Utilidad y seguridad de los ingresos directos a una unidad hospitalaria de agudos de un servicio de geriatría valorados por atención geriátrica en residencias / Utility and safety of direct admission to acute geriatric unit after Nursing Home Geriatric Team assessment

Introducción y objetivo Más de la mitad de los ancianos institucionalizados necesita de una derivación anual a urgencias generando, por su complejidad, un alto uso de recursos y mayor riesgo de eventos adversos. El objetivo del estudio es valorar si la hospitalización directa en una unidad de geriatría de agudos, tras evaluación conjunta del equipo médico de residencia y del geriatra consultor, puede ser una alternativa segura y de utilidad en comparación con la atención en urgencias. Métodos Estudio observacional retrospectivo de los pacientes ingresados en la unidad de geriatría de agudos procedentes de las residencias atendidas por nuestro equipo de atención geriátrica a residencia entre el 01/01/2021 y el 31/12/2021. Se excluyeron los pacientes ingresados de forma programada o con diagnóstico de infección por SARS-CoV-2. Se recogieron variables de la historia clínica (sociodemográficas, clínicas, funcionales, cognitivas). Como variables resultado se registraron mortalidad durante el ingreso, estancia hospitalaria y en urgencias, traslado a urgencias y delirium en las primeras 48h del ingreso, ubicación al alta. Resultados 206 pacientes no COVID ingresaron directamente desde la residencia, 101 derivados desde urgencias (N: 307). Al ingreso el 62,5% presentaba Índice Barthel<40 y el 65% Cruz Roja Mental≥2, con Índice de Charlson ≥3 en el 56,4% de los casos. La mortalidad intrahospitalaria entre los ingresos directos fue del 14,6%, en el grupo derivado de urgencias del 20,8%, p=0,14. La estancia hospitalaria total de los pacientes valorados por atención geriátrica a residencia fue 9,61±6,01 días, mientras en los derivados a urgencias 11,22±5,36 días, p=0,02. Presentaron delirium en las primeras 48h del ingreso, 27,7% de los ingresos directos y 36,6% desde urgencias (p=0,11) (AU)

Background and objective More than half of institutionalized older people need a emergency department visit annually, with high resources consumption and higher risk of adverse events, due to high complexity. Direct admission to Acute Geriatric Unit (AGU), after geriatric consultant and nursing home medical team assessment, could be a safety and effective alternative to emergency department (ED) admission. Methods Retrospective observational study of AGU patients admitted by Nursing Home Geriatric Team between January, 1st and December, 31st, 2021. Planned admissions and SARS-CoV-2 positive patients were excluded. Medical (sociodemographic, clinical, functional and cognitive) records and outcomes data (inpatient mortality, hospital and ED lenght of stay, transfer to ED and delirium within 48h after admission, hospital discharge location) were collected. Results Two hundred and six patients directly admitted, 101 through ED (N 307). 62.5% with Barthel index <40, 65% with dementia, 56.4% with Charlson index ≥3. Inpatient mortality was 14.6% in direct admission, 20.8% in ED referral group, p=0.14. Hospital lenght of stay was 9.61±6.01 days in direct admission, 11.22±5.36 days in ED group, p=0.02. 27.7% of patients with delirium in direct admission and 36.6% in ED group; only one patient was transferred to ED, within 48h after admission. Conclusions Direct admission is a safety and effective alternative to ED referral in institutionalized older people after geriatric assessment, due to no increased mortality, shorter length of stay and hospital cost reduction (AU)

[Utility and safety of direct admission to acute geriatric unit after Nursing Home Geriatric Team assessment]. / Utilidad y seguridad de los ingresos directos a una unidad hospitalaria de agudos de un servicio de geriatría valorados por atención geriátrica en residencias.

BACKGROUND AND OBJECTIVE: More than half of institutionalized older people need a emergency department visit annually, with high resources consumption and higher risk of adverse events, due to high complexity. Direct admission to Acute Geriatric Unit (AGU), after geriatric consultant and nursing home medical team assessment, could be a safety and effective alternative to emergency department (ED) admission. METHODS: Retrospective observational study of AGU patients admitted by Nursing Home Geriatric Team between January, 1st and December, 31st, 2021. Planned admissions and SARS-CoV-2 positive patients were excluded. Medical (sociodemographic, clinical, functional and cognitive) records and outcomes data (inpatient mortality, hospital and ED lenght of stay, transfer to ED and delirium within 48h after admission, hospital discharge location) were collected. RESULTS: Two hundred and six patients directly admitted, 101 through ED (N 307). 62.5% with Barthel index <40, 65% with dementia, 56.4% with Charlson index ≥3. Inpatient mortality was 14.6% in direct admission, 20.8% in ED referral group, p=0.14. Hospital lenght of stay was 9.61±6.01 days in direct admission, 11.22±5.36 days in ED group, p=0.02. 27.7% of patients with delirium in direct admission and 36.6% in ED group; only one patient was transferred to ED, within 48h after admission. CONCLUSIONS: Direct admission is a safety and effective alternative to ED referral in institutionalized older people after geriatric assessment, due to no increased mortality, shorter length of stay and hospital cost reduction.

