Search

Background Studies validating indirect methods to identify nonadherence in chronic patients who visit pharmacies are lacking. The aim of this study was to validate self-reported adherence and assess the variables associated with both overestimation and underestimation of good adherence when using this method. Materials and methods An observational, cross-sectional study was undertaken to validate self-reported adherence in 132 community pharmacies throughout Spain in 6237 chronic patients. The Morisky-Green test was used as the validation method and through a 2 × 2 table, the validity indicators, predictive values, and likelihood ratios were calculated. To assess the variables associated with both overestimation and underestimation of good adherence, multivariate logistic regression analysis and calculation of the area under the ROC curve were used to evaluate discriminatory capacity. Results Sensitivity was 27.8% (95% CI: 26.2–29.4) and specificity was 93.9% (95% CI: 93.1–94.7). Discrepancy analysis obtained a significant overestimation of good adherence (p

The aim of this paper is to present and discuss some recent publications and consensus documents about feeding and hydration in terminal stage patients. First part includes a review since the framework of bioethical problems where these topics may be included. Next point is focussed on a short presentation of some evidences base clinical trials. Finally, in the last part, it is offered information about the most relevant guidelines and consensus documents published along last years. As conclusion, we see that evidence base informing clinical decision-making about artificial hydration in the dying patient is sparse and solutions must be adopted on individual basis. Mental capacity of the patient is one of the most important pillars to take into account. It is important, also, to have good information about the most frequent doubts that patients and relatives may set up.

Objectives: To describe the relationship of body mass index and mortality in older adults, examining the influence of sex and cardiovascular morbidity. Methods: Sixteen-year cohort of a population sample of 1,008 people aged 65 and over. BMI mortality hazard ratios are estimated controlling for age, sex, education, physical activity, smoking, chronic conditions, and ADL (activities of daily living) disability. Results: At baseline the median BMI is 26.8 (Interquartile range: 24.2-29.7 Kg/m2). Findings show that during 16 years there were 672 deaths. The U-shaped curve of the mortality hazard by BMI is wide. The minimum mortality occur at BMI = 30.5 Kg/m2. Findings show that men had lower mortality risk with increasing BMI and that cardiovascular disease was associated with high mortality in the low-BMI category. Discussion: Underweight is a risk factor for mortality among elderly people, whereas overweight and mild obesity are associated with the lowest mortality particularly among men and those with cardiovascular morbidity.

Resumen Objetivo comparar los resultados obtenidos en la estacion unipodal con el analisis del equilibrio estatico mediante posturografia. Metodos 59 sujetos mayores de 64 anos. Se evaluo la estacion unipodal y el Modified Clinical Test for the Sensory Interaction on Balance mediante el posturografo Balance Master (Neurocom®). Grupo A: sujetos que no realizaron la estacion unipodal, y grupo B: los que si pudieron realizarla. Resultados grupo A: 37,2% (22). Grupo B: 62,6% (37). Sobre una superficie dura y con los ojos abiertos, el centro de gravedad del grupo A se desplazo 0,4 grados/s (0,28-0,6) y el del grupo B 0,2 grados/s (0,1-0,3) (p = 0,01). Sobre una superficie firme y con los ojos cerrados, el centro de gravedad del grupo A se desplazo 0,5 grados/s (0,3-0,8) y el del grupo B 0,3 grados/s (0,1-0,4) (p = 0,002). Sobre una superficie almohadillada y con los ojos abiertos, el centro de gravedad del grupo A se desplazo 1,1 grados/s (0,90-1,60) y el del grupo B 0,9 grados/s (0,73-1,3) (p = 0,045). Sobre una superficie almohadillada y con los ojos cerrados, el centro de gravedad del grupo A se desplazo 6 grados/s (4-6) y el del grupo B 2,3 grados/s (1,63-3,08) (p Conclusiones los sujetos de edad avanzada capaces de mantener la estacion unipodal durante al menos 5 s muestran un menor desplazamiento de su centro de gravedad que los que no lo consiguen. Los resultados se mantienen cuando se suprimen las aferencias visual y propioceptiva.

