Calidad asistencial en la atención prestada a los ancianos en los centros residenciales / Quality of Health Care in Homes for the Aged

OBJETIVO: El aumento de ancianos, el envejecimiento de los mayores y la crisis del apoyo informal prestado por las familias producen un incremento en la demanda de servicios residenciales para mayores, los cuales deben proporcionar una atención de calidad que les garantice una vida digna. El objetivo es analizar la calidad asistencial en la atención prestada a los ancianos en los centros residenciales. METODOLOGÍA: Se realizó una revisión bibliográfica sistematizada en las bases de datos PubMed, Scopus, WoS, CINAHL y Dialnet, de los estudios publicados entre 2013 y 2018, relacionados con el tema, en español o inglés, con acceso a texto completo y población mayor de 65 años. RESULTADOS: Se seleccionaron 21 estudios. De los indicadores sobre la calidad asistencial: siete sobre la calidad de vida, cinco sobre atención al residente, tres sobre atención al residente junto con organización, y dos sobre relaciones y derechos de los residentes. De las estrategias de mejora de la calidad asistencial: cuatro sobre cuidados centrados en la persona, guías para el control de infecciones y prescripción de antibióticos; cuatro sobre intervenciones con profesional de salud mental, risoterapia, juegos intergeneracionales, y una herramienta de evaluación del dolor para personas que no se pueden comunicar. Tres plantean más enfermeras y mayor preparación. Uno refiere la adecuación de las habitaciones y buen trato profesional. CONCLUSIONES: En la evaluación de la mayoría de los indicadores de las residencias se hallaron valores por debajo de niveles adecuados. Principalmente se describen estrategias de mejora relacionadas con los profesionales sanitarios

AIM: The rise of elderly, the aging of the aged and the crisis of the informal support provided by families, produce an increase in demand of residential services for the aged, which must provide quality of health care enough to ensure that elderly could lead dignified lives. The aim is to analyze the quality of heath care in homes for the aged. METHODS: A systematized bibliographic review was made in PubMed, Scopus, WoS, CINAHL and Dialnet databases for studies published between 2013-2018, related to the review topic, in spanish or english, with access to the full text and population over 65 years old. RESULTS: 21 studies were selected. About quality indicators, seven studies are connected to quality of life, five studies talk about resident care, three studies report resident care attached to the organization, and two studies are related to resident ́ relations and rights. About improvement strategies, four studies defend person-centered care, guidelines for infections control and appropiate medication prescriptions; four studies suggest interventions with a mental health therapist, laughter therapy, intergenerational playgroups, and a tool to evaluate pain for aged with limited ability to communicate. Three studies propose to increase the number of nurses and their geriatric formation. A study refer room confort and good treatment. CONCLUSIONS: In the evaluation of quality indicators, most values were under appropiate standards. Improvement strategies related to health professionals are mostly described

Promoção do envelhecimento saudável

Instrumentos de avaliação dos indicadores de Saúde da Pessoa Idosa: uma experiência exitosa

Atenção à Saúde do Idoso

Implementation of the Humanitude Care Methodology: contribution to the quality of health care / Implementação da Metodologia de Cuidado Humanitude: contribuição para a qualidade da assistência à saúde / Implementación de la Metodología de Cuidado Humanitud: contribución a la calidad de la asistencia a la salud

ABSTRACT Objective: to evaluate the contribution of the implementation of the Humanitude Care Methodology to the quality of health care in a Continuing Care Unit. Method: an action-research study with a non-probability convenience sampling, involving 34 health professionals from one unit in Portugal. Data was collected through a questionnaire and an observation worksheet for the Structured Sequence of Humanitude Care Procedures. We used data content analysis with the Statistical Package for Social Science, version 17.0. Results: health professionals demonstrated difficulties to provide care for people who are agitated, confused, disoriented, aggressive and who refuse care, and to communicate with patients who do not communicate verbally. The professionals valued the accomplishment of the stages of the observation worksheet. There were discrepancies between the perception of accomplishment and the actual practice. Throughout the implementation of the methodology, there was an increase in the practical application of the procedures, with positive repercussion for the patients and for the professionals. Conclusion: the results allowed to perceive the contribution of the process of implementation of the methodology, through the positive transformations in health care delivery.

