Approach to the elderly patient with vertebral fracture due to bone fragility. / Abordaje del adulto mayor con fractura vertebral por fragilidad osea.

Osteoporosis is a metabolic and systemic disease characterized by alterations at the level of bone tissue with loss of bone mineral density, changes in microarchitecture, mineralization and remodeling that determine greater bone fragility and risk of fracture. Falls in the elderly are a risk factor closely related to fragility fractures and numerous studies demonstrate this relationship. Vertebral fractures are a major cause of morbidity and mortality. The epidemiology differs from osteoporotic fractures at other skeletal sites, as only one-third are clinically recognized. In the elderly, the approach to osteoporotic vertebral fracture involves comprehensive evaluation of the patient, since it is both a cause and a consequence of multiple geriatric syndromes. This fracture, in its acute phase and subsequently, can lead to destabilization of other organs and systems of the elderly, medical complications at different levels, functional deterioration, dependence, and even the need for institutionalization. Therefore, it is important to carry out a multiple assessment of patients with vertebral fractures, addressing not only the history and risk factors of osteoporosis, but also those factors that lead to falls, as well as a comprehensive geriatric assessment and the complications closely associated with it. In this chapter we address each of these aspects that are necessary in the individual and multidimensional approach to the elderly patient with vertebral fracture due to bone fragility.

Factores predictivos del riesgo de fractura de cadera osteoporótica en octogenarios / Predictive factors of osteoporotic hip fracture in octogenarians

Objetivo Este estudio tiene como objetivo identificar los factores de riesgo asociados con las fracturas de cadera osteoporóticas en octogenarios y busca perfeccionar las estrategias de prevención primaria para estas fracturas. Material y métodos Realizamos un estudio de casos y controles en el que participaron personas de 79 años o más con fracturas de cadera, comparándolas con controles de la misma edad y sexo sin antecedentes de fracturas de cadera. Se recogieron factores epidemiológicos, clínicos, antropométricos y analíticos. Se evaluó la presencia de osteoporosis mediante densitometría ósea. Definimos la sarcopenia según los criterios del Grupo de Trabajo Europeo sobre Sarcopenia en Personas Mayores (EWGSOP2). Resultados Se analizaron 95 pacientes por grupo, con una edad media de 82 años, de los cuales 74% eran mujeres. El análisis multivariado incluyó factores estadísticamente significativos encontrados en el análisis univariado (p<0,05). Estos factores incluyeron el índice de Barthel, la evaluación nutricional mediante la herramienta CONUT, el ácido fólico, la deficiencia de vitamina D, la presencia de fracturas previas, la pérdida de agudeza visual, la circunferencia bicipital, la sarcopenia y la osteoporosis (densitometría en el cuello del fémur). El estado nutricional (OR: 0,08 [0,01-0,61]), los niveles de ácido fólico (OR 0,32 [0,1-1]) y la pérdida de agudeza visual (OR 33,16 [2,91-377,87]) fueron los factores de riesgo independientes asociados con fractura de cadera. Conclusiones La evaluación del estado nutricional en pacientes de edad avanzada, junto con una evaluación geriátrica integral, representan herramientas fácilmente reproducibles y rentables. Estas herramientas pueden ayudar eficazmente a identificar a las personas con riesgo de sufrir fracturas de cadera, contribuyendo así a medidas preventivas más específicas y eficientes. (AU)

Objective This study aims to identify the risk factors associated with osteoporotic hip fractures in octogenarians and seeks to refine primary prevention strategies for these fractures. Material and methods We conducted a case–control study involving individuals aged 79 years and older with hip fractures, comparing them to age- and sex-matched controls without a history of hip fractures. We collected epidemiological, clinical, anthropometric, and analytical factors. We evaluated the presence of osteoporosis using bone densitometry. We defined sarcopenia according the European Working Group on Sarcopenia in Older People criteria (EWGSOP2). Results Ninety-five patients per group were analyzed, with a mean age of 82 years, of which 74% were women. The multivariate analysis included statistically significant factors found in the univariate analysis (P<.05). These factors included the Barthel Index, nutritional assessment using the CONUT tool, folic acid, vitamin D deficiency, presence of previous fractures, loss of visual acuity, bicipital circumference, sarcopenia, and osteoporosis (densitometry in the neck of the femur). The nutritional state (OR: 0.08 [0.01–0.61]), the folic acid levels (OR 0.32 [0.1–1]), and a loss of visual acuity (OR 33.16 [2.91–377.87]) were the independent risk factors associated with hip fracture. Conclusions The assessment of nutritional status in elderly patients, coupled with a comprehensive geriatric assessment, represents easily reproducible and cost-effective tools. These tools can effectively aid in identifying individuals at risk of hip fractures, thereby contributing to more targeted and efficient preventive measures. (AU)

Factores predictivos del riesgo de fractura de cadera osteoporótica en octogenarios / Predictive factors of osteoporotic hip fracture in octogenarians

Objetivo Este estudio tiene como objetivo identificar los factores de riesgo asociados con las fracturas de cadera osteoporóticas en octogenarios y busca perfeccionar las estrategias de prevención primaria para estas fracturas. Material y métodos Realizamos un estudio de casos y controles en el que participaron personas de 79 años o más con fracturas de cadera, comparándolas con controles de la misma edad y sexo sin antecedentes de fracturas de cadera. Se recogieron factores epidemiológicos, clínicos, antropométricos y analíticos. Se evaluó la presencia de osteoporosis mediante densitometría ósea. Definimos la sarcopenia según los criterios del Grupo de Trabajo Europeo sobre Sarcopenia en Personas Mayores (EWGSOP2). Resultados Se analizaron 95 pacientes por grupo, con una edad media de 82 años, de los cuales 74% eran mujeres. El análisis multivariado incluyó factores estadísticamente significativos encontrados en el análisis univariado (p<0,05). Estos factores incluyeron el índice de Barthel, la evaluación nutricional mediante la herramienta CONUT, el ácido fólico, la deficiencia de vitamina D, la presencia de fracturas previas, la pérdida de agudeza visual, la circunferencia bicipital, la sarcopenia y la osteoporosis (densitometría en el cuello del fémur). El estado nutricional (OR: 0,08 [0,01-0,61]), los niveles de ácido fólico (OR 0,32 [0,1-1]) y la pérdida de agudeza visual (OR 33,16 [2,91-377,87]) fueron los factores de riesgo independientes asociados con fractura de cadera. Conclusiones La evaluación del estado nutricional en pacientes de edad avanzada, junto con una evaluación geriátrica integral, representan herramientas fácilmente reproducibles y rentables. Estas herramientas pueden ayudar eficazmente a identificar a las personas con riesgo de sufrir fracturas de cadera, contribuyendo así a medidas preventivas más específicas y eficientes. (AU)

