Could olfactory identification be a prognostic factor in detecting cognitive impairment risk in the elderly?

Aging contributes to the deterioration of the olfactory system in humans. Several studies indicate that the olfactory identification test alone may function as a screening test for olfactory dysfunction and they are more feasible to apply in clinical practice. Olfactory identification may be a predictor for cognitive impairment. Multiple studies have considered the use of odor identification as a measure to identify the conversion from normality to mild cognitive impairment or dementia. The objectives were (i) to elucidate the associations between cognitive status and olfactory identification performance in aging; (ii) understand the predictive value of olfactory capacity in identifying subjects with cognitive impairment risk; and (iii) to study how cognitive status and olfactory identification relate with other variables of wellness in aging, such as functional capabilities and clinical measures. For this purpose, a group of 149 participants (77.15 ± 7.29 years; 73 women of 76.7 ± 8 years and 76 men of 77.6 ± 6.52 years) were recruited and were subjected to a sociodemographic questionnaire, a psychological screening tool of general cognitive status, an olfactory identification evaluation, and clinical measures. The participants were divided into groups based on their cutoff scores of previous scientific reports about the Spanish version of Montreal Cognitive Assessment. Our results indicate an age-associated decline in olfactory identification ability and intensity of odor perception. The predictive ability of olfactory identification scores for the risk of mild and severe impairment is around 80%. Olfactory identification decreases with cognitive function. Performance in odor identification is associated with impairment of episodic memory and executive functions. These findings further our current understanding of the association between cognition and olfaction, and support olfactory assessment in screening those at higher risk of dementia.

Polineuropatía periférica sensitivo-motora paraneoplásica asociada a anti-Ri: a propósito de un caso / Paraneoplastic sensory-motor peripheral polyneuropathy associated with anti-Ri: A case report

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[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.

Mortalidad tras fractura de cadera: modelos predictivos / Hip fracture mortality: Predictive models

La estimación preoperatoria del riesgo de mortalidad tras una fractura de cadera es de gran utilidad para planificar el momento de la cirugía y los cuidados perioperatorios, informar al paciente y familiares acerca del pronóstico, y establecer comparaciones entre distintas unidades. Se han desarrollado varios modelos para estratificar el riesgo de mortalidad, pero muestran heterogeneidad en cuanto a tipo de población, variables incluidas, tiempo de seguimiento y métodos estadísticos empleados, lo que hace difícil establecer comparaciones entre ellos. La gran mayoría está pendiente de validación externa en poblaciones diferentes de aquellas en las que se propusieron originalmente. El Nottingham Hip Fracture Score (NHFS) y el Orthopaedic Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (O-POSSUM) son los modelos más utilizados hasta el momento. El NHFS es más sencillo y rápido de aplicar, y al no incluir variables intraoperatorias se puede emplear en el momento del ingreso

The preoperative estimation of the risk of mortality after a hip fracture is very useful to plan time of surgery and perioperative care, inform patients and families about the prognosis and allows comparisons between different units. Different models have been developed to stratify mortality risk, but they show heterogeneity in terms of type of population and variables included, monitoring the time and statistical methods used, which makes it difficult to establish comparisons between them. The vast majority of them are awaiting external validation in populations different from those in which they were originally proposed. So far, the Nottingham Hip Fracture Score (NHFS) and the Orthopaedic Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (O-POSSUM) are the most commonly used models. The NHFS is simpler and faster to apply, and by not including intraoperative variables can be used at the time of admission

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.

Hip fracture mortality: Predictive models. / Mortalidad tras fractura de cadera: modelos predictivos.

The preoperative estimation of the risk of mortality after a hip fracture is very useful to plan time of surgery and perioperative care, inform patients and families about the prognosis and allows comparisons between different units. Different models have been developed to stratify mortality risk, but they show heterogeneity in terms of type of population and variables included, monitoring the time and statistical methods used, which makes it difficult to establish comparisons between them. The vast majority of them are awaiting external validation in populations different from those in which they were originally proposed. So far, the Nottingham Hip Fracture Score (NHFS) and the Orthopaedic Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (O-POSSUM) are the most commonly used models. The NHFS is simpler and faster to apply, and by not including intraoperative variables can be used at the time of admission.

