Asociación entre funcionalidad familiar y deterioro cognitivo leve en la familia con adulto mayor / Association between family functionality and mild cognitive impairment in the family with the elderly

Objetivo: Determinar la asociación entre funcionalidad familiar y deterioro cognitivo leve en la familia con adulto mayor. Metodología: Diseño transversal analítico en familias con pacientes geriátricos. Se consideró familia con paciente geriátrico cuando al menos uno de sus integrantes tenía más de 60años de edad. Los grupos de comparación fueron la familia con paciente geriátrico sin deterioro cognitivo y la familia con paciente geriátrico con deterioro cognitivo leve determinada con el instrumento MoCA. La funcionalidad familiar se evaluó con el instrumento APGAR familiar, el cual identifica tres categorías: funcionalidad familiar, disfuncionalidad familiar moderada y disfuncionalidad familiar severa. El análisis estadístico incluyó chi cuadrado y prueba de Mann Whitney. Resultados: En la familia con paciente geriátrico, en el grupo sin deterioro cognitivo la prevalencia de funcionalidad familiar es del 89,7% y en el grupo con deterioro cognitivo leve la prevalencia de funcionalidad familiar es del 59,3% (MW=4,87, p<0,000). Conclusión: Existe asociación entre funcionalidad familiar y deterioro cognitivo leve.(AU)

Aim: To determine the association between family functionality and mild cognitive impairment in the family with the elderly. Methodology: Analytical cross-sectional design in families with geriatric patients. A family with a geriatric patient was considered when at least one of its members was over 60years of age. The comparison groups were the family with a geriatric patient without cognitive impairment and the family with a geriatric patient with mild cognitive impairment determined with the MoCA instrument. Family functionality was evaluated with the family APGAR instrument, which identifies three categories: family functionality, moderate family dysfunction, and severe family dysfunction. Statistical analysis included Chi square and Mann-Whitney test. Results: In the family with a geriatric patient, in the group without cognitive impairment the prevalence of family functionality is 89.7% and in the group with mild cognitive impairment the prevalence of family functionality is 59.3% (MW=4.87, P<.000). Conclusion: There is an association between family functionality and mild cognitive impairment.(AU)

[Association between family functionality and mild cognitive impairment in the family with the elderly]. / Asociación entre funcionalidad familiar y deterioro cognitivo leve en la familia con adulto mayor.

AIM: To determine the association between family functionality and mild cognitive impairment in the family with the elderly. METHODOLOGY: Analytical cross-sectional design in families with geriatric patients. A family with a geriatric patient was considered when at least one of its members was over 60years of age. The comparison groups were the family with a geriatric patient without cognitive impairment and the family with a geriatric patient with mild cognitive impairment determined with the MoCA instrument. Family functionality was evaluated with the family APGAR instrument, which identifies three categories: family functionality, moderate family dysfunction, and severe family dysfunction. Statistical analysis included Chi square and Mann-Whitney test. RESULTS: In the family with a geriatric patient, in the group without cognitive impairment the prevalence of family functionality is 89.7% and in the group with mild cognitive impairment the prevalence of family functionality is 59.3% (MW=4.87, P<.000). CONCLUSION: There is an association between family functionality and mild cognitive impairment.

Repercusión de la restricción de visitas familiares por la pandemia en la evolución clínica del paciente geriátrico hospitalizado / Impact of the restriction of family visits due to the pandemic on the clinical evolution of the hospitalized geriatric patient

La restricción de acompañamiento de familiares a pacientes hospitalizados tiene consecuencias para el paciente, la familia y los profesionales. En este estudio nos planteamos como objetivo analizar la opinión de los profesionales sanitarios sobre la presencia familiar en los cuidados y recuperación del paciente geriátrico hospitalizado. Se realizó un estudio descriptivo observacional multicéntrico desarrollado mediante una encuesta dirigida a profesionales de hospitales de Madrid. Respondieron 314 profesionales (43,6% enfermeras, 26,1% auxiliares de enfermería y 15,6% médicos) de diferentes hospitales. El 80% (IC 95%: 75-84%) afirmaron que la restricción de las visitas dificultaba la recuperación del paciente, y el 84% (IC 95%: 80-88%) que los cuidados familiares no se pueden suplir por los profesionales, aunque sí mejorar mediante formación y aumento de personal (91%). El 70% piensan que cuando los pacientes están solos, comen y beben menos, sufren más broncoaspiración y delirium, y mayor dificultad para la higiene y la movilización. Los profesionales sanitarios reconocieron que los cuidados que desarrollan los familiares de los pacientes facilitan su recuperación. (AU)

The restriction of family accompaniment of hospitalised patients has consequences for the patient, family and professionals. The aim of this study was to analyse the opinion of healthcare professionals on the family presence in the care and recovery of hospitalised geriatric patients. A descriptive, observational, multicentre study was carried out by means of a survey addressed to professionals from hospitals in Madrid. A total of 314 professionals (43.6% nurses, 26.1% nursing assistants, 15.6% doctors) from different hospitals responded. Eighty percent (95%CI: 75%-84%) stated that the restriction of visits hindered the patient's recovery and 84% (95%CI: 80%-88%) stated that the family care cannot be substituted by professionals, although it can be improved through training and increased staffing (91%). Seventy percent think that when patients are alone, they eat and drink less, suffer more bronchial aspiration and delirium, and have greater difficulty in hygiene and mobilisation. Healthcare professionals recognised that the care provided by patients’ relatives facilitates their recovery. (AU)

[Impact of the restriction of family visits due to the pandemic on the clinical evolution of the hospitalized geriatric patient]. / Repercusión de la restricción de visitas familiares por la pandemia en la evolución clínica del paciente geriátrico hospitalizado.

