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Madrid, Spain

Objective: To determine prevalence and clinical characteristics of elderly diabetic patients in nursing homes. Material and method: Observational and multicentre study in 14 nursing homes in Cádiz (Spain). Study variables: age, sex, prevalence of diabetes, duration of diabetes, complications, macrovascular complications, retinopathy, nephropathy, and neuropathy. Metabolic control: frequency of baseline blood glucose and HbA1c determinations. Metabolic complications suffered. Treatment: oral and type of antidiabetics, insulinisation. Diabetes education. Functional and mental assessment using Barthel index and MMT. Data was analysed using SPSS v17.0. Results: A total of 1952 elderly institutionalised patients were studied, with a diabetes prevalence of 26.44%. The study included 312 patients with a mean age of 79.7 years, of whom 57.4% were women, and 66.9% knew of their diagnosis of diabetes for over 10 years. Vascular events were suffered by 55.1%, with the most common being ischaemic stroke (55.2%), followed by myocardial infarction (18%) and 14.5% with peripheral arterial disease. There were 29.6% with retinopathy, 21.3% diabetic nephropathy, and 25.6% suffering from distal symmetric polyneuropathy. HbA1c analysis was performed in 90.1% of patients, with 50% levels between 7 and 9%, with a six-monthly assessment rate of 63.4%. Metabolic complications: diabetic ketoacidosis 7.1%, hyperosmolar syndrome 2.9%, and 15.7% symptomatic hypoglycaemia. Oral hypoglycaemic agents were being taken by 66% of patients, with the most frequently used being metformin (55.3%) followed by gliclazide and repaglinide (10.2%, 3.4%, respectively). 50.2% were insulinised. 45.6% functional dependence. Barthel Index average of 48.4 points, with 46.1% diagnosed with dementia, moderate state, 36.7%. Conclusions: Diabetic prevalence in nursing homes is high, and institutionalised patients are elderly, long-standing diabetics, with both macro- and microvascular complications, and have a significant level of mental and functional disabilities. © 2011 SEGG.

Lourenco R.A.,State University of Rio de Janeiro | Perez-zepeda M.,Instituto Nacional Of Geriatria | Gutierrez-robledo L.,National Institute of Geriatrics | Garcia-garcia F.J.,Servicio de Geriatria | Rodriguez manas L.,Hospital Universitario Of Getafe
Age and Ageing | Year: 2015

Background: there is a lack of consensus on the diagnosis of sarcopenia. A screening and diagnostic algorithm was proposed by the European Working Group on Sarcopenia in Older People (EWGSOP).Objective: to assess the performance of the EWGSOP algorithm in determining the proportion of subjects suspected of having sarcopenia and selected to undergo subsequent muscle mass (MM) measurement.Design: a cross-sectional study.Setting: the cohorts, Frailty in Brazilian Older People Study-Rio de Janeiro (FIBRA-RJ), Brazil; Coyoacan Cohort (CC), Mexico City, Mexico; and Toledo Study for Healthy Aging (TSHA), Toledo, Spain.Subjects: three thousand two hundred and sixty community-dwelling individuals, 65 years and older.Methods: initially, the EWGSOP algorithm was applied using its originally proposed cut-off values for gait speed and handgrip strength; in the second step, values tailored for the specific cohorts were used.Results: using the originally suggested EWGSOP cut-off points, 83.4% of the total cohort (94.4% in TSHA, 75.5% in FIBRA-RJ, 67.8% in CC) would have been considered as suspected of sarcopenia. Adapted cut-off values lowered the proportion of abnormal results to 34.2% (quintile-based approach) and 23.71% (z-score approach).Conclusions: the algorithm proposed by the EWGSOP is of limited clinical utility in screening older adults for sarcopenia due to the high proportion of subjects selected to further undergo MM assessment. Tailoring cut-off values to specific characteristics of the population being studied reduces the number of people selected for MM assessment, probably improving the performance of the algorithm. Further research including the objective measure of MM is needed to determine the accuracy of these specific cut-off points. © The Author 2014.

