Toxicity in the Elderly from the Perspective of Oncogeriatrics and Palliative Care. Part 1

El cáncer es una enfermedad crónica no transmisible, cuya prevalencia va en aumento debido al envejecimiento poblacional. Aproximadamente, el 50% de los diagnósticos nuevos de cáncer ocurren en población mayor de 65 años. Se ha identificado la edad como factor de riesgo para cáncer. Dada la evidencia limitada frente a esquemas de tratamiento respecto a quimioterapia, radioterapia e inmunoterapia en el adulto mayor, se han evidenciado desenlaces adversos derivados de la toxicidad en sistemas como tegumentario, cardiovascular, renal o neurológico, que repercuten en la adherencia al tratamiento y la calidad de vida de los pacientes. En esta primera publicación de la serie de dos para los médicos no oncólogos se tiene como objetivo describir de forma puntual los diversos tipos de toxicidad, para brindar herramientas de detección temprana de síntomas asociados con toxicidad. Palabras clave: geriatría, anciano, toxicidad aguda, toxicidad crónica, quimioterapia, radioterapia, inmunoterapia.Cancer is a chronic non-communicable disease, whose prevalence is increasing due to population aging. Approximately 50% of new cancer diagnoses occur in the population over 65 years of age, thus age is identified as a risk factor. Given the limited evidence regarding treatment schemes for chemotherapy, radiotherapy and immunotherapy in the elderly, adverse outcomes derived from toxicity in systems such as: integumentary, cardiovascular, renal or neurological have an impact in the adherence to treatment and quality of life of patients. However, these scales have not been validated in Colombia. In this first publication of the series of two publications, the objective is to describe the different types of toxicity to non-oncologists in order to provide tools for early detection of symptoms associated with toxicity secondary to treatment with chemotherapy, radiotherapy and immunotherapy in older adult patients. Keywords: geriatrics, aged, acute toxicity, chronic Toxicity, chemotherapy, radiotherapy, immunotherapy.https://orcid.org/0000-0002-7681-0355https://scholar.google.com/citations?hl=es&user=mfH6dEoAAAAJ&view_op=list_works&sortby=pubdatehttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001394336Revista Nacional - IndexadaA1S

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Factores asociados al deterioro funcional hospitalario en pacientes mayores de 65 años ingresados al hospital universitario San Ignacio en el periodo establecido entre el 1 de diciembre de 2015 hasta el 31 de diciembre de 2017

Introducción: Entendiendo el deterioro funcional hospitalario (DFH) como la pérdida de la capacidad para realizar al menos una actividad básica de la vida diaria (ABVD) en el momento del alta respecto a la situación basal, comprendida ésta como dos semanas antes del inicio de la enfermedad aguda. Existen factores propios del individuo y otros relacionados con la hospitalización que predisponen al individuo a presentar DFH, que repercuten en las altas tasas de reingresos hospitalarios, institucionalización y aumento de la mortalidad. Objetivo: Estimar los factores que predicen el desarrollo de deterioro funcional hospitalario en pacientes adultos mayores de 65 años hospitalizados por la unidad de geriatría en el Hospital Universitario San Ignacio en el periodo establecido entre el 1 de diciembre de 2015 hasta el 31 de diciembre de 2017. Materiales y Métodos: Estudio descriptivo de corte transversal de una cohorte hospitalaria de diciembre de 2015 al 31 de diciembre de 2017. Se llevó a cabo el análisis univariado y multivariado y los cálculos se ajustaron usando el programa STATA. Resultados: Se incluyeron 1055 personas. La prevalencia de DFH fue 41,14%, la edad promedio fue 85,58 años y el Barthel promedio previo al ingreso era de 59. Los tres principales factores de asociados al desarrollo de DFH en la población anciana que consulta a HUSI fueron tiempo de estancia hospitalaria [OR 1,88 IC95%(1,41-2,49) P<0,0001], la malnutrición [OR 1,59 IC95%(1,16-2,19) P=0,004] y el delirium [OR 2,38 IC95%(1,83-3,10) P=<0,001]. Conclusión: El DFH es una condición altamente prevalente en la población geriátrica en nuestra población, los factores asociados a su desarrollo son el tiempo de estancia intrahospitalaria, la malnutrición y el delirium.Introduction: Understanding functional hospital deterioration (HFD) as the loss of the capacity to perform at least one basic activity of daily life (BADL) at the time of hospital discharge respect to the baseline situation, understood as two weeks before the start of the acute disease. There are individual specific factors and others related to hospitalization that predispose the person to present functional hospital deterioration, which have an impact on the high rates of hospital readmissions, institutionalization and increased mortality. Objective: To estimate the factors that predict the development of hospital functional deterioration in adult patients older than 65 years hospitalized by the geriatric unit at the San Ignacio University Hospital in the period established between December 1, 2015 and December 31, 2017. Materials and Methods: Descriptive cross-sectional study of a hospital cohort from December 2015 to December 31, 2017. The univariate and multivariate analysis was carried out and the calculations were adjusted using the STATA program. Results: 1055 people were included. The prevalence of functional hospital deterioration was 41.14%, the average age was 85.58 years and the average Barthel prior to admission was 59. The three main factors associated with the development of functional hospital deterioration in the elderly population that consulted to San Ignacio University Hospital were: hospital stay [OR 1.88 IC95% (1.41-2.49) P <0.0001], malnutrition [OR 1.59 IC95% (1.16-2.19) P = 0.004] and delirium [OR 2.38 IC95% (1.83-3.10) P = <0.001]. Conclusion: The functional hospital deterioration is a highly prevalent condition in the geriatric population in our population, the factors associated with its development are the length of stay in hospital, malnutrition and delirium.Especialista en GeriatríaEspecializació

