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A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a “nosocomiun”, i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below.

Background Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty. Methods A literature search was performed in Medline to detect prospective randomized controlled trials (RCTs) testing the effects of pharmacological interventions or medication optimization in older frail adults on comprehensive frailty scores or partial aspects of frailty that were published from January 1998 to October 2019. Results Twenty-five studies were identified, 4 on comprehensive frailty scores and 21 on aspects of frailty. Two trials on comprehensive frailty scores showed positive results on frailty although the contribution of medication review in a multidimensional approach was unclear. In the studies on aspects related to frailty, ten individual drug interventions showed improvement in physical performance, muscle strength or body composition utilizing alfacalcidol, teriparatide, piroxicam, testosterone, recombinant human chorionic gonadotropin, or capromorelin. There were no studies examining negative effects of drugs on frailty. Conclusion So far, data on a causal relationship between drugs and frailty are inconclusive or related to single-drug interventions on partial aspects of frailty. There is a clear need for RCTs on this topic that should be based on a comprehensive, internationally consistent and thus reproducible concept of frailty assessment.

The increase in life expectancy has led to the appearance of a subgroup of hip fracture (HF) patients with special characteristics known as centenarians. The aim of the present study is to analyse the demographic characteristics, complications and mortality rate of this subgroup in order to identify the specific risk factors for mortality in these patients.Retrospective analysis of 69 patients (58 women and 11 men) aged 100 years or older admitted to a tertiary hospital for HF between 1999 and 2018.The average age was 101.3 years (100-108, median 101). More than half (62.3%) of all patients presented with extracapsular fractures. The most common complications observed were delirium (52.3%) and urinary retention (27.7%). Haematoma (9.2%) was the most common surgical complication. Only 3 patients (7.3%) changed their place of residence after admission. In-hospital, 30-day and 1-year mortality rates were 13.8%, 21.5% and 54.2%, respectively. A high Charlson Comorbidity Index and baseline Functional Ambulation Classification (FAC)3 were associated with a higher in-hospital mortality rate (OR = 1.95 95% CI [1.03-3.69] and OR = 5.7 95% CI [1.2-26.8]), respectively. The presence of more than 3 comorbidities and baseline FAC3 were associated with a higher risk of 30-day mortality (OR = 6, 95% CI [1.4-24.7] and OR = 4, 95% CI [1.13-14.2]), respectively. Dementia has been associated with a higher risk of 30-day and 1-year mortality (OR = 4.6, 95% CI [1.2-16.7]) and OR = 5.11, 95% CI [1.6-21]) respectively.FAC score, number of comorbidities, dementia and the Charlson Comorbidity Index have been shown to be risk factors of mortality in centenarians with HF.

Resumen Cada vez es mayor el numero de pacientes de edad avanzada que esta siendo tratado por especialidades diferentes a la geriatria, las cuales, por las caracteristicas de sus tratamientos, necesitan conocer el pronostico que tiene su indicacion en los pacientes ancianos fragiles y optimizar la situacion de estos pacientes para mejorar dicho pronostico. Las mas frecuentes, actualmente, son oncologia y hematologia, cardiologia, cirugia general y otros servicios quirurgicos. Se entiende por geriatria transversal la ampliacion del area de conocimiento y atencion de la geriatria en sentido horizontal, fuera de sus unidades habituales, aplicando los principios de la medicina geriatrica con un enfoque multidisciplinar al terreno de otros servicios que atienden a pacientes muy mayores y fragiles con enfermedades graves, con el objetivo de ofrecer una atencion centrada en la persona y mejorar su manejo integral. La valoracion geriatrica y la deteccion de la fragilidad en estos casos aportan informacion pronostica y ayudan en la toma de decisiones y en la seleccion de un tratamiento individualizado. En algunos casos es posible mejorar la evolucion de los pacientes y la eficiencia del sistema sanitario. En este articulo se revisan estos conceptos, se describen algunos modelos existentes, se mencionan los instrumentos mas empleados para esta funcion y se resumen algunas actividades de esta nueva area de la asistencia geriatrica. Es previsible que cada vez en mas hospitales se solicite a los servicios de geriatria la implementacion de este tipo de valoraciones e intervenciones. Existe informacion basica para su puesta en marcha, pero no la suficiente como para considerar que estan respondidas todas las preguntas que se plantean. Sera, pues, en los proximos anos un nuevo reto para esta especialidad.

