Fragilidad en ancianos descendientes de longevos: un estudio de casos y controles emparejados

INTRODUCCIÓN: La longevidad humana es un fenotipo complejo influenciado por múltiples determinantes. La fragilidad, un síndrome geriátrico consolidado cuya heredabilidad no está bien establecida, ocupa un lugar preeminente entre ellos. Estudios previos demuestran que los descendientes de progenitores con longevidad extraordinaria, 97 o más años, presentan menor mortalidad, mejor perfil en el proceso de envejecimiento y pueden ser un buen modelo de estudio. Sin embargo ningún estudio ha encontrado de forma concluyente resultados en sarcopenia y fragilidad METODOLOGÍA: Estudio de casos y controles emparejado por edad, género, lugar de nacimiento y residencia, realizado en el Departamento de Salud de La Ribera, de la Comunidad Valenciana, entre el 9 de marzo de 2015 y el 6 de febrero de 2017. Los casos debían tener un progenitor vivo de 97 o más años de edad, tener entre 65 y 80 años, residir en la comunidad, y ser natural y residente habitual en el departamento de salud. Los controles, sin el antecedente de longevidad parental, debían ser del mismo género, la misma edad (5 años) y residir en la misma localidad que el caso con el que se emparejaba. Este estudio se realizó siguiendo las recomendaciones de las guías STROBE. Se analizaron diferencias en fragilidad y sus componentes (según los criterios de Fried), sarcopenia según los criterios europeos (masa muscular medida por bioimpedancia eléctrica), comorbilidad, así como otras variables sociodemográficas, clínicas, funcionales y analíticas. Se emplearon pruebas no paramétricas para muestras relacionadas con el programa SPSS versión 21. RESULTADOS: La muestra obtenida se compuso de 176 sujetos, 88 casos y 88 controles. El 60,2% fueron mujeres. La edad media fue de 70,0 (DE 3,9) años. El antecedente de longevidad extraordinaria se asoció de forma significativa con menor fragilidad, OR= 0,27 (IC95% 0,09-0,76), mayor robustez, OR= 3,33 (IC95% 1,38-8,06). No se II encontraron diferencias significativas en sarcopenia. Los casos también presentaron de forma significativa; mejor nivel formativo, menor percepción de disnea con el esfuerzo, menor prevalencia de obesidad, menor cociente Ldl/ApoB, niveles menores de IL-6 y mayores de SHBG y menor prevalencia de síndromes geriátricos como el dolor, insomnio, polifarmacia y comorbilidad. Así como una tendencia a menor índice de Charlson y menor resistencia a la insulina que resultó significativa a partir de los 70 años. CONCLUSIONES: En nuestro estudio los ancianos con antecedentes parentales de longevidad extraordinaria fueron más robustos, menos frágiles y tuvieron menos síndromes geriátricos que sus controles de la misma edad, género y lugar de nacimiento. Sería conveniente confirmar estos resultados con estudios más amplios que ampliaran las determinaciones a marcadores genéticos y de estrés oxidativo.MedicinaCiencias de la Salu

Early interdisciplinary hospital intervention for elderly patients with hip fractures – functional outcome and mortality

OBJECTIVES: Hip fractures are associated with high levels of co-morbidity and mortality. Orthogeriatric units have been shown to be effective with respect to functional recovery and mortality reduction. The aim of this study is to document the natural history of early multidisciplinary intervention in elderly patients with hip fractures and to establish the prognostic factors of mortality and walking ability after discharge. METHODS: This observational, retrospective study was performed in an orthogeriatric care unit on patients aged >70 years with a diagnosis of hip fracture between 2004 and 2008. This study included 1363 patients with a mean age of 82.7 + 6.4 years. RESULTS: On admission to the unit, the average Barthel score of these patients was 77.2 + 27.8 points, and the average Charlson index score was 2.14 + 2.05. The mean length of stay was 8.9 + 4.26 days, and the readmission rate was 2.3%. The in-hospital mortality rate was 4.7%, and the mortality rates at one, six, and 12 months after discharge were 8.7%, 16.9%, and 25.9%, respectively. The Cox proportional hazards model estimated that male sex, Barthel scale, heart failure, and cognitive impairment were associated with an increased risk of death. With regard to functionality, 63.7% of the patients were able to walk at the time of discharge, whereas 77.4% and 80.1% were able to walk at one month and six months post-discharge, respectively. The factors associated with a worse functional recovery included cognitive impairment, performance status, age, stroke, Charlson score, and delirium during the hospital stay. CONCLUSIONS: Early multidisciplinary intervention appears to be effective for the management of hip fracture. Age, male sex, baseline function, cognitive impairment and previous comorbidities are associated with a higher mortality rate and worse functional recovery

