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

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

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

Prehabilitation and perioperative geriatric care in patients aged over 80 years with colorectal cancer: Results of a cross-speciality geriatrics program.

OBJECTIVES: To describe a perioperative cross-speciality geriatrics program for patients aged >80 years with colorectal cancer (CRC), aimed to detect and manage frailty and to understand its influence on clinical outcomes. MATERIALS AND METHODS: Patients aged >80 years with CRC and proposed for surgery were included from October 2018 to March 2020. Comprehensive geriatric assessments (CGA) were performed. Patients were classified according to the estimated physiological reserve, from fit, frail patients and even the disabled: CGA-1, CGA-2, CGA-3, and CGA-4. Individualised treatment was adapted to each patient's situation. Patients who underwent surgery were followed up by a geriatrician. The presence of complications, length of stay, hospital readmissions at 30 days, and short- and long-term mortality were recorded. RESULTS: Seventy-four patients were included. The mean age was 84.5 ± 4.5 years. 55.4% patients were classified as CGA-1, 24.3% as CGA-2, 16.2% as CGA-3, and 4.1% as CGA-4. No CGA-4 patient was operated on. Frail (CGA-2 and CGA-3) patients had higher medical complications (50% vs 21.2%, p < 0.05) and delirium (30% vs 9.1%, p < 0.05) than fit patients (CGA-1). They also had higher rates of surgical complications (20% vs 15.2%), longer hospital stay (10 ± 6.2 vs 8.4 ± 4.2 days), 30-day readmissions (15% vs 6.3%), and mortality at six (10% vs 3%) and twelve months (20% vs 6.1%), although it was not statistically significant. CONCLUSION: CGA and prehabilitation can classify patients according to their frailty status, support clinicians in decision-making to achieve tailored treatment, and detect clinical conditions for intervention in multiple domains of health in the perioperative period.

Improving hip fracture care in Spain: evolution of quality indicators in the Spanish National Hip Fracture Registry.

This study was carried out to analyze the evolution of the quality indicators in the Spanish National Hip Fracture Registry, after disseminating a series of recommendations based on available clinical practice guidelines to the participating hospitals. Six of the seven proposed quality indicators showed a significant improvement. PURPOSE: The Spanish National Hip Fracture Registry (RNFC) arises from the need to know the process and improve the quality of care. Our goal was to analyze the changes in the RNFC's quality indicators after an intervention based on disseminating specific recommendations among the participating hospitals, following available clinical practice guidelines. METHODS: Study comparing before and after performing an intervention in hospitals participating in the RNFC. Data from the hospitals that registered cases in 2017, and that kept registering cases in 2019. Seven quality indicators were chosen, and a standard to be achieved for each indicator was proposed. The intervention consisted in the dissemination of 25 recommendations with practical measures to improve each quality indicator, based on available clinical practice guidelines, by drafting and publishing a scientific paper and sending it via email and printed cards. Fulfilment of each quality indicator was measured after carrying out the intervention. RESULTS: Forty-three hospitals registered 2674 cases between January and May, 2017, and 8037 during 2019. The quality indicators chosen and the degree of compliance were (all with p<0.05): (1) surgery ≤48 h increased from 38.9 to 45.8%; (2) patients mobilised on the first postoperative day increased from 58.9 to 70.3%; (3) patients with anti-osteoporotic medication at discharge increased from 34.5 to 49.8%; (4) patients with calcium supplements at discharge increased from 48.7 to 62.8%; (5) patients with vitamin D supplements at discharge increased from 71.5 to 84.7%; (6) patients developing a grade >2 pressure ulcer during admission decreased from 6.5 to 5.0%; (7) patients able to move on their own at 1 month fell from 58.8 to 56.4%. More than 48% of hospitals improved the proposed indicators. CONCLUSION: Establishing quality indicators and standards and intervening through the dissemination of specific recommendations to improve these indicators achieved an improvement in hospital performance results on a national level.