Objective. To assess the impact of COVID-19 at nine nursing homes in Madrid, Spain, during the first wave of COVID-19 infection and lockdown period when preventive measures were taken to avoid transmission among residents. Methods. Nine hundred forty-two residents and 846 staff members from nine nursing homes participated in the study (April 18 to June 20, 2020). All participants were tested for SARS-CoV-2 in the nasopharynx by PCR and for IgG antibodies detection. Microbiological status at sampling was defined as active infection (positive PCR ± presence of antibodies), past infection (negative PCR + presence of antibodies), or naïve participants (negative PCR + absence of antibodies). Results. Laboratory results helped classify the residents as having active infection (n=224; 23.8%), past infection (n=462; 49.1%), or being naïve (n=256; 27.1%); staff members were actively infected (n=127; 15.1%), had had a past infection (n=290; 34.2%), or were naïve (n=429; 50.7%). Overall, the percentage of participants with COVID-19 was significantly higher in residents than in staff members (72.8% vs 49.2%; P=0.001). The clinical situation of residents vs staff at sampling was as follows: acute manifestations compatible with COVID-19 (7.3% vs 3.9%; P

Background Cognitive decline is common in older people. Numerous studies point to the detrimental impact of polypharmacy and inappropriate medication on older people’s cognitive function. Here we aim to systematically review evidence on the impact of medication optimisation and drug interventions on cognitive function in older adults. Methods A systematic review was performed using MEDLINE and Web of Science on May 2021. Only randomised controlled trials (RCTs) addressing the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in older adults (aged > 65 years) were included. Single-drug interventions (e.g., on drugs for dementia) were excluded. The quality of the studies was assessed by using the Jadad score. Results Thirteen studies met the inclusion criteria. In five studies a positive impact of the intervention on metric measures of cognitive function was observed. Only one study showed a significant improvement of cognitive function by medication optimisation. The remaining four positive studies tested methylphenidate, selective oestrogen receptor modulators, folic acid and antipsychotics. The mean Jadad score was low (2.7). Conclusion This systematic review identified a small number of heterogenous RCTs investigating the impact of medication optimisation or pharmacological interventions on cognitive function. Five trials showed a positive impact on at least one aspect of cognitive function, with comprehensive medication optimisation not being more successful than focused drug interventions. More prospective trials are needed to specifically assess ways of limiting the negative impact of certain medication in particular and polypharmacy in general on cognitive function in older patients. publishedVersion

Hospitalization in the elderly, even in short stays, is associated with functional impairment. Once the acute illness is reversed, the evolution of this hospital-generated impairment can be variable, and a year after hospitalization more than half of the elderly patients remain impaired. This impairment is associated with a higher risk of institutionalization, of mortality at discharge and of 30-day mortality. Previous studies have shown how interdisciplinary physical exercise programs can improve functionality at discharge and decrease mortality rate, hospital stay and institutionalization.In the Acute Geriatric Unit of the Gregorio Marañon University hospital a randomized controlled trial was carried out to assess the effectiveness of an exercise and health education program to prevent functional decline during hospitalization and at three months after discharge in elderly subjects aged 74 years or older. Patients were excluded if at least one of the following exclusion criteria was met: baseline Barthel Index (15-days prior hospitalization) below 20, severe cognitive impairment or inability to walk. The intervention consisted on a physical exercise program (that included squats, balance, gait stimulation, elastic bands, and inspiratory muscle training) and health education program. The control group received usual care.

Correction to: European Journal of Clinical Pharmacology (2021) 77:1–12 https://doi.org/10.1007/s00228-020–02951-8 \ud \ud The article Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials, written by Farhad Pazan, Mirko Petrovic, Antonio Cherubini, Graziano Onder, Alfonso J. Cruz-Jentoft, Michael Denkinger, Tischa J. M. van der Cammen, Jennifer M. Stevenson, Kinda Ibrahim, Chakravarthi Rajkumar, Marit Stordal Bakken, Jean-Pierre Baeyens, Peter Crome, Thomas Frühwald, Paul Gallaghar, Adalsteinn Guðmundsson, Wilma Knol, Denis O’Mahony, Alberto Pilotto, Elina Rönnemaa, José Antonio Serra-Rexach, George Soulis, Rob J. van Marum, Gijsbertus Ziere, Alpana Mair, Heinrich Burkhardt, Agnieszka Neumann-Podczaska, Katarzyna Wieczorowska- Tobis, Marilia Andreia Fernandes, Heidi Gruner, Dhayana Dallmeier, Jean-Baptiste Beuscart, Nathalie van der Velde and Martin Wehling, was originally published electronically on the publisher’s internet portal on 07 August 2020 without open access. With the author(s)’ decision to opt for Open Choice the copyright of the article changed on 14 May 2021 to © The Author(s) 2021 and the article is forthwith distributed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4.0. \ud The Original article has been corrected.

