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Hip fracture is one of the most frequent disabling injuries, presenting serious complications during the acute and subacute phase. Rehabilitation at home, after hospital discharge, allows rapid functional recovery. The objective of this study is to evaluate the possible usefulness of a home rehabilitation program in patients with hip fracture integrated in a Hospital at Home Unit.Retrospective study that consecutively included patients accepted for home rehabilitation treatment between September 9, 2019 and December 31, 2021 in the Hospital at Home Unit of the Hospital Universitario de la Ribera, Alzira, Valencia. Demographic, clinical, functional and quality of care variables were collected.Two hundred twenty-four subjects were included. The mean age was 84.6 (SD 7.7) years, with 66% women and 34% men, with 32% of patients diagnosed with dementia in one of its degrees of severity. The mean hospital stay was 8.4 (SD 4.1) days and 6.5 (5.3) days in the Hospital at Home Unit rehabilitation program. 90% of the patients included in the program reached the therapeutic goal outlined during hospital admission.The home rehabilitation of patients with hip fracture contributes to a functional recovery of the patient in a shorter time. Further studies are necessary to confirm the results obtained.

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 period

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.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.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.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.

Oxidative stress (OS) has been previously linked to the aging process, as have some diseases and geriatric syndromes as frailty and sarcopenia. The aim of the present study was to perform a systematic review on oxidative stress activity and extreme longevity in humans.We conducted a systematic literature review following the PRISMA guidelines. Observational studies assessing OS-biomarkers and/or antioxidants in long-lived individuals (97 years old or over) comparing them to those of one or more age groups, (at least one of which from comprising elderly subjects) were considered for inclusion. A narrative synthesis was planned. Quality of selected studies was assessed using the Newcastle-Ottawa quality assessment scale (NOS).After screening and eligibility phases, 12 articles were finally selected, with 646 long-lived participants and 1052 controls, 447 adults (20-60 years old) and 605 elderly individuals (over 60 years old). The average score on NOS scale of studies was 4,8 out of 9. Centenarians showed significantly less (p0,05) oxidative damage to lipids in different samples, lower levels of oxidized proteins in plasma and lower superoxide anion levels in neutrophils than elderly groups. Centenarian presented significantly lower superoxide dismutase and higher glutathione reductase activities, higher levels of vitamins A and E, lower of coenzyme Q10, and lower susceptibility to lipid peroxidation than elderly controls.Based on studies of medium-low quality, available evidence suggests that long-lived individuals display less oxidative damage, particularly lower plasma lipid peroxidation biomarkers, than controls. More studies with better experimental designs are needed.

Previous diagnoses of patients with hip fracture influence the hospitalization cost of these patients, either directly or by increasing the risk of in-hospital adverse events associated with increased costs. To investigate how previous diagnoses influence the occurrence of in-hospital adverse events and how both factors impact on hospital costs. This is a retrospective analysis of the hospital Minimum Basic Data Set. Patients aged 70 years or older admitted for hip fracture (HF) at a single University Hospital between January 2012 and December 2016. Both, previous diagnoses and adverse events, were defined according to the International Classification of Diseases (ICD-9/ICD-10). The anticipated cost of each admission was calculated based on diagnosis-related groups and using the “all patients refined” method (APR-DRG). The occurrence of adverse events during hospital stay was assessed by excluding all diagnoses present on admission. The record included 1571 patients with a mean (SD) age of 84 years. The most frequent previous diagnoses were diabetes (n = 432, 27.5%) and dementia (n = 251, 16.0%), and the most frequent adverse events were delirium (n = 238, 15.1%) and anemia (n = 188, 12.0%). The mean (SD) total acute care costs per patient were €8752.1 (1864.4). The presence of heart failure, COPD, and kidney disease at admission significantly increased the hospitalization cost. In-hospital adverse events of delirium, cardiac events, anemia, urinary tract infection, and digestive events significantly increased costs. The multivariate analyses identified kidney disease as a previous diagnosis significantly contributing to explain an increase in hospitalization costs, and delirium, cardiac disease, anemia, urinary infection, respiratory event, and respiratory infection as in-hospital adverse events significantly contributing to an increase of hospitalization costs. Although few baseline comorbidities have a direct impact on hospitalization costs, most previous diagnoses increase the risk of in-hospital adverse events, which ultimately influence the hospitalization cost.

Resumen Introduccion La longevidad humana es un fenomeno complejo en el que influyen factores geneticos y ambientales. El estres oxidativo (EO) puede jugar un papel importante en este proceso. El envejecimiento exitoso podria relacionarse con la habilidad del organismo para hacer frente al EO. Nuestro objetivo es comparar los niveles en plasma de malondialdehido (MDA) y proteinas oxidadas (PO) entre sujetos mayores de 97 anos y con edad entre 70 y 80 anos, para comprender mejor los efectos del estres oxidativo en la longevidad humana. Material y metodos Estudio de casos y controles de base poblacional. Se consideraron casos todas aquellas personas nacidas y residentes en la comarca de la Ribera (Valencia), con edad superior a 97 anos y que aceptaron participar en el mismo. Los controles son sujetos de la misma base poblacional, elegidos al azar, y con edad entre 70 y 80 anos. Se realiza un analisis descriptivo de variables sociodemograficas, clinicas y funcionales; se calcula la razon de odds (OR) de ser centenario en funcion del cuartil de los niveles de PO y MDA; y la significacion estadistica de la tendencia mediante el test Mantel-Haenszel. Resultados Fueron incluidos 28 casos y 31 controles. La situacion funcional, asi como el porcentaje de individuos robustos, fue menor en el grupo de casos que en los controles. Los niveles de MDA fueron menores en los casos (1,44 ± 0,45 vs. 1,84 ± 0,59, p = 0,005), al igual que los niveles de PO (64,29 ± 15,73 vs. 76,52 ± 13,44, p = 0,002). Al comparar a los sujetos con niveles de MDA y PO en el cuartil inferior respecto al superior, la OR de ser centenario es de 3,8 para el MDA y de 5,7 para las PO, con una p = 0,029 y p = 0,044, respectivamente, en la significacion de la tendencia. Conclusiones En los sujetos de nuestro estudio los niveles plasmaticos de MDA y PO son menores en centenarios que en ancianos mas jovenes, y se observa que a menor grado de EO mayor es la probabilidad de ser centenario.

