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Background: Unplanned emergency department visits are an ongoing challenge, since the patients are increasingly ageing, chronic, complex, frail and multimorbid. The aim is to demonstrate the feasibility of establishing a proactive intervention to detect and distribute complex, chronic, unplanned multiple emergency department patients, tailored to the patient's needs. Methods: Prospective study to evaluate the intervention, which is divided into the following drivers: automated pre-selection sent lists, a specific experienced multiple frequent case-manager nurse, and a 3-level territorial derivation consensus protocol. Chronic complex patients presenting two or more times in the last six months to a tertiary hospital emergency department for COPD or HF. Analysis of the percentage of patients well selected by the three drivers, and their corresponding characterisation by the three levels of care to which they are referred: primary, intermediate and specialist care. Number of visits six months before and after referral. Results: 368 patients were selected; the 85% were well selected. The patients' age, frailty, home care percentage, Barthel index and cognition are progressively consistent with the three levels of care of referral according to previously defined and consensus criteria. The intervention achieves lowering participant visits: 3.1 before (SD = 2.42) versus 1.6 after (p < 0.001). Conclusions: An automated selection, plus a territorial protocol consensus of circuits and clinical profiles, together with the autonomous assessment of a multiple case-managing nurse, achieves in a proactive and simple manner, a better and adapted distribution of patients in coherent care levels institutions, regarding their socio-health needs.

Resumen Introduccion Frecuentemente en pacientes muy ancianos institucionalizados coexiste fragilidad y polifarmacia, por ello es importante valorar el grado de fragilidad y la adecuacion terapeutica en este grupo poblacional. El objetivo de este estudio es valorar el grado de fragilidad de una poblacion muy mayor institucionalizada y analizar la prescripcion. Material y metodos Estudio observacional y transversal de una poblacion de 85 anos o mas, institucionalizada en una residencia geriatrica de Barcelona. Se valoro la fragilidad utilizando el Indice Fragil-VIG y la adecuacion de la prescripcion de cada grupo segun los criterios STOPP-Frail. Resultados Se incluyeron 79 pacientes con una media de 90,9 ± 4,2 anos. La mayoria (96,2%) tenian algun grado de fragilidad. Con fragilidad leve habia un 21,5%, moderada un 37,7% y severa un 38%. Para estos 3 grupos, la mediana de farmacos fue de 7. En la mayoria de las prescripciones de los grupos no hallamos diferencias estadisticamente significativas. Solo existian diferencias para los que tenian dificultad en tomar la medicacion, los que tomaban medicacion para la hipertrofia prostatica y suplementos nutricionales. Se encontro en los 3 grupos que hasta un tercio de la prescripcion era inadecuada y que incluso algunas prescripciones estaban contraindicadas en los pacientes mas fragiles. Conclusion Nuestra poblacion anciana tiene un elevado indice de fragilidad con alta prevalencia de polimedicacion y prescripcion inadecuada. La escasa individualizacion de la prescripcion con relacion al grado de fragilidad, sobre todo en aquellos con corto pronostico de vida, nos indica una situacion que debe mejorarse.

Introduction 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. Material and methods 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. Results 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 = 0.498). 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 was 3.8 days (p = 0.031). 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 = 0.036). Conclusions 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 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.