Intravascular B‐cell Lymphoma is a rare lymphoproliferative disorder with a none specific clinical presentation. The association of cutaneous telangiectasia‐like lesions and elevated inflammatory markers should be guaranteed a skin biopsy.

Introduction Malnutrition is common among older people living in nursing homes. Poor nutritional status is associated with functional loss and with worse health. Oral nutritional supplementation (ONS) can be an effective means to counteract weight loss, improve nutritional status and reduce complications in malnourished older people living in nursing homes. The main objective of this study was to assess whether ONS over 12 weeks improved the nutritional status and physical function of malnourished older people living in nursing homes. Methods This was a multi-center, prospective, observational study carried out in 53 nursing homes in Spain. Participants were aged 65 or over. They were prescribed a high-calorie, high-protein ONS to treat well documented malnutrition. Subjects who received enteral nutrition, had special nutritional requirements, or receiving end-of-life care were excluded. Anthropometric data were recorded (weight, height and BMI) as well as scores on nutritional and functional scales (MNA-SF, Barthel index, SPPB, grip strength and Functional Ambulation Categories, FAC) at the beginning of the study and after 12 weeks. Cognitive status, comorbidities and depressive symptoms were also assessed. Frailty status was assessed using the FRAIL scale. Results 320 participants were included, of whom 253 completed the study (mean age 84.2 ± 7.1 years). Baseline BMI was 20.2 ± 2.8. A high prevalence of functional impairment (Barthel Index median 45, range 15–75; median SPPB 4, range 1–6) and cognitive impairment (MMSE median 12, 7–20) was found. Discussion This study identified a population with malnutrition and a high degree of physical and mental disability that mirrors the typical population of many nursing homes. Analysis of the results of this study will help to determine the factors associated with malnutrition and the effect of nutritional intervention in practice.

The coronavirus disease 2019 (COVID-19) produces severe respiratory symptoms such as bilateral pneumonia associated to a high morbidity and mortality, especially in patients of advanced age. Vitamin D deficiency has been reported in several chronic conditions associated with increased inflammation and dysregulation of the immune system. Vitamin D in modulates immune function too. Vitamin D receptor (VDR) is expressed by most immune cells, including B and T lymphocytes, monocytes, macrophages, and dendritic cells and the signalling of vitamin D and VDR together has an anti-inflammatory effect. Some studies have reported that vitamin D treatment could be useful for the prevention and treatment of COVID-19 because vitamin D plays an important role as a modulator of immunocompetence. Over the last few months, some studies have hypothesized the possible beneficial effect of vitamin D supplementation in patients with COVID-19 in order to improve the immune balance and prevent the hyperinflammatory cytokine storm. Some preliminary studies have already shown promising results with vitamin D supplementation in hospitalized COVID-19 patients. Vitamin D should be administered daily until adequate levels are achieved due to vitamin D behaves as a negative acute phase reactant (APR). Despite the lack of evidence on specific doses of vitamin D to treat COVID-19 in older adults, authors consider it is necessary to standardize the use in clinical practice. These recommendations advice supplement vitamin D in a protocoled fashion based on expert opinions, level of evidence 5.

Resumen La valoracion del paciente geriatrico requiere un abordaje multidimensional que cobra especial importancia a la hora de decidir si un paciente con enfermedad critica es candidato a recibir un tratamiento activo, entendiendose por tal el conjunto de medidas destinadas a resolver una patologia aguda. Presentamos la evolucion de 4 pacientes ancianos que ingresaron desde el Servicio de Urgencias habiendose optado exclusivamente por un manejo sintomatico (morfina y/o midazolam) de su patologia aguda. Durante su ingreso en la Unidad de Agudos de Geriatria, dada la mejoria clinica objetivada, se inicio tratamiento activo con actitud expectante. Todos ellos fueron dados de alta tras una evolucion clinica favorable.

Background/aim Estimation of mortality in elderly patients is difficult yet very important when planning care. Previous tools are complicated or do no take into account some major determinants of mortality (i.e., frailty). We designed a simple, accurate, and non–disease–specific tool to predict individual mortality risk after hospital discharge in older adults. Methods Patients admitted to the Acute Geriatric Unit were assessed at adission and at discharge and contacted 6 and 12 months later. Determinants of mortality were obtained. Using multivariable analysis, beta coeffcicients were calculated to build 2 scores able to predict mortality at 6 and 12 months after discharge. The scores were tested on a sample comprising 75% of the patients, who were randomly selected; they were validated using the remaining 25%. Discrimination was assessed using ROC curves. Scores were calculated for each patient and divided into tertiles. Survival analysis was performed. Results Determinants of mortality at 6 months were dependent ambulation at baseline, full dependence at discharge, length of stay, pluripatology, pressure ulcers, low grip strength, malignacy, and male gender. At 12 months the determinants were: dependent amblation at baseline, full dependence at discharge, pluripatology, low BMI, low grip strength, heart failure, malignacy, and male gender. Discrimination and calibration were excellent. Survival analysis demonstrated different survival trajectories (p Conclusions Our incices provide accurate prognostic information in elderly patients after discharge. They can be calculated easily, quickly and do not require technical or laboratory support, thus endorsing their value in dalily clinical practice.

