Intensity of the humoral response to cytomegalovirus is associated with the phenotypic and functional status of the immune system.

Cytomegalovirus (CMV) infection exerts an enormous effect on human immunity, as it is associated with an immune-impaired response, a variety of chronic diseases, and overall survival in elderly individuals. Levels of anti-CMV antibodies may be associated with the differentiation degree of T cell subsets. Titers are significantly higher in the elderly and positively correlated with specific CD4(+) T cell responses to CMV. In the elderly, antibody titers are associated with the degree of differentiation and the T cell receptor excision circle (TREC) content in CD4(+) T cells, with other features of the immune risk profile, and with a reduced ability to respond to immunization in vivo. Associations may be absent in young subjects because their anti-CMV antibody titers are lower than those of the elderly. However, comparing young and elderly individuals with similar antibody levels reveals differences in their highly differentiated and naïve T cells. These are more marked in individuals with high titers. In parallel with the increase in anti-CMV antibodies, the elderly experience a significant reduction in absolute counts of naïve CD4(+) T cells, which may be a strategy to compensate for the expansion of differentiated cells and to avoid an increase in total T cells. In summary, our results show that titers of anti-CMV antibodies, and not only CMV seropositivity, are related to differentiation status and immunocompetence in the elderly, making this as an important prognostic marker of the status of immune system function.

Incapacidad funcional en una población de ancianos en el medio comunitario / Functional impairment in elderly comunity dweling

Objetivos: Conocer la prevalencia de incapacidad funcional en actividades básicas e instrumentales de la vida diaria en una población de ancianos residentes en el medio comunitario, determinar aquellas actividades para las que se incapacitan un mayor número de sujetos e identificar aquellas variables que pudieran estar asociadas a la incapacidad funcional. Método: Diseño; estudio epidemiológico transversal. Sujetos: mayores de 74 años registrados en el padrón municipal del Concejo de Gozón del año 1996. La población de estudio se obtuvo del total de sujetos mayores de 74 años empadronados (n =1.227), extrayendo una muestra de 348 sujetos mediante un muestreo aleatorio simple. Variables de estudio: sociodemográficas (edad, sexo, estado civil, convivientes, nivel de estudios y puntuación en la escala sociofamiliar de Gijón), clínicas (existencia de enfermedades potencialmente incapacitantes y número de enfermedades y fármacos), asistenciales (utilización de ayuda a domicilio formal, teleasistencia y centro de día), funcionales (evaluadas mediante los índices de Barthel y Lawton) y mentales (puntuaciones en la escala de Pfeiffer y la escala de depresión geriátrica).Resultados: 275 ancianos fueron incluidos en el estudio (81,4 años, 62,5 por ciento mujeres). La prevalencia de incapacidad funcional en actividades básicas de la vida diaria (ABVD) fue de 22,9 por ciento y en actividades instrumentales de la vida diaria (AIVD) del 73,5 por ciento, siendo las actividades más afectadas las relacionadas con la movilidad y las labores de la casa. En el análisis de regresión logística se mostraron como predictoras de incapacidad funcional en ABVD las variables: edad (OR 1,14), sexo femenino (OR 5,51), número de enfermedades (OR 1,42) y puntuación en el índice de Lawton (0,52). Asimismo, permanecieron como predictoras de incapacidad en AIVD las variables: edad (OR 1,2), sexo femenino (OR 0,03), número de enfermedades (OR 1,38) y puntuación en el Pfeiffer (1,53). Conclusiones: Para nuestra población de estudio, las variables edad, sexo, número de enfermedades y puntuaciones en el índice de Lawton y la escala de Pfeiffer, parecen comportarse como variables independientes capaces de predecir el riesgo de incapacidad funcional en ABVD y AIVD. Estas variables podrían ser útiles para seleccionar grupos de ancianos con riesgo, que pudieran beneficiarse de intervenciones especializadas dirigidas a prevenir/reducir la incapacidad funcional (AU)

[Groups of resource utilization in acute care units and average length of stay at geriatrics services]. / Grupos de utilizacion de recursos en Unidades de agudos y media estancia de Servicios de Geriatria.

