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Background: Acute care hospitalization increases the likelihood of developing cognitive impairment and delirium in older adults. Objective: To summarize evidence about the effectiveness of exercise and physical rehabilitation interventions on the incidence of delirium and cognitive impairment in acutely hospitalized older patients. Methods: Relevant articles were systematically searched (PubMed, Web of Science, and CINHAL databases) until 26 August 2021. Randomized and nonrandomized controlled trials of in-hospital physical exercise interventions and rehabilitation programs compared to usual care performed for older patients (> 65 years) hospitalized for an acute medical condition were selected. The primary endpoints were changes in the incidence of delirium and cognition during acute hospitalization. The secondary endpoints included functional independence, psychological measures, well-being status, length of hospital stay, transfer after discharge, fall occurrence, hospital readmissions, and mortality rate. The endpoints were evaluated at different time points (at admission, at discharge, and after discharge). Results: Eleven studies from 8 trials (n = 3,646) were included. The methodological quality of the studies was mostly high. None of the studies reported any adverse events related to the intervention. Early rehabilitation improved cognitive function at 3 months postdischarge (Hedge’s g = 0.33, 95% confidence interval [CI] 0.19 to 0.46, p 0.05). Conclusion: In-hospital physical exercise and early rehabilitation programs seem to be safe and effective interventions for enhancing cognitive function after discharge in older patients hospitalized for an acute medical condition. However, no potential benefits were obtained over usual hospital care for the incidence of delirium.

Clinically viable screening tools for detecting individuals at heightened risk for mobility limitations is warranted. However, it remains unclear in acutely hospitalized patients (75 years) whether handgrip strength might be a good predictor for "proxy" muscle strength. To examine the reliability and validity of handgrip strength test in acute hospitalized older adults in comparison with other standardized muscular strength tests, and to examine its ability to discriminate between presence and absence of mobility limitations. Cross-sectional study. A total of 234 patients (mean age 87.0 years, 46% women) admitted to a tertiary public hospital between 2016 and 2017 were recruited. Maximal (one repetition maximum) and power muscle output of the upper and lower extremity along with functional capacity (as assessed with Barthel index and the Short Physical Performance Battery [SPPB]), and cognitive function was measured at admission. Functional impairment (mobility limitations) was defined at SPPB ≤7 points. Pearson's correlation and multivariable linear regression were evaluated between handgrip test and maximal and muscle power output as the reference method to assess concurrent validity. Receiver operating characteristic analysis was used to estimate handgrip strength cutoff point for likelihood of mobility limitations to assess predictive validity. Findings show moderate-to-strong correlations between standardized muscular strength (reference methods) and handgrip strength test (

Aging-related traits, including gradual loss of skeletal muscle mass and chronic inflammation, are linked to altered body composition and impaired physical functionality, which are important contributing factors to the disabling process. We sought to explore the potential relationship between lower-body muscle strength decline and inflammatory mediators in older adults. We performed a cross-sectional analysis in 38 older adults admitted to an acute care of the elderly unit (57.9% women, mean age=87.9±4.9 years; mean body mass index [BMI]=26.5±4.7 kg/m2). Clinical and functional outcomes including weight, height, BMI, dependence, physical and cognitive performance, and muscle strength measured by one-repetition maximum (1RM) for leg-extension, leg-press, chest-press and handgrip strength, were assessed. Blood serum content of 59 cytokines, chemokines and growth factors was assessed by protein arrays. Multivariate linear regression analyses were used to examine the relationship between cytokine concentrations and muscle strength parameters. After controlling for confounding factors (age, sex, BMI, cumulative illness rating score and physical performance score), 1RM leg-press had a significant negative relationship with GRO (CXCL2) (β= −18.13, p=0.049), MIG (CXCL9) (β= −13.94, p=0.004), IGF-1 (β= −19.63, p=0.003), CK-BETA 8 (CCL23) (β= −28.31, p=0.018) and GCP-2 (CXCL6) (β= −25.78, p=0.004). Likewise, 1RM leg-extension had a significant negative relationship with IGFBP-1 (β= −11.49, p=0.023). Thus, several serum cytokines/chemokines and growth factors are negatively associated with lower muscle strength in older patients. Further investigation is required to elucidate the mechanism of elevated inflammatory mediators leading to lower muscle strength.

