Marcela Carrasco

Impact of delirium on short-term mortality in elderly inpatients: a prospective cohort study.

BACKGROUND Delirium is an important problem especially in older medical inpatients. OBJECTIVE The authors asked whether delirium and its duration are associated with higher mortality in a 3-month follow-up period. METHOD In this prospective cohort study, inpatients age 65 and older were assessed every 48 hours with the Confusion Assessment Method. RESULTS Of 542 patients enrolled, 192 (35.4%) developed delirium. After 3 months, mortality in the delirium cohort was 25.9%, and in the nondelirium cohort was 5.8%. Delirium was independently associated with mortality, and increased by 11% for every 48 hours of delirium. CONCLUSION Delirium and increased delirium durations are significantly associated with higher mortality.

Development and validation of a delirium predictive score in older people

BACKGROUND delirium is frequently under diagnosed in older hospitalised patients. Predictive models have not been widely incorporated in clinical practice. OBJECTIVE to develop and validate a predictive score for incident delirium. DESIGN AND SETTING two consecutive observational prospective cohorts (development and validation) in a university affiliated hospital. SUBJECTS inpatients 65 years and older. METHODS in the development cohort patients were assessed within the first 48 h of admission, and every 48 h thereafter, using the confusion assessment method to diagnose delirium and data were collected on comorbidity, illness severity, functional status and laboratory. Delirium predictive score (DPS) was constructed in the development cohort using variables associated with incident delirium in the multivariate analysis (P < 0.05), and then tested in a validation cohort of comparable patients, admitted without delirium. Receiver operating characteristic (ROC) analysis and likelihood ratio (LR) were calculated. RESULTS the development cohort included 374 patients, incident delirium occurred in 25. After multivariate analysis incident delirium was independently associated with lower functional status (Barthel Index) and a proxy for dehydration (elevated urea to creatinine ratio). Using these variables, DPS was constructed with a performance in the ROC curve area of 0.86 (95% CI: 0.82-0.91) and (-) LR = 0.16 and (+) LR = 3.4. The validation cohort included 104 patients and the performance of the score was ROC 0.78 (95% CI: 0.66-0.90). CONCLUSIONS This simple predictive model highlights functional status and a proxy for dehydration as a useful tool for identifying older patients that may benefit from close monitoring and preventive care for early diagnosis of delirium.

Identificación y caracterización del adulto mayor saludable

Aun no existe una definicion operacional de envejecimiento saludable en la practica clinica, pese a ser una meta de las politicas de salud de la OMS. El objetivo de este estudio es desarrollar un protocolo clinico que permita identificar personas mayores saludables en la comunidad, con el fin de estudiar sus caracteristicas clinicas, de laboratorio y funcionalidad. Metodos: Se invito de manera abierta a participar de este estudio a personas mayores saludables. Se considero saludable a individuos mayores de 60 anos, de la comunidad, funcionalmente activos, con baja carga de comorbilidad y que se auto-percibieran saludables. Los participantes fueron entrevistados telefonicamente y aquellos que cumplieron los criterios fueron evaluados mediante una evaluacion geriatrica integral, que incluia evaluacion clinica, antropometrica, funcional (Timed get up and Go), y laboratorio. Resultados: Un total de 384 personas respondieron al llamado y 83 cumplieron los criterios de saludable, 57% mujeres, edad promedio 71 anos (60-98), 78% no consumia ningun medicamento, 100% tenia una capacidad fisica mayor de 3 Mets . El laboratorio basico mostro que cerca del 90% de los sujetos estaba en el rango de normalidad usando los criterios de referencia estandar establecido para poblacion adulta. Conclusiones: Este estudio revela que el protocolo desarrollado fue capaz de identificar personas mayores saludables, con baja carga de comorbilidad y buena funcionalidad. Ademas valida la historia clinica y la valoracion geriatrica integral como instrumento fidedigno para identificar a estos sujetos. Este protocolo podria ser usado para mejorar el conocimiento sobre las caracteristicas propias de un envejecimiento saludable.

Impacto del Delirium en pacientes de edad avanzada hospitalizados: Un estudio prospectivo de cohortes.

BACKGROUND: Delirium is an important problem in older medical inpatients. AIM: To assess if delirium is associated with higher mortality, functional decline or higher rates of readmission or institutionalization in a one year follow-up period. MATERIAL AND METHODS: Prospective cohort study of consecutive patients 65 years and older, admitted to a general hospital medical ward. A psychogeriatric team assessed patients every 48 h using the Confusion Assessment Method (CAM), functionality, acute severity and comorbidity scores. Analysis of one year mortality and telephone functional assessment was performed. RESULTS: Five hundred forty two patients were enrolled and 35.4% had delirium. After one year, mortality was 34.9 and 13% in delirium and non-delirium cohorts, respectively (p < 0.01). After adjustment for covariates, delirium was independently associated with higher mortality, and higher functional decline and institutionalization. No significant differences were seen in readmission rates. CONCLUSIONS: Delirium was significantly associated with higher mortality and functional decline over a one year follow up period in geriatric inpatients.BACKGROUND Delirium is an important problem in older medical inpatients. AIM To assess if delirium is associated with higher mortality, functional decline or higher rates of readmission or institutionalization in a one year follow-up period. MATERIAL AND METHODS Prospective cohort study of consecutive patients 65 years and older, admitted to a general hospital medical ward. A psychogeriatric team assessed patients every 48 h using the Confusion Assessment Method (CAM), functionality, acute severity and comorbidity scores. Analysis of one year mortality and telephone functional assessment was performed. RESULTS Five hundred forty two patients were enrolled and 35.4% had delirium. After one year, mortality was 34.9 and 13% in delirium and non-delirium cohorts, respectively (p < 0.01). After adjustment for covariates, delirium was independently associated with higher mortality, and higher functional decline and institutionalization. No significant differences were seen in readmission rates. CONCLUSIONS Delirium was significantly associated with higher mortality and functional decline over a one year follow up period in geriatric inpatients.

