[PAPPS update on older people 2022]. / Actividades preventivas en el mayor. Actualización PAPPS 2022.

This article examines the latest available evidence on preventive activities in the elderly, including sleep disorders, physical exercise, deprescription, cognitive disorders and dementias, nutrition, social isolation and frailty.

Fragilidad en atención primaria: diagnóstico y manejo multidisciplinar / Frailty in primary care: Diagnosis and multidisciplinary management

El envejecimiento poblacional se asocia a un mayor uso de recursos sociales sanitarios, asociados a la mayor morbimortalidad y discapacidad de este grupo etario. La fragilidad es un síndrome geriátrico previo a la aparición de la dependencia funcional, que permite la identificación de individuos de mayor riesgo de dependencia, institucionalización, efectos adversos de fármacos, mortalidad y otros eventos negativos de salud. Este síndrome es potencialmente reversible con una intervención multicomponente. La atención primaria de salud es el lugar preferente para el diagnóstico y seguimiento de la fragilidad, a través de escalas como la FRAIL scale, el fenotipo de Fried o modelos de acumulación de déficits. Para el seguimiento se precisa la intervención multidimensional y coordinada de diferentes profesionales sanitarios y sociales, con la implicación del paciente y su familia. Se debe fomentar la investigación para determinar las intervenciones más eficaces y los cursos clínicos más frecuentes.(AU)

Population aging is associated with a greater use of social and health resources, associated with greater morbidity, mortality and disability in the elderly. Frailty is a geriatric syndrome prior to the onset of functional decline, which allows the identification of individuals at higher risk of dependency, institutionalization, adverse effects of drugs, mortality and other negative health events. This syndrome is potentially reversible with a multicomponent intervention. Primary health care is the preferred place for the diagnosis and follow-up of frailty, through scales such as the FRAIL scale, the Fried phenotype or deficit accumulation models. Follow-up requires the multidimensional and coordinated intervention of different health and social professionals, with the involvement of the patient and their family. Research should be encouraged to determine the most effective interventions and the most common clinical courses.(AU)

Diagnostic accuracy of the FRAIL scale plus functional measures for frailty screening: a cross-sectional study.

BACKGROUND: There is little knowledge of the diagnostic accuracy of screening programmes for frailty in primary care settings. AIM: To assess a two-step strategy consisting of the administration of the FRAIL scale to those who are non-dependent and aged ≥75 years, followed-up by measurement of the Short Physical Performance Battery (SPPB) or gait speed in those who are positive. DESIGN & SETTING: Cross-sectional and longitudinal cohort study. Analysis of primary care data from the FRAILTOOLS project at five European cities. METHOD: All primary care patients consecutively attending were enrolled. They received the index tests, plus the Fried frailty phenotype (FP) and the frailty index to assess their frailty status. Mortality and worsening of dependency in basic and instrumental activities of daily living (BADL and IADL) over 1 year were ascertained. RESULTS: Prevalence of frailty based on FP was 14.9% in the 362 participants. A FRAIL scale score ≥1 had a sensitivity of 83.3% (95% confidence interval [CI] = 73.1 to 93.6) to detect frailty. A positive result and an SPPB score <11 had a sensitivity of 72.2% (95% CI = 59.9 to 84.6); when combined with a gait speed <1.1 m/s, the sensitivity was 80.0% (95% CI = 68.5 to 91.5). Two-thirds of those screened as positive were not frail. In the best scenario, sensitivities of this last combination to detect IADL and BADL worsening were 69.4% (95% CI = 59.4 to 79.4) and 63.6% (95% CI = 53.4 to 73.9), respectively. CONCLUSION: Combining the FRAIL scale with other functional measures offers an acceptable screening approach for frailty. Accurate prediction of worsening dependency and death need to be confirmed through the piloting of a frailty screening programme.

[Frailty in primary care: Diagnosis and multidisciplinary management]. / Fragilidad en atención primaria: diagnóstico y manejo multidisciplinar.

