[Detection of the largest population susceptible to prescription of a program of exercises in Primary Care to prevent frailty]. / Detección de la población mayor susceptible de prescripción de un programa de ejercicios en Atención Primaria para prevenir la fragilidad.

AIM: Identify the population over 70 year's old treated in primary care who should participate in a physical exercise program to prevent frailty. Analyze the concordance among 2criteria to select the beneficiary population of the program. DESIGN: Population-based cross-sectional study. SETTINGS: Primary Care. PARTICIPANTS: Elderly over 70 years old, living in the Peñagrande neighborhood (Fuencarral district of Madrid) from the Peñagrande cohort, who accepted to participate in 2015 (n = 332). MAIN MEASUREMENTS: The main variable of the study is the need for exercise prescription in people over 70 years old at the Primary Care setting. It was identified through 2different definitions: Prefrail (1-2 of 5 Fried criteria) and Independent individuals with physical performance limited, defined by Consensus on frailty and falls prevention among the elderly (independent and with a total SPPB score <10). RESULTS: The 63,8% of participants (n = 196) need exercise prescription based on criteria defined by Fried and/or the consensus for prevention of frailty and falls in the elderly. In 82 cases the 2criteria were met, 80 were prefrail with normal physical performance and 34 were robust with a limited physical performance. The concordance among both criteria is weak (kappa index 0, 27). CONCLUSION: Almost 2thirds of the elderly have some kind of functional limitation. The criteria of the consensus document to prevent frailty detect half of the pre-frail individuals in the community.

Comprehensive geriatric assessment for identifying older people at risk of hip fracture: cross-sectional study with comparative group.

Background: Hip fracture (HF) is by far the most common serious fragility fracture. Its care is a major challenge to all healthcare systems. Aim: To determine whether there are characteristics of older people identified via comprehensive geriatric assessment (CGA) that help identify those with an increased risk of HF. Methods: The demographic, functional, cognitive and nutritional data of a cohort of patients admitted for acute HF were compared with those of a population cohort representing community-dwelling older people in the same urban district without HF. Bivariate analysis was performed on the variables in both the complete samples and in a subsample of age and sex paired subjects, followed by logistic regression analysis. Results: A total of 509 HF patients and 1315 community-dwelling older people were included. The HF patients were older and more frequently women and had more frequent disability and cognitive impairment, lower handgrip strength, lower body mass index (BMI) and a higher frequency of vitamin D deficiency compared with the community controls (P < 0.001). The variables most strongly associated with the presence of HF in the multivariate analysis, aside from age and female sex, were BMI<22 kg/m2 [odds ratio (OR) = 5.11], disability (OR = 4.32), muscle weakness (OR = 3.01), and vitamin D deficiency (OR = 2.13). Conclusions: There are easily obtained CGA determinants that are strongly associated with fragility HF. The detection of low weight, disability, malnutrition, muscle weakness, and vitamin D deficiency can help identify at-risk older people to implement prevention strategies.

[Quality of registration of dementia diagnosis in primary care: The situation in Spain in 2002-2011]. / Calidad del registro del diagnóstico de demencia en atención primaria. La situación en España en el periodo 2002-2011.

OBJECTIVE: To ascertain the diagnosis associated with specific treatment for dementia in the Primary Care Electronic Clinical Record (PC-ECR) and to analyse the factors associated with the quality of registration. METHODS: Descriptive study of patients taking cholinesterase inhibitors or memantine registered in Database for pharmacoepidemiological research in PC (BIFAP) 2011: 24,575 patients between 2002 and 2011. Diagnoses associated with first prescription of these drugs were grouped into 5 categories: "dementia", "memory impairment", "dementia-related diseases", "intercurrent processes" and "convenience codes". We calculated the prevalence of each category by age and sex for each study year (95%CI) and analysed the associations and trend for 2002-2011 using difference in proportions in independent samples and binary logistic regression. RESULTS: A code of "dementia" was associated with first prescription in 56.5% (95%CI: 55.8-57.1) of patients. It was higher in women [OR1.09 (95%CI: 1.03-1.15)] and with increasing follow-up time [OR1.07 (95%CI: 1.06-1.08) for each year of follow-up]. "Convenience codes" [16.3% (95%CI: 15.8-16.7)] were coded more frequently in women and in those ≥80 years; "Memory impairment" [12.4% (95%CI: 12.0-12.8)], "related diseases" [4.6% (95%CI: 4.4-4.8)] and "intercurrent processes" [10.3% (95%CI: 9.9-10.6)] were used more in men and in persons <80 years. Between 2002 and 2011 improved the use of "convenience codes". CONCLUSIONS: Almost half of the patients taking cholinesterase inhibitors or memantine do not have a diagnosis of dementia registered in their PC-ECR. Registration improves with increasing time of follow-up. Improvements are needed in the PC-ECR, adequate care coordination, and proactive approach to increase the quality of dementia registration.

