Debate: healthcare professionals in nutrition support teams / Debate: profesionales sanitarios en las unidades de nutrición

The debate from the course preceding the SENPE (Spanish Society of Clinical Nutrition and Metabolism) 2020 Conference gathered together well-known professionals who form part of nutritional support teams (NSTs), as well as other specialists from departments whose patients benefit from the services offered by these NSTs. In this article, relevant points from the round table, including strengths and weaknesses detected in the implementation of nutrition support teams, are summarized

El debate del curso previo al congreso de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE) 2020 reunió en una mesa redonda a profesionales de prestigio que forman parte de unidades de nutrición y dietética, y a otros especialistas de servicios cuyos pacientes se benefician de los servicios de estas unidades. En este artículo se muestran los puntos relevantes que se trataron en el mismo y se muestran algunas fortalezas y debilidades que se han detectado en la implementación de las unidades de nutrición

Clinical presentation and outcome across age categories among patients with COVID-19 admitted to a Spanish Emergency Department.

PURPOSE: To determine the differences by age-dependent categories in the clinical profile, presentation, management, and short-term outcomes of patients with laboratory-confirmed COVID-19 admitted to a Spanish Emergency Department (ED). METHODS: Secondary analysis of COVID-19_URG-HCSC registry. We included all consecutive patients with laboratory-confirmed COVID-19 admitted to the ED of the University Hospital Clinico San Carlos (Madrid, Spain). The population was divided into six age groups. Demographic, baseline and acute clinical data, and in-hospital and 30-day outcomes were collected. RESULTS: 1379 confirmed COVID-19 cases (mean age 62 (SD 18) years old; 53.5% male) were included (18.1% < 45 years; 17.8% 45-54 years; 17.9% 55-64 years; 17.2% 65-74 years; 17.0% 75-84 years; and 11.9% ≥ 85 years). A statistically significant association was found between demographic, comorbidity, clinical, radiographic, analytical, and therapeutic variables and short-term results according to age-dependent categories. There were less COVID-specific symptoms and more atypical symptoms among older people. Age was a prognostic factor for hospital admission (aOR = 1.04; 95% CI 1.02-1.05) and in-hospital (aOR = 1.08; 95% CI 1.05-1.10) and 30-day mortality (aOR = 1.07; 95% CI 1.04-1.09), and was associated with not being admitted to intensive care (aOR = 0.95; 95% CI 0.93-0.98). CONCLUSIONS: Older age is associated with less COVID-specific symptoms and more atypical symptoms, and poor short-term outcomes. Age has independent prognostic value and may help in shared decision-making in patients with confirmed COVID-19 infection.

Rasch analysis in the development of the NutriQoL® questionnaire, a specific health-related quality of life instrument for home enteral nutrition.

BACKGROUND: Home enteral nutrition (HEN) is a therapeutic method used in patients who are unable to ingest the required amounts of nutrients but retain a functional gastrointestinal tract. The objective of this study was to compose a specific questionnaire for measuring health-related quality of life (HRQoL) in HEN patients irrespective of their underlying condition and HEN route of administration. METHODS: Literature review, focus groups and semi-structured interviews were used to propose an initial version of the questionnaire which was answered by 165 participants. The responses were analyzed using the Rasch methodology. Firstly, the appropriateness of response options was assessed. Then, the differential item functioning (DIF) was evaluated. Finally, the item fit statistics, infit and outfit, were determined. RESULTS: Rasch analysis was performed on the responses given to the 43 items included in the initial questionnaire. Four items were excluded because more than 50% of respondents answered that the situation proposed did not apply to them. Seven items that showed overlapping and disordered categories were also removed. Pairwise DIF analysis were performed in subgroups defined by underlying disease and administration route. Eleven items presented DIF and were eliminated from the questionnaire. Finally, four items were deleted after analyzing the fit statistics, three of which did not fit the Rasch model and one did not belong to either of the dimensions. The final version of NutriQoL® includes 17 items. CONCLUSIONS: NutriQoL® is a useful instrument to assess the HRQoL of HEN patients with any disease and any administration route.