Objective This study aims to identify the risk factors associated with osteoporotic hip fractures in octogenarians and seeks to refine primary prevention strategies for these fractures. Material and methods We conducted a case–control study involving individuals aged 79 years and older with hip fractures, comparing them to age- and sex-matched controls without a history of hip fractures. We collected epidemiological, clinical, anthropometric, and analytical factors. We evaluated the presence of osteoporosis using bone densitometry. We defined sarcopenia according the European Working Group on Sarcopenia in Older People criteria (EWGSOP2). Results Ninety-five patients per group were analyzed, with a mean age of 82 years, of which 74% were women. The multivariate analysis included statistically significant factors found in the univariate analysis (P<.05). These factors included the Barthel Index, nutritional assessment using the CONUT tool, folic acid, vitamin D deficiency, presence of previous fractures, loss of visual acuity, bicipital circumference, sarcopenia, and osteoporosis (densitometry in the neck of the femur). The nutritional state (OR: 0.08 [0.01–0.61]), the folic acid levels (OR 0.32 [0.1–1]), and a loss of visual acuity (OR 33.16 [2.91–377.87]) were the independent risk factors associated with hip fracture. Conclusions The assessment of nutritional status in elderly patients, coupled with a comprehensive geriatric assessment, represents easily reproducible and cost-effective tools. These tools can effectively aid in identifying individuals at risk of hip fractures, thereby contributing to more targeted and efficient preventive measures. (AU)

Predictive factors of osteoporotic hip fracture in octogenarians.

OBJECTIVE: This study aims to identify the risk factors associated with osteoporotic hip fractures in octogenarians and seeks to refine primary prevention strategies for these fractures. MATERIAL AND METHODS: We conducted a case-control study involving individuals aged 79 years and older with hip fractures, comparing them to age- and sex-matched controls without a history of hip fractures. We collected epidemiological, clinical, anthropometric, and analytical factors. We evaluated the presence of osteoporosis using bone densitometry. We defined sarcopenia according the European Working Group on Sarcopenia in Older People criteria (EWGSOP2). RESULTS: Ninety-five patients per group were analyzed, with a mean age of 82 years, of which 74% were women. The multivariate analysis included statistically significant factors found in the univariate analysis (p < 0.05). These factors included the Barthel Index, nutritional assessment using the CONUT tool, folic acid, vitamin D deficiency, presence of previous fractures, loss of visual acuity, bicipital circumference, sarcopenia, and osteoporosis (densitometry in the neck of the femur). The Nutritional state (OR: 0.08 [0.01-0.61]), the folic acid levels (OR 0.32 [0.1-1]), and a loss of visual acuity (OR 33.16 [2.91-377.87]) were the independent risk factors associated with hip fracture. CONCLUSIONS: The assessment of nutritional status in elderly patients, coupled with a comprehensive geriatric assessment, represents easily reproducible and cost-effective tools. These tools can effectively aid in identifying individuals at risk of hip fractures, thereby contributing to more targeted and efficient preventive measures.

Instrumentos de avaliação multidimensional aplicados ao cuidado de enfermagemda pessoa idosa hospitalizada / Multidimensional assessment instruments applied to nursing care for hospitalized elderly people

Objetivo: descrever os aspectos da avaliação multidimensional no cuidado de enfermagem para a pessoa idosa hospitalizada. Método: revisão integrativa, desenvolvida em seis etapas. Resultados: 55 artigos compuseram o corpus de análise, todos em inglês; sendo predominante: publicações na revista Biomedcentral Geriatrics (n=11); pesquisas realizadas em hospital (n=35); método quantitativo (n=31). Emergiram três conceitos de avaliação multidimensional (n=14): Avaliação Geriátrica, Avaliação Geriátrica Abrangente e Avaliação Multidimensional; e diversas escalas alinhadas a cuidados de enfermagem, destacando-se: avaliação da independência funcional (n=31); avaliação cognitiva (n=22); avaliação nutricional (n=16); fragilidade (n=13); aspectos psicossociais (n=11); comorbidade (n=8); delirium (n=6); riscos (n=3); medicamentos (n=2); anestesiologia (n=2); dor (n=2); lesão por pressão (n=2) e temáticas especificas. Conclusão: a avaliação multidimensional da pessoa idosa é estratégia para qualificação do cuidado e integralidade da assistência, podendo utilizar diversas escalas como ferramentas de avaliação clínica.(AU)

Objective: to describe the aspects of multidimensional assessment in nursing care for hospitalized elderly people. Method: integrative review, developed in six stages. Results: 55 articles made up the corpus of analysis, all in English; predominantly: publications in the journal Biomedcentral Geriatrics (n=11); research carried out in hospital (n=35); quantitative method (n=31). Three concepts of multidimensional assessment emerged (n=14): Geriatric Assessment, Comprehensive Geriatric Assessment and Multidimensional Assessment; and several scales aligned with nursing care, highlighting: assessment of functional independence (n=31); cognitive assessment (n=22); nutritional assessment (n=16); frailty (n=13); psychosocial aspects (n=11); comorbidity (n=8); delirium (n=6); risks (n=3); medications (n=2); anesthesiology (n=2); pain (n=2); pressure injury (n=2) and specific themes. Conclusion: Multidimensional assessment of the elderly is a strategy for improving care and providing comprehensive assistance, and various scales can be used as clinical assessment tools.(AU)

