Enseñanza de la geriatría en las facultades de medicina españolas

La Geriatría es la especialidad médica dedicada a los aspectos preventivos, clínicos, terapéuticos y sociales de las personas mayores. Su desarrollo tuvo lugar en Inglaterra desde 1930 y posteriormente fue introducida en Estados Unidos y otros países europeos como España, creando a lo largo del tiempo una doctrina específica y mostrando resultados clínicos que la definen como especialidad. Desde finales de 1960 distintas organizaciones internacionales han manifestado la importancia de la formación en Geriatría para todos los médicos, pero distintos autores han mostrado la falta de dicha formación y la importancia de su evaluación. Existen algunos estudios sobre el estado de la enseñanza de Geriatría en distintos países con resultados heterogéneos. Recientemente, en España se ha introducido un nuevo plan de Medicina basado en el Espacio Europeo de Educación Superior, ha aumentado el número de facultades de Medicina existentes, y hace muy poco se ha propuesto un nuevo programa europeo sobre formación en Geriatría. Por tanto, parece oportuno evaluar el estado de la formación en Geriatría en las facultades de Medicina españolas..

European Society for Swallowing Disorders: European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome

This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization’s classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies

Evolución de la enseñanza de Geriatría en las facultades de Medicina españolas

Resumen: Objetivo: Determinar la evolución reciente de la enseñanza de la Geriatría en el pregrado en España tras el aumento de facultades de Medicina y el cambio del plan de estudios. Metodología: Se compararon las características de la enseñanza de la Geriatría en las facultades de Medicina españolas mediante dos encuestas nacionales realizadas en 2008 y 2015. En ambos casos se analizaron la inclusión de contenidos de Geriatría, el año y la materia en la que se imparte, las características del profesorado responsable y la duración de la misma. Resultados: La prevalencia de docencia de Geriatría en las facultades de Medicina de las universidades españolas era del 75% en el 2008 y 77,5% en el 2015. Esta docencia se ha ido haciendo con mayor frecuencia obligatoria (66,7 vs. 96,8%, p < 0,005) pero se ha reducido su carácter de asignatura independiente (71,4 vs. 35,5%, p < 0,01). En ambos años aproximadamente el 50% de las facultades contemplaban aspectos teóricos y prácticos y en el 90% las prácticas tenían un carácter obligatorio. Se ha observado un incremento de la participación de los Servicios de Geriatría (27,3 vs. 47,1%) y de los propios geriatras como docentes directos (38,1 vs. 74,2%, p = 0,03). El tiempo medio programado para esta enseñanza era de 36 y 32 h respectivamente. No se han producido cambios significativos en más de la mitad de las facultades existentes en lo que respecta a inclusión de la Geriatría en el plan de estudios de pregrado, docencia independiente, incorporación de contenidos prácticos, estatus de las prácticas y participación de geriatras. Conclusiones: La docencia de Geriatría ha presentado una evolución ligeramente positiva en muchas características, sin lograr una incorporación universal o los niveles alcanzados en otros países de nuestro entorno. Abstract: Objective: To analyse the recent evolution of Geriatric teaching at undergaduate level in Spain after the recent increase in the number of medical schools and the introductions of changes in the offical curricula. Methodology: A comparison of several characteristics of Geriatrics teaching at Spanish medical schools was done through two national surveys carried out in 2008 and 2015. The inclusion of Geriatric contents, the year when they are taught, faculty in charge and teaching hours were compared at both time points. Results: The prevalence of Geriatric training was 75% in 2008 and 77.5% in 2015. This training has become compulsory more frequently (66.7 vs. 96.8%, p < .005) but the independence of Geriatrics related to other matters has decreased (71.4 vs. 35.5%, p < .01). In both surveys 50% of medical schools included theoretical and practical contents and in 90% of practices were compulsory. We found an increased of Geriatrics departments (27.3 vs. 47.1%) and geriatricians (38.1 vs. 74.2%, p= .03) in teaching. The mean duration of this training was 36 and 32 hours respectively. In more than half of the medical schools existing in both years there were no significant changes in any of the characteristics surveyed. Conclusions: The teaching of Geriatrics at pregraduate level shows some positive changes, but universal teaching with standards approaching close countries has not yet been achieved. Palabras clave: Pregrado, Enseñanza, Geriatría, Keywords: Undergraduate, Training, Geriatric

Short-Term Therapeutic Adherence of Hospitalized Older Patients with Oropharyngeal Dysphagia after an Education Intervention: Analysis of Compliance Rates, Risk Factors and Associated Complications