The NutriQoL® questionnaire for assessing health-related quality of life (HRQoL) in patients with home enteral nutrition (HEN): validation and first results / Cuestionario NutriQol® para la evaluación de la calidad de vida relacionada con la salud (CVRS) en pacientes con nutrición enteral domiciliaria (NED): validación y primeros resultados

Introduction: Health-related quality of life (HRQoL) provides a global view of the state of health of a patient receiving home enteral nutrition (HEN). Objective: To evaluate the HRQoL of patients receiving HEN using the NutriQoL® questionnaire, a specific instrument regardless of the underlying disease and route of administration. Materials and methods: Observational, prospective and multicentre study conducted in the context of the validation and assessment of the NutriQoL® questionnaire’s psychometric properties. Results: One-hundred-and-forty individuals [disease: cancer (58.6%), malabsorption and other (27.1%), neurological (13.6%); HEN: supplement (61.4%), sole source of nutrition (35.7%); administration route: oral (54.3%), ostomy (31.4%), nasoenteric tube (12.1%)] participated. NutriQoL® was reliable [ICC: 0.88 (95%CI: 0.80-0.93); Cronbach’s α: 0.77 (1st visit) and 0.83 (2nd visit)], valid (significant Rho), lowly sensitive to changes (effect size 0.23), can be completed by either patients or caregivers (ICC: 0.82). The mean HRQoL (SD) with NutriQoL® was 14.98 (14.86), EQ-5D tariff: 53(0.25), EQ-5D VAS: 54.15(20.64) and COOP/WONCA charts: 23.32(5.66). HRQoL with NutriQoL® was better (p < 0.05) for oral HEN [19.54(13,23)], than nasoenteric tube [14(11.71)], ostomy [7.02 (15.48)]; administered orally [19.54 (13.23)], than by gravity [10.97 (14.46)], pump [8.5 (19.78)] or syringe bolus [7 (11.40)]; as a supplement [19.33 (13.73)] instead of sole source of nutrition [8.18 (14.23)]. Conclusions: NutriQoL® is valid, reliable, even if lowly sensitive to change, and useful to measure HRQoL in this population. More studies are needed to know HRQoL in routine practice (AU)

Introducción: la calidad de vida relacionada con la salud (CVRS) permite disponer de una visión global del estado de salud del paciente que recibe nutrición enteral domiciliaria (NED). Objetivo: evaluar la CVRS de pacientes con NED usando el cuestionario NutriQoL®, herramienta específica para pacientes con NED independientemente de la patología subyacente y vía de administración. Materiales y métodos: estudio observacional, prospectivo, multicéntrico, en el contexto de la validación y evaluación de las propiedades psicométricas del cuestionario NutriQoL®. Resultados: se incluyeron 140 individuos [patologías: oncológica (58,6%), malabsorción y otros (27,1%), neurológica (13,6%); NED: complemento a la alimentación (64,4%), única nutrición (35,7%); vía de administración: oral (54,3%), ostomía (31,4%) y sonda naso-entérica (12,1%)]. El NutriQoL® resultó fiable [CCI: 0,88 (IC95%: 0,80-0,93); α de Cronbach: 0,77 (1ª visita) y 0,83 (2ª visita)], válido (Rho significativas), aunque poco sensible a los cambios (tamaño del efecto: 0,23), pudiendo ser cumplimentado por el paciente o su cuidador (CCI: 0,82). La CVRS media (DE) con NutriQoL® fue 14,98(14,86), con la tarifa EQ-5D: 53(0,25), EVA EQ-5D: 54,15(20,64) y viñetas COOP/WONCA: 23,32(5,66). La CVRS medida con NutriQoL® fue mejor (p < 0,05) en pacientes con NED por vía oral [19,54(13,23)] que con sonda naso-entérica [14(11,71)] u ostomía [7,02(15,48)]; administrada por vía oral [19,54(13,23)] que por gravedad [10,97(14,46)], bomba [8,5(19,78)] o bolo con jeringa [7(11,40)]; como complemento [19,33(13,73)] que como única alimentación [8,18(14,23)]. Conclusiones: NutriQoL® es un cuestionario válido, fi able, aunque poco sensible a los cambios y útil para medir la CVRS en pacientes con NED. Son necesarios más estudios para conocer la CVRS de estos pacientes en la práctica habitual (AU)

Development and validation of a specific questionnaire to assess health-related quality of life in patients with home enteral nutrition: NutriQoL® development.