Population aging is associated with a greater use of social and health resources, associated with greater morbidity, mortality and disability in the elderly. Frailty is a geriatric syndrome prior to the onset of functional decline, which allows the identification of individuals at higher risk of dependency, institutionalization, adverse effects of drugs, mortality and other negative health events. This syndrome is potentially reversible with a multicomponent intervention. Primary health care is the preferred place for the diagnosis and follow-up of frailty, through scales such as the FRAIL scale, the Fried phenotype or deficit accumulation models. Follow-up requires the multidimensional and coordinated intervention of different health and social professionals, with the involvement of the patient and their family. Research should be encouraged to determine the most effective interventions and the most common clinical courses.

Diagnostic accuracy of the frail scale plus functional measures for frailty screening.

BACKGROUND: There is little knowledge of the diagnostic accuracy of screening programmes for frailty in primary care settings. AIM: To assess a two-step strategy consisting of the administration of the FRAIL scale to those who are non-dependent, aged ≥75 years, followed-up by measurement of the Short Physical Performance Battery (SPPB) or gait speed in those who are positive. DESIGN & SETTING: Cross-sectional and longitudinal cohort study. Analysis of primary care data from the FRAILTOOLS project at five European cities. METHOD: All patients consecutively attending were enrolled. They received the index tests plus the Fried phenotype and the frailty index to assess their frailty status. Mortality and worsening of dependency in basic (BADL) and instrumental (IADL) activities of daily living over a year were ascertained. RESULTS: Prevalence of frailty based on frailty phenotype was 14.9% in the 362 participants. A FRAIL scale score ≥1 had a sensitivity of 83.3% (95%CI:73.1-93.6) to detect frailty. A positive result and a SPPB score <11 had a sensitivity of 72.2% (95%CI: 59.9-84.6); when combined with a gait speed <1.1 m/s, the sensitivity was 80% (95%CI: 68.5-91.5). Two thirds of those screened as positive were not frail. In the best scenario, sensitivities of this last combination to detect IADL and BADL worsening were 69.4% (95%CI: 59.4-79.4) and 63.6% (95%CI: 53.4-73.9). CONCLUSION: Combining the FRAIL scale with other functional measures offers an acceptable screening approach for frailty. Accurate prediction of worsening dependency and death need to be confirmed through the piloting of a frailty screening programme.

Priorización por los pacientes de una serie de componentes habituales en la valoración geriátrica integral realizada en Atención Primaria / Prioritization by patients of a series of common components in the standard comprehensive geriatric assessment in Primary Care

Objetivo: Conocer la priorización por personas ≥ 70 años de una serie de componentes habituales en la valoración geriátrica integral (VGI) realizada en Atención Primaria (AP), según su percepción de la influencia en la salud.Método: Estudio transversal en AP mediante cuestionario a 109 personas, excluyendo a pacientes al final de la vida, o con alteración cognitiva, sensorial o psiquiátrica que dificultase su participación.La variable principal fue una selección de 23 ítems del área físico/clínica, funcional, mental y sociofamiliar, habituales en una VGI en AP. Otras: edad, sexo, cuestionario VIDA de actividades instrumentales de la vida diaria, número de medicamentos, índice de comorbilidad de Charlson.Resultados: Mediana de edad 78 años, percentil 75 de 84; 64,2% mujeres. Cuatro personas (3,7%) tenían alterado el cuestionario VIDA (< 32 puntos). Mediana de 5 medicamentos habituales y 98 (90%) sin comorbilidad relevante según el Charlson. Sin diferencias estadísticamente significativas al contrastar sexo con edad, resultado del VIDA y número de medicamentos.Los ítems mejor valorados según estadísticos de centralización fueron fumar y la memoria, y considerando la mejor puntuación (4-5 sobre 5): medicación adecuada (93,6% de los encuestados, IC del 95%, 87,3-96,8), condiciones de boca/dentadura (92,7%, IC del 95%, 86,2-96,2), estado de ánimo (91,7%, IC del 95%, 85,1-95,6), capacidad para realizar AVD (91,7%, IC del 95%, 85,1-95,6).Conclusiones: Los pacientes consideraban fumar, la memoria, la medicación adecuada, el estado de boca/dentadura y de ánimo, y las AVD como más influyentes en la salud. Ante la importancia de la participación de los pacientes en el contenido de la VGI y la escasez de estos trabajos, se hacen pertinentes nuevos estudios que profundicen este tema. (AU)

