Should patients with exceptional longevity be treated for osteoporosis after a hip fracture?

BACKGROUND: There are no studies focusing on treatment for osteoporosis in patients with exceptional longevity after suffering a hip fracture. OBJECTIVE: To assess the advisability of initiating treatment for osteoporosis after a hip fracture according to the incidence of new fragility fractures after discharge, risk factors for mortality and long-term survival. DESIGN: Retrospective review. SETTING: A tertiary university hospital serving a population of ~425 000 inhabitants in Barcelona. SUBJECTS: All patients >95 years old admitted with a fragility hip fracture between December 2009 and September 2015 who survived admission were analysed until the present time. METHODS: Pre-fracture ambulation ability and new fragility fractures after discharge were recorded. Risk factors for 1-year and all post-discharge mortality were calculated with multivariate Cox regression. Kaplan-Meier survival curve analyses were performed. RESULTS: One hundred and seventy-five patients were included. Median survival time was 1.32 years [95% confidence interval (CI) 1.065-1.834], with a maximum of 9.2 years. Male sex [hazard ratio (HR) 2.488, 95% CI 1.420-4.358] and worse previous ability to ambulate (HR 2.291, 95% CI 1.417-3.703) were predictors of mortality. After discharge and up to death or the present time, 10 (5.7%) patients had a new fragility fracture, half of them during the first 6 months. CONCLUSIONS: Few new fragility fractures occurred after discharge and half of these took place in the first 6 months. The decision to start treatment of osteoporosis should be individualised, bearing in mind that women and patients with better previous ambulation ability will have a better chance of survival.

Indoor falls and number of previous falls are independent risk factors for long-term mortality after a hip fracture.

BACKGROUND: Hip fractures are almost always the result of a fall. Causes and circumstances of falls may differ between frail and vigorous patients. AIM: To describe the circumstances of falls causing hip fractures, number of falls during the previous year, and their association with long-term mortality. PATIENTS AND METHODS: The study is a retrospective review conducted in a tertiary university hospital serving a population of 425,000 inhabitants in Barcelona. All patients admitted with hip fractures with medical records describing the circumstances and number of previous falls were included. The number of falls in the previous 12 months was recorded, including the one causing the fracture. The circumstances of the index fall were dichotomized according to whether it was from the patient's own height or above; day or night; indoors or outdoors, due to intrinsic or extrinsic causes. Cumulative mortality was recorded for almost 5 years after hip fracture. RESULTS: Indoor falls were strongly associated with shorter survival. Falling more than once in the previous year was also a risk factor for long-term mortality (hazard ratio 1.461, p < 0.001 and hazard ratio 1.035, p = 0.008 respectively). CONCLUSION: Indoor falls and falling more than once in the previous year are long-term risk factors for mortality after hip fractures. It is always essential to take a careful patient history on admission to determine the number of falls and their circumstances, and special care should be taken to reduce mortality in patients at high risk.

Hip fracture and mortality: study of specific causes of death and risk factors.

The leading causes of mortality in our study were pneumonia, diseases of the circulatory system, and dementias. In patients with hip fractures, the emphasis should be placed not only on measures to prevent falls and osteoporosis, but also on preventing functional decline and pneumonia. PURPOSE: To describe the specific causes of death in patients who died up to 2 years after sustaining a hip fracture, how many of those deaths were directly related to the hip fracture, and the risk factors for mortality. METHODS: A retrospective review of the clinical data of all patients admitted with hip fractures between December 2009 and September 2015. Cause of death was classified according to the International Statistical Classification of Diseases and Related Health Problems (ICD10) RESULTS: In the first 2 years after hip fracture, 911 patients (32.7%) died. The leading causes of mortality were pneumonia 177 (19.4%), diseases of the circulatory system 146 (16%), and dementias 126 (13.9%). Thirty patients (3.2%) died from causes directly related to hip fracture or surgery. Mortality risk factors with a higher relative risk were advanced age, male sex, higher comorbidity, delirium, and medical complications during admission. CONCLUSIONS: Pneumonia and circulatory system diseases were the commonest causes of death in our study. In patients with hip fractures, emphasis should be placed on preventing functional decline and pneumonia. In a few patients, death was directly related to the hip fracture, although decompensation of chronic illness as a result of hip fracture and fracture-related functional decline may have been indirect causes. Patients with worse conditions at admission had the highest risk of mortality.