Objetivo: describir los aspectos de la evaluación multidimensional en los cuidados de enfermería a ancianos hospitalizados. Método: revisión integradora, desarrollada en seis etapas. Resultados: 55 artículos constituyeron el corpus de análisis, todos en inglés; predominaron: publicaciones en la revista Biomedcentral Geriatrics (n=11); investigación realizada en hospital (n=35); método cuantitativo (n=31). Surgieron tres conceptos de evaluación multidimensional (n=14): Valoración Geriátrica, Valoración Geriátrica Integral y Valoración Multidimensional; y varias escalas alineadas con los cuidados de enfermería, destacando: valoración de la independencia funcional (n=31); valoración cognitiva (n=22); valoración nutricional (n=16); fragilidad (n=13); aspectos psicosociales (n=11); comorbilidad (n=8); delirium (n=6); riesgos (n=3); medicación (n=2); anestesiología (n=2); dolor (n=2); lesiones por presión (n=2) y temas específicos. Conclusión: La evaluación multidimensional del anciano es una estrategia para cualificar los cuidados y proporcionar una asistencia integral, y varias escalas pueden utilizarse como instrumentos de evaluación clínica.(AU)

Índice frágil-VIG: Validez convergente y discriminativa respecto a la Short Physical Performance Battery en población general / Frail-VIG index: Convergent and discriminatory validity with respect to Short Physical Performance Battery in general population

Antecedentes y objetivo: El estudio de la fragilidad en atención primaria (AP) mediante índices de fragilidad (IF) es escaso. El índice frágil-VIG evalúa el grado de fragilidad con un enfoque multidimensional. El objetivo principal fue investigar la validez convergente y discriminativa del índice frágil-VIG respecto a la Short Physical Performance Battery (SPPB) en población general ≥ 70 años. Población, materiales y métodos: Estudio descriptivo transversal. Se incluyeron 416 participantes no institucionalizados ≥ 70 años de dos cupos de un centro de salud semiurbano. Las variables principales fueron el índice frágil-VIG y la SPPB. Resultados: El valor bajo la curva ROC del índice frágil-VIG respecto a la SPPB < 7 fue de 0,81 (IC 95% 0,76-0,86). La correlación fue -0,59 (IC 95% -0,524 a -0,649). La media del índice frágil-VIG en los participantes clasificados como no frágiles por SPPB < 7 fue 0,103 (IC 95% 0,094-0,112) y en los clasificados como frágiles, 0,242 (IC 95% 0,215-0,269). Se obtuvieron diferencias significativas en la media y distribución de la SPPB, según las categorías del índice frágil-VIG. La prevalencia de fragilidad según el índice frágil-VIG fue de 29,3% (IC 95% 25,2-33,9), inicial 19%, intermedia 7,5%, avanzada 2,9%. Se clasificaron como participantes frágiles según el índice frágil-VIG y no según la SPPB < 7, 10,4%, y al contrario 9,6%, siendo la media de dominios del índice frágil-VIG afectados 3,9 y 2,2, respectivamente. Conclusiones: El índice frágil-VIG presenta una adecuada validez convergente y discriminativa respecto a la SPPB, lo cual avala su uso en AP. Hay un 20% de participantes clasificados como frágiles de manera discordante, con distinto perfil. (AU)

Background and objective: Studies of frailty in primary health care (PHC) using frailty indexes are scarce. Frail-VIG index assesses the level of frailty through a multidimensional approach. The main objective was to investigate the convergent and discriminative validity of the frail-VIG index with respect to Short Physical Performance Battery (SPPB) in general population ≥ 70 years. Population, materials and methods: Descriptive cross-sectional study. We included 416 non-institutionalized patients aged 70 years or over from two lists of general practitioners in a semi-urban healthcare center. Main variables were: frail-VIG index and SPPB. Results: The value of the area under the ROC curve of frail-VIG index respect SPPB < 7 was 0.81 (95% CI: 0.76–0.86). Pearson's correlation coefficient was −0.59 (95% CI: −0.524 to −0.649). The mean of frail-VIG index in those classified as not frail by SPPB < 7 was 0.103 (95% CI: 0.094–0.112) and in the frail was 0.242 (95% CI: 0.215–0.269). We obtained significant differences in the mean and distribution of the SPPB according to the frail-VIG index categories. The frailty prevalence according to the frail-VIG index was 29.3% (95% CI: 25.2–33.9), initial 19%, intermediate 7.5% and advanced 2.9%. There were frailty people by frail-VIG index and not by SPPB < 7 the 10.4%; on the contrary the 9.6%, the mean of affected domains of frail-VIG index was 3.9 and 2.2, respectively. Conclusions: The frail-VIG index presents adequate convergent and discriminative validity with respect to the SPPB that supports the use in PHC. There is a 20% of participants classified as frail in a discordant way, who presents a different profile. (AU)

[Frail-VIG index: Convergent and discriminatory validity with respect to Short Physical Performance Battery in general population]. / Índice frágil-VIG: Validez convergente y discriminativa respecto a la Short Physical Performance Battery en población general.

BACKGROUND AND OBJECTIVE: Studies of frailty in primary health care (PHC) using frailty indexes are scarce. Frail-VIG index assesses the level of frailty through a multidimensional approach. The main objective was to investigate the convergent and discriminative validity of the frail-VIG index with respect to Short Physical Performance Battery (SPPB) in general population ≥ 70 years. POPULATION, MATERIALS AND METHODS: Descriptive cross-sectional study. We included 416 non-institutionalized patients aged 70 years or over from two lists of general practitioners in a semi-urban healthcare center. Main variables were: frail-VIG index and SPPB. RESULTS: The value of the area under the ROC curve of frail-VIG index respect SPPB < 7 was 0.81 (95% CI: 0.76-0.86). Pearson's correlation coefficient was -0.59 (95% CI: -0.524 to -0.649). The mean of frail-VIG index in those classified as not frail by SPPB < 7 was 0.103 (95% CI: 0.094-0.112) and in the frail was 0.242 (95% CI: 0.215-0.269). We obtained significant differences in the mean and distribution of the SPPB according to the frail-VIG index categories. The frailty prevalence according to the frail-VIG index was 29.3% (95% CI: 25.2-33.9), initial 19%, intermediate 7.5% and advanced 2.9%. There were frailty people by frail-VIG index and not by SPPB < 7 the 10.4%; on the contrary the 9.6%, the mean of affected domains of frail-VIG index was 3.9 and 2.2, respectively. CONCLUSIONS: The frail-VIG index presents adequate convergent and discriminative validity with respect to the SPPB that supports the use in PHC. There is a 20% of participants classified as frail in a discordant way, who presents a different profile.

