Psychotropic Drug Prescription in Nursing Homes During the COVID-19 Pandemic.

BACKGROUND: To limit the introduction of coronavirus disease 2019 (COVID-19) into nursing homes, restrictive measures and social distancing were implemented; however, these caused an increase in affective disorders such as depression and anxiety and an alteration of the behavioral and psychological symptoms of dementia. Therefore, it is expected that prescription trends of psychotropic drugs in nursing homes during the pandemic may have changed significantly. OBJECTIVE: This study aims to compare patterns of prescribing psychotropic drugs in nursing homes during the COVID-19 pandemic to those of the pre-pandemic period. METHODS: This cross-sectional multicenter study was conducted in geriatric units and psychogeriatric units in seven nursing homes in Gipuzkoa, Spain. On 1 March, 2020, data regarding 511 residents in geriatric units and 163 in psychogeriatric units were recorded. This study examined utilization percentages for psychotropic drugs before the pandemic (April 2018-March 2020) and during the pandemic (April 2020-March 2021) in light of projected usage based on previous years. Following the Anatomical, Therapeutic, Chemical Classification System, four therapeutic groups were analyzed: antipsychotics (N05A), benzodiazepines (N05B and N05C), antidepressants (N06A), and antiepileptic drugs (N03A). RESULTS: In the case of geriatric units, a downward trend of prescription was reversed for antipsychotics (-0.41; 95% confidence interval [CI] -1.41, 0.60). Benzodiazepine use also decreased less than expected (-2.00; 95% CI -3.00, -1.00). Antidepressant use increased more than predicted (0.02; 95% CI -0.97, 1.01), as did antiepileptic drug use (2.93; 95% CI 2.27, 3.60). In the psychogeriatric units, the drop in antipsychotic utilization was less than expected (-2.31; 95% CI -3.68, -0.93). Although it was expected that the prescription of benzodiazepines would decrease, usage remained roughly the same (-0.28; 95% CI -2.40, 2.34). Utilization of antidepressants (8.57; 95% CI 6.89, 10.24) and antiepileptic drugs (6.10; 95% CI 3.20, 9.00) increased significantly, which was expected, based on the forecast. CONCLUSIONS: For all categories, usage of psychotropic drugs was higher than anticipated based on the forecast; this increase might be related to the worsening of emotional and behavioral disorders caused by the restrictive measures of the COVID-19 pandemic.

Evaluación del tratamiento antitrombótico en pacientes geriátricos institucionalizados con fibrilación auricular no valvular / Evaluation of antithrombotic treatment in institutionalized geriatric patients with nonvalvular atrial fibrillation

Objetivo: Los objetivos de este trabajo son estudiar el tipo de tratamiento antitrombótico y sus complicaciones en pacientes institucionalizados con fibrilación auricular no valvular y evaluar el grado de controlanticoagulante con medicamentos tipo antivitamina K.Método: Estudio observacional de seguimiento prospectivo realizado en siete centros gerontológicos durante el año 2016, valorandoen aquellos residentes con fibrilación auricular no valvular la terapiaantitrombótica establecida y las incidencias embólicas, hemorrágicasy la mortalidad. En los residentes anticoagulados con antivitamina K semidió el control de la anticoagulación, estimándose un mal control si elmétodo de Rosendaal fuese < 65% o el tiempo en rango terapéuticodirecto < 60%.Resultados: De los 699 residentes analizados, el 20,6% tenían undiagnóstico de fibrilación auricular no valvular, con una edad media de85,83 años. El riesgo cardioembólico fue alto (CHA2DS2-VASc medio4,79), así como el riesgo hemorrágico (HAS-BLED medio 3,04). El 50%estaban anticoagulados, principalmente con antivitamina K, de los cualesal menos el 56% no se encontraban dentro del rango terapéutico. Un16% de los residentes no tenían prescrita terapia antitrombótica, destacando en éstos una mayor dependencia funcional, cognitiva y edad más avanzada. Se encontró una mayor frecuencia de ingresos hospitalarios de causa cardiovascular y de sangrados en aquellos residentes anticoagulados, aunque no hubo diferencias significativas. (AU)

