Errekuperazio funtzionaleko unitate bateko adinduetan minaren, nutrizio egoeraren eta ebaluazio geriatriko integraleko parametroen arteko erlazioa: errehabilitazioaren eraginaren eta gertakarien arrisku faktoreen analisia

278 p.Ebidentziaren arabera, errahabilitazio geriatrikoak, ospitalizazio akutua izan duten adinduetan onurak dituela erakutsi du. Hala ere, hobekuntzak aldagarriak izan daitezke pazientearen arabera. Beraz, ezinbestekoa da arrakasta baldintzatu dezaketen aldagaiak identifikatzea. Horien artean mina eta nutrizio egoera daude. Era berean, egonaldian zehar, pazienteek jasan dezaketen gertakariak (erorketak, ospitalizazioak¿) aurreikusten dituzten aldagaiak identifikatzea ezinbestekoa da, errehabilitazioa baldintzatu dezaketelako.Hori horrela, doktorego tesi honetan, errehabilitazio geriatrikoa burutzen zeuden adinduetan, ingresuko minak, minaren maneiuak parámetro ezberdinekin zuen lotura eta gertakariak aurreikusteko faktoreen analisia burutu da.Ondorio nagusienak, minaren intentsitateak, minaren maneiuak eta nutrizio egoerak, aldagai ezberdinakin zuen lotura antzeman dugu, eta erlazio hau desberdina izan da errehabilitazio ingresu arrazoiaren arabera. Era berean, gertakariak aurreikusteko aldagaiak, desberdinak izan dira ingresu arrazoiaren arabera. Hortaz, doktorego tesi honek, agerian uzten du, ingresu arrazoiaren arabera burutu beharreko estrategiak desberdinak izan beharko liratekeela, bai errehabilitazioaren eboluzioa hobetzeko edota gertakariak ekiditzeko

Incidence and prognosis of vascular complications after percutaneous placement of left ventricular assist device

OBJECTIVE: Mechanical assist devices have found an increasingly important role in high-risk interventional cardiac procedures. The Impella (Abiomed Inc, Danvers, Mass) is a percutaneous left ventricular assist device inserted through the femoral artery under fluoroscopic guidance and positioned in the left ventricular cavity. This study was undertaken to assess the incidence of vascular complications and associated morbidity and mortality that can occur with Impella placement. METHODS: We used a prospective database to review patients who underwent placement of an Impella left ventricular assist device in our tertiary referral center from July 2010 to December 2013. Patient demographics, comorbidities, interventional complications, and 30-day mortality were recorded. RESULTS: The study included 90 patients (60% male). Mean age was 66 years (range, 17-97 years). Hypertension was found in 69% of the patients, 37% were diabetic, 57% had a history of tobacco abuse, and 65% had chronic renal insufficiency. The median preprocedure cardiac ejection fraction was 30%. Most (87%) had undergone coronary artery intervention. Cardiogenic shock was documented in 67 patients (74%). The Impella was placed for an average of 1 day (range, 0-5 days). At least one vascular complication occurred in 15 patients (17%). Acute limb ischemia occurred in 12 patients; of whom four required an amputation and six required open or endovascular surgery. Other complications included groin hematomas and one pseudoaneurysm. All-patient 30-day mortality was 50%, which was not significantly associated with vascular complications. Female sex and cardiogenic shock at the time of insertion were associated with vascular complications (P = .043 and P = .018, respectfully). CONCLUSIONS: Vascular complications are common with placement of the Impella percutaneous left ventricular assist device (17%) and are related to emergency procedures. Vascular complications in this high-risk patient population frequently lead to withdrawal of care. These data provide quality improvement targets for left ventricular assist device programs

Nutritional Status Is Associated with Function, Physical Performance and Falls in Older Adults Admitted to Geriatric Rehabilitation: A Retrospective Cohort Study

Nutritional status is relevant to functional recovery in patients after an acute process requiring rehabilitation. Nevertheless, little is known about the impact of malnutrition on geriatric rehabilitation. This study aimed to determine the association between nutritional status at admission and the evolution of functional and physical outcomes, as well as the capability of nutritional status to identify fallers among patients admitted to geriatric rehabilitation for different reasons. This was a retrospective cohort study of 375 patients. Data collected included age, gender, diagnosis at admission, comorbidities, cognitive and nutritional status, functional and physical measurements, length of stay, mortality and falls. Orthogeriatric patients with worse nutritional status according to the Mini Nutritional Assessment-Short Form (MNA-SF) had a significantly lower Barthel Index at admission and discharge with worse functional gain and poorer outcomes in the Short Physical Performance Battery (SPPB). However, in hospital-deconditioned patients, the MNA-SF score was not significantly associated with functional and physical recovery. Poor nutritional status at admission increased the risk of experiencing at least one fall during rehabilitation in orthogeriatric patients. However, hospital-deconditioned patients who fell had better SPPB scores than those who did not fall. Our results demonstrate the importance of nutritional status in the clinical evolution of orthogeriatric patients throughout the rehabilitation process.This research was supported by the Basque Government (ELKARTEK 19/78; N°. EXPT: KK-2019/00047)

