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1.
Geriatr Gerontol Int ; 20(4): 366-372, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32072727

RESUMO

AIM: The aim of this study was to compare the clinical impact of two intermediate care pathways. METHODS: A prospective, uncontrolled before-after study was carried out to compare two non-synchronic intermediate care frameworks in Spain. Participants in the control group were transferred to the intermediate care center by hospital request, whereas those in the intervention group (Badalona Integrated Care Model [BICM]) were transferred based on a territory approach considering the assessment of an intermediate care team. The clinical characteristics of study participants were assessed at admission and discharge. RESULTS: Compared with participants in the control group, those in the BICM group were significantly older (mean age 81.6 years [SD 10.3] vs 78.3 years [10.1], P < 0.001) and had a lower Barthel score (mean score 32.8 [SD 25.9] vs 39.9 [28.4]; P < 0.001), and a higher proportion of participants with total dependence (38.4% vs 32.2%; P = 0.001). The length of stay in intermediate care was similar in both groups; however, stay in acute care was significantly shorter in the BICM group than in the control group (mean 21 days [SD 19.5] vs 25 days [SD 23]; P < 0.001). No significant differences were found regarding the Barthel Index at discharge, although participants in the BICM group had significantly higher functional gain. CONCLUSIONS: The implementation of a territory-based integrated care pathway in an intermediate care center shifted the profile of admitted patients toward higher complexity. Despite this, patients managed under the integrated care model reduced their dependency and the referral rate to an acute unit during their stay in the intermediate care center. Geriatr Gerontol Int 2020; 20: 366-372.

2.
J Geriatr Phys Ther ; 42(2): 63-72, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29939905

RESUMO

BACKGROUND AND PURPOSE: In older adults, the psychological impact and effects related to the loss of functional capacity are directly related to perceived quality of life (QOL). The predictors of better QOL are increased physical activity, lower prevalence of overweight, lower cases of depression, and lower rate of reported alcohol abuse. On the contrary, the predictors of decreased QOL are female gender, comorbidity, deficient nutritional condition, polypharmacy, loss of mobility, depression and dependency, poor economic conditions, and social isolation and loneliness. Furthermore, QOL in older adults is more dependent on the number of falls than comorbidity. The objective was to investigate the determinants of perceived QOL among independent community-dwelling older adults and to quantify the influence of number of falls and number of risk factors on QOL. METHODS: This is a cross-sectional study of 572 older adults (>70 years of age) seen in 10 primary care centers in La Ribera, Valencia, Spain. Comprehensive geriatric assessment was done by 4 nurses in primary care centers. Functional status and sociodemographic and clinical variables were collected. Quality of life was assessed with the EQ-5D scale. RESULTS: Females predominated (63.3%). Mean age (standard deviation) was 76.1 (3.9) years. The male gender (ß = .09; 95% confidence interval [CI]: 0.05-0.13) was found to be predictive of better QOL, together with physical activity (ß = .04; 95% CI: 0.02-0.06), while the use of drugs affecting the central nervous system (ß = -.08; 95% CI: -0.12 to -0.03), overweight (ß = -.06; 95% CI: 0.1 to - 0.02), comorbidity (ß = -.09; 95% CI: -0.13 to -0.05), the presence of fall risk factors (ß = -.02; 95% CI: -0.03 to 0.01), and the number of previous falls (ß = -.03; 95% CI: -0.06 to 0.01) had a negative impact upon the EQ-5D Index score. CONCLUSIONS: If perceived QOL is used as an indicator of the success of intervention programs, certain factors accompanying the adoption of measures for the prevention of falls may mask the results (failure or success) of the intervention. Because most determinants of QOL are modifiable and physical activity has the potential to improve QOL, this research suggests that physical activity programs should be a component of health care for older adults.