Assessing nutritional status in the elderly evaluation of Chumlea equations for weight.

BACKGROUND: Weight is one of the most important parameters in assessing nutritional status. However, weight can be difficult to measure in elderly people who are unable to stand. Chumlea et al. created two equations to estimate weight in non-ambulatory patients using readily available body measurements. OBJECTIVE: The aim of the study is to analyze the usefulness of Chumlea equations in assessing nutritional status of elderly hospitalized patients. METHODS: We measured weight, height, arm and calf circumference, subscapular skinfold and knee height of 82 hospitalized elderly patients, all of whom were able to stand. Estimated weight (EW) was obtained by Chumlea equations. Body mass index (BMI) and Mini Nutritional Assessment test (MNA) were calculated using actual weight and EW. Bland-Altmann analysis and intraclass correlation coefficient (ICC) between real and estimated parameters were assessed. RESULTS: We found a statistically significant ICC between actual weight and EW (r = 0.926), real BMI and estimated BMI (r = 0.910) and real MNA and estimated MNA (r = 0.982) (p < 0.001). Chumlea equations, however, underestimated weight: 54.05 (DS 11.88) vs 61.46 (DS 13.08); BMI: 22.30 (DS 4.61) vs 25.36 (DS 5.17) and MNA: 22.73 (DS 4.43) vs 23.30 (DS 4.33) (P<0.001). In spite of this underestimation, estimated MNA detected 100% of patients malnourished and 96% of those at risk of malnutrition. CONCLUSIONS: Results obtained by Chumlea equations showed a good ICC with actual body weight and real BMI and MNA, but values were underestimated. These equations can be useful to detect undernourished hospitalized elderly patients.

Assessing nutritional status in the elderly; evaluation of Chumlea´s equations for weight / Valoración del estado nutricional en el anciano; evaluación de las ecuaciones de Chumlea para el cálculo del peso

Background: Weight is one of the most important parameters in assessing nutritional status. However, weight can be difficult to measure in elderly people who are unable to stand. Chumlea et al. created two equations to estimate weight in non-ambulatory patients using readily available body measurements. Objective: The aim of the study is to analyze the usefulness of Chumlea's equations in assessing nutritional status of elderly hospitalized patients. Methods: We measured weight, height, arm and calf circumference, subscapular skinfold and knee height of 82 hospitalized elderly patients, all of whom were able to stand. Estimated weight (EW) was obtained by Chumlea's equations. Body mass index (BMI) and Mini Nutritional Assessment test (MNA) were calculated using actual weight and EW. Bland-Altmann analysis and intraclass correlation coefficient (ICC) between real and estimated parameters were assessed. Results: We found a statistically significant ICC between actual weight and EW (r = 0.926), real BMI and estimated BMI (r = 0.910) and real MNA and estimated MNA (r = 0.982) (P < 0.001). Chumlea's equations, however, underestimated weight: 54.05 (DS 11.88) vs 61.46 (DS 13.08); BMI: 22.30 (DS 4.61) vs 25.36 (DS 5.17) and MNA: 22.73 (DS 4.43) vs 23.30 (DS 4.33) (P<0.001). In spite of this underestimation, estimated MNA detected 100% of patients malnourished and 96% of those at risk of malnutrition. Conclusions: Results obtained by Chumlea's equations showed a good ICC with actual body weight and real BMI and MNA, but values were underestimated. These equations can be useful to detect undernourished hospitalized elderly patients (AU)