Evolution of physical function, cognition, depressive mood, and quality of life during the Covid-19 pandemic in prefrail elderly people: A longitudinal cohort study (Covid-Mefap).

Confinement due to the COVID-19 pandemic has had a major impact on the living habits and health of the population, notably in the pre-frail elderly. This study aimed to study the effect of the COVID-19 pandemic on the physical function, mental function (cognition and mood), and quality of life of pre-frail elderly individuals over 70 years of age following confinement as well as to analyze the variables associated with the observed changes. METHODS: Observational study of a cohort of pre-frail community-dwelling older adults over 70 years of age during the COVID-19 pandemic conducted in primary care. VARIABLES: The main outcome variables were recorded during face-to-face interviews between December 14 of 2020 and August 12 of 2021 using scales for the evaluation of physical function (Short Physical Performance Battery), cognition (Lobo's Mini-Examen Cognoscitivo), depressive mood (Geriatric Depression Scale), and quality of life (EuroQol-5D-3L). Covariates: sociodemographic data and variables related to the pandemic and general health (social support network, COVID-19 infection, exercising, and leisure activities) were also collected. ANALYSIS: The Student's t-test for paired samples and multivariate linear regression models were employed for the statistical analyses. RESULTS: Ninety-two subjects were included in the study. Physical function, cognition, and depressive mood improved during the pandemic, whereas no changes were observed in quality of life. Suffering from COVID-19 was associated with deterioration of the cognitive function (-1.460; CI95%: -2.710 to -0.211). CONCLUSION: Confinement due to the COVID-19 pandemic was not associated with a decline in physical function, cognition, depressive mood, or quality of life in pre-frail individuals over 70 years of age.

[Quality of life and physical activity in prefrail individuals over 70 years in primary care.] / Calidad de vida y actividad física en individuos prefrágiles mayores de 70 años en atención primaria.

OBJECTIVE: Frailty is an increasing problem among the elderly people and it is more frequent in women. Physical activity improves either the function and quality of life. Given the diferences reported by the literature about the quality of life perception and the physical activity practice between men and women, the aim of this study is to analyze the association between health related quality of life (HRQoL) and physical activity in a pre-frail population and to study its relationship with gender. METHODS: Descriptive study in pre-frail individuals over 70 years old assigned to twelve primary care health centers carried out between 2018 Jun and 2020 March in Madrid. The studied variables were registered by clinical interview: Physical activity (Yale), HRQoL (EQ-5D-3L), sociodemographic and clinical variables (comorbidity, depression and pain). Descriptive analysis and multiple linear regression for the whole population and stratified by gender, using the quality of life as dependent variable. RESULTS: The study involved 206 pre-frail individuals (152 women) wih an average age of 78 years. Women had less comorbidity (32.3% versus 55.6%) but more pain (60.5% versus 44.4%) than men. The median of physical activity was 40 points (55.9% of that score was attributable to relaxed walk). HRQoL was 0.74 in utility score and 68 in the EQ-VAS. No differences were found by gender. To walk more than 5 hours a week was found associated with better quality of life by EQ-5D utility score (0.08, IC95%: 0.03 to 0.14), and by EQ-VAS score (5.38, IC95%: 0.25 to 10.51). CONCLUSIONS: Physical activity was associated to better quality of life in a pre-frail population of individuals older than 70 years old.

OBJETIVO: La fragilidad es un problema de creciente magnitud entre los mayores que afecta en mayor proporción a mujeres. La actividad física mejora tanto la funcionalidad como la calidad de vida. Dadas las diferencias en la percepción de la calidad de vida y en la práctica de actividad física entre hombres y mujeres, se planteó como objetivo analizar la asociación entre calidad de vida y actividad física en mayores de 70 años prefrágiles y su relación con el sexo. METODOS: Estudio descriptivo en mayores de 70 años prefrágiles realizado entre junio de 2018 y marzo de 2020 en 12 centros de salud de Madrid. Se recogieron mediante entrevista clínica, variables de actividad física (cuestionario de Yale), calidad de vida (Euroqol-5D); variables sociodemográficas y de salud (comorbilidad, depresión y dolor). Se realizó análisis descriptivo y modelos de regresión lineal múltiple con calidad de vida como variable dependiente (total población y por sexo). RESULTADOS: Participaron en el estudio 206 individuos (152 mujeres), con una edad media de 78 años. Las mujeres presentaron menos comorbilidad (32,3% versus 55,6%) y más dolor (60,5% versus 44,4%) que los hombres. La media de actividad física fue de 40 puntos (55,9% de la puntuación corresponde a pasear relajadamente). La calidad de vida fue de 0,74 segun utilidades y de 68 en la EVA-EQ5D, sin diferencias según sexo. Pasear más de 5 horas/semana se asoció a mejor calidad de vida según utilidades (0,08, IC95%: 0,03 a 0,14), y según EVA (5,38, IC95%: 0,25 a 10,51). CONCLUSIONES: La actividad física se asoció a una mejor calidad de vida en población prefrágil mayor de 70 años.