[Evolution of COVID-19 at nursing homes from the second wave to vaccination. Description of a coordination program between Primary Care, Geriatrics and Public Health.] / Evolución de la COVID-19 en las residencias de personas mayores desde la segunda ola hasta la vacunación. Descripción de un programa de coordinación entre Atención Primaria, Geriatría y Salud Pública.

OBJECTIVE: Nursing homes have suffered in a particularly pronounced way from the effects of COVID-19 so it is very convenient to know the evolution in them of the disease and the impact of SARS-CoV2 vaccination The objective of this study was to analyze COVID-19 pandemic evolution from the start of the second wave to the end of the vaccination campaign at the nursing homes. A coordination program between Primary Care and Geriatrics and Public Health services was activated. METHODS: 2,668 seniors were followed at 39 nursing homes. Data from new cases, active cases, mortality and place of treatment of COVID-19 were collected. A descriptive analysis was performed with the measurement of the absolute number of positive SARS-CoV-2 cases and the frequency distribution. RESULTS: Between August 7th 2020 and February 26th 2021, 30 outbreaks occurred at 21 nursing homes. 300 people tested positive for SARS-CoV-2 (11% of total residents). The daily average of active cases was 27,166 were hospitalized (55%). 66 patients died (22% of those infected), 54 of them (78%) at the hospital. 1,984 PCR tests were performed. The temporary profile of new cases did not follow a distribution "in waves" as in the community. Thirty-seven days after the start of the second dose of vaccination, there were no active cases until March 1st, when new cases were under study for possible vaccine leakage. CONCLUSIONS: The incidence of COVID-19 at nursing homes after the first wave of the pandemic has apparently been lower. The transmission in these centers has followed a different distribution than at community. Mass vaccination has achieved the practical disappearance of the disease.

OBJETIVO: Los centros residenciales han sufrido de una manera especialmente acusada los efectos de la COVID-19 por lo que es muy conveniente conocer la evolución en ellos de la enfermedad y el impacto de la vacunación frente al SARS-CoV2. El objetivo de este estudio fue conocer la evolución de la pandemia de COVID-19 desde el comienzo de la segunda ola hasta el final del proceso de vacunación en las residencias de personas mayores de un área sanitaria, en la cual se activó un programa de coordinación entre Atención Primaria y los servicios de Geriatría y Salud Publica. METODOS: Se siguió a 2.668 personas mayores en 39 residencias. Se recogieron datos de casos nuevos, activos, fallecidos y lugar de tratamiento de la COVID-19. Se realizó un análisis descriptivo con la medición del número absoluto de casos positivo de SARS-CoV-2 y la distribución de frecuencias. RESULTADOS: Entre el 7 de agosto de 2020 y el 26 de febrero de 2021 se produjeron 30 brotes en 21 residencias. Se detectaron 300 casos positivos de SARS-CoV-2 (11% de los residentes totales). La media diaria de casos activos fue 27. Fueron hospitalizados 166 (55%). Fallecieron 66 pacientes (22% de los infectados), 54 de ellos (78%) en el hospital. Se realizaron 1.984 test PCR. El perfil temporal de aparición de casos nuevos no siguió una distribución "en olas" como en la comunidad. Treinta y siete días después del inicio de la segunda dosis de vacunación, no existieron casos activos hasta el 1 de marzo en que aparecieron nuevos casos en estudio por posible escape vacunal. CONCLUSIONES: La incidencia de la COVID-19 en las residencias de personas mayores tras la primera ola de la pandemia es aparentemente inferior. La transmisión en estos centros sigue una distribución diferente a la de la comunidad. El efecto de la vacunación masiva consigue la práctica desaparición de la enfermedad.

