Factores asociados al deterioro funcional en adultos mayores sobrevivientes de COVID-19 hospitalizados en un centro de tercer nivel / Factors associated with functional decline in COVID-19 elderly survivors hospitalized in a tertiary care center

Resumen Antecedentes: La información acerca del deterioro funcional después de una hospitalización por COVID-19 es limitada en personas mayores (PM). Objetivo: Determinar la asociación entre marcadores de inflamación (ferritina), coagulación (dímero D), factores clínicos y el estado funcional de PM que padecieron COVID-19 a seis meses del alta hospitalaria en México. Material y métodos: Estudio de cohorte ambispectiva de 158 pacientes mayores de 65 años hospitalizados por COVID-19 moderado-grave con expediente electrónico completo que permitiera recolectar información y contactarlos a los seis meses del alta. Se definió deterioro funcional como disminución ≥ 10 puntos del índice de Barthel. Mediante regresión logística se determinó el riesgo de asociación entre factores bioquímicos y clínicos y deterioro funcional en el tiempo de seguimiento. Resultados: 46.2 % de los participantes presentó pérdida funcional. Los factores asociados fueron edad ≥ 73 años (RM = 2.53), enfermedad renal crónica (RM = 4.57), puntuación ABC-Goals ≥ 8 (RM = 2.4), ferritina ≥ 605 ng/mL (RM = 3.94) y dímero-D ≥ 930 ng/mL FEU (RM = 17.56). Conclusión: La infección por COVID-19 no solo representa una enfermedad con alto riesgo de mortalidad durante la fase aguda, sino que también se asocia a un alto riesgo de deterioro funcional posterior al egreso hospitalario.

Abstract Background: The information on functional decline after hospitalization for COVID-19 is limited in older adults (OAs). Objective: To determine the association of inflammation (ferritin) and coagulation markers (D-dimer) and clinical factors with the functional status of OAs who suffered from COVID-19 six months after hospital discharge in Mexico. Material and methods: Ambispective cohort study of 158 patients older than 65 years hospitalized for moderate-severe COVID-19 with complete electronic records that would allow to collect information and to contact them six months after discharge. Functional impairment was defined as a decrease ≥ 10 points on the Barthel index. Using logistic regression analysis, the risk of association of biochemical and clinical factors with functional deterioration during follow-up was determined. Results: 46.2 % of participants exhibited functional decline. Associated factors included age ≥ 73 years (OR = 2.53), chronic kidney disease (OR = 4.57), an ABC-Goals score ≥ 8 (OR = 2.4), ferritin ≥ 605 ng/mL (OR = 3.94) and D-dimer ≥ 930 ng/mL (OR = 17.56). Conclusion: COVID-19 infection did not only represent a disease with a high risk of mortality during the acute phase, but is also associated with a high risk of functional impairment after hospital discharge.

Hospitalized older adult: predictors of functional decline / Pessoa idosa hospitalizada: preditores do declínio funcional / Adultos mayores internados: predictores del deterioro funcional

Objective: to identify the predictors of functional decline in hospitalized individuals aged 70 or over, between: baseline and discharge; discharge and follow-up, and baseline and three-month follow-up. Method: a prospective cohort study conducted in internal medicine services. A questionnaire was applied (clinical and demographic variables, and predictors of functional decline) at three moments. The predictors were determined using the binary logistic regression model. Results: the sample included 101 patients, 53.3% female, mean age of 82.47 ± 6.57 years old. The predictors that most contributed to decline in hospitalization were the following: previous hospitalization (OR=1.8), access to social support (OR=4.86), cognitive deficit (OR=6.35), mechanical restraint (OR=7.82), and not having a partner (OR=4.34). Age (OR=1.18) and medical diagnosis (OR=0.10) were the predictors between discharge and follow-up. Being older, delirium during hospitalization (OR=5.92), and presenting risk of functional decline (OR=5.53) were predictors of decline between the baseline and follow-up. Conclusion: the most relevant predictors were age, previous hospitalization, cognitive deficit, restraint, social support, not having a partner, and delirium. Carrying out interventions aimed at minimizing the impact of these predictors can be an important contribution in the prevention of functional decline.

Objetivo: identificar os preditores do declínio funcional em pessoas hospitalizadas com 70 ou mais anos, entre: baseline e alta; alta e follow-up e baseline e follow-up de três meses. Método: estudo de coorte prospectivo realizado em serviços de medicina interna. Aplicado um questionário (variáveis demográficas, clínicas e preditores do declínio funcional) em três momentos. Os preditores foram determinados utilizando o modelo de regressão logística binária. Resultados: a amostra incluiu 101 pacientes, 53.3% do sexo feminino, idade média de 82,47 ± 6,57 anos. Os preditores que mais contribuíram para o declínio na hospitalização foram: internação prévia (RC=1,8), acesso a apoio social (RC=4,86), déficit cognitivo (RC=6,35), contenção mecânica (RC=7,82) e não ter parceiro(a) (RC=4,34). A idade (RC=1,18) e o diagnóstico médico (RC=0,10) foram os preditores entre a alta e o follow-up. Ser mais velho, delirium durante a hospitalização (RC=5,92) e ter risco de declínio funcional (RC=5,53), foram preditores de declinio entre a baseline e o follow-up. Conclusão: os preditores mais relevantes foram idade, internação prévia, déficit cognitivo, contenção, apoio social, não ter parceiro(a) e delirium. Executar intervenções orientadas para minimizar o impacto destes preditores pode ser um importante contributo na prevenção do declínio funcional.