Introducción: En España, como en la mayoría de los países industrializados, se estima un importante incremento en la proporción de personas mayores de 65 años durante los próximos años. La investigación epidemiológica de la demencia en países desarrollados durante la última década puede considerarse escasa. Se hacen necesarios nuevos estudios que permitan monitorizar la frecuencia de la enfermedad y planificar las políticas sanitarias y de servicios sociales. Objetivos: Describir la prevalencia de demencia y sus subtipos en sujetos de edad igual o superior a 65 años, en una zona rural geográficamente definida de la provincia de Valladolid, y analizar la influencia de factores sociodemográficos y clínicos. Metodología: Estudio epidemiológico observacional, transversal, en dos fases con metodología puerta-a-puerta. Se empleó la prevalencia “de punto” como medida de frecuencia de la enfermedad, siendo la fecha de prevalencia el 1 de febrero de 2009. La población inicial estaba constituida por 871 sujetos. Como instrumento de cribado se utilizó el test de los 7 minutos. Resultados: De la población inicial fueron evaluados 711 individuos (81,64%) con edades comprendidas entre 65 y 104 años. Se identificaron 60 casos de demencia. La prevalencia cruda de demencia fue del 8,40% (IC 95%:6,40-10,50). La prevalencia ajustada por edad y sexo a la población europea estándar fue 5,90% (IC 95%:4,20-7,60). La frecuencia de subtipos fue: enfermedad de Alzheimer (85,01%), demencia por cuerpos de Lewy (8,33%), demencia secundarias (3,33%) y demencia indeterminada (3,33%). No se detectó ningún caso de demencia vascular. La demencia por cualquier causa se asoció con la edad (OR en >85 años=7,8), el sexo femenino (OR=3,2), la ausencia de estudios formales (OR=1,9 respecto a sujetos con educación secundaria o más), el antecedente de ictus (OR=5,9) y la depresión (OR=2,3). Conclusiones: La prevalencia ajustada de demencia fue ligeramente inferior a las estimaciones más recientes para Europa occidental. La prevalencia cruda se sitúa en un rango intermedio respecto a otros estudios realizados en España en el medio rural. La enfermedad de Alzheimer fue la causa más frecuente de demencia. A pesar de no identificarse casos de demencia vascular, sí que se evidenciaron determinados casos de enfermedad de Alzheimer con enfermedad vascular significativa. La edad avanzada, el sexo femenino, un bajo nivel cultural y los antecedentes de ictus y depresión fueron factores asociados a la demencia en la población analizada., Departamento de Medicina, Dermatología y Toxicología

Background Numerous studies on involuntary weight loss (IWL) have been published since the 1980s, although most of them have included small samples of patients with specific symptoms. The aim of the present study was to determine the causes, demographic and clinical characteristics and mortality at 12 months in patients attended at a rapid diagnostic unit (RDU) for isolated IWL. Methods A single-center retrospective observational study including all patients presenting to the RDU for isolated IWL between 2005 and 2013. The following data were recorded: demographic and clinical variables, results of complementary tests (blood tests, x-rays, computed tomography scan and digestive endoscopy), main diagnosis and vital status at 12 months. Results Seven hundred and ninety-one patients met the criteria for IWL. Mean age was 67.9 years (SD 4.7), 50.4% were male and mean weight loss was 8.3 kg (SD 4.7). The cause for IWL was malignant disease in 23.6% of patients, non-malignant organic disease in 44.5%, psychiatric disorder in 29.0% and unknown in 3.2%. Overall mortality at 12 months was 18.6% (95%CI: 16.1–21.6). The mortality rate was highest in the group with malignancy (61.1%; 95%CI: 54.2–68.2). Conclusions Almost a quarter of all patients attended at the RDU for IWL were diagnosed with cancer. Mortality at 12 months was higher in this group than in the other three. Malignancy should therefore be ruled out during the first visit for patients attended for IWL.

As frailty and multiple drug therapy often coexists in institutionalised elderly patients, it is important to assess the level of frailty and therapeutic appropriateness in this population group. The aim of the study is to: assess the frailty level of institutionalised elderly patients and to analyse their prescriptions.An observational and cross-sectional study of a geriatric population of 85 years or older, institutionalised in a nursing home in Barcelona. Frailty was assessed using the Frail-VIG index, and the adequacy of the prescription of each group was done according to the STOPP-Frail Criteria.The study included 79 patients, with a mean age of 90.9±4.2 years. Most of them (96.2%) had some degree of frailty. Slight frailty was observed in 21.5%, moderate in 37.7%, and advanced in 38%. The patients were prescribed a median of 7 drugs. No statistically significant differences were found in the majority of the prescriptions of the frailty groups. Differences were only found for those who had difficulty taking the medication, those who took medication for prostatic hypertrophy, and nutritional supplements. In all 3 groups, it was found that up to one third of the prescription was inappropriate, and some were even contraindicated in the most frail patients.The elderly study population has a high frailty index with a high prevalence of multiple drug therapy with inappropriate prescription. The poor individualisation of these prescriptions in relation to the level of frailty, especially in those with short life prognosis, is a situation that should be improved.