First proposal of quality indicators and standards and recommendations to improve the healthcare in the Spanish National Registry of Hip Fracture / Primera propuesta de indicadores y estándares de calidad y recomendaciones de mejora de la atención en el Registro Nacional de Fractura de Cadera

Background: The Spanish National Hip Fracture Registry (or Registro Nacional de Fractura de Cadera, RNFC) is a database of hip fracture patients admitted to Spanish hospitals. Its goals include assessment and continuous improvement of the care process. Objectives: To (1) establish a series of indicators, (2) evaluate their initial fulfillment, (3) propose quality standards, (4) suggest recommendations to facilitate standards compliance, and (5) monitor the indicators. Method: The indicators fulfilled the criteria of (1) evaluating the process or outcome, (2) being clinically relevant for patients, (3) being modifiable through changes in healthcare practice, and (4) being considered important by the RNFC participants. The first quartile obtained by the group of hospitals in each of the respective variables was proposed as the standard. The Indicators Advisory Committee (IAC) elaborated a list of recommendations for each indicator, based on the available evidence. Results: Seven indicators were chosen. These indicators (its baseline compliance vs. the standard to be reached, respectively) were: the proportion of patients receiving surgery within 48h (44% vs. 63%), mobilized the first postoperative day (56% vs. 86%), with antiosteoporotic medication at discharge (32% vs. 61%), with calcium supplements at discharge (46% vs. 77%), with vitamin D supplements at discharge (67% vs. 92%), who developed pressure ulcers during hospitalization (7.2% vs. 2.1%) and with independent mobility at 30 days (58% vs. 70%). The IAC has established 25 recommendations for improving care. Conclusion: The indicators and standards chosen are presented, as well as the list of recommendations. This process completes the first step to improve quality of care. The results will be evaluated 6 months after implementing the recommendations

Antecedentes: El Registro Nacional de Fractura de Cadera (RNFC) es una base de datos de pacientes con fractura de cadera ingresados en hospitales españoles. Entre sus objetivos se encuentran el conocimiento y la mejora continua del proceso asistencial. Objetivos: 1) establecer una serie de indicadores, 2) evaluar su cumplimiento inicial, 3) proponer unos estándares, 4) sugerir recomendaciones para facilitar el cumplimiento de los estándares y 5) realizar una monitorización de los indicadores. Método: Los indicadores cumplían los criterios de: 1) evaluar proceso o resultados, 2) tener relevancia clínica para los pacientes, 3) ser potencialmente modificables mediante cambios en la práctica asistencial y 4) ser considerados importantes por los participantes del RNFC. Se propuso como estándar el primer cuartil obtenido por el grupo de hospitales en cada una de las variables respectivas. El Comité de Indicadores (CI) elaboró una lista de recomendaciones basadas en la evidencia disponible. Resultados: Se eligieron 7 indicadores. Estos indicadores (con su grado de cumplimiento inicial vs. el estándar a alcanzar, respectivamente) fueron la proporción de pacientes intervenidos en menos de 48h (44 vs. 63%), levantados el primer día del postoperatorio (56 vs. 86%), con tratamiento anti-osteoporótico al alta (32 vs. 61%), con tratamiento de calcio al alta (46 vs. 77%), con tratamiento de vitamina D al alta (67 vs. 92%), que desarrollaron úlceras por presión durante la hospitalización (7,2 vs. 2,1%) y con movilidad independiente a los 30 días (58 vs. 70%). El CI ha establecido una serie de 25 recomendaciones para la mejora asistencial. Conclusión: Se presentan los indicadores y estándares elegidos, así como las recomendaciones. Este proceso completa el primer paso de mejora de calidad asistencial, cuyo resultado deberá ser evaluado tras 6 meses de implementación de las recomendaciones elegidas

First proposal of quality indicators and standards and recommendations to improve the healthcare in the Spanish National Registry of Hip Fracture.