3.
Braz J Phys Ther ; 23(1): 19-26, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29914855

RESUMO

BACKGROUND: Aging is associated with an increased risk of accidental falls. Falls in older people have been widely studied in nursing homes and in the elderly with poor functionality, but there have been few investigations into functionally independent community-dwelling older adults. OBJECTIVE: To determine the predictive factors for falls in functionally independent community-dwelling older adults. METHODS: A cohort trial-nested case-control study was carried out. The participants were community-dwelling people aged 70 and over who were treated in primary care centers from December 2012 to May 2014 in la Ribera (Valencia, Spain). RESULTS: There were a total of 374 participants, with a mean age of 76.1 (SD 3.4) years (63.8% females). The subjects presented high functionality scores: Barthel 96.5 (SD 9.4), Lawton 7.2 (SD1.2), Tinetti 25.6 (SD 3.3). The mean number of prescribed drugs was 4.7 (SD 2.9). The cumulative incidence of falls was 39.2%, and 24.1% of these older adults suffered falls. The number of falls in the previous 12 months (OR=1.3; 95%CI: 1.11-1.53; p<0.001) and alpha-blockers (OR=6.72; 95%CI: 1.62-27.79; p=0.009) were predictors of falls. The presence of previous fractures (OR=9.55; 95%CI: 4.1-22.25; p<0.001), a body mass index of ≥30kg/m2 (OR=1.09; 95%CI: 1.01-1.19; p=0.035), and who are using benzodiazepines and beta-blockers (OR=2.77; 95%CI: 1.53-5.02; p<0.001), were predictors of recurrent fallers. CONCLUSIONS: Older people who use alpha-blockers, benzodiazepines and beta-blockers, had previous fractures, with increased body mass index are more likely to fall.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Fraturas Ósseas/fisiopatologia , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Vida Independente , Espanha
4.
J Geriatr Oncol ; 10(2): 298-303, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30217699

RESUMO

OBJECTIVES: Comprehensive geriatric assessment (CGA) has shown to benefit older patients undergoing urological and orthopedic surgery. However, this approach has been scarcely assessed in patients elected for colorectal surgery. MATERIALS AND METHODS: Retrospective cohort of patients aged ≥70 years admitted for elective colorectal cancer surgery to a single hospital between 2008 and 2012. Upon admission, patients were assigned to a usual care (UC) plan or a CGA-based care (GS) plan conducted by a multidisciplinary team, according to standard clinical criteria.Analyzed outcomes included the incidence of delirium and other geriatric syndromes during hospital stay, mortality, readmissions, andnumber of perioperative complications. RESULTS: The cohort included 310 patients, 203 assigned to the GS group and 107 to the UC group. Patients in the GS group had significantly lower Barthel and Lawton scores, higher prevalence of dementia and heart failure, and higher comorbidity burden. Fifty-four (17.5%) patientsexperienced delirium (23 [11.3%] and 31 [29.2%] in the GS and UC groups, respectively; p < .001), and 49 (15.8%) patient experienced other geriatric syndromes (21 [10.3%] and 28 [26.2%] in the GS and UC groups, respectively; p < .001). Serious complications were more frequent in the GS group: 154 (75.9%) vs 60 (56.1%) in the UC group; p < .001. No significant differences were observed between groups regarding readmissions, and in-hospital and post-discharge (1 year follow-up) mortality. CONCLUSIONS: Despite the poorer clinical condition of patients in the GS group, the CGA-based intervention resulted in a lower incidence of delirium and other geriatric syndromes compared with the UC group.

5.
J Am Med Dir Assoc ; 19(10): 860-863, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30268290

RESUMO

OBJECTIVES: To compare clinical outcomes in older patients with acute medical crises attended by a geriatrician-led home hospitalization unit (HHU) vs an inpatient intermediate-care geriatric unit (ICGU) in a post-acute care setting. DESIGN: Quasi-experimental longitudinal study, with 30-day follow-up. PARTICIPANTS: Older patients with chronic conditions attended at the emergency department or day hospital for an acute medical crisis. INTERVENTIONS: Patients were referred to geriatrician-led HHU or ICGU wards. SETTING: An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. MEASUREMENTS: We compared health crisis outcomes (recovery from the acute health crisis, referral to an acute hospital, or death), length of stay, relative functional gain (RFG) at discharge, readmission to an acute care unit within 30 days of discharge, and mortality within 30 days of discharge. RESULTS: We included 171 older adults (57 in the HHU and 114 in the ICGU) with complex conditions at risk of negative outcomes. At baseline, HHU patients were significantly younger and less likely to be cognitively impaired and referred from an emergency department. Most patients in both groups recovered from their health crises (91.2% in the HHU group vs 88.6% in the ICGU group, P = .79). No differences were found between the 2 groups in 30-day mortality (8.6% vs 9.6%, P = >.99). There was a trend toward lower 30-day readmission to an acute care unit in the HHU group (10.5% vs 19.3% in the ICGU group, P = .19). HHU patients had higher RFG (mean 0.75 days vs 0.51 in the ICGU group, P = .01), and a longer stay in the unit (9.7 vs 8.2 days in the ICGU group, P < .01). CONCLUSIONS: These preliminary results suggest that the geriatrician-led HHU seems effective in resolving acute medical crises in older patients with chronic disease. Patients attended by the HHU obtained better functional outcomes compared to those from the ICGU, although the groups did have some baseline differences.