The restriction of family accompaniment of hospitalised patients has consequences for the patient, family and professionals. The aim of this study was to analyse the opinion of healthcare professionals on the family presence in the care and recovery of hospitalised geriatric patients. A descriptive, observational, multicentre study was carried out by means of a survey addressed to professionals from hospitals in Madrid. A total of 314 professionals (43.6% nurses, 26.1% nursing assistants, 15.6% doctors) from different hospitals responded. Eighty percent (95%CI: 75%-84%) stated that the restriction of visits hindered the patient's recovery and 84% (95%CI: 80%-88%) stated that the family care cannot be substituted by professionals, although it can be improved through training and increased staffing (91%). Seventy percent think that when patients are alone, they eat and drink less, suffer more bronchial aspiration and delirium, and have greater difficulty in hygiene and mobilisation. Healthcare professionals recognised that the care provided by patients' relatives facilitates their recovery.

Sarcopenia en pacientes de hospital de día geriátrico / Sarcopenia in a geriatric day hospital

Introducción: La sarcopenia es una enfermedad muscular progresiva y generalizada asociada con un aumento de los resultados adversos para la salud (caídas, fracturas, discapacidad y mortalidad). Multiplica por 4 el riesgo de muerte por cualquier causa y tiene un gran impacto en otros resultados de salud y pérdida de calidad de vida. Objetivo: El objetivo principal de esta investigación es establecer la prevalencia y las variables relacionadas con la sarcopenia en pacientes de un hospital de día geriátrico. Metodología: Muestra de 55 pacientes: 40 mujeres (73%) y 15 hombres (27%), con una edad media de 73,25 años (desviación estándar de 13,4). Resultados: El 87% de los pacientes sobreviven al año de seguimiento. El coeficiente de correlación (positivo) (p < 0,01) para SARC-F y SPPB, SARC-F e índice de Barthel, y dinamómetro e índice de Barthel. El coeficiente de correlación de Pearson (negativo) (p < 0,05) para edad y medicación, índice de fragilidad e índice de Barthel, índice de fragilidad y GDS, e índice de Barthel y SPPB. Conclusiones: se puede concluir que el principal factor de riesgo para sarcopenia es la edad. Cuanto mayor es la edad, mayor es el riesgo de sarcopenia. En los mayores de 80 años se obtiene una alta prevalencia en comparación con otros estudios. La sarcopenia y la fragilidad se consideran fuertes predictores de morbilidad, discapacidad y mortalidad en las personas mayores (AU)

Introduction: Sarcopenia is a progressive and generalized muscledisease associated with an increase in adverse health outcomes (falls, fractures, disability and mortality). It is a disease that multiplies by 4 the risk of death from any cause and has a great impact on other health outcomes and loss of quality of life. Objective: The main objective of this research is to establish the prevalence and variables related to sarcopenia in patients from the geriatric day hospital. Methodology: Sample of 55 patients: 40 women (73%) and 15 men (27%), with a mean age of 73.25 years (standard deviation of 13.4). Results: The 87% of patients survive at one-year follow-up. The Pearson correlation coefficient (positive) (p < 0.01) for SARC-F and SPPB, SARC-F and Barthel index, and dynamometer and Barthel index. The Pearson correlation coefficient (negative) (p < 0.05) for age and medication, frailty index and Barthel index, frailty index (IFVIG) and GDS, and Barthel index and SPPB. Conclusions: it can be concluded that the main factor for sarcopenia is age. The older the age is, the greater the risk for sarcopenia. In those over 80 years of age, we obtain a high prevalence compared to other studies. Sarcopenia and frailty are considered strong predictors of morbidity, disability, and mortality in older people (AU)

Factors affecting urinary incontinence-related quality of life in geriatric patients: an observational cross-sectional study in a tertiary hospital urology clinic in Turkey / Factores que afectan la calidad de vida relacionada con la incontinencia urinaria en pacientes geriátricos: un estudio transversal observacional en una clínica de urología de un hospital terciario en Turquía

Introduction: Geriatric syndromes are associated with morbidity and poor quality of life (QOL). Urinary incontinence (UI) is one of the most prevalent geriatric syndromes. However, there is little research on the association of UI and UI-related QOL with other geriatric syndromes. The aim of this exploratory study were to examine the effect and coexistence of geriatric syndromes, admission type and surgical severity on UI-related QoL in patients hospitalized in the urology clinic. Materials and methods: This study was conducted among 250 older inpatients (aged 65 years and older between October 2019 and March 2020) at Zonguldak Bulent Ecevit University department of Urology, Zonguldak, Turkey. After ethical approval and patient consent, we examined geriatric syndromes and related factors including cognitive impairment, delirium, depression, decreased mobility, multiple drug use, malnutrition, pain and fecal incontinence as well as hospitalization patterns and surgical severity of the patients. UI-related QOL was assessed using the International Consultation on Incontinence Questionnaire-Short Form. Multiple logistic regression analysis was used to evaluate these associations. Results: Geriatric syndromes and related factors were associated with UI. Moderate cognitive decline (odds ratio [OR], 3.764; 95% confidence interval [CI], 1.621- 8.742), Charlson Comorbidity Index (CCI) (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.24–5.05) and the number of medication used (odds ratio [OR], 1,33; 95% confidence interval [CI], 1.11–1.58) were associated with increased probability of having UI. Cognitive impairment, length of hospital stay had an inverse and age of patients had a direct effect on patients UI-related QoL. Conclusions: UI-related quality of life was associated with some factors. Especially in the urology clinic, evaluating the cognitive functions of elderly patients, ... (AU)

