Complejidad y prevalencia de síndromes geriátricos de los pacientes atendidos en unidades sociosanitarias en Catalunya. Estudio multicéntrico del proyecto XARESS / Complexity and prevalence of geriatric syndromes in patients treated in intermediate care units in Catalonia: A multicentre study of XARESS project

Fundamentos: El objetivo fue describir la complejidad y prevalencia de síndromes geriátricos (SG) en unidades sociosanitarias de Catalunya. Métodos: Se estudiaron retrospectivamente 6.471 estancias realizadas durante el año 2014 en los centros participantes del XARESS. Los datos se obtuvieron a partir de la explotación del registro Conjunto Mínimo Básico de Datos de los Recursos Sociosanitarios (CMBD-RSS). Se analizaron de forma descriptiva las prevalencias y las asociaciones entre SG y categoría RUG al ingreso, estancia media y destino al alta, estratificando por tipo de unidad (convalecencia o larga estancia). Resultados: Los participantes presentaron una mediana de 3 SG al ingreso en larga estancia y 2 SG en convalecencia. El número de SG varió con la categoría RUG, aunque en todas ellas se identificaron pacientes sin complejidad (0 SG) y con extrema complejidad (9 SG). La presencia de SG se asoció a estancias medias más largas y mayor dependencia, aunque con gran variabilidad entre SG. No se encontró relación entre los SG y el destino al alta sociosanitaria. Conclusiones: La población atendida en centros sociosanitarios presenta una elevada complejidad y una alta prevalencia de SG al ingreso. La explotación del CMBD-RSS permite caracterizar la complejidad de las personas ingresadas en los centros de convalecencia y larga estancia de la red sociosanitaria catalana

Background: Descriptive study is presented on the complexity and prevalence of geriatric syndromes (GS) in Intermediate Care Units in Catalonia. Methods: A retrospective study was conducted on 6471 stays completed during the year 2014 in the participating centres of the XARESS network. Data was obtained by extracting the information routinely collected on the CMBD-RSS registry (Minimum Basic Dataset for the Intermediate Care Resources). The prevalence and associations between geriatric síndromes (resource group) RG category, length of stay, and destination at discharge is described. Results were stratified by type of unit (convalescence or long stay). Results: Participants presented a median of 3 GS at admission in long stay units, and 2 GS at admission in convalescence units. The number of GS varied with RG category, although in all RG categories, there were patients without complexity (no SG), and patients with extreme complexity (up to 9 GS). Patients with geriatric syndromes had a longer mean length of stay and greater dependence than patients without syndromes, although with great variability across GS. However, the presence of geriatric syndromes had no impact on the destination at discharge. Conclusions: The population cared for in intermediate care units have high complexity and a high prevalence of geriatric syndromes at admission. The CMBD-RSS registry allows the characterisation of complexity of the population admitted to the Catalan convalescence and long term intermediate care units

[Complexity and prevalence of geriatric syndromes in patients treated in intermediate care units in Catalonia: A multicentre study of XARESS project]. / Complejidad y prevalencia de síndromes geriátricos de los pacientes atendidos en unidades sociosanitarias en Catalunya. Estudio multicéntrico del proyecto XARESS.

BACKGROUND: Descriptive study is presented on the complexity and prevalence of geriatric syndromes (GS) in Intermediate Care Units in Catalonia. METHODS: A retrospective study was conducted on 6471 stays completed during the year 2014 in the participating centres of the XARESS network. Data was obtained by extracting the information routinely collected on the CMBD-RSS registry (Minimum Basic Dataset for the Intermediate Care Resources). The prevalence and associations between geriatric síndromes (resource group) RG category, length of stay, and destination at discharge is described. Results were stratified by type of unit (convalescence or long stay). RESULTS: Participants presented a median of 3 GS at admission in long stay units, and 2 GS at admission in convalescence units. The number of GS varied with RG category, although in all RG categories, there were patients without complexity (no SG), and patients with extreme complexity (up to 9 GS). Patients with geriatric syndromes had a longer mean length of stay and greater dependence than patients without syndromes, although with great variability across GS. However, the presence of geriatric syndromes had no impact on the destination at discharge. CONCLUSIONS: The population cared for in intermediate care units have high complexity and a high prevalence of geriatric syndromes at admission. The CMBD-RSS registry allows the characterisation of complexity of the population admitted to the Catalan convalescence and long term intermediate care units.