Resumen Antecedentes y objetivos Existen multiples escalas para la deteccion de fragilidad en ancianos, pero no especificamente para poblacion institucionalizada. El objetivo fue comprobar tras 3 anos de seguimiento que escala predice con mayor precision el declive funcional y la mortalidad. Metodos Estudio longitudinal de cohortes con 110 pacientes mayores de 65 anos institucionalizados en Pamplona (Navarra). Se aplicaron 4 escalas de fragilidad (Fried, Fried Imputada, Rockwood y FRAIL NH). El poder de la asociacion entre las escalas y los resultados se comprobo mediante analisis de regresion lineal y de Cox. Resultados El 46,5% de la muestra fallecio durante el seguimiento, el 68% de ellos en su residencia, con 43 meses de media de supervivencia. El 71,3% de los ancianos estudiados presento discapacidad a los 3 anos, especialmente los fragiles. Los pacientes robustos experimentaron hospitalizaciones mas prolongadas (m = 3,4 dias) que los fragiles. Las escalas Fried Imputada y la FRAIL NH encontraron diferencias estadisticamente significativas entre grupos para las variables estudiadas; Fried Imputada mostro un HR significativo de muerte para sujetos fragiles (HR = 3,3). Conclusiones Las escalas Fried Imputada y FRAIL NH mostraron una mayor capacidad predictiva para declive funcional y cognitivo, siendo la escala Fried Imputada la unica que relaciona la mortalidad con la fragilidad.

Background and objectives There are multiple frailty detection tools, but they have not been specifically developed for the institutionalized population. The aim of this study is to ascertain at 3-year follow-up which tool predicts functional impairment and mortality most precisely. Methods Longitudinal cohort study with 110 patients in Pamplona (Navarra) >65 years. Four frailty tools were applied (Fried Criteria, Rockwood Frailty Scale, FRAIL-NH and Imputed Fried Frailty Criteria). The power of the association between the scales and the results was assessed by linear regression and Cox's analyses. Results 46.5% of the sample died during time to follow-up, 68% of whom died in their nursing home, with 43-month mean survival. Of the studied population, 71.3% showed disability at 3 years, especially the frail subjects. The robust patients had longer hospitalizations (m = 3.4 days) than the frail. Imputed Fried and FRAIL-NH found statistically significant differences between groups for the variables studied. Imputed Fried Frailty Criteria showed a significant HR of death for the frail subjects (HR = 3.3). Conclusions The Imputed Fried and FRAIL-NH tools showed a higher predictive capability for functional and cognitive decline, but only the Imputed Fried Frailty Criteria found a significant relationship between frailty and mortality.

Resumen Cada vez es mayor el numero de pacientes de edad avanzada que esta siendo tratado por especialidades diferentes a la geriatria, las cuales, por las caracteristicas de sus tratamientos, necesitan conocer el pronostico que tiene su indicacion en los pacientes ancianos fragiles y optimizar la situacion de estos pacientes para mejorar dicho pronostico. Las mas frecuentes, actualmente, son oncologia y hematologia, cardiologia, cirugia general y otros servicios quirurgicos. Se entiende por geriatria transversal la ampliacion del area de conocimiento y atencion de la geriatria en sentido horizontal, fuera de sus unidades habituales, aplicando los principios de la medicina geriatrica con un enfoque multidisciplinar al terreno de otros servicios que atienden a pacientes muy mayores y fragiles con enfermedades graves, con el objetivo de ofrecer una atencion centrada en la persona y mejorar su manejo integral. La valoracion geriatrica y la deteccion de la fragilidad en estos casos aportan informacion pronostica y ayudan en la toma de decisiones y en la seleccion de un tratamiento individualizado. En algunos casos es posible mejorar la evolucion de los pacientes y la eficiencia del sistema sanitario. En este articulo se revisan estos conceptos, se describen algunos modelos existentes, se mencionan los instrumentos mas empleados para esta funcion y se resumen algunas actividades de esta nueva area de la asistencia geriatrica. Es previsible que cada vez en mas hospitales se solicite a los servicios de geriatria la implementacion de este tipo de valoraciones e intervenciones. Existe informacion basica para su puesta en marcha, pero no la suficiente como para considerar que estan respondidas todas las preguntas que se plantean. Sera, pues, en los proximos anos un nuevo reto para esta especialidad.

