[Effectiveness and efficiency of acute geriatric units: A classic topic revisited]. / Eficacia y eficiencia de las unidades geriátricas de agudos: un tópico clásico revisitado.

Previous meta-analyses have shown that the hospital admission of older patients in acute geriatric units (AGU) compared to admission to other conventional units, significantly reduced the risk of functional deterioration during hospitalization, increasing the possibility of returning home, with an added reduction in cost of hospitalization. A new meta-analysis on the subject has recently been published in Age and Aging, which adds six new studies to the five clinical trials analyzed in previous meta-analyses. This article analyzes the results of this new meta-analysis, delving into the characteristics of the new studies included and making some considerations on the implications for care in the future development of AGU.

Coordinación entre atención primaria y un servicio de geriatría, 20 años después / Coordination between primary care and a geriatrics service, 20 years later

Objetivo: Describir la evolución de la actividad asistencial y de la coordinación de un equipo especializado hospitalario (equipo de Atención Geriátrica Domiciliaria-AGD) en el apoyo a atención primaria (AP) para la atención de pacientes geriátricos. Emplazamiento: Antigua área de Salud-5 de la Comunidad de Madrid. Participantes, intervenciones y mediciones principales: Evaluación de los pacientes atendidos en su domicilio a petición de AP por AGD, en 1997-1999 y 20 años después, en 2017-2019. Se registraron variables sociodemográficas, clínicas, funcionales y mentales. También datos asistenciales como el tiempo hasta la primera visita, la estancia media, la procedencia y destino de los pacientes, el motivo de consulta y el motivo principal de discapacidad. Resultados: Se atendieron 524 pacientes (58% del total) solicitados desde AP en 1997-1999 y 1196 (72,2% del total) en 2017-2019. Actualmente se muestra un paciente de mayor edad, más incapacitado física y mentalmente, con mayor prevalencia de síndromes geriátricos y mayor fragilidad social. Ha aumentado la demencia como motivo principal de incapacidad, observándose un incremento de la Valoración Geriátrica Integral (VGI) y del control clínico como motivos principales de derivación. Conclusiones: En nuestro medio, transcurridos 20 años, AGD continúa siendo un importante apoyo para AP en el complejo abordaje de los pacientes ancianos frágiles recluidos en su domicilio, que son cada vez más vulnerables desde el punto de vista clínico, funcional, cognitivo y social. Contribuye en el manejo de los síndromes geriátricos, la deprescripción, los ingresos directos hospitalarios cuando se necesitan sin pasar por urgencias y la disminución en la institucionalización, facilitando el mantenimiento del paciente en su domicilio.(AU)

Objective: To describe the evolution of the care and coordination activity of a specialized hospital team (Geriatric Home Care-AGD team) in support of Primary Care (PC) for the care of geriatric patients. Location: Health-5 area of the Community of Madrid. Participants, interventions and main measurements: Evaluation of patients attended at home at the request of PC by AGD, in 1997-1999 and twenty years later, in 2017-2019. Sociodemographic, clinical, functional and mental variables were recorded. Also care data such as time to first visit, average length of stay, origin and destination of patients, reason for consultation and main reason for disability. Results: 524 patients (58% of the total) requested from AP in 1997-1999 and 1196 (72.2% of the total) in 2017-2019 were attended. Currently we show an older patient, more physically and mentally disabled, with a higher prevalence of geriatric syndromes and greater social fragility. Dementia has increased as the main reason for incapacity, with an increase in Comprehensive Geriatric Assessment and clinical control as the main reasons for referral. Conclusion: sin our setting, after 20 years, AGD continues to be an important support for PC in the complex approach to frail elderly patients confined to their homes, who are increasingly vulnerable from a clinical, functional, cognitive and social point of view. It contributes to the management of geriatric syndromes, deprescription, direct hospital admissions when needed without having to go to the emergency department, and a decrease in institutionalization, facilitating the maintenance of the patient at home.(AU)

