Utilidad de un programa de intervención geriátrica en la mejora del uso de fármacos en pacientes institucionalizados / Usefulness of a geriatric intervention program in the improvement of drug treatment for institutionalised patients

Objetivos. Determinar la prevalencia de polifarmacia, prescripciones inadecuadas y subóptimas en pacientes institucionalizados. Analizar el impacto de un programa de intervención geriátrica sobre la optimización y racionalización del uso de fármacos. Material y métodos. Estudio prospectivo sobre una cohorte de 21 sujetos institucionalizados. Variables: prescripción de fármacos, prescripción inadecuada según criterios «Screening Tool for Older Person′s Prescriptions» (STOPP) y prescripción subóptima mediante criterios «Screening Tool to Alert doctors to Right Treatment» (START). Material y métodos. La intervención se basó en evaluar tratamientos y problemas con la medicación, correlacionar tratamientos con situación funcional, mental y esperanza de vida, seleccionar fármacos eficaces y seguros, prescribir genéricos, detectar y evitar polifarmacia, prescripciones inadecuadas y prescripciones subóptimas. Resultados. Veintiún sujetos fueron incluidos en el estudio (80,43±8,84 años, 57,1% mujeres, Barthel de 76,86±27,76 y MMSE de 14,52±7,73). Al ingreso, el número de fármacos era de 6,29±3,48 (20,23% genéricos), el 14,4% consumían 9 o más, el 71,4% cumplía algún criterio STOPP y el 52,4% algún criterio START. Tras la intervención el número de fármacos era de 4,9±3,03 (61,78% genéricos), el 14,3% cumplía algún criterio STOPP y el 4,8% algún criterio START. Conclusiones. La polifarmacia, la prescripción inadecuada y la prescripción subóptima son problemas frecuentes en el medio residencial. Para nuestra población de estudio un programa de intervención basado en la valoración geriátrica y en la racionalización del uso de medicamentos, ha podido disminuir el consumo de fármacos y ha incrementado la utilización de genéricos; todo ello disminuyendo la prescripción inadecuada y subóptima(AU)

Obejectives. To determine the prevalence of polypharmacy, and inadequate or suboptimal prescriptions. To analyse the impact of a geriatric intervention program on the optimisation and rationalisation of the use of drugs in institutionalised patients. Material and methods. A prospective study on a cohort of 21 sheltered subjects. Variables: Drug prescription, inadequate prescription according to «Screening Tool for Older Person's Prescriptions» (STOPP) criteria and suboptimal prescriptions according to «Screening Tool to Alert doctors to Right Treatment» (START) criteria. The intervention was based on analysing treatments and medication issues, correlate treatments to functional and mental situation, together with life expectancy, determine efficient and safe drugs, prescribe generic drugs, detect and avoid polymedication, inadequate and suboptimal prescriptions. Results. Twenty one subjects were include in the study,(mean age 80.43±8.84 years old, with 57.1% women, 76.86±27.76 Barthel and 14.52±7.73 MMSE). On admittance, the number of drugs was 6.29±3.48 (generics on a 20.23% ratio), 14.4% consumed 9 or more, 71.4% complied with any STOPP criteria and 52.4% complied with any START criteria. After the intervention, the number of drugs was 4.9±3.03 (generics on a 61.78 % ratio), 14.3% complied with any STOPP criteria and 4.8% complied with any START criteria. Conclusions. Polymedication, inadequate prescription and suboptimal prescription are frequent issues in residential and nursing environment. For our study population in an intervention program based upon geriatric assessment and the rationalisation on drug use, the drug consumption as well as inadequate and suboptimal prescription has reduced, along with increasing the use of generic drugs(AU)

[Usefulness of a geriatric intervention program in the improvement of drug treatment for institutionalised patients]. / Utilidad de un programa de intervención geriátrica en la mejora del uso de fármacos en pacientes institucionalizados.

