreement. Statements with strong agreement were accepted to be part of the inadequate prescription list. Moderate agreement statements were selected to enter the second questionnaire, and statements with low agreement were further analyzed to determine if it was due to heterogeneity or due to dispersion in the answers. RESULTS: The first questionnaire consisted of 160 proposed sentences, of which 106 reached a high agreement, 32 a moderate agreement, and 22 a low agreement. All sentences proposed in the second questionnaire reached a strong agreement. The total accepted sentences were 138. CONCLUSIONS: We offer a list of inadequate prescription in older patients adapted to the Spanish pharmacopeia and according to the prescription habits in our environment.

Effect of strength exercise with elastic bands and aerobic exercise in the treatment of frailty of the elderly patient with type 2 diabetes mellitus. / Efecto del ejercicio de fuerza muscular mediante bandas elásticas combinado con ejercicio aeróbico en el tratamiento de la fragilidad del paciente anciano con diabetes mellitus tipo 2.

AIM: To evaluate in the elderly diabetic patient the probability of improving the frailty after performing strength exercises with an elastic band and aerobic exercise. METHODS: Prospective study of diabetic patients older than 70 years, with Barthel >80 points and Global Deterioration Scale -Functional Assessment Staging <3 points. Strength exercises with an elastic band 3 days a week and walk 30min a day 5 days a week were recommended. Adherence to the exercises was assessed using the Haynes-Sacket test. Frailty was assessed by the Fried criteria and functional capacity by the Short Physical Performance Battery at baseline and at 6 months. RESULTS: 44 patients completed 6 months of follow-up. There was non-adherence to aerobic exercises in 38.6% of cases and to exercises with elastic bands in 47.7%. The prevalence of frailty decreased from an initial 34.1% to 25% at 6 months (p=0.043) and the percentage of patients with a moderate-severe functional limitation was reduced from 26.2% to 21.4% (p=0.007). Adherence to aerobic exercises (p=0.034) and absence of coronary ischemic heart disease (p=0.043) predisposed to improve frailty. CONCLUSIONS: Performing 6-month strength exercises with an elastic band and aerobic exercise reduces the prevalence of frailty in elderly diabetic patients. The probability of improving frailty decreases in case of coronary ischemic heart disease and increases with adherence to aerobic exercises.

Actitudes, conocimientos y práctica de los profesionales de enfermería en el uso de restricciones físicas con personas mayores / Use of physical restraints on the elderly: Attitudes, knowledge and practice among nursing staff

Objetivos. Explorar las actitudes, los conocimientos y la práctica relacionada con el uso de restricciones físicas en profesionales de enfermería que trabajan con ancianos, así como la relación entre estas variables. Material y métodos. Estudio transversal de tipo descriptivo y correlacional realizado en 8 residencias geriátricas, basado en 3 cuestionarios que examinaban las citadas variables. Resultados. Se incluyeron 378 encuestas (94 enfermeras y 284 auxiliares). Los profesionales tenían una actitud ligeramente en contra de las restricciones, si bien estaban dispuestos a usarlas para evitar caídas. Con relación a los conocimientos, obtuvieron un 66% de aciertos; solo un 32% creía que existen alternativas a la contención y el 69,1% ignoraba que pudiese causar la muerte de pacientes. Además, un 69,8% afirmó que su formación era escasa. La práctica podría considerarse aceptable, si bien un 61,9% opinaba que no sería necesario solicitar a la familia el consentimiento informado y solo el 47,1% de las enfermeras registraría siempre en la historia su uso. Existen diferencias en cuanto a actitudes, conocimientos y práctica entre los 2 grupos profesionales. Se observa que cuanto peores son los conocimientos y más favorable es la actitud hacia este procedimiento, peor es la práctica profesional vinculada a su aplicación. Conclusiones. La actitud del personal ante la restricción física es ambigua, y en sus conocimientos y práctica se han detectado creencias erróneas. Dada la influencia de los conocimientos sobre el resto de las variables es necesario mejorar la formación de los profesionales (AU)