Prevalence of Hospital Functional Impairment in a Colombian Elderly Population at the San Ignacio University Hospital

Introduction: Functional decline following hospitalization (FDH) is defined as the loss of the functional capacity to perform at least one basic activity of daily life (BADL) when being discharged from hospital; a situation compared to functional capacity performed in the last couple of weeks, prior the acute disease. This impairment is precipitated in the elderly by factors such as aging, architectural conditions, malnutrition, hospital routines and physical restraints. The objective of this study is determining the prevalence of functional impairment in adults over 65 years of age hospitalized in the San Ignacio University Hospital (SIUH) and its associated factors. Materials and Methods: A descriptive cross-sectional study of a hospital cohort was carried out from December 1st 2015 to December 31st 2017. Univariate and multivariate analyses were performed to identify associated variables. Results: 1055 people were included,with fdh prevalence of 41.14 %. The three main factors associated with the development of fdh in the elderly population that consulted the siuh were time of hospital stay [or 1.88, CI95% (1.41-2.49), p = <0.0001], malnutrition [or 1.59, CI95 % (1.16-2.19), p = 0.004] and delirium [or 2.38, CI95 % (1.83-3.10), p = <0.001]. Conclusion: FDH is a highly prevalent condition in the geriatric population hospitalized in the San Ignacio University Hospital, where length of stay, malnutrition and delirium are the factors associated with its disease onset.Introdução: o deterioro funcional hospitalar define-se como a perda da capacidade para realizar pelo menos uma atividade básica da vida diária (ABVD) no momento da alta médica respeito à situação funcional duas semanas prévias ao início da doença aguda. Dita situação e precipitada nos idosos por fatores como o envelhecimento, as condições arquitetônicas, a subnutrição, rutinas hospitalares e restrições físicas. O presente estudo busca determinar a prevalência de deterioro funcional em idosos de 65 anos hospitalizados no Hospital Universitário San Ignacio (HUSI) e seus fatores associados. Materiais e métodos: se realizou um estudo descritivo de corte transversal de uma coorte hospitalar de dezembro de 2015 ao 31 de dezembro de 2017; se realizou uma análise univariada e multivariada para identificar variáveis associadas. Resultados: se incluíram 1055 pessoas, com uma prevalência de DFH do 41,14 %. Os três principais fatores associados ao desenvolvimento de DFH na população idosa que consulta ao HUSI foram tempo de permanência hospitalar [or 1,88, CI95% (1,41-2,49), p = <0,0001], a subnutrição [or 1,59, CI95% (1,16-2,19), p = 0,004] e o delirium [or 2,38, CI95% (1,83-3,10), p = <0,001]. Conclusão: o DFH é uma condição altamente prevalente na população geriátrica hospitalizada no Hospital Universitário San Ignacio sendo o tempo de permanência intra-hospitalar, a subnutrição e o delirium fatores associados à sua aparição.Introducción: el deterioro funcional hospitalario (DFH) se define como la pérdida de la capacidad para realizar al menos una actividad básica de la vida diaria (ABVD) en el momento del alta respecto a la situación funcional dos semanas previas al inicio de la enfermedad aguda; dicha situación es precipitada en los ancianos por factores como el envejecimiento, las condiciones arquitectónicas, la desnutrición, las rutinas hospitalarias y las restricciones físicas. El presente estudio busca determinar la prevalencia de deterioro funcional en adultos mayores de 65 años hospitalizados en el Hospital Universitario San Ignacio (HUSI) y sus factores asociados. Materiales y métodos: se realizó un estudio descriptivo de corte transversal de una cohorte hospitalaria de diciembre de 2015 al 31 de diciembre de 2017; se llevó a cabo un análisis univariado y multivariado para identificar variables asociadas. Resultados: se incluyeron 1055 personas, con una prevalencia de DFH del 41,14 %. Los tres principales factores asociados al desarrollo de dfh en la población anciana que consulta al husi fueron tiempo de estancia hospitalaria [or 1,88, CI95% (1,41-2,49), p = <0,0001], malnutrición [or 1,59, CI95 % (1,16-2,19), p = 0,004] y delirium [or 2,38, CI95 % (1,83-3,10), p = <0,001]. Conclusión: el DFH es una condición altamente prevalente en la población geriátrica hospitalizada en el Hospital Universitario San Ignacio, siendo el tiempo de estancia intrahospitalaria, la malnutrición y el delirium factores asociados a su aparición