INTRODUCTION: Home enteral nutrition (HEN) is indicated in patients with a functional gastrointestinal tract but who are unable to meet their nutritional requirements with normally consumed foodstuffs. HEN allows patients to remain in their social and family environment, thus reducing complications and costs associated with hospital admission, while increasing health-related quality of life (HRQoL). HRQoL in patients with HEN is mainly evaluated by generic instruments, which are not sensitive enough to identify certain specific patient-related outcomes of HEN. OBJECTIVE: To develop a specific instrument to measure HRQoL in patients receiving HEN whose results allow interpretation regardless of the underlying disease and nutritional support administration route: the NutriQoL® questionnaire. MATERIALS AND METHODS: The development of the NutriQoL entailed a literature review, focus groups with experts, semistructured interviews with patients, an assessment of face validity and feasibility, and Rasch analysis conducted on data from a sample of 141 patients and 24 caregivers. RESULTS: Of the 52 items initially proposed on the basis of the literature review, expert focus group, and semi-structured interviews with patients and caregivers, 17 items were finally selected through the development process to make up the final version of the NutriQoL, as well as a visual analog scale for global HRQoL scoring. The selected items were evaluated as adequate for frequency, importance, and clarity. Furthermore, they have been shown to be independent of the underlying condition and HEN administration route. CONCLUSION: A new instrument for measuring the HRQoL of patients with HEN in Spain has been developed, whose results are independent of the underlying condition and administration route. The next step will be the validation of the questionnaire to ensure that the instrument is valid, reliable, and sensitive to health status changes in patients, to be used periodically in usual clinical practice.

La prevalencia de sarcopenia en residencias de España: comparación de los resultados del estudio multicéntrico ELLI con otras poblaciones / Prevalence of sarcopenia in Spanish nursing homes: Comparison of the results of the ELLI study with other populations

Introducción. El objetivo principal del estudio es conocer la prevalencia de sarcopenia, según criterios del European Working Group on Sarcopenia in Older People, en ancianos que viven en residencia. Métodos. Estudio multicéntrico en personas mayores de 70 capaces de caminar que viven en residencias. La composición corporal se evaluó mediante bioimpedanciometría, la fuerza de prensión con un dinamómetro Jamar y la velocidad de la marcha sobre un recorrido de 4m. La sarcopenia se evaluó utilizando los criterios del European Working Group on Sarcopenia in Older People (velocidad<0,8m/s; fuerza de prensión<30kg en hombres o<20kg en mujeres, e índice de masa muscular <8,31kg/m2 en hombres o<6,68kg/m2 en mujeres). Resultados. Se incluyeron 276 personas (mediana de edad 87,2 años; 69% mujeres), un 37% tenía sarcopenia (15% hombres, 46% mujeres), un 37% baja masa muscular, un 86% lentitud al caminar y un 95% debilidad muscular. La prevalencia de sarcopenia se incrementó con la edad. El 90% de las personas con sarcopenia presentaban conjuntamente una disminución de fuerza y velocidad. El 39% de personas con lentitud y el 38% de personas con debilidad muscular tenían sarcopenia. Conclusiones. La presencia de sarcopenia es un problema frecuente en personas mayores que viven en residencias, especialmente en mujeres. La mayor parte de los casos son graves, con una disminución concurrente de la fuerza muscular y de rendimiento físico. Aunque la funcionalidad muscular está alterada en 9 de cada 10 participantes, la mayoría de ellos tiene preservada la masa muscular (AU)

Introduction. The main aim of this study is to assess the prevalence of sarcopenia, according to the criteria of the European Working Group on Sarcopenia in Older People, in men and women living in Spanish nursing homes. Methods. Multi-centre study was conducted on ambulatory persons over 69 years old living in nursing homes. Body composition was assessed using bioimpedance analysis, grip strength with a Jamar dynamometer, and gait speed using the 4 metre walk test. Sarcopenia was assessed using the European Working Group on Sarcopenia in Older People criteria (gait speed<0.8m/s; grip strength<30kg in men or 20kg in women, and muscle mass index <8.31kg/m2 in men or<6.68kg/m2 in women). Results. The study included 276 subjects with a median age 87.2 years, and with 69% women. Sarcopenia was demonstrated in 37% (15% men, 46% women), 37% had low muscle mass, 86% low gait speed, and 95% low grip strength. Prevalence of sarcopenia increased with advancing age. Both weakness and low gait speed was observed in 90% of individuals with sarcopenia, with 39% of the total having low gait speed, and 38% with weakness. Conclusion. Sarcopenia is a frequent condition in older persons living in nursing homes, especially among women. Most of the cases are severe, with both low muscle strength and physical performance. Although muscle function is altered in 9 out 10 participants, most of them have preserved muscle mass (AU)