Developing new hospital-at-home models based on Comprehensive Geriatric Assessment: Implementation recommendations by the Working Group on Hospital-at-Home and Community Geriatrics of the Catalan Society of Geriatrics and Gerontology / Desarrollo de nuevos modelos de hospitalización a domicilio basados en la valoración geriátrica integral: recomendaciones del grupo de trabajo de Hospitalización a domicilio y geriatría comunitaria de la Sociedad Catalana de Geriatría y Gerontología para su implementación

Last decade, the Government of Catalonia have urged an integrated care strategy for planning the care model to older populations living with frailty, multimorbidity and advanced illnesses. Based on international evidence that was reviewed by a group of experts from the Catalan Society of Gerontology and Geriatrics, we summarised some recommendation to adapt hospital-at-home care to older populations in our system. We defined Comprehensive Geriatric Assessment (CGA) hospital-at-home (HaH) as a specialised home hospitalisation service formed by interdisciplinary teams, characterised by using the clinical methodology of CGA, and by adapting geriatric units’ protocols for the provision of person-centred care at home. Main benefits of CGA-HaH in these populations are: response to heath crises according to individualised care plans based on the situational diagnosis carried out by Primary Care teams; provision of a comprehensive health and social approach tailored to the complexity of cases and situations; and adaptation of multipurpose hospitalisation, by working on different person-centred care, aspects, such as caregivers support on care provision, focusing on function or home adaptation. (AU)

En la última década el gobierno de Cataluña ha diseñado un plan estratégico de atención integrada para planificar la atención del subgrupo de pacientes mayores con fragilidad, multimorbilidad y enfermedad avanzada, con la intención de mejorar la salud y el manejo clínico. Guiándonos en la evidencia internacional, revisada por un grupo de expertos de la Societat Catalana de Geriatria i Gerontologia, revisamos recomendaciones para adaptar los modelos a la población mayor de nuestro sistema. Así, definimos la hospitalización a domicilio geriátrica o basada en la valoración geriátrica integral (VGI) como una hospitalización a domicilio especializada basada en equipos interdisciplinares que utilizan la VGI como instrumento de trabajo de manera similar a las unidades de hospitalización geriátricas. Estas intervenciones ofrecen beneficios en responder a crisis de salud dando continuidad al diagnóstico situacional y a los planes individualizados planteados por los equipos de atención primaria, en realizar una valoración integral de la complejidad en todos sus aspectos, y en ofrecer una hospitalización integral centrada en la persona, trabajando aspectos como el apoyo a los cuidadores en la atención, la recuperación funcional y la adaptación del domicilio. (AU)

Developing new hospital-at-home models based on Comprehensive Geriatric Assessment: Implementation recommendations by the Working Group on Hospital-at-Home and Community Geriatrics of the Catalan Society of Geriatrics and Gerontology.

Last decade, the Government of Catalonia have urged an integrated care strategy for planning the care model to older populations living with frailty, multimorbidity and advanced illnesses. Based on international evidence that was reviewed by a group of experts from the Catalan Society of Gerontology and Geriatrics, we summarised some recommendation to adapt hospital-at-home care to older populations in our system. We defined Comprehensive Geriatric Assessment (CGA) hospital-at-home (HaH) as a specialised home hospitalisation service formed by interdisciplinary teams, characterised by using the clinical methodology of CGA, and by adapting geriatric units' protocols for the provision of person-centred care at home. Main benefits of CGA-HaH in these populations are: response to heath crises according to individualised care plans based on the situational diagnosis carried out by Primary Care teams; provision of a comprehensive health and social approach tailored to the complexity of cases and situations; and adaptation of multipurpose hospitalisation, by working on different person-centred care, aspects, such as caregivers support on care provision, focusing on function or home adaptation.

Comprehensive geriatric assessment of older patients and associated factors of admission to Emergency Departments in pre-covid 19 Era - A Portuguese study.

OBJECTIVES: Identifying frequent users' (≥3admissions/year) associated factors in an emergency department (ED), using a comprehensive geriatric assessment (CGA), describing the characteristics of patients over 65 years of age. METHODS: A cross-sectional study was performed between August 2017 and June 2018 in an ED in Lisbon, Portugal. CGA was applied and completed with clinical records. Clinical, functional, mental and social scores were created based in Portuguese Society of Internal Medicine, and a statistical model was developed. RESULTS: CGA was applied to 426 patients over 64 years old in an ED. The mean age was 79.3, 84.7% had multimorbidity. 51.2%, 75.6%, and 40% had dependence on basic, instrumental, and walking activities, respectively. 52% had depressive symptoms, 65.7% had cognitive impairment, 63% were undernourished/at risk for malnutrition. 33.1% were socially at risk. Polypharmacy was present with a use on average of 6.5 drugs daily. Social, clinical, functional, and mental scores were unfavourable in 48.6%, 79.6%, 54.9% and 83.1% of the population, respectively. There were 2.7 hospital admissions/year and 39.9% were frequent ED users (≥3/year). The logistic regression model was weak, but showed that patients with polypharmacy, elevated Charlson Comorbidity index and an impairment nutritional status presented higher risk of being frequent users. CONCLUSIONS: This study showed that 97.1% of patients had needs that would justify an interventional care plan. This intervention should be extended to primary care and nursing homes. While not providing a robust model, our study has indicated nutritional problems, polypharmacy, and an elevated Charlson index as the features with more weight in frequent users' admissions.

Comprehensive geriatric assessment of older patients and associated factors of admission to Emergency Departments in pre-covid 19 Era – A Portuguese study / Valoración geriátrica integral de pacientes mayores y factores asociados de frecuentación en servicios de urgencias en la era pre-COVID-19 – Un estudio portugués

Objectives: Identifying frequent users’ (≥3admissions/year) associated factors in an emergency department (ED), using a comprehensive geriatric assessment (CGA), describing the characteristics of patients over 65 years of age. Methods: A cross-sectional study was performed between August 2017 and June 2018 in an ED in Lisbon, Portugal. CGA was applied and completed with clinical records. Clinical, functional, mental and social scores were created based in Portuguese Society of Internal Medicine, and a statistical model was developed. Results: CGA was applied to 426 patients over 64 years old in an ED. The mean age was 79.3, 84.7% had multimorbidity. 51.2%, 75.6%, and 40% had dependence on basic, instrumental, and walking activities, respectively. 52% had depressive symptoms, 65.7% had cognitive impairment, 63% were undernourished/at risk for malnutrition. 33.1% were socially at risk. Polypharmacy was present with a use on average of 6.5 drugs daily. Social, clinical, functional, and mental scores were unfavourable in 48.6%, 79.6%, 54.9% and 83.1% of the population, respectively. There were 2.7 hospital admissions/year and 39.9% were frequent ED users (≥3/year). The logistic regression model was weak, but showed that patients with polypharmacy, elevated Charlson Comorbidity index and an impairment nutritional status presented higher risk of being frequent users. (AU)