Prevalência de deterioro funcional hospitalar em uma população colombiana de idosos no Hospital Universitário San Ignacio

Introducción: el deterioro funcional hospitalario (DFH) se define como la pérdida de la capacidad para realizar al menos una actividad básica de la vida diaria (ABVD) en el momento del alta respecto a la situación funcional dos semanas previas al inicio de la enfermedad aguda; dicha situación es precipitada en los ancianos por factores como el envejecimiento, las condiciones arquitectónicas, la desnutrición, las rutinas hospitalarias y las restricciones físicas. El presente estudio busca determinar la prevalencia de deterioro funcional en adultos mayores de 65 años hospitalizados en el Hospital Universitario San Ignacio (HUSI) y sus factores asociados. Materiales y métodos: se realizó un estudio descriptivo de corte transversal de una cohorte hospitalaria de diciembre de 2015 al 31 de diciembre de 2017; se llevó a cabo un análisis univariado y multivariado para identificar variables asociadas. Resultados: se incluyeron 1055 personas, con una prevalencia de DFH del 41,14 %. Los tres principales factores asociados al desarrollo de dfh en la población anciana que consulta al husi fueron tiempo de estancia hospitalaria [or 1,88, CI95% (1,41-2,49), p = <0,0001], malnutrición [or 1,59, CI95 % (1,16-2,19), p = 0,004] y delirium [or 2,38, CI95 % (1,83-3,10), p = <0,001]. Conclusión: el DFH es una condición altamente prevalente en la población geriátrica hospitalizada en el Hospital Universitario San Ignacio, siendo el tiempo de estancia intrahospitalaria, la malnutrición y el delirium factores asociados a su aparición.Introduction: Functional decline following hospitalization (FDH) is defined as the loss of the functional capacity to perform at least one basic activity of daily life (BADL) when being discharged from hospital; a situation compared to functional capacity performed in the last couple of weeks, prior the acute disease. This impairment is precipitated in the elderly by factors such as aging, architectural conditions, malnutrition, hospital routines and physical restraints. The objective of this study is determining the prevalence of functional impairment in adults over 65 years of age hospitalized in the San Ignacio University Hospital (SIUH) and its associated factors. Materials and Methods: A descriptive cross-sectional study of a hospital cohort was carried out from December 1st 2015 to December 31st 2017. Univariate and multivariate analyses were performed to identify associated variables. Results: 1055 people were included,with fdh prevalence of 41.14 %. The three main factors associated with the development of fdh in the elderly population that consulted the siuh were time of hospital stay [or 1.88, CI95% (1.41-2.49), p = <0.0001], malnutrition [or 1.59, CI95 % (1.16-2.19), p = 0.004] and delirium [or 2.38, CI95 % (1.83-3.10), p = <0.001]. Conclusion: FDH is a highly prevalent condition in the geriatric population hospitalized in the San Ignacio University Hospital, where length of stay, malnutrition and delirium are the factors associated with its disease onset