Background Acute hospitalisation can have adverse effects in older adults, notably functional decline. We aimed to summarize evidence on the effects of exercise interventions in acutely hospitalised older adults. Methods Relevant articles were systematically searched (PubMed, Web of Science, Rehabilitation & Sports Medicine Source, and EMBASE) until 19th March 2020. Randomized controlled trials (RCTs) of in-hospital exercise interventions versus usual care conducted in older adults (>60yrs) hospitalised for an acute medical condition were included. Methodological quality of the studies was assessed with the PEDro scale. Primary outcomes included functional independence and physical performance. Intervention effects were also assessed for other major outcomes (length of hospital stay, incidence of readmission, and mortality). A meta-analysis was conducted when ≥3 studies analysed the same outcome. Results Fifteen studies from 12 RCTs (n = 1748) were included. Methodological quality of the studies was overall high. None of the studies reported any adverse event related to the intervention. Exercise interventions improved functional independence at discharge (standardized mean difference [SMD] = 0.64, 95% confidence interval = 0.19–1.08) and 1–3 months post-discharge (SMD = 0.29, 95%CI = 0.13–0.43), as well as physical performance (SMD = 0.57, 95%CI = 0.18–0.95). No between-group differences were found for length of hospital stay or risk of readmission or mortality (all p > 0.05). Conclusions In-hospital supervised exercise interventions seem overall safe and effective for improving – or attenuating the decline of – functional independence and physical performance in acutely hospitalised older adults. The clinical relevance of these findings remains to be confirmed in future research. Sin financiación 10.895 JCR (2020) Q1, 25/195 Cell Biology 3.523 SJR (2020) Q1, 1/35 Aging No data IDR 2019 UEM

We analyzed inter-individual variability in response to exercise among acutely hospitalized oldest-old adults. In this ancillary analysis of a randomized controlled trial, 268 patients (mean age 88 years) were assigned to a control (n = 125, usual care) or intervention group (n = 143, supervised exercise, i.e., walking and rising from a chair [1&ndash, 3 sessions/day]). Intervention group patients were categorized as responders, non-responders, or adverse responders (improved, no change, or impaired function in activities of daily living [ADL, Katz index] from hospital admission to discharge, respectively). We analyzed the association between responsiveness to exercise and variables assessed at baseline (2 weeks pre-admission), admission, during hospitalization, at discharge, and during a subsequent 3-month follow-up. An impaired ADL function and worse nutritional status at admission were associated to a greater responsiveness, whereas a better ADL function at admission, longer hospitalization and lower comorbidity index were associated with a poorer response (p &lt, 0.05). Adverse responders had worse outcomes at discharge and during the follow-up (e.g., impaired physical performance and greater fall number) (p &lt, 0.05). Although exercise intervention helps to prevent ADL function decline in hospitalized oldest-old people, a number of them&mdash, particularly those with a better functional/health status at admission and longer hospitalization&mdash, are at higher risk of being adverse responders, which can have negative short/middle-term consequences.

Sin financiación 4.669 JCR (2020) Q2, 15/53 Geriatrics & Gerontology 1.840 SJR (2020) Q1, 9/108 Geriatrics and Gerontology No data IDR 2019 UEM

Increasing numbers of older persons are being treated by specialties other than Geriatric Medicine. Specialists turn to Geriatric Teams when they need to accurately stratify their patients' risk and prognosis, predict the potential impact of their, often, invasive interventions, optimise their clinical status, and contribute to discharge planning. Oncology and Haematology, Cardiology, General Surgery, and other surgical departments are examples where such collaborative working is already established, to a varying extent. The use of the term "Cross-speciality Geriatrics" is suggested when geriatric care is provided in clinical areas traditionally outside the reach of Geriatric Teams. The core principles of Geriatric Medicine (comprehensive geriatric assessment, patient-centred multidisciplinary targeted interventions, and input at point-of-care) are adapted to the specifics of each specialty and applied to frail older patients in order to deliver a holistic assessment/treatment, better patient/carer experience, and improved clinical outcomes. Using Comprehensive Geriatric Assessment methodology and Frailty scoring in such patients provides invaluable prognostic information, helps in decision making, and enables personalised treatment strategies. There is evidence that such an approach improves the efficiency of health care systems and patient outcomes. This article includes a review of these concepts, describes existing models of care, presents the most commonly used clinical tools, and offers examples of excellence in this new era of geriatric care. In an ever ageing population it is likely that teams will be asked to provide Cross-specialty Geriatrics across different Health Care systems. The fundamentals for its implementation are in place, but further evidence is required to guide future development and consolidation, making it one of the most important challenges for Geriatrics in the coming years.