RESUMO Objetivo: avaliar a contribuição da implementação da Metodologia de Cuidado Humanitude para a qualidade da assistência à saúde em uma Unidade de Cuidados Continuados. Método: estudo de investigação-ação, que utilizou processo de amostragem não probabilística por conveniência, envolvendo 34 profissionais de saúde de uma unidade, em Portugal. A coleta de dados foi realizada por meio de questionário e planilha de observação de Sequência Estruturada de Procedimentos Cuidativos Humanitude. Utilizou-se análise de conteúdo dos dados e tratamento com Statistical Package for Social Science, versão 17.0. Resultados: os profissionais de saúde manifestaram dificuldades na prestação de cuidados de pessoas agitadas, confusas, desorientadas, agressivas e que recusavam os cuidados e, ainda, na comunicação com pacientes que não se expressavam verbalmente. Os profissionais valorizaram a realização das etapas da planilha de observação e verificaram discrepâncias entre a percepção de realização e a prática realmente efetivada. Ao longo da implementação da metodologia, observou-se aumento da aplicação prática dos procedimentos, repercutindo em ganhos para as pessoas cuidadas e para os profissionais. Conclusões: os resultados permitiram perceber a contribuição do processo de implementação da metodologia na transformação positiva da prestação de cuidados de saúde.

RESUMEN Objetivo: evaluar la contribución de la implementación de la Metodología de Cuidado Humanitud para la calidad de la asistencia a la salud en una Unidad de Cuidados Continuos. Método: estudio de investigación y acción, mediante un proceso de muestreo no probabilístico por conveniencia, con la participación de 34 profesionales de la salud, desde una unidad, en Portugal. Recolección de datos realizada por medio de un cuestionario y una ficha de observación de Secuencia Estructurada de Procedimientos Cuidadativos Humanitud. Utilizado análisis de contenido de los datos y tratamiento con Statistical Package for Social Science, versión 17.0. Resultados: los profesionales de la salud manifestaron dificultades en la prestación de cuidados de personas agitadas, confusas, desorientadas, agresivas y que rechazan los cuidados y aún, de comunicarse con pacientes que no se comunican verbalmente. Los profesionales valoraron la realización de las etapas de la ficha de observación y verificaron discrepancias entre la percepción de realización y la práctica, realmente, efectiva. A lo largo de la implementación de la metodología, se observó un aumento de la aplicación práctica de los procedimientos, repercutiendo en beneficios para las personas cuidadas y para los profesionales. Conclusiones: los resultados permitieron percibir la contribución del proceso de implementación de la metodología, en la transformación positiva de la prestación de atención de salud.

The experience of older people living in an elderly residential home (Panti Sosial Tresna Werdha): a phenomenology

Objective: The aim of this study was to gain an overview of the experiences of older people living in an elderly residential home (Panti Sosial Tresna Werdha [PSTW]). Method: The study used qualitative method with the descriptive phenomenology approach. The participants consisted of six older people who live in institutions. Data were collected through in-depth interviews in accordance with the purpose of the research, and an analysis of the data from the interviews was performed using the analysis stage by Collaizi. Results: Three themes emerged from this study, namely independent living needs and support systems as a reason for staying at PSTW, the adaptive response to life in PSTW, and family support as a contributing factor to remaining at PSTW. Conclusions: Most of the elderly's support came from their children or nephews and nieces. Receiving full emotional support from relatives through family visits was deemed necessary for the elderly, as it made them feel happy to continue the rest of their lives in the elderly care home

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Origins and consequences of technology acquirement by independent-living seniors: towards an integrative model.

