Diferencias en la capacidad predictiva para declive funcional, cognitivo y mortalidad para distintas escalas de fragilidad: un estudio de cohortes longitudinal / Differences in the predictive capability for functional impairment, cognitive decline and mortality of different frailty tools: A longitudinal cohort study

ANTECEDENTES Y OBJETIVOS: Existen múltiples escalas para la detección de fragilidad en ancianos, pero no específicamente para población institucionalizada. El objetivo fue comprobar tras 3 años de seguimiento qué escala predice con mayor precisión el declive funcional y la mortalidad. MÉTODOS: Estudio longitudinal de cohortes con 110 pacientes mayores de 65 años institucionalizados en Pamplona (Navarra). Se aplicaron 4 escalas de fragilidad (Fried, Fried Imputada, Rockwood y FRAIL NH). El poder de la asociación entre las escalas y los resultados se comprobó mediante análisis de regresión lineal y de Cox. RESULTADOS: El 46,5% de la muestra falleció durante el seguimiento, el 68% de ellos en su residencia, con 43 meses de media de supervivencia. El 71,3% de los ancianos estudiados presentó discapacidad a los 3 años, especialmente los frágiles. Los pacientes robustos experimentaron hospitalizaciones más prolongadas (m=3,4 días) que los frágiles. Las escalas Fried Imputada y la FRAIL NH encontraron diferencias estadísticamente significativas entre grupos para las variables estudiadas; Fried Imputada mostró un HR significativo de muerte para sujetos frágiles (HR=3,3). CONCLUSIONES: Las escalas Fried Imputada y FRAIL NH mostraron una mayor capacidad predictiva para declive funcional y cognitivo, siendo la escala Fried Imputada la única que relaciona la mortalidad con la fragilidad

BACKGROUND AND OBJECTIVES: There are multiple frailty detection tools, but they have not been specifically developed for the institutionalised population. The aim of this study is to ascertain at 3-year follow-up which tool predicts functional impairment and mortality most precisely. METHODS: Longitudinal cohort study with 110 patients in Pamplona (Navarra)>65 years. Four frailty tools were applied (Fried Criteria, Rockwood Frailty Scale, FRAIL-NH and Imputed Fried Frailty Criteria). The power of the association between the scales and the results was assessed by linear regression and Cox's analyses. RESULTS: 46.5% of the sample died during time to follow-up, 68% of whom died in their nursing home, with 43-month mean survival. Of the studied population, 71.3% showed disability at 3 years, especially the frail subjects. The robust patients had longer hospitalizations (m=3.4 days) than the frail. Imputed Fried and FRAIL-NH found statistically significant differences between groups for the variables studied. Imputed Fried Frailty Criteria showed a significant HR of death for the frail subjects (HR=3.3). CONCLUSIONS: The Imputed Fried and FRAIL-NH tools showed a higher predictive capability for functional and cognitive decline, but only the Imputed Fried Frailty Criteria found a significant relationship between frailty and mortality

Differences in the predictive capability for functional impairment, cognitive decline and mortality of different frailty tools: A longitudinal cohort study. / Diferencias en la capacidad predictiva para declive funcional, cognitivo y mortalidad para distintas escalas de fragilidad: un estudio de cohortes longitudinal.

BACKGROUND AND OBJECTIVES: There are multiple frailty detection tools, but they have not been specifically developed for the institutionalised population. The aim of this study is to ascertain at 3-year follow-up which tool predicts functional impairment and mortality most precisely. METHODS: Longitudinal cohort study with 110 patients in Pamplona (Navarra)>65 years. Four frailty tools were applied (Fried Criteria, Rockwood Frailty Scale, FRAIL-NH and Imputed Fried Frailty Criteria). The power of the association between the scales and the results was assessed by linear regression and Cox's analyses. RESULTS: 46.5% of the sample died during time to follow-up, 68% of whom died in their nursing home, with 43-month mean survival. Of the studied population, 71.3% showed disability at 3 years, especially the frail subjects. The robust patients had longer hospitalizations (m=3.4 days) than the frail. Imputed Fried and FRAIL-NH found statistically significant differences between groups for the variables studied. Imputed Fried Frailty Criteria showed a significant HR of death for the frail subjects (HR=3.3). CONCLUSIONS: The Imputed Fried and FRAIL-NH tools showed a higher predictive capability for functional and cognitive decline, but only the Imputed Fried Frailty Criteria found a significant relationship between frailty and mortality.