Objective: To know the prioritization by people aged ≥70 of a series of common components in the comprehensive geriatric assessment (CGA) in primary care (PC), according to the influence on health.Method: Cross-sectional descriptive study through questionnaire to 109 people, have been excluded those at the end of life or with cognitive, sensory or mental/psychiatric impairment that made collaboration difficult.The main variable was a selection of 23 items of the physical/clinical, functional, mental and social/family, common components on a CGA in PC. Others: age, sex, VIDA questionnaire of instrumental activities of daily living (IADL), number of medications, and Charlson comorbidity index.Results: Median age 78 years, 75 percentile of 84; 64.2% women. Four people (3.7%) had altered VIDA questionnaire (<32 points). Median of 5 chronic medications, and 98 (90%) comorbidity absence considering Charlson index. Without statistically significant differences contrasting gender with age, result in VIDA, nor number of chronic medications.The best scored items according to centralization statistics were smoking and memory, and considering the best score (4–5 out of 5) of the Likert scale: proper medication (93.6% of the people surveyed, 95% CI: 87.3–96.8), mouth/teeth condition (92.7%, 95% CI: 86.2–96.2), mood (91.7%, 95% CI: 85.1–95.6), and capacity for ADL (91.7%, 95% CI:85.1–95.6).Conclusions: Smoking, memory, proper medication, mouth/teeth condition, mood and ADL were considered as the most influential in health by patients. Because of the important of patient participation in the content of the CGA and the scarcity of these kind of studies, new studies that deepen this issue become relevant. (AU)

[Prioritization by patients of a series of common components in the standard comprehensive geriatric assessment in Primary Care]. / Priorización por los pacientes de una serie de componentes habituales en la valoración geriátrica integral realizada en Atención Primaria.

OBJECTIVE: To know the prioritization by people aged ≥70 of a series of common components in the comprehensive geriatric assessment (CGA) in primary care (PC), according to the influence on health. METHOD: Cross-sectional descriptive study through questionnaire to 109 people, have been excluded those at the end of life or with cognitive, sensory or mental/psychiatric impairment that made collaboration difficult. The main variable was a selection of 23 items of the physical/clinical, functional, mental and social/family, common components on a CGA in PC. Others: age, sex, VIDA questionnaire of instrumental activities of daily living (IADL), number of medications, and Charlson comorbidity index. RESULTS: Median age 78 years, 75 percentile of 84; 64.2% women. Four people (3.7%) had altered VIDA questionnaire (<32 points). Median of 5 chronic medications, and 98 (90%) comorbidity absence considering Charlson index. Without statistically significant differences contrasting gender with age, result in VIDA, nor number of chronic medications. The best scored items according to centralization statistics were smoking and memory, and considering the best score (4-5 out of 5) of the Likert scale: proper medication (93.6% of the people surveyed, 95% CI: 87.3-96.8), mouth/teeth condition (92.7%, 95% CI: 86.2-96.2), mood (91.7%, 95% CI: 85.1-95.6), and capacity for ADL (91.7%, 95% CI:85.1-95.6). CONCLUSIONS: Smoking, memory, proper medication, mouth/teeth condition, mood and ADL were considered as the most influential in health by patients. Because of the important of patient participation in the content of the CGA and the scarcity of these kind of studies, new studies that deepen this issue become relevant.

[Vision of the management of frailty in Primary Health Care.] / Visión del manejo de la fragilidad en Atención Primaria.