Falls are a cause of disability and death in geriatric population. Third part of the elderly suffer at least one fall per year. Neurological illness are a very important risk factor in developing falls.To establish the differences between neurological and not neurological patients with recurrent falls.We select 113 patients over 65 years-old with two or more falls in the last six months, collecting demographic and medical data, as well as a functional, mental and social evaluation, gait and balance tests and posturography. Complementary examinations were done to clarify the diagnosis in each case.Average age was 78 years-old. We define a group A, patients in which the main cause of falls is a neurological disease and group B with a non-neurological cause. Group A shows more number of falls (p0.053), worse functional (p0.002) and mental (p0.001) situation and more comorbility (p = 0.05), as well as worse scores in gait tests.Neurological illness are a very important risk factor in falls due to the disturbances in gait and balance that they produce. Dementia, parkinsonism and cerebrovascular diseases are frequently found in elderly patients with recurrent falls. Patients with falls due to neurological illness tend to fall oftener and have worse mental and functional situation. Evaluating neurological risk factors in geriatric patients with recurrent falls is essential to establish appropriate prevention strategies.

To know nutritional status of a group of institutionalized patients with moderate Alzheimer's Disease (AD), and to ascertain the effects of an intervention with nutritional supplements on morbidity and mortality after one year follow-up.99 patients (mean age: 86.5 years), 80 women, with a diagnosis of AD according with NINCDS/ADRDA criteria, were recruited from 8 nursing-homes. 25 were included in an intervention group and received a nutritional supplements along 12 months. Evolution was evaluated according to the Functional Assessment Staging Test (FAST). Patients with FAST levels 5-6 were included. General clinical variables as well as variables reflecting cognitive state and nutritional status: anthropometric, biochemical data and Mini Nutritional Assessment (MNA) were analysed. Statistical analysis was carry out with the SPSS 10.0 package.Mean time since diagnosis was 49 months, with a 20.2 months duration of institutionalization. Mean value of MNA was 20.1 3.5. 16.5% of patients had a BMI equal o lower than 21. After one year the intervention group showed higher levels of albumin (P=05), pre-albumin (P=05), iron (P=01), zinc (P=05), and beta-carotene (P=05) than the control group. The same response in BMI (P=05), MNA (P=05), and triceps skinfold (P=01). Mortality was lower (16% vs. 22.7%), without statistical significance, in the intervention group, as it was the number of infectious events (47% vs. 66% P=05), and the days in bed (7.5 2.1 vs. 17.3 5.6 P=05).Nutritional supplements applied to a group of patients with AD living in nursing-homes can reduce morbidity and mortality after one year follow-up.

In this review, after some short conceptual and demographical introductory remarks, I will focus my attention on four topics: a) The question of nutritional assessment of the elderly living in a nursing-home; b) Main nutritional disorders; c) Nursing-homes nutritional studies in Spain; and d) Guidelines and protocols.

To analyse the statistical and characteristics of the attendance to the elderly patient at the Emergency Department of a General Hospital.Retrospective study of patientsor = 65 years assisted at the Emergency Department of the Hospital Clínico San Carlos (Madrid), during 1998, taking into consideration different parameters as age, sex, time of year, referred pathology and final destination; results were compared with data relating to the population under 65.Over 28.4% of the 129,586 subjects that attended the Emergency Department were elderly people. Those ones aged between 65-74 years demanded assistance more frequently, being women's requests higher, particularly among the eldest patients. Assistance requests were higher in winter time, being the most common reason for consultation medical and surgical general troubles (76.4%), followed by trauma emergencies (12.35%). Hospital admission's percentage of elderly people was three times higher than the non-elderly ones, needing more admissions men than women (29 vs 22.7%).The high statistical of urgent attendance to the elderly patient compared with younger people as well as the higher number of admissions due to this assistance, seem to make necessary the implantation of Geriatric Evaluation Units at the hospital's Emergency Departments.

Heart disease is the most common cause of death in elderly people. Cardiovascular aging is a continuous and irreversible process. It has a decline rate that varies among individuals and can be modulated by three conceptually different influences, namely, physiological changes due to the passage of time, adaptive sequeles of previous diseases or surgery in younger life, and influence of the individual lifestyle or their own cardiovascular risk factors. The main practical consequences of aging processes are a progressive change in the morphological, functional, and semiological characteristics of the cardiovascular system and an increase in the number of age-related cardiovascular disorders. The main morphological cardiovascular changes with aging happen in the structure of cardiac tissue and chambers, in the conduction system, and in the coronary arteries. But the cardiac function at rest in healthy elderly persons is adequate to meet the body's need. A normal or almost normal cardiac output in the elderly is to be maintained by increasing the stroke volume and the ejection fraction due to an augmented cardiac filling (preload). Atypical clinical pictures are very common in elderly patients with cardiovascular disease. For example, non-cardiac symptoms are the often presenting features. Concerning the treatment of cardiovascular diseases in the elderly, the clinician needs to consider age-related factors as multimorbidity and disabilities, the possible side effects and/or interactions due to pharmacodynamic or/and pharmacocinetic changes. And he has to take into account the social and financial situation of his patient.