BACKGROUND: The Spanish National Hip Fracture Registry (or Registro Nacional de Fractura de Cadera, RNFC) is a database of hip fracture patients admitted to Spanish hospitals. Its goals include assessment and continuous improvement of the care process. OBJECTIVES: To (1) establish a series of indicators, (2) evaluate their initial fulfillment, (3) propose quality standards, (4) suggest recommendations to facilitate standards compliance, and (5) monitor the indicators. METHOD: The indicators fulfilled the criteria of (1) evaluating the process or outcome, (2) being clinically relevant for patients, (3) being modifiable through changes in healthcare practice, and (4) being considered important by the RNFC participants. The first quartile obtained by the group of hospitals in each of the respective variables was proposed as the standard. The Indicators Advisory Committee (IAC) elaborated a list of recommendations for each indicator, based on the available evidence. RESULTS: Seven indicators were chosen. These indicators (its baseline compliance vs. the standard to be reached, respectively) were: the proportion of patients receiving surgery within 48h (44% vs. 63%), mobilized the first postoperative day (56% vs. 86%), with antiosteoporotic medication at discharge (32% vs. 61%), with calcium supplements at discharge (46% vs. 77%), with vitamin D supplements at discharge (67% vs. 92%), who developed pressure ulcers during hospitalization (7.2% vs. 2.1%) and with independent mobility at 30 days (58% vs. 70%). The IAC has established 25 recommendations for improving care. CONCLUSION: The indicators and standards chosen are presented, as well as the list of recommendations. This process completes the first step to improve quality of care. The results will be evaluated 6 months after implementing the recommendations.

Eficiencia de las unidades de agudos de geriatría frente al resto de servicios hospitalarios. Análisis de la casuística de 5 años ajustada por GRD / Efficiency of the acute geriatric units compared to the rest of the hospital departments. A 5-year audit of the case-mix adjusted for diagnosis-related group

Introducción: La ocupación hospitalaria por pacientes mayores es elevada y lo será aún más en los próximos años. Sus estancias suelen ser más prolongadas, por lo que es importante que los hospitales desarrollen estructuras con la mayor eficiencia posible. Método: En un complejo hospitalario de 1.200 camas con dos unidades de geriatría de agudos (UGA), una en el hospital general (HG) y otra en un hospital de apoyo (HA), se analizaron las altas de los 15 grupos relacionados con el diagnóstico (GRD) más frecuentes en geriatría durante 5años y se compararon las estancias de los pacientes mayores de 75años en ambas UGA con las del resto de servicios de sus respectivos centros. Resultados: Se incluyeron 14.948 altas, cuyas estancias fueron 2,9días (25% de la estancia) inferiores en las UGA que en el resto de servicios. Las diferencias en la unidad del HG fueron del 22% (9,2 vs 11,7días) en 2011, del 16% (9,3 vs 11,1días) en 2012, del 21% (9,3 vs 11,1días) en 2013, del 34% (7,4 vs 11,1días) en 2014 y del 25% (8,3 vs 11días) en 2015. Las diferencias en la unidad del HA fueron del 18% (10,4 vs 12,7días) en 2011, del 19% (9,5 vs 11,7días) en 2012, del 25% (8,8 vs 11,7días) en 2013, del 24% (8,8 vs 11,6días) en 2014 y del 32% (9 vs 13,1días) en 2015, todas las diferencias con p<0,05. Conclusiones: Las UGA son un 25% más eficientes que el resto de servicios en el ingreso de pacientes mayores de 75años