Sarcoma de Kaposi clásico / Classic Kaposi sarcoma

No disponible

Eficiencia de las unidades geriátricas de agudos en los hospitales españoles / Efficiency of acute geriatric units in Spain hospitals

Objetivos Revisar los datos publicados de los hospitales españoles en los que se hayan realizado comparaciones entre las estancias de los pacientes ingresados en unidades geriátricas de agudos (UGA) y en otros servicios, mediante la utilización del sistema de Grupos Relacionados por el Diagnóstico (GRD) de clasificación de pacientes. Aportar la experiencia propia en este tema. Material y métodos Se revisaron los trabajos españoles recogidos en una revisión sistemática previa. Se añadió la casuística del hospital, se analizaron los episodios de los pacientes mayores de 74 años dados de alta durante 24 meses incluidos en los GRD más frecuentes. Se compararon las estancias de los pacientes en las UGA con los del resto de los servicios médicos de los hospitales y con el estándar de la comunidad autónoma correspondiente.Resultados Hay datos de 5 hospitales generales españoles. La comparación de las estancias muestra una reducción entre el 8 y el 19% en las UGA comparadas con las de los otros servicios de los mismos hospitales en pacientes similares. En un hospital, la reducción de la estancia media (EM) en geriatría llega al 21% en los mayores de 80 años. En 3 de los 4 hospitales en que se comparó con el estándar, la EM en la UGA fue menor en la mayoría de los GRD, con reducciones del 7 al 9%. Conclusiones Estos resultados permiten concluir que, sobre la base de los sistemas de clasificación y codificación habitualmente usados, las UGA españolas son más eficientes que el resto de los servicios en la hospitalización aguda de los ancianos(AU)

Objectives To review published data from Spanish hospitals in which comparisons had been made between the mean length of stay in patients admitted to acute geriatric units (AGU) and those admitted to other departments using the diagnosis-related groups (DRG) classification system and to describe our own experience. Material and methods The Spanish reports collected in a previous systematic review were reviewed. The case mix of our hospital was added by analyzing episodes in patients older than 74 years old discharged during a 24-month period and included in the most frequent DRGs. The length of stay in patients admitted to the AGU was compared with that in the remaining medical departments in the hospital and with the standard average stay in the corresponding autonomous region. Results Data were obtained from five Spanish general hospitals. The comparison revealed that the mean length of stay in the AGU was 8–19% shorter than that of similar patients in the other medical departments of the same hospitals. In one hospital, the reduction in the mean length of stay was 21% in patients older than 80 years. In three of the four hospitals where comparisons with the standard were performed, the mean length of stay in the AGU was lower for most of the DRGs, showing reductions of 7–9%. Conclusions These results allow us to conclude that, based on the commonly used patient classification and coding system, Spanish AGUs are more efficient than the remaining medical services in the acute hospitalization of elderly patients in our setting (AU)

[Efficiency of acute geriatric units in Spain hospitals]. / Eficiencia de las unidades geriátricas de agudos en los hospitales españoles.

OBJECTIVES: To review published data from Spanish hospitals in which comparisons had been made between the mean length of stay in patients admitted to acute geriatric units (AGU) and those admitted to other departments using the diagnosis-related groups (DRG) classification system and to describe our own experience. MATERIAL AND METHODS: The Spanish reports collected in a previous systematic review were reviewed. The case mix of our hospital was added by analyzing episodes in patients older than 74 years old discharged during a 24-month period and included in the most frequent DRGs. The length of stay in patients admitted to the AGU was compared with that in the remaining medical departments in the hospital and with the standard average stay in the corresponding autonomous region. RESULTS: Data were obtained from five Spanish general hospitals. The comparison revealed that the mean length of stay in the AGU was 8-19% shorter than that of similar patients in the other medical departments of the same hospitals. In one hospital, the reduction in the mean length of stay was 21% in patients older than 80 years. In three of the four hospitals where comparisons with the standard were performed, the mean length of stay in the AGU was lower for most of the DRGs, showing reductions of 7-9%. CONCLUSIONS: These results allow us to conclude that, based on the commonly used patient classification and coding system, Spanish AGUs are more efficient than the remaining medical services in the acute hospitalization of elderly patients in our setting.

[Acute orthogeriatric care (II). Clinical aspects]. / Ortogeriatría en pacientes agudos (II). Aspectos clínicos.