Validation of score in mna scale like nutritional risk factor in institutionalized geriatric patients with moderate and severe cognitive impairment

Introducción: La valoración geriátrica integral incluye el examen del apartado nutricional debido a la alta prevalencia de desnutrición en este tipo de pacientes; especialmente en los pacientes con deterioro cognitivo asociado. Las escalas de cribado del estado nutricional presentan preguntas de autopercepción subjetiva de difícil respuesta en pacientes mayores con demencia. Objetivo: Estudiar la especificidad, el valor predictivo positivo y la sensibilidad de la escala MNA para la detección de malnutrición en pacientes diagnosticados de enfermedad de Alzheimer con deterioro cognitivo avanzado. Material y métodos: Se diseñó un estudio descriptivo poblacional con una muestra de 52 pacientes mayores de 70 años, institucionalizados, con enfermedad de Alzheimer grado moderado y severo. Se estudió la sensibilidad, especificidad y valor predictivo positivo de la escala MNA respecto a los parámetros de malnutrición del American Institute of Nutrition (AIN). Resultados: Los valores de sensibilidad, especificidad y valor predictivo positivo son 60%, 94,7% y 93,8% respectivamente. Existe una correlación significativa (p < 0,001) ente la puntuación obtenida en la escala MNA y la escala de riesgo de caídas Tinneti (r = 0,577), de función Barthel (r = 0,742), de valoración cognitiva MEC (r = 0,651) y los niveles de creatinina (r = 0,402). Más del 50% de la muestra presentó al menos un parámetro de malnutrición AIN alterado. Conclusiones: La escala MNA presenta una menor sensibilidad y especificidad en estos pacientes. El diseño de una escala de valoración nutricional sin valoraciones subjetivas y sólo con parámetros objetivos podría mejorar la eficacia de la misma en ancianos institucionalizados con deterioro cognitivo moderado y severo.Introduction: comprehensive geriatric assessment includes examination of the nutritional status given the high prevalence of hyponutrition in this kind of patients, particularly in patients with associated cognitive impairment. Scales for screening the nutritional status include questions on self-perception difficult to answer by demented elder patients. Objective: To study the specificity, the positive predictive value, and the sensitivity of the MNA scale to detect malnutrition in patients diagnosed with Alzheimer’s disease with advanced cognitive impairment. Material and methods: a population-based descriptive study with a sample of 52 patients older than 70 years, institutionalized, and with moderate-severe Alzheimer’s disease was designed. The sensitivity, specificity, and positive predictive value of MNA scale were studied regarding the parameters on malnutrition of the American Institute of Nutrition (AIN). Results: the sensitivity, specificity, and positive predictive values were 60%, 94.7%, and 93.8%, respectively. There was a significant correlation (p < 0.001) between the score obtained with the MNA Scale and the Tinneti’s Risk of Fall Scale (r = 0.577), the Barthel’s function (r = 0.742), the MCT cognitive assessment (r = 0.651), and creatinine levels (r = 0.402). More than 50% of the sample presented at least one malnutrition parameter altered. Conclusions: the MNA Scale presents lower sensitivity and specificity in these patients. Designing a nutritional assessment scale without subjective evaluations and only with objective parameters might improve its efficiency in institutionalized elderly patients with moderate-severe cognitive impairment.Nutrición humana y dietétic

Respiratory Complications Are the Main Predictors of 1-Year Mortality in Patients with Hip Fractures: The Results from the Alzira Retrospective Cohort Study