Objective: The goals of this study were to analyze the type of antithrombotic treatment administered to institutionalized patients with nonvalvularatrial fibrillation (and any ensuing complications) and to evaluate thedegree of anticoagulation control achieved with vitamin K antagonists.Method: This was a prospective observational follow-up study carriedout in seven elderly care facilities during 2016. Patients with nonvalvular atrial fibrillation were evaluated for their antithrombotic therapy andany embolic or hemorrhagic events, as well as for mortality. Subjects onanticoagulation treatment with VKAs were evaluated for anticoagulationcontrol, with control considered poor if the mean time in therapeutic rangewas < 65% when measured with Rosendaal’s method or < 60% whendetermined by the direct method.Results: Of the 699 residents evaluated, 20.6% had a diagnosis ofNVAF. Average age was 85.83 years. Both the cardioembolic (meanCHA2DS2-VASc score: 4.79), and the hemorrhagic (mean HAS-BLEDscore: 3.04) risk were high. Fifty percent received anticoagulationtreatment, mainly with vitamin K antagonists, of whom at least 56% werenot within the therapeutic range. Sixteen percent of the residents, theoldest and most functionally and cognitively dependent ones, had notbeen prescribed any antithrombotic therapy. A higher frequency of hospital admissions induced by cardiovascular and bleeding events was found in these residents, although differences were not statistically significant. (AU)

Evaluation of antithrombotic treatment in institutionalized geriatric patients with nonvalvular atrial fibrillation.

OBJECTIVE: The goals of this study were to analyze the type of  ntithrombotic treatment administered to institutionalized patients with  nonvalvular atrial fibrillation (and any ensuing complications) and to  evaluate the degree of anticoagulation control achieved with vitamin K  antagonists. Method: This was a prospective observational follow-up study  carried out in seven elderly care facilities during 2016. Patients with  nonvalvular atrial fibrillation were evaluated for their antithrombotic  therapy and any embolic or hemorrhagic events, as well as for mortality.  Subjects on anticoagulation treatment with VKAs were evaluated for  anticoagulation control, with control considered poor if the mean time in  therapeutic range was < 65% when measured with Rosendaal's method or < 60% when determined by the direct method. RESULTS: Of the 699 residents evaluated, 20.6% had a diagnosis of NVAF.  Average age was 85.83 years. Both the cardioembolic (mean CHA2DS2- VASc score: 4.79), and the hemorrhagic (mean HAS-BLED score: 3.04)  risk were high. Fifty percent received anticoagulation treatment, mainly  with vitamin K antagonists, of whom at least 56% were not within the  therapeutic range. Sixteen percent of the residents, the oldest and most  functionally and cognitively dependent ones, had not been prescribed any  antithrombotic therapy. A higher frequency of hospital admissions induced  by cardiovascular and bleeding events was  found in these residents,  although differences were not statistically significant. CONCLUSIONS: Half of institutionalized geriatric patients with nonvalvular atrial fibrillation are anticoagulated, a third on antiplatelet  therapy, and some without any antithrombotic treatment. This study  howed that as functionality decreases, treatment strategies are  increasingly aimed at therapeutic deintensification. Given that the degree  of anticoagulation control with vitamin K antagonists is inadequate in 56%  of cases, it is essential to monitor the time in therapeutic range to  optimize treatment as needed.

Objetivo: Los objetivos de este trabajo son estudiar el tipo de tratamiento antitrombótico y sus complicaciones en pacientes  institucionalizados con fibrilación auricular no valvular y evaluar el grado  de control anticoagulante con medicamentos tipo antivitamina K.Método: Estudio observacional de seguimiento prospectivo realizado en  siete centros gerontológicos durante el año 2016, valorando en aquellos  residentes con fibrilación auricular no valvular la terapia antitrombótica  establecida y las incidencias embólicas, hemorrágicas y la mortalidad. En  los residentes anticoagulados con antivitamina K se midió el control de la  anticoagulación, estimándose un mal control si el método de Rosendaal  fuese < 65% o el tiempo en rango terapéutico directo < 60%.Resultados: De los 699 residentes analizados, el 20,6% tenían un diagnóstico de fibrilación auricular no valvular, con una edad media de 85,83 años. El riesgo cardioembólico fue alto (CHA2DS2-VASc medio 4,79), así como el riesgo hemorrágico (HAS-BLED medio 3,04). El  50% estaban anticoagulados, principalmente con antivitamina K, de los  cuales al menos el 56% no se encontraban dentro del rango terapéutico.  Un 16% de los residentes no tenían prescrita terapia antitrombótica,  destacando en éstos una mayor dependencia funcional, cognitiva y edad  más avanzada. Se encontró una mayor frecuencia de ingresos  hospitalarios  de causa cardiovascular y de sangrados en aquellos  residentes anticoagulados, aunque no hubo diferencias significativas.Conclusiones: La mitad de los pacientes geriátricos institucionalizados con fibrilación auricular no valvular están  anticoagulados, un tercio antiagregados y algunos sin tratamiento  antitrombótico, observando que a medida que disminuye la funcionalidad  las estrategias van en la línea de una desintensificación terapéutica. El  grado de control anticoagulante con antivitamina K es inadecuado en el  56% de los casos, por lo que es imprescindible monitorizar el tiempo en  rango terapéutico para optimizar el tratamiento cuando sea necesario.

