Efficacy of Antiresorptive Treatment in Osteoporotic Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

OBJECTIVES: To investigate concerns surrounding the benefits of antiresorptive drugs in older adults, a systematic review was carried out to evaluate the efficacy of these treatments in the prevention of osteoporotic hip fractures in older adults. DESIGN: a systematic review and meta-analysis of randomized clinical trials. SETTING AND PARTICIPANTS: older adults ≥65 years with osteoporosis, with or without a previous fragility fracture. Studies with cancer-related and corticosteroid-induced osteoporosis, participants <65 years and no reported hip fracture were not included. METHODS: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ISI Web of Science and Scopus databases were searched. The primary outcome was hip fracture, and subgroup analysis (≥75 years, with different drug types and secondary prevention) and sensitivity analysis was carried out using a GRADE evaluation. Secondary outcomes were any type of fractures, vertebral fracture, bone markers and adverse events. The risk of bias was assessment with the Cochrane risk of bias tool. RESULTS: A total of 12 randomised controlled trials (RCTs) qualified for this meta-analysis, with 36,196 participants. Antiresorptive drugs have a statistically significant effect on the prevention of hip fracture (RR=0.70; 95%CI 0.60 to 0.81), but with a moderate GRADE quality of evidence and a high number needed to treat (NNT) of 186. For other outcomes, there is a statistically significant effect, but with a low to moderate quality of evidence. Antiresorptives showed no reduction in the risk of hip fracture in people ≥75 years. The results for different drug types, secondary prevention and sensitivity analysis are similar to the main analyses and have the same concerns. CONCLUSIONS: Antiresorptive drugs have a statistically significant effect on preventing hip fracture but with a moderate quality (unclear/high risk of bias) and high NNT (186). This small benefit disappears in those ≥75 years, but increases in secondary prevention. More RCTs in very old osteoporotic adults are needed.

Morbi-mortality of lower respiratory tract infections in Spain, 1997-2018 / Morbimortalidad de las infecciones del tracto respiratorio inferior en España, 1997-2018

Background:Lower respiratory tract infections (LRTIs) are one of the leading causes of infectious disease mortality worldwide. The aims of the study were to determine the incidence of hospitalizations due to LRTIs, and to analyze the clinical outcomes of the hospitalized patients. Methods:An observational study of hospitalizations due to LRTIs (pneumonia and acute bronchitis/bronchio-litis) in Spain from 1997 to 2018 was carried out. Data were extracted from the national information system for hospital data. Results:Overall, 3.5 % (IQR: 3.4-3.5 %) of total hospitalizations were caused by LRTIs, with a median incidence of 31.2 (IQR: 27.8-33.0) per 10,000 inhabitants/year. The median incidence was higher for pneumonia than for acute bronchitis/bronchiolitis cases (22.2; IQR: 19.1-23.5 vs. 9.0; IQR: 8.4-9.6 per 10,000 inhabitants/year; p < 0.001) and increased by 65.7 % from 1997 to 2018. A 41.2 % of the hospitalizations due to LRTIs took place amongst people over 74 years. The median length of stay was 8.9 days (IQR: 7.6-10.4) and was higher for hospitalizations due to pneumonia than for acute bronchitis/bronchiolitis (9.5 days; IQR: 8.3-10.6 vs. 5.7; IQR: 5.5-6.2; p < 0,001). In 89.1 % of total hospitalizations due to LRTIs, patients were discharged home. In-hospital mortality was 6.8 %, with 9,380 deaths (IQR: 8,192-10,157) per year. Mortality was higher for pneumonia (9.0 vs. 1.7 %; p < 0.001) and doubled from 1997 to 2018 (5,257 deaths in 1997 and 10,514 in 2018). A 75.5 % of the deaths occurred amongst people over 74 years.Conclusions:LRTIs are associated with a high morbi-mortality in Spain. Effective measures that can contribute towards the prevention and treatment of LRTIs need to be adopted.(AU)