Introducción y objetivo: El peso es uno de los parámetros más importantes en la valoración del estado nutricional. Sin embargo puede ser difícil de medir en ancianos que no sean capaces de manetner la bipedestación. Chumlea et al. crearon dos ecuaciones para estimar el peso en pacientes no deambulantes usando medidas corporales sencillas de obtener. El objetivo del estudio es analizar la utilidad de las ecuaciones de Chumlea en la valoración del estado nutricional de los pacientes ancianos hospitalizados. Métodos: En 82 pacientes ancianos hospitalizados, capaces de mantener la bipedestación, se midieron los siguientes parámetros: peso, altura, circunferencia braquial y de la pantorrilla, pliegue subescapular y altura talón-rodilla. Se calculó el peso estimado (EW) con las ecuaciones de Chumlea y con el peso real y el peso estimado se calculó el índice de masa corporal (BMI) y el Mini Nutritional Assessment test (MNA). Se compararon los parámetros reales I los estimados con la correlación de Pearson. Resultados: Se encontraron correlaciones estadísticamente significativas entre el peso real y el estimado (r = 0,93), entre el BMI y el BMI estimado (r = 0,916) y entre el MNA y el MNA estimado(r = 0.982) (P < 0,001). Sin embargo las ecuaciones de Chumlea infraestiman los valores reales: 54,05 (DS 11,88) vs 61,46 (DS 13,08); BMI: 22,30 (DS 4,61) vs 25,36 (DS 5,17) y MNA: 22,73 (DS 4,43) vs 23,30 (DS 4,33) (P < 0,001). A pesar de ello el MNA estimado detecta el 100% de los pacientes malnutridos y el 96% de los que tienen riesgo de malnutrición. Conclusiones: Los resultados obtenidos con las ecuaciones de Chumlea muestran una Buena correlación entre el peso, el BMI y el MNA reales y los estimados aunque los valores están infraestimados. Estas ecuaciones pueden ser útiles para detectar pacientes ancianos hospitalizados malnutridos (AU)

Anemia en el anciano / Anemia in the elderly

La anemia es un problema frecuente en las personas mayores y está relacionada con un aumento de la morbilidad y mortalidad. En las personas ancianas aunque la anemia tiene una prevalencia elevada, existen diversos aspectos como el umbral de hemoglobina por debajo del cual debemos preocuparnos o la identificación de las causas de la misma que no son fáciles de establecer. La presente revisión se centra en conocer lo que se considera niveles de hemoglobina normales en los adultos, las causas más frecuentes de la anemia y sus posibles consecuencias en pacientes de edad avanzada. Se aporta un algoritmo diagnóstico y una aproximación al tratamiento en que se abordan nuevas posibilidades terapéuticas como el hierro parenteral y los agentes estimulantes de la eritropoyesis(AU)

Anemia is a common disorder in the elderly and is associated with increased morbidity and mortality. In elderly subjects, in whom anemia is highly prevalent, there are several aspects, such as a hemoglobin at a level which should concern us limit, or identifying its causes, that are not easy to establish. This review focuses on knowing what is considered to be normal hemoglobin levels in adults and the common causes and potential consequences of anemia in elderly patients. It provides a diagnostic algorithm and an approach to treatment that addresses new treatments such as parenteral iron drugs and erythropoiesis-stimulating agents(AU)

[Anemia in the elderly]. / Anemia en el anciano.

Anemia is a common disorder in the elderly and is associated with increased morbidity and mortality. In elderly subjects, in whom anemia is highly prevalent, there are several aspects, such as a hemoglobin at a level which should concern us limit, or identifying its causes, that are not easy to establish. This review focuses on knowing what is considered to be normal hemoglobin levels in adults and the common causes and potential consequences of anemia in elderly patients. It provides a diagnostic algorithm and an approach to treatment that addresses new treatments such as parenteral iron drugs and erythropoiesis-stimulating agents.

[Hospitalizations due to chronic obstructive pulmonary disease in the elderly]. / Hospitalizaciones por EPOC en el paciente anciano.

