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Drugs are widely used to treat acute and chronic conditions in older people. However, the incidence of adverse drug reactions increases with age and are a frequent cause of hospital admission, especially in patients with multimorbidity and polypharmacy. Many of these adverse drug reactions could potentially be prevented. A prescription is considered to be potentially inappropriate in an older person if it carries a significant risk of producing an adverse drug reaction, especially when a safer alternative is available. In recent years, many instruments have been developed to help detecting potentially inappropriate prescriptions, most of them explicit lists of drugs that should not be used or cannot be used in the presence of certain conditions. The most widely used are the Beers-AGS criteria and the STOPP-START criteria. A systematic use of such instruments has been shown to improve not only the quality of prescriptions, but also several health outcomes in older multimorbid patients. Research is growing on the new concept of deprescription, described as the process of withdrawing inappropriate drugs, supervised by a health care professional, with the intention of reducing polypharmacy, improving outcomes and limiting iatrogenia. Prescriptors should become familiar with the different tools available to improve prescription quality and reduce drug related risks in older complex patients.

The authors apologize for a typing error that occurred in the September 2020 article that changes the meaning of a sentence.

ObjectiveThe task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults.MethodsThese recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care.Recommendations for Screening and AssessmentThe task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation).Recommendations for ManagementA comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.

However, semantics aside, we think that DXA can indeed serve as a reference standard for measuring muscle mass. Obviously, CT and MRI are advanced techniques that can and have been used to obtain important information such as muscle size/volume and more recently amount and distribution of intra‐ and intermuscular adipose tissue. Also individual muscles can be assessed separately. However, with respect to muscle mass, the comparison of DXA with CT/MRI is rather difficult because DXA and QCT/MRI measure different physical parameters

H. Jokinen työryhmän jäsenenä. Introduction: Numerous diagnostic criteria have tried to tackle the variability in clinical manifestations and problematic diagnosis of vascular cognitive impairment (VCI) but none have been universally accepted. These criteria have not been readily comparable, impacting on clinical diagnosis rates and in turn prevalence estimates, research, and treatment. Methods: The Vascular Impairment of Cognition Classification Consensus Study (VICCCS) involved participants (81% academic researchers) from 27 countries in an online Delphi consensus study. Participants reviewed previously proposed concepts to develop new guidelines. Results: VICCCS had a mean of 122 (98-153) respondents across the study and a 67% threshold to represent consensus. VICCCS redefined VCI including classification of mild and major forms of VCI and subtypes. It proposes new standardized VCI-associated terminology and future research priorities to address gaps in current knowledge. Discussion: VICCCS proposes a consensus-based updated conceptualization of VCI intended to facilitate standardization in research. (C) 2016 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

The main objective in caring for elderly patients should be to minimize the functional impact of diseases and maintain autonomy as long as possible. To achieve this goal, geriatric medicine is supported by the comprehensive geriatric assessment (CGA), which encompasses the clinical, functional, mental and societal aspects of disease, detecting problems that would otherwise go unidentified. The CGA uses specific scales to evaluate these problems, which helps identify them and serves to assess the efficacy of interventions. Geriatric syndromes are one of the ways disease manifests in the elderly. Healthcare for the elderly should be focused on the prevention and early detection of these syndromes. Preparing a list of detected problems and a detailed action and treatment plan will optimize the results of the intervention. Healthcare levels in geriatric medicine offer patients the most appropriate and efficient location and care based on their needs during the disease's progression.