Introducción: Los síndromes geriátricos se asocian con morbilidad y mala calidad de vida (CV). La incontinencia urinaria (IU) es uno de los síndromes geriátricos más prevalentes. Sin embargo, hay poca investigación sobre la asociación de la IU y la CdV relacionada con la IU con otros síndromes geriátricos. El objetivo de este estudio exploratorio fue examinar el efecto y la coexistencia de los síndromes geriátricos, el tipo de ingreso y la gravedad quirúrgica en la calidad de vida relacionada con la IU en pacientes hospitalizados en la consulta de urología. Materiales y métodos: este estudio se realizó entre 250 pacientes hospitalizados mayores (de 65 años o más entre octubre de 2019 y marzo de 2020) en el departamento de Urología de la Universidad Zonguldak Bulent Ecevit, Zonguldak, Turquía. Después de la aprobación ética y el consentimiento del paciente, examinamos los síndromes geriátricos y los factores relacionados, incluidos el deterioro cognitivo, el delirio, la depresión, la disminución de la movilidad, el uso de múltiples drogas, la desnutrición, el dolor y la incontinencia fecal, así como los patrones de hospitalización y la gravedad quirúrgica de los pacientes. La calidad de vida relacionada con la IU se evaluó mediante el Cuestionario de consulta internacional sobre incontinencia: formato corto. Se utilizó análisis de regresión logística múltiple para evaluar estas asociaciones. Resultados: Los síndromes geriátricos y factores relacionados se asociaron con la IU. Deterioro cognitivo moderado (odds ratio [OR], 3,764; intervalo de confianza [IC] del 95 %, 1,621-8,742), índice de comorbilidad de Charlson (ICC) (odds ratio [OR], 1,56; intervalo de confianza [IC] del 95 %, 1,24– 5,05) y el número de medicamentos utilizados (odds ratio [OR], 1,33; intervalo de confianza [IC] del 95 %, 1,11–1,58) se asociaron con una mayor probabilidad de tener IU. El deterioro cognitivo, la duración de la estancia hospitalaria tuvieron un efecto inverso y la edad ... . (AU)

Coordinación entre atención primaria y un servicio de geriatría, 20 años después / Coordination between primary care and a geriatrics service, 20 years later

Objetivo: Describir la evolución de la actividad asistencial y de la coordinación de un equipo especializado hospitalario (equipo de Atención Geriátrica Domiciliaria-AGD) en el apoyo a atención primaria (AP) para la atención de pacientes geriátricos. Emplazamiento: Antigua área de Salud-5 de la Comunidad de Madrid. Participantes, intervenciones y mediciones principales: Evaluación de los pacientes atendidos en su domicilio a petición de AP por AGD, en 1997-1999 y 20 años después, en 2017-2019. Se registraron variables sociodemográficas, clínicas, funcionales y mentales. También datos asistenciales como el tiempo hasta la primera visita, la estancia media, la procedencia y destino de los pacientes, el motivo de consulta y el motivo principal de discapacidad. Resultados: Se atendieron 524 pacientes (58% del total) solicitados desde AP en 1997-1999 y 1196 (72,2% del total) en 2017-2019. Actualmente se muestra un paciente de mayor edad, más incapacitado física y mentalmente, con mayor prevalencia de síndromes geriátricos y mayor fragilidad social. Ha aumentado la demencia como motivo principal de incapacidad, observándose un incremento de la Valoración Geriátrica Integral (VGI) y del control clínico como motivos principales de derivación. Conclusiones: En nuestro medio, transcurridos 20 años, AGD continúa siendo un importante apoyo para AP en el complejo abordaje de los pacientes ancianos frágiles recluidos en su domicilio, que son cada vez más vulnerables desde el punto de vista clínico, funcional, cognitivo y social. Contribuye en el manejo de los síndromes geriátricos, la deprescripción, los ingresos directos hospitalarios cuando se necesitan sin pasar por urgencias y la disminución en la institucionalización, facilitando el mantenimiento del paciente en su domicilio.(AU)

Objective: To describe the evolution of the care and coordination activity of a specialized hospital team (Geriatric Home Care-AGD team) in support of Primary Care (PC) for the care of geriatric patients. Location: Health-5 area of the Community of Madrid. Participants, interventions and main measurements: Evaluation of patients attended at home at the request of PC by AGD, in 1997-1999 and twenty years later, in 2017-2019. Sociodemographic, clinical, functional and mental variables were recorded. Also care data such as time to first visit, average length of stay, origin and destination of patients, reason for consultation and main reason for disability. Results: 524 patients (58% of the total) requested from AP in 1997-1999 and 1196 (72.2% of the total) in 2017-2019 were attended. Currently we show an older patient, more physically and mentally disabled, with a higher prevalence of geriatric syndromes and greater social fragility. Dementia has increased as the main reason for incapacity, with an increase in Comprehensive Geriatric Assessment and clinical control as the main reasons for referral. Conclusion: sin our setting, after 20 years, AGD continues to be an important support for PC in the complex approach to frail elderly patients confined to their homes, who are increasingly vulnerable from a clinical, functional, cognitive and social point of view. It contributes to the management of geriatric syndromes, deprescription, direct hospital admissions when needed without having to go to the emergency department, and a decrease in institutionalization, facilitating the maintenance of the patient at home.(AU)

[Coordination between primary care and a geriatrics service, 20 years later]. / Coordinación entre atención primaria y un servicio de geriatría, 20 años después.

OBJECTIVE: To describe the evolution of the care and coordination activity of a specialized hospital team (Geriatric Home Care-AGD team) in support of Primary Care (PC) for the care of geriatric patients. LOCATION: Health-5 area of the Community of Madrid. PARTICIPANTS, INTERVENTIONS AND MAIN MEASUREMENTS: Evaluation of patients attended at home at the request of PC by AGD, in 1997-1999 and twenty years later, in 2017-2019. Sociodemographic, clinical, functional and mental variables were recorded. Also care data such as time to first visit, average length of stay, origin and destination of patients, reason for consultation and main reason for disability. RESULTS: 524 patients (58% of the total) requested from AP in 1997-1999 and 1196 (72.2% of the total) in 2017-2019 were attended. Currently we show an older patient, more physically and mentally disabled, with a higher prevalence of geriatric syndromes and greater social fragility. Dementia has increased as the main reason for incapacity, with an increase in Comprehensive Geriatric Assessment and clinical control as the main reasons for referral. CONCLUSIONS: in our setting, after 20 years, AGD continues to be an important support for PC in the complex approach to frail elderly patients confined to their homes, who are increasingly vulnerable from a clinical, functional, cognitive and social point of view. It contributes to the management of geriatric syndromes, deprescription, direct hospital admissions when needed without having to go to the emergency department, and a decrease in institutionalization, facilitating the maintenance of the patient at home.

