Orthogeriatric management: Improvements in outcomes during hospital admission due to hip fracture

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery

A Community Program of Integrated Care for Frail Older Adults : +AGIL Barcelona

Objectives: To assess the 3-month impact on physical function of a program for community-dwelling frail older adults, based on the integration of primary care, geriatric medicine, and community resources, implemented in \u201creal life\u201d. Design: Interventional cohort study. Setting: Primary care in Barcelona, Spain. Participants: Individuals aged 6580 years (n=134), presenting at least one sign of frailty (i.e., slow gait speed, weakness, memory complaints, involuntary weight loss, poor social support). Intervention: After frailty screening by the primary care team, candidates were referred to a geriatric team (geriatrician + physical therapist), who performed a comprehensive geriatric assessment and designed a tailored multidisciplinary intervention in the community, including a) multi-modal physical activity (PA) sessions, b) promotion of adherence to a Mediterranean diet c) health education and d) medication review. Measurements: Participants were assessed based on a comprehensive geriatric assessment including physical performance (Short Physical Performance Battery -SPPB- and gait speed), at baseline and at a three month follow-up. Results: A total of 112 (83.6%) participants (mean age=80.8 years, 67.9% women) were included in this research. Despite being independent in daily life, participants\u2019 physical performance was impaired (SPPB=7.5, SD=2.1, gait speed=0.71, SD=0.20 m/sec). After three months, 90.2% of participants completed 657.5 physical activity sessions. The mean improvements were +1.47 (SD 1.64) points (p<0.001) for SPPB, +0.08 (SD 0.13) m/sec (p<0.001) for gait speed, 125.5 (SD 12.10) sec (p<0.001) for chair stand test, and 53% (p<0.001) improved their balance. Results remained substantially unchanged after stratifying the analyses according to the severity of frailty. Conclusions: Our results suggested that a \u201creal-world\u201d multidisciplinary intervention, integrating primary care, geriatric care, and community services may improve physical function, a marker of frailty, within 3 months. Further studies are needed to address the long-term impact and scalability of this implementation program

Temporal muscle thickness predicts mortality and disability in older adults diagnosed with mild dementia

ANTECEDENTES: La sarcopenia contribuye al aumento de las hospitalizaciones, deterioro cognitivo, caídas y mortalidad por todas las causas. Diagnóstico actual métodos, como la resonancia magnética corporal y la energía dual. La absorciometría de rayos X es costosa y poco práctica. Cabe destacar que no hay Enfoque estandarizado para evaluar la sarcopenia en clínicas de demencia. Nosotros estudió la asociación del grosor del músculo temporal (TMT) con clave Factores pronósticos en personas con enfermedad de Alzheimer (EA) y Lewy. Demencia corporal (DLB). MÉTODOS: Utilizamos datos del DemVest, una cohorte longitudinal estudio, e incluyó participantes clínicamente diagnosticados con EA leve o DLB. El TMT se midió mediante resonancias magnéticas iniciales. El resultado principal Las medidas fueron cognición, rendimiento funcional, desnutrición y mortalidad. Se consideraron varios factores demográficos y clínicos como posibles factores de confusión. RESULTADOS: La muestra de AD estuvo compuesta principalmente por mujeres (76,9%), 75,5 años (DE 6,95). La muestra DLB estuvo compuesta mayoritariamente por hombres (63,6%), edad 75,8 (DE 6,85). Al inicio del estudio, el TMT mostró asociación con el rendimiento cognitivo en el grupo DLB (Est.=0,593, valor p=0,049). El análisis longitudinal reveló importantes asociaciones entre TMT y deterioro funcional en DLB (Est. = -0,123, valor p 0,007) y aumento de la mortalidad en toda la muestra(HR=0,815, valor p 0,002), el grupo AD (HR=0,834 valor p=0,031) y el grupo DLB grupo (HR=0,767 valor p=0,019) respectivamente. Estas asociaciones siguió siendo significativo después de ajustar por factores de confusión. CONCLUSIONES: La medición TMT se asoció con la mortalidad. en ambos grupos de demencia, así como con la cognición y la función en DLB. TMT surge como una medida rentable de masa muscular que indica relevancia clínica y utilidad en entornos sanitarios. La implementación de la evaluación TMT podría mejorar la atención al paciente y ayudar a identificar a las personas en riesgo de resultados adversos en la demencia leve. Palabras clave: Sarcopenia, Demencia, Grosor del músculo temporal (TMT), músculo, funcionalidad, desnutrición.Q1Q1BACKGROUND: Sarcopenia contributes to increased hospitalizations, cognitive impairment, falls, and all-cause mortality. Current diagnostic methods, like body Magnetic Resonance Imaging and dual-energy X-ray absorptiometry, are costly and impractical. Notably, there is no standardized approach for assessing sarcopenia in dementia clinics. We studied the association of temporal muscle thickness (TMT) with key prognostic factors in people with Alzheimer’s disease (AD) and Lewy body dementia (DLB). METHODS: We utilized data from the DemVest, a longitudinal cohort study, and included participants clinically diagnosed with mild AD or DLB. TMT was measured using baseline MRI scans. The main outcome measures were cognition, functional performance, malnutrition, and mortality. Various demographic and clinical factors were considered as potential confounders. RESULTS: The AD sample was mainly composed by females(76.9%), age 75.5(SD 6.95). The DLB sample was mostly composed by men(63.6%), age 75.8(SD 6.85). At baseline TMT showed significant association with cognitive performance in the DLB group (Est.=0.593, p-value=0.049). The longitudinal analysis revealed significant associations between TMT and functional decline in DLB (Est.=-0.123, p-value 0.007) and increased mortality in the whole sample(HR=0.815, p-value 0.002), the AD group (HR=0.834 p-value=0.031), and the DLB group (HR=0.767 p-value=0.019) respectively. These associations remained significant after adjusting for confounders. CONCLUSIONS: The TMT measurement was associated with mortality in both dementia groups as well as with cognition and function in DLB. TMT emerges as a cost-efficient measure of muscle mass indicating clinical relevance and utility in healthcare settings. Implementing TMT assessment could improve patient care and aid in identifying individuals at risk of adverse outcomes in mild dementia. Key words: Sarcopenia, Dementia, Temporal muscle thickness (TMT), muscle, functionality, malnutrition.https://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