Emergency department prediction model for 30-day mortality after hip fracture: the Spanish National Hip Fracture Registry (RNFC) cohort.

INTRODUCTION: The aim of this study was to design and validate a predictive model for 30-day mortality in a cohort of patients from the Spanish National Hip Fracture Registry (RNFC) with variables collected at the Emergency Department. METHODS: Retrospective study of a prospective database of hip fracture patients ⩾75 years old between 1 January 2017 and 30 September 2019. Patient characteristics, type of fracture and osteoprotective medication were collected at the Emergency Department. Univariate analysis compared the results between patients alive and deceased 30 days after hospital discharge. The variables associated with 30-day mortality in the regression analysis were age >85 years, male sex, indoors pre-fracture mobility, dementia, ASA score >3, pathological fracture, and vitamin D intake. A score scale was created with these variables. Discriminative performance was assessed using the area under the curve (AUC), calibration was assessed by applying Hosmer-Lemeshow goodness-of-fit test and predicted-to-observed mortality was compared. RESULTS: A total of 29,875 hip fracture cases were included in the study. The 30-day mortality of the overall cohort was 7.7%. A scale of 0-9 points was created, with a cut-off point of 4 points for the determination of patients at high risk of mortality. The AUC was 0.886. RNFC score presented good level of calibration (p = 0.139). The predicted-to-observed ratio was 1.09. CONCLUSIONS: The RNFC predictive model with variables collected at the Emergency Department showed an excellent predictive capacity for 30-day mortality in patients after hip fracture.

Frailty assessment to individualize treatment in older patients with lymphoma.

PURPOSE: A study analyzing the application of a protocol of comprehensive geriatric assessment (CGA) in older patients with lymphoma was carried out to allow frailty-based patient classification and individualized treatment. METHODS: Lymphoma patients older than 70 years referred to the Geriatric Clinic at a tertiary hospital between May 2016 and March 2021 were included. The assessment protocol included comorbidity, polypharmacy, nutritional, functional, and mental status, geriatric syndromes, and life expectancy. CGA enabled patient classification into four groups (Type I to Type IV) based on frailty assessment instrument scoring and clinical, functional, and mental status. Variables were compared using parametric and non-parametric statistical tests and Kaplan-Meier survival curves. RESULTS: Ninety-three patients (55.9% women) were included. Median age was 81.1 years (± 5.7). 23 patients (24.7%) were classified as robust (type I), 30 (32.3%) as pre-frail (type II) with potentially reversable deficits, 38 (40.9%) as frail (type III), and 2 (2.2%) as requiring palliative care (type IV). Patients received oncospecific treatment with modifications carried out in 64.5% of cases based on CGA results. Differences in overall survival (p = 0.002), response to treatment (p < 0.001) and likelihood of increased frailty (p = 0.024) were observed, with type III-IV patients showing significantly worse outcomes. CONCLUSION: Performance of standardized, systematic CGA by geriatricians permits older lymphoma patients to be classified according to frailty, with significant differences in terms of clinical outcomes across groups. We propose incorporating CGA performed by geriatricians as part of the multidisciplinary care team to optimize therapeutic strategy for these patients.

Impact of subtrochanteric fractures in the geriatric population: better pre-fracture condition but poorer outcome than pertrochanteric fractures: evidence from the Spanish Hip Fracture Registry.