Objetivo: identificar los predictores del deterioro funcional en personas internadas de al menos 70 años de edad, entre: baseline y alta; alta y follow-up, y baseline y follow-up a los tres meses. Método: estudio de cohorte prospectivo realizado en servicios de Medicina Interna. Se aplicó un cuestionario (variables clínicas y demográficas, y predictores del deterioro funcional) en tres momentos. Los predictores se determinaron por medio del modelo de regresión logística binaria. Resultados: la muestra incluyó a 101 pacientes, 53,3% del sexo femenino, con una media de edad de 82,47 ± 6,57 años. Los predictores que más contribuyeron al deterioro durante la internación fueron los siguientes: internación anterior (OR=1,8), acceso a apoyo social (OR=4,86), déficit cognitivo (OR=6,35), restricción mecánica del movimiento (OR=7,82) y no tener pareja (OR=4,34). La edad (OR=1,18) y el diagnóstico médico (OR=0,10) fueron los predictores entre el alta y el follow-up. Tener edad avanzada, padecer delirium durante la internación (OR=5,92), y presentar riesgo de deterioro funcional (OR=5,53) fueron predictores del deterioro entre la baseline y el follow-up. Conclusión: los predictores más relevantes fueron edad, internación anterior, déficit cognitivo, restricción del movimiento, apoyo social, no tener pareja y delirium. Realizar intervenciones destinadas a minimizar el efecto de estos predictores puede ser un importante aporte para prevenir el deterioro funcional.

Functional outcomes and oncological fatigue among older cancer patients: a cross-sectional study

Abstract Aim: To characterize functional outcomes and oncological fatigue in older cancer patients, and verify the relation of these outcomes with age, number of hospitalizations, and falls within 12-months. Methods: Cross-sectional study involving 116 older adults with cancer undergoing treatment in a hospital in Santiago de Chile. Participants were assessed for independence on the activity of daily living (Barthel index), functional mobility with "timed up and go" (TUG) test, handgrip strength with a Baseline® Hydraulic Hand Dynamometer, and fatigue with Brief Fatigue Inventory. Information about the number of falls and hospitalizations from the previous 12-months was also collected. Results: 21.6% had experienced at least one fall during the previous 12-months, and 52% had been hospitalized over the same period. Handgrip strength was below the cut-off thresholds for older adults and 78.4% were classified with the risk of falls according to the TUG test. Forty-nine percent of participants experienced moderate fatigue, and 58% were dependent to perform activities of daily living. There was a correlation of TUG results with age (r = 0.204; p = 0.028). Conclusions: Older adults with cancer in our study experienced moderate fatigue, a high dependence to perform activities of daily living, especially those associated with mobility, dressing, and bladder or bowel function. Older adults with cancer are more likely to develop functional decline which leads to increased dependency or death. The data suggests they present functional impairment. Physical activity interventions would benefit this population.

Functional mobility problems and cognitive decline in institution-based older adults in Leyte: A correlational study

BACKGROUND@#With the increase of life expectancy, the number of nursing homes accommodating institution-based older adults has also increased. It is important to determine the link between functional decline and cognition among elderlies to assist health care professionals in providing the necessary care to ameliorate the living conditions of elderlies in home institutions. @*METHODS@#This descriptive observational study with correlational design recruited 30 institution-based older adults from three nursing homes in Leyte, Philippines. The researchers used Montreal Cognitive Assessment (MoCA), Timed-Up, and Go Test (TUG) and 10-Meter Walk Test (10MWT) to assess the functionality of the participants and Pearson Product Moment Coefficient Correlation to determine the association between functional mobility and cognitive function. Simple linear regression analysis was employed to determine the level of significance of functional mobility and cognitive function while multivariate linear regression analysis was used to examine the relationship of adjusted covariates. Statistical significance was set at (p˂0.05).@*RESULTS@#The prevalence of probable cognitive impairment was 90%, which was predominant in ≥ 70 years old and male (91.6%). The common functional problems were impairment in dynamic balance and mobility at 70% and gait speed at 73.3%. The result showed significant correlation between the cognition and functional mobility.@*CONCLUSION@#Cognitive impairment is highly prevalent in nursing homes. Institution-based older adults showed impaired dynamic balance and slow speed. Significant correlation between functional mobility problems and cognitive decline in institution-based older persons was established.

