Experiencia en la generación de estrategias de monitorización y evaluación en la implantación de Guías de Práctica Clínica en España / Experience Generating Evaluation and Monitoring Strategies in the Implementation of Clinical Practice Guidelines in Spain / Experiência na geração de estratégias de monitoramento e avaliação na implementação de manuais de prática clínica na Espanha

Introducción. La monitorización de la utilización del conocimiento y la evaluación de resultados permiten conocer la aplicación de la evidencia, cambios en los conocimientos y actitudes, el impacto en resultados de salud y la integración y el mantenimiento de las prácticas adoptadas. Existen debilidades relacionadas con la falta de sistematización, limitaciones de los registros y calidad del proceso. El objetivo de este artículo es describir la experiencia en la generación de estrategias de monitorización y evaluación de resultados de implantación de Guías de Buenas Prácticas en España. División de temas tratados. En primer lugar, se revisan los procesos de medición de resultados en la implantación de Guías, en el marco del Programa Best Practice Spotlight Organizations®, cuya herramienta para liderar el cambio incluye la monitorización y evaluación como una de las seis fases del ciclo de acción. En segundo lugar, se analizan las estrategias de monitorización y evaluación propuestas en la literatura, destacando la Asociación Profesional de Enfermeras de Ontario. Finalmente, se analizan las estrategias de monitorización y evaluación generadas por dos instituciones españolas participantes en el programa, centradas en adecuación de registros, explotación y análisis de indicadores, desarrollo de herramientas, procedimientos de evaluación y mecanismos de difusión y retroalimentación. Conclusiones. La definición de estrategias de monitorización y evaluación planificada de forma temprana contribuye a la viabilidad de la evaluación de la implantación y su sostenibilidad. Es necesario adaptarlas al contexto, con estrategias transversales que alcancen a toda la institución, facilitadas por la institución. Palabras clave: Ciencia de la Implementación; Práctica Clínica Basada en la Evidencia; Evaluación de Resultado en la Atención de Salud; Mecanismos de Evaluación de la Atención de Salud; Indicadores de Calidad de la Atención de Salud

Introduction. Monitoring the usage of knowledge and evaluating results permits one to know the application of the evidence, knowledge, and attitude changes, the impact on health results, integration, and maintenance of the adopted practices. There exist weaknesses related to lack of systematization, limitation of the records, and quality of the process. This article's objective is to describe the experience generating monitoring strategies and evaluation of the results regarding the implementation of good practice guides in Spain. Topics for Reflection. In the first place, the measurement process of the results regarding the implementation of guides are reviewed, in the Best Practice Spotlight Organizations® program frame, whose tool to lead the change includes monitoring and evaluation as one of the sixth phases of the action cycle. In the second place, monitoring and evaluation strategies proposed in the literature are analyzed, highlighting the Professional Nurses Association of Ontario. Finally, the monitoring and evaluation strategies are analyzed by two Spanish institutions participating in the program, focused on the adequation of records, exploitation and indicator analysis, tools development, evaluation procedures, dissemination, and feedback mechanisms. Conclusions: The definition of monitoring and evaluation strategies planned in advance contributes to the viability of the evaluation regarding the implementation and its sustainability. Is necessary to adapt them to the context, with transversal strategies that reach the whole institution, facilitated by the institution. Keywords: Implementation Science; Evidence-Based Practice; Outcome Assessment, Health Care; Health Care Evaluation Mechanisms; Quality Indicators, Health Care

Introdução. Monitorizar a utilização do conhecimento e avaliar os resultados permite-nos conhecer a aplicação das evidências, as mudanças nos conhecimentos e atitudes, o impacto nos resultados de saúde e a integração e manutenção das práticas adotadas. Existem fragilidades relacionadas à falta de sistematização, limitações de registros e qualidade do processo. O objetivo deste artigo é descrever a experiência na geração de estratégias de monitoramento e avaliação dos resultados da implementação de Manuais de Boas Práticas na Espanha. Divisão dos temas abordados. Em primeiro lugar, são revistos os processos de medição de resultados na implementação dos Manuais, no âmbito do Programa Best Practice Spotlight Organizations®, cuja ferramenta para liderar a mudança inclui a monitorização e avaliação como uma das seis fases do ciclo de ação. Em segundo lugar, são analisadas as estratégias de monitoramento e avaliação propostas na literatura, com destaque para a Associação Profissional de Enfermeiros de Ontário. Por fim, são analisadas as estratégias de monitoramento e avaliação geradas por duas instituições espanholas participantes do programa, focadas na adaptação de registros, exploração e análise de indicadores, desenvolvimento de ferramentas, procedimentos de avaliação e mecanismos de divulgação e feedback. Conclusões. A definição de estratégias de monitoramento e avaliação planeadas antecipadamente contribui para a viabilidade da avaliação da implementação e para a sua sustentabilidade. É necessário adaptá-los ao contexto, com estratégias transversais que alcancem toda a instituição, facilitadas pela instituição. Palavras-chave: Ciência da Implementação; Prática Clínica Baseada em Evidências; Avaliação de Resultados em Cuidados de Saúde; Mecanismos de Avaliação da Assistência à Saúde; Indicadores de Qualidade em Assistência à Saúde

