Consecuencias en salud (mortalidad e institucionalización) de la fractura de cadera en la población anciana. Estudio de cohortes poblacional en Segovia / Health consequences (mortality and institutionalization) of hip fracture among the elderly people: Population cohort study in Segovia

Objetivo: Conocer las consecuencias sociosanitarias de la fractura de cadera (FC). Diseño: Estudio de cohortes históricas de una población mayor de 75 años de un área sanitaria durante un periodo de 5 años. Emplazamiento: Área de Salud de Segovia. Participantes: Todos los pacientes mayores de 75 años con diagnóstico de FC, excluyendo desplazados o transeúntes. Intervenciones: Se analizaron los cambios sociosanitarios que se producen tras la FC con respecto a su situación basal y las variables que más influyen en la mortalidad e institucionalización. Medidas principales: Se registraron 1.159FC, con una incidencia anual constante de 10,7‰. La prevalencia fue mayor en mujeres: 7,4 vs. 3,7%. Resultados: El perfil basal fue una mujer de 87 años pluripatológica, no-institucionalizada, que conserva su independencia para la vida diaria y que sufre una FC por una caída accidental en su domicilio. Al final del periodo de estudio un 51% fueron institucionalizados permanentemente influyendo negativamente el tener un peor deterioro mental, una peor dependencia y los reingresos posteriores, además fallecieron un 45,5%, un 25,5% durante el primer año; las condiciones más desfavorables fueron: ser previamente dependiente, tener un deterioro mental severo y sexo masculino, y dentro de las comorbilidades la más influyente fue el tener una anemia previa. Conclusiones: Nuestros datos confirman el deterioro de la autonomía-capacidad funcional tras una FC, en consonancia con lo publicado, y han permitido identificar qué ancianos son los que tienen mayor riesgo de complicaciones a corto y medio plazo (institucionalización y muerte).(AU)

Objective: In order to know the social and health consequences of hip fractures (HF). Design: A retrospective cohort study of an entire health area was carried out in patients aged 75 or more, over a period of 5 years. Site: Segovia Health Area. Participants: All patients older than 75 years with a diagnosis of HF, excluding displaced and passerby. Interventions: The socio-sanitary changes that occur after the HF in respect to their baseline situation (family situation, comorbidities, dependence and mental situation) and the variables which most influence mortality and institutionalization after the HF were analyzed. Main measurements: One thousand one hundred fifty-nine HF were recorded, with a constant annual incidence of 10.7‰. The prevalence was higher in women: 7.4% versus 3.7%. Results: The baseline profile is a pluripatological, non-institutionalized, 87-year-old woman, who retains her independent in her daily life and suffers from a HF due to an accidental fall in her home. At the end of the study period 51% were permanently institutionalized, negatively influencing having worse mental deterioration, worse dependence and subsequent readmissions and in addition, 45.5% died, 25.5% during the first year. The most unfavorable conditions were being previously dependent, having severe mental deterioration, male and within the comorbidities the most influential was previously having an anemia. Conclusions: Our data confirms the deterioration of the autonomy-functional capacity after a HF, in line with what has been published, and has allowed to identify which elderly people are at the greatest risk of complications in the short and medium term (institutionalization and death).(AU)

[Health consequences (mortality and institutionalization) of hip fracture among the elderly people: Population cohort study in Segovia]. / Consecuencias en salud (mortalidad e institucionalización) de la fractura de cadera en la población anciana. Estudio de cohortes poblacional en Segovia.

OBJECTIVE: In order to know the social and health consequences of hip fractures (HF). DESIGN: A retrospective cohort study of an entire health area was carried out in patients aged 75 or more, over a period of 5 years. SITE: Segovia Health Area. PARTICIPANTS: All patients older than 75 years with a diagnosis of HF, excluding displaced and passerby. INTERVENTIONS: The socio-sanitary changes that occur after the HF in respect to their baseline situation (family situation, comorbidities, dependence and mental situation) and the variables which most influence mortality and institutionalization after the HF were analyzed. MAIN MEASUREMENTS: One thousand one hundred fifty-nine HF were recorded, with a constant annual incidence of 10.7‰. The prevalence was higher in women: 7.4% versus 3.7%. RESULTS: The baseline profile is a pluripatological, non-institutionalized, 87-year-old woman, who retains her independent in her daily life and suffers from a HF due to an accidental fall in her home. At the end of the study period 51% were permanently institutionalized, negatively influencing having worse mental deterioration, worse dependence and subsequent readmissions and in addition, 45.5% died, 25.5% during the first year. The most unfavorable conditions were being previously dependent, having severe mental deterioration, male and within the comorbidities the most influential was previously having an anemia. CONCLUSIONS: Our data confirms the deterioration of the autonomy-functional capacity after a HF, in line with what has been published, and has allowed to identify which elderly people are at the greatest risk of complications in the short and medium term (institutionalization and death).

Is There a Characteristic Clinical Profile for Patients with Dementia and Sundown Syndrome?

BACKGROUND: Sundown syndrome (SS) is the onset or worsening of behavioral symptoms in the evening in patients with dementia. OBJECTIVE: To identify the differential clinical profile of patients with dementia who present SS. METHODS: A cross-sectional, case-control observational study was conducted by retrospectively reviewing the medical records of patients with dementia in a specialized Memory Unit. We compared the characteristics of patients with and without SS, including sociodemographic variables, etiology, and severity of the dementia, behavioral symptoms, sleep disorders (considering insomnia and hypersomnia), other diseases and treatments employed. We identified the factors related to SS and conducted a logistic regression analysis to establish a predictive nomogram. RESULTS: Of the 216 study patients with dementia, 41 (19%) had SS. There was a predominance of women (2.4:1), advanced age (p = 0.0001), dependence (p < 0.0001), institutionalization (p < 0.0001), caregiver burden (p < 0.0001), anxiety (p < 0.0001), delirium (p < 0.0001), hallucinations (p < 0.0001), wandering (p < 0.0001), Lewy body dementia (p = 0.05), higher Global Deterioration Scale score (GDS; p < 0.0001), and sleep disorders (p < 0.0001). The multivariate analysis revealed that age (p = 0.048), GDS score (p = 0.01), and the presence of insomnia or hypersomnia (p < 0.0001) independently defined the presence of SS. We established a predictive nomogram for developing SS in patients with dementia, with a predictive capacity of 80.1%. CONCLUSION: In our study, age, a higher score on the GDS, and the presence of insomnia or hypersomnia are differential clinical characteristics of patients with SS. We defined a nomogram that helps predicting the occurrence of SS in patients with dementia.