La tecnología para la mejora de la autonomía y la participación en la discapacidad / Technology to improve autonomy and participation among disabled people

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Postoperative Morbidity and Discharge Destinations After Fast-Track Hip and Knee Arthroplasty in Patients Older Than 85 Years.

BACKGROUND: Elderly patients are at risk of increased length of hospital stay (LOS), postoperative complications, readmission, and discharge to destinations other than home after elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). Recent studies have found that enhanced recovery protocols or fast-track surgery can be safe for elderly patients undergoing these procedures and may result in reduced LOS. However, detailed studies on preoperative comorbidity and differentiation between medical and surgical postoperative morbidity in elderly patients are scarce. The aim of this study was to provide detailed information on postoperative morbidity resulting in LOS >4 days or readmissions <90 days after fast-track THA and TKA in patients ≥85 years. METHODS: This is a descriptive, observational study in consecutive unselected patients ≥85 years undergoing fast-track THA/TKA. The primary outcome was the causes of postoperative morbidity leading to an LOS of >4 days. Secondary outcomes were 90-day surgically related readmissions, discharge destination, 90-day mortality, and role of disposing factors for LOS >4 days and 90-day readmissions. Data on preoperative characteristics were prospectively gathered using patient-reported questionnaires. Data on all admissions were collected using the Danish National Health Registry, ensuring complete follow-up. Any cases of LOS >4 days or readmissions were investigated through review of discharge forms or medical records. Backward stepwise logistic regression was used for analysis of association between disposing factors and LOS >4 days and 90-day readmission. RESULTS: Of 13,775 procedures, 549 were performed in 522 patients ≥85 years. Median age was 87 years (interquartile range, 85-88) and median LOS of 3 days (interquartile range, 2-5). In 27.3% procedures, LOS was >4 days, with 82.7% due to medical causes, most often related to anemia requiring blood transfusion and mobilization issues. Use of walking aids was associated with LOS >4 days (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.26-3.15; P = 0.003), whereas preoperative anemia showed borderline significance (OR, 1.52; 95% CI, 0.99-2.32; P = 0.057). Thirty-eight patients (6.9%) were not discharged directly home, of which 68.4% had LOS >4 days. Readmission rates were 14.2% and 17.9% within 30 and 90 days, respectively, and 75.5% of readmissions within 90 days were medical, mainly due to falls and suspected but disproved venous thromboembolic events. Preoperative anemia was associated with increased (OR, 1.81; 95% CI, 1.13-2.91; P = 0.014) and living alone with decreased (OR, 0.50; 95% CI, 0.31-0.80; P = 0.004) risk of 90-day readmissions. Ninety-day mortality was 2.0%, with 1.0% occurring during primary admission. CONCLUSIONS: Fast-track THA and TKA with an LOS of median 3 days and discharge to home are feasible in most patients ≥85 years. However, further attention to pre- and postoperative anemia and the pathogenesis of medical complications is needed to improve postoperative outcomes and reduce readmissions.

La regulación de los semáforos peatonales en España: ¿tienen las personas mayores tiempo suficiente para cruzar? / The regulation of pedestrian traffic lights in Spain: do older people have enough time to cross the road?

Introducción. En España se siguen registrando quejas ciudadanas denunciando que los semáforos peatonales en áreas urbanas no dan tiempo suficiente para cruzar las calles con seguridad, especialmente a peatones mayores y/o discapacitados. Ello se produce a pesar de existir legislaciones en materia de accesibilidad, las más favorables de las cuales disponen una velocidad de cruce peatonal de 0,7 metros por segundo (m/s). La Encuesta de Salud, Envejecimiento y Jubilación en Europa (SHARE, http://www.share-project.org) midió la velocidad de ambulación normal de una muestra representativa de españoles de edad igual o superior a los 75 años. El presente estudio comparó la velocidad mediana de esta muestra con la velocidad de referencia de 0,7m/s. Material y métodos. Muestra española de la segunda ola de SHARE (versión 2.2.0). Se incluyeron 244 sujetos de edad igual o superior a los 75 años, 121 mujeres y 123 hombres. Resultados. La velocidad mediana de las mujeres fue de 0,40m/s, y la de los hombres 0,60m/s. El análisis de frecuencias mostró que el 75,2% (N=91) de las mujeres y el 66,7% (N=82) de los hombres ambulaban a velocidades inferiores a 0,7m/s. La velocidad de referencia que incluiría el 80% de mujeres y hombres de la muestra sería de 0,25 y 0,31m/s, respectivamente. Conclusiones. La velocidad de referencia de 0,7m/s excluye una gran proporción de personas de edad avanzada. Se necesitan medidas urgentes para evitar la discriminación y garantizar la seguridad de este grupo creciente de la población(AU)

Introduction. In Spain, citizen complaints continue to be filed about pedestrian traffic lights in urban areas not providing enough time to cross roads safely, especially by the elderly and people with disabilities. This is despite the existence of accessibility laws in Spanish regions, the most favorable being to establish that pedestrian traffic lights should be regulated according to a pedestrian crossing speed of 0.7 meters per second (m/s). The Survey of Health, Ageing and Retirement in Europe (SHARE, http://www.share-project.org) measured the normal walking speed of a nationally representative sample of Spanish people of 75 or more years of age. Our study compared the median walking speed of this sample against the reference speed of 0.7m/s. Material and methods. Spanish sample of the second wave of SHARE (version 2.2.0), including 244 subjects of 75 or more years of age of which 121 were women and 123 men. Results. The median walking speed in women was 0.40 m/s, and in men it was 0.60m/s. The analysis of frequencies showed that 75.2% (N=91) of women and 66.7% (N=82) of men had individual walking speeds of less than 0.7m/s. The reference speed that would include the 80% of women and men in the sample would be 0.25 and 0.31m/s, respectively. Conclusion. The reference walking speed of 0.7m/s excludes a great proportion of older people. Urgent corrective measures are needed to avoid discrimination and protect the safety of this growing sector of the population(AU)