Fundamento: Las infecciones del tracto respiratorio inferior (ITRI) constituyen una de las principales causas de mortalidad por enfermedades infecciosas a nivel mundial. Los objetivos del estudio consistieron en determinar la incidencia de hospitalizaciones por ITRI, y en analizar los resultados clínicos de los pacientes hospitalizados. Métodos: Se llevó a cabo un estudio observacional de las hospitalizaciones por ITRI (neumonía y bronquitis/bronquiolitis aguda) en España entre 1997-2018. Los datos se extrajeron del Registro Español de Atención Sanitaria Especializada. Resultados: El 3,5% (RIC: 3,4-3,5%) del total de hospitalizaciones se debieron a ITRI, con una incidencia mediana de 31,2 (RIC: 27,8-33,0) por cada 10.000 habitantes/año. La mediana de incidencia fue superior para las neumonías que para las bronquitis/bronquiolitis agudas (22,2; RIC: 19,1-23,5 vs. 9,0; RIC: 8,4-9,6 por 10.000 habitantes/año; p<0,001), y entre 1997-2018 aumentó un 65,7%. Un 41,2% de las hospitalizaciones por ITRI ocurrieron en mayores de 74 años. La mediana de duración de las hospitalizaciones por ITRI fue 8,9 días (RIC: 7,6-10,4), superior para neumonías (9,5 días; RIC: 8,3-10,6 vs. 5,7; RIC: 5,5-6,2; p<0,001). En un 89,1% de las hospitalizaciones por ITRI los pacientes fueron dados de alta a domicilio. La mortalidad intrahospitalaria fue 6,8%, con 9.380 fallecimientos anuales (RIC: 8,192-10,157). La mortalidad fue superior para neumonías (9,0 vs. 1,7%; p<0,001) y se duplicó entre 1997 y 2018 (5.257 fallecimientos en 1997 y 10.514 en 2018). El 75,5% de las muertes ocurrieron en mayores de 74 años. Conclusiones: Las ITRI se asocian a una elevada morbimortalidad. Se requieren medidas efectivas para su prevención y tratamiento.(AU)

Morbi-mortality of lower respiratory tract infections in Spain, 1997-2018.

BACKGROUND: Lower respiratory tract infections (LRTIs) are one of the leading causes of infectious disease mortality worldwide. The aims of the study were to determine the incidence of hospitalizations due to LRTIs, and to analyze the clinical outcomes of the hospitalized patients. METHODS: An observational study of hospitalizations due to LRTIs (pneumonia and acute bronchitis/bronchiolitis) in Spain from 1997 to 2018 was carried out. Data were extracted from the national information system for hospital data. RESULTS: Overall, 3.5% (IQR: 3.4-3.5%) of total hospitalizations were caused by LRTIs, with a median incidence of 31.2 (IQR: 27.8-33.0) per 10,000 inhabitants/year. The median incidence was higher for pneumonia than for acute bronchitis/bronchiolitis cases (22.2; IQR: 19.1-23.5 vs. 9.0; IQR: 8.4-9.6 per 10,000 inhabitants/year; p<0.001) and increased by 65.7% from 1997 to 2018. A 41.2% of the hospitalizations due to LRTIs took place amongst people over 74 years. The median length of stay was 8.9 days (IQR: 7.6-10.4) and was higher for hospitalizations due to pneumonia than for acute bronchitis/bronchiolitis (9.5 days; IQR: 8.3-10.6 vs. 5.7; IQR: 5.5-6.2; p<0,001). In 89.1% of total hospitalizations due to LRTIs, patients were discharged home. In-hospital mortality was 6.8%, with 9,380 deaths (IQR: 8,192-10,157) per year. Mortality was higher for pneumonia (9.0 vs. 1.7%; p

Transparencia, equidad y acceso a los medicamentos: a propósito de la pandemia por COVID-19 / Transparency, equity and access to medicines: talking of the COVID-19 pandemic

