Potentially Inappropriate Prescribing in Older People Living With HIV: A Scoping Review.

BACKGROUND: Antiretroviral therapy has transformed HIV from a progressive and often fatal infection to a chronic disease. Currently, people living with HIV (PLHIV) have near-normal life expectancy; however, they face accelerated ageing and a rise in non-AIDS-defining HIV-associated conditions. Comorbidities increase the number of prescribed drugs and, therefore, the risk of polypharmacy and prescribing potentially inappropriate medications (PIMs). Still, there are no specific tools to identify PIMs in older PLHIV, which opens a pathway to investigate the particularities in the prescription of medication in this population. METHODS: We conducted a scoping review in 5 electronic databases for studies reporting the use of tools to identify PIMs in older PLHIV. No language or date restrictions were applied. To complete the search, abstracts published in the most relevant HIV Conferences and Events in their editions from 2010 to 2022 were screened. RESULTS: Of 50,193 records returned (13,701 of the databases and 36,492 of the Congresses), 39 studies met the inclusion criteria. Most studies were single-centre and conducted in Europe. Twenty-eight studies were cross-sectional, and most researchers used explicit criteria, mainly Beers and STOPP-START criteria, to identify PIMs. CONCLUSIONS: Potentially inappropriate prescribing is frequent among older PLHIV. Explicit conventional tools to identify PIMs in older populations may need to be adapted to tackle the needs of PLHIV. Implicit tools may be more valid, although their use is more time-consuming, and standardization is complex.

Versión en español de los criterios STOPP/START 3. Avances en la detección de la prescripción inapropiada de medicamentos en personas mayores / Spanish version of the STOPP/START 3 criteria: Advances in the detection of inappropriate prescribing medication in the older people

Los criterios STOPP/START son criterios explícitos basados en sistemas fisiológicos que resumen la evidencia sobre problemas de prescripción relevantes clínicamente relacionados con el uso de medicamentos potencialmente inapropiados (criterios STOPP) y con potenciales omisiones de prescripción (criterios START). Las dos versiones anteriores de los criterios STOPP/START se publicaron en 2008 y en 2015, y sus versiones en español, en 2009 y en 2015. En 2023 se acaba de publicar la versión3 de dichos criterios. El objetivo de este artículo es presentar la versión traducida al español, así como revisar la utilización y el impacto que ha tenido la versión2 del año 2015 en nuestro idioma. Se realizó una traducción del inglés al español por profesionales expertos y con alto nivel de inglés de la versión3 de los criterios STOPP/START, que incorporan la evidencia publicada desde abril de 2014 hasta marzo de 2022. Además, se hizo una revisión sistemática de las publicaciones que han usado la traducción española de la versión previa (versión2 de 2015) de los criterios STOPP/START. La nueva versión, presentada en este artículo, cuenta con 190 criterios STOPP/START (133 criterios STOPP y 57 criterios START), lo que supone un aumento del 40% en el número de criterios en comparación con la versión anterior. En la revisión se encontraron 37 estudios (21 observacionales, 11 de intervención y 5 de otro tipo) que han usado la versión española en lugar de la internacional. La versión3 en español de los criterios STOPP/START es una lista explícita actualizada de medicamentos potencialmente inapropiados y posibles omisiones en la prescripción que tienen el objetivo de optimizar la medicación y minimizar las reacciones adversas a los medicamentos durante la revisión de la medicación en las personas mayores, en particular aquellas con multimorbilidad y polifarmacia (AU)

The STOPP/START criteria are explicit physiologic systems-based criteria that summarize evidence on clinically relevant prescribing problems related to the use of potentially inappropriate medications (STOPP criteria) and potential prescribing omissions (START criteria). The two previous versions of the STOPP/START criteria were published in 2008 and 2015, and their Spanish versions in 2009 and 2015. Version3 of these criteria has just been published in 2023. The aim of this article is to present the Spanish translated version, and to review the use and impact that version2 of 2015 has had in our language. A translation from English to Spanish was performed by expert professionals with a high level of English of version3 of the STOPP/START criteria, which incorporates the evidence published from April 2014 to March 2022. In addition, a systematic review of publications that have used the Spanish translation of the previous version (version2 of 2015) of the STOPP/START criteria was performed. The new version, presented in this article, has 190 STOPP/START criteria (133 STOPP criteria and 57 START criteria), which is a 40% increase in the number of criteria compared to the previous version. The review found 37 studies (21 observational, 11 interventional and 5 other) that used the Spanish version instead of the international version. The Spanish version 3 of the STOPP/START criteria is an updated explicit list of potentially inappropriate medications and possible omissions in prescribing that aims to optimize medication and minimize adverse drug reactions during medication review in the elderly, particularly those with multimorbidity and polypharmacy (AU)