INTRODUCTION: Hospitalizations for decompensation of chronic obstructive pulmonary disease (COPD) mainly occur in the elderly. The aim of this study was to describe the characteristics of octogenarians admitted for COPD and to compare these characteristics with those in a younger group. MATERIAL AND METHODS: All patients hospitalized for COPD in an acute care hospital over three time periods were studied. All patients met spirometric criteria for COPD. A questionnaire evaluating items on prior admissions, days of hospital stay and readmissions in the subsequent year was completed. Data on comorbidity (the Charlson index), functional dependency (Katz index), depression (Yesavage scale), domiciliary medication, socioeconomic position, social resources, and quality of life, among other factors, were gathered. RESULTS: We studied 390 patients, with a mean age of 72 years (SD 9.6), of whom 88 (22%) were aged more than 80 years old. The mean length of hospital stay was 11.4 days, FEV(1) at discharge was 39% of the theoretical value, and 55% of the patients were readmitted in the following year, with no differences between age groups. Patients older than 80 years had a lower body mass index (P<.03), greater comorbidity (P<.001), greater functional dependency (P<.001) and worse scores on the Pffeifer (P<.001) and Yesavage scales (P<.01). CONCLUSIONS: Octogenarians hospitalized for COPD exacerbations have greater comorbidity, depressive features and functional dependency than younger patients. Nevertheless, no differences were found in the length of hospital stay or in readmissions in the following year.

Hospitalizaciones por EPOC en el paciente anciano / Hospitalizations due to chronic obstructive pulmonary disease in the elderly

Introducción: Las hospitalizaciones por descompensación de enfermedad pulmonar obstructiva crónica (EPOC), se producen mayoritariamente en pacientes de edad avanzada. Nuestro objetivo es describir las características de los pacientes octogenarios ingresados por EPOC y compararlas con las del grupo de menor edad. Material y métodos: Se estudió a todos los pacientes hospitalizados por EPOC en un hospital de agudos, durante 3 períodos diferentes. Todos los pacientes cumplían criterios espirométricos de EPOC. Se cumplimentó un cuestionario donde se valoraban los ingresos previos, los días de estancia y los reingresos en el año posterior. Se recogieron la comorbilidad (índice de Charlson), la dependencia funcional (índice de Katz), la depresión (escala Yesavage), la medicación domiciliaria, el nivel socioeconómico, los recursos sociales y la calidad de vida entre otros. Resultados: Se estudió a 390 pacientes, con una edad media±desviación estándar de 72±9,6 años, de los cuales 88 (22%) eran mayores de 80 años. La estancia media fue de 11,4 días, el volumen espiratorio máximo en el primer segundo (FEV1) al alta del 39% del teórico y un 55% de los pacientes reingresaron en el año posterior sin diferencia entre ambos grupos de edad. Los pacientes mayores de 80 años tenían un índice de masa corporal menor (p<0,03), más comorbilidad (p<0,001), dependencia funcional (p<0,001) y peores puntuaciones en las escalas de Pffeifer (p<0,001) y Yesavage (p<0,01). Conclusiones: Los pacientes mayores de 80 años hospitalizados por exacerbación de EPOC presentan mayor comorbilidad, rasgos depresivos y dependencia funcional que los de menor edad. A pesar de ello, no hay diferencia en la estancia media ni en los reingresos en el año posterior (AU)

Introduction: Hospitalizations for decompensation of chronic obstructive pulmonary disease (COPD) mainly occur in the elderly. The aim of this study was to describe the characteristics of octogenarians admitted for COPD and to compare these characteristics with those in a younger group. Material and methods: All patients hospitalized for COPD in an acute care hospital over three time periods were studied. All patients met spirometric criteria for COPD. A questionnaire evaluating items on prior admissions, days of hospital stay and readmissions in the subsequent year was completed. Data on comorbidity (the Charlson index), functional dependency (Katz index), depression (Yesavage scale), domiciliary medication, socioeconomic position, social resources, and quality of life, among other factors, were gathered. Results: We studied 390 patients, with a mean age of 72 years (SD 9.6), of whom 88 (22%) were aged more than 80 years old. The mean length of hospital stay was 11.4 days, FEV1 at discharge was 39% of the theoretical value, and 55% of the patients were readmitted in the following year, with no differences between age groups. Patients older than 80 years had a lower body mass index (P<.03), greater comorbidity (P<.001), greater functional dependency (P<.001) and worse scores on the Pffeifer (P<.001) and Yesavage scales (P<.01). Conclusions: Octogenarians hospitalized for COPD exacerbations have greater comorbidity, depressive features and functional dependency than younger patients. Nevertheless, no differences were found in the length of hospital stay or in readmissions in the following year (AU)

Predictive items of functional decline and 2-year mortality in nonagenarians--the NonaSantfeliu study.