Predictive Model of Quality of Life in Patients with Parkinson's Disease.

Parkinson's disease is a chronic, progressive, and disabling neurodegenerative disease which evolves until the end of life and triggers different mood and organic alterations that influence health-related quality of life. The objective of our study was to identify the factors that negatively impact the quality of life of patients with Parkinson's disease and construct a predictive model of health-related quality of life in these patients. METHODS: An analytical, prospective observational study was carried out, including Parkinson's patients at different stages in the Albacete Health Area. The sample consisted of 155 patients (T0) who were followed up at one (T1) and two years (T2). The instruments used were a purpose-designed data collection questionnaire and the "Parkinson's Disease Questionnaire" (PDQ-39), with a global index where a higher score indicates a worse quality of life. A multivariate analysis was performed by multiple linear regression at T0. Next, the model's predictive capacity was evaluated at T1 and T2 using the area under the ROC curve (AUROC). RESULTS: Predictive factors were: sex, living in a residence, using a cane, using a wheelchair, having a Parkinson's stage of HY > 2, having Alzheimer's disease or a major neurocognitive disorder, having more than five non-motor symptoms, polypharmacy, and disability greater than 66%. This model showed good predictive capacity at one year and two years of follow-up, with an AUROC of 0.89 (95% CI: 0.83-0.94) and 0.83 (95% CI: 0.76-0.89), respectively. CONCLUSIONS: A predictive model constructed with nine variables showed a good discriminative capacity to predict the quality of life of patients with Parkinson's disease at one and two years of follow-up.

Effectiveness of a best practice guideline to manage pain in surgical patients.

BACKGROUND: The prevention and control of acute postoperative pain is essential, not only to avoid unnecessary suffering, but to reduce postoperative morbidity, recovery time, hospital stay and associated costs. AIM: To evaluate the effectiveness of implementing the Clinical Best Practice Guideline (BPG) "Assessment and Management of Pain" recommendations for pain control in surgical patients. METHODS: Prospective, observational, longitudinal study. SUBJECTS: Surgical patients over 14 admitted to the University Hospital Complex of Albacete, and discharged during the last working days of every month. VARIABLES: 1) demographic data, hospital stay. 2) The process indicators of BPG implementation. 3) Patient outcomes: prevalence and intensity of pain in the first 24 postsurgical hours, maximum intensity of pain during hospitalization. TOOLS: Scales of assessment of pain intensity (0-10). DATA COLLECTION: Database of BPSO/CCEC® Program. ETHICAL ASPECTS: Anonymous data. DATA ANALYSIS (SPSS® V12): Descriptive during four periods: baseline (T0: December 2012); initial (T1: June-December 2013); intermediate (T2: 2014-2015); consolidation (T3: 2016-2017). Measurements of central tendency and dispersion, absolute and relative frequencies, according to variables. Comparison of proportions (Chi-Square) and averages (Student t-test, ANOVA). STATISTICAL SIGNIFICANCE: p < 0.05. RESULTS: Included 3934 patients, 52.3% (2058) men. Daily intervention of pain detection was performed in 73.5% (2890) of patients (28% T0; 67.4% T1; 66.7% T2; 89.9% T3; p < 0.0001), assessment of pain with a scale in 65.2% (2567) (0% T0; 48.8% T1; 59.4% T2; 85.6% T3; p < 0.0001); 35.3% (1389) had a care plan for assessment and management of pain (0% T0; 34.6% T1; 32.3% T2; 42.3% T3; p < 0.0001). The percentage of patients who had serious pain (>5) during the first 24 h was reduced from 12.4% (T1) to 5.3% (T3) (p < 0.0001). CONCLUSION: Implementation of recommendations has led to a statistically significant improvement over the periods in the study. Pain intensity and the percentage of patients with severe pain have decreased in a significant way.