The World Health Organization has developed the Integrated Care of Older People (ICOPE) strategy, a program based on the measurement of intrinsic capacity (IC) as "the composite of all physical and mental attributes on which an individual can draw". Multicomponent interventions appear to be the most effective approach to enhance IC and to prevent frailty and disability since adapted physical activity is the preventive intervention that has shown the most evidence in the treatment of frailty and risk of falls. Our paper describes the development of a multi-domain group-based intervention addressed to older people living in the community, aimed at improving and/or maintaining intrinsic capacity by means of promoting physical activity, healthy nutrition, and psychological wellbeing in older people. The process of intervention development is described following the Guidance for reporting intervention development studies in health research (GUIDED). The result of this study is the AMICOPE intervention (Aptitude Multi-domain group-based intervention to improve and/or maintain IC in Older PEople) built upon the ICOPE framework and described following the Template for Intervention Description and Replication (TIDieR) guidelines. The intervention consists of 12 face-to-face sessions held weekly for 2.5 h over three months and facilitated by a pair of health and social care professionals. This study represents the first stage of the UK Medical Research Council framework for developing and evaluating a complex intervention. The next step should be carrying out a feasibility study for the AMICOPE intervention and, at a later stage, assessing the effectiveness in a randomized controlled trial.

To assess whether cardiorespiratory fitness (CRF) is associated with first purchase of a prescribed hypnotic drug in the adult population.A total of 34,357 adult participants (53.9% women) with a mean age of 51.5 years (SD 15.6 years) from the third Trøndelag Health Study (HUNT) of 2006 to 2008 were observed until January 1, 2018. Cardiorespiratory fitness was estimated from a validated nonexercise algorithm. Data on first hypnotics prescription were obtained through linkage to the National Norwegian Prescription Database. Cox regression with 95% CIs was used to estimate hazard ratios (HRs).After 304,899 person-years of follow-up, 5791 participants had their first registered purchase of prescribed hypnotics, corresponding to an incidence rate of 1.90 per 100 person-years. Each 1-metabolic equivalent of task increase in CRF was significantly associated with 5% (HR, 0.95; 95% CI, 0.91 to 0.99; P=.02) and 4% (HR, 0.96; 95% CI, 0.92 to 1.00; P=.046) risk reduction for incident use of hypnotics in men and women, respectively. When CRF was categorized into tertiles with lowest CRF as the reference group, reduced risk was 13% (HR, 0.87; 95% CI, 0.79 to 0.96; P=.006) and 15% (HR, 0.85; 95% CI, 0.77 to 0.95; P=.003) for men in the intermediate and highest CRF category, respectively. In women with highest CRF, the reduced risk was 5% (HR, 0.95; 95% CI, 0.87 to 1.03; P=.22).Cardiorespiratory fitness in adulthood is associated with incident purchase of prescription medication commonly used for sleep problems. These findings suggest that fitness should be considered a target for preventing sleep problems in adults.