The purpose of this study is to describe the characteristics of older patients treated with psychotropic medicines and the associated factors and to assess their inappropriate use. An observational, prospective study was carried out in 672 elderly patients admitted to seven hospitals for a year. A comparison of sociodemographic characteristics, geriatric variables, multimorbidity and the number of prescribed medicines taken in the preceding month before hospitalization between patients treated with psychotropics and those not treated was performed. To assess factors associated with psychotropics, multivariate logistic regression analyses were performed. Inappropriate use was assessed using the Beers and the STOPP criteria. A total of 57.5 % patients (median [Q1-Q3] age 81.7 [78.2-86.1], 65.7 % female) were treated with psychotropics (44.2 % anxiolytics, 22.6 % antidepressants and 10.8 % antipsychotics). Independent factors associated with the use of psychotropics were female gender (OR = 2.3; CI 95 %,1.6-3.5), some degree of disability on admission (slight [OR = 2.2; 1.2-4.2], moderate [OR = 3.2, 1.6-6.6], severe [OR = 3.4; 1.4-8] and very severe [OR = 5.1; 2.0-12.8]) and polypharmacy (5-9 medicines [OR = 3.0; 1.3-6.9] and a parts per thousand yen10 medicines [OR = 6.0; 2.7-13.6]). The associated factors varied depending on the different types of psychotropics. In patients treated with psychotropics, the percentage of those with at least one Beers (61.6 %) or at least one STOPP (71.4 %) criteria was significantly higher in comparison with those not treated with psychotropics (30.7 and 47.7 %, respectively, p < 0.001). Psychotropics are widely used in the elderly population and often their use is inappropriate. Female gender, a poor functional status and polypharmacy, are the characteristics linked to their use. Interventional strategies should be focused on patients with these characteristics.

Objectives Early transfer to intermediate-care hospitals, low-tech but with geriatric expertise, represents an alternative to conventional acute hospitalization for selected older adults visiting emergency departments (EDs). We evaluated if simple screening tools predict discharge destination in patients included in this pathway. Design, Setting, and Participants Cohort study, including patients transferred from ED to the intermediate-care hospital Parc Sanitari Pere Virgili, Barcelona, during 14 months (2012–2013) for exacerbated chronic diseases. Measurements At admission, we collected demographics, comprehensive geriatric assessment, and 3 screening tools (Identification of Seniors at Risk [ISAR], SilverCode, and Walter indicator). Outcome Discharge destination different from usual living situation (combined death and transfer to acute hospitals or long-term nursing care) versus return to previous situation (home or nursing home). Results Of 265 patients (mean age ± SD = 85.3 ± 7.5, 69% women, 58% with acute respiratory infections, 38% with dementia), 80.8% returned to previous living situation after 14.1 ± 6.5 days (mean ± SD). In multivariable Cox proportional hazard models, ISAR >3 points (hazard ratio [HR] 2.06, 95% confidence interval [95% CI] 1.16–3.66) and >1 pressure ulcers (HR 2.09, 95% CI 1.11–3.93), but also continuous ISAR, and, in subanalyses, Walter indicator, increased the risk of negative outcomes. Using ROC curves, ISAR showed the best prediction among other variables, although predictive value was poor (AUC = 0.62 (0.53–0.71) for ISAR >3 and AUC = 0.65 (0.57–0.74) for continuous ISAR). ISAR and SilverCode showed fair prediction of acute hospital readmissions. Conclusions Among geriatric screening tools, ISAR was independently associated with discharge destination in older adults transferred from ED to intermediate care. Predictive validity was poor. Further research on selection of candidates for alternatives to conventional hospitalization is needed.

