Characteristics of falls producing hip fracture in patients on oral anticoagulants.

OBJECTIVE: To analyze the demographic and clinical characteristics of patients on chronic anticoagulant therapy (CAT) admitted because of a hip fracture secondary to a fall, and to compare with patients not receiving CAT. METHODS: A prospective, observational study realized in six hospitals in the Barcelona area. Demographic and clinical characteristics of patients were collected. The index fall characteristics - cause, height, location, and time of occurrence - were evaluated. RESULTS: Of the 1225 patients included, 99 (8%) patients were on CAT. When we compare with the rest logistic regression analysis showed that patients receiving CAT were more likely to be male (odds ratio 3.7), not institutionalized (odds ratio 3.5), to take more number of drugs (odds ratio 1.3), to have dementia (odds ratio 2.1) and stroke (odds ratio 1.7). Results revealed a higher prevalence of combined factors as the cause of the index fall in the group of patients on anticoagulants. CONCLUSIONS: Characteristics of falls were very similar when comparing the group of patients receiving CAT with those who did not. A prior history of falls should lead physicians to take actions for preventing falls causing hip fracture, in all patients and particularly in these on CAT.

El anciano en la unidad de cuidados intensivos / Elderly patient in an intensive critical unit

La asistencia al anciano en la unidad de cuidados intensivos (UCI) es un fenómeno creciente. La gravedad de la enfermedad que condiciona el ingreso y la situación funcional previa, más que la edad, son los elementos determinantes tanto de la mortalidad como del pronóstico vital y funcional a largo plazo. Los estudios demuestran que los ancianos que sobreviven al ingreso recuperan en gran medida la capacidad funcional y la percepción de calidad de vida que tenían previamente. Aunque, como contrapartida, presentan un mayor número de síndromes geriátricos, principalmente el síndrome confusional. La valoración geriátrica debe implementarse en las UCI y, especialmente, al alta de éstas. La utilización de escalas validadas (índice de Lawton, índice de Barthel, EuroQol-5D, entre otras) que evalúan de forma objetiva la capacidad funcional y calidad de vida basal de estos pacientes, han de incorporarse a la rutina asistencial de todos aquellos médicos (geriatras, internistas, intensivistas, anestesistas, etc.) que participan en la potencialmente controvertida decisión de ingresar un anciano en la UCI (AU)

Admission of elderly patients to intensive care units (ICU) is an increasing phenomenon. The severity of the disease causing admission and the basal functional patient's status are conditions more important than age to predict mortality and long term functional outcome. Studies demonstrate that elderly ICU survivors recover after discharge the majority part of their functional capability and perception of quality of life. On the contrary, these patients develop higher number of geriatric syndromes, mainly confusional syndrome. The culture of geriatric comprehensive assessment should be implemented in ICU and especially after discharge. The use of simple and validates scales (Barthel's Index, Lawton's Index and EuroQol-5D…) must be incorporated into the clinical practice. This is a good tool that could be useful for the specialists involved in the usually difficult decision of whether an elderly patient should or not be admitted to an ICU (AU)

[Elderly patient in an intensive critical unit]. / El anciano en la unidad de cuidados intensivos.

Admission of elderly patients to intensive care units (ICU) is an increasing phenomenon. The severity of the disease causing admission and the basal functional patient's status are conditions more important than age to predict mortality and long term functional outcome. Studies demonstrate that elderly ICU survivors recover after discharge the majority part of their functional capability and perception of quality of life. On the contrary, these patients develop higher number of geriatric syndromes, mainly confusional syndrome. The culture of geriatric comprehensive assessment should be implemented in ICU and especially after discharge. The use of simple and validates scales (Barthel's Index, Lawton's Index and EuroQol-5D...) must be incorporated into the clinical practice. This is a good tool that could be useful for the specialists involved in the usually difficult decision of whether an elderly patient should or not be admitted to an ICU.