The present article reviews the clinical principles of acute orthogeriatric care. The application of geriatric medicine to patients with hip fracture is explained. The principal stages of geriatric intervention in this process are mentioned, as are the interventions to be carried out by the geriatric team. Subsequently, we discuss the management of several frequent problems in these patients, such as high surgical risk, pain management, anaemia, delirium, malnutrition, and discharge planning. Lastly, the characteristics of several kinds of patients with special characteristics are mentioned, such as those diagnosed with dementia, nursing home residents or the oldest-old. Areas of improvement in the acute phase are also reviewed, such as mortality reduction, functional outcome improvement and the need for more efficient resource use in patients in the acute phase of hip fracture.

Ortogeriatría en pacientes agudos (II). Aspectos clínicos / Acute orthogeriatric care (II). Clinical aspects

En este trabajo se revisan los principios clínicos de la asistencia ortogeriátrica en pacientes agudos. Se justifica la aplicación de la medicina geriátrica al paciente que ha sufrido una fractura de cadera,se mencionan los momentos principales de actuación en elproceso de la fractura y las acciones a llevar a cabo por el equipo de geriatría. Posteriormente, se analiza en profundidad el manejo de algunos problemas frecuentes en estos enfermos como son el elevado riesgo quirúrgico, el tratamiento del dolor, la anemia, el delirio, la desnutrición y la planificación del alta. Por último,se mencionan las características de algunos tipos de pacientes especiales, como son los que presentan demencia, los que viven en residencias o los muy ancianos y se reseñan algunos temas pendientes de mejora en la atención a la fase aguda, en la reducción de la mortalidad, en la mejora del pronóstico funcionaly en la necesidad de un uso más eficiente de recursos enlos pacientes ingresados con fractura de cadera

The present article reviews the clinical principles of acute orthogeriatric care. The application of geriatric medicine to patients with hip fracture is explained. The principal stages of geriatric intervention in this process are mentioned, as are the interventionsto be carried out by the geriatric team. Subsequently, we discuss the management of several frequent problems in these patients, such as high surgical risk, pain management, anaemia, delirium, malnutrition, and discharge planning. Lastly, the characteristicsof several kinds of patients with special characteristics are mentioned, such as those diagnosed with dementia, nursing home residents or the oldest-old. Areas of improvement in the acute phase are also reviewed, such as mortality reduction, functional outcomeimprovement and the need for more efficient resource usein patients in the acute phase of hip fracture (AU)

[Acute orthogeriatric care (I). Healthcare issues]. / Ortogeriatría en pacientes agudos (I). Aspectos asistenciales.

The present article reviews the historical development of several collaborative care models between orthopaedic and geriatrics departments for the care of patients with hip fracture. Subacute orthogeriatric units are described and special emphasis is placed on geriatric consulting teams and acute orthogeriatric units, as well as on their benefits for the patient and the healthcare service. We also review evidence-based studies that support this type of care for patients with acute hip fracture and guidelines from scientific associations involved in the care of these patients. The cost of care is also analyzed. Lastly, the term "orthogeriatrics" is proposed as a common term for this activity and the need for improved future care is discussed.

Ortogeriatría en pacientes agudos (I). Aspectos asistenciales / Acute orthogeriatric care (I). Healthcare issues

En este trabajo se revisa la evolución histórica de los diferentes modelos de cooperación entre los servicios de traumatología y geriatría para la atención a los pacientes con fractura de cadera. Se mencionan las unidades ortogeriátricas de pacientes subagudosy se hace un énfasis especial en los equipos geriátricos consultores y las unidades de ortogeriatría para pacientes agudos, y se detallan los beneficios que estos sistemas asistenciales aportan al paciente y al sistema sanitario. Se revisan los estudios de medicina basada en pruebas que avalan este tipo de asistencia apacientes con fractura de cadera en fase aguda y las recomendaciones de las sociedades científicas implicadas en el cuidado de estos enfermos. Se analizan los aspectos relacionados con el coste de la asistencia. Por último, se propone la expresión “ortogeriatría”como denominación común para esta actividad y seexpone la necesidad de una mejor asistencia futura

The present article reviews the historical development of several collaborative care models between orthopaedic and geriatrics departments for the care of patients with hip fracture. Subacute orthogeriatric units are described and special emphasis is placed on geriatric consulting teams and acute orthogeriatric units, aswell as on their benefits for the patient and the healthcare service. We also review evidence-based studies that support this type of care for patients with acute hip fracture and guidelines from scientific associations involved in the care of these patients. The cost of care is also analyzed. Lastly, the term “orthogeriatrics” is proposed as a common term for this activity and the need for improved future care is discussed (AU)