Prevalencia de polifarmacia y factores asociados en adultos mayores en España: datos de la Encuesta Nacional de Salud 2017 / Prevalence of polypharmacy and associated factors in older adults in Spain: Data from the National Health Survey 2017

Fundamento y objetivo: Estimar la prevalencia de polifarmacia e hiperpolifarmacia en adultos mayores no institucionalizados en España y analizar los factores asociados. Material y métodos: Estudio transversal a partir de datos de la Encuesta Nacional de Salud de España 2017, con participantes de 65 años o más. Se estimó la prevalencia de polifarmacia (≥5 medicamentos) e hiperpolifarmacia (≥10), y la asociación con diversos factores mediante regresión logística multivariante. Se realizó un análisis de sensibilidad considerando el posible consumo de más de un fármaco para la misma indicación (politerapia). Resultados: Se incluyeron 7.023 participantes, con edad media de 76,0 (desviación estándar [DE] 7,6) años, 59,4% mujeres y consumo medio de 3,3 (DE 2,2) medicamentos por persona. La prevalencia de polifarmacia fue de 27,3% (intervalo de confianza del 95%: 26,2-28,3) y la de hiperpolifarmacia de 0,9% (intervalo de confianza del 95%: 0,7-1,1). El análisis de sensibilidad estimó que la prevalencia podría ascender al menos a un 37,5% y la media a 3,9 (DE 2,5) al considerar la politerapia. Los factores que más se asocian a la polifarmacia fueron el número de enfermedades crónicas, el grado de dependencia para las actividades básicas de la vida diaria, el estado de salud percibido o los contactos con el sistema sanitario; y de forma inversa los déficits sensoriales y la incontinencia. Conclusiones: La prevalencia de polifarmacia en adultos mayores en atención primaria continúa aumentando, y podría estar ampliamente infraestimada. Además de la pluripatología, factores como la capacidad funcional o los síndromes geriátricos, fundamentales en personas mayores, modulan los hábitos de consumo y prescripción de medicamentos en esta población

Background and objective: to estimate the prevalence of polypharmacy and hyperpolypharmacy in non-institutionalised older adults in Spain and assess the associated factors. Material and methods: a cross-sectional study based on data from the National Health Survey of Spain 2017, with participants aged 65 and over. The prevalence of polypharmacy (≥5 medications) and hyperpolypharmacy (≥10) were estimated, as well as the association with several factors through multivariate logistic regression. A sensitivity analysis was carried out considering the possible consumption of more than one drug for the same indication (polytherapy). Results: 7023 participants were included, with a mean age of 76.0 (SD 7.6), 59.4% female and average consumption of 3.3 (SD 2.2) drugs per person. The prevalence of polypharmacy was 27.3% (95% CI 26.2-28.3) and of hyperpolypharmacy 0.9% (95% CI 0.7-1.1). The sensitivity analysis showed that the prevalence could be at least 37.5% and the average 3.9 (SD 2.5) when considering polytherapy. The factors most associated with polypharmacy were the number of chronic diseases, degree of dependence for the basic activities of daily living, self-perceived health or contacts with the health system; and negatively, sensory deficits and incontinence. Conclusions: the prevalence of polypharmacy in the elderly in primary care continues to increase and could be widely underestimated. In addition to multimorbidity, factors such as functional capacity or geriatric syndromes, fundamental in elderly people, modulate the habits of consumption and prescription of drugs in this population

Effectiveness of occupational therapy interventions in acute geriatric wards: A systematic review.

OBJECTIVE: To review the evidence on the effectiveness of specific occupational therapy programs in elderly people hospitalized for acute medical pathology. MATERIALS AND METHODS: Relevant randomized clinical trials were selected by searching the main bibliographic databases to evaluate the effectiveness of in-hospital occupational therapy interventions for people aged 65 years and over who were hospitalized for acute medical pathology. RESULTS: Six studies were finally selected. The interventions consisted of individualized programs of occupational therapy: training and re-education in the activities of daily living (ADL); evaluation, prescription and training in the use of support devices; and providing reports regarding recommendations and referrals on discharge. In five studies, the patients in the intervention group obtained higher scores on assessment tools used to measure functionality in ADL. In one of the studies there was a statistically significant reduction in delirium, as well as an improvement in cognitive function. There was no evidence for the effectiveness of occupational therapy interventions for anxiety, fear and/or perceived safety, in any of the studies analyzed. CONCLUSIONS: The evidence is limited as to whether specific occupational therapy programs are effective in improving functionality in ADL in this group of patients. However, occupational therapy was significantly effective in reducing delirium and improving cognitive function. There is insufficient evidence to claim that specific occupational therapy programs are effective in reducing levels of anxiety, increasing perceived quality of life, reducing readmission rates, or reducing the length of hospital stay.

Prevalence of polypharmacy and associated factors in older adults in Spain: Data from the National Health Survey 2017. / Prevalencia de polifarmacia y factores asociados en adultos mayores en España: datos de la Encuesta Nacional de Salud 2017.