Eficacia y eficiencia de las unidades geriátricas de agudos: un tópico clásico revisitado / Effectiveness and efficiency of acute geriatric units: A classic topic revisited

Metaanálisis previos han mostrado que el ingreso hospitalario de pacientes de edad avanzada en unidades geriátricas de agudos (UGA), comparado con el ingreso en otras unidades convencionales, disminuía de forma significativa el riesgo de deterioro funcional durante la hospitalización, aumentando la posibilidad de volver al domicilio previo al alta, con una reducción añadida del coste de la hospitalización. Recientemente se ha publicado en Age and Ageing un nuevo metaanálisis sobre el tema que añade seis nuevos estudios a los cinco ensayos clínicos analizados en metaanálisis previos. En este artículo se analizan los resultados de este nuevo metaanálisis, profundizando en las características de los nuevos estudios incluidos y realizando algunas consideraciones sobre las implicaciones asistenciales en el desarrollo futuro de las UGA. (AU)

Previous meta-analyses have shown that the hospital admission of older patients in acute geriatric units (AGU) compared to admission to other conventional units, significantly reduced the risk of functional deterioration during hospitalization, increasing the possibility of returning home, with an added reduction in cost of hospitalization. A new meta-analysis on the subject has recently been published in Age and Aging, which adds six new studies to the five clinical trials analyzed in previous meta-analyses. This article analyzes the results of this new meta-analysis, delving into the characteristics of the new studies included and making some considerations on the implications for care in the future development of AGU. (AU)

[Predictive ability of baseline frailty and handgrip strength at admission on outcomes at discharge in a geriatric functional recovery unit]. / Capacidad predictiva de fragilidad basal y fuerza de prensión al ingreso en resultados al alta en una unidad geriátrica de recuperación funcional.

OBJECTIVE: To evaluate the predictive capacity of different frailty scales, as well as the strength of the handgrip, and to determine their relationship with clinical favourable outcomes. PATIENTS AND METHOD: Prospective study of patients admitted to the Geriatric Functional Recovery Unit (GFRU) of the Hospital Central Cruz Roja. The «FRAIL¼ scale, «Clinical Frailty Scale¼ (CFS) and «Fragil-VIG¼ index, and handgrip strength by hydraulic dynamometer were completed on admission. A functional gain was assumed as 20 or more points in the Barthel Index and return to home, as good outcomes at discharge. The discriminative capacity of favourable outcomes for each frailty scale and handgrip strength was analysed by means of ROC curves, calculating the C statistic (area under the curve = AUC). RESULTS: The analysis included 74 patients (median age 82 years; 48.5% women), admitted for stroke recovery (65%), orthopaedic pathology (16%), and other causes (19%). The prevalence of frailty varied between 31% (FRAIL scale), 40% (CFS), and 57.5% («Fragil-VIG¼). Median handgrip strength was 15 Kg in males (interquartile range 11-21), and 9 Kg in females (interquartile range 7-12). At discharge, 51.5% of patients had a functional gain of 20 or more points in Barthel index, and 63% returned to their previous home. The discriminating ability to achieve acceptable functional gain at discharge was good for CFS (AUC = 0.72; 95% CI; 0.60-0.84) and «Fragil-VIG¼ (AUC = 0.72; 95% CI;0.58-0.82), and handgrip strength was the only tool related to return home (AUC = 0.68; 95% CI;0.56-0.81). CONCLUSION: To evaluate frailty on admission to a GFRU contributes to predicting favourable clinical outcomes, but the discriminating capacity of each scale is variable.