[Spanish version of the STOPP/START 3 criteria: Advances in the detection of inappropriate prescribing medication in the older people]. / Versión en español de los criterios STOPP/START 3. Avances en la detección de la prescripción inapropiada de medicamentos en personas mayores.

The STOPP/START criteria are explicit physiologic systems-based criteria that summarize evidence on clinically relevant prescribing problems related to the use of potentially inappropriate medications (STOPP criteria) and potential prescribing omissions (START criteria). The two previous versions of the STOPP/START criteria were published in 2008 and 2015, and their Spanish versions in 2009 and 2015. Version3 of these criteria has just been published in 2023. The aim of this article is to present the Spanish translated version, and to review the use and impact that version2 of 2015 has had in our language. A translation from English to Spanish was performed by expert professionals with a high level of English of version3 of the STOPP/START criteria, which incorporates the evidence published from April 2014 to March 2022. In addition, a systematic review of publications that have used the Spanish translation of the previous version (version2 of 2015) of the STOPP/START criteria was performed. The new version, presented in this article, has 190 STOPP/START criteria (133 STOPP criteria and 57 START criteria), which is a 40% increase in the number of criteria compared to the previous version. The review found 37 studies (21 observational, 11 interventional and 5 other) that used the Spanish version instead of the international version. The Spanish version 3 of the STOPP/START criteria is an updated explicit list of potentially inappropriate medications and possible omissions in prescribing that aims to optimize medication and minimize adverse drug reactions during medication review in the elderly, particularly those with multimorbidity and polypharmacy. With this new version, the original criteria are intended to be more widely disseminated within the Spanish-speaking healthcare community. The Spanish version2 of the STOPP/START has been widely used, so we consider that the translation into Spanish has helped to improve pharmacotherapy in older patients with polypharmacy and multimorbidity in our linguistic environment.

COVID-19 pandemic and mortality in nursing homes across USA and Europe up to October 2021.

PURPOSE: We compared the prevalence of COVID-19 and related mortality in nursing homes (NHs) in 14 countries until October 2021. We explored the relationship between COVID-19 mortality in NHs with the average size of NHs and with the COVID-19 deaths at a population level. METHODS: The total number of COVID-19 cases and COVID-19-related deaths in all NHs as well as the total number of NHs and NH beds were provided by representatives of 14 countries. The population level respective figures in each country were provided up to October 2021. RESULTS: There was a wide variation in prevalence of COVID-19 cases and deaths between countries. We observed a significant correlation between COVID-19 deaths in NHs and that of the total population and between the mean size of NHs and COVID-19 deaths. CONCLUSION: Side-by-side comparisons between countries allow international sharing of good practice to better enable future pandemic preparedness.

Proactive Geriatric Comanagement of Nursing Home Patients by a New Hospital-Based Liaison Geriatric Unit: A New Model for the Future.

During the SARS-CoV-2 pandemic, hospital-based liaison geriatric units (LGUs) were created in Spanish hospitals with the aim to improve health care coordination between nursing homes (NHs) and hospitals. Our university hospital created a comprehensive, proactive LGU serving 31 public and private NHs of different sizes and characteristics to offer support to more than 2500 residents. In the first 3 months of 2021, this LGU performed 1252 assessments (81% as outpatients, 12% at the emergency department, and 7% during hospitalization), avoiding an estimated 49 hospital transfers and 29 hospitalizations. Other activities included giving NHs support and advice during COVID-19 outbreaks, comanagement of selected residents with other hospital-based specialists (implementing telemedicine), and implementation of a protocol that allowed using drugs only approved for hospital use in selected NHs. This model of LGU has been shown to be feasible, to improve residents' health care, and avoid hospital referrals. Long-term care needs to be re-imagined, and hospital geriatric departments need to prove that they are able to offer expertise to support NH health care professionals.