Background Hospitalisation-associated disability due to reduced physical activity levels and prolonged bedrest episodes are highly prevalent in older adults. Objective To assess the effect of gamified interventions on functional capacity in hospitalised older adults. Methods A three-armed non-randomised controlled trial with two experimental intervention groups and a control group was conducted in a tertiary public hospital in Navarre, Spain. Participants were allocated to a simple gamification group (SGG) (n = 21), a technology-based gamification group (TGG) (n = 23) or a control group (CG) (n = 26). The end points were changes in functional capacity, muscle strength, cognition, mood status and quality of life. Results Seventy patients (mean age 86.01 ± 4.27 years old) were included in the study; 29 (41.4%) were women. At discharge, compared to CG, a mean increase of 1.47 points (95%CI, 0.15–2.80 points) and 2.69 points (95%CI, 1.32–4.06 points) was observed (SGG and TGG, respectively) in the SPPB test; as well as an increase of 5.28 points (95%CI, 0.70–9.76 points) in the Barthel Index and 2.03 kg (95%CI, 0.33–3.72 kg) in handgrip strength in the TGG. Regression mediation analyses demonstrated that muscle strength changes (β = 1.30; 95%CI, 0.45–2.14; indirect effect 0.864; 95%CI, 0.09–1.90) significantly mediated the TGG effect on the SPPB score. Conclusions The TGG intervention programme may provide significant benefits in physical and muscle function over usual care and seems to reverse the functional decline frequently associated with acute hospitalisation in older adults.

Key summary points Aim The aims of this study were to describe communication experiences while wearing a mask during the COVID-19 pandemic in 2020, to identify possible mask-related barriers to COVID-19-adapted communications and to investigate whether the ABC mnemonic (A: Attend Mindfully; B: Behave Calmly; C: Communicate Clearly) might address these. Findings The majority of the respondents indicated issues related to lack of time during clinical encounters, uncertainty about how to adapt communication, lack of personal protective equipment, lack of communication skills and lack of information about how to adapt their own communication skills. In addition, the participants indicated acknowledging emotions and providing information using clear, specific, unambiguous, and consistent lay language while wearing a mask were among the main communication challenges created during the COVID-19 pandemic. Finally, the study showed significantly improved self-perceived competency regarding key communication after watching the short video presentation. Message Effective communication in medical encounters must utilize on both verbal and nonverbal skills., Purpose The aims of this study were to describe communication experiences while wearing a mask during COVID-19 pandemic in 2020, to identify possible mask-related barriers to COVID-19-adapted communications and to investigate whether the ABC mnemonic (A: attend mindfully; B: behave calmly; C: communicate clearly) might address these. Methods This study was a cross-sectional, voluntary, web-based survey between January and February 2021. A 22-item survey was developed using the Surveymonkey platform and question styles were varied to include single choice and Likert scales. The respondents were also asked to view a short video presentation, which outlined the ABC mnemonic. CHERRIES (Checklist for Reporting Results of Internet E-Surveys) was used to ensure completeness of reporting. Diverging stacked bar charts were created to illustrate Likert scale responses. Results We received 226 responses. The respondents were mostly women (60.2%) and the majority worked in a teaching hospital (64.6%). The majority of the respondents indicated issues related to lack of time during clinical encounters, uncertainty about how to adapt communication, lack of personal protective equipment, lack of communication skills and lack of information about how to adapt their own communication skills. In addition, the participants indicated acknowledging emotions and providing information using clear, specific, unambiguous, and consistent lay language while wearing a mask were among the main communication challenges created during the COVID-19 pandemic. Finally, the study showed significantly improved self-perceived competency regarding key communication after watching the short video presentation. Conclusion Effective communication in medical encounters requires both verbal and nonverbal skills.