[Social and health resources in Catalonia. Current situation]. / Recursos sociosanitarios en Cataluña. Situación actual.

The network of social and health care has advanced since its inception. Furthermore, news services have been created and some resources have been adapted within the framework of respective health plans. This article presents the current situation of the different social and health resources in Catalonia, as well as the main changes that have occurred in recent years, more specifically in the period of the Health Plan 2011-2015. This period is characterised by an adaptation of the social and health network within the context of chronic care, for which the development of intermediate care resources has become the most relevant aspect. There is also a need to create a single long-term care sector in which the health care quality is guaranteed. Moreover, in this period, integral and cross-care level is promoted in the health system through a greater coordination between all different levels of care. The social and health network, due to its trajectory and expertise, plays a key role in the quality of care for people with social and medical needs.

Complicaciones de la hospitalización en personas mayores / Hospital complications in the elderly

No disponible

The Catalonia WHO Demonstration Project of Palliative Care: Results at 25 Years (1990-2015).

In 2015, the World Health Organization (WHO) Demonstration Project on Palliative Care in Catalonia (Spain) celebrated its 25th anniversary. The present report describes the achievements and progress made through this project. Numerous innovations have been made with regard to the palliative care (PC) model, organization, and policy. As the concept of PC has expanded to include individuals with advanced chronic conditions, new needs in diverse domains have been identified. The WHO resolution on "Strengthening of palliative care as a component of comprehensive care throughout the life course," together with other related WHO initiatives, support the development of a person-centered integrated care PC model with universal coverage. The Catalan Department of Health, together with key institutions, developed a new program in the year 2011 to promote comprehensive and integrated PC approach strategies for individuals with advanced chronic conditions. The program included epidemiologic research to describe the population with progressive and life-limiting illnesses. One key outcome was the development of a specific tool (NECPAL CCOMS-ICO(©)) to identify individuals in the community in need of PC. Other innovations to emerge from this project to improve PC provision include the development of the essential needs approach and integrated models across care settings. Several educational and research programs have been undertaken to complement the process. These results illustrate how a PC program can respond and adapt to emerging needs and demands. The success of the PC approach described here supports more widespread adoption by other key care programs, particularly chronic care programs.

Atención a las personas con demencia en el entorno de la cronicidad / No disponible

En Cataluña, con una población de 7.512.982 habitantes, se ha producido un incremento de la esperanza de vida, en la actualidad de 82,5 años, con una tendencia al envejecimiento de la población. Se trata de un hecho positivo, como consecuencia, en parte, de los avances científicos en medicina, pero que obliga a realizar actuaciones para dar una atención más eficiente a una población que va a vivir más años y la prevalencia de enfermedades crónicas va a ser elevada. En nuestro entorno hay estudios epidemiológicos que han encontrado una prevalencia del 9,6% en las personas de más de 70 años. Los sistemas sanitarios están evolucionando adaptando su funcionamiento a la prevención y atención de la cronicidad. De hecho en Cataluña, a partir del año 1986 se empezó a trabajar con un modelo de atención integral y se crearon estructuras específicas para dar atención a personas mayores con enfermedades crónicas, con enfermedad de Alzheimer y otras demencias, con enfermedades neurodegenerativas y/o con necesidad de cuidados paliativos. Desde entonces hasta la actualidad se han desarrollado diferentes unidades diagnósticas específicas, además de plazas de hospitalización de media y larga estancia psicogeriátricas, y también plazas de hospital de día de psicogeriatría