Use of Primary Care Services, Care Specialized and Drug Use by Population 65 Years and More in the Community of Madrid, Spain. / Utilización de servicios de atención primaria, atención especializada y consumo de medicamentos por la población de 65 años y más en la Comunidad de Madrid.

BACKGROUND: Ageing of the Spanish population results in an increase in health services required. Therefore, determine the frequency of the health services utilization in this age group and analyze their determinants has a great interest.The aim was to analyze the utilization of health services among older people living in two urban neighborhoods of northern Madrid. METHODS: A cross-sectional population-based study. It is studied a cohort of 1327 individuals ≥ 65 years, stratified by age and sex. Nine utilization indicators were defined. For each indicator frequencies and the association of each with the other variables were calculated by multivariate analysis. RESULTS: The distribution of indicators expressed as a percentage of the user population is: GP appoiments/month 64.8% (95%CI 62.3 to 67.4); nursing appoiments/month 44.6% (95% CI 41.2 to 47.2); home medical visits/month 3.1% (95%CI 2.2 to 4.1); home nursing visits/month 3% (95%CI 2.1 to 3.9); hospitalization/year 16.4% (95%CI 14.4 to 18.4); appoiments rheumatologist/orthopedic/year 25.1% (95%CI 22.7 to 27.4); physiotherapist appoiments/year 12.9% (95% CI 11.1 to 14.7); podiatrist appoiments/year 30.6% (95%CI 28.1 to 33.1) and polypharmacy (≥5 drugs) 55.7% (95% CI 53 to 58.4). Comorbidity was the best predictor of health care utilization ranging from OR 4.10 (95%CI: 3.07-5,49) to OR 1.39 (95%CI: 0.97-1.99) in polymedicated and visit the physiotherapist respectively. Cardiovascular disease (OR 1.34; 95%CI 1.03-1,76) and diabetes (OR 1.46; 95%CI: 1.05 -2.02) were independently associated with increased use of family doctor. Dependence was the main determinant for home healthcare (OR 3.38; 95%CI: 1.38-8.28) and nurses (OR 9.71; 95%CI: 4.19-22.48) Mood disorders were associated to polypharmacy (OR 2.06; 95%CI: 1,48-2.86) and to visits to family doctor (OR 1.52; 95%CI: 1,13-2.04). CONCLUSIONS: The comorbidity is the strongest predictor of health services utilization. Cardiovascular diseases and diabetes are independently associated to greater use. Dependence is the main determinant of home care. Mood disorders associated with polypharmacy and increased attendances to the General Practitioner.

OBJETIVO: El envejecimiento de la población española se traduce en un aumento de las prestaciones sanitarias requeridas por la población mayor, por ello conocer la frecuencia de la utilización de los servicios sanitarios de este grupo de edad y analizar sus factores determinantes es de especial interés. El objetivo fue analizar la utilización de servicios sanitarios de la población mayor residente en dos barrios urbanos del norte de Madrid. METODOS: Estudio transversal de base poblacional. Se estudió una cohorte de 1.327 individuos igual o mayor a 65 años, estratificada por edad y sexo. Se definieron 9 indicadores de utilización durante el mes anterio o durante el último año. Para cada indicador se calcularon las frecuencias y la asociación con el resto de variables mediante análisis multivariante. RESULTADOS: la distribución de los indicadores expresada como proporción de la población usuaria fue: consultas médico/mes 64,8% (IC95%:62,3-67,4); consultas enfermería/mes 44,6% (IC95%:41,2-47,2); domicilios médico/mes 3,1% (IC95%:2,2-4,1); domicilios enfermería/mes 3%(IC95%:2,1-3,9); hospitalización/año 16,4% (IC95%:14,4-18,4); consultas reumatólogo/traumatólogo/año 25,1% (IC95%:22,7-27,4); consultas fisioterapeuta/año 12,9% (IC95%:11,1-14,7); consultas podólogo/año 30,6% (IC95%:28,1-33,1) y polimedicados (≥5 fármacos) 55,7% (IC95%: 53-58,4). La comorbilidad fue la variable que mejor predijo la utilización de servicios sanitarios oscilando entre OR 4.10 (IC95%:3.07-5,49) y OR 1,39 (IC95%: 0.97-1.99) para estar polimedicado y visitar al fisioterapeuta respectivamente. Enfermedades cardiovasculares (OR 1,34; IC95%:1.03-1,76) y diabetes (OR 1,46; IC95%:1,05-2,02) se asociaron de forma independiente a mayor utilización del médico de familia. La dependencia fue el principal determinante de atención domiciliaria para el médico (OR 3,38; IC95%: 1,38-8,28) y para enfermería (OR 9.71; IC 95%: 4.19-22.48). Trastornos del ánimo se asociaron a mayor polimedicación (OR 2.06; IC95%: 1,48-2.86) y visitas al médico de familia (OR 1,52; IC 95%:1,13-2.04). CONCLUSIONES: La comorbilidad fue la variable que mejor predijo la utilización de servicios sanitarios. Las enfermedades cardiovasculares y la diabetes se asocian de forma independiente a mayor utilización de servicios. Los trastornos del ánimo se asocian a mayor polimedicación y más visitas al médico de familia.

