Approach to the elderly patient with vertebral fracture due to bone fragility. / Abordaje del adulto mayor con fractura vertebral por fragilidad ósea.

Osteoporosis is a metabolic and systemic disease characterized by alterations at the level of bone tissue with loss of bone mineral density, changes in microarchitecture, mineralization and remodeling that determine greater bone fragility and risk of fracture. Falls in the elderly are a risk factor closely related to fragility fractures and numerous studies demonstrate this relationship. Vertebral fractures are a major cause of morbidity and mortality. The epidemiology differs from osteoporotic fractures at other skeletal sites, as only one-third are clinically recognized. In the elderly, the approach to osteoporotic vertebral fracture involves comprehensive evaluation of the patient, since it is both a cause and a consequence of multiple geriatric syndromes. This fracture, in its acute phase and subsequently, can lead to destabilization of other organs and systems of the elderly, medical complications at different levels, functional deterioration, dependence, and even the need for institutionalization. Therefore, it is important to carry out a multiple assessment of patients with vertebral fractures, addressing not only the history and risk factors of osteoporosis, but also those factors that lead to falls, as well as a comprehensive geriatric assessment and the complications closely associated with it. In this chapter we address each of these aspects that are necessary in the individual and multidimensional approach to the elderly patient with vertebral fracture due to bone fragility.

Factores determinantes de estancia hospitalaria, mortalidad y evolución funcional tras cirugía por fractura de cadera en el anciano / Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients

Objetivos. Analizar las características de los pacientes ingresados por fractura de cadera y su evolución 6 meses tras la cirugía para determinar los factores potencialmente relacionados con estancia hospitalaria, complicaciones médicas, mortalidad y recuperación funcional tras esta enfermedad tan prevalente y con graves consecuencias. Material y métodos. Estudio prospectivo de un grupo de 130 pacientes mayores de 75 años hospitalizados por fractura de cadera de perfil osteoporótico. Se evaluaron sus antecedentes médicos, situación mental y física previas a la caída, tipos de fractura y tratamiento quirúrgico, complicaciones hospitalarias, así como evolución funcional y social tras la hospitalización. Resultados. Los pacientes que tenían mayor grado de deterioro físico y mental previamente a la fractura y los institucionalizados tuvieron peor capacidad de recuperación tras la cirugía. El empleo de terapias alternativas a la transfusión para el tratamiento de la anemia se relacionó con disminución de estancia hospitalaria y mejor capacidad de deambulación a medio plazo. Las principales complicaciones médicas en el ingreso fueron infección e insuficiencia cardiaca, e implicaron prolongación de la hospitalización. La prescripción de suplementos nutricionales en pacientes adecuadamente seleccionados se relacionó con mejor evolución funcional. Conclusiones. La valoración de la situación mental, física y social previas a la fractura debe ser la base de un plan de tratamiento individualizado por ser claramente determinante de pronóstico. Los equipos multidisciplinares con seguimiento médico continuado simultáneo al quirúrgico son importantes para prevenir y tratar precozmente las frecuentes complicaciones perioperatorias. La administración de ferroterapia intravenosa y la prescripción de suplementos de nutrición pueden mejorar la recuperación física a medio plazo del paciente intervenido fractura de cadera (AU)

Objectives. Due to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. Material and methods. A prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalization were evaluated. Results. Patients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture. Conclusions. Evaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture (AU)

Predictive factors of hospital stay, mortality and functional recovery after surgery for hip fracture in elderly patients. / Factores determinantes de estancia hospitalaria, mortalidad y evolución funcional tras cirugía por fractura de cadera en el anciano.

OBJECTIVES: Due to its high prevalence and serious consequences it is very important to be well aware of factors that might be related to medical complications, mortality, hospital stay and functional recovery in elderly patients with hip fracture. MATERIAL AND METHODS: A prospective study of a group of 130 patients aged over 75 years admitted for osteoporotic hip fracture. Their medical records, physical and cognitive status prior to the fall, fracture type and surgical treatment, medical complications and functional and social evolution after hospitalization were evaluated. RESULTS: Patients with greater physical disability, more severe cognitive impairment and those who lived in a nursing home before the fracture had worse functional recovery after surgery. Treatment with intravenous iron to reduce transfusions reduced hospital stay and improved walking ability. Infections and heart failure were the most frequent medical complications and were related to a longer hospital stay. The prescription of nutritional supplements for the patients with real indication improved their physical recovery after the hip fracture CONCLUSIONS: Evaluation of physical, cognitive and social status prior to hip fracture should be the basis of an individual treatment plan because of its great prognostic value. Multidisciplinary teams with continuous monitoring of medical problems should prevent and treat complications as soon as possible. Intravenous iron and specific nutritional supplements can improve functional recovery six months after hip fracture.

Diarrea asociada a Clostridium difficile en el paciente anciano. Perspectiva integral. Réplica / Diarrhea associated to Clostridium dificcile in an elderly patient. Global perspective. Response

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[Clostridium difficile associated diarrhea in the elderly patient]. / Diarrea asociada a Clostridium difficile en el paciente anciano.

Clostridium difficile is the leading cause of infectious nosocomial diarrhea in the elderly. It may cause colitis of variable severity and extraintestinal involvement. Hand transmission is the most important, and it is related to prolonged antibiotic therapies in elderly patients with severe baseline disease. Diagnosis is based on culture and immunological tests to detect its toxins. When there is no response to conservative treatment (withdrawal of the antibiotic and support therapy), metronidazole or vancomycin should be given. Recurrences, up to 20%, are frequent. Preventive measures of its spreading are essential due to the elevated transmission through health care personnel and instruments. Detection of new, more virulent, gene variants of Clostridium difficile have increased the importance of this disease.

Diarrea asociada a Clostridium difficile en el paciente anciano / Clostridium difficile associated diarrhea in the elderly patient

Clostridium difficile es la causa más importante de diarrea infecciosa de transmisión nosocomial en ancianos. Puede producir grados de colitis de intensidad variable y afectación de órganos extraintestinales. Se transmite por vía feco-oral, a veces de forma epidémica en centros sanitarios, y se relaciona con la administración de gran variedad de antibióticos de forma prolongada en pacientes con patología severa de base. El cultivo en medios específicos o la detección de sus toxinas son los métodos habituales de diagnóstico. En caso de no haber respuesta al tratamiento conservador (retirada del antibiótico y terapia de soporte) se administrará metronidazol o vancomicina. Son frecuentes las recurrencias (hasta un 20%). Las medidas preventivas de su diseminación son imprescindibles, por la elevada transmisión a través del personal e instrumental sanitario. La detección de nuevas cepas de mayor virulencia y peor respuesta al tratamiento convencional hace de esta enfermedad nosocomial una entidad de importancia creciente

Clostridium difficile is the leading cause of infectious nosocomial diarrhea in the elderly. It may cause colitis of variable severity and extraintestinal involvement. Hand transmission is the most important, and it is related to prolonged antibiotic therapies in elderly patients with severe baseline disease. Diagnosis is based on culture and immunological tests to detect its toxins. When there is no response to conservative treatment (withdrawal of the antibiotic and support therapy), metronidazole or vancomycin should be given. Recurrences, up to 20%, are frequent. Preventive measures of its spreading are essential due to the elevated transmission through health care personnel and instruments. Detection of new, more virulent, gene variants of Clostridium difficile have increased the importance of this disease