Malnutrition and Poor Physical Function Are Associated With Higher Comorbidity Index in Hospitalized Older Adults

BackgroundThe Charlson Comorbidity Index (CCI) is the most widely used method to measure comorbidity and predict mortality. There is no evidence whether malnutrition and/or poor physical function are associated with higher CCI in hospitalized patients. Therefore, this study aimed to (i) analyze the association between the CCI with nutritional status and with physical function of hospitalized older adults and (ii) examine the individual and combined associations of nutritional status and physical function of older inpatients with comorbidity risk. MethodsA total of 597 hospitalized older adults (84.3 +/- 6.8 years, 50.3% women) were assessed for CCI, nutritional status (the Mini Nutritional Assessment-Short Form [MNA-SF]), and physical function (handgrip strength and the Short Physical Performance Battery [SPPB]). ResultsBetter nutritional status (p < 0.05) and performance with handgrip strength and the SPPB were significantly associated with lower CCI scores among both men (p < 0.005) and women (p < 0.001). Patients with malnutrition or risk of malnutrition (OR: 2.165, 95% CI: 1.408-3.331, p < 0.001) as well as frailty (OR: 3.918, 95% CI: 2.326-6.600, p < 0.001) had significantly increased the risk for being at severe risk of comorbidity. Patients at risk of malnutrition or that are malnourished had higher CCI scores regardless of being fit or unfit according to handgrip strength (p for trend < 0.05), and patients classified as frail had higher CCI despite their nutritional status (p for trend < 0.001). ConclusionsThe current study reinforces the use of the MNA-SF and the SPPB in geriatric hospital patients as they might help to predict poor clinical outcomes and thus indirectly predict post-discharge mortality risk.This study was supported by the Basque Government (2016111138). MA was supported by a grant from the University of the Basque Country (PIF17/186) and IE was supported by a grant from the University of the Basque Country in collaboration with the University of Bordeaux (UBX) (PIFBUR16/07)

Determinants of Participation in a Post-Hospitalization Physical Exercise Program for Older Adults

Background: Older patients often experience a decline in physical function and cognitive status after hospitalization. Although interventions involving physical exercise are effective in improving functional performance, participation in physical exercise interventions among older individuals is low. We aimed to identify factors that contribute to exercise refusal among post-hospitalized older patients. Methods: A cross-sectional study of recruitment data from a randomized controlled trial was conducted involving 495 hospitalized people >= 70 years old. Sociodemographic and clinical data were obtained from the Basque Public Health System database. We determined physical function with the Short Physical Performance Battery (SPPB), nutritional status with the Mini-Nutritional Assessment, frailty according to the Fried phenotype criteria, and cognitive function with the Short Portable Mental Status Questionnaire (SPMSQ). Student's t, Mann-Whitney U, or chi-squared tests were applied for bivariate analysis. Parameters significantly associated with participation were introduced in a logistic multivariate regression model. Results: Among the analyzed patients, 88.8% declined participation in the physical exercise program. Multivariate regression revealed that older age (OR: 1.13; 95% CI: 1.07-1.19), poor nutritional status (OR: 0.81; 95% CI: 0.69-0.95), and reduced home accessibility (OR: 0.27; 95% CI: 0.08-0.94) were predictors of participation refusal. Moreover, patients who declined participation had worse performance on the SPPB (P < 0.05) and its tests of balance, leg strength, and walking speed (P < 0.05). No differences were found between groups in other variables. Conclusions: This study confirms low participation of older adults in a post-hospitalization physical exercise program. Non-participation was associated with increased age, poor nutritional status, and reduced home accessibility. Our findings support the need for intervention design that accounts for these factors to increase older patient participation in beneficial exercise programs.The study was funded by the Department of Education, Language Policy and Culture (2016111138) and a Programme Contract of the Department of Health, both departments of the Government of the Basque Country, which provided financial support during the research. The funders had no role in the study design, data collection and analysis and interpretation or writing the manuscript