Evolution of Quality of Life in Persons with Parkinson's Disease: A Prospective Cohort Study.

Parkinson's disease (PD) is a chronic neurodegenerative disorder that results in important functional symptoms, altered mood, and deterioration in quality of life (QoL). This study aimed to determine the evolution of the QoL in persons with PD in the Albacete health district over a two-year period and identify associated sociodemographic, clinical, and socio-health characteristics. A cohort study was conducted of patients at different stages of PD in the Albacete health district. Calculated sample size: 155 patients. Instruments: A purpose-designed questionnaire for data collection and the "Parkinson Disease Questionnaire" (PDQ-39), which measures 8 dimensions and a global index where a higher score indicates worse quality of life. Three measurements were made: baseline, one year, two years. A descriptive and bivariate analysis was conducted. Ethical aspects: informed consent, anonymized data. Results: Mean age 69.51 (standard deviation, SD 8.73) years, 60% male, 75.5% married, and 85.5% lived with family. The most frequent motor symptoms were slow movement (86.23%), postural instability (55.5%), tremor (45.5%), and dyskinesia (24.6%). Among the non-motor symptoms were fatigue (66.2%), pain, daytime somnolence, constipation, and apathy, with approximately 50% each. The mean QoL score at baseline was 27.47 (SD 16.14); 95% CI (confidence interval) 24.91-30.03. At two years, global QoL had slightly worsened (28.3; SD 17.26; 95% CI 25.41-31.18), with a statistically significant worsening in mobility, activities of daily living, and communication, whereas social support improved.

Preventing Functional Urinary Incontinence in Hip-Fractured Older Adults Through Patient Education: A Randomized Controlled Trial.

The purpose of this study was to evaluate whether an educational intervention would reduce the incidence of functional urinary incontinence (UI) in older adults with a fall-related hip fracture. The project was conducted as a multicenter randomized controlled trial (RCT). A total of 109 patients that had been admitted to six hospitals in Castilla-La Mancha (Spain) for acute treatment of hip fracture, previously continent and without cognitive impairment, were enrolled and randomly assigned to the experimental group (EG) or the control group (CG). Intervention (on EG): urinary habit training (Nursing Interventions Classifications taxonomy) was performed during hospital stay (second to fourth postoperative day), with a telephonic reinforcement 10 days after discharge. The CG received routine care. Primary outcome measure: incidence of UI. Follow-up: telephone assessment 3 and 6 months after discharge (blinded evaluation). The incidence of UI at 6 months was 49% (CG) versus 25.5% (EG) (relative risk = 0.52, 95% confidence interval [0.3, 0.9]; number necessary to treat = 4). The mean of UI episodes was 0.54 (EG) versus 1.8 (CG), p = .007. The educational intervention prevents the development of UI and decreases the number of episodes in case of appearance, in a statistically significant way.

Relationship between Motor and Nonmotor Symptoms and Quality of Life in Patients with Parkinson's Disease.

BACKGROUND: Parkinson's disease (PD) is a chronic neurodegenerative disease that implies a progressive and invalidating functional organic disorder, which continues to evolve till the end of life and causes different mental and physical alterations that influence the quality of life of those affected. OBJECTIVE: To determine the relationship between motor and nonmotor symptoms and the quality of life of persons with PD. METHODS: An analytic, descriptive, cross-sectional study was conducted with patients with different degrees of PD in the Albacete Health district. The estimated sample size required was 155 patients. The instruments used for data collection included a purpose-designed questionnaire and "Parkinson's Disease Questionnaire" (PDQ-39), which measures eight dimensions and has a global index where a higher score indicates a worse quality of life. A descriptive and bivariate analysis was conducted (SPSS® IBM 24.0). Ethical aspects: informed consent and anonymized data. RESULTS: A strong correlation was found between the number of motor and nonmotor symptoms and global health-related quality of life and the domains mobility, activities of daily living, emotional well-being, cognitive status, and pain (p < 0.05). Receiving pharmacological treatment and taking more than four medicines per day was significantly associated with a worse quality of life (p < 0.05). Patients who had undergone surgical treatment did not show better global quality of life (p = 0.076). CONCLUSIONS: All nonmotor symptoms and polypharmacy were significantly associated with a worse global quality of life.

