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Martinez-Velilla N.,Complejo Hospitalario de Navarra | Cambra-Contin K.,Navarrabiomed Fundacion Miguel Servet | Ibanez-Beroiz B.,Navarrabiomed Fundacion Miguel Servet
BMC Geriatrics | Year: 2014

Background: Advancing age is associated with increased vulnerability to chronic health problems. Identifying factors that predict oldest-old status is vital for developing effective clinical interventions and public health strategies. Methods. Observational prospective study of patients aged 75 years and older consecutively admitted to an Acute Geriatric Ward of a tertiary hospital. After a comprehensive geriatric assessment all patients were assessed for five comorbidity indices and two prognostic models. Univariate and multivariate logistic regression models were fitted to assess the association between each score and 5-year mortality. The ability of each score to predict mortality was assessed using the area under the receiver operating characteristic curve. Results: 122 patients were enrolled. All patients were followed up for five years. 90 (74%) of them died during the study period. In the logistic regression analyses, apart from age, cognitive impairment and Barthel Index, three indices were identified as statistically associated with 5-year mortality: the Geriatric Index of Comorbidity and the two prognostic indices. The multivariate model that combined age, sex, cognitive impairment and Barthel showed a good discriminate ability (AUC = 0.79), and it did not improve substantially after adding individually any of the indices. Conclusions: Some prognostic models and the Geriatric Index of Comorbidity are better than other widely used indices such as the Charlson Index in predicting 5-year mortality in hospitalized older patients, however, none of these indices is superior to some components of comprehensive geriatric assessment. © 2014 Martínez-Velilla et al.; licensee BioMed Central Ltd.

The interest in studying frailty in older adults is an emerging fact in cardiology due to the incidence of patients undergoing valve replacement procedures in conditions difficult to quantify from the purely clinical point of view. In this regard, the profile of patients has been changing and often elderly people identify with greater vulnerability shown by different aspects such as walking speed, grip strength, independence for activities of daily living or emotional issues that condition their quality of life. These patients need to be identified prior to surgery in order to offer the best therapeutic option. Therefore, in our centre we set out to identify this group of fragile population with a multidimensional assessment where the nurse, through a specific assessment test, can set the degree of fragility of those patients who have an increased vulnerability. In this article we describe the multidimensional assessment in a pilot experience with 115 patients, where patient characteristics were analyzed, providing an overview of the profile of frailty in the elderly with aortic valve heart disease. © 2015 Elsevier España, S.L.U.

Miguel R.S.,Complejo Hospitalario de Navarra | Gimeno-Ballester V.,Hospital Universitario Miguel Servet | Blazquez A.,Agencia Espanola de Medicamentos y Productos Sanitarios | Mar J.,Clinical Management Service
Gut | Year: 2015

Background A new scenario of therapy for chronic hepatitis C (CHC) is being established with the approval of sofosbuvir (SOF). Objective To estimate the cost-effectiveness of SOF-based regimens approved in the Summary of Product Characteristics (SmPC) versus the standard of care for different genotypes and patient populations (naive or pretreated). Methods A Markov model simulating CHC progression was used to estimate disease treatment costs and effects over patients' lifetimes, from the Spanish National Public Healthcare System perspective. Different therapeutic options were analysed for genotypes 1, 2 and 3 in naive population and for genotype 2 and 3 pretreated patients, according to data obtained from clinical trials. A one-way sensitivity analysis was performed to evaluate the uncertainty of certain parameters: treatment starting age, transition probabilities, drug costs and discount rate. A probabilistic sensitivity analysis was also carried out. Results For the naive population, the option SOF+pegylated-interferon-α (pIFN)+ribavirin (RBV) for 12 weeks recorded in SmPC for genotype 1 and 3 versus pIFN+RBV for 24 weeks estimated an incremental cost-effectiveness ratio (ICER) below the □40 000/quality-adjusted life-year (QALY) benchmark. For the pretreated population, SOF triple therapy reached an ICER on the threshold limit for genotype 3. Other options included in SmPC for different genotypes exceeded the accepted efficiency limit in our setting. Conclusions The options that included SOF+RBV+pIFN in a 12-week course regimen fell below the efficiency threshold considered in our setting. IFN-free regimens administered for 24 weeks reached figures over the benchmark of □40 000/QALY.

Uriz-Otano F.,Hospital San Juan de Dios | Uriz-Otano J.I.,Complejo Hospitalario de Navarra | Malafarina V.,Hospital San Juan de Dios
Journal of the American Medical Directors Association | Year: 2015

Objectives: To assess factors associated with functional recovery and determine the influence of cognitive impairment. Design: Prospective cohort study. Setting: Orthogeriatric rehabilitation ward. Participants: A total of 314 older adults (≥65years) admitted for rehabilitation after a hip operation. Measurements: Patients were stratified according to the Mini Mental State Examination into the following categories: severe cognitive impairment, scores 0 to 15; mild cognitive impairment, scores 16 to 23; and no cognitive impairment, scores ≥24. Their functional status, in terms of activities of daily living (ADLs), was recorded, and their ability to walk was measured with the Functional Ambulation Categories at 3 points in time: basal, on admission, and on discharge. We considered recovery of ADLs and ability to walk to be positive responses to rehabilitation treatment. Results: Of the patients included, 285 finished the study (16 patients were moved to another hospital and 13 patients died) and 280 received rehabilitation treatment, with all 3 groups achieving functional gain (P<.01). Fifty-eight percent of patients recovered both the autonomy in ADLs they had before the fracture and the ability to walk (73.7% without cognitive impairment, 50% mild cognitive impairment, and 5% severe cognitive impairment) (P<.001). Previous walking ability (odds ratio [OR] 5.57, 95% confidence interval [CI] 2.41-12.74) together with the presence of pressure ulcers (OR 11.12, 95% CI 2.88-43.29) and delirium (OR 3.20, 95% CI 1.07-9.52) are sturdier predictive factors for functional recovery than the degree of cognitive impairment (OR 1.12, 95% CI 1.04-1.22). Conclusion: Previous walking ability and the presence of complications, such as pressure ulcers or delirium, play a greater role in functional recovery than cognitive impairment. Not considering these aspects could lead to an overestimation of the impact of cognitive impairment in the recovery of these patients. © 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Casas Herrero A.,Complejo Hospitalario de Navarra | Izquierdo M.,Public University of Navarra
Anales del Sistema Sanitario de Navarra | Year: 2012

Frailty is a state of vulnerability that involves an increased risk of adverse events in older adults. It is a condition with a complex etiology and pathophysiology. At present, there are functional tools for its assessment that are simple and reliable. Physical inactivity is a major risk factor for sarcopenia, a core aspect of frailty. Currently, mulicomponent exercise programs, and especially resistance exercise, are the most relevant interventions to slow down disability and other adverse outcomes. Moreover, these programs are valuable interventions in other frailty domains such as falls, cognitive decline and depression. However, in frail aged patients it is necessary to explore optimal resistance training components and develop specific clinical guides of physical activity for this target population.

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