BACKGROUND: Clinical management in orthogeriatric units and outcome indicators are similar for extracapsular fragility hip fractures, without discriminating between subtrochanteric and pertrochanteric fractures. HYPOTHESIS: Geriatric patients, 75 years or older, with subtrochanteric fractures have worse clinical and functional outcomes than those with pertrochanteric fractures. MATERIALS AND METHODS: Retrospective observational study of data prospectively collected by the Spanish Hip Fracture Registry including patients 75 years or older, admitted for extracapsular hip fractures from January 2017 to June 2019. Demographic and baseline status, pre-operative, post-operative and 30-day follow-up data were included. RESULTS: A total of 13,939 patients with extracapsular hip fractures were registered: 12,199 (87.5%) pertrochanteric and 1740 (12.5%) subtrochanteric. At admission, patients with subtrochanteric fractures were younger (86.5 ± 5.8 versus 87.1 ± 5.6 years old), had better pre-fracture mobility (3.7 ± 2.7 versus 3.9 ± 2.8) (1-to-10 scale, 1 being independent) and were more likely to be living at home; those with pertrochanteric fractures had worse cognitive function (Pfeiffer 3.3 ± 3.3 versus 3.8 ± 3.5). The subtrochanteric fracture group showed worse post-fracture mobility (7.3 ± 2.7 versus 6.7 ± 2.7) and greater deterioration of mobility (3.7 ± 3.0 versus 2.9 ± 2.7). Among individuals living at home at baseline, those with subtrochanteric fractures were more likely to remain in an assisted facility at 30-day follow-up. In-hospital mortality during acute admission was higher for the subtrochanteric group (5.6% versus 4.5%) (p = 0.028). To our knowledge, this is the first paper highlighting the differences between these two fracture groups in the geriatric population. CONCLUSIONS: Subtrochanteric fractures in the older population are a different and worse entity, with greater morbimortality and functional decline than pertrochanteric fractures. Despite being younger and fitter at admission, older patients with subtrochanteric fractures have a higher risk of remaining non-weight bearing and undergoing re-operation and institutionalization. Orthogeriatric units should be aware of this and manage subtrochanteric fractures accordingly. LEVEL OF EVIDENCE: IV.

Development of a new comprehensive preoperative risk score for predicting 1-year mortality in patients with hip fracture: the HULP-HF score. Comparison with 3 other risk prediction models.

PURPOSE: The aim of this study was to develop a new comprehensive preoperative risk score for predicting mortality during the first year after hip fracture (HF) and its comparison with 3 other risk prediction models. METHODS: All patients admitted consecutively with a fragility HF during 1 year in a co-managed orthogeriatric unit at a university hospital were assessed and followed for 1 year. Factors independently associated with 1-year mortality were used to create the HULP-HF (Hospital Universitario La Paz - Hip Fracture) score. The predictive validity, discrimination and calibration of the HULP-HF score, the American Society of Anesthesiologists (ASA) scale, the abbreviated Charlson comorbidity index (a-CCI) and the Nottingham Hip Fracture score (NHFS) were compared. Discriminative performance was assessed using the area under the curve (AUC) and calibration by the Hosmer-Lemeshow goodness-of-fit-test. RESULTS: 509 patients were included. 1-year mortality was 23.2%. The 8 independent mortality risk factors included in the HULP-HF score were age >85 years, baseline functional and cognitive impairment, low body mass index, heart disease, low hand-grip strength, anaemia on admission, and secondary hyperparathyroidism associated with vitamin D deficiency. The AUC was 0.79 in the HULP-HF score, 0.66 in the NHFS, 0.61 in the abbreviated CCI and 0.59 in the ASA scale. The HULP-HF score, the NHFS and the abbreviated CCI all presented good levels of calibration (p > 0.05). CONCLUSIONS: The HULP-HF score has a predictive capacity for 1-year mortality in HF patients slightly superior to that of other previously existing scores.

[Spanish National Hip Fracture Registry (RNFC): First-year results and comparison with other registries and prospective multi-centric studies from Spain]. / Registro Nacional de Fracturas de Cadera (RNFC): resultados del primer año y comparación con otros registros y estudios multicéntricos españoles.

OBJECTIVE: The Spanish National Hip Fracture Registry (Registro Nacional de Fracturas de Cadera or RNFC) is a Spanish, prospective, multi- centric registry, commenced in 2017. The goal of this paper is to present the data from the first annual report and to compare them with autonomic registries and recent prospective multi-centric studies performed in Spain. METHODS: We included persons 75 years or older treated for fragility hip fractures in any of the centers participating in the RNFC between January and October 2017. The descriptive statistics of each variable used the mean (and standard deviation) or the median (and interquartile ranges) for the ordinal variables and the percentage for the categoric variables. A descriptive analysis of the casemix was performed and compared with available data from the aforementioned studies. RESULTS: The RNFC included 7.208 patients from 54 hospitals, with a mean age of 86.7 (SD 5.6) years; 75.4% were women, and 36.4% showed cognitive decline. Mean surgical delay was 75.7 (SD 63.6) hours, and length of stay averaged 10.9 (SD 6.7) days. Of the patients who lived at home (75.4%), less than half (37.0%) returned home at discharge. One-month mortality was 7.1%. Comparison with other studies showed important differences, especially regarding patients newly sent to nursing homes (7.7-29.4%) and with antiosteoporotic treatment at discharge (14.5-36.7%). CONCLUSIONS: The RNFC is the largest prospective database to date that offers data regarding the characteristics of patients hospitalized for hip fractures in Spain. Comparison with recent studies showed some important differences.