Implantación de la Guía de buenas prácticas: valoración del ictus mediante la atención continuada en pacientes hospitalizados / Implementation of the Best practice guideline: Stroke assessment across the continuum of care in hospitalised patients

INTRODUCCIÓN: El ictus es causa importante de morbimortalidad en adultos y supone un elevado coste sociosanitario por las secuelas que provoca. Para minimizarlas es importante aplicar guías de buenas prácticas que aseguren cuidados basados en la evidencia y reduzcan la variabilidad clínica. El objetivo del estudio es evaluar los resultados de implantación de una Guía de buenas prácticas para la atención de pacientes con ictus hospitalizados. MÉTODO: Estudio cuasi-experimental pre/post-intervención. Mayores de 18 años ingresados en el Complejo Hospitalario Universitario de Albacete (CHUA) y Complejo Hospitalario de Navarra (CHN) con diagnóstico de ictus. Variables de proceso: valoración neurológica (Escala canadiense y la National Institute of Health Stroke Scale), valoración de la disfagia (Test del agua y el método de exploración clínica volumen-viscosidad), riesgo de caídas (Escala Downton), detección de dolor (Escala numérica), riesgo de lesiones por presión (Escala Braden) y educación sanitaria. Variables de resultado: neumonía por aspiración, caídas, independencia para las actividades de la vida diaria (índice de Barthel y Rankin modificada), lesiones por presión e intensidad del dolor. RESULTADOS: Se evaluaron 1.270 pacientes en el CHUA y 627 en el CHN, mayoritariamente hombres mayores de 69 años y con alta incidencia de ictus isquémicos. En el CHUA se registraron 16 lesiones por presión, 17 caídas y 20 casos de neumonías por aspiración. En CHN se identificaron 15 casos de lesiones por presión. El aumento de casos podría atribuirse al incremento de pacientes evaluados y a una mayor concienciación para registrar estos eventos. CONCLUSIONES: La aplicación de las recomendaciones de la GBP ha mejorado de manera estadísticamente significativa a lo largo del tiempo, existiendo posibilidades de mejora tanto en la calidad de los cuidados prestados como en los resultados en salud de los pacientes

INTRODUCTION: Stroke is an important cause of morbidity and mortality in adults and implies high social and healthcare costs due to the consequences it causes. To minimize these, it is important to apply best practice guidelines that ensure evidence-based care and reduce clinical variability. The objective of the study is to evaluate the results of implantation of the Ictus Best Practice Guideline for attending in-hospital stroke patients. METHOD: Quasi-experimental pre-post intervention study. Over 18 years of age admitted to the University Hospital Complex of Albacete and Hospital Complex of Navarra with a diagnosis of stroke. Process variables: Neurological assessment (Canadian Scale and the National Institute of Health Stroke Scale), dysphagia assessment (Water Test and the Volume-Viscosity Clinical Exploration Method), risk falls (Downton Scale), pain detection (Numerical Scale), pressure injury risk (Braden Scale), health education. Outcome variables: Aspiration pneumonia, falls, independence of daily life activities (modified Barthel and Rankin index), pressure injuries and pain intensity. RESULTS: 1270 patients were evaluated in CHUA and 627 in CHN, most were men and the average age was over 69 years, with a higher incidence of ischaemic strokes. In CHUA 16 pressure sores, 17 falls and 20 cases of aspiration pneumonia were recorded and 15 cases of pressure sores were identified in CHN. An increase of cases could be attributed to the greater number of patients evaluated and the increased nursing awareness about recording adverse events. CONCLUSIONS: Application of guideline recommendations improved statistically significantly throughout the implementation time. Some possibilities for improvement are detected, so it is necessary to continue working on both the quality of care provided and the health outcomes of patients

Implementation of the Best practice guideline: Stroke assessment across the continuum of care in hospitalised patients. / Implantación de la Guía de buenas prácticas: valoración del ictus mediante la atención continuada en pacientes hospitalizados.

INTRODUCTION: Stroke is an important cause of morbidity and mortality in adults and implies high social and healthcare costs due to the consequences it causes. To minimize these, it is important to apply best practice guidelines that ensure evidence-based care and reduce clinical variability. The objective of the study is to evaluate the results of implantation of the Ictus Best Practice Guideline for attending in-hospital stroke patients. METHOD: Quasi-experimental pre-post intervention study. Over 18 years of age admitted to the University Hospital Complex of Albacete and Hospital Complex of Navarra with a diagnosis of stroke. Process variables: Neurological assessment (Canadian Scale and the National Institute of Health Stroke Scale), dysphagia assessment (Water Test and the Volume-Viscosity Clinical Exploration Method), risk falls (Downton Scale), pain detection (Numerical Scale), pressure injury risk (Braden Scale), health education. OUTCOME VARIABLES: Aspiration pneumonia, falls, independence of daily life activities (modified Barthel and Rankin index), pressure injuries and pain intensity. RESULTS: 1270 patients were evaluated in CHUA and 627 in CHN, most were men and the average age was over 69 years, with a higher incidence of ischaemic strokes. In CHUA 16 pressure sores, 17 falls and 20 cases of aspiration pneumonia were recorded and 15 cases of pressure sores were identified in CHN. An increase of cases could be attributed to the greater number of patients evaluated and the increased nursing awareness about recording adverse events. CONCLUSIONS: Application of guideline recommendations improved statistically significantly throughout the implementation time. Some possibilities for improvement are detected, so it is necessary to continue working on both the quality of care provided and the health outcomes of patients.