In Catalonia, with a population of 7,512,982 people, there has been an increase in life expectancy, currently 82.5 years, with a trend towards an aging population. This is a positive development, as a result, in part, of scientific advances in medicine, but it is necessary to perform actions to provide more efficient care to a population that will live longer and the prevalence of chronic diseases will be high. In our environment there are epidemiological studies that have found a prevalence of 9.6% in people over 70 years. Health systems are evolving to adapt its purpose to the prevention and chronicity care. In fact, in Catalonia, since 1986, a model of integrated care and specific structures were created to provide care to seniors with chronic diseases, Alzheimer’s disease and other dementias, neurodegenerative diseases and / or needs for palliative care. Until now, different specific diagnostic units have been developed, in addition to hospitalization medium and long stay psychogeriatric beds and also psychogeriatric day hospital places

Osteoporosis y fractura de cadera. Modelo asistencial / No disponible

La osteoporosis y, secundariamente, la fractura de cadera son dos entidades inseparables que acontecen en la mayoría de los casos en individuos de edad avanzada, principalmente mujeres, y con otros problemas de salud. La elevada prevalencia de síndromes geriátricos en los pacientes con fractura de cadera requiere un abordaje integral, e integrado, entre los diferentes profesionales y niveles asistenciales que priorice la continuidad asistencial y los resultados en salud a largo plazo. Las herramientas clave en este abordaje son la valoración geriátrica integral, el trabajo en equipo interdisciplinar, la atención centrada en el paciente y las guías de práctica clínica. Los modelos de atención integrada emergen como una respuesta más adecuada en la atención a la fractura de cadera porque los diferentes agentes implicados comparten objetivos comunes, colocan al paciente en el centro de la atención, eliminan barreras y permiten racionalizar los recursos(AU)

Osteoporosis and hip fracture are two inseparable conditions in most cases in older female patients with other health problems. A comprehensive-multidisciplinary integrated approach is required because of high prevalence of geriatric syndromes in hip fracture patients. Care continuum and long-term results must be enhanced. Comprehensive geriatric assessment, multidisciplinary teamwork, patientfocused care, and evidenced-based practices are the management key tools for these patients. Integrated care models seems to be the best answer in hip fracture because common targets are shared between all implicated agents, patient is sited in the center of care, barriers are suppressed, and resources rationalized(AU)

[Evolution of patient colonization with methicillin-resistant Staphylococcus aureus in a skilled nursing facility]. / Evolución de la colonización por Staphylococcus aureus resistente a meticilina en un hospital de media y larga estancia.

BACKGROUND AND OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) asymptomatic colonization is common in long-term care facilities, but the burden of symptomatic infection appears to be low. It is not usually known whether a patient is colonized at the time of admission to the geriatric facility. Our purpose was to determine the prevalence, characteristics and factors associated with MRSA colonization on admission, and the cumulative incidence of colonization over the following 6 months. PATIENTS AND METHOD: Longitudinal and prospective study conducted over a 6-month period. All patients were screened at admission using nasal and ulcers swabs within the first 24h. Patients were screened also at the end of the study to assess carrier status. RESULTS: The prevalence of MRSA colonization was 7.6% at the entry (25 patients). In the multivariate analysis, advanced age, recent use of antibiotics, prior colonization by MRSA, and peripheral vascular disease were independent risk factors for colonization at admission. With standard precautions, the 6-month cumulative incidence of MRSA colonization was 4.2%. CONCLUSIONS: In our long-term care facility, MRSA colonization at the time of admission was frequent. Few patients were colonized during the study and no episodes of infection were reported. Probably, standard precautions, including hand washing and appropriate barrier procedures during the care of wounds, are the most useful control measures.