Peripheral IL-6 Levels but not Sarcopenia Are Predictive of 1-Year Mortality After Hip Fracture in Older Patients.

BACKGROUND: Sarcopenic patients may have an increased risk of poor outcomes after a hip fracture. The objective of this study was to determine whether sarcopenia and a set of biomarkers were potential predictors of 1-year-mortality in older patients after a hip fracture. METHODS: About 150 patients at least 80 years old were hospitalized for the surgical treatment of a hip fracture. The primary outcome measure was the death in the first year after the hip fracture. Sarcopenia was defined at baseline by having both low muscle mass (bioimpedance analysis) and handgrip and using the updated European Working Group on Sarcopenia in Older People (EWGSOP2) definition of probable sarcopenia. Janssen's (J) and Masanés (M) cutoff points were used to define low muscle mass. RESULTS: Mortality 1 year after the hip fracture was 11.5%. In univariate analyses, baseline sarcopenia was not associated with mortality, using neither of the muscle mass cutoff points: 5.9% in sarcopenic (J) versus 12.4% in non-sarcopenic participants (p = .694) and 16% in sarcopenic (M) versus 9.6% in non-sarcopenic participants (p = .285). Probable sarcopenia (EWGSOP2) was not associated with mortality. Peripheral levels of IL-6 at baseline were significantly higher in the group of participants who died in the year after the hip fracture (17.14 ± 16.74 vs 11.42 ± 7.99 pg/mL, p = .026). TNF-α peripheral levels had a nonsignificant trend to be higher in participants who died. No other biomarker was associated with mortality. CONCLUSIONS: Sarcopenia at baseline was not a predictor of 1-year mortality in older patients after a hip fracture. IL-6 was associated with a higher risk of mortality in these patients, regardless of sarcopenia status.

Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial.

BACKGROUND: Multi-morbidity and polypharmacy increase the risk of non-trivial adverse drug reactions (ADRs) in older people during hospitalization. Despite this, there are no established interventions for hospital-acquired ADR prevention. METHODS: We undertook a pragmatic, multi-national, parallel arm prospective randomized open-label, blinded endpoint (PROBE) controlled trial enrolling patients at six European medical centres. We randomized 1,537 older medical and surgical patients with multi-morbidity and polypharmacy on admission in a 1:1 ratio to SENATOR software-guided medication optimization plus standard care (intervention, n = 772, mean number of daily medications = 9.34) or standard care alone (control, n = 765, mean number of daily medications = 9.23) using block randomization stratified by site and admission type. Attending clinicians in the intervention arm received SENATOR-generated advice at a single time point with recommendations they could choose to adopt or not. The primary endpoint was occurrence of probable or certain ADRs within 14 days of randomization. Secondary endpoints were primary endpoint derivatives; tertiary endpoints included all-cause mortality, re-hospitalization, composite healthcare utilization and health-related quality of life. RESULTS: For the primary endpoint, there was no difference between the intervention and control groups (24.5 vs. 24.8%; OR 0.98; 95% CI 0.77-1.24; P = 0.88). Similarly, with secondary and tertiary endpoints, there were no significant differences. Among attending clinicians in the intervention group, implementation of SENATOR software-generated medication advice points was poor (~15%). CONCLUSIONS: In this trial, uptake of software-generated medication advice to minimize ADRs was poor and did not reduce ADR incidence during index hospitalization.

Síndrome serotoninérgico inducido por polifarmacia / Serotoninergic syndrome induced by multiple medications

No disponible

Biomarkers of sarcopenia in very old patients with hip fracture.