[Vitamin D deficiency in a cohort over 65 years: prevalence and association with sociodemographic and health factors]. / Déficit de vitamina D en una cohorte de mayores de 65 años: prevalencia y asociación con factores sociodemográficos y de salud.

INTRODUCTION: Vitamin D deficiency is common in the elderly, especially among institutionalized and/or hip fracture patients. However, there are few population studies on the prevalence of this deficiency in the general population over 64 years in our environment. The aim of this study was to determine the prevalence of vitamin D deficiency in an urban population cohort of over 64 years, and analyze its relationship with sociodemographic, climatic, and health factors. MATERIAL AND METHODS: Cross-sectional study from «Peñagrande cohort¼, a population-based cohort consisting of people over 64 years. We determined 25-hydroxyvitamin D levels, and recorded sociodemographic data (age, sex, marital status, education, socioeconomic status), season of measurement and health variables (comorbidity, obesity, malnutrition, renal failure, cognitive impairment, vitamin D supplements, and disability). RESULTS: A total of 468 individuals with a mean age of 76.0 years (SD: 7.7) were included, of which 53.4% were women. The mean value of vitamin D was 20.3 ± 11.7 ng/mL. The large majority (86.3%, 95% CI: 83.0-89.5) had a vitamin insufficiency (≤ 30 ng/ml), and 35.2% (95% CI: 30.8-39.7) showed severe vitamin deficiency (≤ 15 ng/ml). Vitamin insufficiency increases linearly with age (OR 1.06; 95% CI: 1.01-1.11), and was associated with low socioeconomic status (OR 3.29; 95% CI: 1.55-6.95). Severe vitamin D deficiency increases with age (OR 1.06; 95% CI: 1.02-1.09), female gender (OR 1.80; 95% CI: 1.18-2.75) and with cognitive impairment (OR 1.71; 95% CI: 1.04-2.83). CONCLUSION: The prevalence of vitamin D deficiency in people over 65 years of age in our community is high. It would be advisable to determine the vitamin D values in the high risk elderly in order to introduce measures of pharmacological supplementation in those with inadequate levels.

Detección de la población mayor susceptible de prescripción de un programa de ejercicios en Atención Primaria para prevenir la fragilidad / Detection of the largest population susceptible to prescription of a program of exercises in Primary Care to prevent frailty

Objetivo: Identificar a la población mayor de 70 años atendida en Atención Primaria, susceptible de participar en un programa de ejercicio físico para prevenir fragilidad. Analizar la concordancia entre 2 criterios para seleccionar la población beneficiaria del programa. Diseño: Estudio transversal de base poblacional. Emplazamiento: Atención Primaria. Participantes: Mayores de 70 años no frágiles residentes del Barrio Peñagrande (distrito Fuencarral, Madrid) pertenecientes a la cohorte de Peñagrande localizables en 2015 y que aceptaron participar (n = 307). Mediciones principales: La variable principal del estudio es la necesidad de prescripción de ejercicio en Atención Primaria en personas mayores de 70 años; se identificó a través de 2 definiciones diferentes: personas prefrágiles (1 o 2 de los 5 criterios de Fried) y personas independientes con desempeño físico limitado, definida por los criterios del documento de consenso sobre prevención de fragilidad y caídas en la persona mayor (mayor de 70 años independiente y con puntuación total del SPPB < 10). Resultados: El 63,84% de los participantes (n = 196) necesitan prescripción del ejercicio por ser prefrágiles y/o por cumplir los criterios definidos en el documento de consenso. En 82 casos cumplían los 2criterios (prefragilidad y desempeño físico disminuido), 80 eran prefrágiles con desempeño físico normal y 34 eran robustos con desempeño físico limitado. La concordancia entre ambos criterios es débil (índice kappa 0,27). Conclusión: Casi 2 tercios de los mayores presentan algún tipo de limitación funcional. Los criterios del documento de consenso para prevenir la fragilidad detectan a la mitad de los individuos prefrágiles de la comunidad