BACKGROUND: Living independently can be challenging for seniors. Technologies are expected to help older adults age in place, yet little empirical research is available on how seniors develop a need for technologies, how they acquire these technologies, and how these subsequently affect their lives. Aging is complex, dynamic and personal. But how does this translate to seniors' adoption and acceptance of technology? To better understand origins and consequences of technology acquirement by independent-living seniors, an explorative longitudinal qualitative field study was set up. METHODS: Home visits were made to 33 community-dwelling seniors living in the Netherlands, on three occasions (2012-2014). Semi-structured interviews were conducted on the timeline of acquirements, and people and factors involved in acquirements. Additionally, participants were interviewed on experiences in using technologies since acquirement. Thematic analysis was employed to analyze interview transcripts, using a realist approach to better understand the contexts, mechanisms and outcomes of technology acquirements. RESULTS: Findings were accumulated in a new conceptual model: The Cycle of Technology Acquirement by Independent-Living Seniors (C-TAILS), which provides an integrative perspective on why and how technologies are acquired, and why these may or may not prove to be appropriate and effective, considering an independent-living senior's needs and circumstances at a given point in time. We found that externally driven and purely desire-driven acquirements led to a higher risk of suboptimal use and low levels of need satisfaction. CONCLUSIONS: Technology acquirement by independent-living seniors may be best characterized as a heterogeneous process with many different origins, pathways and consequences. Furthermore, technologies that are acquired in ways that are not congruent with seniors' personal needs and circumstances run a higher risk of proving to be ineffective or inappropriate. Yet, these needs and circumstances are subject to change, and the C-TAILS model can be employed to better understand contexts and mechanisms that come into play.

Prevalencia del diagnóstico de demencia en pacientes ancianos institucionalizados en Zaragoza. Estudio piloto / Prevalence of dementia patients diagnosis of elderly home care in Zaragoza. Pilot study

Introducción. El proceso de envejecimiento biológico de las personas es irreversible, y comienza prácticamente desde el nacimiento. Los avances sociales y sanitarios han hecho que la esperanza de vida aumente de forma exponencial, lo cual ha producido que los síndromes asociados al envejecimiento se conviertan en uno de los principales problemas del siglo XXI. Las enfermedades neurodegenerativas constituyen el paradigma de enfermedad crónica incapacitante. Las personas con demencia suelen ser los usuarios más habituales en las residencias de la tercera edad. Aquellos que padecen demencia, además de padecer una alteración importante en las funciones cognitivas, pueden presentar los llamados síntomas psicológicos y conductuales de la demencia (SPCD). Objetivo. Determinar la prevalencia del diagnóstico de demencia en la población de una residencia geriátrica y cuántos usuarios presentan deterioro cognitivo sin estar diagnosticados. Conclusiones. Existe un porcentaje importante de usuarios que presentan deterioro cognitivo en las pruebas diagnósticas sin estar diagnosticados de demencia (AU)

Introduction. The process of biological aging of people is irreversible, and starts virtually from birth. Health and social advances have made life expectancy increases exponentially, making the syndromes associated with aging become one of the main problems of the XXI century. Neurodegenerative diseases are the paradigm of chronic disabling disease. People with dementia are often the most regular users in the elderly care homes. They also suffer significant alterations in cognitive functions, and may have the so-called psychological and behavioural symptoms of dementia (BPSD). Objectives. To determine the prevalence of diagnosis of dementia in the population of a nursing home and how many users present undiagnosed cognitive impairment. Conclusions. There are a significant percentage of users who have cognitive impairment in diagnostic tests without being diagnosed with dementia (AU)

Cohort Differences in Received Social Support in Later Life: The Role of Network Type.