Multimorbilidad y síndromes geriátricos. Su efecto sobre la mortalidad en adultos mayores con sepsis / Multimorbidity and geriatric syndromes. Their effect on mortality in older adults with sepsis

Resumen Introducción: la sepsis se diagnostica en más de 60% de los adultos mayores (AM) en el mundo. Estos AM con frecuencia presentan multimorbilidad y alguno de los síndromes geriátricos, llevando a discapacidad física, cognitiva y psicosocial, lo cual produce altos costos para los sistemas de salud, resultando en un problema grave de salud pública. Objetivo: identificar el impacto de la multimorbilidad y los síndromes geriátricos en la morta lidad de AM hospitalizados por sepsis en una unidad geriátrica de agudos a 30 días de su ingreso. Material y métodos: estudio observacional, analítico de casos y controles anidado en una cohorte. Resultados: se analizaron 238 pacientes con edad media de 83.15±7.12 años, 52.1% fueron mujeres y el 99% tenían al menos una comorbilidad, la mortalidad a 30 días fue 34%. La infección urinaria fue la causa principal de hospitalización (42.9%), obteniendo un aislamiento microbio-lógico en 43.3% de los casos, siendo la Escherichia coli el agente causal más frecuente (46.6%). La regresión logística múltiple mostró que la enfermedad renal crónica (OR 2.1 IC 95% 1.1-4.8; p=0.037), el delirium (OR 3.1 IC 95% 1.6-5.8; p=0.001) y la discapacidad (índice de Barthel <60; OR 3.4 IC 95% 1.5-7.5; p=0.002) se asociaron de manera significativa con la mortalidad a 30 días desde el ingreso a la unidad geriátrica de agudos en paciente con sepsis. Conclusión: en los AM hospitalizados por sepsis, la multimorbilidad, la enfermedad re nal crónica y los síndromes geriátricos representados por delirium y discapacidad fueron los predictores de mortalidad a 30 días. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2125).

Abstract Introduction: sepsis is diagnosed in more than 60% of older adults (OAs) worldwide. These OAs often have multimorbidity and one of the geriatric syndromes, leading to physical, cognitive and psychosocial disability with consequently high healthcare costs, resulting in a serious public health problem. Objective: to determine the impact of multimorbidity and geriatric syndromes on the 30-day mortality rate of OAs hospitalized for sepsis in an acute geriatric unit Materials and methods: an observational, analytical, nested case-control study. Results: 238 patients with a mean age of 83.15±7.12 were analyzed; 52.1% were women and 99% had at least one comorbidity; the 30-day mortality was 34%. Urinary tract infection was the main cause of hospitalization (42.9%), with microbiological isolation achieved in 43.3% of cases and Escherichia coli being the most common causal agent (46.6%). Multiple logistic regression showed that chronic kidney disease (OR 2.1 95% CI 1.1-4.8; p=0.037), delirium (OR 3.1 95% CI 1.6-5.8; p=0.001) and disability (Barthel index <60; OR 3.4 95% CI 1.5-7.5; p=0.002) were significantly related to 30-day mortality in patients with sepsis admitted to an acute geriatric unit. Conclusion: in OAs hospitalized for sepsis, multimorbidity, chronic kidney disease and geriatric syndromes (represented by delirium and disability) were the predictors of 30-day mortality. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2125).

Desempenho do teste de sentar e levantar de trinta segundos na população geriátrica da comunidade: um estudo transversal / Thirty second sit to stand test performance in community dwelling geriatric population: a cross-sectional study

INTRODUÇÃO: Encontrar os valores de referência para o teste de sentar e levantar de 30 segundos e estudar a correlação das medidas antropométricas com o teste na população indiana geriátrica residente na comunidade. MATERIAL E MÉTODOS: 136 indivíduos com idade >60 anos foram recrutados neste estudo transversal e observacional. O estudo foi realizado na Índia. Após a triagem inicial, as medidas antropométricas foram registradas. Em seguida, foi realizado o teste de sentar e levantar de 30 segundos. RESULTADOS: Os valores normais da década para o teste foram relatados como (média±DP): 60-70 anos (10,2±3,6), 71- 80 anos (9,5±3,4) e 81-90 anos (8,5±5,2). Idade, altura, circunferência da cintura e circunferência do quadril foram significativamente associadas aos valores do teste. CONCLUSÃO: Os valores normais para o teste de sentar e levantar de 30 segundos para a população geriátrica da comunidade foram relatados como média ± DP 10,0 ± 3,7. Os fatores antropométricos devem ser levados em consideração ao realizar o teste de sentar e levantar de 30 segundos em ambientes clínicos.

INTRODUCTION: To find the reference values for the 30-second sit-to-stand test and study the correlation of anthropometric measures with the test in the communitydwelling geriatric Indian population. MATERIAL AND METHODS: 136 individuals aged >60 years were recruited in this cross-sectional observational study. The study was conducted in India. After the initial screening, anthropometric measurements were recorded. Then, the 30-second sit-tostand test was conducted. RESULTS: Normal decade-wise values for the test were reported to be (mean ± SD): 60-70 years (10.2±3.6), 71-80 years (9.5±3.4), and 81-90 years (8.5±5.2). Age, height, waist circumference, and hip circumference were significantly associated with the 30-second sit-to-stand test values. CONCLUSION: Normal values for the test in the community-dwelling geriatric population were reported to be mean ± SD 10.0±3.7. Anthropometric factors should be taken into consideration when performing the 30-second sitto-stand test in clinical settings.