Assuntos
Doença Crônica/terapia , Serviços Hospitalares de Assistência Domiciliar , Hospitalização , Cuidados Semi-Intensivos , Idoso de 80 Anos ou mais , Doença Crônica/epidemiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Estudos Longitudinais , Masculino , Readmissão do Paciente/estatística & dados numéricos , Recuperação de Função Fisiológica , Espanha/epidemiologia
6.
Nutr Hosp ; 34(5): 1305-1310, 2017 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-29280644

RESUMO

AIM: A retrospective cohort study was performed in order to evaluate the prevalence of pressure ulcers (PrUs) in older patients admitted to a geriatric rehabilitation unit of a postacute care hospital and to investigate the impact of the presence of PrUs on clinical outcomes of the rehabilitation process. METHODS: We studied 668 post-acute patients consecutively attended, from January 2010 to December 2011. The effect of having PrUs at admission was evaluated based on its impact on outcomes: final destination, functional status, mortality and length of stay in the rehabilitation unit. RESULTS: PrUs prevalence at admission was 16%. Patients with PrUs were older, more disabled and had more complex conditions, including malnutrition and cognitive impairment. In the bivariate analysis, we found patients with PrUs at admission had worst final outcome (%): discharge home (69.2 vs.82.5), discharge long term care setting (14 vs.6.4), discharge acute care (8.4 vs.6.2) and death (8.4 vs.4.8); p < 0.001, and worst Barthel Index score at discharge 57 (SD 34.1) vs.83 (SD 33.6); p < 0.001, with longer length of stay in the unit 61 (SD 42.3) vs.53 (SD 37.1); p 0.004. In the multivariate analysis, PrUs presence was found as one of the variables with significant association to no return to home. Finally, a negative association between PrUs at admission and functional gain at discharge of the postacute unit was identified. CONCLUSIONS: PrUs were prevalent and had negative impact on clinical outcomes of our geriatric unit, as discharge destination, functional gain and Length of Stay, in vulnerable patients.


Assuntos
Lesão por Pressão/complicações , Reabilitação , Resultado do Tratamento , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Desnutrição/complicações , Estudos Retrospectivos
7.
Nutr. hosp ; 34(6): 1305-1310, nov.-dic. 2017. tab
Artigo em Inglês | IBECS | ID: ibc-168968

RESUMO

Aim: A retrospective cohort study was performed in order to evaluate the prevalence of pressure ulcers (PrUs) in older patients admitted to a geriatric rehabilitation unit of a postacute care hospital and to investigate the impact of the presence of PrUs on clinical outcomes of the rehabilitation process. Methods: We studied 668 post-acute patients consecutively attended, from January 2010 to December 2011. The effect of having PrUs at admission was evaluated based on its impact on outcomes: final destination, functional status, mortality and length of stay in the rehabilitation unit. Results: PrUs prevalence at admission was 16%. Patients with PrUs were older, more disabled and had more complex conditions, including malnutrition and cognitive impairment. In the bivariate analysis, we found patients with PrUs at admission had worst final outcome (%): discharge home (69.2 vs. 82.5), discharge long term care setting (14 vs. 6.4), discharge acute care (8.4 vs. 6.2) and death (8.4 vs. 4.8); p < 0.001, and worst Barthel Index score at discharge 57 (SD 34.1) vs. 83 (SD 33.6); p < 0.001, with longer length of stay in the unit 61 (SD 42.3) vs. 53 (SD 37.1); p 0.004. In the multivariate analysis, PrUs presence was found as one of the variables with significant association to no return to home. Finally, a negative association between PrUs at admission and functional gain at discharge of the postacute unit was identified. Conclusions: PrUs were prevalent and had negative impact on clinical outcomes of our geriatric unit, as discharge destination, functional gain and Length of Stay, in vulnerable patients (AU)