[Prevalence of prescription of anticholinergic/sedative burden drugs among older people with dementia living in nursing homes]. / Prevalencia de prescripción de fármacos con carga anticolinérgica/sedante en adultos mayores institucionalizados con demencia.

BACKGROUND AND OBJECTIVE: Dementia is one of the most frequent diseases in the elderly, being its prevalence of up to 64% in institutionalized people. In this population, in addition to antidementia drugs, it is common to prescribe drugs with anticholinergic/sedative burden that, due to their adverse effects, could worsen their functionality and cognitive status. The objective is to estimate the prevalence of the use of drugs with anticholinergic/ sedative burden in institutionalized older adults with dementia and to assess the associated factors. MATERIALS AND METHODS: A cross-sectional study developed in older with dementia living in nursing homes. The prevalence of prescription of anticholinergic/sedative drugs was estimated according to the Drug Burden Index (DBI). A comparative analysis of the DBI score was performed between different types of dementia as well as among various factors and according to the anticholinergic/sedative risk, establishing as a cut-off point of DBI≥1 (high anticholinergic/sedative risk). RESULTS: 178 residents were included. 83.7% had some drug with anticholinergic/sedative burden according to DBI. 50% had a DBI≥1 score. Residents with vascular dementia had a mean DBI of 1.34 (SD 0.84), a significantly higher score than residents with Alzheimer's disease (0.41, 95% CI 0.04-0.78).). Likewise, a higher DBI was associated with more polypharmacy (3.36; 95% CI 2.64-4.08), more falls, hospital admissions and emergency room visits (P<.05). CONCLUSIONS: Polypharmacy and prescription of anticholinergic/sedative drugs is frequent among institutionalized older adults with dementia, finding an association between DBI, falls and hospital admissions or emergency department visits. Therefore, it is necessary to propose interdisciplinary pharmacotherapeutic optimization strategies.

Prevalencia de diabetes mellitus tipo 2 y su tratamiento farmacológico en personas institucionalizadas en centros residenciales / Patients in Nursing Homes: type 2 diabetes mellitus prevalence and its pharmacologic therapy

OBJETIVO: Determinar la prevalencia de diabetes mellitus tipo 2 y sus características clínicas, tratamiento farmacológico específico y problemas derivados en personas institucionalizadas en centros residenciales. MÉTODO: Estudio observacional, transversal llevado a cabo en marzo de 2019 en seis centros residenciales en personas con diagnóstico de diabetes mellitus tipo 2. Se recogieron variables demográficas, clínicas y bioquímicas, tratamiento farmacológico específico y eventos de hipoglucemia y caídas el año anterior. RESULTADOS: La prevalencia de diabetes mellitus tipo 2 fue del 21,7%. El 70,90% de los pacientes tuvieron una glucohemoglobina ≤ 7% el último año, mostrando el 92% de los pacientes una fragilidad moderada-severa. Se encontraron 0,4 hipoglucemias/residente-año, siendo más frecuentes en pacientes insulinizados y en aquellos con función renal deteriorada. Sin embargo, no se encontraron más caídas en pacientes insulinizados (p > 0,05). El tratamiento de la diabetes fue adecuado de acuerdo a las recomendaciones de tratamiento en personas mayores. CONCLUSIONES: Se observa una prevalencia de diabetes tipo 2 ligeramente inferior a lo encontrado en la literatura especializada, con un control estricto de la enfermedad y una apropiada adecuación farmacoterapéutica según las recomendaciones de la European Diabetes Working Party for Older People. Los pacientes insulinizados y aquellos con función renal deteriorada tienen mayor riesgo de hipoglucemia

