RESUMO
OBJECTIVE: Delirium is a serious neuropsychiatric syndrome frequently occurring in hospitalized older adults, for which pharmacological treatments have shown limited effectiveness. Multicomponent physical exercise programs have demonstrated functional benefits; however, the impact of exercise on the course of delirium remains unexplored. The aim of this study was to investigate the effect of an individualized, multicomponent exercise intervention on the evolution of delirium and patient outcomes. DESIGN: A single-center, single-blind randomized controlled trial. SETTING AND PARTICIPANTS: Medical inpatients with delirium in an acute geriatric unit of a tertiary public hospital. METHODS: Thirty-six patients (mean age 87 years) were recruited and randomized into 2 groups. The control group received usual care and the intervention group received individualized physical exercise (1 daily session) for 3 consecutive days. Primary endpoints were the duration and severity of delirium (4-AT, Memorial Delirium Assessment Scale) and change in functional status [Barthel Index, Short Physical Performance Battery, Hierarchical Assessment of Balance and Mobility (HABAM), and handgrip strength]. Secondary endpoints included length of stay, falls, and health outcomes at 1- and 3-month follow-up. RESULTS: The intervention group showed more functional improvement at discharge (HABAM, P = .015) and follow-up (Barthel, P = .041; Lawton P = .027). Less cognitive decline was observed at 1 and 3 months (Informant Questionnaire on Cognitive Decline in the Elderly, P = .017). Exercise seemed to reduce delirium duration by 1 day and contribute to delirium resolution at discharge, although findings did not reach statistical significance. No exercise-related adverse events occurred. CONCLUSION AND IMPLICATIONS: Findings suggest that individualized exercise in acutely hospitalized older patients with delirium is safe, may improve delirium course and help preserve post-hospitalization function and cognition.
RESUMO
Background Polypharmacy is a common condition among older adults and is associated with adverse drug reactions and health outcomes, including falls, functional and cognitive impairment, and frailty. Methods A prospective observational study will be conducted on older adults with polypharmacy. The aim is to assess the impact of a specialized outpatient clinic focused on pharmacotherapy optimization recently integrated into daily clinical practice in a Spanish public tertiary teaching hospital on patients functional and cognitive abilities. Patients who attend a first consultation and meet inclusion criteria (≥75 years old, have a life expectancy≥3 months, and polypharmacy (≥5 prescribed medications) will be invited to participate in the study, until reach a calculated sample size of 104 participants. Patients will be excluded if they are enrolled in a clinical trial related to medication or in the event of a no-show or cancellation of the appointment at the first visit. Participants will receive usual care: a first consultation including multidisciplinary pharmacological optimization in the context of a CGA and subsequent face-to-face and/or telephone follow-up (∼3 and ∼6 months). The primary endpoint will be the functional (Barthel index) and cognitive change in capacities (IPCR Índice de Incapacidad psíquica de la Cruz Roja). Secondary endpoints include medication changes, changes in patients quality of life, rate of falling, and use of healthcare resources. Discussion We expect that the close collaboration between professionals from different disciplines working together will be an effective strategy to improve the functional and cognitive abilities of older adults. Trial registration ClinicalTrials.gov: NCT05408598 (March 1, 2022) (AU)
Antecedentes La polifarmacia es una condición común entre los adultos mayores, y se asocia a reacciones adversas a medicamentos y a resultados negativos en la salud como caídas, deterioro funcional y cognitivo, y fragilidad. Métodos Se realizará un estudio observacional prospectivo en adultos mayores con polifarmacia. El objetivo es evaluar el impacto de una consulta especializada ambulatoria centrada en la optimización farmacológica y recientemente integrada en la práctica clínica habitual en un hospital universitario público español, sobre las capacidades funcionales y cognitivas de los pacientes. Los pacientes que acudan a una primera consulta y cumplan los criterios de inclusión (≥75 años, tengan una esperanza de vida ≥3 meses, y polifarmacia (≥5 medicamentos prescritos) serán invitados a participar en el estudio, hasta alcanzar un tamaño muestral calculado de 104 participantes. Los pacientes serán excluidos si ya participan en un ensayo clínico relacionado con medicación o en caso de no presentarse o cancelar la consulta inicial. Los participantes recibirán la atención habitual: una primera consulta que incluirá la optimización farmacológica en el contexto de una valoración geriátrica integral (VGI) y un seguimiento posterior presencial y/o telefónico (∼3 y ∼6 meses). La variable principal será el cambio en las capacidades funcionales (índice de Barthel) y cognitivas (Índice de Incapacidad Psíquica de la Cruz Roja [IPCR]) medidas al inicio y durante el seguimiento. Las variables secundarias incluyen cambios en la medicación, en la calidad de vida de los pacientes, en la tasa de caídas y en el uso de recursos sanitarios. Discusión Esperamos que esta estrecha colaboración entre profesionales de diferentes disciplinas que trabajan conjuntamente sea una estrategia eficaz para mejorar las capacidades funcionales y cognitivas de los adultos mayores. Registro del ensayo ClinicalTrials.gov: NCT05408598 (1 de marzo de 2022) (AU)