Objetivo: se realizó un estudio de cohorte retrospectivo para evaluar la prevalencia de úlceras por presión (PRU) en pacientes mayores ingresados en una unidad de rehabilitación geriátrica de postagudos (atención intermedia) e investigar el impacto de la presencia de PrU en los resultados clínicos del proceso de rehabilitación. Métodos: se estudiaron 668 pacientes ingresados de forma consecutiva, de enero de 2010 a diciembre de 2011. Se evaluó el impacto de la presencia de PrU en el momento del ingreso en relación a los siguientes resultados de salud: destino final, estado funcional, mortalidad y duración de la estancia en la unidad de rehabilitación. Resultados: la prevalencia de PrU en el momento del ingreso fue del 16%. Los pacientes con PrU tenían mayor edad, más presencia de discapacidad y tenían una mayor prevalencia de condiciones complejas, incluyendo desnutrición y deterioro cognitivo. En el análisis bivariado se encontró que los pacientes con PrU al ingreso presentaron un peor resultado final (%): alta a domicilio (69,2 vs. 82,5), ingreso en unidades de larga estancia (14 vs. 6,4), reingreso hospitalario (8,4 vs. 6,2) y fallecimiento (8,4 vs. 4,8); p < 0,001, y un peor índice de Barthel al momento del alta (57 frente a 83); p < 0,001, con mayor duración de la estancia en la unidad (61 frente a 53 días); p 0,004. En el análisis multivariante, la presencia de PrU en el momento del ingreso, se asoció como variable predictora negativa de retorno a domicilio, así como predictora negativa respecto a la ganancia funcional al alta de la unidad postagudos. Conclusiones: las PrUs fueron prevalentes y tuvieron un impacto negativo en los resultados clínicos de nuestra unidad geriátrica, como destino de alta, ganancia funcional y duración de la estancia, en pacientes vulnerables (AU)


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Lesão por Pressão/dietoterapia , Lesão por Pressão/epidemiologia , Doença Aguda/epidemiologia , Lesão por Pressão/prevenção & controle , Lesão por Pressão/reabilitação , Estudos Retrospectivos , Estudos de Coortes , Doença Aguda/reabilitação , Análise Multivariada , Tempo de Internação , Análise de Dados/métodos
9.
Maturitas ; 94: 155-160, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27823737

RESUMO

BACKGROUND: The risk of falls increases with age. Balance alteration and polypharmacy are independent contributors to an increased risk of falls. OBJECTIVE: The primary aim was to assess whether a proprioceptive exercise programme reduces the incidence of falls. A secondary aim was to assess the association between drugs and falls. DESIGN: This was a before-after non-randomised intervention study. PARTICIPANTS: The study recruited independent and cognitively intact community-dwelling people aged over 69 years, from December 2012 to May 2014. METHODS: The intervention was done by a nurse and consisted of a monthly supervised group session of proprioceptive training for 1 year, supplemented by a home diary exercise. Daily medication was reviewed. RESULTS: We included 572 subjects (63.3% women), mean age 76.1±3.9 years. The mean number of drugs prescribed at the start of the study was 4.7±3.0and 353 of the participants (61.7%) were taking four or more drugs a day. The elderly who fell were more dependent in their activities of daily living (Barthel index), and their balance was worse (determined using the Tinetti scale), as were their results on a cognitive scale (the MEC). After the intervention, an increase in self-perceived quality of life (EQ5D) was reported. The incidence of falls was reduced from 37.5% in the 12 months prior to the intervention to 25.7% in the 12 months after the intervention. During the follow-up, beta-blocker use was associated with an increased incidence of falls (OR=2.05; 95%IC: 1.24-3.39; p=0.005). In contrast, antiplatelet/anticoagulation drugs were associated with a lower risk of falls (OR=0.7; 95%IC: 0.55-0.88; p=0.003). CONCLUSIONS: The proprioceptive exercise programme reduced the incidence of falls in community-dwelling older people. Multiple drug use was an independent predictor of an increased risk of falls, and specific drug groups were associated with falls.


Assuntos
Acidentes por Quedas/prevenção & controle , Atividades Cotidianas , Terapia por Exercício/métodos , Equilíbrio Postural/fisiologia , Propriocepção/fisiologia , Qualidade de Vida , Acidentes por Quedas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Resultado do Tratamento
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