The situation of infection in the elderly in Spain: a multidisciplinary opinion document.

Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed.

Validation of self-reported adherence in chronic patients visiting pharmacies and factors associated with the overestimation and underestimation of good adherence.

BACKGROUND: Studies validating indirect methods to identify nonadherence in chronic patients who visit pharmacies are lacking. The aim of this study was to validate self-reported adherence and assess the variables associated with both overestimation and underestimation of good adherence when using this method. MATERIALS AND METHODS: An observational, cross-sectional study was undertaken to validate self-reported adherence in 132 community pharmacies throughout Spain in 6237 chronic patients. The Morisky-Green test was used as the validation method and through a 2 × 2 table, the validity indicators, predictive values, and likelihood ratios were calculated. To assess the variables associated with both overestimation and underestimation of good adherence, multivariate logistic regression analysis and calculation of the area under the ROC curve were used to evaluate discriminatory capacity. RESULTS: Sensitivity was 27.8% (95% CI: 26.2-29.4) and specificity was 93.9% (95% CI: 93.1-94.7). Discrepancy analysis obtained a significant overestimation of good adherence (p < 0.001). The factors associated with overestimating good adherence were performing a mnemonic trick (p < 0.001), not self-medicating (p < 0.001), a high level of physical activity (p < 0.001), and an older age (p = 0.014). Factors associated with underestimation were self-medication (p < 0.001), desiring more information (p < 0.001), smoking (p = 0.014), not engaging in physical activity in the low (p = 0.006) or high (p < 0.001) categories, having a younger mean age (p = 0.007), and taking two to three (p = 0.029) or four or more (p < 0.001) chronic treatments. CONCLUSION: Self-reported adherence has good specificity but poor sensitivity. The associated profiles of the discrepancies were obtained to identify both good and poor adherence.

Outcomes of very elderly trauma ICU patients. Results from the Spanish trauma ICU registry.

OBJECTIVE: To analyze outcomes and factors related to mortality among very elderly trauma patients admitted to intensive care units (ICUs) participating in the Spanish trauma ICU registry. DESIGN: A multicenter nationwide registry. Retrospective analysis. November 2012-May 2017. SETTING: Participating ICUs. PATIENTS: Trauma patients aged ≥80 years. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: The outcomes and influence of limitation of life sustaining therapy (LLST) were analyzed. Comparisons were established using the Wilcoxon test, Chi-squared test or Fisher's exact test as appropriate. Multiple logistic regression analysis was performed to analyze variables related to mortality. A p-value <0.05 was considered statistically significant. RESULTS: The mean patient age was 83.4±3.3 years; 281 males (60.4%). Low-energy falls were the mechanisms of injury in 256 patients (55.1%). The mean ISS was 20.5±11.1, with a mean ICU stay of 7.45±9.9 days. The probability of survival based on the TRISS methodology was 69.8±29.7%. The ICU mortality rate was 15.5%, with an in-hospital mortality rate of 19.2%. The main cause of mortality was intracranial hypertension (42.7%). The ISS, the need for first- and second-tier measures to control intracranial pressure, and being admitted to the ICU for organ donation were independent mortality predictors. LLST was applied in 128 patients (27.9%). Patients who received LLST were older, with more severe trauma, and with more severe brain injury. CONCLUSIONS: Very elderly trauma ICU patients presented mortality rates lower than predicted on the basis of the severity of injury.

Progression of Alzheimer disease in Europe: data from the European ICTUS study.