There are few studies on Fracture Liaison Service (FLS) that evaluate older patients after a hip fracture (HF) through comprehensive geriatric assessment. We aim to determine these patients' characteristics, outcomes, and prescribed treatments.A retrospective observational study of a cohort of patients older than 65 years admitted with HFs to an orthogeriatric unit between February 25th (2013) and December 16th (2016). After hospitalization, those patients with a good baseline social, functional, and cognitive situation were referred to the FLS. A comprehensive geriatric assessment and treatment adjustment were conducted. A comparison between FLS patients and HF patients non-referred was made.From 1887 patients admitted to the orthogeriatric unit, 469 (23%) were referred to the FLS. Of those, 335 were women (77.2%) and 337 (77.6%) lived in the community. The FLS patients had a better functional status (97.1% of the patients with independent gait versus 79.2%) than non-FLS patients (p0.001). After 3 months in the FLS, 356 (82%) patients had independent gait and had improved their analytical values. Antiosteoporotic treatment was prescribed to 322 patients (74%), vitamin D supplements to 397 (91.5%), calcium to 321 (74%), and physical exercise to 421 (97%).Patients referred to an FLS were younger, with a better functional and cognitive situation. At hospital discharge, they frequently presented gait impairment and laboratory abnormalities (anemia, hypoproteinemia, vitamin D deficiency) that presented good recovery due to the patient's previous baseline. These patients benefit from comprehensive treatment (pharmacological and non-pharmacological).

Background physical activity reduces frailty in community-dwelling older adults. How exercise influences frailty in hospitalised older adults requires additional investigation. Objectives (i) to examine the impact of an exercise intervention on frailty in older adults admitted to an acute care ward, and (ii) to determine the impact of baseline frailty on the effectiveness of this intervention. Setting/participants this is a secondary analysis of a randomised controlled clinical trial that tested an intensive exercise intervention in ≥75-year-old adults admitted to an acute care ward. Methods the intervention included two daily sessions of moderate-intensity exercises (control received usual care). A 63-item Frailty Index (FI) was constructed, and three groups were formed: Results a total of 323 individuals were included. The mean age was 87.1 years (± 4.8 standard deviation [SD]) and 56.3% were females. The intervention group improved FI from 0.26 (± 0.10 SD) to 0.20 (± 0.10 SD), whereas the control group FI worsened from 0.25 (± 0.1 SD) to 0.27 (± 0.10 SD). After stratifying by baseline FI, SPPB and depression improved in the intervention group across all levels of frailty; FI, BI and quality of life only improved in individuals with a baseline FI ≥ 0.2. Conclusions frailty improves with an intensive individualised exercise intervention, especially in those with high baseline levels of frailty. In addition, frailty is a useful outcome when examining the impact of an intervention of hospitalised older adults.

The increase in life expectancy has led to profound changes in disease prevention and health maintenance. Because of the impact of dysbiosis on the host's health, it is worth considering microbiome-targeted therapies to attenuate or delay age-related perturbations.The aim of the present review was to systematically evaluate the impact of probiotics, prebiotics, and synbiotics on the major events that affect individuals aged 65 or older.We performed a literature search in MEDLINE and the Cochrane Central Register of Controlled Trials. Randomized Clinical Trials (RCTs) performed on old people and published between 2009 and 2019 were included.Nine RCTs and 1 secondary analysis (n = 475, 55.8% female) were eligible for inclusion and retrieved in this systematic review. Overall, most interventions resulted in improvements in certain parameters when compared to control (glucose homeostasis, cognitive function, frailty phenotype, gut microbiota profile, immune parameters), while others remained unvariable.The use of probiotics and prebiotics raises a great opportunity to modulate the process of aging and looks promising for health prevention in old adults. However, more RCTs in subjects older than 65 years are needed to elucidate the suitability of these supplementations and establish the underlying potential mechanisms.

