Search

Resumen Introduccion El objetivo de este estudio es evaluar la eficacia de un cambio en la estrategia de manejo del riesgo de delirium en una unidad de ortogeriatria. Material y metodos Estudio prospectivo, comparativo, no aleatorizado de 2 cohortes de pacientes. Una cohorte (grupo control) tratado con la terapia estandar con tramadol de rescate y diazepam, y otra cohorte (grupo experimental) tratado con morfina a dosis bajas de rescate junto con benzodiacepinas de vida media corta y tratamiento preventivo con neurolepticos, en los pacientes de alto riesgo. Resultados Se ha incluido a 85 pacientes (42 en el grupo control y 43 en el grupo experimental). Edad media: 85 anos (71-105). Un total de 29 pacientes (34%) han tenido un episodio de delirium durante el ingreso actual, 16 pacientes (38%) en el grupo control y 13 pacientes (30%) en el grupo experimental, respectivamente (p = 0,498). La duracion media del delirium en los 29 pacientes que lo presentaron fue de 5,3 dias. Esta duracion fue en el grupo control de 6,6 dias y en el grupo experimental de 3,8 dias, respectivamente (p = 0,031). En el grupo de pacientes que tenian antecedente de delirium previo, se aprecia que hay una menor incidencia de delirium durante el ingreso actual en el grupo experimental (80% vs. 17%, p = 0,036). Conclusiones La terapia experimental ha resultado eficaz, ya que se ha podido observar una tendencia a disminuir la incidencia del delirium y en los casos que lo han presentado la terapia sirvio para disminuir su duracion con diferencias estadisticamente significativas.

To analyse the impact of an integrated health intervention focused on polypharmacy and inappropriate prescribing (IP) in elderly people with multimorbidity.Patients were referred for assessment and intervention from primary care or hospital to an interdisciplinary team composed of primary and hospital medical staff and nurses. Pharmacological assessment was centred on polypharmacy and IP using the STOPP/START criteria. Changes in polypharmacy and in IP were analysed at the end of the intervention and at 6 months.One hundred consecutive patients (mean (SD) age 81.5(8.0) years, 54(54%) male) were analysed. Mean prescribed medicines at baseline was10. There were no significant changes at the end of the intervention and at 6 months. The proportion of patients with two or more STOPP criteria reduced from 37% at the beginning of the intervention to 18% at the end (p.001), and the proportion of those with START criteria from 13% to 6% (p = .004). These differences persisted at 6 months. The number of STOPP and START criteria before the intervention was associated with a decrease in the STOPP and START criteria at the end of the intervention and at 6 months. A reduction in polypharmacy (p= .041) and in falls (p= .034) was observed at 6 months in those with a decrease in the STOPP criteria at the end of the intervention.An integrated health intervention centred on polypharmacy and IP in elderly people improves inappropriate prescribing that persists beyond the intervention.

The objective of this study is to evaluate the efficacy of a change in the management of the risk of delirium in an orthogeriatric unit.Prospective, comparative, non-randomised study of two cohorts of patients. One cohort (control group) treated with standard therapy with tramadol rescue and diazepam and another cohort (experimental group) treated with rescue with morphine at low doses and short half-life benzodiazepines as well as preventive treatment with neuroleptics in patients at high risk.Eighty-five patients were included (42 in the control group and 43 in the experimental group). Mean age: 85 (71-105). Twenty-nine patients (34%) had an episode of delirium during the current admission, 16 patients (38%) in the control group and 13 patients (30%) in the experimental group respectively (P=.498). The mean duration of delirium in the 29 patients who presented it was 5.3 days. This duration in the control group was 6.6 days and in the experimental group 3.8 days (P=.031). In the group of patients who had previous delirium, a lower incidence of delirium was seen during the current admission in the experimental group (80% vs 17% P=.036).Experimental treatment has been effective since a trend to a lower incidence of delirium has been observed. In the patients who have suffered an episode of delirium, the treatment served to decrease its duration with statistically significant differences.