Introduction: Hospital occupancy rate by older patients is high, and it will be even higher in the future. Their hospital stay is usually longer, making it important for hospitals to develop structures with the best efficiency possible. Method: Hospital discharges of patients older than 75years with the 15 most frequent Diagnosis-Related Groups (DRG) in Geriatrics were recorded during a 5-year period in a 1,200-bed hospital. Length of stay was compared between the two acute geriatric units (AGU), one in the general hospital (GH) and another in an affiliate hospital (AH), as well as with the rest of departments. Results: A total of 14,948 discharged patients were included. Length of stay was 2.9 (25%) days shorter in AGU units than in the rest of departments. Differences were 22% (9.2 vs 11.7days) in 2011, 16% (9.3 vs 11.1days) in 2012, 21% (9.3 vs 11.1days) in 2013, 34% (7.4 vs 11.1days) in 2014, and 25% (8.3 vs 11days) in 2015 in the GH. Differences were 18% (10.4 vs 12.7days) in 2011, 19% (9.5 vs 11.7days) in 2012, 25% (8.8 vs 11.7days) in 2013, 24% (8.8 vs 11.6days) in 2014, and 32% (9 vs 13.1days) in 2015 at the AH, all of them with a P<.05. Conclusions: AGU are 25% more efficient than the rest of hospital departments in managing hospital admissions of patients older than 75years

Registro de fracturas de cadera multicéntrico de unidades de Ortogeriatría de la Comunidad Autónoma de Madrid / Multi-centre register study of hip fractures in Orthogeriatric Units in the Community of Madrid (Spain)

Objetivos: Describir las características de pacientes con fractura de cadera (FC) ingresados desde enero de 2015 a diciembre de 2016 en ocho unidades de Ortogeriatría de hospitales públicos de la Comunidad Autónoma de Madrid. Material y métodos: Estudio descriptivo, prospectivo y multicéntrico. Se constituyó en 2014 un grupo de trabajo en FC; se invitó a la participación a todos los hospitales con algún tipo de asistencia conjunta entre Traumatología y Geriatría, participando los geriatras responsables de la unidad de Ortogeriatría de ocho hospitales. Se consensuó una base de datos con las variables con impacto en resultados de salud (sociodemográficas, clínicas y evolutivas durante el proceso asistencial). Resultados: Se incluyeron 3.995 pacientes; el 76,3% eran mujeres, y la edad media fue de 85,3años (rango 58-108años). El 67% fueron clasificados según el Physical Status Classification System de la American Society of Anesthesiologist (ASA) como III-IV. Se intervinieron el 96,7% de los pacientes (el 35,9% de ellos en las primeras 48h del ingreso, con una mediana de tiempo de retraso quirúrgico de 3días). La principal causa del retraso quirúrgico fueron los problemas logísticos en el 43,5% de los casos. La estancia hospitalaria media fue de 11,2días. Precisaron trasfusión el 53,1%. La mortalidad durante el ingreso fue del 5,3%. Conclusiones: Los registros de FC son un elemento imprescindible para conocer el proceso de atención a estos pacientes y poder aprender y mejorar la calidad asistencial. Nuestros resultados se adecúan a los de otros registros internacionales. Se debe mejorar el tiempo de espera prequirúrgica, consiguiendo intervenir en las primeras 48h a todos los pacientes sin datos de inestabilidad clínica. Igualmente se precisa mayor dotación de recursos de recuperación funcional y mayor uniformidad de estos

Objective: To describe the characteristics of patients with hip fractures admitted over a period of two years (from January 2015 to December 2016) in eight Orthogeriatric Units in public hospitals of the Community of Madrid. Material and method: This is a descriptive, prospective and multi-centre study. In 2014, all hospitals in Madrid providing joint Geriatric and Traumatology assistance were invited to a recently created orthogeriatric work group. Geriatricians in charge of the Orthogeriatric Unit from eight hospitals took part in this study. The participants established a database including all variables that influenced health outcomes (socio-demographic and clinical variables). Results: The study includes 3,995 patients, with a mean age of 85.3years (range: 58-108years old). Two-thirds of them were ASA (American Society Physical Status Classification System) III-IV. Almost all (96.7%) of the patients underwent a surgical operation, and 35.9% of them were operated during the first 48hours. The delay was mainly due to logistic problems (43.5%). The mean hospital stay was 11.2days. Just over half (53.1%) of the patients required a blood transfusion. In-hospital mortality was 5.3%. Discussion: Hip fracture registries are essential tools to monitor the healthcare process of these patients, as well as to improve the quality of care. Our results are similar to other records. It would be necessary to improve pre-operative time, which must be less than 48hours in patients without clinical instability. We also need more resources for functional recovery and more uniformity

[Multi-centre register study of hip fractures in Orthogeriatric Units in the Community of Madrid (Spain)]. / Registro de fracturas de cadera multicéntrico de unidades de Ortogeriatría de la Comunidad Autónoma de Madrid.