Objectives: To investigate the attitudes, knowledge and practice on the use of physical restraints by nursing staff working with the elderly, as well as the relationship existing between these variables. Material and methods: A cross-sectional descriptive and correlational study was conducted among professionals from eight nursing homes. Three questionnaires asking about the mentioned variables were used. Results: A total of 378 questionnaires were finally included (94 nurses and 284 auxiliary nurses). The professionals’ attitude was generally against the use of restraints, although they were in favour of using them to avoid falls. With regard to knowledge, they obtained 66% of the correct answers; only 32% believed that there were alternatives to restraints, and 69.1% were unaware that these procedures could cause the death of patients. A total of 69.8% said that their training regarding restraint was limited. The practice could be considered acceptable, although the 61.9% thought it was not necessary to get informed consent from the family, and only 47.1% of the nurses always recorded its use in the patient’s history. Differences between attitudes, knowledge and practice were found among the two groups. A relationship between the variables was confirmed; less knowledge and more favourable attitude towards physical restraints correlate with a worst practice. Conclusions: The attitude of the staff to physical restraints is ambiguous, and erroneous concepts have been detected in their knowledge and practice. Given the influence of knowledge on the rest of the variables, the training of the professionals needs to be improved (AU)

[Use of physical restraints on the elderly: attitudes, knowledge and practice among nursing staff]. / Actitudes, conocimientos y práctica de los profesionales de enfermería en el uso de restricciones físicas con personas mayores.

OBJECTIVES: To investigate the attitudes, knowledge and practice on the use of physical restraints by nursing staff working with the elderly, as well as the relationship existing between these variables. MATERIAL AND METHODS: A cross-sectional descriptive and correlational study was conducted among professionals from eight nursing homes. Three questionnaires asking about the mentioned variables were used. RESULTS: A total of 378 questionnaires were finally included (94 nurses and 284 auxiliary nurses). The professionals' attitude was generally against the use of restraints, although they were in favour of using them to avoid falls. With regard to knowledge, they obtained 66% of the correct answers; only 32% believed that there were alternatives to restraints, and 69.1% were unaware that these procedures could cause the death of patients. A total of 69.8% said that their training regarding restraint was limited. The practice could be considered acceptable, although the 61.9% thought it was not necessary to get informed consent from the family, and only 47.1% of the nurses always recorded its use in the patient's history. Differences between attitudes, knowledge and practice were found among the two groups. A relationship between the variables was confirmed; less knowledge and more favourable attitude towards physical restraints correlate with a worst practice. CONCLUSIONS: The attitude of the staff to physical restraints is ambiguous, and erroneous concepts have been detected in their knowledge and practice. Given the influence of knowledge on the rest of the variables, the training of the professionals needs to be improved.

Índice de Charlson versus índice de Barthel como predictor de mortalidad e institucionalización en una unidad geriátrica de agudos y media estancia / Barthel and Charlson indexes for the prognosis of mortality and institutionalization in hospitalized geriatric patients

Introducción Comparar la validez del índice de Barthel (IB), el índice de comorbilidad de Charlson (ICC) y, una variante de este último, el índice de comorbilidad de Charlson corregido por la edad (ICCE) en el pronóstico de mortalidad e institucionalización en pacientes geriátricos hospitalizados.Material y métodos Se realiza un estudio retrospectivo de todos los pacientes ingresados durante el año 2006 en una unidad de agudos y media estancia de un servicio de geriatría (n=343). Como variables independientes se recogieron el IB al ingreso (registrado en la historia clínica de los pacientes) y el ICC e ICCE recogidos a posteriori con la información disponible. La variable resultado fue la ocurrencia de muerte o la institucionalización al alta del paciente, recogiéndose valores de sensibilidad y especificidad para cada uno de los puntos de corte seleccionados de las escalas evaluadas, y elaborando una curva ROC para cada una de ellas, calculando el área bajo la curva (ABC) con su intervalo de confianza (IC) del 95%. Resultados La muestra tenía una edad media de 82,3 años, con el 58,6% de mujeres. El ABC correspondiente al IB fue de 0,736 (IC del 95%=0,68–0,79), para el ICC fue de 0,61 (IC del 95%=0,55–0,67) y para el ICCE fue de 0,625 (IC del 95%=0,56–0,69), encontrándose diferencias estadísticamente significativas entre el ABC del IB frente al ABC de los otros dos índices (p<0,01).Conclusiones Como predictores de mortalidad e institucionalización, la validez del IB fue superior a la de los ICC (original y corregido por la edad). Por este motivo, el IB puede tener una mayor utilidad para el uso más adecuado de los recursos sanitarios disponibles(AU)