Coto-Yglesias F.,Servicio de Geriatria
Journal of Human Hypertension | Year: 2015

We studied the relationships between blood pressure (BP), pulse pressure (PP) and cardiovascular (CV) death in older adults using data from 2346 participants enrolled in the Costa Rican CRELES study, mean age 76 years (s.d. 10.2), 31% qualified as wide PP. All covariates included and analyzed were collected prospectively as part of a 4-year home-based follow-up; mortality was tracked for an additional 3 years, identifying 266 CV deaths. Longitudinal data revealed little change over time in systolic BP (SBP), a decline in diastolic BP, and widening of PP. Wide PP was associated with higher risk of CV death but only among individuals receiving antihypertensive drug therapy. Individuals with both wide PP and receiving therapy had 2.6 hazard rate of CV death relative to people with normal-PP plus not taking treatment (TRT), even adjusting for SBP. Increasing PP between visits was significantly associated to higher CV death independently of TRT status. SBP and DBP were not significantly associated to CV death when the effect of PP was controlled for. Conclusion: elderly hypertensive patients with wide or increasing PP, especially if receiving TRT, are the highest CV risk group, thus must be carefully assessed, monitored and treated with caution.Journal of Human Hypertension advance online publication, 17 December 2015; doi:10.1038/jhh.2015.117. © 2015 Macmillan Publishers Limited

Ribera Casado J.M.,Servicio de Geriatria
European Geriatric Medicine | Year: 2012

Geriatric medicine has contributed to the advance of medicine by bringing into several basic principles, most of them consolidated nowadays as standard care. Some of these principles have been "exported" to other specialities. Among these principles are: fighting against immobility, multidisciplinary teams, orthogeriatic care, day hospitals, progressive patient care, home care, memory clinics and stroke units, the importance of environment, the value of quality of life, the fight against ageism, the description of geriatrics' syndromes, and the introduction of Comprehensive Geriatric Assessment as a working tool. At present we must find valid answers to questions like: who are we today? Who are our target patients? Or where is geriatric medicine nowadays? Among the main challenges of geriatric medicine are: to reach a universal presence of geriatric medicine in the public health care system of every country, to incorporate teaching of geriatric medicine to every School of Medicine, to contribute to establish good public health educational programmes for older people, to reach comprehensive, inclusive and successful coordination of medical and social services for older individuals, and to fight against all forms of ageism. We must, also, to take into account as priorities clinical research and prevention. Finally, it is necessary to avoid some risks. The main of them are the temptation of the so-called "antiaging" ideas, or to fall in rivalry or competence with other specialities. © 2012 Published by Elsevier Masson SAS.

Objectives. To diagnose drug-related problems (DRPs) in patients over 64 years of age at the time of hospitalization. Materials and methods. The detection of overprescription and misprescription of medications was done using the Index of Appropriate Drug Use, and for underprescription the Indication of Adequate Drug Use in Vulnerable Elderly Adults and the test of the Evaluation of the Underuse of Drugs were used. The evaluation of drug adherence and adverse drug reactions was completed using the Morisky-Green Questionnaire and the Karch and Lasgna Algorithm, respectively. Results. The study was conducted in 100 inpatients in a geriatric service in a multi-specialty hospital in Lima, Peru; the median age was 76.26 ± 6.91and 55% were males. After evaluating 555 drugs with the Index of Appropriate Drug Use, 254 of them (45.8%) qualified for at least one or more of the criteria studied for inadequate prescription, corresponding to 89 of the studied patients. We found the underuse (21%) of Warfarin or aspirin by eligible patients with auricular fibrillation, and no use (59%) of beta blockers by patients with a history of acute myocardial infarction. The non-adherence and frequency of adverse reactions that motivated hospitalization were 63% and 24%, respectively. Conclusions. The diagnosis of DRPs in elderly adults at the time of hospitalization using valid instruments is extremely useful and should be part of the integral geriatric evaluation of the elderly.

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