Aim: Identify the population over 70 year's old treated in primary care who should participate in a physical exercise program to prevent frailty. Analyze the concordance among 2 criteria to select the beneficiary population of the program. Design: Population-based cross-sectional study. Settings: Primary Care. Participants: Elderly over 70 years old, living in the Peñagrande neighborhood (Fuencarral district of Madrid) from the Peñagrande cohort, who accepted to participate in 2015 (n = 332). Main measurements: The main variable of the study is the need for exercise prescription in people over 70 years old at the Primary Care setting. It was identified through 2 different definitions: Prefrail (1-2 of 5 Fried criteria) and Independent individuals with physical performance limited, defined by Consensus on frailty and falls prevention among the elderly (independent and with a total SPPB score <10). Results: The 63,8% of participants (n = 196) need exercise prescription based on criteria defined by Fried and/or the consensus for prevention of frailty and falls in the elderly. In 82 cases the 2 criteria were met, 80 were prefrail with normal physical performance and 34 were robust with a limited physical performance. The concordance among both criteria is weak (kappa index 0, 27). Conclusion: Almost 2 thirds of the elderly have some kind of functional limitation. The criteria of the consensus document to prevent frailty detect half of the pre-frail individuals in the community

Variabilidad en la utilización de servicios sanitarios por las personas mayores relacionada con el cupo médico al que pertenecen / Variability in the use of health services by the elderly related to the medical list to which they belong

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Calidad del registro del diagnóstico de demencia en atención primaria. La situación en España en el periodo 2002-2011 / Quality of registration of dementia diagnosis in primary care: The situation in Spain in 2002-2011

OBJETIVO: Comprobar el diagnóstico asociado al tratamiento específico para demencia en la historia clínica electrónica de atención primaria (HCE-AP) y analizar los factores asociados a la calidad del registro. MÉTODO: Estudio descriptivo de los pacientes con anticolinesterásicos o memantina registrados en la Base para Investigación Farmacoepidemiológica en atención primaria (BIFAP) 2011: 24.575 pacientes entre 2002 y 2011. Los diagnósticos asociados a la primera prescripción de estos fármacos se agruparon en 5 categorías: «demencia», «alteraciones de memoria», «enfermedades relacionadas con demencia», «procesos intercurrentes» y «códigos de conveniencia». Se calculó la prevalencia de cada categoría por edad y sexo en cada año de estudio (IC 95%) y se analizaron asociaciones y tendencia 2002-2011, utilizando diferencias de proporciones para muestras independientes y regresión logística binaria. RESULTADOS: El 56,5% (IC 95%: 55,8-57,1) de los pacientes tenían asociado código «demencia» a la primera prescripción. Se registró mejor en mujeres (OR: 1,09 [IC 95%: 1,03-1,15]) y al aumentar el tiempo transcurrido (OR: 1,07 [IC 95%: 1,06-1,08] por cada año de seguimiento). Los «códigos de conveniencia» (16,3% [IC 95%: 15,8-16,7]) se utilizaron más en mujeres y ≥ 80 años; las «alteraciones de memoria» (12,4% [IC 95%: 12,0-12,8]), «enfermedades relacionadas» (4,6% [IC 95%: 4,4-4,8]) y «procesos intercurrentes» (10,3% [IC 95%: 9,9-10,6]) más en hombres y < 80 años. De 2002 a 2011 mejoró el uso de «códigos de conveniencia». CONCLUSIONES: Casi la mitad de los pacientes con anticolinesterásicos o memantina no tienen registrado diagnóstico de demencia en su HCE-AP. El registro mejora al aumentar el tiempo de seguimiento. Se requieren mejoras de la HCE-AP, coordinación asistencial adecuada y actitud activa para aumentar la calidad del registro de demencia

OBJECTIVE: To ascertain the diagnosis associated with specific treatment for dementia in the Primary Care Electronic Clinical Record (PC-ECR) and to analyse the factors associated with the quality of registration. METHODS: Descriptive study of patients taking cholinesterase inhibitors or memantine registered in Database for pharmacoepidemiological research in PC (BIFAP) 2011: 24,575 patients between 2002 and 2011. Diagnoses associated with first prescription of these drugs were grouped into 5 categories: 'dementia', 'memory impairment', 'dementia-related diseases', 'intercurrent processes' and 'convenience codes'. We calculated the prevalence of each category by age and sex for each study year (95% CI) and analysed the associations and trend for 2002-2011 using difference in proportions in independent samples and binary logistic regression. RESULTS: A code of 'dementia' was associated with first prescription in 56.5% (95% CI: 55.8-57.1) of PATIENTS: It was higher in women [OR 1.09 (95% CI: 1.03-1.15)] and with increasing follow-up time [OR 1.07 (95% CI: 1.06-1.08) for each year of follow-up]. 'Convenience codes' [16.3% (95% CI: 15.8-16.7)] were coded more frequently in women and in those ≥ 80 years; 'Memory impairment' [12.4% (95% CI: 12.0-12.8)], 'related diseases' [4.6% (95% CI: 4.4-4.8)] and 'intercurrent processes' [10.3% (95% CI: 9.9-10.6)] were used more in men and in persons < 80 years. Between 2002 and 2011 improved the use of 'convenience codes'. CONCLUSIONS: Almost half of the patients taking cholinesterase inhibitors or memantine do not have a diagnosis of dementia registered in their PC-ECR. Registration improves with increasing time of follow-up. Improvements are needed in the PC-ECR, adequate care coordination, and proactive approach to increase the quality of dementia registration