Introduction To compare the validity of the Barthel (BI) and Charlson comorbidity index (CCI) as well as the age-adjusted CCI for the prognosis of mortality and institutionalization in hospitalized geriatric patients.Material and methods A retrospective study was conducted to evaluate patients admitted to an acute care geriatric ward and mid-term care facility in 2006 (n=343). The independent variables were the admission BI (registered in the clinical history in all patients) and the CCI and the age-adjusted CCI, which were registered “a posteriori” using the available information. The outcome variable was mortality or institutionalization when the patient was discharged. The sensitivity and specificity values for each of the cut-off points selected from the scales analyzed were recorded and ROC curves were constructed for each of these points; the area under the curve (AUC) with a confidence interval (CI) of up to 95% was calculated.Results The mean age was 82.3 years (58.6% women). The AUC was 0.736 (95% CI=0.68–0.79) for the BI, 0.61 (95% CI=0.55–0.67) for the CCI and 0.625 (95% CI=0.56–0.69) for the age-adjusted CCI. Statistically significant differences were found among the AUC of the BI compared with that of the other two indexes (p<0.01).Conclusions As predictors of mortality and institutionalization, the BI was superior to the CCI and the age-adjusted CCI. The BI could therefore be more useful than the other two indexes when considering an adequate use of healthcare services (AU)

[Barthel and Charlson indexes for the prognosis of mortality and institutionalization in hospitalized geriatric patients]. / Indice de Charlson versus índice de Barthel como predictor de mortalidad e institucionalización en una unidad geriátrica de agudos y media estancia.

INTRODUCTION: To compare the validity of the Barthel (BI) and Charlson comorbidity index (CCI) as well as the age-adjusted CCI for the prognosis of mortality and institutionalization in hospitalized geriatric patients. MATERIAL AND METHODS: A retrospective study was conducted to evaluate patients admitted to an acute care geriatric ward and mid-term care facility in 2006 (n=343). The independent variables were the admission BI (registered in the clinical history in all patients) and the CCI and the age-adjusted CCI, which were registered "a posteriori" using the available information. The outcome variable was mortality or institutionalization when the patient was discharged. The sensitivity and specificity values for each of the cut-off points selected from the scales analyzed were recorded and ROC curves were constructed for each of these points; the area under the curve (AUC) with a confidence interval (CI) of up to 95% was calculated. RESULTS: The mean age was 82.3 years (58.6% women). The AUC was 0.736 (95% CI=0.68-0.79) for the BI, 0.61 (95% CI=0.55-0.67) for the CCI and 0.625 (95% CI=0.56-0.69) for the age-adjusted CCI. Statistically significant differences were found among the AUC of the BI compared with that of the other two indexes (p<0.01). CONCLUSIONS: As predictors of mortality and institutionalization, the BI was superior to the CCI and the age-adjusted CCI. The BI could therefore be more useful than the other two indexes when considering an adequate use of healthcare services.

Resultados de salud en geriatría. Una aproximación con base en las intervenciones de un hospital de día / No disponible

