El anciano con insuficiencia cardíaca terminal: hacia una colaboración entre servicios de geriatría y medicina paliativa / End-stage heart failure in the elderly: Towards collaboration between geriatrics and palliative medicine

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El anciano con enfermedad avanzada de órgano. Consideraciones desde la geriatría, la medicina paliativa y la bioética / Advanced organ failure in the elderly. Some issues from a geriatrics, palliative medicine and bioethics perspectives

Objetivo: analizar la bibliografía existente respecto a los conocimientos, habilidades y actitudes que estas disciplinas pueden aportar en la mejora de la calidad técnica, ética y humana de la asistencia sanitaria a ancianos con enfermedad avanzada, multimorbilidad, fragilidad y demencia progresiva. Material y métodos: revisión exhaustiva, focalizando en la bibliografía existente sobre la interrelación entre la medicina geriátrica y la medicina paliativa, la educación en bioética, herramientas pronósticas, el estado funcional y la humanización de la asistencia. Resultados: la planificación anticipada de las decisiones, la valoración geriátrica integral, el estudio de los valores del paciente y su inclusión en la toma de decisiones y la necesidad de promover una ética de la virtud, del cuidado y de la organización sanitaria constituyen elementos esenciales para conseguir dicho objetivo. Conclusiones: los profesionales y las organizaciones sanitarias deben aspirar a la excelencia como una exigencia moral. Para ello es prioritario adquirir virtudes de cuidado y conceptos fundamentales de medicina geriátrica y medicina paliativa, constituyendo el estado funcional, la planificación anticipada de los cuidados y el abordaje de las necesidades del binomio paciente-familia cuestiones irrenunciables que hay que proteger, cuidar y promover

Objective: to analyze the literature as regards the knowledge, skills and attitudes that these disciplines can provide in improving technical, ethical and human quality health care in the elderly with advanced organ failure, multimorbidity, frailty and progressive dementia. Material and methods: a comprehensive review focused on available references on the interrelationship between geriatric medicine and palliative medicine, education in bioethics, prognostic tools, functional status, and the humanization of health care. Results: advance care planning, comprehensive geriatric assessment, the study of the values of the patient and their introduction in decision-making process, as well as the need to promote moral, care, and healthcare organizational ethics, are essential elements to achieve this objective. Conclusions: practitioners and healthcare organizations should seek excellence as a moral requirement. To achieve this, there is a priority to acquire virtues of care and fundamental concepts of geriatric and palliative medicine, assessing functional status, advance care planning and patient/family needs as essential issues to protect, care for and promote them in all care settings

[Advanced organ failure in the elderly. Some issues from a geriatrics, palliative medicine and bioethics perspectives]. / El anciano con enfermedad avanzada de órgano. Consideraciones desde la geriatría, la medicina paliativa y la bioética.

OBJECTIVE: To analyze the literature as regards the knowledge, skills and attitudes that these disciplines can provide in improving technical, ethical and human quality health care in the elderly with advanced organ failure, multimorbidity, frailty and progressive dementia. MATERIAL AND METHODS: A comprehensive review focused on available references on the interrelationship between geriatric medicine and palliative medicine, education in bioethics, prognostic tools, functional status, and the humanization of health care. RESULTS: Advance care planning, comprehensive geriatric assessment, the study of the values of the patient and their introduction in decision-making process, as well as the need to promote moral, care, and healthcare organizational ethics, are essential elements to achieve this objective. CONCLUSIONS: Practitioners and healthcare organizations should seek excellence as a moral requirement. To achieve this, there is a priority to acquire virtues of care and fundamental concepts of geriatric and palliative medicine, assessing functional status, advance care planning and patient/family needs as essential issues to protect, care for and promote them in all care settings.