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 CONCLUSIONS: We observed higher 12-month mortality and less functional recovery with increasing severity of dementia. Geriatr Gerontol Int 2014; ●●: ●●-●●. Language: en

SummaryHip fracture is very common among older patients, who are characterized by increased co-morbidities, including cognitive impairment. These patients have an increased risk of falls and fractures, poorer functional recovery and lower survival both in hospital and 12 months after discharge. We review the survival and functional outcomes of older patients with cognitive impairment and hip fracture managed in orthogeriatric units, and highlight the gaps in our knowledge of the efficacy and efficiency of specific orthogeriatric programmes for such patients and the future research perspectives in this field.

Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard., Video abstract

Human longevity is a complex issue influenced by genetic and environmental factors. Oxidative stress (OE) could play an important role in this process. Succesful aging could be related with the organism ability facing OE. In the present study we compared malondialdehyde (MDA) and oxidized proteins (OP) plasma levels, in elderly people older than 97 years and 70-80 years old, to better understand the effects of OE on human longevity.Population-based case control study. We considered as cases patients who were born and live on la Ribera county in Valencia (Spain) older than 97 years old and who accepted to participate in the study. Controls were from the same poblational base, chosen randomly, and 70-80 years old. We made a descriptive analysis of sociodemographic, clinic and functional variables; an odds ratio (OR) estimation of being centenarian by OP and MDA quartiles; and a tendency analysis by Mantel-Haenszel test.Twenty eight cases and 31 controls were included. Functional state and robust percentage were worse in cases. MDA (1,44±0,45 vs 1,84±0,59, p=0,005), and OP (64,29±15,73 vs. 76,52±13,44, p=0,002) levels, were significantly lower in cases. The OR of being centenarian in lower/higher quartile were 3,8 for MDA and 5,7 for OP, with a Mantel-Haenszel signification of 0,029 and 0,044 respectively.In our study OE level were lower in centenarians than in younger elderly, and the lower the OE grade, the higher were the likelihood of being centenarian.

To identify how the severity of dementia influences functional recovery and mortality in elderly patients hospitalized for hip fracture.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.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).We observed higher 12-month mortality and less functional recovery with increasing severity of dementia.

Annual circulation of influenza virus coincides with a peak in cardiovascular and pneumonia mortality/morbidity. This study aimed to determine the effectiveness of MF59-adjuvanted subunit influenza vaccine in preventing hospitalisation due to acute coronary syndrome (ACS), cerebrovascular accident (CVA) and pneumonia in the elderly. Three case-control studies were performed during the 2004-2005 influenza season in three health districts in Valencia, Spain (total elderly [>64 years of age] population: n=105,454). Controls were patients admitted for an acute surgical process or trauma within 10 days of case admission. In total, 159 patients were hospitalised for ACS, 148 for CVA and 242 for pneumonia. The risk of hospitalisation after the start of the influenza season was significantly lower in vaccinated patients compared with non-vaccinated patients (adjusted odds ratios: 0.13 [P=0.013] for ACS; 0.07 [P=0.007] for CVA; 0.31 [P=0.005] for pneumonia). During peak virus circulation, vaccination with MF59-adjuvanted subunit influenza vaccine was associated with an 87% relative risk reduction in hospitalisation for ACS, 93% for CVA, and 69% for pneumonia.

Case-control study designed to determine the effectiveness of an MF59-adjuvanted influenza vaccine in the population aged 65 years and older living in the community. Detailed health histories were obtained on both cases and controls that included a functional measure of co-morbidity (Barthel Index). Subjects were all eligible persons admitted to various hospitals with a diagnosis of pneumonia during the winter months and were matched by sex, hospital and admission week to controls admitted for non-medical reasons. The influenza vaccination programme using the MF59-adjuvanted influenza vaccine significantly reduced the probability of being hospitalised for pneumonia in the elderly over 64 years of age, even in a season with a low influenza activity, during which the predominant circulating strains were types B and A (H1N1). (C) 2004 Elsevier Ltd. All rights reserved.

Preliminary results for the 2014/15 season indicate low to null effect of vaccination against influenza A(H3N2)-related disease. As of week 5 2015, there have been 1,136 hospital admissions, 210 were due to influenza and 98% of subtype A strains were H3. Adjusted influenza vaccine effectiveness was 33% (range: 6–53%) overall and 40% (range: 13% to 59%) in those 65 years and older. Vaccination reduced by 44% (28–68%) the probability of admission with influenza. The study was funded by a contract between FISABIO and Sanofi-Pasteur.