OBEJECTIVES: To determine the prevalence of polypharmacy, and inadequate or suboptimal prescriptions. To analyse the impact of a geriatric intervention program on the optimisation and rationalisation of the use of drugs in institutionalised patients. MATERIAL AND METHODS: A prospective study on a cohort of 21 sheltered subjects. VARIABLES: Drug prescription, inadequate prescription according to "Screening Tool for Older Person's Prescriptions" (STOPP) criteria and suboptimal prescriptions according to "Screening Tool to Alert doctors to Right Treatment" (START) criteria. The intervention was based on analysing treatments and medication issues, correlate treatments to functional and mental situation, together with life expectancy, determine efficient and safe drugs, prescribe generic drugs, detect and avoid polymedication, inadequate and suboptimal prescriptions. RESULTS: Twenty one subjects were include in the study,(mean age 80.43±8.84 years old, with 57.1% women, 76.86±27.76 Barthel and 14.52±7.73 MMSE). On admittance, the number of drugs was 6.29±3.48 (generics on a 20.23% ratio), 14.4% consumed 9 or more, 71.4% complied with any STOPP criteria and 52.4% complied with any START criteria. After the intervention, the number of drugs was 4.9±3.03 (generics on a 61.78 % ratio), 14.3% complied with any STOPP criteria and 4.8% complied with any START criteria. CONCLUSIONS: Polymedication, inadequate prescription and suboptimal prescription are frequent issues in residential and nursing environment. For our study population in an intervention program based upon geriatric assessment and the rationalisation on drug use, the drug consumption as well as inadequate and suboptimal prescription has reduced, along with increasing the use of generic drugs.

[Strongyloides stercoralis infestation in an immunocompetent 82-year-old woman]. / Infestación por Strongyloides stercoralis en una paciente de 82 años inmunocompetente.

A laboratory finding of eosinophilia in patients with gastrointestinal symptoms should prompt the differential diagnosis of a parasitosis. The diagnosis is based on identification of larvae in three different stool samples. We report the case of an 82-year-old woman who was independent for instrumental and advanced activities of daily living and showed no risk factors for strongyloidiasis who was admitted to our service with diarrhoea and abdominal pain. Blood examination showed peripheral eosinophilia of 38%. Stool sample revealed Strongyloides stercoralis. In the patient's case history, we found similar clinical features with fluctuating eosinophilia over the previous 8 years. The patient was treated with albendazole, resulting in clinical improvement and elimination of eosinophilia.

Infestación por Strongyloides stercoralis en una paciente de 82 años inmunocompetente / Strongyloides stercoralis infestation in an immunocompetent 82-year-old woman

La presencia de clínica abdominal y eosinofilia debe hacernos sospechar una infección por parásitos. El diagnóstico se realiza a través del examen de heces, analizando 3 muestras distintas. Presentamos el caso de una mujer de 82 años, independiente para las actividades instrumentales y avanzadas, sin factores de riesgo conocidos para estrongiloidosis, que ingresó en nuestro servicio con un cuadro de diarrea y molestias abdominales. En las pruebas complementarias destacaba una eosinofilia del 38%. En el examen de las heces se observaron larvas compatibles con Strongyloides stercoralis. En su historia clínica encontramos varios episodios previos con clínica similar y presencia de eosinofilia fluctuante que comenzaron 8 años antes. Fue tratada con albendazol con resolución de la clínica y desaparición de la eosinofilia (AU)

A laboratory finding of eosinophilia in patients with gastrointestinal symptoms should prompt the differential diagnosis of a parasitosis. The diagnosis is based on identification of larvae in three different stool samples. We report the case of an 82-year-old woman who was independent for instrumental and advanced activities of daily living and showed no risk factors for strongyloidiasis who was admitted to our service with diarrhoea and abdominal pain. Blood examination showed peripheral eosinophilia of 38%. Stool sample revealed Strongyloides stercoralis. In the patient's case history, we found similar clinical features with fluctuating eosinophilia over the previous 8 years. The patient was treated with albendazole, resulting in clinical improvement and elimination of eosinophilia (AU)

[Risk factors associated with functional impairment at discharge and at three months after discharge in elderly individuals hospitalized for heart failure]. / Variables asociadas a deterioro funcional al alta y a los 3 meses en ancianos hospitalizados por insuficiencia cardíaca.