BACKGROUND: Hip fracture is both a cause and a consequence of sarcopenia. Older persons with sarcopenia have an increased risk of falling, and the prevalence of sarcopenia may be increased in those who suffer a hip fracture. The aim of this study was to explore potential biomarkers (neuromuscular and peripheral pro-inflammatory and oxidative stress markers) that may be associated with sarcopenia in very old persons with hip fracture. METHODS: We recruited 150 consecutive patients ≥80 years old admitted to an orthogeriatric unit for an osteoporotic hip fracture. Muscle mass was assessed pre-operatively using bioelectrical impedance analysis; Janssen's (J) and Masanés' (M) reference cut-off points were used to define low muscle mass. Muscle strength was assessed with handgrip strength (Jamar's dynamometer). Sarcopenia was defined by having both low muscle mass and strength and using the European Working Group on Sarcopenia in Older People 2 definition of probable sarcopenia (low grip strength). Peripheral markers-pro-inflammatory and oxidative stress parameters-were determined either in the plasma or in the erythrocyte fraction obtained from peripheral whole blood of every patient pre-operatively. RESULTS: Mean age was 87.6 ± 4.9 years, and 78.7% were women. The prevalence of sarcopenia was 11.5% with Janssen's, 34.9% with Masanés' cut-offs, and 93.3% with the European Working Group on Sarcopenia in Older People 2 definition of probable sarcopenia. Among the four pro-inflammatory cytokines tested in plasma, only tumour necrosis factor-α was different (lower) in sarcopenic than in non-sarcopenic participants using both muscle mass cut-offs (J 7.9 ± 6.2 vs. 8.3 ± 5.8, M 6.8 ± 4.7 vs. 9.1 ± 6.2). Erythrocyte glutathione system showed a non-significant tendency to lower glutathione levels and glutathione/oxidized glutathione ratios in sarcopenic participants compared with non-sarcopenic subjects. Catalase activity was also lower in sarcopenic participants (J 2904 ± 1429 vs. 3329 ± 1483, M 3037 ± 1430 vs. 3431 ± 1498). No significant differences were found between groups in chymotrypsin-like activity of the 20S proteasome, superoxide dismutase, glutathione peroxidase and butyrylcholinesterase activity, C-terminal agrin fragment, interferon-γ, or interleukin-1ß. CONCLUSIONS: The prevalence of sarcopenia in patients with hip fracture varies according to the definition and the muscle mass reference cut-off points used. We did not find differences in most neuromuscular, pro-inflammatory, or oxidative stress markers, except for lower peripheral tumour necrosis factor-α levels and catalase activity in sarcopenic participants, which may be markers of an early inflammatory reaction that is hampered in sarcopenic patients.

Prevalencia de sarcopenia y características de los sarcopénicos en pacientes mayores de 80 años ingresados por fractura de cadera / Prevalence of sarcopenia and characteristics of sarcopenic subjects in patients over 80 years with hip fracture

Objetivo: calcular la prevalencia de sarcopenia en ancianos ingresados por fractura de cadera (FC) y comparar las características de sarcopénicos y no sarcopénicos. Método: se incluyeron 150 pacientes consecutivos de 80 o más años ingresados por una FC. Se diagnosticó sarcopenia a aquellos con baja masa muscular (bioimpedanciometría, puntos de corte de Janssen y Masanés) y baja fuerza muscular (dinamómetro de Jamar). Se recogieron variables sociodemográficas, cognitivas (Pfeiffer, GDS-Reisberg), funcionales (Barthel, FAC), nutricionales (MNA-SF, índice de masa corporal [IMC], ángulo de fase) y se registró el número de caídas y el número de fármacos. Resultados: edad media: 87,6 ± 4,9 años (78,7% mujeres). La prevalencia de sarcopenia fue del 11,5% (Janssen) y 34,9% (Masanés). Del 77,5% que deambulaba de forma independiente, un 40% había sufrido ≥ 3 caídas. El 38% padecía demencia. Un 80,4% presentaba dependencia leve-moderada y el 14,2% era independiente para actividades básicas de la vida diaria (ABVD). El MNA era compatible con malnutrición en el 12,6% y tomaba ≥ 4 medicamentos el 85,2%. Los pacientes sarcopénicos (Masanés) presentaban índice de masa corporal más bajo (18,6 vs. 24,3, p = 0,003); no se encontraron diferencias entre sarcopénicos y no sarcopénicos en otras variables. No hubo asociación entre el ángulo de fase y la sarcopenia. Conclusiones: hasta un tercio de los pacientes mayores que ingresaron por FC presentan sarcopenia en el momento del ingreso. La prevalencia, en el presente estudio, depende de los puntos de corte usados para definir la baja masa muscular. En contra de lo previsible, los pacientes sarcopénicos con FC muy mayores apenas se diferencian de los no sarcopénicos, salvo por un menor IMC