Specialized Care Resources for Diagnosis and Management of Patients Who Have Suffered Falls: Results of a National Survey in Geriatric Units.

INTRODUCTION: Clinical guidelines recommend comprehensive multifactorial assessment and intervention to prevent falls and fractures in older populations. METHODS: A descriptive study was conducted by the Falls Study Group of the Spanish Geriatric Medicine Society (SEMEG) to outline which types of healthcare-specific resources were assigned for fall assessment in Spanish geriatric departments. A self-reported seven-item questionnaire was delivered from February 2019 to February 2020. Where geriatric medicine departments were not available, we tried to contact geriatricians working in those areas. RESULTS: Information was obtained regarding 91 participant centers from 15 autonomous communities, 35.1% being from Catalonia and 20.8% from Madrid. A total of 21.6% reported a multidisciplinary falls unit, half of them in geriatric day hospitals. Half of them reported fall assessment as part of a general geriatric assessment in general geriatric outpatient clinics (49.5%) and, in 74.7% of cases, the assessment was based on functional tests. A total of 18.7% reported the use of biomechanical tools, such as posturography, gait-rides or accelerometers, for gait and balance analysis, and 5.5% used dual X-ray absorptiometry. A total of 34% reported research activity focused on falls or related areas. Regarding intervention strategies, 59% reported in-hospital exercise programs focused on gait and balance improvement and 79% were aware of community programs or the pathways to refer patients to these resources. CONCLUSIONS: This study provides a necessary starting point for a future deep analysis. Although this study was carried out in Spain, it highlights the need to improve public health in the field of fall prevention, as well as the need, when implementing public health measures, to verify that these measures are implemented homogeneously throughout the territory. Therefore, although this analysis was at the local level, it could be useful for other countries to reproduce the model.

Gangrena de Fournier en varón de 89 años: un diagnóstico clínico urgente / Fournier's gangrene in an 89-year-old male: An urgent clinical diagnosis

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Health impact on the elderly survivors of COVID-19: Six months follow up.

PURPOSE: To analyse factors associated with mortality at 6 months in survivors older than 70 years after hospital admission for SARS-CoV-2. METHODS: Descriptive observational study with follow-up at 6 months. All patients over 70 years of age, discharged from the Hospital Central de la Cruz Roja, after hospitalization for COVID-19 consecutively during the months March to May 2020 were included. The outcome at 6 months (mortality, readmissions) were collected. RESULTS: A total of 165 patients were included. Mean age 88.5±6.73, women 69.1%. High comorbidity 33.9%. Mean previous Barthel Index was 65.39±33.64 and at discharge 58.12±34.04. 24.2% had severe polypharmacy and 47.9% severe frailty. Six months after hospital discharge, 13% died and 23.8% required at least one readmission. More than half of the sample had some of the following sequelae: dyspnea 20%(33), functional impairment 41.7%(69), cognitive impairment 31.3%(52) or depressive symptoms 42.4%(70). Functional impairment at discharge was associated with an increased risk of mortality (OR 5.33; 95% CI 1.11-25.73). CONCLUSIONS: The functional status was a factor associated with risk of mortality at 6 months.

Health impact on the elderly survivors of COVID-19: Six months follow up / Impacto en la salud de los ancianos supervivientes de COVID-19: seguimiento a los 6 meses

Purpose: To analyse factors associated with mortality at 6 months in survivors older than 70 years after hospital admission for SARS-CoV-2.Methods: Descriptive observational study with follow-up at 6 months. All patients over 70 years of age, discharged from the Hospital Central de la Cruz Roja, after hospitalization for COVID-19 consecutively during the months March to May 2020 were included. The outcome at 6 months (mortality, readmissions) were collected.Results: A total of 165 patients were included. Mean age 88.5±6.73, women 69.1%. High comorbidity 33.9%. Mean previous Barthel Index was 65.39±33.64 and at discharge 58.12±34.04.24.2% had severe polypharmacy and 47.9% severe frailty.Six months after hospital discharge, 13% died and 23.8% required at least one readmission. More than half of the sample had some of the following sequelae: dyspnea 20%(33), functional impairment 41.7%(69), cognitive impairment 31.3%(52) or depressive symptoms 42.4%(70).Functional impairment at discharge was associated with an increased risk of mortality (OR 5.33; 95% CI 1.11–25.73).Conclusions: The functional status was a factor associated with risk of mortality at 6 months. (AU)