La pandemia por COVID-19 ha generado una crisis a todos los niveles, desde el sanitario hasta el económico, laboral y social. Los sistemas sanitarios han mostrado una enorme capacidad de adaptación a las necesidades, que han requerido de rápidas actuaciones. Realizar un análisis de la situación es esencial para redimensionar las necesidades y hacer un uso más eficiente de los recursos disponibles con vistas a futuro. Algunas de las cuestiones que nos permitirán avanzar para garantizar que el sistema siga siendo sostenible y equitativo son el disponer de investigación científica de calidad y realizar una evaluación crítica de la misma, la prudencia en la práctica médica, la transparencia y el acceso a la información, la inversión pública en I+D+I, el desarrollo de nuevos modelos de financiación de medicamentos y la cooperación internacional

The COVID-19 pandemic has generated a crisis at all levels, from health sector to the economic, working and social fields. Health systems have shown an enormous capacity to adapt to the needs, which have required rapid actions. To carry out an analysis of the situation is essential to resize needs and make a more efficient use of available resources with a view to the future. Some of the issues that will allow us to make progress in ensuring that the system remains sustainable and equitable are good quality scientific research with appropriate critical appraisal, prudence in medical practice, transparency and access to information, public investment in R+D+I, development of new drug financing models and international cooperation

Heterogeneidad en el cribado poblacional de la fragilidad / Heterogeneity amongst different diagnostic tools in frailty screening

Fundamento: La fragilidad supone una situación de vulnerabilidad predisponente a resultados adversos en salud, relacionada con la edad y la pérdida de capacidad funcional. Aunque Atención Primaria (AP) es un nivel asistencial privilegiado para detectarla precozmente e instaurar medidas que frenen su progresión, no existe una herramienta gold standard para su detección. El objetivo es analizar la prevalencia de fragilidad en AP y evidenciar la herramienta diagnóstica más útil para este medio. Materialy métodos: Estudio transversal realizado en una muestra de 225 personas seleccionadas aleatoriamente de una población de 4.252 mayores de 75 años de tres zonas de Navarra. Se realizaron cuatro pruebas diagnósticas de fragilidad: el fenotipo de Fried, el Short Physical Performance Battery (SPPB), el Up-to Go (TUG) y el de la velocidad de la marcha (VM). Los participantes que no consiguieron finalizar alguna de las pruebas no fueron considerados en el análisis posterior. Resultados: El 51% de los participantes eran hombres, con edad media de 80,5 años, el 80% polimedicados, el 8,4% con deterioro cognitivo y el 31,1 y el 41,3% independientes para las actividades básicas e instrumentales, respectivamente, de la vida diaria. La prevalencia de fragilidad fue 8,4% (Fried), 13,7% (SPPB), 46,2% (TUG) y 52,2% (VM). Conclusiones. Se detectó gran heterogeneidad en la prevalencia de fragilidad según la herramienta diagnóstica empleada. Es necesaria una herramienta fiable, rápida y sencilla para la detección precoz de la fragilidad en AP por lo que, según los resultados y las peculiaridades de AP, proponemos el TUG o la VM como buenos predictores precoces de este deterioro

Background: Frailty means a state of vulnerability with a predisposition to adverse health outcomes, closely related to age and a consequent loss of functional capability. Early detection is important for initiating measures to slow its progression. Primary Health Care (PHC) occupies a privileged place in this. However, we do not possess a gold standard tool for its detection. Our aim is to analyse the prevalence of frailty in PHC and define the most useful diagnostic tool for this area. Methods: Cross-sectional study with 225 people were selected from a population of 4,252 people aged over 75 years-old, from three different basic health zones of Navarre. Four different diagnostic tests for frailty were conducted: the Fried phenotype, the Short Physical Performance Battery (SPPB), the Timed Up-to-Go test (TUG) and the Gait Speed test (GS). Patients who were unable to finish any of the tests weren't included in the subsequent analysis. Results: Fifty-one percent of participants were men, with mean age 80.5 years-old, 80% were taking more than five daily drugs, 8.4% had cognitive impairment, and 31.1 and 41.3% were independent for basic and instrumental activities, respectively, of daily living. The frailty prevalence was 8.3% for Fried phenotype, 13.7% for SPPB, 46.2% for TUG and 52.2% for Gait Speed. Conclusion: Great heterogeneity in the prevalence of frailty was shown depending on the tool employed. As a reliable, fast and simple tool for early detection of frailty is needed in PHC, based on our results and the particularities of PHC, we propose TUG or GS as good early predictors of this decline