Resumen Objetivo Analizar la prevalencia y caracteristicas de pacientes con anemia ingresados en una unidad geriatrica de agudos, y su valor pronostico de mortalidad al ano. Material y metodos Estudio descriptivo prospectivo en el que se incluyo a los pacientes ingresados en la unidad de geriatria. Se diagnostico la anemia segun los criterios de la Organizacion Mundial de la Salud. A todos los enfermos se les realizo una valoracion geriatrica integral. Un ano mas tarde se realizo seguimiento via telefonica y se valoro mortalidad y situacion funcional. Resultados Se incluyo a 145 pacientes, edad media de 81 anos, de los cuales 93 (64,13%) presentaban anemia. Los tipos mas frecuentes de anemia fueron la de procesos cronicos y la ferropenica. El indice de Barthel fue menor en los pacientes con anemia (p Conclusion La anemia es un enfermedad muy prevalente en pacientes de edad avanzada que ingresan por un proceso agudo y se asocia con una peor situacion funcional.

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.

To analyse potentially inappropriate prescribing (PIP) in elderly polypathological patients (PP).Multicentre observational, prospective study of 672 patients aged 75 years and older hospitalised in Internal Medicine between April 2011 and March 2012. The Beers, STOPP-START and ACOVE criteria were used to detect potentially inappropriate prescribing and the results of PP and non-PP patients were compared.Of the 672 patients included, 419 (62%) were polypathological, of which 89.3% met PIP criteria versus 79.4% of non-polypathological patients (p0.01). 40.3% of polypathological patients met at least one Beers criteria, 62.8% at least one STOPP criteria, 62.3% at least one START criteria and 65.6% at least one ACOVE criteria. The rate of potentially inappropriate prescribing was higher in polypathological patients regardless of the tool used.Given the high rate of potentially inappropriate prescribing in polypathological patients, strategies to improve prescribing adequacy must be developed.

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 incidencia de reacciones adversas a medicamentos (RAM) en pacientes ancianos hospitalizados es un problema clinico de gran importancia. El objetivo del estudio ha sido conocer la incidencia de RAM en pacientes ancianos hospitalizados, analizar los factores implicados en su aparicion y evaluar las RAM detectadas. Pacientes y metodo Estudio multicentrico prospectivo en pacientes mayores de 65 anos, seguidos durante su ingreso hospitalario o sociosanitario, en los que se efectuo una valoracion geriatrica completa y un protocolo de recogida de sospecha de RAM durante el ingreso, asi como complicaciones acontecidas. Se estudiaron las variables asociadas a RAM y se realizo un analisis multivariable mediante regresion logistica multiple. Resultados Se incluyo a 865 pacientes, 185 (21%) de 5 unidades hospitalarias, 325 (38%) de 8 unidades de convalecencia y 355 (41%) de 8 unidades de larga estancia. La incidencia de RAM fue del 9%. Por centros, en las unidades de agudos se detecto una incidencia del 15%, del 5% en unidades de convalecencia y del 10% en larga estancia (p Conclusiones La incidencia de RAM en nuestro estudio ha sido cercana al 10%, asociandose al consumo de farmacos, a la presencia de SCA y al tipo de unidad, siendo mas frecuentes en las unidades de larga estancia y de agudos. Las RAM detectadas fueron principalmente de tipo A, de gravedad moderada, causalidad probable y parcialmente evitables.

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.

To describe the characteristics, prevalence and prognostic of anemia in older patients admitted to an acute geriatric unit.A prospective descriptive study was conducted on patients admitted to a geriatric unit. Anemia was defined using the World Health Organization criteria. A comprehensive geriatric assessment was performed on all patients. When possible, a telephone follow-up re-evaluation (mortality, functional status) was performed one year after discharge.A total of 145 patients were studied. The mean age was 81 years, and 93 (64.13%) were anemic. Chronic diseases and iron deficiency anemia were the most frequent. Anemic patients had lower scores in the Barthel Index (P.05). The mortality one year after discharge was 47.9%, with no differences between anemic or non-anemic patients (OR 2.07, [0.98-4.4]). All the geriatric indexes (Barthel index; Charlson comorbidity index, Mini-mental state examination and Mini Nutritional Assessment) showed worse scores in patients who died one year after discharge.The prevalence of anemia in the elderly admitted to a geriatric unit is elevated, and associated with a poorer functional status.