OBJETIVO: El Registro Nacional de Fracturas de Cadera (RNFC) es un registro español multicéntrico, prospectivo y continuo, que comenzó en 2017. El objetivo de este artículo fue presentar los datos del primer informe anual y compararlos con los registros autonómicos y los estudios multicéntricos realizados recientemente en España. METODOS: Se incluyeron las personas de 75 años o más atendidas con el diagnóstico de fractura de cadera por fragilidad en alguno de los hospitales participantes en el RNFC, entre enero y octubre de 2017. En el análisis estadístico se utilizó la media y desviación estándar o mediana y rangos intercuartílicos para las variables numéricas y los porcentajes para las variables categóricas. Se realizó un análisis descriptivo global de la casuística y se comparó con los datos disponibles de los estudios previos mencionados. RESULTADOS: Se registraron 7.208 personas de 54 hospitales, con una edad media de 86,7 años (DE 5,6). El 75,4% fueron mujeres y el 36,4% presentaron deterioro cognitivo previo. La demora quirúrgica media fue de 75,7 horas (DE 63,6) y la estancia media fue de 10,9 días (DE 6,7). De las personas que vivían en un domicilio antes de la fractura (75,4%), menos de la mitad (37,0%) volvieron a él tras el alta hospitalaria. Al mes, había fallecido el 7,1%. La comparación con los otros estudios mostró algunas diferencias importantes, sobre todo en la ubicación previa, en el porcentaje de pacientes institucionalizados de novo (7,7-29,4%) y en el porcentaje con tratamiento antiosteoporótico al alta (14,5-36,7%). CONCLUSIONES: El RNFC es la mayor base de datos prospectiva que aporta datos sobre el perfil de los pacientes hospitalizados por fractura de cadera en España. La comparación con otros estudios recientes muestra algunas diferencias importantes.

Registro Nacional de Fracturas de Cadera (RNFC): resultados del primer año y comparación con otros registros y estudios multicéntricos españoles / Spanish National Hip Fracture Registry (RNFC):First-year results and comparison with other registries and prospective multi-centric studies from Spain

OBJETIVO: El Registro Nacional de Fracturas de Cadera (RNFC) es un registro español multicéntrico, prospectivo y continuo, que comenzó en 2017. El objetivo de este artículo fue presentar los datos del primer informe anual y compararlos con los registros autonómicos y los estudios multicéntricos realizados recientemente en España. MÉTODOS: Se incluyeron las personas de 75 años o más atendidas con el diagnóstico de fractura de cadera por fragilidad en alguno de los hospitales participantes en el RNFC, entre enero y octubre de 2017. En el análisis estadístico se utilizó la media y desviación estándar o mediana y rangos intercuartílicos para las variables numéricas y los porcentajes para las variables categóricas. Se realizó un análisis descriptivo global de la casuística y se comparó con los datos disponibles de los estudios previos mencionados. RESULTADOS: Se registraron 7.208 personas de 54 hospitales, con una edad media de 86,7 años (DE 5,6). El 75,4% fueron mujeres y el 36,4% presentaron deterioro cognitivo previo. La demora quirúrgica media fue de 75,7 horas (DE 63,6) y la estancia media fue de 10,9 días (DE 6,7). De las personas que vivían en un domicilio antes de la fractura (75,4%), menos de la mitad (37,0%) volvieron a él tras el alta hospitalaria. Al mes, había fallecido el 7,1%. La comparación con los otros estudios mostró algunas diferencias importantes, sobre todo en la ubicación previa, en el porcentaje de pacientes institucionalizados de novo (7,7-29,4%) y en el porcentaje con tratamiento antiosteoporótico al alta (14,5-36,7%). CONCLUSIONES: El RNFC es la mayor base de datos prospectiva que aporta datos sobre el perfil de los pacientes hospitalizados por fractura de cadera en España. La comparación con otros estudios recientes muestra algunas diferencias importantes