ObjectiveHospitalisation-associated disability (HAD, defined as the loss of ability to perform one or more basic activities of daily living [ADL] independently at discharge) is a frequent condition among older patients. The present study aimed to assess whether a simple inpatient exercise programme decreases the incidence of HAD in acutely hospitalised very old patients.DesignIn this randomized controlled trial (Activity in GEriatric acute CARe, AGECAR) participants were assigned to a control or intervention (exercise) group, and were assessed at baseline, admission, discharge, and 3 months thereafter.Setting and participants268 patients (mean age 88 years, range 75–102) admitted to an acute care for elders (ACE) unit of a Public Hospital were randomized to a control (n=125) or intervention (exercise) group (n=143).MethodsBoth groups received usual care, and patients in the intervention group also performed simple supervised exercises (walking and rising from a chair, for a total daily duration of ∼20 min). We measured incident HAD at discharge and after 3 months (primary outcome); and Short Physical Performance Battery (SPPB), ambulatory capacity, number of falls, re-hospitalisation and death during a 3-month follow-up (secondary outcomes).ResultsMedian duration of hospitalisation was 7 days (interquartile range 4 days). Compared with admission, the intervention group had a lower risk of HAD at discharge (odds ratio [OR]: 0.32; 95% confidence interval [CI]: 0.11–0.92) and at 3-months follow-up (OR 0.24; 95% CI: 0.08–0.74) than controls during follow-up. No intervention effect was noted for the other secondary endpoints (all p>0.05), although a trend towards a lower mortality risk was observed in the intervention group (p=0.078).Conclusion and implicationsThese findings demonstrate that a simple inpatient exercise programme significantly decreases the risk of HAD in acutely hospitalised, very old patients.Trial registrationNCT0137489 (https://clinicaltrials.gov/ct2/show/NCT01374893).Brief summaryA simple inpatient intervention consisting of walking and rising from a chair (∼20 minutes/day) considerably decreases the risk of hospitalisation-associated disability in acutely hospitalised older patients.

Recentemente, observa-se que o desenvolvimento da tecnologia da informação vem auxiliando inúmeras práticas na área da saúde, em atividades como diagnóstico, terapia, gerenciamento e educação, o que exige a necessidade de mudanças e desenvolvimento de novas habilidades pelos profissionais das áreas envolvidas. A realização de cirurgias assistidas virtualmente vem ganhando espaço com o avanço da tecnologia, porém durante esse procedimento, estudantes não podem manipular a cirurgia por se tratar de um paciente dentro de um procedimento real, dificultando assim a imersão do aluno ou médico. Este projeto visa criar um protótipo de simulação cirúrgica completa utilizando Realidade Virtual e Aumentada para que o estudante possa realizar uma Neurocirurgia de forma a conseguir trabalhar com o procedimento, sem riscos para os paciente e com imersividade total no procedimento, proporcionando assim um melhor aproveitamento de aprendizagem., XII SIMPÓSIO DE ENGENHARIA BIOMÉDICA- IX SIMPÓSIO DE INSTRUMENTAÇÃO E IMAGENS MÉDICAS

Objectives The number of nonagenarian patients with hip fracture is increasing. The goals of this study were to describe the characteristics and in-hospital course of a cohort of 1177 nonagenarians admitted for hip fracture compared with younger patients, and to identify risk factors for 30-day mortality after admission. Methods A retrospective observational cohort study including patients 65 years of age or older admitted for hip fracture during various periods from February 1997 to December 2016. We defined 3 age groups: 65–79, 80–89, and 90 years and older. We included sociodemographic variables, baseline functional status, comorbidities, fracture and surgical characteristics, postoperative complications, length of stay, in-hospital and 30-day mortality. Multiple logistic regression analysis was used to study risk factors for 30-day mortality in surgically treated nonagenarians. Results Nonagenarians were more likely to be women and to have dementia and heart disease. Some 72% walked independently before the fracture. The most relevant treatable risk factors for 30-day mortality in nonagenarians (in terms of higher Odd Ratio [OR]) were developing respiratory infection (OR 4.56, 95%CI 2.73–7.63). Better prefracture functional status (higher Katz score; OR 0.83, 95% CI 0.74–0.92) and spinal anesthesia (OR 0.19, 95%CI 0.05–0.68) decreased risk of 30-day mortality. Conclusions Nonagenarian patients with hip fracture differ significantly from younger patients concerning clinical characteristics, medical complications, and in-hospital and 30-day mortality rates. We identified several variables on which we could act to reduce 30-day mortality, such as respiratory infection, electrolyte disorders, polypharmacy, cardiac arrhythmia, and spinal anesthesia.