Repercusión de un sistema centralizado de ingresos sobre la eficacia y eficiencia de una unidad geriátrica de recuperación funcional / Impact of a centralised hospital admission system on the efficacy and efficiency of a geriatric functional recovery unit

OBJETIVO: Evaluar la influencia del cambio en la gestión de ingresos en una unidad geriátrica de recuperación funcional (UGRF) sobre su actividad y resultados asistenciales. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo. Se recogieron datos registrados desde el año 2000 de la UGRF del Hospital Central Cruz Roja, agrupados en periodos de 4 años, salvo los ingresos centralizados (septiembre de 2016-diciembre de 2018). Los datos recogidos al ingreso fueron Escala Funcional y Mental de Cruz Roja, índice de Barthel, diagnóstico principal motivo del deterioro funcional (que se agrupó en ictus, patología ortopédica y cuadros de inmovilidad multifactorial) y comorbilidad evaluada por el índice de Charlson. Como variables de resultado se estudiaron la ganancia funcional al alta, tanto global como relativa, la estancia hospitalaria, la eficiencia funcional, las altas a residencia y los retraslados a unidad de agudos. Analizamos la relación entre los ingresos realizados de manera centralizada desde una unidad externa y el periodo previo (ingresos gestionados directamente desde la UGRF) en las variables resultados utilizando un análisis multivariante (regresión lineal para variables resultado continuas y regresión logística para las dicotómicas) ajustado por variables al ingreso. RESULTADOS: En el análisis multivariante los pacientes ingresados desde la unidad central presentaron una mayor ganancia funcional global y relativa (diferencia de medias de 3,49 puntos con IC 95%=1,65-5,33 y 12,41% con IC 95%=0,74-24,08, respectivamente), mayor estancia (12,92 días; IC 95%=11,54-14,30) y menor eficiencia (−0,36; IC 95%=−0,16 a −0,57), mayor riesgo de institucionalización (OR 1,61; IC 95%=1,19-2,16) y riesgo de retraslado a unidad de agudos (OR 3,16; IC 95%=2,24-4,47). CONCLUSIONES: El sistema centralizado de ingreso influyó en la mejora de parámetros funcionales, pero a costa de una mayor estancia y una menor eficiencia asistencial, objetivándose un incremento de la institucionalización al alta y de los retraslados a unidades de agudos

OBJECTIVE: To evaluate the influence of a change in the management of admissions on the activity and care outcomes of a Geriatric Functional Recovery Unit (GFRU). MATERIAL AND METHODS: A retrospective observational study was conducted. Since 2000, the Hospital Central Cruz Roja GFRU has been collecting data grouped into periods of 4 years, except for the centralised admissions (September 2016-December 2018). The data collected on admission included the Red Cross Functional and Mental scales, the Barthel index, the main diagnosis of the functional decline (grouped into stroke, orthopaedic problem, and multifactorial immobility episodes), and comorbidity evaluated by the Charlson index. The following outcome variables were analysed: the overall and relative functional gain at discharge; length of hospital stay; the functional efficiency, discharges to nursing homes, and transfers to acute care units. An analysis was made of the relationship between the admissions from the centralised unit and the previous period (directly admission managed by GFRU), using multivariate analysis (linear regression for continuous outcome variables and logistic regression for the dichotomous ones), adjusted for admission variables. RESULTS: Patients admitted from the centralised unit showed a greater overall and relative functional gain (difference between both means: 3.49 points, 95% CI; 1.65-5.33, and 12.41%, 95% CI; 0.74-24.08, respectively), longer stay (12.92 days, 95% CI; 11.54-14.30) and lower efficiency (−0.36, 95% CI; −0.16 to −0.57), higher risk of institutionalisation (OR 1.61, 95% CI; 1.19-2.16), and transfers to acute care units (OR 3.16, 95% CI; 2.24-4.47). CONCLUSIONS: A centralised admissions system had an influence on the improvement of functional parameters in the patients, but with a longer length of hospital stay, and lower efficiency. Increases in institutionalisation at discharge and transfers to acute care units were also observed

[Impact of a centralised hospital admission system on the efficacy and efficiency of a geriatric functional recovery unit]. / Repercusión de un sistema centralizado de ingresos sobre la eficacia y eficiencia de una unidad geriátrica de recuperación funcional.