Características clínicas y pronóstico de la lesión medular traumática en pacientes mayores de 75 años / Clinical characteristics and prognosis of spinal cord injury in individuals over 75 years old

Objetivos Analizar la incidencia y las características de la lesión medular (LM) traumática en la población geriátrica de Galicia (España), el manejo hospitalario y el pronóstico vital y funcional. Material y métodos Estudio comparativo retrospectivo. Se incluyen los pacientes ingresados por LM traumática aguda entre enero de 2010 y diciembre de 2016. Se establecen 2 grupos: mayores y menores de 75 años, actuando los últimos como grupo control. Resultados Recogidos 379 pacientes (27,2% ≥75 años). La etiología más frecuente en el grupo ≥75 años fueron las caídas: 80,6%. El 65,7% presentaban lesiones medulares incompletas con un índice motor (IM) medio de 44,9/100. Al alta el 90,8% eran dependientes, precisando silla de ruedas el 53,8%. La mortalidad hospitalaria fue del 34,9%. En comparación con el grupo control, los pacientes mayores sufrieron más lesiones cervicales (74,8 vs. 51,2%; p<0,001), mayor retraso diagnóstico (31,1 vs. 9,2%; p<0,001) y mortalidad hospitalaria (34,9 vs. 3,2%; p<0,001). Se realizaron menos intervenciones quirúrgicas y con mayor demora. Los porcentajes de ingreso en la UCI, ventilación mecánica y realización de traqueostomía fueron similares. No se encontraron diferencias significativas en cuanto a evolución neurológica según la escala American Spinal Injury Association (ASIA) (p=0,46) o el IM (p=0,48). Conclusiones 1) La frecuencia de LM traumática en ancianos en Galicia es elevada; 2) La evolución neurológica medida por el ASIA es similar a pacientes más jóvenes, si bien el nivel de dependencia al alta es mayor; 3) El nivel de cuidados hospitalarios es similar en ambos grupos salvo por la indicación quirúrgica, y 4) La mortalidad hospitalaria es alta (AU)

Objective To analyze the incidence and characteristics of traumatic spinal cord injury (SCI) in geriatric population of Galicia (Spain), hospital management and functional prognosis. Methods Comparative retrospective study. Patients admitted with acute traumatic SCI during the time period between January 2010 and December 2016 were included. Two groups established: The elderly over and under 75 years of age, with the latter acting as a control group. Results Three hundred seventy-nine patients were studied (27.2% ≥75 years). The main etiology in the >75 years group were falls: 80.6%. There were 65.7% who presented incomplete spinal cord injuries with mean motor index (MI) of 44.9/100. Upon discharge, 90.8% were dependent. Hospital mortality was 34.9%. Those >75 years suffered from more cervical injuries (74.8 vs. 51.2%; p<0.001), longer delay in diagnosis (31.1 vs. 9.2%; p<0.001) and higher hospital mortality (34.9 vs. 3.2%; p<0.001). Fewer surgical interventions were performed, with a longer delay. Percentages for admission into ICU, mechanical ventilation and performing a tracheostomy proved to be similar. There were no significant differences found in the evolution according to the ASIA scale or the MI. Conclusions 1) The frequency of traumatic SCI in the elderly in Galicia is high; 2) Neurological evolution is similar to younger patients but the level of dependence is higher; 3) The level of care provided is similar in both groups, except for the surgical indication, and 4) Hospital mortality is high (AU)

Clinical characteristics and prognosis of spinal cord injury in individuals over 75 years old.

OBJECTIVE: To analyze the incidence and characteristics of traumatic spinal cord injury (SCI) in geriatric population of Galicia (Spain), hospital management and functional prognosis METHODS: Comparative retrospective study. Patients admitted with acute traumatic SCI during the time period between January 2010 and December 2016 were included. Two groups established: The elderly over and under 75 years of age, with the latter acting as a control group. RESULTS: 379 patients were studied (27.2% ≥75 years). The main etiology in the >75 years group were falls: 80.6%. There were 65.7% who presented incomplete spinal cord injuries with mean motor index (MI) of 44.9/100. Upon discharge, 90.8% were dependent. Hospital mortality was 34.9%. Those >75 years suffered from more cervical injuries (74.8 vs. 51.2%, p < 0.001), longer delay in diagnosis (31.1% vs. 9.2%, p < 0.001) and higher hospital mortality (34.9% vs. 3.2%, p < 0.001). Fewer surgical interventions were performed, with a longer delay. Percentages for admission into ICU, mechanical ventilation and performing a tracheostomy proved to be similar. There were no significant differences found in the evolution according to the ASIA scale or the MI. CONCLUSIONS: 1) The frequency of traumatic SCI in the elderly in Galicia is high. 2) Neurological evolution is similar to younger patients but the level of dependence is higher. 3) The level of care provided is similar in both groups, except for the surgical indication. 4) Hospital mortality is high.

Percepciones de los profesionales de enfermería sobre los cuidados en el paciente geriátrico / Perceptions of Nursing professionals about care in the geriatric patient

Objetivos: Conocer y describir cómo perciben las enfermeras que trabajan con pacientes geriátricos los cuidados de enfermería proporcionados, los problemas con los que se encuentran, así como las soluciones para mejorarlos. Métodos: Estudio cualitativo de tipo fenomenológico basado en entrevistas semiestructuradas. La información obtenida se analizó mediante análisis de contenido y se verificó con la triangulación de los resultados. Resultados: Emergieron siete categorías coincidentes en todas las entrevistas realizadas: percepciones de las enfermeras sobre los cuidados de enfermería en el paciente geriátrico, calidad de los cuidados de enfermería, dificultades al proporcionar los cuidados de enfermería, propuestas de mejoras de enfermería, satisfacción del paciente y familia con la enfermera, presente y futuro de la profesión enfermera, y el trabajo de equipo. Las enfermeras consideran el cuidado como un arte y la esencia de la profesión; la persona enferma es la pieza clave que justifica la profesión. Conclusiones: os profesionales consideran que son fundamentales: el reconocimiento de las especialidades de enfermería, la formación continua, que las administraciones motiven a sus profesionales, prevenir el síndrome de estar quemado, enseñar a trabajar en equipo y avanzar hacia la seguridad del paciente y del profesional (AU)

Objectives: Objectives: to know and describe how nurses perceive the care they provide in the daily work with geriatric patients, the problems they find as well as the solutions to improve them. Methods: qualitative phenomenological study based on semi-structured interviews. The information obtained was analyzed by content analysis and verified with the triangulation of the results. Results: Seven matching categories emerged in all the conducted interviews: nurses perceptions about the care of geriatric patient, quality of nursing care, difficulties to apply nursing care, proposals for improvement of nursing, patient and family satisfaction with the nurse work, present and future of the nursing profession, and the teamwork. Nurses consider care as an art and the essence of the profession; the sick person is the key piece that justifies the profession. Conclusions: professionals believe that, are fundamental: the recognition of nursing specialties, continuous education and training, that the administrations to motivate their professionals, prevention of the burnt-out syndrome, teach to work as a team, and move towards patient and professional safety (AU)