Objectives To assess if the impact of oral nutritional supplements (ONS) on nutritional and functional status in malnourished older persons living in nursing homes shown by clinical trials are also found outside a trial setting. Design Observational, multicenter, prospective, pragmatic study. Setting and Participants This study was carried out in 38 nursing homes throughout Spain. Nursing home physicians recruited consecutive residents, older than 65 years, with a diagnosis of malnutrition, when a clinical decision to start ONS had been taken after unsuccessful initial management with dietary interventions. Intervention The participants received daily 2 bottles of an energy-rich, high-protein commercial ONS for 3 months. Measures Primary outcomes were changes in nutritional status (body weight, body mass index [BMI], and Mini Nutritional Assessment-Short Form [MNA-SF]); secondary outcomes were functional changes (Functional Ambulation Classification, Barthel index, handgrip strength, and Short Physical Performance Battery [SPPB]), as well as safety and adherence after 12 weeks of follow-up. Results A total of 282 residents (median age 86 years, 67% women) were included, and 244 (86.5%) completed the follow-up. At baseline, 77.3% of the participants were malnourished (BMI 19.7 kg/m2, interquartile range 18.3–21.8). After 12 weeks of follow-up, participants experienced significant increases in body weight (2.6 ± 3.1 kg, 5.2 ± 5.9%), BMI (1.0 ± 1.2 kg/m2) and MNA-SF (4.0 ± 2.5 points). There were also significant improvements in functional status measured by the Barthel index, handgrip strength, SPPB, and gait speed. Good adherence was registered in 94.6% of the participants. No relevant side effects were found. Conclusions and Implications Improvements in nutritional and functional status can be found when using a high-protein, high-calorie ONS in older undernourished people living in nursing homes.

The European Working Group on Sarcopenia in Older People (EWGSOP) has proposed different methods and cut-off points for the three parameters that define sarcopenia: muscle mass, muscle strength and physical performance. Although this facilitates clinical practice, it limits comparability between studies and leads to wide differences in published prevalence rates. The aim of this study was to assess how changes in cut-off points for muscle mass, gait speed and grip strength affected sarcopenia prevalence according to EWGSOP criteria. Cross-sectional analysis of elderly individuals recruited from outpatient clinics (n=298) and nursing homes (n=276). We measured muscle mass, grip strength and gait speed and assessed how changes in cut-off points changed sarcopenia prevalence in both populations. An increase from 5.45 kg/m2 to 6.68 kg/m2 in the muscle mass index for female outpatients and nursing-home residents increased sarcopenia prevalence from 4% to 23% and from 9% to 47%, respectively; for men, for an increase from 7.25 kg/m2 to 8.87 kg/m2, the corresponding increases were from 1% to 22% and from 6% to 41%, respectively. Changes in gait speed and grip strength had a limited impact on sarcopenia prevalence. The cut-off points used for muscle mass affect the reported prevalence rates for sarcopenia and, in turn, affect comparability between studies. The main factors influencing the magnitude of the change are muscle mass index distribution in the population and the absolute value of the cut-off points: the same difference between two references (e.g., 7.5 kg/m2 to 7.75 kg/m2 or 7.75 kg/m2 to 8 kg/m2) may produce different changes in prevalence. Changes in cut-off points for gait speed and grip strength had a limited impact on sarcopenia prevalence and on study comparability.

Resumen Introduccion El objetivo principal del estudio es conocer la prevalencia de sarcopenia, segun criterios del European Working Group on Sarcopenia in Older People, en ancianos que viven en residencia. Metodos Estudio multicentrico en personas mayores de 70 capaces de caminar que viven en residencias. La composicion corporal se evaluo mediante bioimpedanciometria, la fuerza de prension con un dinamometro Jamar y la velocidad de la marcha sobre un recorrido de 4 m. La sarcopenia se evaluo utilizando los criterios del European Working Group on Sarcopenia in Older People (velocidad 2 en hombres o 2 en mujeres). Resultados Se incluyeron 276 personas (mediana de edad 87,2 anos; 69% mujeres), un 37% tenia sarcopenia (15% hombres, 46% mujeres), un 37% baja masa muscular, un 86% lentitud al caminar y un 95% debilidad muscular. La prevalencia de sarcopenia se incremento con la edad. El 90% de las personas con sarcopenia presentaban conjuntamente una disminucion de fuerza y velocidad. El 39% de personas con lentitud y el 38% de personas con debilidad muscular tenian sarcopenia. Conclusiones La presencia de sarcopenia es un problema frecuente en personas mayores que viven en residencias, especialmente en mujeres. La mayor parte de los casos son graves, con una disminucion concurrente de la fuerza muscular y de rendimiento fisico. Aunque la funcionalidad muscular esta alterada en 9 de cada 10 participantes, la mayoria de ellos tiene preservada la masa muscular.