Prevalência de deterioro funcional hospitalar em uma população colombiana de idosos no Hospital Universitário San Ignacio

Introduction: Functional decline following hospitalization (FDH) is defined as the loss of the functional capacity to perform at least one basic activity of daily life (BADL) when being discharged from hospital; a situation compared to functional capacity performed in the last couple of weeks, prior the acute disease. This impairment is precipitated in the elderly by factors such as aging, architectural conditions, malnutrition, hospital routines and physical restraints. The objective of this study is determining the prevalence of functional impairment in adults over 65 years of age hospitalized in the San Ignacio University Hospital (SIUH) and its associated factors. Materials and Methods: A descriptive cross-sectional study of a hospital cohort was carried out from December 1st 2015 to December 31st 2017. Univariate and multivariate analyses were performed to identify associated variables. Results: 1055 people were included,with fdh prevalence of 41.14 %. The three main factors associated with the development of fdh in the elderly population that consulted the siuh were time of hospital stay [or 1.88, CI95% (1.41-2.49), p = <0.0001], malnutrition [or 1.59, CI95 % (1.16-2.19), p = 0.004] and delirium [or 2.38, CI95 % (1.83-3.10), p = <0.001]. Conclusion: FDH is a highly prevalent condition in the geriatric population hospitalized in the San Ignacio University Hospital, where length of stay, malnutrition and delirium are the factors associated with its disease onset.Introducción: el deterioro funcional hospitalario (DFH) se define como la pérdida de la capacidad para realizar al menos una actividad básica de la vida diaria (ABVD) en el momento del alta respecto a la situación funcional dos semanas previas al inicio de la enfermedad aguda; dicha situación es precipitada en los ancianos por factores como el envejecimiento, las condiciones arquitectónicas, la desnutrición, las rutinas hospitalarias y las restricciones físicas. El presente estudio busca determinar la prevalencia de deterioro funcional en adultos mayores de 65 años hospitalizados en el Hospital Universitario San Ignacio (HUSI) y sus factores asociados. Materiales y métodos: se realizó un estudio descriptivo de corte transversal de una cohorte hospitalaria de diciembre de 2015 al 31 de diciembre de 2017; se llevó a cabo un análisis univariado y multivariado para identificar variables asociadas. Resultados: se incluyeron 1055 personas, con una prevalencia de DFH del 41,14 %. Los tres principales factores asociados al desarrollo de dfh en la población anciana que consulta al husi fueron tiempo de estancia hospitalaria [or 1,88, CI95% (1,41-2,49), p = <0,0001], malnutrición [or 1,59, CI95 % (1,16-2,19), p = 0,004] y delirium [or 2,38, CI95 % (1,83-3,10), p = <0,001]. Conclusión: el DFH es una condición altamente prevalente en la población geriátrica hospitalizada en el Hospital Universitario San Ignacio, siendo el tiempo de estancia intrahospitalaria, la malnutrición y el delirium factores asociados a su aparición.Introdução: o deterioro funcional hospitalar define-se como a perda da capacidade para realizar pelo menos uma atividade básica da vida diária (ABVD) no momento da alta médica respeito à situação funcional duas semanas prévias ao início da doença aguda. Dita situação e precipitada nos idosos por fatores como o envelhecimento, as condições arquitetônicas, a subnutrição, rutinas hospitalares e restrições físicas. O presente estudo busca determinar a prevalência de deterioro funcional em idosos de 65 anos hospitalizados no Hospital Universitário San Ignacio (HUSI) e seus fatores associados. Materiais e métodos: se realizou um estudo descritivo de corte transversal de uma coorte hospitalar de dezembro de 2015 ao 31 de dezembro de 2017; se realizou uma análise univariada e multivariada para identificar variáveis associadas. Resultados: se incluíram 1055 pessoas, com uma prevalência de DFH do 41,14 %. Os três principais fatores associados ao desenvolvimento de DFH na população idosa que consulta ao HUSI foram tempo de permanência hospitalar [or 1,88, CI95% (1,41-2,49), p = <0,0001], a subnutrição [or 1,59, CI95% (1,16-2,19), p = 0,004] e o delirium [or 2,38, CI95% (1,83-3,10), p = <0,001]. Conclusão: o DFH é uma condição altamente prevalente na população geriátrica hospitalizada no Hospital Universitário San Ignacio sendo o tempo de permanência intra-hospitalar, a subnutrição e o delirium fatores associados à sua aparição