Tasa de filtración glomerular y deterioro funcional en una unidad geriátrica de agudos / Glomerular filtration rate and functional decline in an acute geriatric unit

RESUMEN Introducción: una tasa baja de Filtración Glomerular estimada (FGe) se asocia con deterioro funcional. Se sabe poco sobre esa asociación en ancianos hospitalizados. Objetivo: determinar si la disminución de la FGe se asocia a deterioro funcional. Metodología: estudio de cohorte prospectiva, incluyó 1826 pacientes mayores de 60 años hospitalizados en Unidad Geriátrica de Agudos, admitidos entre enero de 2012 y agosto de 2015. El desenlace fue el estado funcional evaluado mediante el Índice de Barthel (IB) en cuatro momentos. La función renal fue estimada según MDRD-4, se agruparon en cuatro categorías según FGe (normal ≥90, leve 60-89, moderado 59-30, severo <30). Se usaron modelos de regresión logística multivariada y procedimiento Glimmix para análisis longitudinales. Resultados: edad promedio 82,3±7,2 años, 51 % eran mujeres. En la regresión logística multivariada, un IB≤60 al ingreso estuvo asociado con edad ≥80 años, género femenino, comorbilidad alta, deterioro social, hipoalbuminemia, anemia, MMSE<19; mientras que la falla renal leve o moderada, disminuyen este riesgo. En el análisis longitudinal, la disminución de IB total durante el seguimiento se asoció con edad ≥80 años, género femenino, deterioro social, estancia hospitalaria ≥15 días, comorbilidad alta, hipoalbuminemia y MMSE <19. La presencia de falla renal leve, moderada o severa se asoció con mayor IB a través del tiempo. Conclusiones: una disminución de FGe está asociada con bajo riesgo de deterioro funcional al ingreso y al seguimiento. Estos hallazgos difieren de reportes previos en la literatura.

SUMMARY Introduction: Low estimated Glomerular filtration rate (eGFR) is associated with functional decline. Little is known on that association in hospitalized elderly. Objective: Determine if low eGFR is associated with functional decline. Methods: Prospective cohort study that included 1826 patients 60 years and older hospitalized in a Geriatric Acute Unit, admitted between January 2012 and August 2015. The outcome was functional status assessed four times by the Barthel Index (BI). Kidney function was estimated by MDRD-4 IDMS and was grouped into four categories according to eGFR (normal ≥90, mild 60-89, moderate 59-30, severe <30). Multivariate logistic regression models and GLIMMIX procedure for longitudinal analyzes were used. Results: Mean age was 82.3±7.2 years, 51 % were women. In multivariate logistic regression, a BI≤60 at admission was associated with age ≥80, female gender, high comorbidity, social deterioration, hypoalbuminemia, anemia, MMSE<19, while the presence of mild or moderate renal failure reduced this risk. In the longitudinal analysis, lower total BI at follow-up was associated with age ≥80, female gender, social deterioration, hospital stay ≥15 days, high comorbidity, hypoalbuminemia, MMSE<19. The presence of mild, moderate or severe renal impairment was associated with higher BI over time. Conclusions: A low eGFR was associated with lower risk for functional decline at admission and overtime. These findings differ from previous reports in the literature.

Frontotemporal dementia: clinical, neuropsychological, and neuroimaging description / Demencia frontotemporal: descripción clínica, neuropsicológica e imaginológica

Objetivo: To describe the relation between the clinical, neuropsychological, and brain imaging findings in a group of patients with fronto temporal dementia. Methods: A sample of 21 patients was collected, and their charts, cognitive profiles, and brain imagines were reviewed; all patients were evaluated as outpatients at the Hospital Psiquiátrico Universitario del Valle, in Cali, Colombia. Results: The mean age was 59.8 years old, the time elapsed between the beginning of the symptoms and the diagnosis was 2.7 years, the more frequent variant was the behavioral one, the main alteration at the magnetic resonance imaging was the frontotemporal atrophy, and the more frequent alteration on the brain SPECT was the frontotemporal hypo perfusion. On the cognitive evaluation the main finding was the normal scoring in praxis, which was related to a temporo parietal hypo perfusion at the brain SPECT (p <0.02). Mimnimental either CLOX were useful as screening tests.

Objetivo: Describir la relación entre los hallazgos clínicos, neuropsicológicos e imagenológicos en un grupo de pacientes con el diagnóstico de DFT. Métodos: Se revisaron las historias clínicas, pruebas cognitivas e imágenes cerebrales estructurales y de perfusión de 21 pacientes del Hospital Psiquiátrico Universitario del Valle, Cali, Colombia. Resultados: El promedio de edad fue de 59.8 años, el tiempo de evolución de la enfermedad fue de 2.7 años, la variante más frecuente fue la comportamental, la alteración más frecuente en la RMN fue la atrofia frontotemporal y en el SPECT fue la hipoperfusión frontotemporal. El hallazgo más importante fue el rendimiento normal del 61.9% de los pacientes en pruebas de praxis, la cual se relacionó con alteración en la perfusión temporo parietal en el SPECT (p <0.02). El minimental ni el clox sirvieron como pruebas de tamizaje.