OBJECTIVE: To determine type 2 diabetes mellitus prevalence, clinical features, specific pharmacologic treatment and problems faced in nursing home patients.METHOD: Observational, cross-sectional study conducted in March 2019 in six nursing homes, examining persons diagnosed with type 2 dia-betes mellitus. Demographic, clinical and biochemical variables, specific pharmacologic therapy and hypoglycemia events as well as falls during the previous year were collected.RESULTS: Prevalence of type 2 diabetes mellitus was 21.7%. 70.90% of the patients had glycated hemoglobin ≤ 7% last year, with 92% of the patients having a moderate-severe frailty. 0.4 hypoglycemia/resident-year were found, being more frequent in patients receiving insulinization and in those with impaired renal function. However, no further falls were found in insulinized patients (p > 0.05). Diabetes therapy was adequate according to treatment recommendations for the elderly. CONCLUSIONS: Prevalence of type 2 diabetes is slightly lower than that found in the literature, finding a strict control of the disease and an appro-priate pharmacotherapeutic adequacy according to the recommendations by the European Diabetes Working Party for Older People. Insulinized patients and those with impaired renal function have a higher risk of hypo-glycemia

Patients in Nursing Homes: type 2 diabetes mellitus prevalence and its pharmacologic therapy.

OBJECTIVE: To determine type 2 diabetes mellitus prevalence, clinical features, specific pharmacologic treatment and problems faced in nursing home patients. METHOD: Observational, cross-sectional study conducted in March 2019  in six nursing homes, examining persons diagnosed with type 2 diabetes mellitus. Demographic, clinical and biochemical variables,  specific pharmacologic therapy and hypoglycemia events as well as falls  during the previous year were collected. RESULTS: Prevalence of type 2 diabetes mellitus was 21.7%. 70.90% of the patients had glycated hemoglobin ≤ 7% last year, with 92% of  the patients having a moderate-severe frailty. 0.4  hypoglycemia/resident-year were found, being more frequent in patients receiving insulinization and in those with impaired renal function.  However, no further falls were found in insulinized patients (p > 0.05).  Diabetes therapy was adequate according to treatment  recommendations for the elderly. CONCLUSIONS: Prevalence of type 2 diabetes is slightly lower than that found in the literature, finding a strict control of the disease and an  appropriate pharmacotherapeutic adequacy according to the  recommendations by the European Diabetes Working Party for Older  People. Insulinized patients and those with impaired renal function have  a higher risk of hypoglycemia.

Objetivo: Determinar la prevalencia de diabetes mellitus tipo 2 y sus características clínicas, tratamiento farmacológico específico y  problemas derivados en personas institucionalizadas en centros  residenciales.Método: Estudio observacional, transversal llevado a cabo en marzo de  2019 en seis centros residenciales en personas con diagnóstico de diabetes mellitus tipo 2. Se recogieron variables demográficas,  clínicas y bioquímicas, tratamiento farmacológico específico y eventos  de hipoglucemia y caídas el año anterior.Resultados: La prevalencia de diabetes mellitus tipo 2 fue del 21,7%. El 70,90% de los pacientes tuvieron una glucohemoglobina ≤  7% el último año, mostrando el 92% de los pacientes una fragilidad  moderada-severa. Se encontraron 0,4 hipoglucemias/residente-año,  siendo más frecuentes en pacientes insulinizados y en aquellos con  función renal deteriorada. Sin embargo, no se encontraron más caídas  en pacientes insulinizados (p > 0,05). El tratamiento de la diabetes fue  adecuado de acuerdo a las recomendaciones de tratamiento en  personas mayores.Conclusiones: Se observa una prevalencia de diabetes tipo 2  ligeramente inferior a lo encontrado en la literatura especializada, con  un control estricto de la enfermedad y una apropiada adecuación  farmacoterapéutica según las recomendaciones de la European Diabetes Working Party for Older People. Los pacientes insulinizados y aquellos  con función renal deteriorada tienen mayor riesgo de hipoglucemia.

[Pharmacological treatment]. / Terapias farmacológicas.