Objetivo: Analizar los factores asociados a la mortalidad a los 6 meses en los supervivientes mayores de 70 años tras el ingreso hospitalario por SARS-CoV-2.Métodos: Estudio observacional descriptivo con seguimiento a los 6 meses. Se incluyeron todos los pacientes mayores de 70 años, dados de alta en el Hospital Central de la Cruz Roja, tras ingreso hospitalario por COVID-19 de forma consecutiva durante los meses de marzo a mayo de 2020. Se recogieron los resultados a los 6 meses (mortalidad, reingresos).Resultados: Se incluyeron 165 pacientes. Edad media: 88,5±6,73, mujeres: 69,1%. Alta comorbilidad del 33,9%. La media del índice de Barthel previo fue de 65,39±33,64 y al alta 58,12±34,04. El 24,2% tenía polifarmacia severa y el 47,9% fragilidad severa.Seis meses después del alta hospitalaria, el 13% falleció y el 23,8% requirió al menos un reingreso. Más de la mitad de la muestra tenía alguna de las siguientes secuelas: disnea el 20% (33), deterioro funcional el 41,7% (69), deterioro cognitivo el 31,3% (52) o síntomas depresivos el 42,4% (70).El deterioro funcional al alta se asoció a un mayor riesgo de mortalidad (OR: 5,33; IC 95%: 1,11-25,73).Conclusiones: El estado funcional fue un factor asociado al riesgo de mortalidad a los 6 meses. (AU)

[An opportunity to identify and prevent frailty through falls intervention.] / Oportunidad para la detección y manejo precoz de la fragilidad a través del abordaje de las caídas.

Falls are one of the classic giant geriatric syndromes with a multifactorial etiopathogenesis and closely related to frailty, being this relationship bidirectional. The Consensus Document on the Prevention of Frailty and Falls approved by the Interterritorial Council of the National Health System in 2014 provides recommendations for the screening of frailty and falls in all older adults in order to develop a management plan in high risk older adults so to prevent disability. This review describes the intrinsic relationship between frailty and falls, falls assessment and screening instruments to use and detect frailty and finally gives evidence-based recommendations to reduce falls impact.

Las caídas son uno de los grandes síndromes geriátricos, con una etiopatogenia multifactorial y con una estrecha relación con la fragilidad, siendo esta relación bidireccional. El Documento de Consenso sobre Prevención de Fragilidad y Caídas aprobado por el Consejo Interterritorial del Sistema Nacional de Salud en 2014, propone un cribado universal de fragilidad y riesgo de caídas, con el objetivo de intervenir en aquellos ancianos de alto riesgo y por tanto prevenir discapacidad. Esta revisión evalúa la relación intrínseca entre caídas y fragilidad, describe las herramientas de valoración del paciente que presenta caídas, incidiendo en aquellos aspectos que detectan fragilidad y finalmente propone intervenciones que han demostrado reducir su impacto.

Predictive Factors of Pulmonary Embolism in Older Patients with SARS-CoV-2: The OCTA-COVID-19 Study.

BACKGROUND: The risk of pulmonary embolism (PE) has not been studied in older patients affected by COVID-19. We aimed to assess PE incidence and risk factors in a population of older patients infected with SARS-CoV-2. METHODS: An ambispective, observational cohort study. A total of 305 patients ≥ 75 years old had the SARS-CoV-2 infection from March to May 2020. The incidence rate of PE was estimated as the proportion of new cases within the whole sample. Youden's index was used to assess the cutoff point of D-dimer. To select factors associated with the risk of PE, time-to-event analyses were performed using cause-specific hazard models. RESULTS: In total, 305 patients with a median age of 87 years (62.3% female) were studied; 67.9% were referred from nursing homes and 90.4% received any type of anticoagulation. A total of 64.9% showed frailty and 44% presented with dementia. The PE incidence was 5.6%. The cutoff value of a D-dimer level over 2.59 mg/L showed a sensitivity of 82.4% and specificity of 73.8% in discriminating a PE diagnosis. In the multivariate analysis, the factors associated with PE were previous oncological events and D-dimer levels. CONCLUSIONS: The PE incidence was 5.6%, and major risk factors for PE were oncological antecedents and increased plasma D-dimer levels.

Health status in survivors older than 70 years after hospitalization with COVID-19: observational follow-up study at 3 months.

PURPOSE: To analyze factors associated with mortality at 3 months and readmissions, functional and cognitive decline, anorexia and affective disorders in patients aged > 70 years surviving after hospital admission for SARS-CoV-2. METHODS: Patients aged > 70 years, discharged after hospitalization with COVID-19. OUTCOME VARIABLES: mortality, readmissions, functional and cognitive impairment, anorexia and mood disorder. RESULTS: 165 cases at 3 months after hospital discharge, 8.5% died and 20% required at least one hospital readmission. The presence of severe dependence at discharge (BI < 40) was associated at 3 months with a higher risk of mortality (OR 5.08; 95% CI 1.53-16.91) and readmissions (OR 4.53; 95% CI 1.96-10.49). The post-hospitalization functional deterioration was associated with persistence of deterioration at 3 months (OR 24.57; 95% CI 9.24-65.39), cognitive deterioration (OR 2.32; 95% CI 1.03-5.25) and affective (OR 4.40; 95% CI 1.84-10.55) CONCLUSIONS: Loss function in older people after hospitalization by COVID-19 may contribute to identify patients with a higher risk of sequelae in the short term that require closer follow-up.