Primary Care (PC) and community are the priority health sites for the detection and management of frailty. There are good guidelines (Strategy and consensus of the National Health Service, ADVANTAGE European Joint Action, recommendations of the Program of Prevention and Health Promotion Activities of the Spanish Society of Family and Community Medicine PAPPS-semFYC, Fisterra guideline); however, its implementation is not taking place with the expected magnitude or speed, also considering the influence of the COVID-19 pandemic. The detection and management of frailty requires multidisciplinary work by professionals who usually carry out their activity at the first level of care (physicians, nurses, social workers), with others whose integration is advisable (nutritionists, physiotherapists, etc.); and counting on others of reference (geriatricians). On the other hand, it is necessary to work with comprehensive approaches based on good coordination between PC and the Community, with various experiences in this regard. The support by the Information and Communication Technologies (ICT) can be very interesting, with tools for both users and careers (e.g., VIVIFRAIL), as well as for social and health professionals (e.g., VALINTAN or WHO ICOPE-Handbook App). Strategies to intervene in fragility in a more effective and systematic way must be consolidated: with an adequate professional training, establishment of campaigns and dissemination ways for visualizing its relevance and extend their intervention, prioritization of the most effective programmed assistance activities (highlighting fragility), multidisciplinary work with coordination and participation of the different healthcare and community levels and of the patients themselves, and providing the PC with adequate resources.

La Atención Primaria (AP) y la comunidad constituyen el medio asistencial primordial para el manejo de la fragilidad. Se cuenta con buenas directrices (Estrategia y Consenso del Sistema Nacional de Salud, Acción Conjunta Europea ADVANTAGE, recomendaciones del Programa de Actividades de Prevención y de Promoción de la Salud de la Sociedad Española de Medicina familiar y Comunitaria: PAPPS-semFYC, guía Fisterra...); no obstante, su implantación no se está dando con la magnitud ni rapidez esperada, considerando también la influencia de la pandemia por la COVID-19. La detección y manejo de la fragilidad exige un trabajo multidisciplinar de profesionales que habitualmente desarrollan su actividad en el primer nivel asistencial (profesionales de medicina, enfermería y trabajo social), junto con otros cuya integración es aconsejable (nutricionistas, fisioterapeutas, etc...) y contando con otros profesionales de referencia (geriatras). Por otro lado, es necesario trabajar con enfoques integrales basados en una buena coordinación entre AP y la Comunidad, existiendo diversas experiencias en este sentido. El apoyo de las Tecnologías de la Información y Comunicación (TIC) puede ser muy interesante, existiendo herramientas tanto para usuarios y personas cuidadoras (por ej. VIVIFRAIL), como para profesionales sociosanitarios (por ej. VALINTAN o WHO ICOPE-Handbook App). Deben consolidarse las estrategias para intervenir en fragilidad de una manera más efectiva y sistemática: con la formación adecuada de los profesionales, establecimiento de campañas y difusión que hagan visualizar la relevancia y extender su intervención, priorizando las actividades asistenciales programadas más efectivas (destacando la fragilidad), a través del trabajo multidisciplinar con coordinación y participación de los diferentes niveles asistenciales y comunitarios y de los propios pacientes, y dotando de medios y recursos a la AP.

Herramienta informática VALINTAN (www. valintan. com) de valoración geriátrica para atención primaria / Computerized geriatric assessment tool VALINTAN (www. valintan. com) for primary care

No disponible

Baseline Functional Status and One-year Mortality After Hospital Admission in Elderly Patients: a prospective cohort study.

INTRODUCTION: Hospitalization represents a major factor that may precipitate the loss of functional status and the cascade into dependence. The main objective of our study was to determine the effect of functional status measured before hospital admission on survival at one year after hospitalization in elderly patients. METHODS: Prospective cohort study of adult patients (over 65 years of age) admitted to either the general ward or intensive Care units (ICU) of a tertiary teaching hospital in Buenos Aires, Argentina. Main exposure was the pre-admission functional status determined by means of the modified "VIDA" questionnaire, which evaluates the instrumental activities of daily living. We used a multivariate Cox proportional hazards model to estimate the effect of prior functional status on time to all-cause death while controlling for measured confounding. Secondarily, we analyzed the effect of post-discharge functional decline on long-term outcomes. RESULTS: 297 patients were included in the present study. 12.8% died during hospitalization and 86 patients (33.2%) died within one year after hospital discharge. Functional status prior to hospital admission, measured by the VIDA questionnaire (e.g., one point increase), was associated with a lower hazard of all-cause mortality during follow-up (Hazard Ratio [HR]: 0.96; 95% Confidence Interval [CI]: 0.94-0.98). Finally, functional decline measured at 15 days after hospital discharge, was associated with higher risk of all-cause death during follow-up (HR: 2.19, 95% CI: 1.09-4.37) Conclusion: Pre-morbid functional status impacts long term outcomes after unplanned hospitalizations in elderly adults. Future studies should confirm these findings and evaluate the potential impact on clinical decision-making.

