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.

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.

[Gait impairment and dysphagia due to a giant basilar aneurysm in a nonagenarian]. / Alteración de la marcha y disfagia secundaria a aneurisma basilar gigante en mujer nonagenaria.

We describe the case of a 90-year-old woman with a giant fusiform cerebral aneurysm of the basilar artery who developed progressive ataxia and dysphagia. The interest of this case lies in the type, size, localization and clinical manifestations of the aneurysm. We analyze the case and review the main features of this entity.

Alteración de la marcha y disfagia secundaria a aneurisma basilar gigante en mujer nonagenaria / Gait impairment and dysphagia due to a giant basilar aneurysm in a nonagenarian

A continuación se presenta el caso de una mujer de 90 años de edad que presenta un aneurisma cerebral gigante de la arteria basilar, de tipo fusiforme, que en su evolución desarrolla un cuadro progresivo de ataxia y de disfagia. El caso destaca por el tipo de aneurisma, su tamaño, su localización y sus manifestaciones clínicas. Se analiza el caso y se revisan los aspectos fundamentales en el diagnóstico de esta enfermedad (AU)

We describe the case of a 90-year-old woman with a giant fusiform cerebral aneurysm of the basilar artery who developed progressive ataxia and dysphagia. The interest of this case lies in the type, size, localization and clinical manifestations of the aneurysm. We analyze the case and review the main features of this entity (AU)

Infecciones respiratorias / Respiratory tract infections

Las infecciones respiratorias son una de las principales causas de mortalidad y hospitalización en personas ingresadas en residencias de ancianos. Como resultado de ello hay un creciente interés en su epidemiología aunque todavía diversos aspectos no han sido evaluados de manera sistemática debido a la falta de ensayos clínicos. Pocos estudios han comparado diferentes estrategias terapéuticas antibióticas y resultados. Los ancianos institucionalizados que presentan neumonía son habitualmente hospitalizados y estos ingresos están asociados con los múltiples riesgos inherentes a la propia hospitalización, así como con importantes costes económicos. Se han desarrollado diferentes modelos predictivos para identificar a los residentes con bajo y alto riesgo de mortalidad. El siguiente trabajo revisa la literatura e intenta ayudar en las decisiones diarias en una residencia (AU)

Respiratory tract infection is a leading cause of mortality and hospitalization in nursing home residents. As a result, interest has increased in the epidemiology of these infections. However, several issues remain to be systematically evaluated due to the lack of clinical trials. Few studies have compared different antibiotic treatment strategies and outcomes. Nursing home residents with pneumonia are frequently hospitalized and these transfers are associated with the multiple hazards of hospitalization as well as with economic costs. Several predictive models have been developed to help clinicians identify residents at low and high risk of mortality. This present article analyzes the relevant literature and attempts to provide information of help in day-to-day decision-making in nursing homes (AU)