[Heterogeneity amongst different diagnostic tools in frailty screening]. / Heterogeneidad en el cribado poblacional de la fragilidad.

BACKGROUND: Frailty means a state of vulnerability with a predisposition to adverse health outcomes, closely related to age and a consequent loss of functional capability. Early detection is important for initiating measures to slow its progression. Primary Health Care (PHC) occupies a privileged place in this. However, we do not possess a gold standard tool for its detection. Our aim is to analyse the prevalence of frailty in PHC and define the most useful diagnostic tool for this area. METHODS: Cross-sectional study with 225 people were selected from a population of 4,252 people aged over 75 years-old, from three different basic health zones of Navarre. Four different diagnostic tests for frailty were conducted: the Fried phenotype, the Short Physical Performance Battery (SPPB), the Timed Up-to-Go test (TUG) and the Gait Speed test (GS). Patients who were unable to finish any of the tests weren't included in the subsequent analysis. RESULTS: Fifty-one percent of participants were men, with mean age 80.5 years-old, 80% were taking more than five daily drugs, 8.4% had cognitive impairment, and 31.1 and 41.3% were independent for basic and instrumental activities, respectively, of daily living. The frailty prevalence was 8.3% for Fried phenotype, 13.7% for SPPB, 46.2% for TUG and 52.2% for Gait Speed. CONCLUSION: Great heterogeneity in the prevalence of frailty was shown depending on the tool employed. As a reliable, fast and simple tool for early detection of frailty is needed in PHC, based on our results and the particularities of PHC, we propose TUG or GS as good early predictors of this decline.

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research.

Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research.

Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

The relationship between frailty and polypharmacy in older people: A systematic review.

AIMS: Frailty is a complex geriatric syndrome resulting in decreased physiological reserves. Frailty and polypharmacy are common in older adults and the focus of extensive studies, although little is known about the impact they may have on each other. This is the first systematic review analysing the available evidence on the relationship between frailty and polypharmacy in older adults. METHODS: Systematic review of quantitative studies. A comprehensive literature search for publications in English or Spanish was performed on MEDLINE, CINAHL, the Cochrane Database and PsycINFO in September 2017 without applying restrictions on the date of publication. Studies reporting any relationship between frailty and polypharmacy in older adults were considered. RESULTS: A total of 25 publications were included, all of them observational studies. Evaluation of Fried's frailty criteria was the most common approach, followed by the Edmonton Frail Scale and FRAIL scale. Sixteen of 18 cross-sectional analyses and five of seven longitudinal analyses demonstrated a significant association between an increased number of medications and frailty. The causal relationship is unclear and appears to be bidirectional. Our analysis of published data suggests that polypharmacy could be a major contributor to the development of frailty. CONCLUSIONS: A reduction of polypharmacy could be a cautious strategy to prevent and manage frailty. Further research is needed to confirm the possible benefits of reducing polypharmacy in the development, reversion or delay of frailty.