Deterioro funcional asociado a la hospitalización en pacientes mayores de 65 años / Hospitalisation as a risk for functional decline in older adults

El deterioro funcional es un riesgo asociado a la hospitalización en las personas mayores, con elevada prevalencia (35-70%) y graves consecuencias. OBJETIVO: Determinar la incidencia del deterioro funcional relacionado con la hospitalización (DFH) en personas mayores ingresadas en el Área Médica del Complejo Hospitalario Universitario de Albacete. MÉTODO: Se ha realizado un estudio de cohortes, cuya variable principal ha sido el DFH (pérdida de capacidad para realizar actividades cotidianas durante el ingreso y tras el alta); se han incluido otras variables (demográficas, relacionadas con el ingreso, patologías asociadas, estado cognitivo). Los datos se recogieron por entrevista presencial al paciente y cuidadores, llamada telefónica tras el alta y revisión de historia clínica. RESULTADOS: Se incluyeron 104 pacientes, de los que un 51,9% eran mujeres; la edad media fue 79,97 años (dt = 7,89), IC 95% [78,43; 81,5] y la estancia media de 10,11 días (dt = 7,65) IC 95% [8,62; 11,6]. El primer día del ingreso 43 (41,4%) pacientes presentaban estado mental intacto. Se produjo DFH en las primeras 24 horas en 60 (57,7%) pacientes; tras el alta hospitalaria, el deterioro existía en un 32,6% de los 92 pacientes que pudieron ser evaluados. En pacientes que antes del ingreso eran independientes para las actividades cotidianas, un 19% quedó con dependencia importante. El DFH se relacionó de forma estadísticamente significativa con los antecedentes de caídas y la edad. CONCLUSIONES: El DFH se produce en un porcentaje elevado de los mayores de 65 años; entre los previamente independientes, casi la quinta parte queda en situación de dependencia

Functional decline: (FD) is a risk associated with hospital admission in older people, due to its high prevalence (35-70%) and its serious consequences. AIM: To determine the incidence of FD in the elderly after hospital admission at the Geriatric and Internal Medicine wards of a tertiary teaching hospital (Albacete, Spain). METHOD: A cohort study has been designed, whose primary focus was FD, defined as the loss of independence to perform the activities of daily living between preadmission status and discharge. Demographic characteristics, comorbidity, length of hospital stay and cognitive status have been analysed. Data collection was performed by interviews with patients and caregivers during hospitalization and after discharge (by phone), as well as by revision of clinical records. RESULTS: 104 patients were evaluated, of which 51.9% were female; the average age was 79.97 years (dt = 7.89) IC 95% [78.43, 81.5] and the average length of stay was 10.11 days (dt = 7.65) IC 95% [8.62,11.6]. The proportion of patients who showed a normal cognitive status on the first in-hospital day was 41.4% (43 patients). FD was present in 60 (57.7%) patients in the first day of hospitalisation; when discharged, 32.6% of 92 patients who could be evaluated showed FD.19% of patients who were previously independent in activities of daily living developed a serious dependence after discharge. FD was associated statistically with age and a history of previous falls. CONCLUSIONS: FD takes place in a high percentage of the elderly PATIENTS: Among the previously independent patients, 19% remains in a situation of dependence after discharge

[Hospitalisation as a risk for functional decline in older adults]. / Deterioro funcional asociado a la hospitalización en pacientes mayores de 65 años.