The clinical progression of Alzheimer disease (AD) was studied in European subjects under treatment with AChE inhibitors (AChE-I) in relation to geographical location over a 2-years period. One thousand three hundred and six subjects from 11 European countries were clustered into 3 regions (North, South, West) and investigated with biannual follow-up over 2 years. Primary outcomes were cognitive, functional and behavioral measures. Caregiver burden, hospital admission and admission to nursing home were also recorded. Participant cognitive function declined non-linearly over time (MMSE: -1.5 pts/first year, -2.5 pts/second year; ADAScog: + 3.5 pts/first year, + 4.8 pts/second year), while the progression of behavioral disturbances (NPI scale) was linear. Neither scale showed regional differences, and progression of the disease was similar across Europe despite different health care systems. Functional decline (ADL, IADL) tended to progress more rapidly in Southern Europe (p=0.09), while progression of caregiver burden (Zarit Burden Interview) was most rapid in Northern Europe (5.6 pts/y, p=0.04). Incidences of hospital admission (10.44, 95%CI: 8.13-12.75, p < 0.001) and admission to nursing home (2.97, 95%CI: 1.83-4.11, p < 0.001) were lowest in Southern Europe. In general cognitive and functional decline was slower than in former cohorts. European geographical location reflecting differences in culture and in health care system does not impact on the progression of AD but does influence the management of AD subjects and caregiver burden.

Caídas en el paciente neurogeriátrico. Réplica / Falls in patients with neurogeriatric disorders. Reply

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Recomendaciones de bebida e hidrataciónpara la población española / Spanish guidelines for hydration

El agua contenida en los alimentos junto con la que bebemos y el resto de los líquidos que ingerimos, tienen que garantizar nuestra correcta hidratación en todas las edades y circunstancias vitales. En consecuencia, es muy importante que su consumo tenga asegurada la calidad y la cantidad. La ingestión adecuada de agua total se ha establecido para prevenir los efectos deletéreos de la deshidratación que incluyen trastornos funcionales y metabólicos. Es conocido como el grado de hidratación puede influir sobre la salud y el bienestar de las personas. En la mujer embarazada, una parte importante del aumento de su peso se produce a expensas del incremento del volumen plasmático. En el caso de la lactancia, resulta obvia la importancia de mantener una ingesta hídrica adecuada si queremos preservar localidad y cantidad de la leche y, por lo tanto, el estado nutricional del niño y de la madre. En el caso del niño, su balance hídrico tiene que estar equilibrado a través de aportaciones cotidianas suficientes. Las necesidades basales de líquidos en los mayores se cifran en torno a 30-35 mL por Kilogramo de peso y día. Hay circunstancias que incrementan las necesidades de líquidos del organismo como el estrés, la actividad y el ejercicio físico, el aumento de la temperatura ambiental ,la fiebre, las pérdidas de líquidos por vómitos y/o diarreas, la diabetes descompensada, las quemaduras, etc. Los factores que condicionan el ejercicio en relación con la hidratación son: las características del ejercicio, las condiciones ambientales, las características individuales, el acostumbramiento a las condiciones climáticas externas, el entrenamiento, el umbral y la capacidad de sudoración. Todo ello hace que resulte muy conveniente instaurar unas Guías directrices que puedan orientar a los consumidores, así como a los distintos profesionales dela salud, sobre lo que resulta más adecuado beber o aconsejar beber en cada momento (AU)

Water is a natural resource essential to life and essential in our daily food. The water contained in food which along with liquids we drink and the rest we eat, we have to ensure proper hydration in all ages and life circumstances. It is very important that its consumption has ensured the quality and quantity. The adequate intake of total water has been established to prevent the deleterious effects of dehydration (especially acute effects) that include functional and metabolic disorders. It is known that the degree of hydration can influence the health and welfare of people, including his mental concentration and other cognitive aspects, their physical performance and heat tolerance. In pregnant women, an important part of its increasing weight occurs at the expense of the volume plasma increase. In the case of breastfeeding, if we consider that approximately 87-90% the composition of milk is water, it is obvious the importance of maintaining an adequate water intake if we want to preserve the quality and quantity of milk and, hence, the nutritional status of children and mothers. In the case of children, their water balance has to be balanced through sufficient contributions every day, especially in the early stages of life where they are most vulnerable to fluids and electrolytes imbalances. Children -especially infants and those who start walking-are at increased risk, even deadly, dehydration than adults. The factors that determine the exercise in relation to the hydration are the characteristics of the exercise, environmental conditions, individual characteristics, accustomed to external weather conditions, training, and capacity threshold of sweating. In recent years, besides the traditional beverages, a wide range of new drinks that often have a significant caloric value, have proliferated in the marketplace for. This makes it highly desirable to establish some guidelines (AU)