Oropharyngeal dysphagia (OD) is associated with adverse outcomes that require a multidisciplinary approach with different strategies. Our aim was to assess the adherence of older patients to dysphagia management recommendations during hospitalization, after a specific nurse guided dysphagia education intervention and to identify short term complications of OD and their relationship with short-term adherence. We carried out a prospective observational study in an acute and an orthogeriatric unit of a university hospital over ten months with a one-month follow-up. Four hundred and forty-seven patients (mean age 92 years, 70.7% women) were diagnosed with dysphagia using Volume-Viscosity Swallow Test (V-VST). Compensatory measures and individualized recommendations were explained in detail by trained nurse. Therapeutic adherence was directly observed during hospital admission, after an education intervention, and self-reported after one-month. We also recorded the following reported complications at one month, including respiratory infection, use of antibiotics, weight loss, transfers to the emergency department, or hospitalization). Postural measures and liquid volume were advised to all patients, followed by modified texture food (95.5%), fluid thickeners (32.7%), and delivery method (12.5%). The in-hospital compliance rate with all recommendations was 37.1% and one-month after hospital discharge was 76.4%. Both compliance rates were interrelated and were lower in patients with dementia, malnutrition, and safety signs. Higher compliance rates were observed for sitting feeding and food texture, and an increase in adherence after discharge in the liquid volume and use of thickeners. Multivariate logistic regression analysis showed that adherence to recommendations during the month after discharge was associated with lower short-term mortality and complications (i.e., respiratory infection, use of antibiotics, weight loss, transfers to the emergency department, or hospitalization). One-third of our participants followed recommendations during hospitalization and three-quarters one month after admission, with higher compliance for posture and food texture. Compliance should be routinely assessed and fostered in older patients with dysphagia

Antimicrobial Agent Use for Urinary Tract Infection in Long-Term Care Facilities in Spain: Results from a Retrospective Analytical Cohort Analysis

Urinary tract infections (UTIs) are highly prevalent in long-term care facilities, constituting the most common infection in this setting. Our research focuses on analyzing clinical characteristics and antimicrobial prescriptions for UTIs in residents across nursing homes (NH) in Spain. This is a retrospective analytical cohort analysis using a multifaceted approach based on the normalization process theory to improve healthcare quality provided by nursing staff in 34 NHs in Spain. In this study, we present the results of the first audit including 719 UTI cases collected between February and April 2023, with an average age of 85.5 years and 74.5% being women. Cystitis and pyelonephritis presented distinct symptom patterns. Notably, 6% of asymptomatic bacteriuria cases were treated. The prevalence of dipstick usage was 83%, and that of urine culture was only 16%, raising concerns about overreliance, including in the 46 asymptomatic cases, leading to potential overdiagnosis and antibiotic overtreatment. Improved diagnostic criteria and personalized strategies are crucial for UTI management in NHs, emphasizing the need for personalized guidelines on the management of UTIs to mitigate indiscriminate antibiotic use in asymptomatic cases

Factors Associated with SARS-CoV-2 Infection in Fully Vaccinated Nursing Home Residents and Workers

Persons living or working in nursing homes faced a higher risk of SARS-CoV-2 infections during the pandemic, resulting in heightened morbidity and mortality among older adults despite robust vaccination efforts. This prospective study evaluated the humoral and cellular immunity in fully vaccinated residents and workers from two nursing homes in Madrid, Spain, from 2020 to 2021. Measurements of IgG levels were conducted in August 2020 (pre-vaccination) and June and September 2021 (post-vaccination), alongside assessments of neutralizing antibodies and cellular responses in September 2021 among the most vulnerable individuals. Follow-up extended until February 2022 to identify risk factors for SARS-CoV-2 infection or mortality, involving 267 residents (mean age 87.6 years, 81.3% women) and 302 workers (mean age 50.7 years, 82.1% women). Residents exhibited a significantly higher likelihood of experiencing COVID-19 before June 2021 compared with nursing staff (OR [95% CI], 7.2 [3.0 to 17.2], p Omicron variant wave, residents and staff showed a similar rate of SARS-CoV-2 infection. Notably, preceding clinical or immunological factors before receiving three vaccination doses did not demonstrate associations with COVID-19 infection or overall mortality in our participant cohort

European Society for Swallowing Disorders - European Union Geriatric Medicine Society white paper : oropharyngeal dysphagia as a geriatric syndrome

This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization's classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies

Centenarians and their hearts: a prospective registry with comprehensive geriatric assessment, electrocardiogram, echocardiography, and follow-up

Background Data on the cardiac characteristics of centenarians are scarce. Our aim was to describe electrocardiogram (ECG) and echocardiography in a cohort of centenarians and to correlate them with clinical data. Methods We used prospective multicenter registry of 118 centenarians (28 men) with a mean age of 101.5 ± 1.7 years. Electrocardiogram was performed in 103 subjects (87.3%) and echocardiography in 100 (84.7%). All subjects underwent a follow-up for at least 6 months. Results Centenarians with abnormal ECG were less frequently females (72% vs 93%), had higher rates of previous consumption of tobacco (14% vs 0) and alcohol (24% vs 12%), and scored lower in the perception of health status (6.8 ± 2.0 vs 8.3 ± 6.8). Centenarians with significant abnormalities in echocardiography were less frequently able to walk 6 m (33% vs 54%). Atrial fibrillation/flutter was found in 27 subjects (26%). Mean left ventricular (LV) ejection fraction was 60.0 ± 10.5%. Moderate or severe aortic valve stenosis was found in 16%, mitral valve regurgitation in 15%, and aortic valve regurgitation in 13%. Diastolic dysfunction was assessed in 79 subjects and was present in 55 (69.6%). Katz index and LV dilation were independently associated with the ability to walk 6 m. Age, Charlson and Katz indexes, and the presence of significant abnormalities in echocardiography were associated with mortality. Conclusions Centenarians have frequent ECG alterations and abnormalities in echocardiography. More than one fifth has atrial fibrillation, and most have diastolic dysfunction. Left ventricular dilation was associated with the ability to walk 6 m. Significant abnormalities in echocardiography were associated with mortality.4.332 JCR (2015) Q1, 26/124 Cardiac & cardiovascular systemsUE