Resumen: Introducción: Las fracturas de cadera representan un desafío importante para las personas mayores dada su Alta incidencia y tasa de mortalidad a un año. El objetivo de este estudio fue identificar las principales predictores de mortalidad a un año en adultos mayores hospitalizados por fracturas de cadera. Métodos: Realizamos un estudio de cohorte retrospectivo en el que participaron adultos de 70 años o más que ingresaron en el hospital para fracturas de cadera por fragilidad entre el 1 de enero de 2014 y el 31 de diciembre de 2021. Un total de 3229 pacientes fueron reclutados, y 846 (26,2%) experimentaron mortalidad al año. Resultados: complicaciones respiratorias (HR 2,42, IC 95% 1,42–4,14; p = 0,001) fueron los predictores más significativos de mortalidad a un año, seguido del reingreso hospitalario (HR 1,96, IC 95% 1,66-2,32; p < 0,001), el sexo masculino (HR 1,88, IC 95% 1,46–2,32; p < 0,001), complicaciones cardíacas (HR 1,88, IC 95% 1,46-2,32; p < 0,001) y un diagnóstico de demencia al ingreso (HR 1,37, IC95% 1,13-1,66; p = 0,001). El índice Charlson y el índice americano El sistema de clasificación del estado físico de la Sociedad de Anestesiólogos también aumentó significativamente el riesgo de mortalidad. Por el contrario, niveles más altos de hemoglobina al ingreso y albúmina elevada al alta. redujo significativamente el riesgo de mortalidad. Conclusiones: La tasa de mortalidad a un año es sustancial. en adultos mayores con fracturas de cadera que ingresan en una unidad de ortogeriatría. La Apropiada Manejo de la anemia, los trastornos nutricionales y la comorbilidad al ingreso y durante el seguimiento. podría potencialmente mitigar la mortalidad a largo plazo después de fracturas de cadera. Palabras clave: fractura de cadera; adultos mayores; Mortalidad a 1 año; factores de riesgo; atención ortogeriátrica; fragilidad fracturasQ2Q2Abstract: Introduction: Hip fractures pose a significant challenge for older individuals given their high incidence and one-year mortality rate. The objective of this study was to identify the primary predictors of one-year mortality in older adults hospitalized for hip fractures. Methods: We conducted a retrospective cohort study involving adults aged 70 years or older who were admitted to the hospital for fragility hip fractures between 1 January 2014 and 31 December 2021. A total of 3229 patients were recruited, with 846 (26.2%) experiencing one-year mortality. Results: Respiratory complications (HR 2.42, 95%CI 1.42–4.14; p = 0.001) were the most significant predictors of one-year mortality, followed by hospital readmission (HR 1.96, 95%CI 1.66–2.32; p < 0.001), the male sex (HR 1.88, 95%CI 1.46–2.32; p < 0.001), cardiac complications (HR 1.88, 95%CI 1.46–2.32; p < 0.001), and a diagnosis of dementia at admission (HR 1.37, 95%CI 1.13–1.66; p = 0.001). The Charlson Index and the American Society of Anesthesiologists physical status classification system also significantly increased the mortality risk. Conversely, higher hemoglobin levels at admission and elevated albumin at discharge significantly reduced the mortality risk. Conclusions: The one-year mortality rate is substantial in older adults with hip fractures who are admitted to an orthogeriatric unit. The appropriate management of anemia, nutritional disorders, and comorbidity at admission and during the followup could potentially mitigate long-term mortality after hip fractures. Keywords: hip fracture; older adults; 1-year mortality; risk factors; orthogeriatric care; fragility fractureshttps://orcid.org/0000-0001-5832-0603https://scholar.google.com/citations?user=MrICwaMAAAAJ&hl=enhttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001429659Revista Internacional - IndexadaS

A daily multidisciplinary assessment of older adults undergoing elective colorectal cancer surgery is associated with reduced delirium and geriatric syndromes

Objectives Comprehensive geriatric assessment (CGA) has shown to benefit older patients undergoing urological and orthopedic surgery. However, this approach has been scarcely assessed in patients elected for colorectal surgery. Materials and Methods Retrospective cohort of patients aged ≥70 years admitted for elective colorectal cancer surgery to a single hospital between 2008 and 2012. Upon admission, patients were assigned to a usual care (UC) plan or a CGA-based care (GS) plan conducted by a multidisciplinary team, according to standard clinical criteria.Analyzed outcomes included the incidence of delirium and other geriatric syndromes during hospital stay, mortality, readmissions, andnumber of perioperative complications. Results The cohort included 310 patients, 203 assigned to the GS group and 107 to the UC group. Patients in the GS group had significantly lower Barthel and Lawton scores, higher prevalence of dementia and heart failure, and higher comorbidity burden. Fifty-four (17.5%) patientsexperienced delirium (23 [11.3%] and 31 [29.2%] in the GS and UC groups, respectively; p < .001), and 49 (15.8%) patient experienced other geriatric syndromes (21 [10.3%] and 28 [26.2%] in the GS and UC groups, respectively; p < .001). Serious complications were more frequent in the GS group: 154 (75.9%) vs 60 (56.1%) in the UC group; p < .001. No significant differences were observed between groups regarding readmissions, and in-hospital and post-discharge (1 year follow-up) mortality. Conclusions Despite the poorer clinical condition of patients in the GS group, the CGA-based intervention resulted in a lower incidence of delirium and other geriatric syndromes compared with the UC group.Fisioterapi