Reliability and Responsiveness of NutriQoL® Questionnaire.

INTRODUCTION: NutriQoL® (Nestlé Health Science, Vevay, Switzerland) is a questionnaire developed to assess the health-related quality-of-life (HRQoL) of patients with home enteral nutrition (HEN) irrespective of their underlying condition and route of administration. The aim of this work is assessing the questionnaire's reliability and responsiveness to change. METHODS: Two cohorts of patients with HEN and their primary caregivers were enrolled to assess reliability and responsiveness, respectively. All participants had to be 18 years of age or older, without mental deterioration (≤3 or 4 errors in the Pfeiffer's test) and with sufficient functional status (>40 points on Karnovsky's performance status scale). When the patients' ability to respond to the questionnaire was impaired due to underlying disease, their caregivers answered on their behalf. NutriQoL was administered in two and three visits to reliability and responsiveness cohorts, respectively. Test-retest reliability and internal consistency were assessed by the intra-class correlation coefficient (ICC) and the Cronbach's α, respectively. Responsiveness was evaluated by standardized effect size and standardized response mean between basal visit and third visit. Finally, the minimal clinically important difference (MCID) was estimated. RESULTS: A total of 54 and 86 participants were recruited to the reliability and responsiveness cohort, respectively. Thirty-five caregivers were selected to assess the inter-observer reliability. ICC values confirmed the good reproducibility level (ICC >0.75) of the questionnaire in both "physical functioning and activities of daily living" and "social life" domains and total score. The assessment of internal consistency in both domains of the questionnaire showed good internal consistency in visit 2. ICC showed the excellent agreement level between caregiver and patient in the global NutriQoL score. Finally, patients classified as having a minimal change in their health reported a mean (standard deviation) MCID in NutriQoL score of 0.63 (11.51). CONCLUSION: NutriQoL is a reliable and unique instrument to measure the HRQoL in HEN patients. NutriQoL detects changes in the health status of the patient. Nevertheless, further research is needed to determine the full extent of the questionnaire responsiveness.

[Prevalence of sarcopenia in Spanish nursing homes: Comparison of the results of the ELLI study with other populations]. / La prevalencia de sarcopenia en residencias de España: comparación de los resultados del estudio multicéntrico ELLI con otras poblaciones.

INTRODUCTION: The main aim of this study is to assess the prevalence of sarcopenia, according to the criteria of the European Working Group on Sarcopenia in Older People, in men and women living in Spanish nursing homes. METHODS: Multi-centre study was conducted on ambulatory persons over 69 years old living in nursing homes. Body composition was assessed using bioimpedance analysis, grip strength with a Jamar dynamometer, and gait speed using the 4 metre walk test. Sarcopenia was assessed using the European Working Group on Sarcopenia in Older People criteria (gait speed<0.8m/s; grip strength<30kg in men or 20kg in women, and muscle mass index <8.31kg/m(2) in men or<6.68kg/m(2) in women). RESULTS: The study included 276 subjects with a median age 87.2 years, and with 69% women. Sarcopenia was demonstrated in 37% (15% men, 46% women), 37% had low muscle mass, 86% low gait speed, and 95% low grip strength. Prevalence of sarcopenia increased with advancing age. Both weakness and low gait speed was observed in 90% of individuals with sarcopenia, with 39% of the total having low gait speed, and 38% with weakness. CONCLUSION: Sarcopenia is a frequent condition in older persons living in nursing homes, especially among women. Most of the cases are severe, with both low muscle strength and physical performance. Although muscle function is altered in 9 out 10 participants, most of them have preserved muscle mass.