UNLABELLED: FUNCTIONAL DECLINE: (FD) is a risk associated with hospital admission in older people, due to its high prevalence (35-70%) and its serious consequences. AIM: To determine the incidence of FD in the elderly after hospital admission at the Geriatric and Internal Medicine wards of a tertiary teaching hospital (Albacete, Spain). METHOD: A cohort study has been designed, whose primary focus was FD, defined as the loss of independence to perform the activities of daily living between preadmission status and discharge. Demographic characteristics, comorbidity, length of hospital stay and cognitive status have been analysed. Data collection was performed by interviews with patients and caregivers during hospitalization and after discharge (by phone), as well as by revision of clinical records. RESULTS: 104 patients were evaluated, of which 51.9% were female; the average age was 79.97 years (dt=7.89) IC 95% [78.43, 81.5] and the average length of stay was 10.11 days (dt=7.65) IC 95% [8.62,11.6]. The proportion of patients who showed a normal cognitive status on the first in-hospital day was 41.4% (43 patients). FD was present in 60 (57.7%) patients in the first day of hospitalisation; when discharged, 32.6% of 92 patients who could be evaluated showed FD. 19% of patients who were previously independent in activities of daily living developed a serious dependence after discharge. FD was associated statistically with age and a history of previous falls. CONCLUSIONS: FD takes place in a high percentage of the elderly patients. Among the previously independent patients, 19% remains in a situation of dependence after discharge.

Recovery of activities of daily living among older people one year after hip fracture.

This article aims to determine the functional recovery of older people, who were previously independent in activities of daily living (ADLs) and without cognitive impairment, in the year following a fall-related hip fracture. A cohort study was carried out among patients admitted to University General Hospital of Albacete (Spain). Consecutive sampling was performed. Variables included demographic, habitual residence, type of hip fracture, mental status (Short Portable Mental Status Questionnaire [SPMSQ] Pfeiffer), and independence in ADLs (according to the Barthel Index [BI]) prior to the fall and after the fracture. For 205 patients, 1 year after surgery, the mean BI score was 78.09 (SD = 25.13); (vs. 90.02 before the hip fracture), 59% showed urinary continence (vs. 79%), and 65% walked without assistance (vs. 82%). Regarding predictors of recovery, results indicate that patients who are older, who suffer complications after hospital discharge, or who reside in nursing homes experience poorer recovery in ADLs. Only 47.9% of the patients regained prior levels of autonomy 1 year after surgery.

Características de la fractura de cadera y posterior recuperación en pacientes mayores de 65 años con historia de caídas recurrentes / Characteristics of hip fracture and functional recovery in elderly people with a history of recurrent falling

Introducción. Las caídas recurrentes ocurren entre el 14,8 y 19% de la población anciana y se relacionan con mayor riesgo de tener fractura. Es poco conocida la influencia que los antecedentes de caídas recurrentes puedan tener sobre la recuperación tras una fractura de cadera. Material y método. Cohorte de pacientes mayores de 65 años ingresados en el Complejo Hospitalario Universitario de Albacete por fractura de cadera secundaria a caída, durante 1 año. Se consideró caída recurrente la presencia de 2 o más caídas en los 6 meses previos a la fractura. Se recogieron al ingreso variables sociodemográficas, circunstancias de la caída, número de caídas en los 6 meses previos, tipo de fractura y reparación, comorbilidad, situación cognitiva al ingreso (test Pfeiffer), tratamiento farmacológico e independencia para actividades de la vida diaria (Índice de Barthel–IB). Una submuestra de pacientes con IB previo a fractura ≥60 y Pfeiffer al ingreso ≤4 fueron seguidos a los 3, 6 y 12 meses. Resultados. De los 335 pacientes ingresados, se recogieron datos en 279, de los cuales un 19,4% habían sufrido previamente 2 o más caídas. Comparados con los que no tenían antecedentes de caídas recurrentes, presentan peor estado mental al ingreso, mayor media de patologías asociadas, menor porcentaje de independencia para vestirse y para transferencias cama-sillón, de manera estadísticamente significativa. En los 201 pacientes con seguimiento, el deterioro del IB al año respecto al previo a la fractura fue mayor en pacientes con caídas recurrentes (-20,8±31,54 vs -10,73±20,21; p=0,04) focalizándose más en la independencia para comer (76% vs 91,9%; p<0,05), asearse (72% vs 91,9%; p<0,01), continencia fecal (60% vs 78,7%; p<0,05) y deambular en domicilio (80% vs 93,3%; p<0,05). Conclusiones. En pacientes sin deterioro funcional moderado o severo previo a la fractura y cognitivamente estables, la recuperación de la independencia tras fractura de cadera es significativamente menor en el grupo de caídas recurrentes(AU)

