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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/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.

Frailty reflects a state of decreased physiological reserve and vulnerability to stressors. Its prevalence among patients with cardiovascular disease is as high as 60%. Frailty is associated with a poor prognosis for patients with heart failure, increasingly frequent hospitalization, and death. The recent published listing criteria for heart transplantation of the International Society for Heart and Lung Transplantation recommend assessing frailty (class IIb recommendation, level of evidence C). However, this recommendation is not based on prospective studies, and frailty scores have only been validated in patients age > 65 years. The aim of the FELICITAR registry (Frailty Evaluation After List Inclusion, Characteristics and Influence on Transplantation and Results) is to assess the impact of frailty on prognosis before and after heart transplantation. A series of 100 patients from 3 Spanish centers will be included as soon as they are added to the national heart transplantation waiting list. Frailty will be evaluated again every 3 months until heart transplantation and at 3, 6, and 12 months thereafter. Depression, cognitive assessment, and quality of life also will be analyzed. The 2 primary endpoints are all‐cause mortality and prevalence of frailty assessed using the Fried frailty index. Results from this study may show that frailty is frequent in patients with advanced heart failure listed for heart transplantation and is associated with a poor prognosis both before and after surgery. The findings may contribute to a better understanding of the characteristics of the optimal candidate for heart transplantation. Grant 2017 of the Spanish Society of Cardiology, Heart Failure and Heart Transplantation Section Cátedra ASISA‐Universidad Europea de Madrid 2017/UEM31 2.455 JCR (2018) Q2, 67/136 Cardiac & Cardiovascular Systems 1.219 SJR (2018) Q1, 75/365 Cardiology and Cardiovascular Medicine, 389/2844 Medicine (miscellaneous) No data IDR 2018 UEM

Resumen Objetivo Conocer en la practica cual o cuales son los criterios considerados por los geriatras hospitalarios como los mas idoneos para seleccionar a los pacientes que mas se pueden beneficiar de la atencion geriatrica hospitalaria. Material y metodos Se elaboro una encuesta en la que se presentaron diversos criterios socio-demograficos, clinicos, funcionales y mentales incluidos en las definiciones de paciente geriatrico y anciano fragil. La encuesta se envio a todos los especialistas en Geriatria de los diferentes hospitales del Servicio Madrileno de Salud. Se les pidio que respondieran a cada criterio indicando si lo consideraban muy prioritario, prioritario, poco prioritario o nada prioritario. Las respuestas se agruparon segun el tipo de hospital (con docencia MIR, sin docencia MIR y hospitales de apoyo de media y larga estancia). Resultados Se recibieron un total de 83 encuestas (70% de la poblacion a estudio): 42 de hospitales con docencia MIR de Geriatria (74% de las posibles), 20 de aquellos con urgencias externas, pero sin docencia MIR (56% de las posibles) y 21 de hospitales de media y larga estancia (84% de las posibles). Todos los criterios propuestos fueron considerados individualmente como prioritarios o muy prioritarios por mas del 50% de los encuestados. La edad de 85 y mas anos, el ingreso por fractura de cadera, la presencia de deterioro funcional o cognitivo agudo, la fragilidad y el deterioro inexplicado del estado de salud fueron considerados de manera individual como criterios muy prioritarios para la seleccion de poblacion diana por mas del 85% de los encuestados. Conclusiones Determinados criterios como la edad muy avanzada o la presencia de procesos geriatricos especificos como fractura de cadera o deterioro funcional o cognitivo agudo, son identificados por los geriatras como utiles para seleccionar a los pacientes hospitalizados subsidiarios de recibir atencion geriatrica especializada.

Introduccion el ingreso hospitalario por enfermedad aguda supone para determinados ancianos de riesgo una perdida de autonomia no siempre relacionada con la enfermedad causante de dicha hospitalizacion. La importancia de este problema en nuestro medio sanitario, y si existen diferencias segun el servicio en que se produzca el ingreso, no se conocen suficientemente. Objetivo estudiar la incidencia de deterioro funcional, factores asociados y diferencias entre los servicios de medicina interna y geriatria, en ancianos hospitalizados por enfermedad aguda. Material y metodos estudio prospectivo de cohortes. Analizamos las caracteristicas sociodemograficas, la comorbilidad motivo de ingreso y gravedad, el uso de varias practicas hospitalarias, la tasa de mortalidad y de perdida funcional durante el ingreso. Se definio deterioro funcional como la perdida de autonomia para al menos una de las actividades basicas de la vida diaria, con respecto a la situacion previa al ingreso. La influencia del servicio se analizo mediante un modelo de regresion logistica multiple. Resultados estudiamos a 379 pacientes (140 en el servicio de geriatria [SG] y 239 en medicina interna [MI]). Los pacientes ingresados en SG eran mayores (87 frente a 81,5 anos; p 48 h, el uso de psicofarmacos y sujeciones o de medicacion nocturna se asociaron a deterioro funcional. En el analisis multivariable, el ingreso en MI se asocio a mayor riesgo de deterioro funcional. Conclusiones el deterioro funcional durante la hospitalizacion es frecuente en los pacientes fragiles. Determinados factores asociados con la practica clinica y, por tanto, modificables se asocian a ese deterioro. El ingreso de estos pacientes en el SG conlleva menor perdida de autonomia que su ingreso en MI.

In some elderly individuals, hospital admission for acute illness represents a possible loss of autonomy not always related to the reason for hospitalization. The importance of this problem and the possible existence of differences among services are not sufficiently well known.To compare the incidence of functional decline and associated risk factors during hospitalization between an acute care geriatric unit (GU) and an internal medicine (IM) ward.We performed a prospective, cohort study. Sociodemographic characteristics, comorbidity, cause of admission, severity, use of several hospital practices, mortality rate and functional decline were analyzed. Functional decline was defined as the loss of independence to perform at least one of the basic activities of daily living with respect to preadmission status. The influence of the admitting service was evaluated by a multiple logistic regression model.A total of 379 patients were included (140 in the GU and 239 in IM). Compared with IM, patients in the GU were older (87 vs 81.5; P.001), had a greater prevalence of dementia and visual alterations and worse previous functional status. The proportion of patients who spent48 hours in bed and who received nocturnal medication was lower in the GU. The functional decline rate was greater in IM than in the GU (60.2% vs 48%; P=.04). Length of hospital stay was similar in both groups (7.7 vs 8.1 days; P=.37). Functional decline was associated with age, delirium, lack of mobilization, bed rest for48 h, psychotropic drugs, nocturnal medication and physical restraints. In the multivariate analysis, admission to IM was associated with a greater risk of functional decline.Functional decline during hospitalization for acute diseases is frequent among frail patients. Many modifiable clinical practices are associated with this complication. In patients at risk of delirium, admission to geriatric wards may be associated with less functional deterioration than admission to internal medicine wards.