OBJECTIVE: The Spanish National Hip Fracture Registry (Registro Nacional de Fracturas de Cadera or RNFC) is a Spanish, prospective, multi-centric registry, commenced in 2017. The goal of this paper is to present the data from the first annual report and to compare them with autonomic registries and recent prospective multi-centric studies performed in Spain. METHODS: We included persons 75 years or older treated for fragility hip fractures in any of the centers participating in the RNFC between January and October 2017. The descriptive statistics of each variable used the mean (and standard deviation) or the median (and interquartile ranges) for the ordinal variables and the percentage for the categoric variables. A descriptive analysis of the casemix was performed and compared with available data from the aforementioned studies. RESULTS: The RNFC included 7.208 patients from 54 hospitals, with a mean age of 86.7 (SD 5.6) years; 75.4% were women, and 36.4% showed cognitive decline. Mean surgical delay was 75.7 (SD 63.6) hours, and length of stay averaged 10.9 (SD 6.7) days. Of the patients who lived at home (75.4%), less than half (37.0%) returned home at discharge. One-month mortality was 7.1%. Comparison with other studies showed important differences, especially regarding patients newly sent to nursing homes (7.7-29.4%) and with antiosteoporotic treatment at discharge (14.5-36.7%). CONCLUSIONS: The RNFC is the largest prospective database to date that offers data regarding the characteristics of patients hospitalized for hip fractures in Spain. Comparison with recent studies showed some important differences

Encuesta sobre la actividad de interconsultas a geriatría en los hospitales españoles / A survey on geriatric consultation activity in Spanish hospit

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Baseline and pre-operative 1-year mortality risk factors in a cohort of 509 hip fracture patients consecutively admitted to a co-managed orthogeriatric unit (FONDA Cohort).

INTRODUCTION: The aim of this study was to determine the patient characteristics that predict 1-year mortality after a hip fracture (HF). METHODS: All patients admitted consecutively with fragility HF during 1 year in a co-managed orthogeriatric unit of a university hospital (FONDA cohort) were assesed. Baseline and admission demographic, clinical, functional, analytical and body-composition variables were collected in the first 72 h after admission. A protocol designed to minimize the consequences of the HF was applied. One year after the fracture patients or their carers were contacted by telephone to ascertain their vital status. RESULTS: A total of 509 patients with a mean age of 85.6 years were included. One-year mortality was 23.2%. The final multivariate model included 8 independent mortality risk factors: age >85 years, baseline functional impairment in basic activities of daily living, low body mass index, cognitive impairment, heart disease, low hand-grip strength, anaemia at admission, and secondary hyperparathyroidism associated with vitamin D deficiency. The association of several of these factors greatly increased mortality risk, with an OR (95% confidence interval [CI]) of 5.372 (3.227-8.806) in patients with 4 to 5 factors, and an OR (95% CI) of 11.097 (6.432-19.144) in those with 6 or more factors. CONCLUSIONS: In addition to previously known factors (such as age, impairment in basic activities of daily living, cognitive impairment, malnutrition and anaemia at admission), other factors, such as muscle strength and hyperparathyroidism associated with vitamin D deficiency, are associated with greater 1-year mortality after a HF.

Frecuencia de sarcopenia y características de los pacientes estudiados mediante criterios EWGSOP uniformes en estudios españoles / Fequency of sarcopenia and characteristics of the patients studied using uniform EWGSOP criteria in Spanish studies

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Managing multimorbidity in primary care in patients with chronic respiratory conditions.

The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety. Multimorbidity is associated with increased health-care utilisation and specifically with an increased number of prescription drugs in individuals with multiple chronic conditions such as chronic obstructive pulmonary disease. This npj Primary Care Respiratory Medicine Education Section case study involves a patient in a primary care consultation presenting several common diseases prevalent in people of this age. The patient takes nine different drugs at this moment, one or more pills for each condition, which amounts to polypharmacy. The problems related with polypharmacy recommend that a routine medication review by primary care physicians be performed to reduce the risk of adverse effects of polypharmacy among those with multiple chronic conditions. The primary care physician has the challenging role of integrating all of the clinical problems affecting the patient and reviewing all medicaments (including over-the-counter medications) taken by the patient at any point in time, and has the has the key to prevent the unwanted consequences of polypharmacy. Multimorbid chronic disease management can be achieved with the use of care planning, unified disease templates, use of information technology with appointment reminders and with the help of the wider primary care and community teams.