Purpose: This study aims to assess inappropriate prescribing (IP) to elderly patients during the month prior to hospitalization and to compare different IP criteria. Methods: An observational, prospective and multicentric study was carried out in the internal medicine services of seven Spanish hospitals. Patients aged 75 years and olderwere randomly selected after hospital admission for a year. To assess potentially inappropriate medicines (PIMs), the Beers and STOPP criteria were used and to assess potentially prescribing omissions (PPOs), the START criteria and ACOVE-3 medicine quality indicators were used. An analysis to assess factors associated with IP was performed. Results: 672 patients [median age (Q1-Q3) 82 (79-86) years, 55.9% female] were included. Median prescribed medicines in the month prior to hospitalization were 10(Q1-Q3 7-13). The prevalence of IP was 87.6%, and 54.3% of patients had PIMs and PPOs concurrently. A higher prevalence rate of PIMs was predicted using the STOPP criteria than with the Beers criteria (p < 0.001) and a higher prevalence of PPOs using the ACOVE-3 criteria than using the START criteria (p < 0.001) was observed. Polypharmacy (>= 10 medicines) was the strongest predictor of IP [OR = 11.34 95% confidence interval (CI) 4.96-25.94], PIMs [OR = 14.16, 95% CI 6.44-31.12], Beers-listed PIMs [OR = 8.19, 95% CI 3.01-22.28] and STOPP-listed PIMs [OR = 8.21, 95% CI 3.47-19.44]. PIMs was the strongest predictor of PPOs [OR = 2.79, 95% CI 1.81-4.28]. Conclusions: A high prevalence of polypharmacy and PIMs and PPOs were reported. More than half the patients had simultaneous PIMs and PPOs. The related factors to PIMs and PPOs were different. (c) 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Purpose: There are limited tools to assess potential prescribing omissions (PPOs) or underprescribing in the elderly. The ACOVE project defines comprehensive quality care indicators for older people and some of these indicators focused on appropriate use of medicines. The aim of the present study was to assess the inter-rater reliability between observers using the ACOVE 3 prescribing indicated medications indicators and compare it with the inter-rater reliability obtained for the Screening Tool of Older Person's Prescriptions (STOPP)/Screening Tool to Alert Doctors to Right Treatment (START) criteria. Methods: In the context of an observational and multicentric study of a cohort of 672 patients 75 years and older who were hospitalized in Internal Medicine services of seven Spanish hospitals, an inter-rater reliability study using the ACOVE selected indicators and the STOPP/START criteria was carried out between April 2011 and March 2012. Three patients were randomly selected in each participating hospital, one for each four months of study. Results: A total of 21 patients (mean (SD) age of 84.3 (5.6) years, 57.1% female) were included in the inter-rater reliability study. For the STOPP, START and ACOVE criteria, the median kappa coefficient for the seven hospital analyses was 0.97, 0.92 and 0.95, respectively. Out of 123 total indicators in only 7 (5.7%) was the kappa coefficient value below 0.75. Only for 2 (5.6%) of the 37 studies selected ACOVE quality indicators was the kappa coefficient value less than 0.75. Conclusions: A high inter-rater reliability was obtained for the selected underprescribing quality indicators of ACOVE 3. These quality indicators may be considered a useful tool in detecting underprescribing to the elderly patients. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Producción Científica, To describe the prevalence of dementia and subtypes in a general elderly population in northwestern Spain and to analyze the influence of socio-demographic factors. Methods: Cross-sectional, two-phase, door-to-door, population-based study. A total of 870 individuals from a rural region and 2,119 individuals from an urban region of Valladolid, Spain, were involved. The seven-minute screen neurocognitive battery was used in the screening phase. A control group was included. Results: A total of 2,170 individuals aged 65 to 104 years (57% women) were assessed. There were 184 subjects diagnosed with dementia. The crude prevalence was 8.5% (95% CI: 7.3-9.7). Age- and sex-adjusted prevalence was 5.5 (95% CI: 4.5-6.5). Main subtypes of dementia were: Alzheimer’s disease (AD) 77.7%, Lewy Body disease, 7.6% and vascular dementia (VD) 5.9%. Crude prevalences were 6.6% (AD), 0.6% (Lewy Body disease), and 0.5% (VD). Dementia was associated with age (OR 1.14 for 1-year increase in age), female sex (OR 1.79) and the absence of formal education (OR 2.53 compared to subjects with primary education or more). Conclusion: The prevalence of dementia in the study population was lower than the most recent estimates for Western Europe. There was a high proportion of AD among all dementia cases and very low prevalence of VD. Old age, female sex, and low education level were independent risk factors for dementia and AD.