Recurrent falls affect between 14.8% and 19% of the elderly population, and are associated with an increased risk of fracture. We know little about the influence the history of recurrent falls may have on recovery after hip fracture. Methods. Cohort study. The patients included were, over 65 years admitted during a 1 year period to the General University Hospital of Albacete with a hip fracture due to a fall. Recurrent falls were defined as a history of two or more falls within the 6 months prior to the fracture. Variables: demographic data, circumstances of fall, number of falls in the previous 6 months, type of fracture and its repair, comorbidity and drug treatment, cognitive status at admission (Pfeiffer test) and independence for activities of daily living (Barthel Index - BI) were collected. A subsample of patients with pre-fracture BI≥60 and Pfeiffer at admission≤4 was followed up at 3, 6 and 12 months. Results. A total of 335 patients were admitted. Data were collected on 279 of them, 19.4% of whom had previously suffered two or more falls. The recurrent fallers had a worse mental status on admission, a higher number of associated diseases, a lower percentage of independence in dressing and in bed-chair transferring than patients without history of recurrent falls, all statistically significant. In the 201 patients followed up, the impairment on the BI after 12 months compared to the BI previous to fracture was higher in recurrent fallers (-20.8±31.54 vs -10.73±20.21, P=.04), focusing more on independence in eating (76% vs 91.9%, P<.05), grooming (72% vs 91,9%, P<.01), faecal continence (60% vs 78.7%, p<.05) and walking indoors (80% vs 93.3%, P<.05). Conclusions. The recovery of independence after hip fracture is significantly lower in the group of recurrent fallers in patients without moderate or severe functional impairment previous to fracture and cognitively stable(AU)

[Characteristics of hip fracture and functional recovery in elderly people with a history of recurrent falling]. / Características de la fractura de cadera y posterior recuperación en pacientes mayores de 65 años con historia de caídas recurrentes.

UNLABELLED: Recurrent falls affect between 14.8% and 19% of the elderly population, and are associated with an increased risk of fracture. We know little about the influence the history of recurrent falls may have on recovery after hip fracture. METHODS: Cohort study. The patients included were, over 65 years admitted during a 1 year period to the General University Hospital of Albacete with a hip fracture due to a fall. Recurrent falls were defined as a history of two or more falls within the 6 months prior to the fracture. VARIABLES: demographic data, circumstances of fall, number of falls in the previous 6 months, type of fracture and its repair, comorbidity and drug treatment, cognitive status at admission (Pfeiffer test) and independence for activities of daily living (Barthel Index - BI) were collected. A subsample of patients with pre-fracture BI ≥ 60 and Pfeiffer at admission ≤ 4 was followed up at 3, 6 and 12 months. RESULTS: A total of 335 patients were admitted. Data were collected on 279 of them, 19.4% of whom had previously suffered two or more falls. The recurrent fallers had a worse mental status on admission, a higher number of associated diseases, a lower percentage of independence in dressing and in bed-chair transferring than patients without history of recurrent falls, all statistically significant. In the 201 patients followed up, the impairment on the BI after 12 months compared to the BI previous to fracture was higher in recurrent fallers (-20.8 ± 31.54 vs -10.73 ± 20.21, P=.04), focusing more on independence in eating (76% vs 91.9%, P<.05), grooming (72% vs 91,9%, P<.01), faecal continence (60% vs 78.7%, p<.05) and walking indoors (80% vs 93.3%, P<.05). CONCLUSIONS: The recovery of independence after hip fracture is significantly lower in the group of recurrent fallers in patients without moderate or severe functional impairment previous to fracture and cognitively stable.