Sin financiación 5.393 JCR (2021) Q1, 3/68 Rehabilitation 0.892 SJR (2021) Q1, 64/294 Orthopedics and Sports Medicine No data IDR 2021 UEM

Background: Lung cancer is the second most prevalent common cancer in the world and predominantly affects older adults. This study aimed to examine the impact of an exercise programme in the use of health resources in older adults and to assess their changes in frailty status. Design: This is a secondary analysis of a quasi-experimental study with a non-randomized control group. Setting: Oncogeriatrics Unit of the Complejo Hospitalario de Navarra, Spain. Participants: Newly diagnosed patients with NSCLC stage I–IV. Intervention: Multicomponent exercise programme that combined resistance, endurance, balance and flexibility exercises. Each session lasted 45–50 minutes, and the exercise protocol was performed twice a week over 10 weeks. Measurements: Mortality, readmissions and Visits to the Emergency Department. Change in frailty status according to Fried, VES-13 and G-8 scales. Results: 26 patients completed the 10-weeks intervention (IG). Mean age in the control group (CG) was 74.5 (3.6 SD) vs 79 (3 SD) in the IG, and 78,9% were male in the IG vs 71,4% in the CG. No major adverse events or health-related issues attributable to the testing or training sessions were noted. Significant between-group differences were obtained on visits to the emergency department during the year post-intervention (4 vs 1; p:0.034). No differences were found in mortality rate and readmissions, where an increasing trend was observed in the CG compared with the IG in the latter (2 vs 0; p 0.092). Fried scale was the unique indicator that seemed to be able to detect changes in frailty status after the intervention. Conclusions: A multicomponent exercise training programme seems to reduce the number of visits to the emergency department at one-year post-intervention in older adults with NSCLC during adjuvant therapy or palliative treatment, and is able to modify the frailty status when measured with the Fried scale.

The World Health Organization has developed the Integrated Care of Older People (ICOPE) strategy, a program based on the measurement of intrinsic capacity (IC) as 'the composite of all physical and mental attributes on which an individual can draw'. Multicomponent interventions appear to be the most effective approach to enhance IC and to prevent frailty and disability since adapted physical activity is the preventive intervention that has shown the most evidence in the treatment of frailty and risk of falls. Our paper describes the development of a multi-domain group-based intervention addressed to older people living in the community, aimed at improving and/or maintaining intrinsic capacity by means of promoting physical activity, healthy nutrition, and psychological wellbeing in older people. The process of intervention development is described following the Guidance for reporting intervention development studies in health research (GUIDED). The result of this study is the AMICOPE intervention (Aptitude Multi-domain group-based intervention to improve and/or maintain IC in Older PEople) built upon the ICOPE framework and described following the Template for Intervention Description and Replication (TIDieR) guidelines. The intervention consists of 12 face-to-face sessions held weekly for 2.5 h over three months and facilitated by a pair of health and social care professionals. This study represents the first stage of the UK Medical Research Council framework for developing and evaluating a complex intervention. The next step should be carrying out a feasibility study for the AMICOPE intervention and, at a later stage, assessing the effectiveness in a randomized controlled trial. This research was funded by the program POCTEFA (European Union) in the context of the APTITUDE project, reference EFA232/16. Nicolás Martínez-Velilla received funding from La Caixa Foundation (ID 100010434), under agreement LCF/PR/PR15/51100006.

Objective To review the evidence on the effectiveness of specific occupational therapy programs in elderly people hospitalized for acute medical pathology. Materials and methods Relevant randomized clinical trials were selected by searching the main bibliographic databases to evaluate the effectiveness of in-hospital occupational therapy interventions for people aged 65 years and over who were hospitalized for acute medical pathology. Results Six studies were finally selected. The interventions consisted of individualized programs of occupational therapy: training and re-education in the activities of daily living (ADL); evaluation, prescription and training in the use of support devices; and providing reports regarding recommendations and referrals on discharge. In five studies, the patients in the intervention group obtained higher scores on assessment tools used to measure functionality in ADL. In one of the studies there was a statistically significant reduction in delirium, as well as an improvement in cognitive function. There was no evidence for the effectiveness of occupational therapy interventions for anxiety, fear and/or perceived safety, in any of the studies analyzed. Conclusions The evidence is limited as to whether specific occupational therapy programs are effective in improving functionality in ADL in this group of patients. However, occupational therapy was significantly effective in reducing delirium and improving cognitive function. There is insufficient evidence to claim that specific occupational therapy programs are effective in reducing levels of anxiety, increasing perceived quality of life, reducing readmission rates, or reducing the length of hospital stay.