Evolución de la colonización por Staphylococcus aureus resistente a meticilina en un hospital de media y larga estancia / Evolution of patient colonization with methicillin-resistant Staphylococcus aureus in a skilled nursing facility

Fundamento y objetivo: la colonización por Staphylococcus aureus resistente a meticilina (SARM) es frecuente en centros de media y larga estancia, pero las tasas de infección son bajas. Habitualmente se desconoce el estado de portador de un paciente en el momento del ingreso. Nos hemos propuesto estudiar la prevalencia, las características clínicas y los factores relacionados con el hecho de ser portador al ingresar en el hospital, así como la incidencia de colonización de los pacientes una vez ingresados durante un período de 6 meses. Pacientes y método: se ha realizado un estudio longitudinal y prospectivo durante un período de 6 meses. Se efectuó a todos los pacientes un frotis nasal y de las heridas dentro de las primeras 24h de ingreso, estudio que se repitió en el momento del alta o de finalización del estudio. Resultados: la proporción de pacientes colonizados al ingresar fue del 7,6% (n=25). En el análisis multivariable, la edad, el uso reciente de antibióticos, la colonización previa y la presencia de enfermedad vascular periférica fueron las variables asociadas de forma independiente con el estado de portador. Tomando las precauciones estándar sólo un 4,2% de los pacientes se colonizaron durante el ingreso. Conclusiones: en nuestro centro de media y larga estancia, un número importante de pacientes presentó colonización por SARM al ingresar. Fueron pocos los que se colonizaron durante el ingreso y no se describieron episodios de infección durante el período del estudio. Probablemente las precauciones estándar, entre ellas el lavado de las manos y los métodos de barrera en las curas de heridas, son medidas adecuadas para evitar la diseminación de la colonización por SARM (AU)

Background and objective: Methicillin-resistant Staphylococcus aureus (MRSA) asymptomatic colonization is common in long-term care facilities, but the burden of symptomatic infection appears to be low. It is not usually known whether a patient is colonized at the time of admission to the geriatric facility. Our purpose was to determine the prevalence, characteristics and factors associated with MRSA colonization on admission, and the cumulative incidence of colonization over the following 6 months. Patients and method: Longitudinal and prospective study conducted over a 6-month period. All patients were screened at admission using nasal and ulcers swabs within the first 24h. Patients were screened also at the end of the study to assess carrier status. Results: The prevalence of MRSA colonization was 7.6% at the entry (25 patients). In the multivariate analysis, advanced age, recent use of antibiotics, prior colonization by MRSA, and peripheral vascular disease were independent risk factors for colonization at admission. With standard precautions, the 6-month cumulative incidence of MRSA colonization was 4.2%. Conclusions: In our long-term care facility, MRSA colonization at the time of admission was frequent. Few patients were colonized during the study and no episodes of infection were reported. Probably, standard precautions, including hand washing and appropriate barrier procedures during the care of wounds, are the most useful control measures (AU)

Intervención nutricional en la EPOC en el anciano / No disponible

La enfermedad pulmonar obstructiva crónica (EPOC) se caracteriza por una obstrucción progresiva y escasamente reversible al flujo aéreo. La pérdida de peso es una complicación frecuente en estos pacientes y un factor determinante de su capacidad funcional, estado de salud y mortalidad. La intervención en los ancianos con EPOC ha de ir precedida de una valoración que identifique el estado nutricional, los factores de riesgo y los objetivos terapéuticos. Las recomendaciones dietéticas deben contener proporciones adecuadas de macro- y micronutrientes pararecuperar o mantener el estado nutricional y evitar complicaciones. Individualizar el tratamientoes muy importante para mejorar la calidad de vida de estos pacientes (AU)

Chronic obstructive pulmonary disease (COPD) is characterized by progressive and partially reversible airway obstruction. Weight loss is a frequently occurring complication in patients with COPD and is a determining factor of functional capacity, health status and mortality. For elderly patients with COPD, nutrition therapy is initiated after the evaluation of the nutritional state of the patient, which identifies nutritional risk, there by allowing the proper level of treatment to be established. The prescribed diet should contain appropriate proportions of macronutrients and micronutrients in order to regain or maintain the proper nutritional state and to avoid complications. In the treatment of elderly patients with COPD, individualized nutrition therapy is extremely important and has been shown to be fundamental to improving quality of life (AU)