Consumo de medicamentos en mayores de 65 años en Oporto (Portugal) y riesgo de prescripción de medicamentos potencialmente inapropiados / Consumption of drugs in over 65 in Porto (Portugal) and risk of potentially inappropriate medication prescribing

Objetivo: Conocer el consumo de medicamentos entre los mayores de un área de Oporto, determinar la prevalencia de la prescripción de medicamentos potencialmente inapropiados y analizar su asociación con la polimedicación y otros factores. Diseño: Estudio observacional transversal de base poblacional. Emplazamiento: Unidade de Saúde Familiar Rainha D. Amélia, Centro histórico de Oporto (Portugal). Participantes: Muestra de 747 personas representativa de la población de 65 años y más del área de referencia. Mediciones principales: Identificación de todos los medicamentos prescritos utilizando los registros electrónicos disponibles. Se definió polimedicación como el tratamiento simultáneo con 5 o más medicamentos, y medicación potencialmente inapropiada (MPI) como el uso de medicamentos considerados inadecuados según los criterios de Beers 2012. Se recogieron datos sociodemográficos, de diagnóstico y de utilización de servicios. Se utilizó la regresión logística para analizar la asociación de las distintas covariables con el uso de MPI. Resultados: El 89,2% (IC 95%: 87,6-92,0) de la población de estudio tenían prescrito, al menos, un medicamento. El 59,2% (IC 95%: 55,7-62,7) estaban polimedicados. El 37,0% (IC 95%: 33,5-40,5) consumían MPI. La prescripción de MPI se asocia a mayor edad (OR = 1,02 [IC 95%: 1,00-1,05]), polimedicación (OR = 4,45 [IC 95%: 3,12-6,36]), depresión/ansiedad (OR = 2,18 [IC 95%: 1,36-3,51]) y artrosis (OR = 1,64 [IC 95%: 1,11-2,42]). Conclusiones: La prescripción de fármacos, polimedicación y uso de MPI son muy elevados en la población portuguesa estudiada. La polimedicación es el factor más importante asociado al consumo de MPI. La prescripción de ansiolíticos, antidepresivos o antiinflamatorios debe hacerse con mucho cuidado ante el riesgo de los MPI (AU)

Objective: To determine medication consumption in the older people from a central area of Oporto; determine the prevalence of prescription of Potentially Inappropriate Medication and to analyse the polypharmacy and other important connected factors. Design, setting and patients: Cross-sectional study with a sample of 747 patients older than 64 years, who were attended in a Primary care health centre: USF Rainha D. Amélia, Oporto, Portugal. Main outcome measures: identification of all medication prescribed from electronic registers. Polypharmacy was considered more than 5 medication prescribed and Potential Inappropriate Medication was identified by Beers criteria 2012. The socio-demographic factors, diagnosis and health care services use were registered too. Logistic regression analysis was used to determine the association between co-variables. ;Results There were 89.2% (95% CI: 87.6-92.0) of the studied population with at least one prescription. The polypharmacy was present at 59.2% (95% CI: 55.7-62.7) of people. The Potential Inappropriate Medication was present in 37.0% (95% CI: 33.5-40.5) of the cases. The Potential Inappropriate Medication was related with increasing age [OR = 1.02 (95% CI: 1.00-1.05)], polypharmacy [OR = 4.45 (95% CI: 3.12-6.36)], and be diagnosed with depression/anxiety [OR = 2.18 (95% CI: 1.36-3.51)] and/or arthrosis [OR = 1.64 (95% CI: 1.11-2.42)]. Conclusion: The rate of medication prescription, polypharmacy and the prescription of Potentially Inappropriate Medication are very high in Portuguese population studied. The polypharmacy is the most important factor related with this potential inappropriate medication. The physician need to have carefully with prescription of the anxiolytic and anti-inflammatory pain drugs (AU)

Prevalence of sarcopenia in acute hip fracture patients and its influence on short-term clinical outcome.