OBJECTIVE: To describe the characteristics of patients with hip fractures admitted over a period of two years (from January 2015 to December 2016) in eight Orthogeriatric Units in public hospitals of the Community of Madrid. MATERIAL AND METHOD: This is a descriptive, prospective and multi-centre study. In 2014, all hospitals in Madrid providing joint Geriatric and Traumatology assistance were invited to a recently created orthogeriatric work group. Geriatricians in charge of the Orthogeriatric Unit from eight hospitals took part in this study. The participants established a database including all variables that influenced health outcomes (socio-demographic and clinical variables). RESULTS: The study includes 3,995 patients, with a mean age of 85.3years (range: 58-108years old). Two-thirds of them were ASA (American Society Physical Status Classification System) III-IV. Almost all (96.7%) of the patients underwent a surgical operation, and 35.9% of them were operated during the first 48hours. The delay was mainly due to logistic problems (43.5%). The mean hospital stay was 11.2days. Just over half (53.1%) of the patients required a blood transfusion. In-hospital mortality was 5.3%. DISCUSSION: Hip fracture registries are essential tools to monitor the healthcare process of these patients, as well as to improve the quality of care. Our results are similar to other records. It would be necessary to improve pre-operative time, which must be less than 48hours in patients without clinical instability. We also need more resources for functional recovery and more uniformity.

[Efficiency of the acute geriatric units compared to the rest of the hospital departments. A 5-year audit of the case-mix adjusted for diagnosis-related group]. / Eficiencia de las unidades de agudos de geriatría frente al resto de servicios hospitalarios. Análisis de la casuística de 5 años ajustada por GRD.

INTRODUCTION: Hospital occupancy rate by older patients is high, and it will be even higher in the future. Their hospital stay is usually longer, making it important for hospitals to develop structures with the best efficiency possible. METHOD: Hospital discharges of patients older than 75years with the 15 most frequent Diagnosis-Related Groups (DRG) in Geriatrics were recorded during a 5-year period in a 1,200-bed hospital. Length of stay was compared between the two acute geriatric units (AGU), one in the general hospital (GH) and another in an affiliate hospital (AH), as well as with the rest of departments. RESULTS: A total of 14,948 discharged patients were included. Length of stay was 2.9 (25%) days shorter in AGU units than in the rest of departments. Differences were 22% (9.2 vs 11.7days) in 2011, 16% (9.3 vs 11.1days) in 2012, 21% (9.3 vs 11.1days) in 2013, 34% (7.4 vs 11.1days) in 2014, and 25% (8.3 vs 11days) in 2015 in the GH. Differences were 18% (10.4 vs 12.7days) in 2011, 19% (9.5 vs 11.7days) in 2012, 25% (8.8 vs 11.7days) in 2013, 24% (8.8 vs 11.6days) in 2014, and 32% (9 vs 13.1days) in 2015 at the AH, all of them with a P<.05. CONCLUSIONS: AGU are 25% more efficient than the rest of hospital departments in managing hospital admissions of patients older than 75years.

Cambios en la percepción de los alumnos de medicina sobre la geriatría tras una rotación clínica docente / Changes in the perception of medical students towards Geriatrics after a clinical-teaching rotation

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Mujer de 83 años con disnea y edemas en miembros inferiores / An 83 year old woman with dyspnoea and oedema of the lower limbs

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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)

Ortogeriatría en pacientes agudos: actuar, pero también evaluar y comparar, como medidas para mejorar / Orthogeriatrics in acute patients: To act, but also assess and compare as a way to improve

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[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.