The present study analyzes the main clinical types of urinary incontinence in the elderly population and its clinical-urodynamic correlation to facilitate definitive diagnosis.The study was conducted in 948 elderly patients (382 male, 566 female; mean age 72.4 years) with urinary incontinence. Patient clinical and urodynamic records were reviewed. The most common clinical types were urge-incontinence (56.4%) and incontinence with coughing associated with urge-incontinence (32.3%); the latter type was the most common in women. The most frequent urodynamic diagnoses were isolated bladder instability (29.9%), followed by obstruction (15.6%) and stress incontinence (14%).The most common symptom in bladder instability was urge-incontinence, while incontinence with coughing was found to be the most common symptom in urinary stress incontinence. A significant correlation was found between the postvoid residual urine and the main urodynamic diagnoses. Multivariate analysis showed that classification by clinical types of incontinence together with measurement of residual urine can facilitate diagnosis, although this approach has a low sensitivity for the main forms of isolated incontinence. The mixed forms require a urodynamic study.

This paper reviews the current questions and the new aspects related to Infective Endocarditis in elderly patients. Four points are emphasized: a) epidemiological changes during the last decades, b) clinical features and diagnostic challenges of infective endocarditis in the elderly, c) mortality and prognosis, and d) preventive and therapeutic measures that must be taken into account.

Forty-two elderly patients were subjected to a nutritional assessment and an intravenous magnesium load (0.5 mmol/kg). After 48 h, patients with protein-calorie malnutrition (PCM) showed magnesium retentions (MgR) above 20 per cent, thus indicating magnesium deficit, and greater (P0.001) than those from well-nourished patients. The discriminating cross-point for undernourished patients was at 28 per cent with 95 per cent sensibility and specificity. There were significant correlations between MgR and most nutritional parameters. An increase of the RMg constitutes a PCM indicator which may be useful to quantify it.

to asses in a group of elderly patients included in a Home Care Unit, the level of immobility, the functional status based on the Katz's index and the Red Cross scale, and their medical, psychological and social consequences.assessment of elderly patients visited during three consecutive months, through and standardized protocol with 14 items related with the previous aspects.114 elderly patients (71% females) were visited during this time. The mean age was 82.4 years. 71 patients (65.7%) had immobility, with a mean age of 83.4 years and females predominance. Based on the level of immobility, 24 patients were in bed and 44 patients were able to be in bed-armchair. 74% of the patients were severely disabled on the activities daily living (Katz G); 85% of the patients had a severe physical disability (Red Cross scale 4-5), whereas a lower percentage (36%) had severe mental disability (Red Cross scale 4-5). Neurological disorders were the most frequent etiology of immobility (72%), with only one cause in 27 patients, two causes in 20 patients and more than three causes in 24 patients. Medical consequences were the most frequent, mainly urinary and chest infections, pressure sores and constipation.Immobility's syndrome represents a common medical problem in the geriatric care, related specially with the neurological and osteo-articular disorders, conditioning a high mobility.

Cerebrovascular disease is the third cause of death in much of the occidental countries. Nowadays atrial fibrillation (AF) is well recognized as an independent and important risk factor for stroke in elderly people. Our aim is to know the frequency of AF in the patients who were admitted to a hospital for an ischemic stroke, the clinical risk factors associated to brain embolism and the prevention of cardiogenic brain embolism.164 patients older than 65 years were admitted to the hospital during 5 months, those who were suspected of stroke were studied prospectively. Only the patients who had a cerebral infarction demonstrated by computed tomography of brain with a neurological alteration of at least 3 days were included in the study.Fifty eight patients (27 men) met the ischemic stroke criteria. 22 of them had AF (9 men). Three of them had no other clinical risk factors associated and 19 had: hypertension in 10 cases, 8 had previous stroke and 1 had a episode of congestive heart failure 3 months before being admitted in the hospital. At the moment of admission only 4 patients were treated with aspirin and none with warfarin.a) 38% of elderly patients with stroke have AF. b) The association with other clinical factors that increase the risk of brain embolism is high (86%). c) The percentage of patients having a preventing treatment for cardiogenic embolism is very low.