Resumen Fundamento y objetivo El consumo cronico de benzodiacepinas es frecuente en los pacientes ancianos. El objetivo del estudio es evaluar posibles diferencias entre los pacientes que toman benzodiacepinas y los que no. Ademas, se analiza si hay diferencias entre los tratados con benzodiacepinas segun si el motivo del ingreso hospitalario era medico o quirurgico. Pacientes y metodo Se realizo un estudio prospectivo y multicentrico de 393 pacientes ingresados por causa medica en 6 unidades geriatricas de agudos y se compararon con datos previos de 1.225 ingresados por fractura de femur. Se recogieron datos sociodemograficos, la capacidad funcional mediante el indice de Barthel (IB), la comorbilidad (indice de Charlson), y de deteccion de deterioro cognitivo (test de Pfeiffer). Resultados Se incluyeron 1.618 pacientes, con una media (DE) de edad de 82,9 (6,5) anos. Tomaban de forma cronica benzodiacepinas un total de 581 (35,9%) pacientes, 132 (33,6%) de los ingresos por causa medica y 449 (36,6%) de los ingresos por fractura de femur (p = 0,27). En el analisis multivariante se asocio a la toma de benzodiacepinas una mayor edad, el estar institucionalizado y un mayor consumo total de farmacos. Entre los pacientes que tomaban benzodiacepinas de forma cronica destacaba que los que ingresaban por causa medica vivian mas en la comunidad, caian menos, tenian un peor IB, y mayor comorbilidad y polifarmacia. Conclusiones Mas de una tercera parte de los pacientes mayores ingresados por causa medica o traumatologica tomaban benzodiacepinas de forma cronica. Existen diferencias en los perfiles de los pacientes segun tomaran o no benzodiacepinas, asi como entre los que tomaban benzodiacepinas segun cual fuera el motivo de ingreso hospitalario.

Resumen Fundamento La antibioticoterapia intravenosa domiciliaria (AID) ha demostrado su seguridad y eficacia en un gran numero de infecciones comunes. Sin embargo, existen pocos trabajos publicados sobre su papel en el tratamiento de las infecciones causadas por bacterias multirresistentes. Los objetivos de este trabajo son definir las caracteristicas clinicas y epidemiologicas de los pacientes con infecciones causadas por microorganismos multirresistentes tratados con AID, asi como estudiar su utilidad en este tipo de infecciones. Material y metodo Analizamos todos los pacientes que por requerir AID ingresaron en nuestra Unidad de Hospitalizacion a Domicilio (UHD) desde marzo de 2007 hasta febrero de 2010. Los pacientes se dividieron en dos grupos: los pacientes con infecciones causadas por microorganismos multirresistentes fueron incluidos en el grupo a estudio, mientras que el resto de pacientes formo el grupo control. Resultados Se incluyeron 487 pacientes, de los cuales 82 formaron el grupo a estudio. La comorbilidad y la dependencia fisica en este grupo fueron mayores que en el grupo control (p = 0,000 y p = 0,002 respectivamente). La mayoria de los pacientes tuvieron una evolucion clinica satisfactoria. Sin embargo, 17 (20,7%) pacientes del grupo a estudio reingresaron durante el tratamiento y otros 22 (26,8%) reingresaron 3 meses despues del alta definitiva de nuestra unidad, siendo las diferencias entre ambos grupos estadisticamente significativas. Conclusiones Los pacientes con infecciones causadas por microorganismos multirresistentes y AID tienen mayor comorbilidad, dependencia fisica y frecuencia de reingresos hospitalarios. Sin embargo, la AID es util en el tratamiento de este tipo de infecciones en pacientes adecuadamente seleccionados.

Fundamento y objetivo La antibioterapia domiciliaria es una modalidad asistencial alternativa a la hospitalizacion a domicilio que ha demostrado su seguridad en un gran numero de enfermedades infecciosas. Los objetivos principales de este articulo son: a) exponer nuestra experiencia, como unidad de hospitalizacion a domicilio (UHD) integrada dentro del servicio de medicina interna, en el tratamiento antibiotico intravenoso, y b) definer los parametros que pueden predecir un reingreso hospitalario. Pacientes y metodo Se incluyo en el estudio a todos los pacientes ingresados en nuestra UHD por enfermedad infecciosa subsidiaria de antibioterapia intravenosa desde marzo de 2006 hasta marzo de 2007. Resultados Se incluyo en el estudio a 145 pacientes. El 92% de los casos recibio el alta por buena evolucion clinica. Once pacientes ingresaron en el hospital durante el episodio clinico como consecuencia de la propia infeccion, y solo 2 presentaron algun tipo de reaccion adversa a causa del tratamiento. Veintidos pacientes ingresaron en el hospital 3 meses despues del alta de la UHD, fundamentalmente por enfermedad cronica. Conclusiones La antibioterapia intravenosa domiciliaria es una buena opcion asistencial en una gran variedad de enfermedades infecciosas. A pesar de ello, la propia infeccion y el estado basal del paciente influyen activamente en la probabilidad de reingresos hospitalarios.

