Association of orthogeriatric services with long-term mortality in patients with hip fracture.

PURPOSE: To assess the impact of the comprehensive orthogeriatric care model (OGM) on 2-year survival, length of stay (LOS), discharges to nursing homes, and antiosteoporotic treatment (AOT) in patients with hip fracture. METHODS: Retrospective cohort study. Hospitals were classified as OGM if the patient was cared for in a comprehensive orthogeriatric unit. We included data from patients ≥ 65 years old discharged between 2012 and 2013. The main outcome was 12- and 24-month mortality. The variables collected were sex, type of fracture, comorbidities, AOT, LOS, and discharge to nursing homes. Survival analysis was performed with Kaplan-Meier method and comparison with Mantel-Haenszel test. Factors associated with death were determined by logistic regression. RESULTS: First admissions in the 12 (out of 32) hospitals with OGM were 3580 of 9215 (38.8%). Patients in OGM had more comorbidities and discharges to nursing homes, shorter LOS, and less prescription of AOT. Two years after the admission the deceased patients were 3000 (32.6%). The survival was lower in males (p < 0.001), in the older age groups (p < 0.001), and in patients with Charlson > 1 (p < 0.001). Factors associated with increased risk of death at 12 and 24 months (logistic regression) were male gender, age and Charlson > 1, while care in the OGM decreased the risk. OGM benefited more patients > 80 years and those with Charlson < 1. CONCLUSIONS: Patients admitted in OGM have shorter stays, more discharges to nursing homes, lower prescription of AOT, and better 12- and 24-month survival adjusted by sex, age, and comorbidities compared to non-OGM care.

Relación entre hipertensión arterial y la demencia / Relation between high blood pressure and dementia

La prevalencia de hipertensión arterial así como la de las demencias es elevada. Especialmente para las demencias, y asociado con el envejecimiento poblacional, el número de pacientes aumentará en un futuro próximo. Dada la ausencia de tratamientos curativos en la actualidad sería importante conseguir una prevención efectiva. Estudios transversales, y muy especialmente poblacionales, han relacionado la presencia de niveles de tensión arterial elevada con la presencia de declive cognitivo y demencia, pero no solo demencia en sus formas vasculares sino también demencia de Alzheimer. Sin embargo, estudios de intervención no han logrado modificar la presencia de deterioro cognitivo en los grupos tratados. En el trabajo y mediante una revisión bibliográfica nos planteamos como preguntas, cuáles son los mecanismos que relacionan la hipertensión arterial con una enfermedad neuronal degenerativa, como es la demencia de Alzheimer y por qué los trabajos de intervención no han logrado reducir la incidencia de demencia en los pacientes tratados (AU)

The prevalence of high blood pressure and dementia disorders is high. The number of patients is expected to increase in the near future, especially for dementias and associated to the population aging. As there are currently no curative treatments, effective prevention is needed. Cross-sectional, and especially population, studies, have showed a relation between high blood pressure and cognitive decline and dementia, this not being only limited to vascular dementia but also includes Alzheimer’s disease. However, intervention studies have failed to change the presence of cognitive deterioration in the groups studied. In this work, and through a review of the literature, we have posed the questions on what mechanisms would related high blood pressure with a degenerative neuron disease, such as Alzheimer’s disease, and why interventional studies have not achieved a reduction in the incidence of dementia of the patients treated (AU)

Dificultades en la clínica para el tratamiento en el anciano con comorbilidad / Difficulties in the symptoms for the treatment of the elderly with comorbidity

Los estudios demográficos de proyección de la población señalan un aumento importante de las personas de más de 80 años. En los grupos poblacionales de edad avanzada es frecuente la aparición de comorbilidad y de síndromes geriátricos. La patología cardiovascular, los déficits cognitivos, los cuadros confusionales, los problemas nutricionales, la incontinencia urinaria o el tratamiento del dolor son algunas de las situaciones con las que nos podemos encontrar en los pacientes de edad avanzada. Para tratar adecuadamente a estas personas con pluripatología es necesaria una valoración exhaustiva que nos permita detectar las enfermedades presentes o latentes y así priorizar los objetivos terapéuticos. La valoración geriátrica integral es el instrumento empleado para la correcta evaluación del enfermo geriátrico con comorbilidad. Los beneficios y la eficiencia de esta metodología de valoración están ampliamente descritos en la literatura

The demographic studies of population projection indicate a significant increase of persons over 80 years. In the elderly population group, appearance of comorbidity and geriatric syndrome syndromes is common. Cardiovascular disease, cognitive deficits, confusional pictures, nutritional problems, urinary incontinence or treatment of pain are some of the conditions that we may find in elderly patients. In order to adequately treat these persons with multiple diseases, an exhaustive assessment must be made to detect present or latent diseases and thus give priority to the therapeutic objectives. Complete geriatric assessment is the instrument used for the correct assessment of the geriatric patient with comorbidity. The benefits and efficiency of this assessment method are widely described in the literature

Enfermos pluripatológicos y atención geriátrica / No disponible

No disponible

[Incidence of infection acquired at a health center]. / Incidencia de infección adquirida en un centro sociosanitario.

BACKGROUND: Nosocomial infections in geriatric patients have specific features in geriatric health care facilities and services. The incidence of nosocomial infection in a long-term care hospital is described. PATIENTS AND METHOD: The study was carried in L'AlianCa from Barcelona, a long-term care hospital of 138 beds of geriatric rehabilitation or convalescence. All nosocomial infections occurred in 1999 were recorded. The criteria of nosocomial infection were those of McGeer, adapted to make them suitable to a long-term care hospital. The statistical methods employed were the Student'st test to compare means and chi2 to compare proportions. RESULTS: The incidence of nosocomial infections was 2.8 per 1,000 resident care days, showing a statistically significant increase in the group aged over 75 (p = 0.009). Infected patients had longer hospital stay and greater physical dependence. Lower respiratory tract infections were the most common type of infection accounting for the 39.7% of the cases. The mortality rate was greater in the infected group (RR: 2.61; CI 95%, 1.60-4.25). CONCLUSIONS: Elderly patients are at greater risk of contracting nosocomial infections. It is necessary to develop infection control programs useful for the long-term care hospital.