BACKGROUND: Few studies have prospectively evaluated predictors of mortality or decline in functional capacity in nonagenarians. The aim of this study is to determine predictors of death or functional decline in basic activities of daily living in nonagenarians after 2 years of follow-up. METHODS: One hundred and seventy-six nonagenarians were prospectively evaluated. Functional status was determined by the Lawton-Brody index (LI) and the Barthel Index (BI), and cognition by the Spanish version of the Mental State Examination. The Charlson score was used to measure co-morbidity. Nutritional status was evaluated by the short version of the Mini Nutritional Assessment questionnaire. RESULTS: The sample comprised 135 women (76.3%) and 41 men. Mean age was 93 +/- 3.2 years. Mortality after 2 years was 36.3%. Forty-six (41%) of the 112 survivors presented BI losses >19%. One hundred and ten subjects (63%) presented the combined negative outcome item (death or functional decline). A multiple stepwise logistic regression analysis identified two variables associated with a fall of >19% on the BI or death: a low LI (odds ratio 0.785, 95% CI 0.656-0.940) and a low score at baseline on the Spanish version of the Mental State Examination (odds ratio 0.950, 95% CI 0.914-0.987). CONCLUSION: Better cognitive status and higher capacity to perform instrumental activities of daily living (ADL) at baseline are the best predictors to identify which nonagenarians survived without major functional decline after a 2-year follow-up period.

Predictive items of one-year mortality in nonagenarians. The NonaSantfeliu Study.

BACKGROUND AND AIMS: Few studies have prospectively evaluated predictors of mortality in nonagenarian cohorts. Our objective was to determine a set of predictors of all-cause mortality in a cohort of nonagenarians after one year of follow-up. METHODS: 186 nonagenarians were evaluated prospectively, 137 of whom lived in their own homes (74%) and 49 (26%) were institutionalized. Functional status was determined by the Lawton-Brody (LI) and Barthel Index (BI), and cognition by the Spanish version of the Mini Mental State Examination (MEC). The Charlson score was used to measure global comorbidity. Nutritional status was evaluated by the short version of the Mini Nutritional Assessment questionnaire (short- MNA). RESULTS: The sample was composed of 143 women (76.5%) and 43 men, with a mean age of 93.06 (3.1) years. The rate of mortality was 19.3%. There were no differences in mortality between men and women. Although the BI and LI were both related to 1-year mortality in bivariate, unadjusted analysis, their contribution was minimal in multivariate analyses. Age, heart failure and short-MNA remained associated with mortality in the multivariate analyses. CONCLUSIONS: This study supported the importance of age, heart failure and nutritional status in predicting 1- year mortality in nonagenarians.

Valoración y tratamiento del estreñimiento en el anciano / Evaluation and treatment of constipation in the elderly

El estreñimiento o constipación es un problema muy frecuente en las personas mayores y, además, tiene muchas implicaciones sanitarias y psicológicas. El envejecimiento supone la unión de factores que convergen en la aparición del estreñimiento tales como: inmovilidad, deshidratación o simplemente la polimedicación. La tendencia a banalizar este estreñimiento como enfermedad puede ocasionar complicaciones y problemas físicos en las personas que lo presentan. Durante la siguiente revisión analizaremos la epidemiología, el correcto diagnóstico y el tratamiento, tanto farmacológico como no farmacológico, del estreñimiento en personas mayores. El paciente anciano deberá seguir unas normas no farmacológicas iniciales de movilidad, hidratación e ingesta de fibra, y utilizar los laxantes cuando las medidas no farmacológicas no son suficientes. Así, se analizarán los diferentes tratamientos y la conveniencia de cada uno en los distintos casos

Constipation is a highly frequent problem in the elderly and it has many health and psychological implications. Ageing implies a combination of factors that converge in the appearance of constipation, including immobility, dehydration and polypharmacy. The tendency to trivialise constipation as a pathology may cause complications and physical problems in sufferers. The following review analyses the epidemiology, correct diagnosis and pharmacological and non-pharmacological treatment of constipation in the elderly. The elderly patient should follow certain initial non-pharmacological recommendations, such as mobility, hydration and fibre intake, and use laxatives whenever nonpharmacological measures prove insufficient. The review includes an analysis of various treatments and the advisability of one rather than another in distinct cases