Utilización de servicios de atención primaria, atención especializada y consumo de medicamentos por la población de 65 años y más en la Comunidad de Madrid / Use of primary care services, care specialized and drug use by population 65 years and more in Madrid, Spain

Fundamento: El envejecimiento de la población española se traduce en un aumento de las prestaciones sanitarias requeridas por la población mayor, por ello conocer la frecuencia de la utilización de los servicios sanitarios de este grupo de edad y analizar sus factores determinantes es de especial interés. El objetivo fue analizar la utilización de servicios sanitarios de la población mayor residente en dos barrios urbanos del norte de Madrid. Métodos: Estudio transversal de base poblacional. Se estudió una cohorte de 1.327 individuos igual o mayor a 65 años, estratificada por edad y sexo. Se definieron 9 indicadores de utilización durante el mes anterio o durante el último año. Para cada indicador se calcularon las frecuencias y la asociación con el resto de variables mediante análisis multivariante. Resultados: la distribución de los indicadores expresada como proporción de la población usuaria fue: consultas médico/mes 64,8% (IC95%:62,3-67,4); consultas enfermería/mes 44,6% (IC95%:41,2-47,2); domicilios médico/mes 3,1% (IC95%:2,2-4,1); domicilios enfermería/mes 3%(IC95%:2,1-3,9); hospitalización/año 16,4% (IC95%:14,4-18,4); consultas reumatólogo/traumatólogo/año 25,1% (IC95%:22,7-27,4); consultas fisioterapeuta/año 12,9% (IC95%:11,1-14,7); consultas podólogo/año 30,6% (IC95%:28,1-33,1) y polimedicados (≥5 fármacos) 55,7% (IC95%: 53-58,4). La comorbilidad fue la variable que mejor predijo la utilización de servicios sanitarios oscilando entre OR 4.10 (IC95%:3.07-5,49) y OR 1,39 (IC95%: 0.97-1.99) para estar polimedicado y visitar al fisioterapeuta respectivamente. Enfermedades cardiovasculares (OR 1,34; IC95%:1.03-1,76) y diabetes (OR 1,46; IC95%:1,05-2,02) se asociaron de forma independiente a mayor utilización del médico de familia. La dependencia fue el principal determinante de atención domiciliaria para el médico (OR 3,38; IC95%: 1,38-8,28) y para enfermería (OR 9.71; IC 95%: 4.19-22.48). Trastornos del ánimo se asociaron a mayor polimedicación (OR 2.06; IC95%: 1,48-2.86) y visitas al médico de familia (OR 1,52; IC 95%:1,13-2.04). Conclusiones: La comorbilidad fue la variable que mejor predijo la utilización de servicios sanitarios. Las enfermedades cardiovasculares y la diabetes se asocian de forma independiente a mayor utilización de servicios. Los trastornos del ánimo se asocian a mayor polimedicación y más visitas al médico de familia (AU)