Intervenciones para optimizar el tratamiento farmacológico en ancianos hospitalizados: una revisión sistemática / Interventions to optimize pharmacologic treatment in hospitalized older adults: a systematic review

Objetivo. Resumir la evidencia sobre las intervenciones orientadas a optimizar el tratamiento farmacológico en ancianos hospitalizados. Material y métodos. Se realizó una búsqueda en las principales bases de datos bibliográficas, seleccionando estudios prospectivos en pacientes mayores de 65 años hospitalizados que realizaran intervenciones dirigidas a optimizar el tratamiento farmacológico, disminuir la polifarmacia y mejorar la adecuación terapéutica, los resultados en salud o el aprovechamiento del sistema sanitario. Resultados. Se seleccionaron 18 estudios. Las intervenciones consistieron en revisiones de medicación, detección de medicamentos predefinidos como potencialmente inadecuados en ancianos, asesoramiento de un equipo especializado en geriatría, uso de un sistema informático de apoyo a la prescripción o formación específica al equipo de enfermería. Hasta 14 estudios evaluaron la adecuación terapéutica, demostrando 13 de ellos una mejoría en alguno de los parámetros. Siete estudios midieron el impacto de la intervención sobre la polifarmacia, pero solo uno mejoró los resultados respecto al control. Otros siete estudios analizaron la mortalidad, no demostrándose una disminución de la misma en ninguno. Solo uno de seis estudios mostró una reducción de reingresos hospitalarios y uno de cuatro estudios una disminución de las visitas a urgencias. Conclusiones. Pese a la heterogeneidad de las intervenciones y de las variables analizadas, se obtuvieron mejores resultados en las variables de proceso, especialmente en la adecuación terapéutica, que en aquellas que midieron resultados en salud, donde hubo una mayor variabilidad (AU)

Objective. To summarise the evidence on interventions aimed at optimising the drug treatment of hospitalised elderly patients. Material and methods. We conducted a search in the main medical literature databases, selecting prospective studies of hospitalised patients older than 65 years who underwent interventions aimed at optimising drug treatment, decreasing polypharmacy and improving the medication appropriateness, health outcomes and exploitation of the healthcare system. Results. We selected 18 studies whose interventions consisted of medication reviews, detection of predefined drugs as potentially inappropriate for the elderly, counselling from a specialised geriatric team, the use of a computer support system for prescriptions and specific training for the nursing team. Up to 14 studies assessed the medication appropriateness, 13 of which showed an improvement in one or more of the parameters. Seven studies measured the impact of the intervention on polypharmacy, but only one improved the outcomes compared with the control. Seven other studies analysed mortality, but none of them showed a reduction in that rate. Only 1 of 6 studies showed a reduction in the number of hospital readmissions, and 1 of 4 studies showed a reduction in the number of emergency department visits. Conclusions. Despite the heterogeneity of the analysed interventions and variables, we obtained better results in the process variables (especially in medication appropriateness) than in those that measured health outcomes, which had greater variability (AU)

[Interventions to optimize pharmacologic treatment in hospitalized older adults: a systematic review]. / Intervenciones para optimizar el tratamiento farmacológico en ancianos hospitalizados: una revisión sistemática.

OBJECTIVE: To summarise the evidence on interventions aimed at optimising the drug treatment of hospitalised elderly patients. MATERIAL AND METHODS: We conducted a search in the main medical literature databases, selecting prospective studies of hospitalised patients older than 65 years who underwent interventions aimed at optimising drug treatment, decreasing polypharmacy and improving the medication appropriateness, health outcomes and exploitation of the healthcare system. RESULTS: We selected 18 studies whose interventions consisted of medication reviews, detection of predefined drugs as potentially inappropriate for the elderly, counselling from a specialised geriatric team, the use of a computer support system for prescriptions and specific training for the nursing team. Up to 14 studies assessed the medication appropriateness, 13 of which showed an improvement in one or more of the parameters. Seven studies measured the impact of the intervention on polypharmacy, but only one improved the outcomes compared with the control. Seven other studies analysed mortality, but none of them showed a reduction in that rate. Only 1 of 6 studies showed a reduction in the number of hospital readmissions, and 1 of 4 studies showed a reduction in the number of emergency department visits. CONCLUSIONS: Despite the heterogeneity of the analysed interventions and variables, we obtained better results in the process variables (especially in medication appropriateness) than in those that measured health outcomes, which had greater variability.