[Characteristics of falls of neurological cause in the elderly]. / Caracteristicas de las caídas de causa neurológica en ancianos.

INTRODUCTION: Falls are a cause of disability and death in geriatric population. Third part of the elderly suffer at least one fall per year. Neurological illness are a very important risk factor in developing falls. AIM: To establish the differences between neurological and not neurological patients with recurrent falls. PATIENTS AND METHODS: We select 113 patients over 65 years-old with two or more falls in the last six months, collecting demographic and medical data, as well as a functional, mental and social evaluation, gait and balance tests and posturography. Complementary examinations were done to clarify the diagnosis in each case. RESULTS: Average age was 78 years-old. We define a group A, patients in which the main cause of falls is a neurological disease and group B with a non-neurological cause. Group A shows more number of falls (p < 0.053), worse functional (p < 0.002) and mental (p < 0.001) situation and more comorbility (p = 0.05), as well as worse scores in gait tests. CONCLUSIONS: Neurological illness are a very important risk factor in falls due to the disturbances in gait and balance that they produce. Dementia, parkinsonism and cerebrovascular diseases are frequently found in elderly patients with recurrent falls. Patients with falls due to neurological illness tend to fall oftener and have worse mental and functional situation. Evaluating neurological risk factors in geriatric patients with recurrent falls is essential to establish appropriate prevention strategies.

Características de las caídas de causa neurológica en ancianos / Characteristics of valls of neurological cause in the elderly

Las caídas son causa de discapacidad y muerte en la población geriátrica. Un tercio de los ancianossufre al menos una caída al año. Las patologías neurológicas son un importante factor de riesgo en la producción de caídas. Objetivo. Establecer las diferencias entre ancianos con caídas de repetición en función de que padezcan o no alguna patologíaneurológica. Pacientes y métodos. Se seleccionaron 113 pacientes mayores de 65 años con dos o más caídas en los últimos seis meses y se recogieron variables demográficas y médicas, valoración funcional, mental, social, de la marcha y el equilibrio, y posturografía. Se realizaron las pruebas complementarias en cada caso para aclarar el diagnóstico. Resultados.La edad media fue de 78 años. Se definió un grupo A, pacientes en los que la causa fundamental de la caída era neurológica, y un grupo B, con causa no neurológica. El grupo A presentó mayor número de caídas (p = 0,053), peor situación funcional (p = 0,002) y mental (p < 0,001) y mayor morbilidad (p = 0,05), así como peor puntuación en los test de valoración de lamarcha. Conclusiones. Las enfermedades neurológicas constituyen un importante factor de riesgo en la producción de caídas por las alteraciones de la marcha y el equilibrio que producen. Las demencias, los síndromes parkinsonianos y la enfermedadcerebrovascular se encuentran con frecuencia entre la población de ancianos con caídas de repetición. Los pacientes con caídas de causa neurológica presentan más caídas y peor situación funcional y mental. Identificar factores de riesgo neurológico en ancianos con caídas resulta fundamental para establecer estrategias de prevención adecuadas (AU)