Introducción: La hospitalización representa un factor que puede favorecer la pérdida de la funcionalidad. El objetivo principal de este estudio fue determinar el efecto de la funcionalidad previa a la admisión hospitalaria sobre la sobrevida al año del egreso, en pacientes adultos mayores. Métodos: Este estudio de cohorte prospectiva incluyó pacientes de 65 años o mayores que fueron hospitalizados en la sala general o la unidad de terapia intensiva en un hospital universitario de la ciudad de Buenos Aires, Argentina. La funcionalidad basal fue medida a través del cuestionario VIDA modificado, el cual evalúa las actividades instrumentales de la vida diaria. Utilizamos un modelo multivariable de Cox para estimar el efecto de la funcionalidad basal sobre la sobrevida al año posterior al egreso, el cual permitió ajustar por potenciales confundidores. Además, analizamos el efecto de la funcionalidad luego del egreso hospitalario sobre la mortalidad al año del mismo. Resultados: Se incluyeron 297 pacientes, de los cuales 12.8% fallecieron durante la hospitalización, y 86 pacientes (33.2%) fallecieron dentro del año del egreso hospitalario. Un aumento de un punto en la escala de la funcionalidad basal (es decir, mejor funcionalidad), se asoció a una disminución en el riesgo de muerte al año del egreso (Hazard Ratio [HR]: 0.96; Intervalo de confianza [IC] 95%: 0.94­0.98). Por ultimo, la declinación funcional posterior al egreso hospitalario se asoció a un mayor riesgo de muerte durante el seguimiento (HR: 2.19, IC 95%: 1.09­4.37). Conclusión: La funcionalidad previa a la hospitalización de los adultos mayores impacta en los resultados a largo plazo luego de una hospitalización.

Validez predictiva del cuestionario VIDA considerando pérdida funcional, institucionalización o muerte en pacientes pluripatológicos / Predictive validity of the VIDA questionnaire on functional decline, institutionalisation or death in patients with multiple morbidities

INTRODUCCIÓN: El cuestionario español VIDA valora actividades instrumentales de la vida diaria (AIVD) en mayores, con adecuada validez de contenido, constructo y fiabilidad. El objetivo era analizar su validez predictiva, en pacientes pluripatológicos ≥65 años sin dependencia severa/total en actividades básicas de la vida diaria (ABVD, índice de Barthel ≥60 puntos), considerando el cambio a este grado de dependencia severa/total, institucionalización o muerte a 8 y 18 meses de seguimiento. MATERIALES Y MÉTODOS: Estudio prospectivo de prueba diagnóstica. Se consideraron 197 pacientes (a 8 meses) y 185 pacientes (a 18 meses) incluidos en el programa de pluripatológicos según estratificación por Adjusted Clinical Groups (ACG) o cumpliendo criterios de Ollero, excluyendo institucionalizados, al final de la vida o en diálisis, con un índice de Barthel basal ≥60 puntos; se les pasó el cuestionario VIDA al inicio. Otras variables basales fueron: edad, sexo, índice de Charlson, número de medicamentos, índice de Lawton-Brody. El evento de resultado era pasar a un índice de Barthel <60, o institucionalización, o muerte en cada periodo. RESULTADOS: La mediana de edad fue de 81 años (RIC: 74,5-85); el 45,2% eran mujeres. A 8 meses, el mejor punto de corte del VIDA fue ≤31 puntos (sensibilidad [S]: 81,5% [IC95%: 61,2-93]; especificidad [E]: 58,2% [IC95%: 50,4-65,7]; VPP: 23,7%; VPN: 95,2%), ≤30 en mujeres, ≤34 en hombres; a 18 meses, fue ≤29 puntos (S: 61,4 [IC95%: 47,6-73,7]; E: 76,6 [IC95%: 68,1-83,4]; VPP: 53,9; VPN: 81,7). CONCLUSIONES: Se aportan puntos de corte, global y por sexo, para predecir el paso a dependencia severa/total en ABVD, o institucionalización o muerte en pacientes pluripatológicos. Parece mejor para detectar eventos a corto plazo y descartarlos a largo plazo