BACKGROUND AND OBJECTIVE: to estimate the prevalence of polypharmacy and hyperpolypharmacy in non-institutionalised older adults in Spain and assess the associated factors. MATERIAL AND METHODS: a cross-sectional study based on data from the National Health Survey of Spain 2017, with participants aged 65 and over. The prevalence of polypharmacy (≥5 medications) and hyperpolypharmacy (≥10) were estimated, as well as the association with several factors through multivariate logistic regression. A sensitivity analysis was carried out considering the possible consumption of more than one drug for the same indication (polytherapy). RESULTS: 7023 participants were included, with a mean age of 76.0 (SD 7.6), 59.4% female and average consumption of 3.3 (SD 2.2) drugs per person. The prevalence of polypharmacy was 27.3% (95% CI 26.2-28.3) and of hyperpolypharmacy 0.9% (95% CI 0.7-1.1). The sensitivity analysis showed that the prevalence could be at least 37.5% and the average 3.9 (SD 2.5) when considering polytherapy. The factors most associated with polypharmacy were the number of chronic diseases, degree of dependence for the basic activities of daily living, self-perceived health or contacts with the health system; and negatively, sensory deficits and incontinence. CONCLUSIONS: the prevalence of polypharmacy in the elderly in primary care continues to increase and could be widely underestimated. In addition to multimorbidity, factors such as functional capacity or geriatric syndromes, fundamental in elderly people, modulate the habits of consumption and prescription of drugs in this population.

Prestroke Mobility and Dementia as Predictors of Stroke Outcomes in Patients Over 65 Years of Age: A Cohort Study From The Swedish Dementia and Stroke Registries.

OBJECTIVES: To explore the association between prestroke mobility dependency and dementia on functioning and mortality outcomes after stroke in patients>65 years of age. DESIGN: Longitudinal cohort study based on SveDem, the Swedish Dementia Registry and Riksstroke, the Swedish Stroke Registry. PARTICIPANTS: A total of 1689 patients with dementia >65 years of age registered in SveDem and suffering a first stroke between 2007 and 2014 were matched with 7973 controls without dementia with stroke. MEASUREMENTS: Odds ratios (ORs) and 95% confidence intervals (CIs) for intrahospital mortality, and functioning and mortality outcomes at 3 months were calculated. Functioning included level of residential assistance (living at home without help, at home with help, or nursing home) and mobility dependency (independent, needing help to move outdoors, or needing help indoors and outdoors). RESULTS: Prestroke dependency in activities of daily living and mobility were worse in patients with dementia than controls without dementia. In unadjusted analyses, patients with dementia were more often discharged to nursing homes (51% vs 20%; P < .001). Mortality at 3 months was higher in patients with dementia (31% vs 23% P < .001) and fewer were living at home without help (21% vs 55%; P < .001). In adjusted analyses, prestroke dementia was associated with higher risk of 3-month mortality (OR 1.34; 95% CI 1.18-1.52), requiring a higher level of residential assistance (OR 4.07; 3.49-.75) and suffering from more dependency in relation to mobility (OR 2.57; 2.20-3.02). Patients with dementia who were independent for mobility prestroke were more likely to be discharged to a nursing home compared with patients without dementia with the same prestroke mobility (37% vs 16%; P < .001), but there were no differences in discharge to geriatric rehabilitation (19% for both; P = .976). Patients, who moved independently before stroke, were more often discharged home (60% vs 28%) and had lower mortality. In adjusted analyses, prestroke mobility limitations were associated with higher odds for poorer mobility, needing more residential assistance, and death. CONCLUSIONS: Patients with mobility impairments and/or dementia present a high burden of disability after a stroke. There is a need for research on stroke interventions among these populations.

Thrombolysis in acute ischemic stroke in patients with dementia: A Swedish registry study.

OBJECTIVE: To compare access to intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) and its outcomes in patients with and without dementia. METHODS: This was a longitudinal cohort study of the Swedish dementia and stroke registries. Patients with preexisting dementia who had AIS from 2010 to 2014 (n = 1,356) were compared with matched patients without dementia (n = 6,755). We examined access to thrombolysis and its outcomes at 3 months (death, residency, and modified Rankin Scale [mRS] score). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with logistic and ordinal logistic regression. RESULTS: The median age at stroke onset was 83 years in both groups. IVT was administered to 94 (7.0%) patients with dementia and 639 (9.5%) patients without dementia. The OR of receiving IVT was 0.68 (95% CI 0.54-0.86) for patients with dementia. When the analysis was repeated exclusively among patients independent in everyday activities, dementia status was no longer significant (OR 0.79, 95% CI 0.60-1.06). However, differences persisted in patients ≤80 years of age (OR 0.58, 95% CI 0.36-0.94). In patients who received thrombolysis, the incidence of symptomatic intracerebral hemorrhage (sICH; 7.4% vs 7.3%) and death at 3 months (22.0% vs 18.8%) did not differ significantly between the 2 groups. However, mRS score and accommodation status were worse among patients with dementia after 3 months in adjusted analyses (both p < 0.001). Unfavorable outcomes with an mRS score of 5 to 6 were doubled in patients with dementia (56.1% vs 28.1%). CONCLUSIONS: Younger patients with dementia and AIS are less likely to receive IVT. Among patients receiving thrombolysis, there are no differences in sICH or death, although patients with dementia have worse accommodation and functional outcomes at 3 months.