Alzheimer's disease (AD) is a chronic degenerative and inflammatory process leading to synapticdysfunction and neuronal death. A review about the pharmacological treatment alternatives is made: acetylcholinesterase inhibitors (AChEI), a nutritional supplement (Souvenaid) and Ginkgo biloba. A special emphasis on Ginkgo biloba due to the controversy about its use and the approval by the European Medicines Agency is made.

Terapias farmacológicas / Pharmacological treatment

La enfermedad de Alzheimer es un proceso degenerativo e inflamatorio crónico que conduce a una disfunción sináptica y a la muerte neuronal. Se realiza una revisión sobre las alternativas terapéuticas farmacológicas: los inhibidores de la acetilcolinesterasa, la memantina, un suplemento alimenticio: Souvenaid y la Ginkgo biloba. Se hace un especial hincapié en la Ginkgo biloba dadas las controversias sobre su uso y la aprobación por parte de la European Medicines Agency (AU)

Alzheimer’s disease (AD) is a chronic degenerative and inflammatory process leading to synaptic dysfunction and neuronal death. A review about the pharmacological treatment alternatives is made: acetylcholinesterase inhibitors (AChEI), a nutritional supplement (Souvenaid) and Ginkgo biloba. A special emphasis on Ginkgo biloba due to the controversy about its use and the approval by the European Medicines Agency is made (AU)

Errores de conciliación en pacientes pluripatológicos / Medication reconciliation errors in patients with multiple diseases

No disponible

Epidemiología infecciosa en centros gerontológicos / Infection epidemiology in gerontology centres

Introducción. Los procesos infecciosos en centros gerontológicos (CG) constituyen una de las causas importantes de mortalidad y descompensación de patologías crónicas concomitantes. Para conocer su magnitud y distribución, se inició un sistema de vigilancia epidemiológica. Material y métodos. Durante los años 2006-2009 se realizó un estudio de prevalencia en 4 CG de Fundación Matia. Se midió la prevalencia realizando un corte anual, recogiendo: tipo de infección, datos demográficos, factores de riesgo y uso de antibióticos. La incidencia se midió en un CG como centro piloto durante 2 años, recogiendo: tipo de infección y uso de antibióticos. Resultados. La prevalencia en los CG osciló entre el 4,80 y el 6,44%. La densidad de incidencia de infección en el estudio piloto estuvo entre 3,45-5,77 infecciones por 1.000 residentes-día. La localización infecciosa más frecuente, y en este orden, fue la respiratoria, la urinaria y la cutánea. La incidencia de infección respiratoria es mayor de manera estadísticamente significativa ante la presencia de disfagia, malnutrición y enfermedad pulmonar obstructiva crónica. Sin embargo, en la incidencia infección urinaria no se aprecia relación significativa con los diferentes factores de riesgo analizados. Conclusiones. La frecuencia y las repercusiones de las infecciones nosocomiales en este tipo de centros pone de relieve la necesidad de controles epidemiológicos periódicos para adaptar planes de intervención y desarrollar medidas preventivas adecuadas(AU)

Introduction. Infection processes in gerontology centres (GC) are one of the main causes of mortality and aggravation of concomitant chronic diseases. An epidemiological surveillance system was set up to find out their magnitude and distribution. Material and methods. A prevalence study was conducted during the years 2006-2009 in 4 GCs of the Matia Foundation. Prevalence was measured by making an annual cut-off, recording: infection type, demographic data, risk factors and antibiotic use. The incidence was measured for two years in one GC as a pilot centre, recording: infection type and antibiotic use. Results. The prevalence in the GCs varied between 4.8% and 6.44%. The infection incidence density in the pilot study was between 3.45-5.77 infections per 1,000 resident days. The most common infection location and in this order were, respiratory, urinary and cutaneous. The incidence of respiratory infection is more statistically significant in the presence of dysphagia, malnutrition and COPD. However, no significant relationship was seen in the incidence of urinary infection with the different risk factors analysed. Conclusions. The frequency and repercussions of nosocomial infections in GCs demonstrate the need for intervention plans and the development of adequate prevention measures(AU)

[Infection epidemiology in gerontology centres]. / Epidemiología infecciosa en centros gerontológicos.