AIM: Current international criteria provide standardized procedures to diagnose sarcopenia in older people. However, to date few data exist on patients with acute disease. The present study was carried out to determine the frequency of sarcopenia in acute hip fracture patients, and its association with their baseline characteristics and prognosis during hospitalization. METHODS: Data were collected from 509 consecutive patients hospitalized for hip fracture. The European Working Group on Sarcopenia in Older People Criteria for sarcopenia were applied in the first 72 h. Muscle mass was measured by electrical bioimpedance and grip strength by hydraulic dynamometer. Clinical, functional and cognitive characteristics were assessed at baseline and hospital discharge, and their association with the presence of sarcopenia was studied. RESULTS: A total of 479 patients (94%) met the inclusion criteria. The mean age was 85.3 (SD 6.8 years). The frequency of sarcopenia was 17.1% (12.4% in men, 18.3% in women). Sarcopenia was associated with residence in nursing homes (30.5% vs 19.6%, P = 0.030), older age (86.8, SD 6.2 vs 85.1, SD 6.9 years, P = 0.038), and lower body mass index (23.1, SD 3.6 vs 25.6, SD 4.23, P < 0.001). In the multivariate analysis, only low body mass index was predictive of sarcopenia (OR 0.85, 95% CI 0.80-0.91). Sarcopenia was associated with worse functional prognosis at discharge in the crude analysis (OR 1.88, 95% CI 1.15-3.07), but not in the multivariate analysis (OR 1.68, 95% CI 0.99-2.84). CONCLUSIONS: Sarcopenia was detected in almost one of five acute hip fracture patients and was associated with lower body mass index, but an association with worse prognosis at discharge could not be confirmed. Geriatr Gerontol Int 2016; 16: 1021-1027.

[Consumption of drugs in over 65 in Porto (Portugal) and risk of potentially inappropriate medication prescribing]. / Consumo de medicamentos en mayores de 65 años en Oporto (Portugal) y riesgo de prescripción de medicamentos potencialmente inapropiados.

OBJECTIVE: To determine medication consumption in the older people from a central area of Oporto; determine the prevalence of prescription of Potentially Inappropriate Medication and to analyse the polypharmacy and other important connected factors. DESIGN, SETTING AND PATIENTS: Cross-sectional study with a sample of 747 patients older than 64 years, who were attended in a Primary care health centre: USF Rainha D. Amélia, Oporto, Portugal. MAIN OUTCOME MEASURES: identification of all medication prescribed from electronic registers. Polypharmacy was considered more than 5 medication prescribed and Potential Inappropriate Medication was identified by Beers criteria 2012. The socio-demographic factors, diagnosis and health care services use were registered too. Logistic regression analysis was used to determine the association between co-variables. RESULTS: There were 89.2% (95%CI: 87.6-92.0) of the studied population with at least one prescription. The polypharmacy was present at 59.2% (95%CI: 55.7-62.7) of people. The Potential Inappropriate Medication was present in 37.0% (95%CI: 33.5-40.5) of the cases. The Potential Inappropriate Medication was related with increasing age [OR=1.02 (95%CI: 1.00-1.05)], polypharmacy [OR=4.45 (95%CI: 3.12-6.36)], and be diagnosed with depression/anxiety [OR=2.18 (95%CI: 1.36-3.51)] and/or arthrosis [OR=1.64 (95%CI: 1.11-2.42)]. CONCLUSION: The rate of medication prescription, polypharmacy and the prescription of Potentially Inappropriate Medication are very high in Portuguese population studied. The polypharmacy is the most important factor related with this potential inappropriate medication. The physician need to have carefully with prescription of the anxiolytic and anti-inflammatory pain drugs.

The orthogeriatric unit for acute patients: a new model of care that improves efficiency in the management of patients with hip fracture.