OBJECTIVES: The objective is to assess cohort differences in received emotional and instrumental support in relation to network types. The main guiding hypothesis is that due to increased salience of non-kin with recent social change, those in friend-focused and diverse network types receive more support in later birth cohorts than earlier birth cohorts. METHOD: Data from the Longitudinal Aging Study Amsterdam are employed. We investigate cohort differences in total received emotional and instrumental support in a series of linear regression models comparing birth cohorts aged 55-64, 65-74, 75-84, and 85-94 across three time periods (1992, 2002, and 2012). RESULTS: Four network types (friend, family, restricted, and diverse) are identified. Friend-focused networks are more common in later birth cohorts, restrictive networks less common. Those in friend-focused networks in later cohorts report receiving more emotional and instrumental support. No differences in received support are evident upon diverse networks. DISCUSSION: The increased salience of non-kin is reflected in an increase in received emotional and instrumental support in friend-focused networks in later birth cohorts. The preponderance of non-kin in networks should not be perceived as a deficit model for social relationships as restrictive networks are declining across birth cohorts.

Resilience at information processing level in older adults: maintained attention for happy faces when positive mood is low

Even though ageing is associated with declining cognitive capabilities, research has demonstrated an agerelated improvement in affective well-being. This improvement can be related to increased resilience, developing as changes in emotion regulation at information-processing level. During negative mood, emotion regulation becomes a priority as demonstrated by an increased preference for positive over negative information in older adults. However, the effect of a positive mood on older adult’s attentional preferences has not been established yet. To investigate this, 37 older adults were randomly assigned to a relaxation or a control condition (music). Mood state was assessed before and after the manipulation. Attentional bias was measured by an exogenous cueing task, in which the location of the target was correctly or incorrectly cued by happy, sad or neutral facial pictures. Both groups showed a decrease in negative mood (p < .001, 95% CI [2.73, 5.97], d = .82) without changes in positive mood. The relaxation group showed a significantly bigger increase in feeling relaxed (p = .017, η2 p = .15). No significant group differences were found for attentional bias. However, over the whole group, less positive mood after the manipulation was associated with more maintained attention for positive information (r = -.49, p < .01). These results indicate that older adults deploy emotion regulation strategies in attention during low positive mood. Flexible attentional processing of emotional information might serve as a resilience factor to maintain well-being during later stages of life (AU)

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Papel de los inhibidores SGLT2 en el paciente anciano con diabetes mellitus; debemos evitar la discriminación por razón de edad / Role of SGLT2 inhibitors in elderly diabetic patients; we should avoid ageism

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Evolución, manejo diagnóstico y terapéutico en ancianos diagnosticados de sarcoidosis con afectación torácica: a propósito de 6 casos / Evolution, diagnosis and treatment of elderly subjects with thoracic sarcoidosis: Report of 6 cases

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Transition between inpatient mental health settings and community or care home settings

This guideline covers the period before, during and after a person is admitted to, and discharged from, a mental health hospital. It aims to help people who use mental health services, and their families and carers, to have a better experience of transition by improving the way it's planned and carried out. The Care Quality Commission uses NICE guidelines as evidence to inform the inspection process.

Salud, bienestar y convivencia de los ancianos. La situación portuguesa, española y europea / Health, wellbeing and conviviality of the elderly. The portuguese, spanish and european situation

Objetivo. Describir las características del envejecimiento en Portugal y España, en contraste con la realidad de los diecinueve países de la Unión Europea. Metodología. La visión del mayor se ve desde diferentes dimensiones: el estado de salud, el nivel de bienestar, las relaciones de convivencia y el sentimiento de soledad. El análisis se ha basado en los resultados obtenidos en el European Social Survey, round 5. Resultados. En Portugal, en comparación con España, se han identificado en la población anciana: mayores dificultades financieras, una peor percepción del estado de salud y del nivel de bienestar, pero, simultáneamente, menos limitación en la realización de las actividades de la vida diaria. Con respecto a las relaciones de convivencia en la población anciana, Portugal y España se diferencian del resto de la realidad europea analizada, con una frecuencia elevada de actividades de convivencia. Conclusión. Se ha podido constatar la existencia de especificidades nacionales que sugieren la existencia de factores sociales y culturales en la experiencia de la vejez (AU)