BACKGROUND: In recent years, Patient Classifications Systems (PCS's) have been implement in Spain for the purpose of gauging the "hospital product". However, the most conventional systems are not very well-suited to the senior citizen population, among whom illness-related disability is a determining factor with regard to explaining the usage of resources and the results of the health care provided. Therefore, the idea was brought forth of implementing a system in units providing senior citizen care which would entail this parameter, that is, the Resource Usage Groups (RUG's), analyzing the characteristics and differences in the RUG-related spread in four Geriatrics Units. METHODS: A cross-sectional study based on consecutive cutoff points in periods longer than the average stay in each unit, the patients admitted in the acute care units and average stay in the Geriatrics Unit of the Hospital Monte Narango (HMN) (n = 318), Hospital Central de la Cruz Roja (HCCR) (n = 384), Hospital General de Guadalajara (HG) (n = 272) and Hospital Virgen del Valle (HVV) (n = 390), with regard to the spread thereof according to the RUG-T18 classification. The possible differences among the hospitals in question were analyzed by means of the chi-square statistical test (SPSS for Windows). RESULTS: For the overall sample, the patients were divided into groups R, S and C of the classification, groups P and B being represented to a very small degree, differences having been found to exist among the different hospitals. Hence, the HCCR is that which handles the largest percentage of patients in the R group (47.64% vs. 23.66% at HMN; 20.57% at HG and 20.53% at HVV) and a smaller percentage of patients in the S Group (3.12% vs. 6.40% at HMN; 9.92% at HG and 9.76% at HVV) and the C Group (48.94% vs. 76.29% at HMN; 66.89% at HG and 68.36% at HVV). Differences were likewise found to exist in the individual analysis for the acute care units and average length of stay. CONCLUSIONS: The resource usage groups can be useful with regard to ascertaining differences in the health care loads in hospital care for senior citizens.

Insuficiencia social: concepto y método para su valoración clínica / Social insufficiency: concept and method for its clinical evaluation

No disponible

Características y evolución de la enfermedad cerebrovascular en una unidad de ictus dependiente de un Servicio de Geriatría / Characteristics and evolution of the cerebrovascular disease in the geriatric service stroke unit

OBJETIVO: Describir las peculiaridades de nuestra Unidad de Ictus, así como explorar las características y evolución de los pacientes ingresados. MATERIAL Y MÉTODOS: Se describe la Unidad de Ictus y su funcionamiento, analizando los pacientes ingresados durante el período comprendido entre el 1-4-97 y el 31-9-98, en lo que se refiere a factores sociodemográficos, clínicos, funcionales y asistenciales. RESULTADOS: Durante el período de estudio ingresaron en la Unidad 466 pacientes (edad media 79,38 ñ 7,35, 61,8 por ciento mujeres), procedentes de su domicilio en un 93 por ciento de los casos. El IB previo fue de 87,5 ñ 22,2 y la puntuación en la escala de Orpington al ingreso fue de 4,62 ñ 1,8, permitiéndonos clasificar al 30,9 por ciento (n: 144) de los pacientes en el grupo de buen pronóstico, el 26,6 por ciento (n: 124) en el de moderado y el 42,5 por ciento (n: 198) en el de mal pronóstico. El 86,1 por ciento de los ictus fueron de perfil isquémico y su localización más frecuente fue hemisférica izquierda (52,1 por ciento de los casos). Un 73,6 por ciento de los pacientes fueron valorados por el Rehabilitador, comenzando tratamiento funcional específico un 79,3 por ciento (n: 372) de ellos. Los 397 pacientes dados de alta presentaban un IB de 52,57 ñ 33,66 puntos, habiendo conseguido durante el ingreso una ganancia en el IB 21,22 ñ 19,18. Un 42,9 por ciento de los cuidadores acudieron específicamente a valoración por la trabajadora social, con un cambio de ubicación al alta en el 25,2 por ciento de los pacientes, siendo institucionalizados un 16,1 por ciento del total de la muestra. La estancia media global fue de 20,2 ñ 16,9 días. CONCLUSIONES: Comparada con la literatura referente a unidades de ictus nuestra serie cuenta con una edad media más elevada y peor pronóstico al ingreso. Un elevado porcentaje de los pacientes es considerado candidato a tratamiento funcional, consiguiendo una ganancia media en el IB de 20 puntos y manteniendo índices de institucionalización, complicaciones y estancias medias hospitalarias reducidas (AU)