Background and objective To estimate the prevalence of polypharmacy and hyperpolypharmacy in non-institutionalised older adults in Spain and assess the associated factors. Material and methods A cross-sectional study based on data from the National Health Survey of Spain 2017, with participants aged 65 and over. The prevalence of polypharmacy (≥5 medications) and hyperpolypharmacy (≥10) were estimated, as well as the association with several factors through multivariate logistic regression. A sensitivity analysis was carried out considering the possible consumption of more than one drug for the same indication (polytherapy). Results 7023 participants were included, with a mean age of 76.0 (SD 7.6), 59.4% female and average consumption of 3.3 (SD 2.2) drugs per person. The prevalence of polypharmacy was 27.3% (95% C I 26.2–28.3) and of hyperpolypharmacy 0.9% (95% CI 0.7–1.1). The sensitivity analysis showed that the prevalence could be at least 37.5% and the average 3.9 (SD 2.5) when considering polytherapy. The factors most associated with polypharmacy were the number of chronic diseases, degree of dependence for the basic activities of daily living, self-perceived health or contacts with the health system; and negatively, sensory deficits and incontinence. Conclusions The prevalence of polypharmacy in the elderly in primary care continues to increase and could be widely underestimated. In addition to multimorbidity, factors such as functional capacity or geriatric syndromes, fundamental in elderly people, modulate the habits of consumption and prescription of drugs in this population.

Resumen Fundamento y objetivo Estimar la prevalencia de polifarmacia e hiperpolifarmacia en adultos mayores no institucionalizados en Espana y analizar los factores asociados. Material y metodos Estudio transversal a partir de datos de la Encuesta Nacional de Salud de Espana 2017, con participantes de 65 anos o mas. Se estimo la prevalencia de polifarmacia (≥ 5 medicamentos) e hiperpolifarmacia (≥ 10), y la asociacion con diversos factores mediante regresion logistica multivariante. Se realizo un analisis de sensibilidad considerando el posible consumo de mas de un farmaco para la misma indicacion (politerapia). Resultados Se incluyeron 7.023 participantes, con edad media de 76,0 (desviacion estandar [DE] 7,6) anos, 59,4% mujeres y consumo medio de 3,3 (DE 2,2) medicamentos por persona. La prevalencia de polifarmacia fue de 27,3% (intervalo de confianza del 95%: 26,2-28,3) y la de hiperpolifarmacia de 0,9% (intervalo de confianza del 95%: 0,7-1,1). El analisis de sensibilidad estimo que la prevalencia podria ascender al menos a un 37,5% y la media a 3,9 (DE 2,5) al considerar la politerapia. Los factores que mas se asocian a la polifarmacia fueron el numero de enfermedades cronicas, el grado de dependencia para las actividades basicas de la vida diaria, el estado de salud percibido o los contactos con el sistema sanitario; y de forma inversa los deficits sensoriales y la incontinencia. Conclusiones La prevalencia de polifarmacia en adultos mayores en atencion primaria continua aumentando, y podria estar ampliamente infraestimada. Ademas de la pluripatologia, factores como la capacidad funcional o los sindromes geriatricos, fundamentales en personas mayores, modulan los habitos de consumo y prescripcion de medicamentos en esta poblacion.