Resumen: Introducción: La enfermedad de Alzheimer (EA) produce un deterioro cognitivo progresivo que conlleva la pérdida de independencia para las actividades de la vida diaria, siendo la rivastigmina uno de los fármacos utilizados para su tratamiento sintomático. Objetivo: Evaluar el manejo terapéutico con distintas formas galénicas de rivastigmina, en sujetos con EA en la práctica clínica habitual. Pacientes y métodos: Estudio transversal, multicéntrico realizado en consultas españolas de Geriatría, Psiquiatría y Neurología, en sujetos con EA de leve a moderadamente grave que recibían rivastigmina. Se recogieron datos sobre el modo de uso de rivastigmina oral (RO) y transdérmica (RTD), el cumplimiento terapéutico (grado de adherencia) y la satisfacción del cuidador. Resultados: Se evaluaron 2.252 sujetos con edad media de 77,2 años; 60,2% mujeres. El 58,4% presentaban EA moderada-moderadamente grave. El 54,4% habían iniciado el tratamiento con RO y el 45,6% con RTD; el 35,6% de aquellos con RO cambiaron a la vía transdérmica. El 77,5% con RTD requirió un solo ajuste de dosis vs. 11,8% con RO. El 80,8% de los sujetos con RTD alcanzaron la dosis máxima de rivastigmina (vs. 57,1% RO) en menos tiempo (51,6 vs. 205,8 días). El cumplimiento fue mayor con RTD (60,5 vs. 47,2%) así como el porcentaje de cuidadores satisfechos con el tratamiento (89,4 vs.81,9%). Conclusiones: En la práctica clínica habitual, la RTD facilita la dosificación y mejora el cumplimiento, permitiendo a un mayor porcentaje de sujetos alcanzar la dosis máxima recomendada de rivastigmina en un plazo de tiempo menor. Abstract: Introduction: Alzheimer disease (AD) causes progressive cognitive decline leading to loss of independence for activities of daily living; rivastigmine is one of the drugs used for symptomatic management. Objective: To assess the therapeutic use of different pharmaceutical forms of rivastigmine in patients with AD in normal clinical practice. Patients and methods: Cross-sectional, observational, multi-centre study conducted on patients with mild to moderate AD treated with rivastigmine in Spanish outpatient clinics specialising in Geriatrics, Psychiatry, and Neurology. Data regarding use of oral (OR) and transdermal (TDR) rivastigmine, compliance (degree of adherence), and caregiver satisfaction with treatment were evaluated. Results: In total, 2252 patients with a mean age of 77.2 years were included; 60.2% were women. AD was moderate to moderately severe in 58.4%. Rivastigmine treatment was started orally in 54.4% of the patients and transdermally in 45.6%; 35.6% of those who started treatment by the OR route switched to TDR. A single dose adjustment was sufficient for 77.5% of patients on TDR treatment vs 11.8% of patients receiving OR treatment. More patients on TDR treatment (80.8% vs. 57.1% on OR treatment) reached the maximum therapeutic dose of rivastigmine and did so in a shorter period of time (51.6 vs 205.8 days). Compliance rates (60.5% vs 47.2%) and caregivers’ satisfaction with treatment (89.4% vs 81.9%) were also higher for TDR. Conclusions: In normal clinical practice, using the TDR route of administration improves dose titration and drug compliance, allowing more patients to reach the maximum recommended dose of rivastigmine in a shorter time period. Palabras clave: Alzheimer, Cumplimiento, Manejo terapéutico, Rivastigmina, Satisfacción, Vía de administración, Keywords: Alzheimer, Compliance, Treatment management, Rivastigmine, Satisfaction, Administration route

The concept of frailty was introduced in literature to help atclinically depicting the transition of a robust older individualinto a different clinical phenotype of risk (1-5). Frailty isgenerally described as a multisystemic impairment responsiblefor a state of increased vulnerability to endogenous andexogenous stressors (6, 7). This syndrome may represent thefirst step towards the evident and clinically relevant functionaldisability (a cornerstone outcome for geriatric medicine)8, andhas shown to be predictive of major negative health-relatedevents, including

Los enfermos mayores tienen caracteristicas peculiares en su proceso de enfermedad y en la forma de afrontarla. Es preciso adaptar l anamnesis, la exploracion, la solicitud de pruebas diagnosticas y la toma de decisiones a sus caracteristicas especiales.

Objetivo : Validar una version de cinco items de la Escala de Depresion Geriatrica (GDS) de Yesavage para el screening de la depresion en poblacion espanola mayor de 65 anos. DiseNo : Comparacion de los resultados obtenidos con la escala GDS de 5 y de 15 items frente al diagnostico clinico de depresion como patron de referencia. Participantes : Se incluyeron 155 pacientes geriatricos (69,7% mujeres, 78,3 ± 5,8 anos) elegidos mediante muestreo aleatorio simple de entre todos los que acudieron a la consulta de geriatria de un hospital entre enero de 1996 y junio de 1999. Se excluyeron aquellos con Miniexamen cognoscitivo IntervenciOn : Se realizo una evaluacion geriatrica exhaustiva que incluia la GDS de Yesavage de 15 items y cinco items. Se calculo la sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN) de las dos versiones de la escala de depresion geriatrica tomando como patron de referencia el diagnostico clinico de trastornos del estado de animo segun criterios del DSM-IV. Resultados : Prevalencia de depresion: 56,1%. Los pacientes deprimidos y no deprimidos eran semejantes en todas sus caracteristicas, salvo una mayor prevalencia de depresion en las mujeres. La escala GDS-5 tuvo una sensibilidad de 0,99, especificidad 0,57, VPP 0,75, VPN 0,98. Para la GDS-15 estos valores fueron: sensibilidad 0,93, especificidad 0,73, VPP 0,82, VPN 0,89. La escala GDS-5 se comportaba de forma diferente en hombres y mujeres, con menor especificidad en mujeres (0,45) que en varones (0,77). Conclusiones : Esta version de cinco items de la GDS podria ser util como prueba de screening de depresion en varones mayores, pero su rendimiento es peor que el de la version de 15 items en las mujeres.

Unintended weight loss is a significant problem in elderly subjects, with a high prevalence and potential complications. This problem has multiple ethiologies: it is mostly due to organic disease, but drugs can be potential offenders. Fluoxetin has different gastrointestinal side effects, but only one previous study has described it’s relation with severe unintended weight loss. We present here an 80 years old woman with unintended weight loss due to the use of fluoxetine.