Aim: to estimate the prevalence of sarcopenia in very old patients admitted to an Orthogeriatric Unit for the treatment of a hip fracture (HF), and to compare characteristics of patients with and without sarcopenia. Methods: one hundred and fifty consecutive patients ≥ 80 years old admitted with HF were included. Sarcopenia was diagnosed with low muscle mass (bioimpedance, using two different cut-off points, Janssen and Masanés) and low grip strength (Jamar's dynamometer). Socio-demographic, nutritional variables (MNA-SF, body mass index [BMI], phase angle), cognitive (Pfeiffer, Reisberg's GDS) and functional variables (Barthel index, FAC) were registered, as well as the number of recent falls and medications on admission. Results: mean age: 87.6 ± 4.9 years (78.7% women). Prevalence of sarcopenia: 11.5% (Janssen's cut-offs) and 34.9% (Masanés cut-offs). Of the 77.5% who had independent ambulation before the fracture, 40% reported three or more recent falls. Before admission, 38% had dementia and 80.4% had mild to moderate dependence to BADL before admission; 14.2% were independent for all BADL. MNA was suggestive of malnutrition in 12.6%, and 85.2% were on four or more prescribed drugs. Sarcopenic (Masanés) had a lower BMI than non-sarcopenic participants (18.6 vs 24.3, p = 0.003), but no other significant differences were found between both groups. Phase angle was also unrelated to sarcopenia status. Conclusions: up to one third of very old patients with HF had sarcopenia on admission. Prevalence varied widely depending on the cut-off points selected to define low muscle mass. Sarcopenic patients in this setting were mostly similar to non-sarcopenic patients, except for a lower BMI

Diez recomendaciones para mejorar la enseñanza de la Geriatría en el pregrado / Ten recommendations to improve undergraduate training in Geriatric Medicine

Introducción: El envejecimiento de la población y los avances científicos hacen imprescindible una formación específica en Geriatría para todos los estudiantes de Medicina. Existen distintas recomendaciones internacionales sobre la docencia de Geriatría en el pregrado, que aún está lejos de ofrecerse de forma generalizada. El objetivo de este trabajo fue desarrollar un listado nacional de recomendaciones sobre la docencia de la medicina geriátrica en el pregrado. Material y métodos: Se elaboró un decálogo considerando la situación de la docencia de Geriatría en España en el 2016/2017 y las recomendaciones internacionales. Se alcanzó un consenso global entre los miembros del Grupo de Trabajo de la SEGG «Enseñanza de la Geriatría en el pregrado» mediante 2reuniones presenciales y discusiones a través de correo electrónico. Resultados: Se propone un decálogo de recomendaciones sobre la docencia de Geriatría en las facultades de Medicina españolas, incluyendo las características recomendables con relación a su estado, duración, contenidos, prácticas, profesorado, métodos docentes e innovación. Conclusiones: Estas recomendaciones tienen la finalidad de ayudar a mejorar la enseñanza de Geriatría. Pueden ser empleadas por las distintas facultades de Medicina, ya sea para adaptar la docencia de la Geriatría ya sea para incorporarla

Introduction: Population ageing and scientific progress have made specific training in Geriatrics essential for any medical students. There are different international recommendations on the teaching of Geriatric Medicine at undergraduate level, but they are still far from being offered systematically. The aim of this work was to develop a National list of recommendations in order to improve training in Geriatric Medicine at the undergraduate level. Material and methods: A list of 10 recommendations was produced by reflecting on the Geriatric training situation in Spain in 2016/2017 and international recommendations. Consensus was reached among the members of the Spanish Society of Geriatrics and Gerontology (SEGG) working group on «Geriatric training at undergraduate level» through 2meetings and online discussions. Results: A list of 10 of recommendations on Geriatric training in Spanish Medical Schools is proposed, including areas such as, the status of the discipline in the curriculum, length, contents, practical training, lecturers, teaching methods, and innovation. Conclusions: These recommendations are intended to improve Geriatrics training. They can be used by different Medical Schools either to adapt their programs or to start training in Geriatric Medicine

[Prevalence of sarcopenia and characteristics of sarcopenic subjects in patients over 80 years with hip fracture]. / Prevalencia de sarcopenia y características de los sarcopénicos en pacientes mayores de 80 años ingresados por fractura de cadera.