Background: Ageing of the Spanish population results in an increase in health services required. Therefore, determine the frequency of the health services utilization in this age group and analyze their determinants has a great interest.The aim was to analyze the utilization of health services among older people living in two urban neighborhoods of northern Madrid. Method: cross-sectional population-based study. It is studied a cohort of 1327 individuals ≥ 65 years, stratified by age and sex. Nine utilization indicators were defined. For each indicator frequencies and the association of each with the other variables were calculated by multivariate analysis. Results: The distribution of indicators expressed as a percentage of the user population is: GP appoiments/month 64.8% (95%CI 62.3 to 67.4); nursing appoiments/month 44.6% (95% CI 41.2 to 47.2); home medical visits/month 3.1% (95%CI 2.2 to 4.1); home nursing visits/month 3% (95%CI 2.1 to 3.9); hospitalization/year 16.4% (95%CI 14.4 to 18.4); appoiments rheumatologist/orthopedic/year 25.1% (95%CI 22.7 to 27.4); physiotherapist appoiments/year 12.9% (95% CI 11.1 to 14.7); podiatrist appoiments/year 30.6% (95%CI 28.1 to 33.1) and polypharmacy (≥5 drugs) 55.7% (95% CI 53 to 58.4). Comorbidity was the best predictor of health care utilization ranging from OR 4.10 (95%CI: 3.07-5,49) to OR 1.39 (95%CI: 0.97-1.99) in polymedicated and visit the physiotherapist respectively. Cardiovascular disease (OR 1.34; 95%CI 1.03-1,76) and diabetes (OR 1.46; 95%CI: 1.05 -2.02) were independently associated with increased use of family doctor. Dependence was the main determinant for home healthcare (OR 3.38; 95%CI: 1.38-8.28) and nurses (OR 9.71; 95%CI: 4.19-22.48) Mood disorders were associated to polypharmacy (OR 2.06; 95%CI: 1,48-2.86) and to visits to family doctor (OR 1.52; 95%CI: 1,13-2.04). Conclusions: The comorbidity is the strongest predictor of health services utilization. Cardiovascular diseases and diabetes are independently associated to greater use. Dependence is the main determinant of home care. Mood disorders associated with polypharmacy and increased attendances to the General Practitioner (AU)

Déficit de vitamina D en una cohorte de mayores de 65 años: prevalencia y asociación con factores sociodemográficos y de salud / Vitamin D deficiency in a cohort over 65 years: Prevalence and association with sociodemographic and health factors

Introducción. La hipovitaminosis D es frecuente en los ancianos, especialmente entre los institucionalizados y/o con fractura de cadera. Sin embargo, existen pocos estudios sobre la prevalencia de este déficit en la población general mayor de 64 años de nuestro entorno. El objetivo del presente trabajo es conocer la prevalencia de hipovitaminosis D en una cohorte poblacional urbana de mayores de 64 años, y analizar su relación con factores sociodemográficos, climáticos y de salud. Material y métodos. Se realizó un estudio descriptivo transversal a partir de la «cohorte de Peñagrande», de base poblacional y formada por mayores de 64 años. Se determinó el valor de 25-hidroxivitamina D en sangre y se recogieron variables sociodemográficas (edad, sexo, estado civil, nivel educativo, nivel socioeconómico), estación del año en que se realizó la determinación, y de salud (comorbilidad, obesidad, desnutrición, insuficiencia renal, deterioro cognitivo, discapacidad e ingesta de suplementos de vitamina D). Resultados. Se obtuvo una muestra de 468 individuos siendo el 53,4% mujeres y la edad media de 76 años (DE 7,7). El valor medio de vitamina D fue de 20,3 ± 11,7 ng/mL. El 86,3% (IC95%: 83,0-89,5) presentó insuficiencia vitamínica (≤ 30 ng/mL) y el 35,2% (IC95%: 30,8-39,7) deficiencia grave (≤ 15 ng/mL). La insuficiencia vitamínica se incrementa linealmente con la edad (OR 1,06; IC95%: 1,01-1,11), y con nivel socioeconómico bajo (OR 3,29; IC95%: 1,55-6,95). La deficiencia severa de vitamina D aumenta con la edad (OR 1,06; IC95%: 1,02-1,09), el sexo femenino (OR 1,80; IC95%: 1,18-2,75) y con deterioro cognitivo (OR 1,71; IC95%: 1,04-2,83). Conclusión. La prevalencia de hipovitaminosis D en los mayores de 65 años de nuestra comunidad es elevada. Sería muy recomendable poder determinar los valores de vitamina D en mayores de riesgo en atención primaria con el objetivo de adoptar medidas de suplementación farmacológica en los pacientes con niveles no adecuados (AU)

ntroduction: Vitamin D deficiency is common in the elderly, especially among institutionalized and/or hip fracture patients. However, there are few population studies on the prevalence of this deficiency in the general population over 64 years in our environment. The aim of this study was to determine the prevalence of vitamin D deficiency in an urban population cohort of over 64 years, and analyze its relationship with sociodemographic, climatic, and health factors. Material and methods: Cross-sectional study from « Peñagrande cohort », a population-based cohort consisting of people over 64 years. We determined 25-hydroxyvitamin D levels, and recorded sociodemographic data (age, sex, marital status, education, socioeconomic status), season of measurement and health variables (comorbidity, obesity, malnutrition, renal failure, cognitive impairment, vitamin D supplements, and disability). Results: A total of 468 individuals with a mean age of 76.0 years (SD: 7.7) were included, of which 53.4% were women. The mean value of vitamin D was 20.3 ± 11.7 ng/mL. The large majority (86.3%, 95% CI: 83.0-89.5) had a vitamin insufficiency ( ≤ 30 ng/ml), and 35.2% (95% CI: 30.8-39.7) showed severe vitamin deficiency ( ≤ 15 ng/ml). Vitamin insufficiency increases linearly with age (OR 1.06; 95% CI: 1.01-1.11), and was associated with low socioeconomic status (OR 3.29; 95% CI: 1.55-6.95). Severe vitamin D deficiency increases with age (OR 1.06; 95% CI: 1.02-1.09), female gender (OR 1.80; 95% CI: 1.18-2.75) and with cognitive impairment (OR 1.71; 95% CI: 1.04-2.83). Conclusion: The prevalence of vitamin D deficiency in people over 65 years of age in our community is high. It would be advisable to determine the vitamin D values in the high risk elderly in order to introduce measures of pharmacological supplementation in those with inadequate levels (AU)