Objetivos: Identificar factores asociados con usuarios frecuentadores (≥ 3 ingresos/año) en un departamento de urgencias (DU), mediante valoración geriátrica integral (VGI) y describir las características de los pacientes mayores de 65 años que acuden a urgencias.Métodos: El estudio transversal se realizó entre agosto del 2017 y junio del 2018 en un DU de Lisboa, Portugal. Se realizó una VGI además de la historia clínica. Se crearon scores clínicos, funcionales, mentales, sociales, basándose en el protocolo de cuestionario del grupo de geriatría de la Sociedad Portuguesa de Medicina Interna y se desarrolló un modelo estadístico para identificar los factores asociados con la alta frecuentación.Resultados: Se realizó una VGI a 426 usuarios mayores de un DU. La edad media fue de 79,3 años, siendo 53,8% mujeres con un 84,7% de multimorbilidad, 51,2% de dependencia de las actividades básicas (Katz), 75,6% instrumentales (Lawton < 5 en mujeres, < 3 hombres y 40% de dependencia de la marcha (Holden). El 52% tenían síntomas depresivos (Yesavage), 65,7% tenían deterioro cognitivo (MMSE < 24), 63% estaban desnutridos/en riesgo de desnutrición (MNA < 23,5). El 33,1% estaba en riesgo social (Gijón, APGAR familiar). La polifarmacia con el uso de un promedio de 6,5 medicamentos al día. Los scores sociales, clínicos, funcionales y mentales fueron adversos en el 48,6, 79,6, 54,9 y 83,1%, respectivamente. Hubo 2,7 admisiones/año y el 39,9% eran usuarios frecuentes de DU (≥ 3/año). Un modelo de regresión logística fue débil, pero mostró que los pacientes con polifarmacia, índice de comorbilidad de Charlson elevado y un estado nutricional adverso presentaban mayor riesgo de ser usuarios frecuentes. (AU)

Descripción y aplicación clínica de las escalas de valoración geriátrica integral: una revisión sistemática rápida de revisiones / Description and clinical application of comprehensive geriatric assessment scales: a rapid systematic review of reviews

Objetivo Realizar una descripción de las principales escalas utilizadas en la valoración geriátrica integral mediante un análisis narrativo detallando su aplicación clínica en relación con sus ventajas y desventajas en función de sus propiedades psicométricas (valoración mental) y los sesgos en su aplicación. Las escalas seleccionadas fueron: índice de Barthel, índice de Katz, escala de Lawton y Brody, mini-examen del estado mental, test del reloj, escala de depresión geriátrica y la escala de recursos sociales. Métodos Se realizó una revisión sistemática rápida de revisiones en MEDLINE (PubMed) hasta enero de 2021, informando de los hallazgos mediante PRISMA, 2020. Para construir la estrategia de búsqueda reproducible se empleó el lenguaje MeSH, palabras clave y los operadores booleanos AND y OR. Resultados Se seleccionaron 31 que cumplieron los criterios de elegibilidad; 18 revisiones sistemáticas, 12 revisiones de la literatura y una revisión de alcance. Se encontraron múltiples versiones para algunas de las escalas y se constataron sesgos en su interpretación. Se recomienda la administración de cuestionarios cortos y fáciles de aplicar y se aconseja que los puntos de corte se definan según la educación formal. Conclusión Las escalas de valoración geriátrica integral son instrumentos baratos, eficaces y útiles para detectar problemas y potencialidad en las personas mayores. Deben ser de fácil aplicación, no extensas, válidas para múltiples culturas y distintos niveles de educación formal y aplicables a diferentes grados de discapacidad. Es recomendable que los profesionales sanitarios se entrenen en su uso para evitar sesgos en la interpretación de los resultados (AU)

Objective This work aims to describe the main scales used in comprehensive geriatric assessment through a narrative analysis detailing their clinical application in relation to their advantages and disadvantages in terms of their psychometric properties (mental assessment) and biases in their application. The scales selected were: Barthel Index, Katz Index, Lawton and Brody Scale, Mini-Mental State Examination, Clock Test, Geriatric Depression Scale, and the Social Resources Scale. Methods We conducted a rapid systematic review of reviews in MEDLINE (PubMed) up to January 2021, reporting findings using PRISMA, 2020. MeSH language, keywords, and the Boolean operators AND and OR were used to construct the reproducible search strategy. Results Thirty-one works were selected that met the eligibility criteria: 18 systematic reviews, 12 literature reviews, and one scoping review. Multiple versions were found for some of the scales and biases in their interpretation were observed. Short, easy-to-administer questionnaires are recommended and cut-off points should be defined by formal education. Conclusion Comprehensive geriatric assessment scales are inexpensive, effective, and useful instruments for identifying problems and potential problems in the elderly. They should be easy to apply, not extensive, valid for multiple cultures and different levels of formal education, and applicable to individuals with different degrees of disability. It is recommended that health professionals be instructed in their use to avoid biases in the interpretation of the results (AU)

Profile and 3-month evolution of geriatric patients after a hip fracture followed-up at a Fracture Liaison Service (FLS).

INTRODUCTION: There are few studies on Fracture Liaison Service (FLS) that evaluate older patients after a hip fracture (HF) through comprehensive geriatric assessment. We aim to determine these patients' characteristics, outcomes, and prescribed treatments. METHODS: A retrospective observational study of a cohort of patients older than 65 years admitted with HFs to an orthogeriatric unit between February 25th (2013) and December 16th (2016). After hospitalization, those patients with a good baseline social, functional, and cognitive situation were referred to the FLS. A comprehensive geriatric assessment and treatment adjustment were conducted. A comparison between FLS patients and HF patients non-referred was made. RESULTS: From 1887 patients admitted to the orthogeriatric unit, 469 (23%) were referred to the FLS. Of those, 335 were women (77.2%) and 337 (77.6%) lived in the community. The FLS patients had a better functional status (97.1% of the patients with independent gait versus 79.2%) than non-FLS patients (p<0.001). After 3 months in the FLS, 356 (82%) patients had independent gait and had improved their analytical values. Antiosteoporotic treatment was prescribed to 322 patients (74%), vitamin D supplements to 397 (91.5%), calcium to 321 (74%), and physical exercise to 421 (97%). CONCLUSIONS: Patients referred to an FLS were younger, with a better functional and cognitive situation. At hospital discharge, they frequently presented gait impairment and laboratory abnormalities (anemia, hypoproteinemia, vitamin D deficiency) that presented good recovery due to the patient's previous baseline. These patients benefit from comprehensive treatment (pharmacological and non-pharmacological).