Prevalence of sarcopenia in patients attending outpatient geriatric clinics: the ELLI study.

OBJECTIVES: the aim of this study is to know the prevalence of sarcopenia in geriatric outpatient clinics using the EGWSOP (European Working Group on Sarcopenia in Older People) diagnostic criteria that include muscle mass, muscle strength and physical performance. METHODS: subjects over 69 years old, able to walk without help and who attended five geriatric outpatient clinics were recruited. Body composition was assessed using bioimpedance analysis (BIA), grip strength using a JAMAR dynamometer and physical performance by the 4 m gait speed. Sarcopenia was diagnosed using the EGWSOP criteria (gait speed <0.8 m/s; grip strength <30 kg in men or <20 kg in women, and muscle mass index (MMI) <8.31 kg/m(2) in men or <6.68 kg/m(2) in women). RESULTS: two hundred and ninety-eight subjects were included (median age 83.2 years, 63.1% women). 19.1% had sarcopenia (12.7% men, 22.9% women); 20.1% had low muscle mass; 68.8% had low gait speed and 81.2% low grip strength. Only 21.9% of the subjects with low grip strength and 19.5% of those with low gait speed had sarcopenia. No correlations between muscle mass and either muscle strength or gait speed were detected. CONCLUSIONS: sarcopenia is present in one out of five subjects attending geriatric outpatient clinics.

Prevalencia de sarcopenia en consultas de geriatría y residencias. Estudio ELLI / Prevalence of sarcopenia in geriatric outpatients and nursing homes. The ELLI study

Introducción: Existen hasta ahora pocos estudios sistemáticos con los nuevos criterios diagnósticos sobre la prevalencia de la sarcopenia en distintos niveles asistenciales geriátricos. Objetivo: Conocer la prevalencia de sarcopenia, aplicando los criterios y el algoritmo diagnóstico propuesto por el European Working Group on Sarcopenia in older People (EWGSOP), en personas mayores que acuden a consultas externas de geriatría y en aquellas que están ingresadas en residencias. Material y métodos: Estudio multicéntrico nacional en 2 muestras de personas mayores: una formada por aquellas que acuden a consultas externas de geriatría hospitalarias, y la otra por aquellas que están ingresadas en una residencia. Se recogen variables demográficas, antecedentes clínicos, medicamentos consumidos, presencia de síndromes geriátricos, situación funcional (valoración de las actividades básicas e instrumentales de la vida diaria), movilidad, situación cognitiva, comorbilidad, calidad de vida, valoración nutricional y parámetros analíticos. Para realizar el diagnóstico de sarcopenia se valora la velocidad de la marcha (4 m), la fuerza de prensión de la mano y la composición corporal mediante bioimpedanciometría. Resultados: Utilizando el algoritmo diagnóstico del EWGSOP se espera obtener datos sobre la prevalencia de sarcopenia en la población mayor española. Además se analizará la concordancia entre los 3 parámetros de la definición (masa muscular, fuerza muscular y rendimiento físico) y se aplicarán los diferentes puntos de corte existentes para cada uno de ellos, explorando el rendimiento diagnóstico de cada uno de ellos. Por último, se analizarán los datos demográficos, antropométricos y funcionales que definen a los pacientes con sarcopenia Conclusiones: El estudio ELLI permitirá profundizar en el conocimiento de la prevalencia de sarcopenia en los mayores de nuestro entorno (AU)

Background: There are few systematic studies on the prevalence of sarcopenia using the new diagnostic criteria in different geriatric care settings. Objective: To estimate the prevalence of sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria in older subjects living in nursing homes and in those who attend geriatric outpatient clinics. Material and methods: A single country multicentre study in two samples of older subjects: patients cared for in outpatient geriatric clinics, and individuals living in nursing homes. Data collected will include demographic variables, medical history, medication, geriatric syndromes, functional status (assessment of basic and instrumental activities of daily living), mobility, cognitive status, comorbidity, quality of life, nutritional status, and laboratory parameters. For the diagnosis of sarcopenia, 4 m walking speed, handgrip strength, and body composition measured by bioelectrical impedance analysis will be assessed. Results: Using the EWGSOP algorithm, the prevalence of sarcopenia in an elderly Spanish population will be estimated. In addition, concordance and correlation between the three parameters included in the definition (muscle mass, muscle strength, and physical performance) will be analysed, using the different existing cut-off points, and examining the diagnostic accuracy of each. Finally, demographic, anthropometric and functional data that define subjects with sarcopenia will be investigated. Conclusions: The ELLI study should improve knowledge on the prevalence and characteristics of sarcopenia in older people in our population (AU)

[Prevalence of sarcopenia in geriatric outpatients and nursing homes. The ELLI study]. / Prevalencia de sarcopenia en consultas de geriatría y residencias. Estudio ELLI.