Falls are a cause of disability and death in geriatric population. Third part of the elderly suffer at leastone fall per year. Neurological illness are a very important risk factor in developing falls. Aim. To establish the differences between neurological and not neurological patients with recurrent falls. Patients and methods. We select 113 patients over 65years-old with two or more falls in the last six months, collecting demographic and medical data, as well as a functional, mental and social evaluation, gait and balance tests and posturography. Complementary examinations were done to clarifythe diagnosis in each case. Results. Average age was 78 years-old. We define a group A, patients in which the main cause of falls is a neurological disease and group B with a non-neurological cause. Group A shows more number of falls (p < 0.053), worse functional (p < 0.002) and mental (p < 0.001) situation and more comorbility (p = 0.05), as well as worse scores in gaittests. Conclusions. Neurological illness are a very important risk factor in falls due to the disturbances in gait and balance that they produce. Dementia, parkinsonism and cerebrovascular diseases are frequently found in elderly patients with recurrent falls. Patients with falls due to neurological illness tend to fall oftener and have worse mental and functional situation. Evaluating neurological risk factors in geriatric patients with recurrent falls is essential to establish appropriate prevention strategies (AU)

[Neurohormonal blockade in patients with heart failure at discharge from hospital]. / Bloqueo neurohormonal al alta en pacientes con insuficiencia cardiaca.

With the objective to value the degree of fulfillment of the pharmacological processing in patients with heart failure was designed the study of therapeutic adherence in heart failure (ATICA). During the period of inclusion educational, social, demographic data have been obtained, personal antecedents, analytic and physical exploration of the patients. These data mentioned are the ones that are reflected in the present pilot study. The total of patients included is 554, the majority of which are women, the middle ages is advanced and they present a fraction of eyección conserved in more than the half. In the therapeutic plan only was collected information of groups with neurohormonal action and of great recognition in the processing of the heart failure. The most utilized pharmacological group are the IECA, nevertheless medicines as the espirolactona or the betablocker continue showing a worrying degree of infrautilización, although they present a greater prescription that in other series.

Bloqueo neurohormonal al alta en pacientes con insuficiencia cardiaca / Neurohormonal blockade in patients with heart failure at discharge from hospital

Con el objetivo de valorar el grado de cumplimiento del tratamiento farmacológico en pacientes con ICC se diseñó el estudio de adherencia terapéutica en insuficiencia cardiaca (ATICA). Durante el periodo de inclusión se han obtenido datos demográficos, sociales, educacionales, antecedentes personales, exploración física y analítica de los pacientes. Estos datos mencionados son los que se reflejan en el presente estudio piloto. El total de pacientes incluidos es de 586, la mayoría de los cuales son mujeres, la edad media es avanzada y presentan una fracción de eyección conservada en más de la mitad. Respecto al esquema terapéutico únicamente se recogió información de grupos con acción neurohormonal y de reconocimiento en el tratamiento de la ICC. El grupo farmacológico más utilizado son los IECA, sin embargo fármacos como la espirolactona o los BB, siguen mostrando un grado de infrautilización preocupante, aunque presentan una prescripción mayor que en otras series

With the objective to value the degree of fulfillment of the pharmacological processing in patients with heart failure was designed the study of therapeutic adherence in heart failure (ATICA). During the period of inclusion educational, social, demographic data have been obtained, personal antecedents, analytic and physical exploration of the patients. These data mentioned are the ones that are reflected in the present pilot study. The total of patients included is 554, the majority of which are women, the middle ages is advanced and they present a fraction of eyección conserved in more than the half. In the therapeutic plan only was collected information of groups with neurohormonal action and of great recognition in the processing of the heart failure. The most utilized pharmacological group are the IECA, nevertheless medicines as the espirolactona or the betablocker continue showing a worrying degree of infrautilización, although they present a greater prescription that in other series

Insuficiencia cardíaca y hospitalización: ¿son los mismos pacientes? / Heart failure and hospitalization: are they the same patients?

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Enseñanza de la geriatría en el pregrado / Teaching of geriatrics to undergraduates

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El síndrome confusional agudo: un «síndrome geriátrico» en alza / Acute confusional syndrome: a raising «geriatric syndrome»

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Vejez y hospitalización / Old age and hospitalization

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