Objective. To characterize the specificities of aging in Portugal and Spain, in contrast to the reality of nineteen countries of the European Union. Methodology. The senior condition is characterized in different dimensions: health status, the level of wellbeing, conviviality and sense of loneliness. For that we have analyzed the results of the European Social Survey, round 5. Results. In Portugal, compared to Spain, it has been identified in the elderly population: greater financial difficulties, poorer perceived health status and wellbeing but, simultaneously, less limitation in performing activities of daily life. Respecting to conviviality, Portugal and Spain are distinct from other populations of the European reality analyzed, with a high frequency of convivial activities. Conclusion. In conclusion it was found the existence of national characteristics that suggest the existence of social and cultural factors that determine the experience of aging (AU)

El reto de conectar con las necesidades reales de las personas mayores y fomentar un envejecimiento activo y saludable: inspiración en iniciativas actuales / No disponible

Este artículo parte del marco de referencia del "Envejecimiento Activo" ("Active Ageing" - World Health Organization, WHO) y a través de los tres pilares propuestos en su definición de "Participación", "Salud" y "Seguridad", se presenta una reflexión sobre la necesidad de disponer de programas que fomenten y equilibren la propia responsabilidad individual, así como los entornos adecuados y favorables para las personas mayores y la solidaridad intergeneracional. Para ello se han revisado diferentes iniciativas actuales de experiencias intergeneracionales tanto a nivel nacional como internacional, las cuales abordan el tema del aislamiento personal y social y cómo combatir la soledad. A través del enfoque de análisis adoptado en esta revisión de iniciativas, se ha contribuido a relacionar el concepto de "Envejecimiento Activo" y a entender los diferentes factores que intervienen, con la intención de ir más allá de la literatura existente que lista una serie de elementos de éxito y aislados del mencionado concepto. Para ello, se han incluido los tres pilares clave que dotan de significado a la conceptualización de "Envejecimiento Activo", junto con las dimensiones individual-interindividual/relacional y social que conforman dicho marco de referencia. Cada una de las iniciativas seleccionadas presentan una gran riqueza y multidimensionalidad (cubren ambas dimensiones individuales y sociales) y nos ofrecen una fuerte inspiración y excelentes respuestas en cuanto a cuáles son las claves de éxito a tener en cuenta a la hora de diseñar y aplicar un programa psico-social "para" y "con" las personas mayores. Éstas permiten dotar a las personas mayores de un gran apoderamiento y ejercer así un rol y poder de decisión clave a nivel personal y social

This paper is focused on the "Active Ageing" framework ("Active Ageing" - World Health Organization, WHO) and through the three suggested "Participation", "Health" and "Security" pillars included on its definition, some thoughts are presented regarding the need to have a range of programmes which encourage and balance own individual responsibility, as well as having the most suitable environments that favour older people and intergenerational solidarity. In order to address this, several current initiatives of intergenerational experiences have been reviewed both at a national and international level. These address personal and social isolation and how to fight loneliness. Through the adopted analysis approach within such initiatives review, the contribution has been to connect the "Active Ageing" concept and to understand the different factors that are taking part. Such approach attempts to go beyond existing literature that provides a list of different successful elements which are isolated from the mentioned concept. In order to do so, the three key pillars which provide meaning to the "Active Ageing" conceptualisation have been included, together with the individual-interindividual/relational and social dimensions which shape such framework. Each of the selected initiatives encompass great richness and multi-dimensional levels (both individual and social dimensions are covered); being a powerful source of inspiration which provide excellent answers in order to identify the key successful elements one needs to take into account in order to design and apply a psycho-social programme "for" and "with" older people. These allow older people to empower themselves and therefore to be able to exercise their role and key decision making power both at a personal and social level

Evolución del modelo de atención residencial, una propuesta de centro de mayores / Model evolution residential care, a proposed senior center

El envejecimiento demográfico y el cambio en las características de la persona mayor hacen necesaria la creación de centros que otorguen un papel central a la persona. La tendencia internacional aboga por modelos residenciales centrados en la persona, aunque en España todavía se centran en los servicios. Objetivo: proponer un centro de mayores dentro del marco del modelo de Atención Integral Centrado en la Persona. Metodología: investigación cualitativa a través de observación participante en diversos centros residenciales y revisión bibliográfica. Resultados: este estudio propone un centro de mayores, con características de hogar, donde se pone énfasis en la biografía, capacidades y necesidades de los usuarios. Conclusiones: un centro basado en el modelo de Atención Integral Centrado en la Persona, mejora la independencia y la calidad de vida de los residentes