BACKGROUND: There are few systematic studies on the prevalence of sarcopenia using the new diagnostic criteria in different geriatric care settings. OBJECTIVE: To estimate the prevalence of sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria in older subjects living in nursing homes and in those who attend geriatric outpatient clinics. MATERIAL AND METHODS: A single country multicentre study in two samples of older subjects: patients cared for in outpatient geriatric clinics, and individuals living in nursing homes. Data collected will include demographic variables, medical history, medication, geriatric syndromes, functional status (assessment of basic and instrumental activities of daily living), mobility, cognitive status, comorbidity, quality of life, nutritional status, and laboratory parameters. For the diagnosis of sarcopenia, 4m walking speed, handgrip strength, and body composition measured by bioelectrical impedance analysis will be assessed. RESULTS: Using the EWGSOP algorithm, the prevalence of sarcopenia in an elderly Spanish population will be estimated. In addition, concordance and correlation between the three parameters included in the definition (muscle mass, muscle strength, and physical performance) will be analysed, using the different existing cut-off points, and examining the diagnostic accuracy of each. Finally, demographic, anthropometric and functional data that define subjects with sarcopenia will be investigated. CONCLUSIONS: The ELLI study should improve knowledge on the prevalence and characteristics of sarcopenia in older people in our population.

Improving electronic sensor reliability by robust outlier screening.

Electronic sensors are widely used in different application areas, and in some of them, such as automotive or medical equipment, they must perform with an extremely low defect rate. Increasing reliability is paramount. Outlier detection algorithms are a key component in screening latent defects and decreasing the number of customer quality incidents (CQIs). This paper focuses on new spatial algorithms (Good Die in a Bad Cluster with Statistical Bins (GDBC SB) and Bad Bin in a Bad Cluster (BBBC)) and an advanced outlier screening method, called Robust Dynamic Part Averaging Testing (RDPAT), as well as two practical improvements, which significantly enhance existing algorithms. Those methods have been used in production in Freescale® Semiconductor probe factories around the world for several years. Moreover, a study was conducted with production data of 289,080 dice with 26 CQIs to determine and compare the efficiency and effectiveness of all these algorithms in identifying CQIs.

[Elderly patients with recurrent falls. Role of posturographic studies]. / Valor de la posturografía en ancianos con caídas de repetición.

BACKGROUND AND OBJECTIVE: Our purpose was to provide information about static and dynamic balance posturographic disorders in elderly people with recurrent falls, and to compare the results with a healthy elderly group. PATIENTS AND METHOD: We included 95 subjects: 57 patients who fell (86% women; age, 78.1 years) and 38 controls. Posturography by Balance Master (Neurocom). Tests performed included: a) weight bearing squat (WBS); b) modified clinical test for the sensory interaction on balance (MCT); c) sit to stand (SS); d) walk across (WA), and e) step and over (SO). RESULTS: No differences in the WBS test between both groups. MCT test: The speed of the movement of the gravity center standing on a firm surface was faster in the fallers group, both with open (p = 0.034) and closed eyes (p = 0.003). The same was seen when we assessed the balance on a foam surface (p < 0.005). 45% of subjects with falls showed instability and fell when they tried to stand if we altered propioceptive conditions and nullified visual afference, as compared to only 18.4% of the control group (p = 0.009). SS test: The elapsed time (in seconds) in order to stand was greater in the study group. d) WA test: Walking velocity was faster in the fallers group. SO test: Non-fallers made more body pressure when they went down a step, without interaction with age or gender. CONCLUSIONS: There was an increase in the number of individuals in the fallers group who fell after nullifying visual and propioceptive afferences. It seems necessary to identify these patients in order to establish early intervention programs. The abnormal results in tests which assess daily life activities could be associated with an after-fall anxiety syndrome. Posturography could be a good way to detect the after-fall anxiety syndrome and to develop effective strategies for prevention and treatment.