OBJECTIVE: To evaluate the influence of a change in the management of admissions on the activity and care outcomes of a Geriatric Functional Recovery Unit (GFRU). MATERIAL AND METHODS: A retrospective observational study was conducted. Since 2000, the Hospital Central Cruz Roja GFRU has been collecting data grouped into periods of 4 years, except for the centralised admissions (September 2016-December 2018). The data collected on admission included the Red Cross Functional and Mental scales, the Barthel index, the main diagnosis of the functional decline (grouped into stroke, orthopaedic problem, and multifactorial immobility episodes), and comorbidity evaluated by the Charlson index. The following outcome variables were analysed: the overall and relative functional gain at discharge; length of hospital stay; the functional efficiency, discharges to nursing homes, and transfers to acute care units. An analysis was made of the relationship between the admissions from the centralised unit and the previous period (directly admission managed by GFRU), using multivariate analysis (linear regression for continuous outcome variables and logistic regression for the dichotomous ones), adjusted for admission variables. RESULTS: Patients admitted from the centralised unit showed a greater overall and relative functional gain (difference between both means: 3.49 points, 95% CI; 1.65-5.33, and 12.41%, 95% CI; 0.74-24.08, respectively), longer stay (12.92 days, 95% CI; 11.54-14.30) and lower efficiency (-0.36, 95% CI; -0.16 to -0.57), higher risk of institutionalisation (OR 1.61, 95% CI; 1.19-2.16), and transfers to acute care units (OR 3.16, 95% CI; 2.24-4.47). CONCLUSIONS: A centralised admissions system had an influence on the improvement of functional parameters in the patients, but with a longer length of hospital stay, and lower efficiency. Increases in institutionalisation at discharge and transfers to acute care units were also observed.

Influencia de la duración de la estancia hospitalaria sobre la mortalidad tras el alta en pacientes mayores con patología médica aguda / Influence of length of hospital stay on mortality after discharge in older patients with acute medical diseases

Objetivo: Analizar la influencia de la estancia hospitalaria sobre la mortalidad a los 6 meses del alta en ancianos. Métodos: Estudio longitudinal observacional en pacientes supervivientes al alta tras un ingreso hospitalario. Se realizó un análisis de regresión logística binaria para estudiar factores relacionados con la estancia prolongada (>12 días). Se estudió la relación entre la mortalidad a los 6 meses y los cuartiles de estancia mediante un análisis de regresión de Cox. Resultados: Se estudiaron 1180 pacientes, con una edad media de 86,6 años (desviación estándar: 6,9). La mediana de estancia fue de 8 días (rango intercuartílico: 5-12). La mortalidad a los 6 meses fue del 26,1%. Tras ajustar por edad, sexo, diagnóstico principal, comorbilidad, albúmina al ingreso, deterioro funcional al ingreso y situación funcional y mental al alta, la estancia por encima de la mediana se relacionó con la mortalidad a los 6 meses: para 9-12 días, hazard ratio (HR) de 1,79 e intervalo de confianza del 95% (IC95%) de 1,01-3,14; para más de 12 días, HR de 2,04 e IC95% de 1,19-3,53. Conclusiones: La estancia hospitalaria prolongada es un factor de riesgo independiente de mortalidad a los 6 meses tras la hospitalización (AU)

Objective: To analyse whether hospital length of stay is associated with mortality at six months after discharge in the elderly. Methods: An observational longitudinal study of patients surviving at hospital discharge. A binary logistic regression analysis was performed to study factors related to extended stay (> 12 days). The relationship between mortality at 6 months and length-of-stay quartiles was studied using a Cox regression analysis. Results: 1180 patients were studied with a mean age of 86.6 years (standard deviation: 6.9). The median length of stay was 8 days (interquartile range: 5-12). Six-month mortality was 26.1%. After adjusting for age, gender, main diagnosis, comorbidity, albumin at admission, functional deterioration at admission and functional and mental status at discharge, hospital stay above the median was associated with mortality at 6 months: 9-12 days, HR=1.79, 95% CI: 1.01-3.14; and > 12 days, HR=2.04, 95% CI: 1.19-3.53. Conclusions Prolonged hospital stay is an independent risk factor for mortality at 6 months after discharge (AU)

[Influence of length of hospital stay on mortality after discharge in older patients with acute medical diseases]. / Influencia de la duración de la estancia hospitalaria sobre la mortalidad tras el alta en pacientes mayores con patología médica aguda.

