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.

[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.

End of life care in Acute Geriatric Units: making decisions about sedation.

Decisions regarding sedation as part of End-of-life Care in Acute Geriatric Hospitals, especially considering their 10% mortality rate, require an extremely rigorous approach to ensure complete ethical and clinical conformity. Developing a sedation protocol which examines a series of ethical and clinical safeguards regarding the implementation of this therapeutic measure facilitates and improves the decision-making process and encourages reflection among the professionals involved. Here we examine whether the protocol established in our hospital for terminal sedation was appropriately applied for those patients who passed away over the course of one year in our unit, and who received sedation in their final days.

Mortalidad hospitalaria y situación funcional / Functional status and in-hospital mortality

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Respuesta de los autores: Insuficiencia cardíaca y NT-proBNP. Respuesta de los autores / Author's reply: Heart failure and NT-proBNP. Author's reply

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[Adherence to pharmaceutical guidance in patients over 85 years of age with chronic heart failure-stage C. Effects on 12-month mortality]. / Seguimiento de guías farmacoterapéuticas en mayores de 85 años con insuficiencia cardiaca estadio C. Efecto sobre la mortalidad al año.

OBJECTIVE: To describe factors related to prescription on discharge of treatment for Chronic Heart Failure(CHF)-Stage C and to analyse whether this is related to 12month-mortality. MATERIAL AND METHODS: Observational follow-up study of patients over 85 hospitalized during 2006/7 with Stage C-Chronic Heart Failure in an outskirt support hospital. Drug-prescription adherence was assessed according to the American Heart Society 2005-Guidelines and recommendations of the American Geriatrics Society-2007. A multivariate analysis of logistic regression was performed to obtain odds for 12-month mortality for each recommended therapy, adjusting by mortality risk factors. RESULTS: 104 patients aged 90+/-3yr were followed on discharge, 85% of which were women. NYHA-classes were distributed NYHA I-28,2%, II-37,9%, III-30,1%, IV-3,9%. Most frequently prescribed drugs were loop diuretics (83,3%) and IACEs/ARB (62%), and the less frequent beta-blockers (19,1%). IACEs/ARB were prescribed to those with lower functional impairment (p=0.04), and beta-blockers to those with worse NYHA class (p=0.02). All recommended prescriptions had a tendency to 12 month mortality risk reduction, even adjusted by age, functional status, co-morbidity, NYHA class and co-morbid atrial fibrillation, except for spironolactone (OR-1,8; IC95% 0,48-17,19). CONCLUSIONS: Treatment with CHF disease-modifying therapies except for spironolactone can reduce 12 month risk mortality, also in the oldest old. There exists room for improvement in frequency of drug prescription in this group of age.

Seguimiento de guías farmacoterapéuticas en mayores de 85 años con insuficiencia cardiaca estadio C. Efecto sobre la mortalidad al año / Adherence to pharmaceutical guidance in patients over 85 years of age with chronic heart failure-stage C. Effects on 12-month mortality

Objetivo: Describir factores relacionados con la prescripción farmacológica al alta hospitalaria de tratamiento para Insuficiencia Cardiaca (IC)-estadio C y analizar la relación entre dicho tratamiento y la incidencia de muerte al año. Material y Métodos: Estudio observacional prospectivo de pacientes mayores de 85 años ingresados en 2006 y 2007 con IC descompensada en un hospital de apoyo periurbano. La adecuación de la prescripción farmacológica se evaluó según las recomendaciones de la Sociedad Americana de Geriatría-2007 y American Heart Association-2005. Se realizó un análisis multivariante de regresión logística para objetivar el riesgo de mortalidad con los fármacos recomendados para tratar la IC estadío C ajustado por factores basales predictores de mortalidad. Resultados: Se siguieron 104 pacientes de 90±3 años, 85% mujeres con clase funcional basal NYHA I-28,2%, II-37,9%, III-30,1%, IV-3,9%. La fármacos más frecuentemente prescritos fueron diuréticos de asa (83,3%) e IECAs/ARA II (62%) y el menos frecuente beta-bloqueantes (19,1%). Se prescribieron más IECAs/ARAII a menor deterioro funcional (p=0.04), más Betabloqueantes a peor clase NYHA (p=0.02). Todos los fármacos estudiados presentaron una tendencia a reducir el riesgo de mortalidad al año ajustado por edad, situación funcional, comorbilidad, clase NYHA y presencia de fibrilación auricular, salvo la espironolactona (OR-1,8; IC95% 0,48–17,19). Conclusiones: El tratamiento con fármacos moduladores de IC salvo la espironolactona puede reducir el riesgo de mortalidad al año en pacientes también mayores de 85 años, existiendo un margen de mejoría en la frecuencia de prescripción en este grupo de edad (AU)

Objective: To describe factors related to prescription on discharge of treatment for Chronic Heart Failure(CHF)-Stage C and to analyse whether this is related to 12month-mortality. Material and methods: Observational follow-up study of patients over 85 hospitalized during 2006/7 with Stage C-Chronic Heart Failure in an outskirt support hospital. Drug-prescription adherence was assessed according to the American Heart Society 2005-Guidelines and recommendations of the American Geriatrics Society-2007. A multivariate analysis of logistic regression was performed to obtain odds for 12-month mortality for each recommended therapy, adjusting by mortality risk factors. Results: 104 patients aged 90±3yr were followed on discharge, 85% of which were women. NYHA-classes were distributed NYHA I-28,2%, II-37,9%, III-30,1%, IV-3,9%. Most frequently prescribed drugs were loop diuretics (83,3%) and IACEs/ARB (62%), and the less frequent beta-blockers (19,1%). IACEs/ARB were prescribed to those with lower functional impairment (p=0.04), and beta-blockers to those with worse NYHA class (p=0.02). All recommended prescriptions had a tendency to 12 month mortality risk reduction, even adjusted by age, functional status, co-morbidity, NYHA class and co-morbid atrial fibrillation, except for spironolactone (OR-1,8; IC95% 0,48–17,19). Conclusions: Treatment with CHF disease-modifying therapies except for spironolactone can reduce 12 month risk mortality, also in the oldest old. There exists room for improvement in frequency of drug prescription in this group of age (AU)