INTRODUCTION: Aim: to estimate the prevalence of sarcopenia in very old patients admitted to an Orthogeriatric Unit for the treatment of a hip fracture (HF), and to compare characteristics of patients with and without sarcopenia. Methods: one hundred and fifty consecutive patients ≥ 80 years old admitted with HF were included. Sarcopenia was diagnosed with low muscle mass (bioimpedance, using two different cut-off points, Janssen and Masanés) and low grip strength (Jamar's dynamometer). Socio-demographic, nutritional variables (MNA-SF, body mass index [BMI], phase angle), cognitive (Pfeiffer, Reisberg's GDS) and functional variables (Barthel index, FAC) were registered, as well as the number of recent falls and medications on admission. Results: mean age: 87.6 ± 4.9 years (78.7% women). Prevalence of sarcopenia: 11.5% (Janssen's cut-offs) and 34.9% (Masanés cut-offs). Of the 77.5% who had independent ambulation before the fracture, 40% reported three or more recent falls. Before admission, 38% had dementia and 80.4% had mild to moderate dependence to BADL before admission; 14.2% were independent for all BADL. MNA was suggestive of malnutrition in 12.6%, and 85.2% were on four or more prescribed drugs. Sarcopenic (Masanés) had a lower BMI than non-sarcopenic participants (18.6 vs 24.3, p = 0.003), but no other significant differences were found between both groups. Phase angle was also unrelated to sarcopenia status. Conclusions: up to one third of very old patients with HF had sarcopenia on admission. Prevalence varied widely depending on the cut-off points selected to define low muscle mass. Sarcopenic patients in this setting were mostly similar to non-sarcopenic patients, except for a lower BMI.

INTRODUCCIÓN: Objetivo: calcular la prevalencia de sarcopenia en ancianos ingresados por fractura de cadera (FC) y comparar las características de sarcopénicos y no sarcopénicos. Método: se incluyeron 150 pacientes consecutivos de 80 o más años ingresados por una FC. Se diagnosticó sarcopenia a aquellos con baja masa muscular (bioimpedanciometría, puntos de corte de Janssen y Masanés) y baja fuerza muscular (dinamómetro de Jamar). Se recogieron variables sociodemográficas, cognitivas (Pfeiffer, GDS-Reisberg), funcionales (Barthel, FAC), nutricionales (MNA-SF, índice de masa corporal [IMC], ángulo de fase) y se registró el número de caídas y el número de fármacos. Resultados: edad media: 87,6 ± 4,9 años (78,7% mujeres). La prevalencia de sarcopenia fue del 11,5% (Janssen) y 34,9% (Masanés). Del 77,5% que deambulaba de forma independiente, un 40% había sufrido ≥ 3 caídas. El 38% padecía demencia. Un 80,4% presentaba dependencia leve-moderada y el 14,2% era independiente para actividades básicas de la vida diaria (ABVD). El MNA era compatible con malnutrición en el 12,6% y tomaba ≥ 4 medicamentos el 85,2%. Los pacientes sarcopénicos (Masanés) presentaban índice de masa corporal más bajo (18,6 vs. 24,3, p = 0,003); no se encontraron diferencias entre sarcopénicos y no sarcopénicos en otras variables. No hubo asociación entre el ángulo de fase y la sarcopenia. Conclusiones: hasta un tercio de los pacientes mayores que ingresaron por FC presentan sarcopenia en el momento del ingreso. La prevalencia, en el presente estudio, depende de los puntos de corte usados para definir la baja masa muscular. En contra de lo previsible, los pacientes sarcopénicos con FC muy mayores apenas se diferencian de los no sarcopénicos, salvo por un menor IMC.

Uso potencialmente inapropiado de fármacos en cuidados paliativos: versión en castellano de los criterios STOPP-Frail (STOPP-Pal) / Inappropriate drug use in palliative care: SPANISH version of the STOPP-Frail criteria (STOPP-Pal)

La polimedicación y la utilización inapropiada de medicamentos en los pacientes mayores con enfermedad en fase terminal constituyen un grave problema sanitario, tanto por el incremento de efectos adversos prevenibles como por los costes sanitarios asociados a los mismos. Existen diferentes publicaciones que recomiendan la suspensión de determinados medicamentos cuando la esperanza de vida es limitada y el objetivo terapéutico no es la prevención ni la curación, sino el control de los síntomas. Recientemente se han publicado una lista de criterios explícitos (STOPP-Frail) que pueden ayudar al médico prescriptor a la toma de decisiones en la deprescripción de determinados fármacos en pacientes de edad avanzada y con enfermedad en fase terminal. En este artículo se presenta la versión traducida al castellano de los STOPP-Frail que pasará a llamarse STOPP-Pal para evitar confusiones con el concepto de fragilidad más utilizado