OBJECTIVE: To analyse whether hospital length of stay is associated with mortality at six months after discharge in the elderly. METHODS: An observational longitudinal study of patients surviving at hospital discharge. A binary logistic regression analysis was performed to study factors related to extended stay (> 12 days). The relationship between mortality at 6 months and length-of-stay quartiles was studied using a Cox regression analysis. RESULTS: 1180 patients were studied with a mean age of 86.6 years (standard deviation: 6.9). The median length of stay was 8 days (interquartile range: 5-12). Six-month mortality was 26.1%. After adjusting for age, gender, main diagnosis, comorbidity, albumin at admission, functional deterioration at admission and functional and mental status at discharge, hospital stay above the median was associated with mortality at 6 months: 9-12 days, HR=1.79, 95% CI: 1.01-3.14; and > 12 days, HR=2.04, 95% CI: 1.19-3.53. CONCLUSIONS: Prolonged hospital stay is an independent risk factor for mortality at 6 months after discharge.

Anemia y mortalidad tras el ingreso en una unidad geriátrica de agudos / Anaemia and mortality after admission to an acute geriatric unit

No disponible

El anciano frágil. Detección y tratamiento en AP / The frail elderly. Detection and management in Primary Care

En el artículo se revisa el estado actual en la detección y directrices de tratamiento del anciano frágil desde la AP, que incluye las recomendaciones 2009 del Programa de Actividades Preventivas y de Promoción de la Salud de la Sociedad Española de Medicina Familiar y Comunitaria (PAPPS-semFYC) derivadas de éste, y delimita líneas futuras pertinentes de revisar.La falta de un límite preciso entre la fragilidad y la buena funcionalidad, y con la discapacidad y dependencia, dificulta su definición y delimitación. Las 2 maneras más extendidas en la actualidad para detectar ancianos frágiles son la selección sobre la base de factores de riesgo con consistente predicción de presentar episodios adversos y pérdida funcional (edad avanzada, hospitalización, caídas, alteración de la movilidad y equilibrio, debilidad muscular y poco ejercicio, comorbilidad, condicionantes sociales adversos, polifarmacia), o sobre la base de la pérdida de funcionalidad incipiente o precoz sin que exista todavía un grado ostensible de discapacidad o dependencia, y con posibilidades de reversibilidad o modificación con intervenciones adecuadas; otras opciones de detección, aunque menos empleadas o en fase experimental, son la detección de acuerdo con la existencia de un fenotipo (síndrome geriátrico) según criterios clínicos determinados por Fried, o por marcadores biológicos (estadio preclínico)(AU)

In this article the current state in the detection and management directives of the frail elderly from Primary Care are reviewed. These include the recommendations of the 2009 Preventive Activities Program and Health Promotion of the Spanish Society of Family and Community Medicine (PAPPS-semFYC) and define future lines worthy of review.The lack of defined limits between frailty and good functionality, and with disability and dependency, makes it difficult to diagnose. The two currently most widely methods for detecting the frail elderly are: screening based on risk factors with a sound prediction of suffering adverse events and functional loss (advanced age, hospitalisation, falls, changes in movement and balance, muscle weakness and little exercise, comorbidity, adverse social conditions, multiple medications, etc.) or based on the loss of incipient functionality or early loss if there is still no ostensible degree of incapacity or dependence, and with the possibilities of reversing or modifying it with suitable interventions. Other detection methods, although less used or in the experimental phase include, detection of a phenotype (geriatric syndrome) according to clinical criteria established by Fried, or by biological markers (pre-clinical stage)(AU)