Hiponatremia en pacientes geriátricos con insuficiencia cardiaca / Hyponatremia in geriatric patients with heart failure

Introducción: La hiponatremia es la alteración electrolítica más frecuente en el paciente geriátrico. Existen evidencias que la asocian a un peor pronóstico en pacientes con insuficiencia cardiaca. Objetivo: Caracterizar los pacientes geriátricos ingresados con hiponatremia al ingreso e insuficiencia cardíaca. Método: Se realizó un estudio descriptivo, longitudinal y prospectivo durante el año 2018 en el Hospital Universitario Clínico Quirúrgico Calixto García que incluyó 260 pacientes con insuficiencia cardíaca e hiponatremia al ingreso. Para el análisis estadístico de los datos reutilizaron la prueba de chi cuadrada y el análisis multivariado de ANOVA para la asociación entre variables. Resultados: La edad media fue 72,6 ± 8,2, predominaron las mujeres (55,0 por ciento). Prevaleció la puntuación de Charlson 3-4 (33,8 por ciento), la fracción de eyección conservada, 70,8 por ciento; clase funcional III, 33,8 por ciento; estadía menor a 6 días, 43,1 por ciento y fallecieron 51,9 por ciento de la muestra estudiada. Se asociaron significativamente con la mortalidad al egreso, el índice de comorbilidad y la clase funcional III-IV, p< 0,05. Conclusiones: Existe una elevada mortalidad en pacientes geriátricos hospitalizados por insuficiencia cardiaca e hiponatremia al ingreso asociada a la presencia de comorbilidad y a la clasificación de la insuficiencia cardiaca(AU)

Introduction: Hyponatremia is the most frequent electrolyte alteration in geriatric patients. There is evidence that associates it with a worse prognosis in patients with heart failure. Objective: To describe geriatric patients admitted with hyponatremia on admission and heart failure. Method: A descriptive, longitudinal and prospective study was carried out in 2018 at Calixto García Surgical Clinical University Hospital, including 260 patients with heart failure and hyponatremia on admission. For the statistical analysis of the data, they reused the chi-square test and the multivariate analysis of ANOVA for the association between variables. Results: The mean age was 72.6 ± 8.2, women predominated (55.0 percent). Prevalence was observed in the Charlson score 3-4 (33.8 percent), the ejection fraction preserved (70.8 percent); functional class III was 33.8 percent; 43.1 percent stayed less than 6 days and 51.9 percent of the sample studied died. They were significantly associated with mortality at discharge, the comorbidity index and functional class III-IV, p <0.05. Conclusions: There is a high mortality in geriatric patients hospitalized for heart failure and hyponatremia on admission associated with the presence of comorbidity and the classification of heart failure(AU)

Limitações à utilização da escala integrada de rastreio da propriocepção: estudo de viabilidade de um inquérito transversal / A limitation on the use of Integrated Proprioception Screening Scale: a feasibility cross-sectional survey study

INTRODUÇÃO: A propriocepção é essencial durante a implementação do movimento para atualizar os comandos de alimentação adiante resultantes da imagem visual e no planejamento e alteração de comandos motores gerados internamente. A escala integrada de rastreio da propriocepção (IPSS) avalia a propriocepção em vários domínios diferentes em pessoas com doença de Parkinson. OBJETIVOS: Determinar as limitações da IPSS enfrentadas por fisioterapeuta neurológico e voluntários geriátricos em ambientes clínicos. MATERIAIS E MÉTODOS: Dez Neuro-fisioterapeutas e trinta voluntários geriátricos de cada terapeuta foram recrutados para este estudo de viabilidade de pesquisa transversal. Os participantes foram selecionados de acordo com os critérios de inclusão. Os questionários foram projetados e criados para avaliar as dificuldades enfrentadas pelos terapeutas e voluntários geriátricos em termos de tempo necessário para a administração da escala, do nível de compreensão da escala e seus subníveis, e o esforço físico experimentado pelo terapeuta e voluntários geriátricos. A IPSS foi administrada pelo terapeuta. Goniômetro Universal, fita métrica e dispositivo de rastreamento de movimento foram usados durante a administração da IPSS. Após a administração, os questionários foram distribuídos e preenchidos por Neuro-fisioterapeutas e voluntários geriátricos. O teste Shapiro-Wilk foi usado para testar a normalidade, pois os dados eram inferiores a 50. RESULTADOS: Os dados foram expressos em mediana e intervalo. Skewness e Kurtosis também foram medidos. As variáveis foram expressas na forma de gráficos circulares. CONCLUSÃO: O estudo concluiu que o IPSS tem várias limitações como subjetivamente relatado pelos terapeutas e voluntários.

INTRODUCTION: Proprioception is essential during the movement implementation to update the feedforward commands resulting from the visual image and in planning and amendment of internally generated motor commands. The integrated proprioception screening scale (IPSS) assesses proprioception in different domains in people with Parkinson's disease. OBJECTIVES: To determine the limitations of IPSS faced by Neuro-physiotherapists and geriatric volunteers in clinical settings. MATERIALS AND METHODS: Ten Neuro-physiotherapists and thirty geriatric volunteers under each therapist were recruited for this feasibility cross-sectional survey study. Participants were selected according to the inclusion criteria. Questionnaires were designed and created to evaluate difficulties faced by therapists and geriatric volunteers in terms of time taken for the administration of the scale, level of understanding of the scale and its sublevels, and physical exertion experienced by both therapists and geriatric volunteers. The therapist administered IPSS. Universal Goniometer, measuring tape, and motion tracking device were used during the IPSS administration. After administration, Questionnaires were circulated and filled by Neuro-physiotherapists and geriatric volunteers. Shapiro-Wilk test was used for testing the normality, as data was less than 50. RESULTS: As the data follows not a normal distribution, data was expressed in median and range. Skewness and Kurtosis were also measured. Variables were expressed in the form of pie charts. CONCLUSION: The study concluded that IPSS has several limitations as subjectively reported by the therapists and volunteers.