Ejercicio y envejecimiento saludable / No disponible

La actividad física regular ha demostrado que disminuye la mortalidad, la morbilidad y ayuda a mantener la independencia funcional. Aporta beneficios en la gran mayoría de los sistemas del organismo, mejorando la funcionalidad y el perfil cardiovascular, diabetes, osteoporosis, enfermedades respiratorias, cáncer, osteoartritis y la función neurocognitiva. Estos beneficios también se observan en los ancianos. Aún así, la prevalencia del sedentarismo en las personas de edad avanzada es alta, por lo que se hacen necesarias intervenciones de promoción del ejercicio y de mejora de la adhesión a dichos programas (AU)

The evidence has shown that physical activity decreases morbidity, mortality and helps to maintain functional independence. It brings benefits in most of the body systems, improving the functionality and the cardiovascular profile, pulmonary diseases, diabetes, osteoporosis, cancer, osteoarthritis, and neurocognitive function. These benefits are also observed in the elderly. However, the prevalence of sedentary lifestyle in older people is high, so its necessary to promote and improve the participation inexercise programs (AU)

[Prevalence of hypertension in elderly long-term care residents in Spain. The Geriatric HTA study]. / Prevalencia de hipertensión arterial en ancianos ingresados en centros sociosanitarios y residencias españoles. Estudio Geriatric HTA.

BACKGROUND AND OBJECTIVE: This study aimed to estimate the prevalence of hypertension in elderly long-term care residents in Spain and to describe such population in terms of comorbidity and hypertension treatment and control. PATIENTS AND METHOD: A countrywide cross-sectional study was conducted in May 2003 among long-term care residents aged 65 or more. Patients in palliative care units were excluded. Hypertension was defined in patients who fulfilled at least one of the following criteria: diagnosis of hypertension on the medical record, antihypertensive medication and/or highest blood pressure values during the previous year > or = 140/90 mmHg. RESULTS: Overall, 13,272 subjects - mean age (standard deviation) 82.9 (7.5) years (range: 65-106 years) - were included from 223 centres; 70.6% were women. Almost 2 thirds of patients met at least one hypertension criterion (8,242 patients, 62.1%; 95% confidence interval, 61.3-62.9%). In those patients, other frequent cardiovascular risk factors were obesity (26.3%), diabetes (25.7%) and dislipemia (23.8%). A concomitant diagnosis of dementia, peripheral vascular disease, stroke or congestive heart failure was present in 37.1%, 28.3%, 26.0% and 25.1%, respectively. The proportion of hypertensive patients receiving at least one antihypertensive drug was 69.7%. Diuretics were the most commonly used agents (46.3%), followed by angiotensine converting enzyme inhibitors (34.6%). The latest blood pressure measurement was < 140/90 mmHg in 60.4% of the hypertensive patients. CONCLUSIONS: Elderly long-term care residents in Spain showed a high prevalence of hypertension and other cardiovascular risk factors, and a substantial degree of associated clinical conditions. The proportion of antihypertensive drug therapy was comparable to those reported in similar studies.

Prevalencia de hipertensión arterial en ancianos ingresados en centros sociosanitarios y residencias españoles. Estudio Geriatric HTA / Prevalence of hypertension in elderly long-term care residents in Spain. The Geriatric HTA study