Comparación del uso de las ecuaciones de estimación del filtrado glomerular renal en personas de 75 años o más sin enfermedad renal conocida / Comparison of equations to estimate the glomerular filtration in people aged 75 or older without known renal disease

Fundamento y objetivo: Comparar en pacientes de 75 años o más sin enfermedad renal conocida las estimaciones del filtrado glomerular renal (FGR), según la ecuación Modification of Diet in Renal Disease (MDRD), con respecto al estimado, según la ecuación de Cockroft-Gault (CG) y el aclaramiento de creatinina en orina de 24h (AC-orina 24h). Pacientes y método: Se incluyeron 70 pacientes de 75 años o más de las consultas externas de Geriatría. Se comparó y se correlacionó el FGR según MDRD con la de CG y AC-orina 24h.Resultados: La FGR media (DE) obtenida fue, según AC-orina 24h, de 56,60ml/min/1,73m2 (22,79) y, según CG, de 54,27ml/min/1,73m2 (15,25); significativamente menor que con MDRD (69,78ml/min/1,73m2 [18,53] [p<0,001]). A mayor edad, se observó mayor diferencia entre el FGR con MDRD y CG (coeficiente de correlación lineal: 0,59; p<0,001). La concordancia para la detección de enfermedad renal entre FGR con MDRD y con CG (coeficiente κ=0,37; intervalo de confianza [IC] del 95%: 0,19–0,55) y entre MDRD y AC-orina 24h (coeficiente κ=0,39; IC del 95%: 0,22–0,57) fue moderada. Conclusiones: En edades iguales o mayores de 75 años, las estimaciones del FGR obtenidas con las ecuaciones MDRD y CG no son intercambiables. Son necesarios estudios específicos en los más ancianos para establecer la ecuación más precisa (AU)

Background and objective: To compare the glomerular filtration rate (GFR) of patients aged 75 and older without known renal disease estimated by the MDRD-4-IDMS (MDRD) formula, urine 24h creatinine clearance (24h-CC) and Cockroft-Gault (CG) formula. Patients and Methods: There were included 70 persons aged 75 and older from the geriatric external consultation. We compared the MDRD against the CG and the 24h-CC.Results: Means of GFR were: 24h-CC: 56,60±22,79ml/min/1.73m2 and CG: 54,27±15,25ml/min/1.73m2, significantly lower than with MDRD: 69,78±18,53ml/min/1.73m2 (p<0.001). Age was correlated with the difference between CG and MDRD (coefficient of correlation: 0,59; r2:0,34; p<0,001). Moderate agreement was obtained between MDRD with CG (k coefficient=0.37; CI95%=0.19–0.55) and MDRD with 24-CC (k coefficient=0.39; CI95%=0.22–0.57).Conclusions: The MDRD and CG formulas to estimate the FGR in people aged 75 and older are not interchangeable. There are needed specific studies in old people to establish the most precise formula (AU)

Repercusión asistencial y coste hospitalario de la infección por Staphylococcus aureus meticilina resistente en una unidad geriátrica de agudos / Staphylococcus aureus infection in an acute geriatric unit