Fundamento y objetivo El delirium es un problema frecuente durante el ingreso hospitalario. Estudiamos la prevalencia de delirium en los pacientes ingresados en unidades de hospitalizacion de medicina interna general. Un segundo objetivo fue analizar si habia diferencias entre los pacientes con o sin delirium. Pacientes y metodo Estudio transversal de 165 pacientes ingresados por procesos medicos en 6 unidades de hospitalizacion de medicina interna general. Se cuantifico la capacidad funcional mediante el indice de Barthel (IB) y la comorbilidad mediante el indice de Charlson. Se utilizo el Confusional Assessment Method para el diagnostico de delirium en forma de corte transversal. Resultados Se ha evaluado a 101 mujeres (61,2%) y 64 varones, con una media (desviacion estandar) de edad de 80,3 (12) anos. La media del indice de Charlson fue de 2,6 (1,7). La media del IB previo al ingreso fue de 71,5 (27) y en el momento de la valoracion era de 40,3 (30). Presentaban delirium en el momento de la valoracion 42 (25,4%) pacientes. La regresion logistica mostro como variables independientes asociadas a tener delirium un peor IB en el momento de la valoracion y el diagnostico previo de demencia. Conclusiones Un alto porcentaje de los pacientes ingresados en unidades de hospitalizacion de medicina interna general presentan delirium. El deterioro cognitivo previo y una peor puntuacion en el IB en el momento de la valoracion tienen relacion con mayor riesgo de tener delirium.

Chronic consumption of benzodiazepines is common in elderly patients. The aim of the study was to analyse the possible differences between patients taking benzodiazepines and those without them. We also determined, among patients on benzodiazepines, if any differences were related to medical or surgical admissions.We performed a prospective and multicentre study of 393 patients admitted consecutively for medical reasons to 6 geriatrics acute units; these patients were compared to 1,225 patients hospitalized for a hip fracture. We collected sociodemographic data, functional capacity by the Barthel's index (BI), comorbidity by the Charlson's index and cognitive impairment by the Pfeiffer test.We evaluated 1,618 patients, with a median age of 82.9 (6.5) years. Among patients admitted for medical causes, 581 (35.9%) were taking benzodiazepines chronically as did 449 (36.6%) patients in the hip fracture group (p=0.27). In the multivariate analysis, factors associated with the use of benzodiazepines included older age, institutionalization and a higher number of drug consumption. Differences according to the admission reason showed that patients admitted for medical causes lived more frequently in the community and had less falls, worse BI as well as a higher number of comorbidities and polypharmacy.More than one third of elderly patients hospitalized for medical or traumatology causes were taking benzodiazepines chronically. Different patients' profiles can be observed according to whether they are or not taking benzodiazepines and to the admission's cause in the subgroup of patients on benzodiazepines.

Although home intravenous antimicrobial infusion therapy (HIVAIT) has proved its safety and efficacy in a great number of common infections, there are few published studies about its role in the treatment of infections caused by multi-drug resistant microorganisms. Our objectives are to study clinical and epidemiological characteristics of patients with multi-drug resistant microorganism infections treated with HIVAIT, and its usefulness in this type of infections.We analyzed all patients diagnosed of infections requiring HIVAIT and admitted to our Hospital at Home Unit (HHU) from March 2007 to February 2010. Subjects were divided into two groups: patients with multi-drug resistant microorganism infections as a study group, and the remaining patients as a control group.A total of 487 patients were included, 82 in the study group. Comorbidity and physical dependence were higher in this group than in the control group (p=0.000 and p=0.002 respectively). The majority of patients were discharged because of a satisfactory clinical evolution. However, 17 (20.7%) patients in the study group required readmission to hospital during treatment and another 22 (26.8%) were re-admitted to hospital 3 months after discharge from HHU. There were significant differences between the results from the control group in clinical readmissions.Patients with multi-drug resistant microorganism infections and HIVAIT have higher comorbidity, physical dependence, and frequency of hospital readmissions. However, HIVAIT is useful in this kind of infections if the patients are appropriately selected.

Intravenous antibiotic therapy at home has showed its efficacy as an alternative to hospitalization care in many infectious pathologies. The objectives of this study are: a) to expose our experience, as hospital at home unit (HHU) integrated within a service of internal medicine, in the antibiotic treatment, and b) to define those parameters that can predict hospital readmissions.This study included all patients with infectious pathology and intravenous antibiotic therapy who were admitted in our HHU from March 2006 to March 2007.145 patients were included in this study. Successful treatment was observed in 92% of patients. Eleven patients were re-admitted at hospital during the episode by infectious disease, and only 2 of them showed adverse effects to treatment. Twenty-two patients were re-admitted at hospital 3 months after due to chronic pathology.Intravenous antibiotic therapy at home is a good alternative in many infectious pathologies. Infectious pathology and baseline state can be predictors of hospital readmissions.