[3D/3D+ as a tool for rapid geriatric assessment and adequacy of the care resource at discharge from the Emergency Department]. / Las 3D/3D+ como herramienta de valoración geriátrica rápida y de adecuación del recurso asistencial al alta de los Servicios de Urgencias.

OBJECTIVE: Assess the 3D/3D+ rapid geriatric assessment tool for the early detection of frailty, its usefulness to identify the effects of the acute process on the functional, physical, cognitive and socioenvironmental dimensions, as well as the medications that may have triggered the patient's reason for visit. Finally, assess the usefulness of 3D/3D+ together with the clinical diagnosis to adequate care resource at discharge from the emergency department (ED). METHOD: Retrospective observational cohort study. Patients ≥75 years old, with clinical complexity visited at the ED were included. Basal frailty status was assessed using 3D (basal component), and the multidimensional impact of the acute process using 3D+ (current component). The main dependent variable was adequacy of the care resource at ED discharge. RESULTS: 278 patients were included, mean age 86 years (interquartile range: 83-90), 59.7% were women. According to the basal component (3D), 83.1% (95%CI: 78.2-87.3) presented some degree of frailty. The current component (3D+) was altered in 60.1% (95%CI: 54.1-65.9). The adequacy of ED discharge was correct in 96.4% (95%CI: 93.0-98.0). One out of 4patients was admitted to a medicine ward. CONCLUSIONS: 3D/3D+ facilitates an optimal model of emergency care adapted to patients ≥ 75 years old treated in EDs. It stratifies the level of frailty (3D), detects the severity of patients' acute problems (3D+) and contributes to decision-making regarding the most appropriate care resource at ED discharge.

Profile and 3-month evolution of geriatric patients after a hip fracture followed-up at a Fracture Liaison Service (FLS) / Perfil y evolución a 3 meses de pacientes con fractura de cadera evaluados en una unidad de coordinación de fracturas (Fracture Liaison Service [FLS])

Introduction: There are few studies on Fracture Liaison Service (FLS) that evaluate older patients after a hip fracture (HF) through comprehensive geriatric assessment. We aim to determine these patients’ characteristics, outcomes, and prescribed treatments.Methods: A retrospective observational study of a cohort of patients older than 65 years admitted with HFs to an orthogeriatric unit between February 25th (2013) and December 16th (2016). After hospitalization, those patients with a good baseline social, functional, and cognitive situation were referred to the FLS. A comprehensive geriatric assessment and treatment adjustment were conducted. A comparison between FLS patients and HF patients non-referred was made.Results: From 1887 patients admitted to the orthogeriatric unit, 469 (23%) were referred to the FLS. Of those, 335 were women (77.2%) and 337 (77.6%) lived in the community. The FLS patients had a better functional status (97.1% of the patients with independent gait versus 79.2%) than non-FLS patients (p<0.001). After 3 months in the FLS, 356 (82%) patients had independent gait and had improved their analytical values. Antiosteoporotic treatment was prescribed to 322 patients (74%), vitamin D supplements to 397 (91.5%), calcium to 321 (74%), and physical exercise to 421 (97%).Conclusions: Patients referred to an FLS were younger, with a better functional and cognitive situation. At hospital discharge, they frequently presented gait impairment and laboratory abnormalities (anemia, hypoproteinemia, vitamin D deficiency) that presented good recovery due to the patient's previous baseline. These patients benefit from comprehensive treatment (pharmacological and non-pharmacological). (AU)

Introducción: Hay pocos estudios sobre las unidades de coordinación de fracturas (Fracture Liaison Services [FLS]) que evalúen a pacientes mayores tras una fractura de cadera (FC) a través de una valoración geriátrica integral. Nuestro objetivo es determinar las características de estos pacientes, los resultados y los tratamientos prescritos.Métodos: Estudio observacional retrospectivo de una cohorte de mayores de 65años ingresados tras fractura de cadera (FC) entre el 25 de febrero de 2013 y el 31 de diciembre de 2016 en una unidad de ortogeriatría. Tras el alta hospitalaria, los pacientes con buen soporte social y buena situación funcional y cognitiva fueron citados en la FLS. Se realizó una evaluación geriátrica integral y un ajuste del tratamiento. Dichos pacientes se compararon con pacientes con fractura de cadera no derivados a esta unidad.Resultados: Un total de 1.887 pacientes ingresaron en la unidad de ortogeriatría, y 469 (23%) fueron derivados a la FLS. De ellos, 335 fueron mujeres (77,2%) y 337 (77,6%) vivían en el domicilio. Los atendidos en la FLS tuvieron mejor funcionalidad (97,1% de pacientes con deambulación independiente versus 79,2%) que los no incluidos (p<0,001). A los 3meses en la FLS, 356 (82%) pacientes presentaban deambulación independiente y habían mejorado sus valores analíticos. Se prescribieron antiosteoporóticos a 332 pacientes (74%), suplementos de vitaminaD a 397 (91,5%), calcio a 321 (74%) y ejercicio físico a 421 (97%).Conclusiones: Los pacientes atendidos en una FLS fueron más jóvenes, con mejor situación funcional y cognitiva. Al alta hospitalaria, frecuentemente presentaron inestabilidad de la marcha y alteraciones analíticas (anemia, hipoproteinemia, déficit de vitamina D) que tuvieron buena evolución dado el estado previo del paciente. Estos pacientes se benefician de un tratamiento integral (farmacológico y no farmacológico). (AU)

Las 3D/3D+ como herramienta de valoración geriátrica rápida y de adecuación del recurso asistencial al alta de los Servicios de Urgencias / 3D/3D+ as a tool for rapid geriatric assessment and adequacy of the care resource at discharge from the Emergency Department