Objetivo Conocer el riesgo de muerte, el deterioro funcional, la institucionalización y el coste hospitalario asociado a la infección por Staphylococcus aureus meticilina resistente (SAMR) en una unidad geriátrica de agudos (UGA). Material y métodos Recogida retrospectiva de datos de pacientes ingresados en una UGA durante 5 años (del 1-1-2001 al 1-1-2006). Se compara la mortalidad, la institucionalización y la pérdida funcional al alta, la estancia y los costes hospitalarios en pacientes con SAMR y en el resto de los pacientes sin SAMR. La infección por SAMR fue documentada por el Servicio de Microbiología por cultivo y antibiograma, junto con el diagnóstico clínico de infección hospitalaria recogida en la historia clínica. Resultados La muestra de estudio fue de 47 pacientes con SAMR (edad media de 86,15±5,5 años) y 4.281 pacientes sin SAMR (edad media de 85,25±6 años). Los pacientes con SAMR presentaron mayor mortalidad (25,5 vs. 7,7%; p<0,001); peor situación funcional al alta (índice de Barthel: 39,43±33,05 vs. 55,24±34,99; p<0,01) y mayor institucionalización (29 vs. 9%; p<0,001). También se objetivó una mayor estancia media (22,15±13,67 vs. 10,64±7,53 días; p<0,001) junto con un incremento del coste hospitalario por paciente (7.517,71±4.639,59 vs. 3.611,21±2.609,98 euros, p<0,001). En el análisis multivariante, tras ajustar por edad, sexo y situación funcional y mental previa al ingreso, la infección por SAMR se asoció de forma independiente a mayor riesgo de muerte (Odds ratio [OR] = 3,92; intervalo de confianza [IC] al 95%=1,95–7,86), deterioro funcional al alta (OR=2,4; IC al 95%=1,22–5,01) e institucionalización (OR=6,50; IC al 95%=2,60–12,22), con incremento importante de la estancia hospitalaria (coeficiente beta=11,55 días; IC al 95%=9,32–13,75). Conclusión La infección por SAMR en la UGA se asocia a una mayor mortalidad, pérdida funcional y más frecuente institucionalización al alta hospitalaria, con importante incremento de la estancia y del coste hospitalario (AU)

ObjectiveThe aim of this study was to determine the risk of mortality, functional decline and institutionalization, as well as the hospital cost associated with patients with methicillin-resistant Staphylococcus aureus (MRSA) infection in an Acute Geriatric Unit (AGU).Material and methodsWe retrospectively gathered data on patients admitted to the AGU over a 5-year period (from 1/1/2001 to 1/1/06). Mortality, institutionalization, functional impairment at discharge, length of hospital stay, and hospital costs were compared between patients with and without MRSA. MRSA infection was documented by the microbiology department using culture and antibiogram, as well as by clinical diagnosis of hospital infection registered in the medical record.ResultsData were obtained from 47 patients with MRSA (mean age 86.15±5.5 years) and from 4281 patients without MRSA (mean age 85.25±6 years). MRSA-infected patients had higher mortality (25.5% vs. 7.7%, p<0.001), worse functional status at discharge (Barthel index 39.43±33.05 vs. 55.24±34.99, p<0.01) and more frequent institutionalization (29% vs. 9%, p<0.001). Longer length of hospital stay (22.15±13.67 vs. 10.64±7.69 days, p<0.001) and higher hospital cost per patient (7517.71±4639.59 vs 3611.21±2609.98 €, p<0.001) were also observed. In the multivariate analysis adjusted by age, sex, and baseline functional and cognitive status, MRSA infection was independently associated with higher mortality (OR=3.92; 95% CI=1.95–7.86), worse functional status at discharge (OR=2.48; 95% CI=1.22–5.01), institutionalization at discharge (OR=6.50; 95% CI=2.60–12.22), and substantial increase in length of hospital stay (Beta coefficient=11.55 days; 95% CI=9.32–13.75).ConclusionMRSA infection in the AGU is associated with higher mortality, worse functional status at discharge and a higher incidence of institutionalization, as well as significantly longer length of stay and higher hospital costs(AU)

[Staphylococcus aureus infection in an acute geriatric unit]. / Repercusión asistencial y coste hospitalario de la infección por Staphylococcus aureus meticilina resistente en una unidad geriátrica de agudos.

