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OBJECTIVES: To determine the frequency of medical adverse events in elderly patients admitted to an acute care geriatric unit, the predictive factors of occurrence, and the correlation between adverse events and hospital mortality rates. METHODS: This prospective study included 171 admissions of patients aged 60 years and older in the acute care geriatric unit in a teaching hospital in Brazil between 2007 and 2008. The following variables were assessed at admission: the patient age, gender, number of prescription drugs, geriatric syndromes (e.g., immobility, postural instability, dementia, depression, delirium, and incontinence), comorbidities, functional status (evaluated with the Katz Index of Independence in Activities of Daily Living), and severity of illness (evaluated with the Simplified Acute Physiology Score Il). The incidence of delirium, infection, mortality, and the prescription of potentially inappropriate medications (based on the Beers criteria) were assessed during hospitalization. An observer who was uninvolved in patient care reported the adverse events. RESULTS: The mean age of the sample was 78.12 years. A total of 187 medical adverse events occurred in 94 admissions (55%). The predictors of medical adverse events were undetermined. Compared with the patients with no adverse events, the patients with medical adverse events had a significantly longer hospital stay (21.41 ± 15.08 days versus 10.91 ± 7.21 days) and a higher mortality rate (39 deaths [41.5%] versus 17 deaths [22.1%]). Mortality was significantly predicted by the Simplified Acute Physiology Score II score (odds ratio [OR] = 1.13, confidence interval [CI] 95%, 1.07 to 1.20), the Katz score (OR=1.47, CI 95%, 1.18 to 1.83), and medical adverse events (OR = 3.59, CI 95%, 1.55 to 8.30). CONCLUSION: Medical adverse events should be monitored in every elderly hospitalized patient because there is no risk profile for susceptible patients, and the consequences of adverse events are serious, sometimes leading to longer hospital stays or even death.

OBJECTIVE: The objective of this study was to determine predictors of in-hospital mortality among older patients admitted to a geriatric care unit. INTRODUCTION: The growing number of older individuals among hospitalized patients demands a thorough investigation of the factors that contribute to their mortality. METHODS: This was a prospective observational study implemented from February 2004 to October 2007 in a tertiary university hospital. A consecutive sample of 922 patients was evaluated for possible inclusion in this study. Patients hospitalized for palliative care, those who declined to participate, and those with incomplete data were excluded, resulting in a group of 856 patients aged 60 to 104 years. Bivariate and multivariate analyses were performed to determine associations between in-patient mortality and gender, age, length of stay, number of prescribed medications and diagnoses at admission, history of heart failure, neoplastic disease, immobility syndrome, delirium, infectious disease, and laboratory tests at admission (serum albumin and creatinine). RESULTS: The overall mortality rate was 16.4%. The following factors were associated with higher in-hospital mortality: delirium (OR=4.13, CI=2.65–6.44, P

Introdução: idosos hospitalizados apresentam maior risco de sofrer eventos adversos na internação que adultos jovens, com consequências mórbidas significativas. O objetivo deste estudo é estimar prospectivamente a freqüência de eventos adversos médicos, os fatores de risco para sua ocorrência e sua relação com óbito intrahospitalar em idosos admitidos aos leitos destinados a cuidados de descompensações clínicas agudas de uma enfermaria de geriatria. Métodos: estudo de coorte prospectivo incluindo as admissões de pacientes com 60 anos ou mais aos leitos destinados a cuidados de descompensações clínicas agudas da Enfermaria de Geriatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, com duração maior de 24 horas, entre abril de 2007 e julho de 2008. Na admissão foram obtidos dados sobre sexo, idade, número de drogas utilizadas, presença de síndromes geriátricas (imobilidade, instabilidade postural, incontinência esfincteriana, demência, depressão e delirium), comorbidades, status funcional (índice de Katz) e gravidade de doença (SAPS II). Durante o período de internação avaliou-se a ocorrência de delirium, infecção, a prescrição de medicamentos inapropriados ao idoso (critérios de Beers) e óbito intrahospitalar. Um observador não envolvido nos cuidados dos pacientes relatou a ocorrência de eventos adversos médicos. Resultados: foram incluídas 171 admissões de pacientes, com idade média de 78,12 anos ± 9,27, sendo 101 do sexo feminino. Ocorreram 187 eventos adversos médicos em 94 admissões (55%), com 2,01 eventos por admissão. Não foi possível identificar fatores preditores da ocorrência de eventos adversos médicos. As admissões com ocorrência de eventos adversos apresentaram maior tempo de internação na enfermaria de geriatria (21,41 dias ± 15,08 X 10,91 dias ± 7,21, p

Objectives The aims of this study were to determine the prevalence of osteosarcopenic obesity (OSO) and to investigate its association with frailty and physical performance in Mexican community-dwelling middle-aged and older women. Design Cross-sectional analysis of a prospective cohort. Setting The FraDySMex study, a 2-round evaluation of community-dwelling adults from 2 municipalities in Mexico City. Participants Participants were 434 women aged 50 years or older, living in the designated area in Mexico City. Measurements Body composition was measured with dual-energy X-ray absorptiometry and OSO was defined by the coexistence of sarcopenia, osteopenia, or osteoporosis and obesity. Information regarding demographic characteristics; comorbidities; mental status; nutritional status; and history of falls, fractures, and hospitalization was obtained from questionnaires. Objective measurements of muscle strength and function were grip strength using a hand dynamometer, 6-meter gait speed using a GAIT Rite instrumented walkway, and lower extremity functioning measured by the Short Physical Performance Battery (SPPB). Frailty was assessed using the Frailty Phenotype (Fried criteria), the Gerontopole Frailty Screening Tool (GFST), and the FRAIL scale, to build 3 logistic regression models. Results The prevalence of OSO was 19% (n = 81). Frailty (according to the Frailty Phenotype and the GFST) and poor physical performance measured by the SPPB were independently associated with OSO, controlled by age. In the logistic regression model assessing frailty with the Frailty Phenotype, the odds ratio (95% confidence interval) for frailty was 4.86 (2.47–9.55), and for poor physical performance it was 2.11 (1.15–3.89). In the model assessing frailty with the GFST, it was 2.12 (1.10–4.11), and for poor physical performance it was 2.15 (1.18–3.92). Finally, in the model with the FRAIL scale, it was 1.69 (0.85–3.36) for frailty and 2.29 (1.27–4.15) for poor physical performance. Conclusion OSO is a frequent condition in middle-aged and older women, and it is independently associated with frailty and poor physical performance.

OBJECTIVE: To assess the relation between P-wave and QT dispersions in elderly patients with heart failure. METHODS: Forty-seven elderly patients (75.6±6 years) with stable heart failure in NYHA functional classes II or III and with ejection fractions of 37±6% underwent body surface mapping to analyze P-wave and QT dispersions. The degree of correlation between P-wave and QT dispersions was assessed, and P-wave dispersion values in patients with QT dispersion greater than and smaller than 100 ms were compared. RESULTS: The mean values of P-wave and QT dispersions were 54±14 ms and 68±27 ms, respectively. The correlation between the 2 variables was R=0.41 (p=0.04). In patients with QT dispersion values > 100 ms, P-wave dispersion was significantly greater than in those with QT dispersion values < 100 ms (58±16 vs 53±12 ms, p=0.04 ). CONCLUSION: Our results suggest that, in elderly patients with heart failure, a correlation between the values of P-wave and QT dispersions exists. These findings may have etiopathogenic, pathophysiologic, prognostic, and therapeutic implications, which should be investigated in other studies.