We performed a prospective, quasi-experimental, randomised, interventional study comparing two models of care for patients admitted with osteoporotic hip fractures between February and August 2007 in a tertiary university hospital. The usual model of care was treatment of patients admitted to the orthopaedics ward, with consultation by the geriatrician (CG model). The study model involved admission to an acute orthogeriatric unit (OGU model), with joint care provided by geriatricians and orthopaedic surgeons which included immediate geriatric assessment, coordinated daily clinical care, weekly combined ward rounds, and joint planning of the surgical schedule, initial mobilisation, discharge date and destination. No differences were found between CG patients (123) and OGU patients (101) in terms of previous characteristics, number of patients surgically treated, functional level obtained, or discharge destination. OGU patients had earlier geriatric assessment (median 1 day, P25-P75: 1-2) than CG patients (median 4 days, P25-P75: 3-8), earlier surgery (median 5 days from admission to OGU, P25-P75: 3-6, versus 6 days in the CG group, P25-P75: 5-9), and had a shorter acute hospital stay (33% reduction, median 12 days in OGU, P25-P75: 9-14, versus 18 days, P25-P75: 13-23 in the CG group) and total (acute and subacute) hospital stay (30% reduction, median 14 days in OGU, P25-P75: 10-31, versus 20 days, P25-P75: 14-30 in the CG group). All these comparisons were statistically significant (p<0.01). The organization of an OGU in a tertiary hospital allowed hip fracture patients to receive earlier geriatric assessment and surgical treatment. Acute hospital stay was reduced by 33%, and total hospital stay was reduced by 30% with no differences at discharge in clinical and functional outcomes.

Calidad de los instrumentos de valoración funcional en geriatría: del invento de la rueda a la era electrónica / No disponible

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Resultados asistenciales de las unidades geriátricas de agudos. Revisión sistemática / Measuring results in acute care for the elderly units. A systematic review

Fundamento: revisar de manera sistemática la información existente en la literatura científica sobre los resultados asistenciales de las unidades geriátricas de agudos (UGA) hospitalarias. Material y método: la estrategia de búsqueda incluyó la consulta en bases bibliográficas (MEDLINE, EMBASE, Dialnet y Cochrane Central Register of Controlled Trials), la revisión de los sumarios de 5 revistas de geriatría y la búsqueda retrospectiva de citas en los artículos existentes. Resultados: se encontraron 41 publicaciones con datos sobre resultados asistenciales de las UGA. De ellas, 21 cumplieron los criterios de inclusión. Éstas aportaron datos de 18 experiencias en 19 hospitales. Todos los trabajos, excepto uno, encontraron una reducción de la estancia media en las UGA respecto a la hospitalización en otros servicios. La reducción fue del 30 al 54% en los trabajos que analizaron muestras históricas, superior al 10% en la mayoría de los estudios de bases de datos hospitalarias y del 17 al 46% (p < 0,01) en los estudios de casos y controles. De los 5 estudios aleatorizados con grupo control, 2 mostraron reducciones significativas de la estancia media (del 19 y el 24%, p < 0,01); otros 2, tendencias en el mismo sentido (del 3 y el 12%, respectivamente), y, 1 incremento de la estancia (32%). Estos estudios encontraron tendencias a la reducción de costes, a menor institucionalización y a mejoría funcional en los pacientes de las UGA. Conclusiones: los estudios existentes muestran una reducción de las estancias de los ancianos hospitalizados por enfermedad aguda en unidades geriátricas respecto a la hospitalización convencional en otros servicios médicos. Esto supone un ahorro de recursos sin merma en la calidad asistencial. Debe plantearse la puesta en marcha de UGA en los hospitales donde no existan todavía

Background: the aim of this study was to perform a systematic review of the scientific information related to the results of in-hospital acute care for the elderly (ACE) units. Material and method: the search strategy included consultation of different bibliographic databases (MEDLINE, EMBASE, Dialnet and the Cochrane Central Register of Controlled Trials), review of the contents pages of five geriatric journals, and a retrospective search of the references in published articles. Results: forty-one articles with information on the results of ACE units were identified. Of these, only 21 met the inclusion criteria. These 21 articles provided data on 18 experiences in 19 hospitals. All the studies except one found a reduction in the mean length of stay in ACE units compared with conventional hospitalization. This reduction ranged from 30% to 54% in studies with historical samples, was more than 10% in hospital database studies, and ranged from 17% to 46% (P<.01) in case-control studies. Of 5 randomized controlled studies, 2 reported significant reductions in length of stay (19% and 24%, P<.01), another two studies reported trends in the same direction (3% and 12%) and 1 study found an increase in length of stay (32%) in the ACE unit. These studies reported tendencies towards reduced costs, lower institutionalization and functional improvement in patients admitted to ACE units. Conclusions: the studies performed to date show reductions in length of stay in elderly patients admitted to ACE units for acute illness compared with conventional hospitalization, leading to resource savings without decreasing the quality of care. The establishment of ACE units should be considered in hospitals without these units