OBJECTIVE: The aim of this study was to determine the risk of mortality, functional decline and institutionalization, as well as the hospital cost associated with patients with methicillin-resistant Staphylococcus aureus (MRSA) infection in an Acute Geriatric Unit (AGU). MATERIAL AND METHODS: We retrospectively gathered data on patients admitted to the AGU over a 5-year period (from 1/1/2001 to 1/1/06). Mortality, institutionalization, functional impairment at discharge, length of hospital stay, and hospital costs were compared between patients with and without MRSA. MRSA infection was documented by the microbiology department using culture and antibiogram, as well as by clinical diagnosis of hospital infection registered in the medical record. RESULTS: Data were obtained from 47 patients with MRSA (mean age 86.15+/-5.5 years) and from 4281 patients without MRSA (mean age 85.25+/-6 years). MRSA-infected patients had higher mortality (25.5% vs. 7.7%, p<0.001), worse functional status at discharge (Barthel index 39.43+/-33.05 vs. 55.24+/-34.99, p<0.01) and more frequent institutionalization (29% vs. 9%, p<0.001). Longer length of hospital stay (22.15+/-13.67 vs. 10.64+/-7.69 days, p<0.001) and higher hospital cost per patient (7517.71+/-4639.59 vs 3611.21+/-2609.98 euro, p<0.001) were also observed. In the multivariate analysis adjusted by age, sex, and baseline functional and cognitive status, MRSA infection was independently associated with higher mortality (OR=3.92; 95% CI=1.95-7.86), worse functional status at discharge (OR=2.48; 95% CI=1.22-5.01), institutionalization at discharge (OR=6.50; 95% CI=2.60-12.22), and substantial increase in length of hospital stay (Beta coefficient=11.55 days; 95% CI=9.32-13.75). CONCLUSION: MRSA infection in the AGU is associated with higher mortality, worse functional status at discharge and a higher incidence of institutionalization, as well as significantly longer length of stay and higher hospital costs.

[The frail elderly. Detection and management in Primary Care]. / El anciano frágil. Detección y tratamiento en AP.

In this article the current state in the detection and management directives of the frail elderly from Primary Care are reviewed. These include the recommendations of the 2009 Preventive Activities Program and Health Promotion of the Spanish Society of Family and Community Medicine (PAPPS-semFYC) and define future lines worthy of review. The lack of defined limits between frailty and good functionality, and with disability and dependency, makes it difficult to diagnose. The two currently most widely methods for detecting the frail elderly are: screening based on risk factors with a sound prediction of suffering adverse events and functional loss (advanced age, hospitalisation, falls, changes in movement and balance, muscle weakness and little exercise, comorbidity, adverse social conditions, multiple medications, etc.) or based on the loss of incipient functionality or early loss if there is still no ostensible degree of incapacity or dependence, and with the possibilities of reversing or modifying it with suitable interventions. Other detection methods, although less used or in the experimental phase include, detection of a phenotype (geriatric syndrome) according to clinical criteria established by Fried, or by biological markers (pre-clinical stage).

[Comparison of equations to estimate the glomerular filtration in people aged 75 or older without known renal disease]. / Comparación del uso de las ecuaciones de estimación del filtrado glomerular renal en personas de 75 años o más sin enfermedad renal conocida.

BACKGROUND AND OBJECTIVE: To compare the glomerular filtration rate (GFR) of patients aged 75 and older without known renal disease estimated by the MDRD-4-IDMS (MDRD) formula, urine 24h creatinine clearance (24h-CC) and Cockroft-Gault (CG) formula. PATIENTS AND METHODS: There were included 70 persons aged 75 and older from the geriatric external consultation. We compared the MDRD against the CG and the 24h-CC. RESULTS: Means of GFR were: 24h-CC: 56,60 + or - 22,79 ml/min/1.73 m(2) and CG: 54,27 + or - 15,25 ml/min/1.73 m(2), significantly lower than with MDRD: 69,78 + or - 18,53 ml/min/1.73 m(2) (p<0.001). Age was correlated with the difference between CG and MDRD (coefficient of correlation: 0,59; r(2):0,34; p<0,001). Moderate agreement was obtained between MDRD with CG (k coefficient = 0.37; CI95%=0.19-0.55) and MDRD with 24-CC (k coefficient = 0.39; CI95% = 0.22-0.57). CONCLUSIONS: The MDRD and CG formulas to estimate the FGR in people aged 75 and older are not interchangeable. There are needed specific studies in old people to establish the most precise formula.

Prevención de la dependencia en las personas mayores / Preventing dependency in the elderly

No disponible

No disponible