Objetivos: Investigar resultados de salud, para medir las consecuencias de la práctica asistencial en un aspecto clave: la repercusión de las intervenciones en la situación funcional de los pacientes admitidos en hospital de día de geriatría (HDG). Pacientes y métodos: Estudio observacional retrospectivo de la situación funcional, mediante el Índice de Barthel (IB), al ingreso y al alta, características, procedencia, factores de riesgo, motivo de ingreso, tratamiento y destino al alta; de todos los pacientes admitidos en un HDG durante el año 2004. Análisis mediante la T de student para muestras relacionadas del IB. Estimación del coeficiente de correlación de Pearson para relacionar situación funcional y edad. Resultados: N= 127. Edad: 77.61±12.49 años. Estancia media en HDG: 38.4 días. 41% procedían de la Unidad Geriátrica de Agudos. El 75.5% presentaban cardiopatía como patología previa. La inmovilidad era el factor de riesgo en el 72% de los casos y fue el motivo principal de inclusión en HDG en el 42%. El 94% recibieron fisioterapia. La media de IB al ingreso fue de 57,126 y al alta de 62,086, además de existir una fuerte correlación positiva (R=+0.93) entre los dos índices, su diferencia - utilizandoel test de la t de student - siempre resultó significativa, indicando mejoría. No se encontró una correlación fuerte entre IB al ingreso y edad (R=+0.147). El 70% volvió a su domicilio tras el alta, un 4.6% precisó institucionalización. Conclusiones: Mejoría de la situación funcional y baja institucionalización tras intervención en HDG (AU)

Objectives: To investigate health results, in order to measure the consequences of welfare practice in a crucial aspect: repercussion of interventions on the functional situation of the patients admitted in ageriatric day hospital (HDG). Patients and methods: Retrospective observacional study of functional situation, using Barthel index functional level scale (BI), at admission and discharge, patient’s characteristics, origin, risk factors, reason for admission, treatment and destiny at discharge; of all the patients admitted in a HDG during year 2004. Analysis with T of student, for related samples was used, as well as Binary lineal regression calculation to relate functional situation and age. Results: N = 127. Age: 77.61±12, 49 years. Average hospital stay in HDG: 38, 4 days. 41% came fromthe Acute Geriatric Unit. The 75, 5% presented/displayed heart disease as previous pathology. Immobility was a risk factor in 72% of the cases and the main reason for inclusion in HDG in 42%. 94% received physiotherapy. Average of IB at admission was of 57.126 and at discharge of 62.086, being this significant difference (R=+0.93). Strong correlation between IB at entrance and age (R=+0.147) was not befound. 70% returned to their home after the discharge, 4,6% needed institutionalization. Conclusions: Improvement of functional situation and low institutionalization after intervention in HDG (AU)

Total knee arthroplasty in the elderly. Is there an age limit?

The goal of this study was to compare the results of the total knee arthroplasty (TKA) in 2 study groups only differing by age. We have analyzed 218 TKA cases (138 women and 80 men) with at least 2 years follow-up. Mean age was 70 years (SD, 7.38 years; range, 43 to 98 years). An age cutoff point at 75 years defined the 2 study groups: 167 cases younger than 75 years and 51 older. Results were evaluated using the Hospital for Special Surgery Score. Mean score was raised from 53.43 (SD, 9.186) preoperatively to 85.57 (SD, 10.763) in 2 years follow-up (P < .001). The final score did not show significant differences between both groups (86.11 for the younger group and 83.8 for the older group). Differences in pain on walking, pain at rest, walk, range of motion, climbing stairs, transfer, muscle strength, or instability were not found between the patients younger and older than 75 years. We did not find any differences in TKA, functional score, or pain between the 2 studied groups.

Measurement of bone mineral density is possible with standard radiographs: a study involving total knee replacement.

BACKGROUND: Measured bone density correlates well with the mechanical properties of the bone. Our objective was to evaluate optical densitometry as a method of measuring the periprosthetic bone density of the tibial platform in total knee replacement using serial dual-energy X-ray absorptiometry (DXA) as the reference test. METHODS: 30 patients who underwent a cemented total knee replacement were followed up for over 2 years. Standard radiographs of the knee were obtained at 12 and 24 months. These were photographed with a digital camera and enhanced with image processing software. A DXA scan was performed at the same time as the reference method. 3 regions of interest were defined under the tibial plateau (medial, lateral and stem positions). RESULTS: After 24 months of follow-up there was a significant decrease in density in the 3 regions, both with the optical and DXA methods. The concordance between methods was studied using Bland and Altman plots, Cronbach's alpha and intraclass correlation coefficients resulted in values from 0.72 to 0.87, depending on the region and the follow-up time. INTERPRETATION: Quantification of optical density values with a standardized measurement system on conventional radiographs is a reliable and efficient method of determining the bone mineral density.