Fundamento y objetivo: Los objetivos del estudio han sido estimar la prevalencia de hipertensión arterial (HTA) en los ancianos institucionalizados en España y por comunidad autónoma, y describir el perfil del anciano hipertenso atendido en estos centros. Pacientes y método: Se ha realizado un estudio transversal de prevalencia de HTA, de ámbito estatal. Se incluyó a personas mayores de 65 años institucionalizadas. Se excluyó a las ingresadas en unidades de cuidados paliativos. Se consideraron criterios de HTA para el estudio los siguientes: diagnóstico de HTA en la historia clínica, tratamiento farmacológico antihipertensivo y valor más alto de presión arterial en el último año de 140/90 mmHg o superior. Resultados: Se incluyó a 13.272 pacientes de 223 centros, pertenecientes a las 17 comunidades autónomas y a la ciudad autónoma de Melilla, con una media (desviación estándar) de edad de 82,9 (7,5) años; el 70,6% eran mujeres. Cumplían al menos un criterio de HTA 8.242 pacientes (62,1%; intervalo de confianza del 95%, 61,3-62,9%). La HTA se asociaba a obesidad en el 26,3% de los casos, a diabetes en el 25,7% y a dislipemias en el 23,8%. La comorbilidad más frecuente fue la demencia (37,1%), seguida de la insuficiencia vascular periférica (28,3%), el ictus (26,0%) y la insuficiencia cardíaca (25,1%). El 69,7% de los hipertensos (intervalo de confianza del 95%, 68,7-70,6%) recibía tratamiento farmacológico antihipertensivo. Los antihipertensivos más utilizados eran los diuréticos (46,3%) y los inhibidores de la enzima de conversión de la angiotensina (34,6%). La última determinación de la presión arterial efectuada en el centro fue inferior a 140/90 mmHg en el 60,4% de los hipertensos. Conclusiones: Los ancianos institucionalizados en nuestro entorno presentan una elevada prevalencia de HTA, con una comorbilidad notable y una proporción de tratamiento farmacológico antihipertensivo similar a las publicadas en otros países

Background and objective: This study aimed to estimate the prevalence of hypertension in elderly long-term care residents in Spain and to describe such population in terms of comorbidity and hypertension treatment and control. Patients and method: A countrywide cross-sectional study was conducted in May 2003 among long-term care residents aged 65 or more. Patients in palliative care units were excluded. Hypertension was defined in patients who fulfilled at least one of the following criteria: diagnosis of hypertension on the medical record, antihypertensive medication and/or highest blood pressure values during the previous year $ 140/90 mmHg. Results: Overall, 13,272 subjects ­mean age (standard deviation) 82.9 (7.5) years (range: 65-106 years)­ were included from 223 centres; 70.6% were women. Almost 2 thirds of patients met at least one hypertension criterion (8,242 patients, 62.1%; 95% confidence interval, 61.3-62.9%). In those patients, other frequent cardiovascular risk factors were obesity (26.3%), diabetes (25.7%) and dislipemia (23.8%). A concomitant diagnosis of dementia, peripheral vascular disease, stroke or congestive heart failure was present in 37.1%, 28.3%, 26.0% and 25.1%, respectively. The proportion of hypertensive patients receiving at least one antihypertensive drug was 69.7%. Diuretics were the most commonly used agents (46.3%), followed by angiotensine converting enzyme inhibitors (34.6%). The latest blood pressure measurement was < 140/90 mmHg in 60.4% of the hypertensive patients. Conclusions: Elderly long-term care residents in Spain showed a high prevalence of hypertension and other cardiovascular risk factors, and a substantial degree of associated clinical conditions. The proportion of antihypertensive drug therapy was comparable to those reported in similar studies

Unidades de Convalecencia / Geriatric convalescence unit

Las unidades geriátricas de convalecencia tienen como objetivo la recuperaciónde funciones perdidas por una enfermedad . La eficacia deestas unidades y la necesidad de plazas hospitalarias son factores quehan contribuído a que los pacientes ingresados sean cada vez mascomplejos. La atención subaguda podrá realizarse con una mayordotación de personal y una revisión del sistema de financiación

The convalescent care geriatric units have as an objective the recoveryof the lost functions caused by a disease. The efficiency of these unitsand the need of hospital beds are factors which have contributed to thefact that patients will be every time more complex. The subacute carewill be able to be accomplished with a greater endowment of personneland a review of the financing system

Nuevas tecnologías, nuevos problemas. Repercusión sobre la geriatría / New technologies, new problems. The problem of geriatrics

Los países desarrollados presentan un progresivo envejecimiento de la población. Las nuevas tecnologías pueden ser útiles al anciano, pero hay una discriminación en su utilización por criterio de edad. En este artículo se revisan discriminaciones al aplicar los avances en geriatría, el acceso a la alta tecnología y la participación en ensayos clínicos. La valoración geriátrica integral es un instrumento que puede ser de ayuda en la gestión de recursos (AU)