Impacto del apoyo familiar en la presencia de quejas depresivas en personas mayores de Santiago de Chile

INTRODUCTION Epidemiological changes can have an effect on social and, and in particular, family ties, which are important elements in the mental health of older people. The objective of this study was to evaluate the impact of family support on depressive disorders in older people of the community. MATERIAL AND METHODS Face to face interviews were conducted on a representative sample of adults 60 years and older, living in urban area of Santiago de Chile. The information on depressive disorders was related to family composition, emotional and instrumental support, presence of conflict, health self-perception, functionality and self-efficiency. Data were analyzed using logistic regression models. RESULTS From a total of 394 participants, 62% females, mean age 74 years (SD=8.1), 16% felt depressed almost every day. Depressive disorders were significantly associated in regression models with impaired self-perception of health and efficacy, lower instrumental support, and with the presence of conflict. The variable that most contributed to the model was self-rated poor health, increasing the odds of depressive disorders by 3.2. CONCLUSIONS Poor perception of health was the main determining factor for depressive complaints in older people, followed by lower family support, specifically instrumental support, and the presence of conflict. This information can help future programs in order to improve the quality of life in older people.

Marcadores de inflamación sistémica en pacientes ex fumadores con enfermedad pulmonar obstructiva crónica en etapa estable

BACKGROUND Low grade systemic inflammation is commonly observed in chronic obstructive pulmonary disease (COPD). AIM To evaluate the extent of systemic inflammation in a group of ex-smokers with COPD in stable condition and its relation with pulmonary function and clinical manifestations. PATIENTS AND METHODS We studied 104 ex-smokers aged 69 ± 8 years (62 males) with mild to very severe COPD and 52 healthy non-smoker subjects aged 66 ± 11 years (13 males) as control group. High sensitivity serum C reactive protein (CRP), interleukin 6 (IL6), fibrinogen (F) and neutrophil count (Nc) were measured. Forced expiratory volume in the first minute (FEV1), inspiratory capacity (IC), arterial blood gases, six minutes walking test, dyspnea and body mass index (BMI) were measured, calculating the BODE index. Health status was assessed using the Saint George Respiratory Questionnaire (SGRQ), the chronic respiratory questionnaire (CRQ), registering the number of acute exacerbations (AE) during the previous year and inhaled steroids use. Systemic inflammation was considered present when levels of CRP or IL6 were above the percentile 95 of controls (7.98 mg/L and 3.42 pg/ml, respectively). RESULTS COPD patients had significantly higher CRP and IL6 levels than controls. Their F and Nc levels were within normal limits. Systemic inflammation was present in 56 patients, which had similar disease severity and frequency of inhaled steroid use, compared with patients without inflammation. Patients with systemic inflammation had more AE in the previous year; lower inspiratory capacity, greater dyspnea during the six minutes walk test and worse SGRQ and CRQ scores. CONCLUSIONS Low-grade systemic inflammation was found in 56 of 104 ex-smokers with COPD. This group showed a greater degree of lung hyperinflation, dyspnea on exercise and poor quality of life.

Uso inapropiado de medicamentos en adultos mayores: resultados de la Encuesta Nacional de Salud 2010

Background: Inappropriate medication use in older people is an important source of adverse events and complications. Aim: To determine the frequency of inappropriate medication use in the general population. Material and methods: As part of the 2010 Chilean National Health Survey, 1048 persons aged 65 years or more were interviewed about medication use. The information obtained was analyzed using standardized Beer’s criteria, adapted for the Chilean population, to define inappropriate medication use. A logistic regression model was performed to define risk factors for inappropriate medication use. Results: Ten percent of subjects had a high risk of inappropriate medication use. The most common medications used were chlorphenamine, amitriptyline, diazepam, chlorpromazine, chlordiazepoxide and piroxicam. The risk factors detected were female gender, polypharmacy and a bad health self-perception. Conclusions: Inappropriate medication use is common among Chilean older people and should be discouraged.

Deterioro cognitivo e hiperparatiroidismo primario: resultado favorable después de cirugía: Caso clínico

We report a 79-year-old male patient presenting with progressive memory loss associated with anxiety and muscularpain. An extensive biochemical control revealed high serum calcium and parathormone levels, and normal thyroid hormones. Cognitive assessment prior to surgery was compatible with mild cognitive impairment, showing significant improvement two months after parathyroidectomy. Our case suggests that, although rare, primary hyperparathyroidism should be considered as a possible cause of cognitive decline in the elderly.

Optimización perioperatoria del paciente anciano con fractura osteoporótica de cadera

The number of osteoporotic fractures is increasing along with population aging. Most patients with these type of fractures are older than 65 years, with multiple chronic conditions and different degrees of disability. Hip fracture is the most relevant osteoporotic fracture due to its frequency, costs, severity and complications. Multidisciplinary management is of the utmost importance to obtain good therapeutic results. We herein review the management of this fracture. Orthogeriatric joint management should be incorporated in fragility fracture treatment. We contribute with general recommendations for the perioperative management, which can be homologated for the management of older patients with other type of fragility fractures.