Age over 25 years, but not plasma adrenocorticotropic hormone con-cen-tration above the seasonally adjusted reference range is predictive for radio-graphically assessed changes of chronic laminitis in elderly horses.

INTRODUCTION: Endocrinopathic laminitis occurs as a consequence of hormonal derangements like pituitary pars intermedia dysfunction (PPID). The objective of the present study was to assess the occurrence of radiographic changes associated with chronic laminitis in elderly, clinically sound horses. Fifty-one horses were included in the study. Horses were assigned to different age groups, in groups according to their BCS and CNS as well as to groups with different ACTH concentrations in order to assess their risk of chronic laminitis (reported as odds ratios (OR) and confidence intervals (CI)). Horses assigned to an older age group (26-32 years) were significantly more likely to have radiographically assessed changes of chronic laminitis than horses in a younger age group (15-25 years) (OR 3.33; CI 1.05-10.59). The other variables (body condition score, cresty neck score, ACTH concentration) were not associated with an increased risk of having laminitic changes in these horses.

INTRODUCTION: La fourbure endocrinopathique survient à la suite de troubles hormonaux tels que le dysfonctionnement de la pars intermedia de l'hypophyse (DPIH). L'objectif de la présente étude était d'évaluer les changements radiographiques associés à la fourbure subclinique chez les chevaux âgés cliniquement sains. Cinquante et un chevaux ont été inclus dans l'étude. Les chevaux ont été assignés à différents groupes d'âge, en groupes en fonction de leur Body Condition Score (BCS) et de leur Cresty Neck Score (CNS) ainsi que des groupes avec différentes concentrations d'ACTH afin d'évaluer leur risque de fourbure chronique (rapportés sous forme de rapports de cotes (Odds-Ratio, OR) et d'intervalles de confiance (IC)). Les chevaux faisant partie d'un groupe d'âge plus avancé (26 à 32 ans) étaient significativement plus susceptibles de présenter des signes radiographiques de fourbure chronique que les chevaux d'un groupe d'âge plus jeune (15 à 25 ans) (OR 3,33; IC 1,05­10,59). Les autres variables (BCS, CNS, concentration d'ACTH) n'étaient pas associées à un risque accru de modifications de type fourbure chez ces chevaux.

Abdomen agudo quirúrgico en el paciente geriátrico / Surgical Acute Abdomen in the Geriatric Patient

RESUMEN Introducción: El abdomen agudo es causa frecuente de ingreso hospitalario en pacientes geriátricos. Objetivo: Caracterizar el comportamiento del abdomen agudo quirúrgico en el paciente geriátrico en un servicio de cirugía general. Métodos: Se realizó un estudio observacional descriptivo longitudinal de corte transversal en 169 pacientes. Los datos procedieron de las historias clínicas del Hospital Universitario "Manuel Ascunce Domenech" de Camagüey, desde enero de 2014 a diciembre de 2016 y se procesaron mediante estadística descriptiva, relacionándose algunas variables de manera no inferencial. Resultados: El 52,2 por ciento de los pacientes eran hombres. El 42,6 por ciento tenía edades entre 60 y 69 años. El 28,9 por ciento presentaron la oclusión intestinal como etiología. Hubo un 39,5 por ciento de complicaciones, el 54,5 por ciento de ellas fueron infecciosas. La mortalidad fue de un 22,5 por ciento. El 26,6 por ciento de los fallecidos presentaba oclusión intestinal. Conclusiones: Casi una décima parte de los pacientes fallecieron, la peritonitis fibropurulenta y el choque séptico fueron las causas más frecuentes de los decesos. La oclusión intestinal como causa de abdomen agudo pareció influir en la mortalidad de la muestra estudiada(AU)

ABSTRACT Introduction: Acute abdomen is a frequent cause of hospital admission in geriatric patients. Objective: To characterize the occurrence of acute surgical abdomen in the geriatric patient in a general surgery service. Methods: An observational, descriptive, longitudinal and cross-sectional study was carried out with 169 patients. The data were obtained from the medical records of Manuel Ascunce Domenech University Hospital in Camagüey, from January 2014 to December 2016, and were processed using descriptive statistics, relating some variables in a noninferential way. Results: 52.2 percent of the patients were men. 42.6 percent were aged between 60 and 69 years. 28.9 percent presented intestinal occlusion as an etiology. There were 39.5 percent of complications, 54.5 percent of which were infectious. Mortality was 22.5 percent. 26.6 percent of the deceased had intestinal obstruction. Conclusions: Almost one tenth of the patients died, with fibrinopurulent peritonitis and septic shock being the most frequent causes of death. Intestinal occlusion as a cause of acute abdomen appeared to influence mortality in the sample studied(AU)

Índice de riesgo nutricional geriátrico en pacientes hospitalizados por enfermedades vasculares periféricas / Geriatric nutritional risk indexes in patients hospitalized due to peripheral vascular diseases

Introducción: El índice de riesgo nutricional geriátrico es un instrumento simple y exacto que permite identificar a pacientes hospitalizados con este riesgo. Objetivo: Valorar la prevalencia de riesgo nutricional en pacientes ingresados por presentar una enfermedad vascular. Métodos: Se evaluaron de forma transversal 102 pacientes mayores de 18 años (65 % hombres) ingresados de forma consecutiva entre octubre y diciembre de 2018 en el Instituto Nacional de Angiología y Cirugía Vascular en La Habana Cuba, independientemente de la enfermedad de base y que estuvieran de acuerdo en participar en el estudio. La variable principal de salida fue la proporción de pacientes con riesgo nutricional: riesgo alto (< 82), moderado (82-92), bajo (93-98) y sin riesgo (> 98); las variables secundarias resultaron la edad, el sexo, el índice de masa corporal y la concentración de albúmina. Resultados: El 12,9 por ciento (intervalo de confianza 95 por ciento: 6,2-19,6); el 16,8 por ciento (9,4-24,2) y el 22,8 por ciento (14,5-31,3) de los pacientes presentaron un riesgo nutricional alto, moderado y ligero, respectivamente. Solo el 47,5 por ciento (37,6-57,4), de los pacientes no presentó riesgo nutricional. La edad y el sexo no mostraron correlación con el riesgo nutricional; la concentración de albúmina y el índice de masa corporal y el índice de riesgo nutricional sí se asociaron de forma importante (R2: 0,98 y 0,59, respectivamente). Conclusiones: La prevalencia de pacientes con riesgo nutricional es elevada en el ámbito hospitalario y puede evaluarse por intermedio del índice de riesgo nutricional geriátrico(AU)

