ABSTRACT
La colonoscopia (CS) es una técnica invasiva, fundamental para el estudio del colon. Es un procedimiento seguro y bien tolerado. Sin embargo, en personas de edad avanzada o con fragilidad (PEA/F) aumenta el riesgo de acontecimientos adversos, preparación insuficiente o exploraciones incompletas. El objetivo de este documento de posicionamiento fue consensuar recomendaciones sobre valoración del riesgo, indicaciones y cuidados especiales necesarios para la CS en PEA/F. El documento fue redactado por un grupo de expertos designados por la SCD, la SCGiG y la CAMFiC entre 2020 y 2022. Se consensuaron 8 afirmaciones y recomendaciones, entre ellas: no realizar CS a los pacientes con fragilidad avanzada, indicar CS solo si los beneficios son claramente superiores a los riesgos en fragilidad moderada, no repetir CS en PEA/F que tienen una CS completa previa sin lesiones y no indicar CS de cribado en pacientes con fragilidad moderada o avanzada (AU)
Colonoscopy (CS) is an invasive diagnostic and therapeutic technique, allowing the study of the colon. It is a safe and well tolerated procedure. However, CS is associated with an increased risk of adverse events, insufficient preparation and incomplete examinations in the elderly or frail patient (PEA/F). The objective of this position paper was to develop a set of recommendations on risk assessment, indications and special care required for CS in the PEA/F. It was drafted by a group of experts appointed by the SCD, SCGiG and CAMFiC that agreed on eight statements and recommendations, between them to recommend against performing CS in patients with advanced frailty, to indicate CS only if the benefits clearly outweigh the risks in moderate frailty and to avoid repeating CS in patients with a previous normal procedure. We also recommended against performing screening CS in patients with moderate or advanced frailty (AU)
Subject(s)
Humans , Aged , Aged, 80 and over , Colonoscopy/adverse effects , Colonoscopy/methods , Frail Elderly , Societies, Medical , Risk Factors , SpainABSTRACT
Colonoscopy (CS) is an invasive diagnostic and therapeutic technique, allowing the study of the colon. It is a safe and well tolerated procedure. However, CS is associated with an increased risk of adverse events, insufficient preparation and incomplete examinations in the elderly or frail patient (PEA/F). The objective of this position paper was to develop a set of recommendations on risk assessment, indications and special care required for CS in the PEA/F. It was drafted by a group of experts appointed by the SCD, SCGiG and CAMFiC that agreed on eight statements and recommendations, between them to recommend against performing CS in patients with advanced frailty, to indicate CS only if the benefits clearly outweigh the risks in moderate frailty and to avoid repeating CS in patients with a previous normal procedure. We also recommended against performing screening CS in patients with moderate or advanced frailty.
Subject(s)
Frailty , Humans , Aged , Frailty/diagnosis , Frail Elderly , Colonoscopy/methods , Risk AssessmentABSTRACT
OBJECTIVE: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. DESIGN: Cross-sectional study nested in the 2017 "Delirium Day" project. SETTING AND PARTICIPANTS: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. METHODS: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). RESULTS: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63). CONCLUSIONS AND IMPLICATIONS: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.
Subject(s)
Delirium , Hearing Loss , Activities of Daily Living , Cross-Sectional Studies , Delirium/epidemiology , Hearing Loss/epidemiology , Humans , Italy , Risk FactorsABSTRACT
Desde 1996, momento en que se generalizó el uso del tratamiento antirretroviral de alta eficacia, se ha producido un cambio pronóstico importante para los pacientes con infección por el virus de la inmunodeficiencia humana, cronificando la infección y presentando expectativas de vida similar, en algunos casos, a la población general no infectada. Por otro lado, los factores de riesgo para la adquisición de la infección están cambiando, siendo actualmente la vía sexual la principal vía de contagio. Los pacientes ancianos han sido considerados tradicionalmente un grupo de bajo riesgo para la infección, pero las mejoras en el tratamiento de la disfunción eréctil y una falsa sensación de seguridad que conlleva a un bajo uso de métodos anticonceptivos de barrera comportan que los pacientes ancianos presenten un riesgo no despreciable para infectarse. El personal sanitario también infraestima el riesgo en estos pacientes, llevando a retrasos diagnósticos y en el inicio del tratamiento, que empeoran el pronóstico de estos pacientes (AU)
Since 1996, with the widespread use of highly active antiretroviral treatment, a shift has important prognostic for patients infected with the human immunodeficiency virus, becoming a chronic infection and presenting life expectancy similar, in some cases, to not infected general population. Moreover, risk factors for acquisition of infection are changing, sexual intercourse is the main risk factor for HIV. Elderly patients have traditionally been considered a low risk group for infection, but improvements in the treatment of erectile dysfunction and a false sense of security that leads to a low use of barrier methods behave that elderly patients present a non-negligible risk to be infected. Health staff also under estimates the risk in these patients, leading to delays in diagnosis and initiation of treatment, which worsen the prognosis of those patients (AU)