To know the Primary Care Physicians opinion related to their own praxis, background, and needs for a specific medical support in geriatric medicine.A closed mailed questionnaire, with 22 items. Descriptive analysis of the results. PEOPLE SAMPLE: 559 answers. 77% men. Age: main group (44%) between 35 and 39 years old. 80% of the sample worked in health centers as primary care physicians.a) Praxis: 50% of the physicians attend more than 20 elderly patients every day. 38% of them have specific aged oriented protocols. 74% of them take age into account when decide the appropriate doses of drugs. b) Geriatric background: None at the undergraduate period: 96%. Some sort of postgraduate formation: 42%. Are able to identify at less a geriatric book: 34%. A score of 4.5 (over 10) was the result of their own assessment about their level of geriatric knowledge. 95% of the answers miss a better formation in geriatrics, and 93% of them think that this formation would change their clinical approach to the elderly patient. c) Needs of specialized geriatric support: It would be helpful to them according to a 84% of the answers. It could be as a "Geriatric Inhospital Service" in the opinion of a 44% of the cases (this question had a 18% of abstentions); and with geriatricians working as extrahospitalary consultants according to the answers of the 79% (6% of abstentions).Primary care physicians have: 1. Many elderly patients, with an acceptable level of attention to them. 2. A poor geriatric formation and awareness of their needs. 3. Need of a specialized support in their daily work.

Arterial hypertension (AHT) is one of the principal health problems facing the community today. Because the prevalence of AHT among the elderly is high and management of the condition is problematic, concern is increasing as the population ages. This article provides the following: a) a short summary of epidemiological data, the most important being the criteria used to define the disease, which has a prevalence of around 50% in patients over 65 years of age (and higher among women); b) a discussion of the role of AHT as a risk factor in the elderly; c) a review of the most important findings and conclusions from studies carried out among the elderly, and d) some final considerations toward the eventual formulation of treatment guidelines.

Introduccion. Las caidas son causa de discapacidad y muerte en la poblacion geriatrica. Un tercio de los ancianos sufre al menos una caida al ano. Las patologias neurologicas son un importante factor de riesgo en la produccion de caidas. Objetivo. Establecer las diferencias entre ancianos con caidas de repeticion en funcion de que padezcan o no alguna patologia neurologica. Pacientes y metodos. Se seleccionaron 113 pacientes mayores de 65 anos con dos o mas caidas en los ultimos seis meses y se recogieron variables demograficas y medicas, valoracion funcional, mental, social, de la marcha y el equilibrio, y posturografia. Se realizaron las pruebas complementarias en cada caso para aclarar el diagnostico. Resultados. La edad media fue de 78 anos. Se definio un grupo A, pacientes en los que la causa fundamental de la caida era neurologica, y un grupo B, con causa no neurologica. El grupo A presento mayor numero de caidas (p = 0,053), peor situacion funcional (p = 0,002) y mental (p < 0,001) y mayor morbilidad (p = 0,05), asi como peor puntuacion en los test de valoracion de la marcha. Conclusiones. Las enfermedades neurologicas constituyen un importante factor de riesgo en la produccion de caidas por las alteraciones de la marcha y el equilibrio que producen. Las demencias, los sindromes parkinsonianos y la enfermedad cerebrovascular se encuentran con frecuencia entre la poblacion de ancianos con caidas de repeticion. Los pacientes con caidas de causa neurologica presentan mas caidas y peor situacion funcional y mental. Identificar factores de riesgo neurologico en ancianos con caidas resulta fundamental para establecer estrategias de prevencion adecuadas.

Data of 22 patients with primary double tumors are reviewed, collected from a total of 39.000 clinical protocols of which 1.168 were malignant. All were histologically verified. Criteria were those established by WarrenGates i.e. a) each tumor must present clear signs of malignancy, b) each tumor must be different from the other, c) all possibility that one tumor may be a metastasis of the other must be excluded. Twelve of the cases were male and 10 female, representing 1.88% of the total with malignancies. In 6 cases both tumors appeared simultaneously, while the time interval was between 1 and 43 years in the remaining 16. Hematologic neoplasias are predominant with 12/44, followed by digestive and urogenital ones with 8/44 in each sub-group. Association between double tumors is assessed and causal factors which may influence or favor the appearance of two or more neoplasias are discussed.