Falta de adherencia en ancianos frágiles a un programa estructurado multicomponente de ejercicio físico / The lack of adherence to a structured multicomponent program of physical exercise by the frail elderly

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Consideraciones sobre los estudios de prevalencia de fragilidad en el mayor en España / Comments on studies on the prevalence of frailty in the elderly in Spain

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Prevalencia de fragilidad en una población urbana de mayores de 65 años y su relación con comorbilidad y discapacidad / Prevalence of frailty in an elderly Spanish urban population. Relationship with comorbidity and disability

ObjetivoEstimar la prevalencia de fragilidad según los criterios de Fried en una población urbana española de 65 años o más y analizar los factores sociodemográficos y de salud asociados.PoblaciónPacientes de 65 años o más residentes en el Barrio de Peñagrande (distrito Fuencarral de Madrid).DiseñoEstudio transversal sobre la población basal del estudio «cohorte Peñagrande» formada por 814 individuos.Mediciones principalesLa fragilidad se definió por la presencia de 3 o más de los siguientes criterios: pérdida de peso no intencionada, debilidad muscular, agotamiento, lentitud al caminar y baja actividad física. Se midieron edad, sexo, estado civil, nivel educativo, ingresos del hogar, número de trastornos crónicos y capacidad funcional. Se realizó un análisis descriptivo ponderado por edad y sexo. Se estimó la asociación con odds ratio (OR) e intervalos de confianza (IC).ResultadosLa tasa de respuesta obtenida fue del 73,3%, el 48,6% eran hombres y la mediana de edad fue de 76 años (71–83). La prevalencia de fragilidad estimada en la población de estudio fue del 10,3% (IC del 95%: 8,2–12,5): el 8,1% en hombres y el 11,9% en mujeres (p=0,084).ResultadosLa fragilidad se asoció de forma independiente a edad superior a los 85 años (OR=3,61; IC del 95%: 1,26–10,29), a bajo nivel educativo (OR=1,71; IC del 95%: 1,01–2,90), a comorbilidad (OR=1,27; IC del 95%: 1,03–1,56 por cada proceso crónico) y a discapacidad (OR=15,61; IC del 95%: 8,88–27,45).ConclusionesLa prevalencia de fragilidad en una población española de mayores de 65 años es similar a estudios publicados en otros países. En nuestro medio, la población potencialmente beneficiaria del cribado de fragilidad serían los mayores de 85 años y los individuos con múltiples procesos crónicos y con bajo nivel educativo(AU)

AimTo estimate prevalence of frailty, by Fried criteria, in a Spanish urban old population, and to analyse relationship with comorbidity and disability.PopulationAged ≥65 living in Peñagrande area (Fuencarral district in Madrid, Spain).DesignCross-sectional study. Baseline evaluation of "Cohort of Peñagrande" established in 814 person.MeasurementsFrailty was defined by the presence of ≥3 of the following criteria: unintentional weight loss, weakness (grip strength), exhaustion, low walking speed, and low physical activity. Age, gender, marital status, educational level, global income at home, comorbidity and disability were measured. A descriptive bivariate and multivariate analysis was performed and ponderated by age and gender in study population. Association was estimated by Odds Ratio and confidence intervals (OR, IC 95%).Results73,3% participated (N=814), 48,6% were men and the median age was 76 [71–83]. The estimated prevalence of frailty in the study population was 10,3% (IC95%: 8,2–12,5): 8,1% male and 11,9% female (p=0.084).ResultsFrailty was associated with aged ≥85 (OR=3,61; IC95%: 1,26–10,29), low educational level (OR=1,71; IC95%: 1,01–2,90), comorbidity (OR=1,27; IC95%:1,03–1,56 by each process) and disability (OR=15,61; IC95%: 8,88–27,45).ConclusionsPrevalence of frailty in an elderly spanish population is similar to international studies. In our environment first beneficiary population for frailty detection is constituted by people aged ≥85, and those with comorbidity and low educational level(AU)