La unidad de ortogeriatría de agudos. Evaluación de su efecto en el curso clínico de los pacientes con fractura de cadera y estimación de su impacto económico / The acute orthogeriatric unit. Assessment of its effect on the clinical course of patients with hip fractures and an estimate of its financial impact

Objetivos. Estudiar los efectos del tratamiento de los pacientes con fractura de cadera en una unidad ortogeriátrica conjunta entre los servicios de traumatología y geriatría comparados con el tratamiento hospitalario habitual y analizar las diferencias de costes entre ambos sistemas de asistencia. Material y métodos. Estudio prospectivo cuasi-experimental de intervención, aleatorizado, en 506 pacientes ingresados en un hospital terciario con el diagnóstico de fractura de cadera osteoporótica. El sistema habitual de tratamiento fue el ingreso a cargo de traumatología con interconsulta a geriatría (tipo IC) y el sistema a estudio consistió en el ingreso en una unidad ortogeriátrica (UOG) para el tratamiento conjunto integrado entre los especialistas en traumatología y geriatría. Éste incluyó la designación de un interlocutor único por cada servicio, seguimiento por la enfermera de ortogeriatría, valoración geriátrica precoz, atención clínica diaria coordinada, pase de visita conjunto semanal y planificación coordinada de la programación quirúrgica, del inicio de la deambulación y del destino y momento del alta. Resultados. Se incluyó a 255 pacientes consecutivos ingresados en la UOG y 251 tratados simultáneamente mediante IC. No existieron diferencias, salvo por una edad ligeramente inferior en el grupo de UOG, en las características previas ni en la tasa de intervención quirúrgica de ambos grupos. En los pacientes de la UOG fue más frecuente recibir rehabilitación en la fase aguda, ser capaz de caminar al alta y ser derivado a unidades de recuperación funcional (todas con p<0,05). Los pacientes ingresados en la UOG recibieron una valoración geriátrica más precoz y fueron intervenidos antes que los tratados mediante IC (p<0,01). La estancia en la planta de agudos fue un 34% menor en los pacientes de la UOG (media 12,48±5 frente a 18,9±8,6 días; p<0,001) (mediana de 12 [9-14] días frente a 17 [13-23]; p<0,001). La estancia hospitalaria total, incluida la estancia en las unidades de recuperación funcional, fue un 11% menor en los pacientes de la UOG (media 21,16±14,7 frente a 23,9±13,8 días; p<0,001) (mediana 14 [10-31] frente a 20 [14-30] días; p<0,001). La UOG obtuvo un ahorro de costes por paciente de entre 1.207 € y 1.633 € mediante el modelo de coste por proceso y de 3.741 € mediante el modelo de costes por estancias. Conclusiones. La UOG es un nivel asistencial que aporta mejoras en la evolución funcional de los pacientes y una reducción total de estancias hospitalarias. En base a ello reduce los costes de asistencia. Estos resultados hacen recomendable este sistema de atención a los pacientes con fractura de cadera en fase aguda(AU)