Objetivo: Evaluar la herramienta de valoración geriátrica rápida 3D/3D+como cribado precoz de fragilidad; su utilidad para identificar la repercusión del proceso agudo en las dimensiones funcional, cognitiva, social y los posibles fármacos desencadenantes del motivo de consulta. Por último, la utilidad de las 3D/3D+junto al diagnóstico clínico para adecuar el recurso asistencial al alta del servicio de Urgencias hospitalario (SUH).Método: Estudio observacional de cohortes retrospectivo. Se incluyó a los pacientes de 75 o más años con complejidad clínica que fueron atendidos en el área médica del SUH. Se valoró el grado de fragilidad basal mediante las 3D (componente basal) y la repercusión multidimensional debida al proceso agudo mediante las 3D+(componente actual). La variable dependiente principal fue la adecuación del recurso asistencial al alta del SUH.Resultados: Se incluyó a 278 pacientes de edad media 86 años (rango intercuartil: 83-90) y 59,7% de mujeres. Según el componente basal (3D), el 83,1% (IC del 95%: 78,2-87,3) presentaba algún grado de fragilidad. El componente actual (3D+) estaba alterado en el 60,1% (IC del 95%: 54,1-65,9). La adecuación al alta del SUH fue correcta en un 96,4% (IC del 95%: 93,0-98,0). Uno de cada 4pacientes ingresó en hospitalización convencional.Conclusiones: Las 3D/3D+facilita un modelo óptimo de atención urgente adaptada a los pacientes de 75 o más años atendidos en los SUH. Estratifica el grado fragilidad (3D), detecta la gravedad debido al problema agudo por el que paciente consulta (3D+) y contribuye a la toma de decisiones sobre el recurso asistencial más apropiado al alta del SUH. (AU)

Objective: Assess the 3D/3D+ rapid geriatric assessment tool for the early detection of frailty, its usefulness to identify the effects of the acute process on the functional, physical, cognitive and socioenvironmental dimensions, as well as the medications that may have triggered the patient's reason for visit. Finally, assess the usefulness of 3D/3D+ together with the clinical diagnosis to adequate care resource at discharge from the emergency department (ED).Method: Retrospective observational cohort study. Patients ≥75 years old, with clinical complexity visited at the ED were included. Basal frailty status was assessed using 3D (basal component), and the multidimensional impact of the acute process using 3D+ (current component). The main dependent variable was adequacy of the care resource at ED discharge.Results: 278 patients were included, mean age 86 years (interquartile range: 83–90), 59.7% were women. According to the basal component (3D), 83.1% (95%CI: 78.2–87.3) presented some degree of frailty. The current component (3D+) was altered in 60.1% (95%CI: 54.1–65.9). The adequacy of ED discharge was correct in 96.4% (95%CI: 93.0–98.0). One out of 4patients was admitted to a medicine ward.Conclusions: 3D/3D+ facilitates an optimal model of emergency care adapted to patients ≥ 75 years old treated in EDs. It stratifies the level of frailty (3D), detects the severity of patients’ acute problems (3D+) and contributes to decision-making regarding the most appropriate care resource at ED discharge. (AU)

Description and clinical application of comprehensive geriatric assessment scales: A rapid systematic review of reviews.

OBJECTIVE: This work aims to describe the main scales used in comprehensive geriatric assessment through a narrative analysis detailing their clinical application in relation to their advantages and disadvantages in terms of their psychometric properties (mental assessment) and biases in their application. The scales selected were: Barthel Index, Katz Index, Lawton and Brody Scale, Mini-Mental State Examination, Clock Test, Geriatric Depression Scale, and the Social Resources Scale. METHODS: We conducted a rapid systematic review of reviews in MEDLINE (PubMed) up to January 2021, reporting findings using PRISMA, 2020. MeSH language, keywords, and the Boolean operators AND and OR were used to construct the reproducible search strategy. RESULTS: Thirty-one works were selected that met the eligibility criteria: 18 systematic reviews, 12 literature reviews, and one scoping review. Multiple versions were found for some of the scales and biases in their interpretation were observed. Short, easy-to-administer questionnaires are recommended and cut-off points should be defined by formal education. CONCLUSION: Comprehensive geriatric assessment scales are inexpensive, effective, and useful instruments for identifying problems and potential problems in the elderly. They should be easy to apply, not extensive, valid for multiple cultures and different levels of formal education, and applicable to individuals with different degrees of disability. It is recommended that health professionals be instructed in their use to avoid biases in the interpretation of the results.

Multimorbilidad y síndromes geriátricos. Su efecto sobre la mortalidad en adultos mayores con sepsis / Multimorbidity and geriatric syndromes. Their effect on mortality in older adults with sepsis

Resumen Introducción: la sepsis se diagnostica en más de 60% de los adultos mayores (AM) en el mundo. Estos AM con frecuencia presentan multimorbilidad y alguno de los síndromes geriátricos, llevando a discapacidad física, cognitiva y psicosocial, lo cual produce altos costos para los sistemas de salud, resultando en un problema grave de salud pública. Objetivo: identificar el impacto de la multimorbilidad y los síndromes geriátricos en la morta lidad de AM hospitalizados por sepsis en una unidad geriátrica de agudos a 30 días de su ingreso. Material y métodos: estudio observacional, analítico de casos y controles anidado en una cohorte. Resultados: se analizaron 238 pacientes con edad media de 83.15±7.12 años, 52.1% fueron mujeres y el 99% tenían al menos una comorbilidad, la mortalidad a 30 días fue 34%. La infección urinaria fue la causa principal de hospitalización (42.9%), obteniendo un aislamiento microbio-lógico en 43.3% de los casos, siendo la Escherichia coli el agente causal más frecuente (46.6%). La regresión logística múltiple mostró que la enfermedad renal crónica (OR 2.1 IC 95% 1.1-4.8; p=0.037), el delirium (OR 3.1 IC 95% 1.6-5.8; p=0.001) y la discapacidad (índice de Barthel <60; OR 3.4 IC 95% 1.5-7.5; p=0.002) se asociaron de manera significativa con la mortalidad a 30 días desde el ingreso a la unidad geriátrica de agudos en paciente con sepsis. Conclusión: en los AM hospitalizados por sepsis, la multimorbilidad, la enfermedad re nal crónica y los síndromes geriátricos representados por delirium y discapacidad fueron los predictores de mortalidad a 30 días. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2125).