Analysis of hip-fracture falls in the elderly

Objetivos. Identificar circunstancias en que se producen caídas que comportan fractura de cadera en mayores de 65 años y factores de riesgo presentes en el momento de la caída. Método. Estudio observacional analítico. Pacientes mayores de 65 años, ingresados en el Complejo Hospitalario Universitario de Albacete por fractura de cadera secundaria a caída. Duracion recogida de datos 1 año. Variables: sociodemográficas, circunstancias de caída, características de fractura, caídas en 6 meses anteriores, enfermedades presentes, tratamiento farmacológico habitual y estado mental, recogidas de historia clínica y entrevista. Análisis estadístico descriptivo, comparación de medias (t de Student) y comparación de proporciones (χ2), según sus condiciones de aplicación; odds ratio con intervalos de confianza del 95%; regresión logística binaria múltiple. Resultados. Total, 312 pacientes. Media de edad, 81,68 años (65-99), 232 mujeres (74,3%). Estaban institucionalizados 35 (11,2%), 212 sin antecedentes de caídas (68%) ni alteración del estado mental (196; 62,8%). Las caídas se produjeron en el domicilio (189; 63,2%), y sólo en un 14% (41), por la noche. El modo de producirse está relacionado mayoritariamente con factores extrínsecos (tropezar, 31,5%; resbalar, 24,1%; n=257). En un 96% (n=300) existían enfermedades previas (media, 2,32), las más frecuentes, hipertensión arterial (177 casos; 59%) y diabetes (72; 24%). Los fármacos más utilizados fueron los inhibidores de agregación plaquetaria (31,9%; 82 casos), distintos antihipertensivos, diuréticos (30,4%; 78), hipoglucemiantes orales (16%; 41), ansiolíticos (14,4%; 37) y antidepresivos (13,6%; 35). La autonomía previa para deambulación en la calle aparece como factor protector para caídas en interiores. Conclusiones. En nuestro estudio las fracturas de cadera secundarias a caídas se han producido mayoritariamente en personas de edad avanzada, sin antecedentes de caídas en los 6 meses previos, en el domicilio familiar, en horario de mayor actividad y por factores extrínsecos (AU)

Aims. To identify the circumstances associated with falls resulting in hip fracture in the elderly, and risk factors for this kind of fall. Method. A 12 month observational study of patients over 65 years, admitted for hip fracture resulting from a fall to the General University Hospital of Albacete. Variables: demographic data, circumstances of fall, type of fracture, previous falls, associated diseases, regular drug treatment and mental status, collected from medical records and interviews. Descriptive statistical analyses were performed, which included, comparison of means (t test), comparison of proportions (χ2), odds ratio and corresponding 95% confidence intervals, and logistic regression models. Results. A total of 312 patients were included with a mean age 81.68 years (range, 65-99), of which 74.3% (232) were women. Only 35 patients (11,2%) lived in an institution, 212 (68%) had not had a fall during previous six months, and 116 patients (37.2%) had cognitive impairment. Falls occurred indoors (189 patients, 63.2%), with only 14% (41) during the night. Most of falls were related to extrinsic factors (31.5% tripping, slipping 24.1%; n=257). Patients had previous diseases in a 96% (300) of cases, with the most common being hypertension (177 patients, 59%) and diabetes (72, 24%). Drugs most frequently taken were anti-platelets (82, 31.9%), antihypertensives, diuretics (78, 30.4%), oral hypoglycaemic agents (41, 16%), anxiolytics (37, 14.4%) and antidepressants (35, 13.6%). The prior independence for walking on the street appears as a protective factor to fall indoors. Conclusions. In this sample, falls resulting in hip fracture occurred commonly in elderly people without previous falls, while at home, at a time of increased activity, and by extrinsic factors (AU)

[Analysis of hip-fracture falls in the elderly]. / Análisis de las caídas que producen fractura de cadera en ancianos.

AIMS: To identify the circumstances associated with falls resulting in hip fracture in the elderly, and risk factors for this kind of fall. METHOD: A 12 month observational study of patients over 65 years, admitted for hip fracture resulting from a fall to the General University Hospital of Albacete. VARIABLES: demographic data, circumstances of fall, type of fracture, previous falls, associated diseases, regular drug treatment and mental status, collected from medical records and interviews. Descriptive statistical analyses were performed, which included, comparison of means (t test), comparison of proportions (χ(2)), odds ratio and corresponding 95% confidence intervals, and logistic regression models. RESULTS: A total of 312 patients were included with a mean age 81.68 years (range, 65-99), of which 74.3% (232) were women. Only 35 patients (11,2%) lived in an institution, 212 (68%) had not had a fall during previous six months, and 116 patients (37.2%) had cognitive impairment. Falls occurred indoors (189 patients, 63.2%), with only 14% (41) during the night. Most of falls were related to extrinsic factors (31.5% tripping, slipping 24.1%; n=257). Patients had previous diseases in a 96% (300) of cases, with the most common being hypertension (177 patients, 59%) and diabetes (72, 24%). Drugs most frequently taken were anti-platelets (82, 31.9%), antihypertensives, diuretics (78, 30.4%), oral hypoglycaemic agents (41, 16%), anxiolytics (37, 14.4%) and antidepressants (35, 13.6%). The prior independence for walking on the street appears as a protective factor to fall indoors. CONCLUSIONS: In this sample, falls resulting in hip fracture occurred commonly in elderly people without previous falls, while at home, at a time of increased activity, and by extrinsic factors.