Deterioro cognitivo y riesgo de caída en el anciano / Cognitive impairment and the risk of falling in the elderly

El anciano con deterioro cognitivo presenta un alto riesgo de caída puesto de manifiesto por asociaciones específicas entre parámetros de la marcha y funciones cognitivas. En las últimas décadas se ha demostrado esta asociación, existiendo cada vez más evidencia de que los dominios de la cognición tales como la atención, función ejecutiva y tipos de memoria son críticos para una regulación correcta de la marcha. Las alteraciones de la marcha pueden comportarse como marcadores diagnósticos precoces de demencia. Un método novedoso, sencillo y relevante de evaluar el riesgo de caída, especialmente en ancianos con deterioro cognitivo, es la utilización de pruebas duales. La evidencia sobre las posibles actuaciones para disminuir el riesgo de caída en este grupo poblacional resulta escasa, siendo la vitamina D y el ejercicio físico las intervenciones más prometedoras(AU)

Risk of fall is significantly increased in old people with cognitive decline due to specific associations between gait parameters and cognition. This association has recently been demonstrated, there being increasing evidence that cognitive domains such as attention, executive function and types of memory are critical for the correct regulation of gait. Gait disturbances can appear as early predictors of dementia in elderly patients. In the assessment of the fall risk, the use of dual tasks is novel, simple and relevant, especially in cognitive decline. Evidence for interventions in this population is limited, with vitamin D and physical exercise being the most encouraging, for decreasing the risk of fall in dementia(AU)

[Cognitive impairment and the risk of falling in the elderly]. / Deterioro cognitivo y riesgo de caída en el anciano.

Risk of fall is significantly increased in old people with cognitive decline due to specific associations between gait parameters and cognition. This association has recently been demonstrated, there being increasing evidence that cognitive domains such as attention, executive function and types of memory are critical for the correct regulation of gait. Gait disturbances can appear as early predictors of dementia in elderly patients. In the assessment of the fall risk, the use of dual tasks is novel, simple and relevant, especially in cognitive decline. Evidence for interventions in this population is limited, with vitamin D and physical exercise being the most encouraging, for decreasing the risk of fall in dementia.

Aspectos fisiopatológicos, clínicos y terapéuticos de la disfunción eréctil en el anciano / Sexual dysfunction in the elderly. Pathophysiological and medical issues. Treatment of erectile dysfunction

La disfunción eréctil (DE) es una condición que no solo afecta de forma negativa a la capacidad sexual del anciano sino también a su calidad de vida, involucrando a su pareja. Fomentar la búsqueda de ayuda profesional por parte del anciano con este problema clínico, es un reto educacional importante que necesita ser dirigido a través de iniciativas médicas, sociales y políticas. La patogénesis exacta de la DE es desconocida, aunque se presume un origen multifactorial; la enfermedad vascular es la causa más frecuente, siendo la disfunción endotelial el denominador fisiopatológico común. Se ha postulado que la DE es un síntoma centinela de acontecimientos cardiovasculares clínicos y su detección debiera conducir a una investigación e intervención sobre los factores de riesgo cardiovascular. Por lo tanto, cuando una persona mayor se presenta con DE, debe realizarse una historia y exploración física minuciosas así como análisis adecuados con el objetivo de detectar patologías asociadas

Erectile dysfunction (ED) is a very distressing condition that not only negatively affects the elderly man¡äs sexual ability, but also his overall quality of life and that of his partner. Encouraging men, alone or as a couple, to seek professional help is a major educational challenge which needs to be met by medical, social and political initiatives. The exact pathogenesis of ED remains unknown, but is presumed to be multifactorial; vascular disease is the most frequent cause with endothelial dysfunction being the common denominator. It has been postulated that ED is a sentinel symptom of cardiovascular clinical events and should prompt investigation and intervention for cardiovascular risk factors. Therefore, when a patient presents with ED, a thorough history and physical examination should be performed, as well as appropriate laboratory tests aimed at detecting associated diseases(AU)

[Sexual dysfunction in the elderly. Pathophysiological and medical issues. Treatment of erectile dysfunction]. / Aspectos fisiopatológicos, clínicos y terapéuticos de la disfunción eréctil en el anciano.

Erectile dysfunction (ED) is a very distressing condition that not only negatively affects the elderly man's sexual ability, but also his overall quality of life and that of his partner. Encouraging men, alone or as a couple, to seek professional help is a major educational challenge which needs to be met by medical, social and political initiatives. The exact pathogenesis of ED remains unknown, but is presumed to be multifactorial; vascular disease is the most frequent cause with endothelial dysfunction being the common denominator. It has been postulated that ED is a sentinel symptom of cardiovascular clinical events and should prompt investigation and intervention for cardiovascular risk factors. Therefore, when a patient presents with ED, a thorough history and physical examination should be performed, as well as appropriate laboratory tests aimed at detecting associated diseases.