Aims The aim of this study was to evaluate the prevalence, clinical features, and the independent impact of frailty—a geriatric syndrome characterized by the decline of physiological systems—and its components, on prognosis after heart failure (HF) hospitalization. Methods and results FRAIL-HF is a prospective cohort study including 450 non-dependent patients ≥70 years old hospitalized for HF. Frailty was screened according to the biological phenotype criteria (low physical activity, weight loss, slow walking speed, weak grip strength, and exhaustion). The independent influence of frailty on mortality, functional decline, and readmission risks was calculated adjusted for HF characteristics and co-morbidities. Mean age was 80 ± 6 years; 76% fulfilled frailty criteria. Frail patients were older, more often female, but showed no differences in chronic co-morbidities, LVEF, and NT-proBNP levels. Slow walking speed was the most discriminative component between frail (89.2%) and non-frail patients (26%). Overall, 1-year survival was 89% in the non-frail group and 75% in frail subjects (P = 0.003). After adjusting for age, gender, chronic and acute co-morbidities, NYHA, and NT-proBNP, frail patients showed higher risks for 30-day functional decline [odds ratio (OR) 2.20, 95% confidence interval (CI) 1.19–4.08], 1-year all-cause mortality [hazard ratio (HR) 2.13, 95% CI 1.07–4.23], and 1-year readmission (OR 1.96, 95% CI 1.14–3.34). The association of individual components with 1-year adjusted mortality risk was HR 2.14, 95% CI 1.05–4.39 for low physical activity and HR 1.77, 95% CI 0.95–3.29 for slow walking speed. Conclusion Frailty is highly prevalent even among non-dependent elderly HF patients, and is an independent predictor of early disability, long-term mortality, and readmission. Individual frailty components may be useful for risk prediction.

Societies are progressively aging, with the oldest old (i.e., those aged >80-85 years) being the most rapidly expanding population segment. However, advanced aging comes at a price, as it is associated with an increased incidence of the so-called age-related conditions, including a greater risk for loss of functional independence. How to combat sarcopenia, frailty, and overall intrinsic capacity decline in the elderly is a major challenge for modern medicine, and exercise appears to be a potential solution. In this article, we first summarize the physiological mechanisms underlying the age-related deterioration in intrinsic capacity, particularly regarding those phenotypes related to functional decline. The main methods available for the physical assessment of the oldest old are then described, and finally the multisystem benefits that exercise (or "exercise mimetics" in those situations in which volitional exercise is not feasible) can provide to this population segment are reviewed. In summary, lifetime physical exercise can help to attenuate the loss of many of the properties affected by aging, especially when the latter is accompanied by an inactive lifestyle and benefits can also be obtained in frail individuals who start exercising at an advanced age. Multicomponent programs combining mainly aerobic and resistance training should be included in the oldest old, particularly during disuse situations such as hospitalization. However, evidence is still needed to support the effectiveness of passive physical strategies including neuromuscular electrical stimulation or vibration for the prevention of disuse-induced negative adaptations in those oldest old people who are unable to do physical exercise. © 2019 American Physiological Society. Compr Physiol 9:1281-1304, 2019.

Clinical evaluation of elderly patients must include a comprehensive geriatric assessment. This is vital when deciding if a patient with a demonstrated critical disease should receive an active treatment, defined as the set of measures to treat an acute disease. The clinical outcomes are presented of four elderly patients who were admitted from the Emergency Department and whose severe acute diseases were treated with Comfort Measures Only. During their admission in the Geriatrics Acute Unit, and due to a reported clinical improvement, an active treatment was provided. All patients were discharge from the hospital after a favourable clinical course.