Motivos de ingreso en residencias geriátricas en Calahorra (La Rioja) / No disponible

Los estudios epidemiológicos muestran un importanteaumento en el número de personas mayores en nuestropaís. Frecuentemente, éstas por diversas circunstanciasno pueden seguir viviendo en la comunidad. Elobjetivo de este estudio es evaluar los motivos de ingresoen cuatro residencias geriátricas de la zona deCalahorra (Rioja). Se evaluaron 237 residentes. Setrataba de 143 (58%) mujeres y 94 (42%) varones,con una edad media de 79,9 (10) años. Entre losmotivos de ingreso, destacaba como primera causa laproblemática social con 117 casos (49%). Debido aeste elevado porcentaje de residentes que ingresan poruna causa social, parece obligado una mejoría de lasituación en la comunidad de los pacientes más ancianosy el que se disponga de una red de recursos adecuadosa las necesidades que permita en muchas ocasionesque las personas mayores puedan seguir viviendoen el propio domicilio(AU)

Epidemiological studies in Spain show a increase in elderlypeople. Frequently, by different causes they can't be leavein community. The aim of this study was to evaluate thecause of admission in a nursing house in Calahorra region(Rioja). We included 237 habitants of nursing home.There were 143 women (58%) and 94 men with a meanage of 79.9 (10) years. The most prevalent cause ofnursing home admission was a social problem (49%). Inconclusion due a greater proportion of patients admittedin a nursing home by a social problem is necessary abetter social recourses to permit remainig some elderlypeople in their own-house(AU)

No correlation between mini-nutritional assessment (short form) scale and clinical outcomes in 73 elderly patients admitted for hip fracture.

BACKGROUND AND AIMS: Malnutrition in general and protein deficiency in particular, both upon admission and during the recovery period, may adversely influence the clinical outcome after hip fracture. This study investigates the relationship between nutritional status measured by the Mini-Nutritional Assessment short form (MNA-SF) and biological markers in elderly hip-fractured patients. METHODS: A prospective study in a university hospital. The MNA-SF nutritional scale and laboratory values (serum albumin, cholesterol, total lymphocyte count) were assessed within three days after hip fracture surgery. RESULTS: Seventy-three patients were included: 61 (84%) were women and 12 men. Mean age was 81.5+/-7.1 years. Inhospital mortality was 10%. The mean MNA-SF score was 11+/-0.5 (range 3-14); according to these values, 39 patients (53%) were at risk of malnutrition. MNA-SF scores were not significantly correlated to patients' laboratory values. Fourteen episodes of nosocomial infection were diagnosed in 11 patients, and 6 patients developed pressure ulcers during hospitalization. CONCLUSIONS: MNA-SF test scale values reflect a clinical process in post-operative hip-fractured patients which is different from serum albumin, cholesterol or lymphocyte count.

Valoración geriátrica de un paciente ingresado en un hospital de agudos / Comprehensive geriatric assessment in acute care hospital

En los hospitales de agudos es cada vez mayor el porcentajes de pacientesingresados con una edad avanzada, en que será importante quese realice una valoración geriátrica global y por lo tanto se complementela historia clínica con una correcta valoración de la situación social,funcional y cognitiva. La mayoría de estudios han demostrado la efectividadde la valoración geriátrica global en términos de conseguir unamenor perdida funcional, una menor estancia hospitalaria, un porcentajemenor de nueva institucionalización al alta hospitalaria y así mismode un menor número de reingresos. En el presente trabajo se evalúanalgunas de las características, que en nuestra opinión, debe teneruna valoración geriátrica global en los pacientes ancianos ingresadosen hospitales de agudos

Comprehensive geriatric assessment, addressing physical, cognitive andsocial function, of elderly patients admitted in acute care hospitals isessential for optimal clinical management. Most of studies have beendemonstrated significant benefits from the process of geriatricassessment, including reduced functional decline, hospital length stay,rehospitalizations and increasing likelihood of living home. In thismanuscript we reported our opinion about the principal characteristicsof a comprehensive geriatric assessment in elderly patients hospitalizedin acute care hospitals