INTRODUCTION: The VIDA Spanish questionnaire assesses instrumental activities of daily living (IADL) in elderly people, and has shown to have adequate content, construct validity, and reliability. The objective was to analyse its predictive validity in patients with multiple morbidities aged ≥65 years without severe/total dependence in basic activities (BADL, Barthel index ≥60 points), by measuring any changes in this severe/total level of dependence, institutionalisation, or death at 8 and 18 months of follow-up. METHODS: A prospective study of a diagnostic test was conducted on 197 patients (8 months) and 185 (18 months) included in the multiple morbidities program according to stratification by Adjusted Clinical Groups (ACG) or by fulfilling the Ollero criteria. Patients that were institutionalised, at the end of life, or on dialysis, or with a baseline Barthel index ≥60 points were excluded. The VIDA questionnaire was applied at baseline. The other baseline variables included age, gender, Charlson index, number of drugs, and Lawton-Brody index. The outcome event was changing the Barthel index to <60, or institutionalisation, or death, in each follow-up period. RESULTS: The median age was 81 years (IQR 74.5-85), and 45.2% were women. At 8 months, the best cut-off point for VIDA was ≤31 points (Sensitivity [S] 81.5%, [95% CI; 61.2-93.0]; Specificity (Sp) 58.2% [95% CI; 50.4-65.7], PPV 23.7%; NPV 95.2%), ≤30 in women, ≤34 in men. And at 18 months, ≤29 points (S 61.4 [95% CI; 47.6-73.7]; Sp 76.6 [95% CI; 68.1-83.4]; PPV 53.9; NPV 81.7). CONCLUSIONS: Overall cut-off points are provided as well as those for gender, predicting severe/total BADL decline, or institutionalization or death in patients with multiple morbidities. It seems to detect short-term events better and rules them out in the long term

[PAPPS GdT Major 2020 Update]. / Actualización PAPPS GdT Mayor 2020.

In this update, we have introduced new topics that we believe are of vital importance in the major areas, such as the revision of walking aids, as well as recommendations on nutrition and social isolation. Recommendations on deprescribing, fragility, mild cognitive impairment, and dementia have already been presented in previous updates.

[Predictive validity of the VIDA questionnaire on functional decline, institutionalisation or death in patients with multiple morbidities]. / Validez predictiva del cuestionario VIDA considerando pérdida funcional, institucionalización o muerte en pacientes pluripatológicos.

INTRODUCTION: The VIDA Spanish questionnaire assesses instrumental activities of daily living (IADL) in elderly people, and has shown to have adequate content, construct validity, and reliability. The objective was to analyse its predictive validity in patients with multiple morbidities aged ≥65 years without severe/total dependence in basic activities (BADL, Barthel index ≥60 points), by measuring any changes in this severe/total level of dependence, institutionalisation, or death at 8 and 18 months of follow-up. METHODS: A prospective study of a diagnostic test was conducted on 197 patients (8 months) and 185 (18 months) included in the multiple morbidities program according to stratification by Adjusted Clinical Groups (ACG) or by fulfilling the Ollero criteria. Patients that were institutionalised, at the end of life, or on dialysis, or with a baseline Barthel index ≥60 points were excluded. The VIDA questionnaire was applied at baseline. The other baseline variables included age, gender, Charlson index, number of drugs, and Lawton-Brody index. The outcome event was changing the Barthel index to <60, or institutionalisation, or death, in each follow-up period. RESULTS: The median age was 81 years (IQR 74.5-85), and 45.2% were women. At 8 months, the best cut-off point for VIDA was ≤31 points (Sensitivity [S] 81.5%, [95% CI; 61.2-93.0]; Specificity (Sp) 58.2% [95% CI; 50.4-65.7], PPV 23.7%; NPV 95.2%), ≤30 in women, ≤34 in men. And at 18 months, ≤29 points (S 61.4 [95% CI; 47.6-73.7]; Sp 76.6 [95% CI; 68.1-83.4]; PPV 53.9; NPV 81.7). CONCLUSIONS: Overall cut-off points are provided as well as those for gender, predicting severe/total BADL decline, or institutionalization or death in patients with multiple morbidities. It seems to detect short-term events better and rules them out in the long term.