Valor de la posturografía en ancianos con caídas de repetición / Elderly patients with recurrent falls: role of posturographic studies

FUNDAMENTO Y OBJETIVO: Describir las alteraciones del equilibrio estático y dinámico en ancianoscon caídas de repetición y comparar los resultados con un grupo sin caídas.PACIENTES Y MÉTODO: Se incluyó a 95 sujetos, 57 en el grupo de estudio (un 86% eran mujeres yla edad media de 78,1 años) y 38 controles. La posturografía se realizó con Balance Master deNeurocom. Las pruebas seleccionadas fueron: a) desplazamiento (WBS); b) mantenimiento debipedestación (MCT); c) bipedestación desde sentado (SS); d) marcha (WA), y e) subir y bajarescalones (SO).RESULTADOS: No se observaron diferencias entre ambos grupos en la prueba WBS. En la pruebaMCT se obtuvo una diferencia a favor del grupo con caídas en velocidad de desplazamiento delcentro de gravedad sobre superficie firme en bipedestación con los ojos abiertos (p = 0,034) ycerrados (p = 0,003). Al igual que sobre superficie almohadillada con ojos abiertos (p = 0,002)y cerrados (p = 0,015). Los sujetos con caídas de repetición tenían inestabilidad y caída(44,9%) al intentar mantener la bipedestación debido a una disminución de la sensibilidadpropioceptiva y anulación de la aferencia visual frente a los controles (18,4%) (p = 0,009). Enla prueba SS, los sujetos con antecedentes de caídas tardaron un tiempo mayor en alcanzar labipedestación desde la posición de sentado y sin apoyos (p = 0,001). Respecto a la prueba WAse observó una mayor velocidad de la marcha en el grupo de caídas (p < 0,001). Finalmente,en la prueba SO, los pacientes sin antecedentes de caídas ejercieron mayor presión corporal alsubir escalones independientemente de la edad y el sexo.CONCLUSIONES: La anulación conjunta de las aferencias visuales y propioceptivas facilita la apariciónde nuevas caídas. Identificar esta situación puede ser útil para establecer políticas preventivas.Los resultados alterados de las pruebas que valoran las actividades básicas de la vidadiaria podrían estar relacionados con el síndrome poscaída. La posturografía es una técnica útilen el estudio de estos pacientes y puede permitir la puesta en marcha de programas efectivosde tratamiento

BACKGROUND AND OBJECTIVE: Our purpose was to provide information about static and dynamic balanceposturographic disorders in elderly people with recurrent falls, and to compare the resultswith a healthy elderly group.PATIENTS AND METHOD: We included 95 subjects: 57 patients who fell (86% women; age, 78.1years) and 38 controls. Posturography by Balance Master (Neurocom). Tests performed included:a) weight bearing squat (WBS); b) modified clinical test for the sensory interaction on balance(MCT); c) sit to stand (SS); d) walk across (WA), and e) step and over (SO).RESULTS: No differences in the WBS test between both groups. MCT test: The speed of the movementof the gravity center standing on a firm surface was faster in the fallers group, bothwith open (p = 0.034) and closed eyes (p = 0.003). The same was seen when weassessed the balance on a foam surface (p < 0.005). 45% of subjects with falls showed instabilityand fell when they tried to stand if we altered propioceptive conditions and nullified visualafference, as compared to only 18.4% of the control group (p = 0.009). SS test: The elapsedtime (in seconds) in order to stand was greater in the study group. d) WA test: Walkingvelocity was faster in the fallers group. SO test: Non-fallers made more body pressure whenthey went down a step, without interaction with age or gender.CONCLUSIONS: There was an increase in the number of individuals in the fallers group who fell afternullifying visual and propioceptive afferences. It seems necessary to identify these patientsin order to establish early intervention programs. The abnormal results in tests which assessdaily life activities could be associated with an after-fall anxiety syndrome. Posturography couldbe a good way to detect the after-fall anxiety syndrome and to develop effective strategies forprevention and treatment