Abstract Introduction: sepsis is diagnosed in more than 60% of older adults (OAs) worldwide. These OAs often have multimorbidity and one of the geriatric syndromes, leading to physical, cognitive and psychosocial disability with consequently high healthcare costs, resulting in a serious public health problem. Objective: to determine the impact of multimorbidity and geriatric syndromes on the 30-day mortality rate of OAs hospitalized for sepsis in an acute geriatric unit Materials and methods: an observational, analytical, nested case-control study. Results: 238 patients with a mean age of 83.15±7.12 were analyzed; 52.1% were women and 99% had at least one comorbidity; the 30-day mortality was 34%. Urinary tract infection was the main cause of hospitalization (42.9%), with microbiological isolation achieved in 43.3% of cases and Escherichia coli being the most common causal agent (46.6%). Multiple logistic regression showed that chronic kidney disease (OR 2.1 95% CI 1.1-4.8; p=0.037), delirium (OR 3.1 95% CI 1.6-5.8; p=0.001) and disability (Barthel index <60; OR 3.4 95% CI 1.5-7.5; p=0.002) were significantly related to 30-day mortality in patients with sepsis admitted to an acute geriatric unit. Conclusion: in OAs hospitalized for sepsis, multimorbidity, chronic kidney disease and geriatric syndromes (represented by delirium and disability) were the predictors of 30-day mortality. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2125).

Componentes de la valoración geriátrica y adherencia terapéutica en el paciente anciano con infarto agudo de miocardio / Components of geriatric assessment and therapeutic adherence in elderly patients with acute myocardial infarction

Antecedentes y objetivo: La mala adherencia terapéutica tras un infarto agudo de miocardio (IAM) puede conllevar complicaciones graves precoces. La información sobre el impacto de la valoración geriátrica en la adherencia es escasa. El objetivo de este estudio fue analizar, en pacientes mayores con IAM, el impacto de la valoración geriátrica en la adherencia terapéutica 12 meses tras el ingreso.Materiales y métodos: Un estudio previo aleatorizó a pacientes de edad>75 años que habían presentado un IAM a un programa de educación sanitaria de enfermería o manejo convencional. Se evaluó el impacto de dicha intervención en la adherencia terapéutica tras 12 meses. Se realizó valoración geriátrica intrahospitalaria. Para este subestudio se analizaron los predictores de adherencia mediante regresión logística binaria. Se consideró adherentes a aquellos pacientes que lo resultaron en las 4 herramientas: el test de Morisky-Green, Haynes-Sackett, asistencia a visitas y correcta retirada de fármacos de farmacia.Resultados: Se incluyó a 119 pacientes, con una edad media de 82,2 años. Al año, un total de 42 pacientes (35,3%) fueron adherentes. Los predictores de mala adherencia en el modelo final fueron el sexo masculino, el peor filtrado glomerular, el deterioro cognitivo, el riesgo nutricional, el hecho de no vivir solo y no haber participado en el grupo de intervención.Conclusiones: Los datos de esta serie muestran una baja adherencia terapéutica en las personas mayores después de un IAM. El deterioro cognitivo o el riesgo nutricional se asociaron de forma significativa con una peor adherencia, de forma contraria a una intervención de enfermería, lo que pone de relieve la importancia de la educación sanitaria y la supervisión en pacientes de alto riesgo. (AU)

Background and objective: Poor therapeutic adherence after acute myocardial infarction (AMI) can lead to early serious complications. Information on the impact of geriatric assessment on adherence is scarce. The objective of this study was to analyze, in older patients with AMI, the impact of geriatric assessment on therapeutic adherence 12 months after admission.Materials and methods: A previous study randomized patients aged >75 years who had presented an AMI to a nursing health education program versus conventional management, evaluating the impact of this intervention on therapeutic adherence after 12 months. In-hospital geriatric assessment was performed. For this substudy, the adherence predictors were analyzed using binary logistic regression. Those patients who obtained adherence in the 4 tools were considered adherent: the Morisky-Green, Haynes-Sackett test, attendance at visits and correct withdrawal of drugs from the pharmacy.Results: A total of 119 patients with a mean age of 82.2 years were included. At one year, a total of 42 patients (35.3%) were adherent. The predictors of poor adherence in the final model were male sex, worse glomerular filtration rate, cognitive impairment, nutritional risk, not living alone and not belonging to the intervention group.Conclusions: The data of this series show a low therapeutic adherence in the elderly after an AMI. Cognitive impairment or nutritional risk was significantly associated with poorer adherence, contrary to a nursing intervention, which highlights the importance of health education and supervision in high-risk patients. (AU)

[Components of geriatric assessment and therapeutic adherence in elderly patients with acute myocardial infarction]. / Componentes de la valoración geriátrica y adherencia terapéutica en el paciente anciano con infarto agudo de miocardio.

BACKGROUND AND OBJECTIVE: Poor therapeutic adherence after acute myocardial infarction (AMI) can lead to early serious complications. Information on the impact of geriatric assessment on adherence is scarce. The objective of this study was to analyze, in older patients with AMI, the impact of geriatric assessment on therapeutic adherence 12 months after admission. MATERIALS AND METHODS: A previous study randomized patients aged >75 years who had presented an AMI to a nursing health education program versus conventional management, evaluating the impact of this intervention on therapeutic adherence after 12 months. In-hospital geriatric assessment was performed. For this substudy, the adherence predictors were analyzed using binary logistic regression. Those patients who obtained adherence in the 4 tools were considered adherent: the Morisky-Green, Haynes-Sackett test, attendance at visits and correct withdrawal of drugs from the pharmacy. RESULTS: A total of 119 patients with a mean age of 82.2 years were included. At one year, a total of 42 patients (35.3%) were adherent. The predictors of poor adherence in the final model were male sex, worse glomerular filtration rate, cognitive impairment, nutritional risk, not living alone and not belonging to the intervention group. CONCLUSIONS: The data of this series show a low therapeutic adherence in the elderly after an AMI. Cognitive impairment or nutritional risk was significantly associated with poorer adherence, contrary to a nursing intervention, which highlights the importance of health education and supervision in high-risk patients.