Functional decline, mortality and institutionalization after 18 months in multimorbid older persons living in the community: the FUNCIPLUR longitudinal study.

INTRODUCTION: Studying functional decline in multimorbidity patients is important for improving patient management. We sought to analyse long-term functional decline, mortality and institutionalization and associated factors in over-65-year-olds with multimorbidity, comparing with previous short-term results. METHODS: A prospective study was conducted in three primary care centres, over 18 months, in a random sample of patients (n = 241) ≥ 65 years on a clinical care programme for multimorbidity. Primary outcomes were decrease in functional status category (Barthel or Lawton scales), alone and together with death and institutionalization. Other variables were sociodemographic characteristics, comorbidity, medications and hospitalisation. RESULTS: Patients initially included had five chronic conditions (IQR 4-6) and were on 11 (IQR 9-14) chronic medications; their median age was 82 years (75th percentile 86); 38.2% had impaired function at baseline. Of the 216 patients included in the analysis, 47 died; 11 were institutionalized; and 158 completed follow-up, but of these, 81 (51.3%, 95% CI 43.5-58.9) experienced functional decline. That is, 139/216 (64.4%, 95% CI 57.8-70.4%) had outcome events and these were associated with older age (OR 1.1, 95% CI 1.0-1.1, p = 0.002) and having ≥ 1 admission during follow-up (OR 4.1, 95% CI 2.1-8.9%, p < 0.001). Considering all 241 patients, there were 234 admissions during follow-up, in 117 patients. CONCLUSIONS: Two-thirds of patients showed functional decline, died or were institutionalized. The factors associated with loss of function at 18 months were similar to those observed at 8 months, notably previous hospital admissions. These findings are important as they indicate functional decline and increasing care needs are potentially predictable/modifiable.

Functional decline and associated factors in patients with multimorbidity at 8 months of follow-up in primary care: the functionality in pluripathological patients (FUNCIPLUR) longitudinal descriptive study.

OBJECTIVE: To analyse short-term functional decline and associated factors in over 65-year-olds with multimorbidity. DESIGN AND SETTING: Prospective multicentre study conducted in three primary care centres, over an 8-month period. During this period, we also analysed admissions to two referral hospitals. PARTICIPANTS: Of the 241 patients ≥65 years included randomly in the study, 155 were already part of a multimorbidity programme (stratified by 'Adjusted Clinical Groups') and 86 were newly included (patients who met Ollero's criteria and with ≥1 hospital admission the previous year). Patients who were institutionalised, unable to complete follow-up or receiving dialysis were excluded. OUTCOMES AND VARIABLES: The primary outcome was the decrease in functional status category (Barthel Index or Lawton Scale). Other variables considered were sociodemographic characteristics, comorbidity, medications, number of admissions and functional status on discharge. RESULTS: Patients had a median age of 82 years (P75 86) and of five selected chronic conditions (IQR 4-6), and took 11 (IQR 9-14) regular medications; 46.9% were women; 38.2% had impaired function at baseline.Overall, 200 persons completed the follow-up; 10.4% (n=25) of the initial sample died within the 8 months. In 20.5% (95% CI 15.5% to 26.6%) of them we recorded a decrease in functionality, associated with older age (OR 1.1, 95% CI 1.0 to 1.2) and with having ≥1 admission during the follow-up (OR 3.6, 95% CI 1.6 to 7.7). There were 133 hospital admissions in total during the follow-up considering all the patients included, and a functional decline was observed in 35.5% (95% CI 25.7% to 46.7%) of the 76 discharges in which functional status was assessed. CONCLUSIONS: A fifth of patients showed functional decline or loss of independence in just 8 months. These findings are important as functional decline and the increasing care needs are potentially predictable and modifiable. Age and hospitalisation were closely associated with this decline.

Actividades preventivas en los mayores. Actualización PAPPS 2018 / No disponible

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