Demografic aging and changes of elder people characteristics necessitate the creation of centers that give a central role to the person. International trends call for residential models centered onto the person, but in Spain they are still focused on services. This study aims to propose an elderly center within the framework of Integral Attention Person-centered Model. Methodology: Qualitative research through participant observation in various elderly centers and bibliographic revision. Results: This study proposes an elderly center with home features where emphasis is placed on people biography and the abilities and needs of the users. Conclusions: a center based on Integral Care Person Centered model, improve independence and quality of life of residents

Prevalencia de desnutrición en población anciana de dos barrios urbanos de Asturias / Prevalence of malnurition in elderly from two districts of Asturias

Fundamento: Dado al aumento de personas mayores en nuestro país, consideramos oportuno estimar la prevalencia de desnutrición y su alto riesgo en población de 75 años o más no institucionalizada en dos barrios urbanos de Asturias. Métodos: Estudio descriptivo transversal. Se seleccionaron a 626 sujetos mediante muestreo aleatorio simple. Variables: Edad, sexo, peso, talla, índice de masa corporal, soporte familiar, nivel cultural, nivel de dependencia, circunferencia del brazo y pantorrilla y estado nutricional a través del cuestionario Mini Nutritional Assessment (MNA). Análisis mediante inferencia Bayesiana. Resultados: Se estudiaron a 445 sujetos. Edad media 81,8 años y 56,8% mujeres. La media posterior de la prevalencia de desnutrición fue del 3,1% (Intervalo de Credibilidad 95% (ICred: 1,8 a 4,9%)), siendo mayor en mujeres (4,6 vs 1,5%). La media posterior de la prevalencia de alto riesgo de desnutrición fue 13,8% (ICred: 11 a 17,4%), siendo mayor en mujeres (15,3 vs 12,4%). El nivel de dependencia mostró una fuerte asociación con la desnutrición (OR = 5,1 ICred: 2,5-12,2). Conclusiones: La desnutrición y el alto riesgo de padecerla son un problema presente en la población mayor que vive en su domicilio. Debería considerarse la valoración sistemática tanto del estado nutricional como de la capacidad funcional en Atención Primaria (AU)

Background: Given the increase of elderly people in our country, we consider it appropriate to estimate the prevalence of malnutrition and high risk in non-institutionalized population aged 75 years and older in two urban districts of Asturias. Methods: Cross-sectional study. 626 individuals were selected by simple random sampling. Variables: Age, gender, weight, height, body mass index, family support, cultural level, level of dependence, arm and calf circumference, and nutritional status by means of the Mini Nutritional Assessment (MNA). Data analysis was carried out through Bayesian inference. Results: 445 individuals were studied. Mean age 81.8 years old and 56.8% were women. The posterior mean prevalence of malnutrition was 3.1% (Credible Interval 95% (CrI 1.8 to 4.9%)), higher in women (4.6 vs 1.5%). The posterior mean prevalence of high risk for malnutrition was 13.8% (CrI: 11 to 17.4%) being higher in women (15.3 vs 12.4%). The level of dependence showed a strong association with malnutrition (OR = 5.1 CrI: 2.5-12.2). Conclusion: Malnutrition and high risk of suffering from it is a problem in elderly people living at home. Systematic assessment of nutritional status should be consider as well as functional capacity (AU)

Fragmentation in social security old-age benefit provision in China.