Multiple medication and inappropriate drug prescription are prevalent and challenging problems in older patients in end-of-life situations, and increases both preventable adverse events and health care costs. Recent literature recommends de-prescribing some drugs in patients with short life expectancy, when the aim of drug treatments is not prevention or cure, but symptom control. Recently, a list of explicit criteria (STOPP-Frail) intended to guide prescribing physicians in decision making on the use of drugs in older patients with terminal conditions. This article presents a Spanish version of such criteria, which have been named STOPP-Pal to avoid confusion with the current concept of frailty

[Ten recommendations to improve undergraduate training in Geriatric Medicine]. / Diez recomendaciones para mejorar la enseñanza de la Geriatría en el pregrado.

INTRODUCTION: Population ageing and scientific progress have made specific training in Geriatrics essential for any medical students. There are different international recommendations on the teaching of Geriatric Medicine at undergraduate level, but they are still far from being offered systematically. The aim of this work was to develop a National list of recommendations in order to improve training in Geriatric Medicine at the undergraduate level. MATERIAL AND METHODS: A list of 10 recommendations was produced by reflecting on the Geriatric training situation in Spain in 2016/2017 and international recommendations. Consensus was reached among the members of the Spanish Society of Geriatrics and Gerontology (SEGG) working group on «Geriatric training at undergraduate level¼ through 2meetings and online discussions. RESULTS: A list of 10 of recommendations on Geriatric training in Spanish Medical Schools is proposed, including areas such as, the status of the discipline in the curriculum, length, contents, practical training, lecturers, teaching methods, and innovation. CONCLUSIONS: These recommendations are intended to improve Geriatrics training. They can be used by different Medical Schools either to adapt their programs or to start training in Geriatric Medicine.

Evolución de la enseñanza de Geriatría en las facultades de Medicina españolas / Evolution of Geriatric teaching at Spanish Medical schools

OBJETIVO: Determinar la evolución reciente de la enseñanza de la Geriatría en el pregrado en España tras el aumento de facultades de Medicina y el cambio del plan de estudios. METODOLOGÍA: Se compararon las características de la enseñanza de la Geriatría en las facultades de Medicina españolas mediante dos encuestas nacionales realizadas en 2008 y 2015. En ambos casos se analizaron la inclusión de contenidos de Geriatría, el año y la materia en la que se imparte, las características del profesorado responsable y la duración de la misma. RESULTADOS: La prevalencia de docencia de Geriatría en las facultades de Medicina de las universidades españolas era del 75% en el 2008 y 77,5% en el 2015. Esta docencia se ha ido haciendo con mayor frecuencia obligatoria (66,7 vs. 96,8%, p < 0,005) pero se ha reducido su carácter de asignatura independiente (71,4 vs. 35,5%, p < 0,01). En ambos años aproximadamente el 50% de las facultades contemplaban aspectos teóricos y prácticos y en el 90% las prácticas tenían un carácter obligatorio. Se ha observado un incremento de la participación de los Servicios de Geriatría (27,3 vs. 47,1%) y de los propios geriatras como docentes directos (38,1 vs. 74,2%, p = 0,03). El tiempo medio programado para esta enseñanza era de 36 y 32 h respectivamente. No se han producido cambios significativos en más de la mitad de las facultades existentes en lo que respecta a inclusión de la Geriatría en el plan de estudios de pregrado, docencia independiente, incorporación de contenidos prácticos, estatus de las prácticas y participación de geriatras. CONCLUSIONES: La docencia de Geriatría ha presentado una evolución ligeramente positiva en muchas características, sin lograr una incorporación universal o los niveles alcanzados en otros países de nuestro entorno