OBJECTIVE: To determine the characteristics of elderly persons hospitalized for congestive heart failure and identify the factors associated with functional impairment or death at discharge and 3 months later. MATERIAL AND METHODS: We performed a prospective observational study that included 162 patients admitted to an Acute Geriatric Care Unit with a diagnosis of heart failure from February to July 2007. Socio-demographic, clinical, functional and cognitive factors were recorded during admission. Functional and vital measurements were reported at discharge and 3 months later. RESULTS: The incidence of mortality or functional decline was 48.8% at discharge and was 37.3% 3 months later. In the final model, predictors of functional impairment or mortality at discharge were days of hospital stay and a worse Pfeiffer test score (odds ratio [OR]: 1.74; 95% confidence interval [CI]: 1.33-2.29). Three months after discharge, independent prognostic factors were age (OR: 1.09; 95% CI: 1.02-1.17), hyponatremia (OR: 0.85; 95% CI: 0.77-0.94), length of QRS in milliseconds (OR: 0.98; 95% CI: 0.97-0.99), absence of ventricular hypertrophy (OR: 0.42; 95% CI: 0.19-0.94), and a poor result in the Pfeiffer Test (OR: 1.40; 95% CI: 1.13-1.73). CONCLUSIONS: Cognitive evaluation during hospital admission for heart failure in the elderly helps to select individuals at risk of functional impairment or death at discharge and 3 months later.

Variables asociadas a deterioro funcional al alta y a los 3 meses en ancianos hospitalizados por insuficiencia cardíaca / Risk factors associated with functional impairment at discharge and at three months after discharge in elderly individuals hospitalized for heart failure

Objetivo: Describir las características de pacientes ancianos hospitalizados con un diagnóstico de insuficiencia cardíaca y establecer las variables asociadas con el desarrollo de deterioro funcional o defunción al alta y a los 3 meses. Materia y métodos: Estudio observacional y prospectivo en el que se incluyó a 162 pacientes con el diagnóstico de insuficiencia cardíaca que ingresaron en una unidad de agudos de geriatría entre febrero y julio de 2007. Durante la hospitalización se recogieron variables clínicas, sociodemográficas, funcionales y cognitivas, y al alta y a los 3 meses, datos sobre su estado funcional y vital. Resultados: La incidencia de mortalidad o deterioro funcional al alta y a los 3 meses fue del 48,8 y el 37,3%, respectivamente. En el modelo final permanecieron como predictores de deterioro funcional o defunción al alta los días de estancia hospitalaria y una peor puntuación en el cuestionario de Pfeiffer (odds ratio [OR]=1,74; intervalo de confianza [IC] del 95%, 1,33¿2,29). A los 3 meses las variables relacionadas fueron la edad (OR=1,09; IC del 95%, 1,02¿1,17), la hiponatremia (OR=0,85; IC del 95%, 0,77¿0,94), el tamaño del QRS en milisegundos (OR=0,98; IC del 95%, 0,97¿0,99), la ausencia de HVI (OR=0,42; IC del 95%, 0,19¿0,94) y la prueba de Pfeiffer alterada (OR=1,40; IC del 95%, 1,13¿1,73). Conclusiones: La valoración cognitiva durante la hospitalización de un anciano por insuficiencia cardíaca facilita la selección de individuos susceptibles de deterioro funcional o defunción al alta y a los 3 meses (AU)

Objective: To determine the characteristics of elderly persons hospitalized for congestive heart failure and identify the factors associated with functional impairment or death at discharge and 3 months later. Material and methods: We performed a prospective observational study that included 162 patients admitted to an Acute Geriatric Care Unit with a diagnosis of heart failure from February to July 2007. Socio-demographic, clinical, functional and cognitive factors were recorded during admission. Functional and vital measurements were reported at discharge and 3 months later. Results: The incidence of mortality or functional decline was 48.8% at discharge and was 37.3% 3 months later. In the final model, predictors of functional impairment or mortality at discharge were days of hospital stay and a worse Pfeiffer test score (odds ratio [OR]: 1.74; 95% confidence interval [CI]: 1.33¿2.29). Three months after discharge, independent prognostic factors were age (OR: 1.09; 95% CI: 1.02¿1.17), hyponatremia (OR: 0.85; 95% CI: 0.77¿0.94), length of QRS in milliseconds (OR: 0.98; 95% CI: 0.97¿0.99), absence of ventricular hypertrophy (OR: 0.42; 95% CI: 0.19¿0.94), and a poor result in the Pfeiffer Test (OR: 1.40; 95% CI: 1.13¿1.73). Conclusions: Cognitive evaluation during hospital admission for heart failure in the elderly helps to select individuals at risk of functional impairment or death at discharge and 3 months later (AU)