Malnutrition and Increased Risk of Adverse Outcomes in Elderly Patients Undergoing Elective Colorectal Cancer Surgery: A Case-Control Study Nested in a Cohort

Background: Malnutrition increases worse outcomes during hospital admission for elective colorectal cancer (CRC) surgery in older adults. Methods: This work was designed an observational, monocentric, case-control study nested in a cohort of patients undergoing elective surgery for CRC disease at the Hospital Universitario de la Ribera (HULR) (Alzira, Valencia, Spain) between 2011 and 2019. The study considered patients with a CONUT score in the range of moderate to severe malnutrition (>4 points), with control patients with normal nutritional situations or mild malnutrition. Results: Moderate-to-severe malnutrition cases presented a greater length of stay (LOS), a higher incidence of adverse events (both medical and surgical complications), a higher incidence of surgical-wound infection, a greater need for blood transfusion, and a greater amount of transfused packed red blood cells. During hospitalization, the percentage of patients without nutritional risk decreased from 46 to 9%, and an increase in mild, moderate, and severe risk was observed. Patients with severe nutritional risk at hospital admission had significantly increased mortality at 365 days after discharge (HR: 2.96 (95% CI 1.14–7.70, p = 0.002)). After adjusting for sex, age, and Charlson index score, patients with severe nutritional risk at admission maintained a higher mortality risk (HR: 3.08 (95% CI 1.10–8.63, p = 0.032)). Conclusion: Malnutrition prevalence is high in older adults undergoing CRC elective surgery. Furthermore, this prevalence increases during hospital admission. Malnutrition is linked to worse outcomes, such as LOS, surgical and clinical complications, and mortality. For this reason, nutritional interventions are very important in the perioperative perio

Severity of cognitive impairment as a prognostic factor for mortality and functional recovery of geriatric patients with hip fracture

Aim To identify how the severity of dementia influences functional recovery and mortality in elderly patients hospitalized for hip fracture. Methods An observational retrospective study of 1258 patients aged older than 69 years and diagnosed with hip fracture who received care within an orthogeriatrics unit from 2004 to 2008 was carried out. During a 12‐month follow‐up period, functional recovery and mortality outcomes were measured. Results Dementia was present in 383 (28.1%) patients: it was mild in 183 (48%), moderate in 102 (26.5%) and severe in 98 (25.5%). Compared with patients with preserved cognitive status, patients with dementia had the following statistically significant differences (means [standard deviation] or percentage): older age (preserved, 82.29 years [6.5 years]; mild, 83.63 years [6.1 years]; moderate, 83.47 years [5.9 years]; severe, 84.46 years [6.1 years]; P < 0.001); lower Barthel Index (89.7 [21.6], 72.7 [24.6], 58.9 [28.6], 38.0 [28.1]; P < 0.001); delirium (11.7%, 25.6%, 37.6%, 44.7%; P < 0.001); less ambulation at 6 months postdischarge (83.9%, 72.8%, 56.9%, 41.7%; P < 0.001); and higher mortality at discharge (4%, 5.7%, 8.2%, 10.6%; P < 0.001) and 12 months after discharge (21.2%, 32.3%, 46.3%, 53.5%; P < 0.001). Patients with severe dementia had lower probability of functional recovery at discharge (OR 0.272, 95% CI 0.140–0.526, P < 0.001) and 6 months after discharge (OR 0.439, 95% CI 0.197–0.979, P = 0.04), as well as a greater probability of dying (HR 1.640, 95% CI 1.020–2.635, P = 0.04). Conclusions We observed higher 12‐month mortality and less functional recovery with increasing severity of dementia.Medicin