OBJECTIVE: To analyse the recent evolution of Geriatric teaching at undergaduate level in Spain after the recent increase in the number of medical schools and the introductions of changes in the offical curricula. METHODOLOGY: A comparison of several characteristics of Geriatrics teaching at Spanish medical schools was done through two national surveys carried out in 2008 and 2015. The inclusion of Geriatric contents, the year when they are taught, faculty in charge and teaching hours were compared at both time points. RESULTS: The prevalence of Geriatric training was 75% in 2008 and 77.5% in 2015. This training has become compulsory more frequently (66.7 vs. 96.8%, p < .005) but the independence of Geriatrics related to other matters has decreased (71.4 vs. 35.5%, p < .01). In both surveys 50% of medical schools included theoretical and practical contents and in 90% of practices were compulsory. We found an increased of Geriatrics departments (27.3 vs. 47.1%) and geriatricians (38.1 vs. 74.2%, p= .03) in teaching. The mean duration of this training was 36 and 32hours respectively. In more than half of the medical schools existing in both years there were no significant changes in any of the characteristics surveyed. CONCLUSIONS: The teaching of Geriatrics at pregraduate level shows some positive changes, but universal teaching with standards approaching close countries has not yet been achieved

[Inappropriate drug use in palliative care: SPANISH version of the STOPP-Frail criteria (STOPP-Pal)]. / Uso potencialmente inapropiado de fármacos en cuidados paliativos: versión en castellano de los criterios STOPP-Frail (STOPP-Pal).

Multiple medication and inappropriate drug prescription are prevalent and challenging problems in older patients in end-of-life situations, and increases both preventable adverse events and health care costs. Recent literature recommends de-prescribing some drugs in patients with short life expectancy, when the aim of drug treatments is not prevention or cure, but symptom control. Recently, a list of explicit criteria (STOPP-Frail) intended to guide prescribing physicians in decision making on the use of drugs in older patients with terminal conditions. This article presents a Spanish version of such criteria, which have been named STOPP-Pal to avoid confusion with the current concept of frailty.

How clinical practitioners assess frailty in their daily practice: an international survey.

INTRODUCTION: Various operational definitions have been proposed to assess the frailty condition among older individuals. Our objective was to assess how practitioners measure the geriatric syndrome of frailty in their daily routine. METHODS: An online survey was sent to national geriatric societies affiliated to the European Union Geriatric Medicine Society (EUGMS) and to members of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). RESULTS: A total of 388 clinicians from 44 countries answered to the survey. Most of them were medical doctors (93%), and their primary field of practice was geriatrics (83%). Two hundred and five clinicians (52.8%) always assessed frailty in their daily practice, 38.1% reported to "sometimes" measure it, and 9.1% never assess it. A substantial proportion of clinicians (64.9%) diagnose frailty using more than one instrument. The most widely used tool was the gait speed test, adopted by 43.8% of the clinicians, followed by clinical frailty scale (34.3%), the SPPB test (30.2%), the frailty phenotype (26.8%) and the frailty index (16.8%). CONCLUSION: A variety of tools is used to assess frailty of older patients in clinical practice highlighting the need for standardisation and guidelines.

Technology-induced errors associated with computerized provider order entry software for older patients.

Background The introduction of new technologies in the prescribing process has seen the emergence of new types of medication errors. Objective To determine the prevalence and consequences of technology-induced prescription errors associated with a computerized provider order entry (CPOE) system in hospitalized older patients. Setting Patients 65 years or older admitted to the Departments of Internal Medicine, General Surgery, and Vascular Surgery of a tertiary hospital. Method Prospective observational 6-month study. Technology-induced errors were classified according to various taxonomies. Interrater reliability was measured. Consequences were assessed by interviewing patients and healthcare providers and classified according to their severity. Main outcome measure Prevalence of technology-induced errors. Results A total of 117 patients were included and 107 technology-induced errors were recorded. The prevalence of these errors was 3.65%. Half of the errors were clinical errors (n = 54) and the majority of these were classified as wrong dose, wrong strength, or wrong formulation. Clinical errors were 9 times more likely to be more severe than procedural errors (14.8 vs 1.9%; OR 9.04, 95% CI 1.09-75.07). Most of the errors did not reach the patient. Almost all errors were related to human-machine interactions due to wrong (n = 61) or partial (n = 41) entries. Conclusion Technology-induced errors are common and intrinsic to the implementation of new technologies such as CPOE. The majority of errors appear to be related to human-machine interactions and are of low severity. Prospective trials should be conducted to analyse in detail the way these errors occur and to establish strategies to solve them and increase patient safety.