INTRODUCTION: Infection processes in gerontology centres (GC) are one of the main causes of mortality and aggravation of concomitant chronic diseases. An epidemiological surveillance system was set up to find out their magnitude and distribution. MATERIAL AND METHODS: A prevalence study was conducted during the years 2006-2009 in 4 GCs of the Matia Foundation. Prevalence was measured by making an annual cut-off, recording: infection type, demographic data, risk factors and antibiotic use. The incidence was measured for two years in one GC as a pilot centre, recording: infection type and antibiotic use. RESULTS: The prevalence in the GCs varied between 4.8% and 6.44%. The infection incidence density in the pilot study was between 3.45-5.77 infections per 1,000 resident days. The most common infection location and in this order were, respiratory, urinary and cutaneous. The incidence of respiratory infection is more statistically significant in the presence of dysphagia, malnutrition and COPD. However, no significant relationship was seen in the incidence of urinary infection with the different risk factors analysed. CONCLUSIONS: The frequency and repercussions of nosocomial infections in GCs demonstrate the need for intervention plans and the development of adequate prevention measures.

Diabetes mellitus y calidad de vida en población geriátrica institucionalizada / Diabetes mellitus and quality of life in nursing homes

Objetivo: describir el perfil clínico de la diabetes mellitus (DM) en población geriátrica institucionalizada, sus complicaciones crónicas y su percepción de la calidad de vida. Material y métodos: estudio descriptivo, transversal, realizado en el medio residencial mediante la valoración geriátrica integral, comparando la frecuencia de aparición de afecciones crónicas y de síndromes geriátricos en los pacientes diabéticos. En el grupo sin deterioro cognitivo se determinó la calidad de vida percibida con el cuestionario COOP-WONCA y su riesgo cardiovascular con la escala de Framingham. Se establecieron comparaciones con un nivel de significación estadística de p < 0,05. Resultados: se evaluó a 190 pacientes con una edad media ± desviación estándar de 83,1 ± 8,2 años; un 76,8% eran mujeres. El 50,5% presentaba una dependencia grave y el 57,0% cumplía criterios de demencia. La prevalencia de DM fue del 27,4%, de predominio en mujeres mayores de 80 años; 11 casos adicionales presentaban glucemia basal alterada (110-125 mg/dl). Entre los pacientes con DM existe mayor asociación con hipertensión y complicaciones vasculares, así como de incontinencia urinaria y sobrepeso. En un 65% los valores de hemoglobina glucosilada (HbA1C) fueron < 7% y el tratamiento fundamental se realizó con antidiabéticos orales. El riesgo cardiovascular es alto o muy alto en la población institucionalizada con DM. Los pacientes diabéticos sin deterioro cognitivo presentan una mejor percepción de salud que los no diabéticos (p < 0,05). Conclusiones: la DM en la población geriátrica institucionalizada tiene una alta prevalencia. Es fundamental realizar una valoración geriátrica integral para evaluar los riesgos potenciales y mantener, en lo posible, la calidad de vida de estos pacientes (AU)

Objectives: to describe the clinical profile of diabetes mellitus (DM) in elderly nursing home residents, as well as chronic complications and residents' perceptions of their quality of life. Material and methods: a cross-sectional descriptive study was performed in the residential setting through comprehensive geriatric assessment. The frequency of chronic diseases and geriatric syndromes in patients with diabetes was compared. In residents without cognitive impairment, perceived quality of life was determined through the COOP-WONCA questionnaire and cardiovascular risk was assessed with the Framingham scale. Statistical significance was set at P<.05. Results: a total of 190 residents were evaluated. The mean age was 83.1 years (SD 8.2) and 76.8% were women. Severe dependency was found in 50.5% and criteria for dementia were met by 57.0%. The prevalence of DM was 27.4%. DM predominated in women aged more than 80 years. A further 11 patients showed altered baseline glycemia (110-125 mg/dl). Among patients with DM there was a greater association with hypertension and vascular complications, as well as with urinary incontinence and overweight. HbA1C levels were <7% in 65% and the main treatment was oral antidiabetic agents. Cardiovascular risk was high or very high in nursing home residents with DM. Perceived quality of life was higher in diabetic residents without cognitive impairment than in residents without diabetes (P<.05). Conclusions: DM is highly prevalent among elderly residents of nursing homes. Comprehensive geriatric assessment is essential to evaluate potential risks and to optimize quality of life in these patients (AU)