Currently, in many countries most workers are covered by a national social security benefits program that applies equally in all parts of the country. In China, however, social security old-age benefits are provided in a highly fragmented manner. This article documents the high degree of fragmentation. It discusses both why that has occurred and the effects of the fragmentation on participants. It examines effects of the fragmentation on benefit levels, focusing on variations in the generosity of benefit formulas but also considering other measures of benefit adequacy. Fragmentation is seen to cause differences in benefit levels even within a single city. While the new National Rural Pension Scheme is a major improvement in the provision of retirement security for rural workers, important differences still exist in the social security programs for urban and rural workers.

Valoración geriátrica y factores asociados a mortalidad en ancianos con insuficiencia cardíaca ingresados en una unidad de geriatría de agudos / Geriatric assessment and factors associated with mortality in elderly patients with heart failure admitted to an acute geriatric unit

Introducción y objetivos. La insuficiencia cardíaca es muy prevalente y con elevada mortalidad, sobre todo en ancianos. Predecir su curso e identificar pacientes en fase avanzada es difícil. El presente trabajo pretende identificar variables incluidas en la valoración geriátrica integral y otras variables clínicas que se asocien a un incremento de riesgo de muerte al año en ancianos ingresados por insuficiencia cardíaca. Material y métodos. Estudio prospectivo de 101 pacientes (edad media, 85,9 ± 6,3 años, 81% mujeres) que ingresaron durante el año 2006 en una unidad de geriatría de agudos con diagnóstico principal de insuficiencia cardíaca. Se registraron: datos demográficos, cardiopatía predisponente, factor precipitante de la descompensación, comorbilidad, número de fármacos al alta y tratamiento específico de la insuficiencia cardíaca, estancia media, reingresos, mortalidad al año del alta. La valoración geriátrica evaluaba: discapacidad en actividades básicas diarias (índice de Barthel) e instrumentales (índice de Lawton), función cognitiva (test de Pfeiffer), comorbilidad (índice de Charlson) y síndromes geriátricos. Resultados. En un modelo multivariante de regresión logística, los factores relacionados con la mortalidad fueron: mayor discapacidad previa (menor índice de Barthel previo) (OR [IC 95% =1,03 [1,01-1,06]; p = 0,040) y mayor número de reingresos (OR [IC 95%] = 3,53 [1,19-10,44]; p = 0,023). El sexo femenino resultó protector (OR [IC 95%] = 0,15 [0,04-0,59]; p = 0,007). Conclusiones. La discapacidad en actividades diarias y los reingresos se asociaban con mayor riesgo de muerte al año, y el sexo femenino resultó protector. Si fueran confirmados en otros estudios, estos datos podrían reforzar la necesidad de realizar una valoración geriátrica integral sistemática en ancianos con esta patología (AU)

Introduction and objectives. Heart failure (HF) is very prevalent in older adults, and is associated with a high mortality. The prediction of the outcome of HF and the identification of patients in advanced stages is difficult. The present work aims at identifying variables of the geriatric assessment and other clinical variables associated with an increased risk of death at one year in older adults with HF. Material and methods. Prospective study of 101 patients (mean age, 85.9 ± 6.3 years, 81% women) admitted during 2006 to an Acute Geriatric Unit, with principal diagnosis of HF. We recorded: demographic data, predisposing heart disease, main trigger of exacerbation, comorbidity, number of prescriptions at discharge and specific treatment of HF, average length-of-stay, readmissions, and mortality at one year after discharge. Geriatric assessment included: disability in basic (Barthel index) and instrumental (Lawton index) activities of daily living, cognitive function (Pfeiffer test), comorbidity (Charlson index), and geriatric syndromes. Results. In a multivariable logistic regression model, previous disability (lower Barthel index) (OR [95%CI] = 1.03 [1.01-1.06]; P = .040) and higher number of re-admissions (OR [95%CI] = 3.53 [1.19-10.44]; P = .023) were associated with 1-year mortality. Female sex had a protective effect (OR [95%CI] = 0.15 [0.04-0.59]; P = .007). Conclusions. Disability in the basic activities of daily living and re-admissions were associated with increased 1-year mortality in older adults, whereas female sex was protective. If confirmed in further studies, these data could reinforce the need for a systematic comprehensive geriatric assessment in older adults with HF (AU)