Acute medical illness requiring hospitalization usually is a critical event in the trajectory leading to disability in older adults. Functional decline frequently occurs during hospitalization, resulting in a loss of Independence in activities of daily living after discharge. The aim of the study was to assess the functional decline in different ADLs of hospitalized elderly patients in an Acute Care for Elderly (ACE) unit incorporating a body-worn inertial sensor and accompanying custom algorithms. 38 hospitalized older adults (age ≥ 75) were included. The patients completed different functional tasks, including a balance test, Gait Velocity Test (GVT), verbal and arithmetic dual-task gait, and a sit-to-stand ability test at admission and discharge. Movement-related parameters were acquired from a unique tri-axial inertial sensor unit. Maximal muscle strength and muscle power output endpoints were also assessed. The results indicated that significant improvements (p 0.05) were found at discharge compared with the admission values for gait variability and spatiotemporal parameters in the 4- and 6-meter GVT. These significant gains were also obtained in the verbal GVT. In contrast, a significant reduction was found in the functional status measured with the Barthel Index scale. Regarding to the sit-to-stand ability, lower peak power was observed in the sit-to-stand phase of the task at discharge. In conclusion, inertial sensor unit and our custom, validated, algorithms represent a feasible tool for measuring and monitoring functional trajectory during hospitalization in older adults and they are sensitive to detect differences in movement pattern parameters in different ADLs such as walking and the ability to stand from a seated position.

Resumen Introduccion El envejecimiento de la poblacion y los avances cientificos hacen imprescindible una formacion especifica en Geriatria para todos los estudiantes de Medicina. Existen distintas recomendaciones internacionales sobre la docencia de Geriatria en el pregrado, que aun esta lejos de ofrecerse de forma generalizada. El objetivo de este trabajo fue desarrollar un listado nacional de recomendaciones sobre la docencia de la medicina geriatrica en el pregrado. Material y metodos Se elaboro un decalogo considerando la situacion de la docencia de Geriatria en Espana en el 2016/2017 y las recomendaciones internacionales. Se alcanzo un consenso global entre los miembros del Grupo de Trabajo de la SEGG «Ensenanza de la Geriatria en el pregrado» mediante 2 reuniones presenciales y discusiones a traves de correo electronico. Resultados Se propone un decalogo de recomendaciones sobre la docencia de Geriatria en las facultades de Medicina espanolas, incluyendo las caracteristicas recomendables con relacion a su estado, duracion, contenidos, practicas, profesorado, metodos docentes e innovacion. Conclusiones Estas recomendaciones tienen la finalidad de ayudar a mejorar la ensenanza de Geriatria. Pueden ser empleadas por las distintas facultades de Medicina, ya sea para adaptar la docencia de la Geriatria ya sea para incorporarla.

Aim Older patients admitted to acute geriatric units (AGU) frequently use many medications and are particularly vulnerable to adverse drug events, so specific interventions in this setting are required. In the present study, we describe a new medicine optimization strategy in an AGU, and explore its potential in reducing polypharmacy and improving medication appropriateness. Methods The present prospective study included patients aged ≥75 years who were admitted to an AGU in a tertiary hospital. An intervention based on a pharmacist clinical interview, medication history and a structured medication review within a comprehensive geriatric assessment was proposed. The differences regarding polypharmacy as the primary outcome (≥5 chronic drugs), hyperpolypharmacy (≥10), number of drugs, drug-related problems and Screening Tool of Older Person's Prescription/Screening Tool to Alert Doctors to Right Treatment criteria between admission and discharge were evaluated. Results From October 2016 to April 2017, 234 patients were enrolled, aged 87.6 years (SD 4.6 years); 143 (61.1%) were women. The intervention resulted in a statistically significant improvement in polypharmacy (-10.2%, 95% CI -15.3, -5.2), hyperpolypharmacy (-16.6%, 95% CI -22.3 -11.0), number of medications (-1.4, 95% CI -1.8, -1.0), Screening Tool of Older Person's Prescription criteria (-19.2%, 95% CI -24.9, -13.6), Screening Tool to Alert Doctors to Right Treatment criteria (-6.8%, 95% CI -10.1, -3.5) and drug-related problems (-2.7, 95% CI -2.9, -2.4; P ≤ 0.001 for all). Conclusions A systematic pharmacist-led intervention at hospital admission to an AGU within a comprehensive geriatric assessment was associated to a decrease in polypharmacy, drug-related problems and potentially inappropriate prescribing. Geriatr Gerontol Int 2019; 19: 530-536.