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.

Producción Científica, This article describes the rationale and design of a population-based survey of dementia in Valladolid (northwestern Spain). The main aim of the study was to assess the epidemiology of dementia and its subtypes. Prevalence of anosognosia in dementia patients, nutritional status, diet characteristics, and determinants of non-diagnosed dementia in the community were studied. The main sociodemographic, educational, and general health status characteristics of the study population are described. Methods: Cross-over and cohort, population-based study. A two-phase door-to-door study was performed. Both urban and rural environments were included. In phase 1 (February 2009 – February 2010) 28 trained physicians examined a population of 2,989 subjects (age: ≥ 65 years). The seven-minute screen neurocognitive battery was used. In phase 2 (May 2009 – May 2010) 4 neurologists, 1 geriatrician, and 3 neuropsychologists confirmed the diagnosis of dementia and subtype in patients screened positive by a structured neurological evaluation. Specific instruments to assess anosognosia, the nutritional status and diet characteristics were used. Of the initial sample, 2,170 subjects were evaluated (57% female, mean age 76.5 ± 7.8, 5.2% institutionalized), whose characteristics are described. 227 persons were excluded for various reasons. Among those eligible were 592 non-responders. The attrition bias of non-responders was lower in rural areas. 241 screened positive (11.1%). Discussion: The survey will explore some clinical, social and health related life-style variables of dementia. The population size and the diversification of social and educational backgrounds will contribute to a better knowledge of dementia in our environment. Keywords: Dementia prevalence, Epidemiology, Undiagnosed dementia, Population-based survey, Seven-minute screen, Anosognosia, Nutritional assessment

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.

Objective. To assess the effectiveness of an intervention after comprehensive geriatric assessment (CGA) in reducing morbidity and mortality in patients over 74 years in primary care. Methods. Randomized controlled trial with 18 months of follow-up. Patients in the control group (CG) followed usual care. Patients in the intervention group (IG) were classified as at risk or non-risk of frailty based on the CGA. Patients at non-risk of frailty in the IG were provided with recommendations about healthy habits and adherence to treatment in group sessions, while patients at risk of frailty were visited individually by a geriatrician. Results. Six hundred and twenty patients were randomized to the IG (49.7%) or to the CG (50.3%), 83.2% completed follow-up. Cox’s proportional hazards model showed as covariates the study group (hazard ratio [HR] 0.58; 95% confidence interval [CI] 0.28–1.22), risk of frailty (HR 1.33; 95% CI 0.71–2.51) and the interaction between both (HR 3.08; 95% CI 1.22–7.78). Forty-nine percent of the patients in the IG and 43% in the CG were at risk of frailty at baseline. At the end of the study, 27.9% of the IG and 13.5% of the CG had reversed their initial at risk of frailty status (P = 0.027). Multivariate predictors of reversible risk of frailty were younger age, not being at risk of depression, low consumption of medications and the intervention itself. Conclusions. A specific intervention in patients over 74 years attended in primary care reduces morbidity and mortality in patients at risk of frailty and increases the proportion of patients that reversed their initial status at risk of frailty.

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.

P.H. Ponte Marquez, O. Torres Bonafonte, J. Garcia Moreno, A. Lopez Soto, N. Ramirez Duque, A. Fernandez Mayo, F. Formiga, A. Antonia, X. Vidal, J. Barbe, A. San-Jose, A. Roca-Cusachs, R.D. Ruiz Hidalgo Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Hospital General Juan Ramon Jimenez, Huelva, Spain; Hospital Clinic, Barcelona, Spain; Hospital Universitario Virgen del Rocio, Sevilla, Spain; Hospital San Juan de Dios del Aljarafe, Sevilla, Spain; Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain; Hospital Universitari Vall d‘Hebron, Barcelona, Spain

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.