With the advent of low-cost 3D sensors and 3D printers, scene and object 3D surface reconstruction has become an important research topic in the last years. In this work, we propose an automatic (unsupervised) method for 3D surface reconstruction from raw unorganized point clouds acquired using low-cost 3D sensors. We have modified the growing neural gas network, which is a suitable model because of its flexibility, rapid adaptation and excellent quality of representation, to perform 3D surface reconstruction of different real-world objects and scenes. Some improvements have been made on the original algorithm considering colour and surface normal information of input data during the learning stage and creating complete triangular meshes instead of basic wire-frame representations. The proposed method is able to successfully create 3D faces online, whereas existing 3D reconstruction methods based on self-organizing maps required post-processing steps to close gaps and holes produced during the 3D reconstruction process. A set of quantitative and qualitative experiments were carried out to validate the proposed method. The method has been implemented and tested on real data, and has been found to be effective at reconstructing noisy point clouds obtained using low-cost 3D sensors. This work was partially funded by the Spanish Government DPI2013-40534-R Grant.

Sin financiación 4.899 JCR (2018) Q1, 6/53 Geriatrics & Gerontology 2.123 SJR (2018) Q1, 6/114 Geriatrics and Gerontology, 9/259 Health Policy, 139/2844 Medicine (miscellaneous), 2/152 Nursing (miscellaneous) No data IDR 2018 UEM

Forkhead box O3A (FOXOA3) and apolipoprotein E (APOE) are arguably the strongest gene candidates to influence human exceptional longevity (EL, i.e., being a centenarian), but inconsistency exists among cohorts. Epistasis, defined as the effect of one locus being dependent on the presence of 'modifier genes', may contribute to explain the missing heritability of complex phenotypes such as EL. We assessed the potential association of epistasis among candidate polymorphisms related to physical capacity, as well as antioxidant defense and cardiometabolic traits, and EL in the Japanese population. A total of 1565 individuals were studied, subdivided into 822 middle-aged controls and 743 centenarians. Results: We found a FOXOA3 rs2802292 T-allele-dependent association of fibronectin type III domain-containing 5 (FDNC5) rs16835198 with EL: the frequency of carriers of the FOXOA3 rs2802292 T-allele among individuals with the rs16835198 GG genotype was significantly higher in cases than in controls (P

Objective To estimate the incidence of musculoskeletal-related acute physical disability in the elderly (APDE). Methods A primary care–based registry was established in Madrid's Health Area 7 from October 1, 2005 to September 31, 2006. We included all persons age ≥65 years, who were non-institutionalized and covered by the health cards assigned to the participating general practitioners (GPs). A case of APDE was defined as a moderate mobility alteration in the disability level within the Rosser's Classification System, in the last 3 months, related to a musculoskeletal cause. Incidence rates (IRs) were estimated per 10,000 person-years by direct standardization with a 95% confidence interval (95% CI). Results Eight primary care centers and 23 GPs participated in the registry, covering 8,546 elderly patients. In the inclusion year, the GPs identified 147 new APDE cases in 106 patients. The annual estimated incidence of APDE was 331 cases per 10,000 person-years (95% CI 280–389) and the IR of new patients with an APDE episode was 239 (95% CI 196–288); the IR was higher in women (344 cases; 95% CI 279.8–423.0) than in men (207 cases; 95% CI 127.0–338.2). Conclusion The incidence estimate of acute physical disability related to musculoskeletal disorders in the elderly should help us to determine the magnitude of this health problem, as well as the first step to establishing a specific practice for the recovery of cases and for the prevention of loss of functioning, mobility, and independence.

The clinical scenario of heart failure (HF) in older hospitalized patients is complex and influenced by acute and chronic comorbidities, coexistent geriatric syndromes, the patient's ability for self-care after discharge, and degree of social support. The impact of all these factors on clinical outcomes or disability evolution is not sufficiently known. FRAIL-HF is a prospective observational cohort study designed to evaluate clinical outcomes (mortality and readmission), functional evolution, quality of life, and use of social resources at 1, 3, 6, and 12 months after admission in nondependent elderly patients hospitalized for HF. Clinical features, medical treatment, self-care ability, and health literacy were prospectively evaluated and a comprehensive geriatric assessment with special focus on frailty was systematically performed in hospital to assess interactions and relationships with postdischarge outcomes. Between May 2009 and May 2011, 450 consecutive patients with a mean age of 80 ± 6 years were enrolled. Comorbidity was high (mean Charlson index, 3.4 ± 2.9). Despite being nondependent, 118 (26%) had minor disability for basic activities of daily living, only 76 (16.2%) had no difficulty in walking 400 meters, and 340 (75.5%) were living alone or with another elderly person. In addition, 316 patients (70.2%) fulfilled frailty criteria. Even nondependent older patients hospitalized for HF show a high prevalence of clinical and nonclinical factors that may influence prognosis and are usually not considered in routine clinical practice. The results of FRAIL-HF will provide important information about the relationship between these factors and different postdischarge clinical, functional, and quality-of-life outcomes.