Objective. To study the effects of the management of hip fracture patients in an acute orthogeriatric unit shared between the departments of Orthopedic Surgery and Geriatrics compared with the usual hospital care, and to analyse financial differences in both systems of care. Method. Prospective quasy-experimental randomized intervention study in 506 patients admited to a terciary hospital with an osteoporotic hip fracture. The usual model of care was the admission to the orthopedic ward with a request to Geriatrics (RC) and the study model consisted of the admission to an orthogeriatric unit (OGU) for the shared co-management between orthopaedic surgeons and geriatricians. This model included the appointment of one spokesperson from each department, the specialist geriatric nurse management, early geriatric assessment, shared daily clinical care, weekly joint ward round and coordinated planning of the surgery schedule, the start of the ambulation and the time and setting of patient discharge. Results. Two hundred fifty five consecutive patients admitted to the OGU and 251 patients managed simultaneusly by the RC model were included. Except for a mean age slightly lower in the OGU group, there were no differences neither in the baseline patients characteristics nor in the surgical rates between the two groups. Among the OGU patients group it was more frequent to receive rehabilitation in the acute setting, to be able to walk at discharge and to be referred to a geriatric rehabilitation unit (all with P<.05). The OGU patients received geriatric assessment and were operated on earlier than the RC patients (P<.001). The length of stay in the acute ward was 34% shorter in the OGU patients (mean 12.48±5 vs 18.9±8.6 days, P<.001) (median 12 [9-14] vs 17 [13-23] days, P<.001). The whole hospital length of stay, including the days spent in the geriatric rehabilitation units, was 11% shorter in the OGU patients (mean 21.16 ±14.7 vs 23.9 ±13.8 days, P<0.05) (median 14 [10-31] vs 20 [14-30] days, P<.001). The OGU saved 1,207 € to 1,633 € per patient when estimated by the costs for process model, and 3,741 € when estimated by the costs for stay model. Conclusions. The OGU is a hospital setting that provides an improvement in the patients functional outcome and a reduction in the hospital length of stay. Therefore it saves health care resources. These findings show the OGU as an advisable setting for the acute care of hip fracture patients(AU)

[The acute orthogeriatric unit. Assessment of its effect on the clinical course of patients with hip fractures and an estimate of its financial impact]. / La unidad de ortogeriatría de agudos. Evaluación de su efecto en el curso clínico de los pacientes con fractura de cadera y estimación de su impacto económico.

OBJECTIVE: To study the effects of the management of hip fracture patients in an acute orthogeriatric unit shared between the departments of Orthopedic Surgery and Geriatrics compared with the usual hospital care, and to analyse financial differences in both systems of care. METHOD: Prospective quasy-experimental randomized intervention study in 506 patients admitted to a terciary hospital with an osteoporotic hip fracture. The usual model of care was the admission to the orthopedic ward with a request to Geriatrics (RC) and the study model consisted of the admission to an orthogeriatric unit (OGU) for the shared co-management between orthopaedic surgeons and geriatricians. This model included the appointment of one spokesperson from each department, the specialist geriatric nurse management, early geriatric assessment, shared daily clinical care, weekly joint ward round and coordinated planning of the surgery schedule, the start of the ambulation and the time and setting of patient discharge. RESULTS: Two hundred fifty five consecutive patients admitted to the OGU and 251 patients managed simultaneously by the RC model were included. Except for a mean age slightly lower in the OGU group, there were no differences neither in the baseline patients characteristics nor in the surgical rates between the two groups. Among the OGU patients group it was more frequent to receive rehabilitation in the acute setting, to be able to walk at discharge and to be referred to a geriatric rehabilitation unit (all with P < .05). The OGU patients received geriatric assessment and were operated on earlier than the RC patients (P < .001). The length of stay in the acute ward was 34% shorter in the OGU patients (mean 12.48 ± 5 vs 18.9 ± 8.6 days, P < .001) (median 12 [9-14] vs 17 [13-23] days, P < .001). The whole hospital length of stay, including the days spent in the geriatric rehabilitation units, was 11% shorter in the OGU patients (mean 21.16 ± 14.7 vs 23.9 ± 13.8 days, P < 0.05) (median 14 [10-31] vs 20 [14-30] days, P < .001). The OGU saved 1,207 € to 1,633 € per patient when estimated by the costs for process model, and 3,741 € when estimated by the costs for stay model. CONCLUSIONS: The OGU is a hospital setting that provides an improvement in the patients functional outcome and a reduction in the hospital length of stay. Therefore it saves health care resources. These findings show the OGU as an advisable setting for the acute care of hip fracture patients.