Introduction: The Geriatric nutritional risk index is a simple and accurate instrument that allows identifying hospitalized patients with this risk. Objective: To assess the prevalence of nutritional risk in patients admitted for presenting a vascular disease. Methods: There were evaluated in cross-sectional way 102 patients older than 18 years (65% male) admitted consecutively from October to December, 2018 at the National Institute of Angiology and Vascular Surgery in Havana, Cuba, regardless of the underlying disease and who agreed to participate in the study. The main variable was the proportion of patients with nutritional risk: high risk (<82), moderate (82-92), low (93-98) and without risk (>98); secondary variables were age, sex, body mass index and the concentration of albumin. Results: The 12.9 percent (95 percent confidence interval: 6,2-19,6); the 16.8 percent (9,4-24,2) and the 22.8 percent (14,5-31,3) of the patients had high, moderate, and light nutritional risks, respectively. Only 47.5 percent (37,6-57,4) of the patients did not present nutritional risk. The age and sex showed no correlation with the nutritional risk; the concentration of albumin and body mass index and the index of nutritional risk were significantly associated (R2: 0.98 and 0.59, respectively). Conclusions: The prevalence of patients with nutritional risk is high in the hospital scope and it can be evaluated through the geriatric nutritional risk index(AU)

Papiloma coroideo atípico en paciente de la tercera edad: Revisión bibliográfica a propósito de un caso / Atypical choroidal papilloma in an elderly patient: A literature review on a case

Introducción: Los tumores del plexo coroideo son raros. Contabilizan del 0,3 a 0,6% de la totalidad de los tumores cerebrales en adultos y del 10 a 20% en infantes; en quienes se ha registrado el 70% de estos y de los cuales al menos un 50% suceden en menores de dos años de edad. Objetivos: Esta publicación consiste en describir un caso de la tercera edad con papiloma atípico del cuarto ventrículo, la forma de resolución seleccionada y revisar la bibliografía del tema. Presentación del caso: Masculino de 71 años de edad que consulta por inestabilidad en la marcha y cefalea holocraneana intermitente. Al examen se muestra desorientado, con trastornos mnésicos, marcha magnética e incontinencia urinaria. Se realiza TC contrastada y posterior RM de cerebro con gadolinio objetivándose lesión espacio ocupante hipo-isointensa de 10 cc. Aprox. ocupando el 4to ventrículo, con realce intenso a la administración de contraste y ventriculomegalia asociada con edema transependimario. Intervención: Se realiza exéresis, logrando resección completa y mejoría clínica. Discusión: El papiloma atípico de plexo coroideo (Grado II) es una entidad intermedia que se distingue fundamentalmente del papiloma de grado I por su actividad mitótica; 2 o más mitosis en 10 campos. Conclusión: Este reporte, aborda una patología quirúrgicamente desafiante, potencialmente curable y clásicamente infantil, pero que también puede presentarse en la población geriátrica.

Introduction: Choroid plexus tumors are rare. They account for 0.3 to 0.6% of all brain tumors in adults and 10 to 20% in infants; in whom 70% of these have been registered and of which at least 50% occur in children under two years of age. Objectives: This publication consists of describing a case of the third age with atypical papilloma of the fourth ventricle, the selected form of resolution and reviewing the bibliography on the subject. Case presentation: 71-year-old male who consulted for gait instability and intermittent holocranial headache. On examination, he was disoriented, with memory disorders, magnetic gait, and urinary incontinence. Contrast-enhanced CT and subsequent MRI of the brain with gadolinium were performed, showing a 10 cc hypo-isointense occupying space lesion. Approx. occupying the 4th ventricle, with intense enhancement to contrast administration and ventriculomegaly associated with transependymal edema. Intervention: Exeresis is performed, achieving complete resection and clinical improvement. Discussion: Atypical choroid plexus papilloma (Grade II) is an intermediate entity that is fundamentally distinguished from grade I papilloma by its mitotic activity; 2 or more mitoses in 10 fields. Conclusion: This report addresses a surgically challenging pathology, potentially curable and classically infantile, but which can also occur in the geriatric population.

Clinical characteristics and prognosis of spinal cord injury in individuals over 75 years old. / Características clínicas y pronóstico de la lesión medular traumática en pacientes mayores de 75 años.

OBJECTIVE: To analyze the incidence and characteristics of traumatic spinal cord injury (SCI) in geriatric population of Galicia (Spain), hospital management and functional prognosis. METHODS: Comparative retrospective study. Patients admitted with acute traumatic SCI during the time period between January 2010 and December 2016 were included. Two groups established: The elderly over and under 75 years of age, with the latter acting as a control group. RESULTS: Three hundred seventy-nine patients were studied (27.2% ≥75 years). The main etiology in the >75 years group were falls: 80.6%. There were 65.7% who presented incomplete spinal cord injuries with mean motor index (MI) of 44.9/100. Upon discharge, 90.8% were dependent. Hospital mortality was 34.9%. Those >75 years suffered from more cervical injuries (74.8 vs. 51.2%; p<0.001), longer delay in diagnosis (31.1 vs. 9.2%; p<0.001) and higher hospital mortality (34.9 vs. 3.2%; p<0.001). Fewer surgical interventions were performed, with a longer delay. Percentages for admission into ICU, mechanical ventilation and performing a tracheostomy proved to be similar. There were no significant differences found in the evolution according to the ASIA scale or the MI. CONCLUSIONS: 1) The frequency of traumatic SCI in the elderly in Galicia is high; 2) Neurological evolution is similar to younger patients but the level of dependence is higher; 3) The level of care provided is similar in both groups, except for the surgical indication, and 4) Hospital mortality is high.