[Functional deterioration of basic daily living activities after an emergency service consultation]. / Deterioro funcional en actividades básicas de la vida diaria tras la consulta en un servicio de urgencias.

OBJECTIVE: To determine the incidence of functional decline of elderly patients discharged from an emergency department and to analized functional impairment as a risk of readmission. METHODS: A prospective cohort aged 75 or older were followed up after discharge from an emergency department between 01-02-95 and 01-04-95. The study protocol included sociodemografics, clinicals, functionals and mentalsoutcomes. We studied the incidence of functional decline in basic activities of daily living, with Barthel Index, and association with the risk of readmission. RESULTS: The sample was composed by 125 elders (mean aged 81.9 +/- 4.6 years and 60.8% were women). The incidence of functional decline in basic activities of daily living at the visit to emergency department was 20.8% and one moth after discharge was 18.4%. Both activities with more functional impairment were bathing, dressing and movility activities. Functional decline was associated with the risk of readmission at emergency department (Odds Ratio = 4.1 [1.4-11.8]) CONCLUSIONS: 20% of patients who are discharged of emergency department present a new functional impairment in basics activities of daily living. Functional decline is associated with the risk of readmission one moth after discharged.

[Functional deterioration secondary to hospitalization for an acute disease in the elderly. An analysis of its incidence and the associated risk factors]. / Deterioro funcional secundario a la hospitalización por enfermedad aguda en el anciano. Análisis de la incidencia y los factores de riesgo asociados.

OBJECTIVE: To determine the incidence of functional impairment at hospital admission and after hospital discharge, and to identify those factors that could be predictors of such impairment in a cohort of elderly people with high level of independence in the basic activities of daily living (BADL). DESIGN: Epidemiologic, longitudinal and prospective study. SETTING: Acute unit in a geriatric department. SUBJECTS: The follow-up population was made up by 150 subjects older than 65 years, admitted on account of acute medical conditions from December, 15th, 1995, to December, 15th, 1996, who were independent for walking and independent or with slight dependence for BADL. STUDY PARAMETERS: All patients were evaluated at 48 hours after admission and one month after discharge by means of a protocol including sociodemographic, clinical, attending, functional and mental parameters. RESULTS: The incidence of functional impairment at hospital admission was 70.66%; such impairment persisted one month after discharge in 29.3% of subjects. The most involved activities related to motility. In the analysis of crude data, the following parameters showed association with functional impairment risk one month after discharge: female sex (OR: 2.5), sensorial organ pathology (OR: 2.6), hospital stay longer than 15 days (OR: 7.2), and Lawton Index score (3.8 +/- 2.6 in impaired patients vs. 4.9 +/- 2 in non-impaired patients; p < 0.01). Barthel Index score at admission lower than 60 (OR: 9.5), Cognitive Miniexam score lower than 28 (OR: 4.1), Informant Test score higher than 84 (OR: 2.5) and Geriatric Depression Scale score 9 (OR: 3.1). In the logistic regression model, the following parameters remained as predictors of impairment: sex (OR: 3.3), days of hospital stay (OR: 2.3) and Barthel Index score at admission (OR: 6.1) and Cognitive Miniexam score (OR: 2.7). CONCLUSIONS: For our population, sex, hospital stay days, functional impairment in Barthel Index at admission and Cognitive Miniexam score parameters seem to behave as independent variables that can predict functional impairment risk for BADL one month after discharge. These parameters could be useful to select groups of elderly people with impairment risk, who could benefit from specialized interventions leading to prevent/decrease functional impairment secondary to acute disease and hospitalization.