Delirium is a common problem among people during hospitalization. The aim of the study was to analyze the prevalence and characteristics of delirium among patients admitted by medical conditions.We performed a transversal cohort study in 165 patients admitted to 6 tertiary teaching hospitals. We scored the Barthel index (BI) previously to their admission, and also comorbidity using the Charlson index. Diagnosis of delirium was assessed using the Confusional Assessment Method in this transversal study.There were 101 women (61.2%) and 64 men. The mean (SD) age was 80.3 (12) years. The average of Charlson Index was 2.6 (1.7). Previous and evaluation BI were 71.5 (27) and 40.3 (30) respectively. Forty-two patients (25.4%) had delirium. Poor BI at the evaluation and previous diagnosis of dementia were significant independent variables associated with delirium in the logistic regression analysis.Delirium is frequent in medical hospitalized patients. Previous dementia and low BI at the evaluation among medical patients are associated with delirium.

The incidence of adverse drug reactions (ADRs) in hospitalized elderly patients is an important clinical problem. The purpose of this study was to determine the incidence of ADRs in elderly in-patients, to analyze the factors involved in their presentation and to evaluate the reactions detected.Prospective multicenter study in patients older than 65 years during their stay in hospital or nursing home. The assessment consisted of a complete geriatric evaluation and a protocol for collecting information on suspected ADRs during hospitalization or nursing home stay. A multivariate analysis by multiple logistic regression was performed.The study included 865 patients: 185 (21%) from 5 hospital units; 325 (38%) from 8 convalescent centers; and 355 (41%) from 8 long-term centers. The incidence of ADRs was 9%. In acute units the incidence was 15%; in post-acute units, 5%; and in long-term centers, 10% (p0.004). In the global multivariate analysis, the risk of experiencing an ADR was associated with a greater use of medications (OR = 1.15; 1.07 1.23 for each additional drug), the presentation of delirium (OR = 3.6; 1.95-6.85) and the type of unit (acute OR = 2.6; 1.16-6.01; long-term OR = 3.3; 1.62-7.05). Fifty type A ADRs were detected (65%). With regard to severity, 36 (47%) were moderate, 27 (35%) were mild, and 14 (18%) were severe. Causality: 58 (76%) probable and 17 (20%) possible. Potential avoidability: 39 (51%) were unavoidable and 38 (49%) were totally or partially avoidable; of these, 15 (39%) were the result of an interaction with another drug.The incidence of ADRs in our study was close to 10%. ADRs were associated with the frequency of use, presence of delirium and type of unit, and occurred most frequently in acute and long-term units. ADRs were principally type A, moderate severity, probable causality and partially avoidable.

Fundamento Conocer la prescripcion y el uso de los farmacos para el sistema nervioso central (SNC), en concreto neurolepticos, benzodiacepinas y anti-depresivos, en 19 residencias geriatricas de Barcelona ciudad. Metodo Estudio descriptivo transversal de las historias clinicas de 384 personas que viven en estas RG. El uso adecuado de los farmacos se valoro utilizando los criterios de Beers et al y los de Garrad et al. Resultados La edad media (DE) de los residentes fue de 83 (2,0) anos. El consumo medio (DE) de farmacos fue de 5 (2,7); 248 personas (64,6%) tomaban al menos uno para el SNC, 81 (21%) tomaban neurolepticos, 179 (46,6%) benzodiacepinas y 73 (19%) antidepresivos. Cuarenta y ocho residentes (12,5%) consumian benzodiacepinas de vida media larga, 26 (6,7%) superaban el tiempo recomendado para benzodiacepinas de vida media corta. En 21 (26%) de los residentes que tomaban neurolepticos su uso seria injustificado. Conclusiones Es necesario reducir en las RG el consumo de benzodiacepinas de vida media larga, favorecer el buen uso de los neurolepticos y conseguir una identificacion correcta de los estados depresivos.

Fundamento Estudiar los principales factores de riesgo de infeccion por Clostridium difficile en una unidad de geriatria. Pacientes y metodo Estudio de casos y controles retrospectivo. Resultados El analisis multivariante confirmo la nutricion enteral por sonda nasogas-trica (OR = 6,73; IC del 95%, 1,01-45,35) y los dias de tratamiento antibiotico (OR = 1,15; IC del 95%, 1,01-1,28) como factores de riesgo independientes para la infeccion por C. difficile. Conclusiones El tratamiento antibiotico, el sondaje nasogastrico y las caracteristicas de fragilidad de este grupo de pacientes se asocian a la infeccion por C. difficile.