Fuerza prensil de la mano asociada al grado de autonomía y riesgo de caída en ancianos

Objetivo: Determinación de la fuerza de prensión de la mano como indicador de la capacidad funcional y grado de autonomía para actividades cotidianas en personas de la tercera edad. Diseño: Se realizó un estudio observacional de diseño transversal. Emplazamiento: Medio comunitario. Centros cívicos, centros culturales y residencias de la tercera edad de la comarca del Bages (Barcelona). 2 Participantes: Se estudió a 61 personas, 40 mujeres y 21 hombres, con un rango de edad comprendido entre los 65 y 90 años, quienes no presentaban afecciones invalidantes graves. Se solicitó su colaboración y aceptación voluntaria tras informar del objetivo del estudio. Mediciones principales: El grado de autonomía funcional se valoró mediante el test de Barthel y el test de Lawton-Brody, y el riesgo de caída mediante el test de Tinetti. La fuerza muscular máxima voluntaria (FMMV) se determinó mediante el test de prensión de la mano (handgrip). Resultados: Los hombres mostraron una correlación positiva y estadísticamente significativa (p=0.001) entre la fuerza prensil de la mano y el grado de autonomía funcional y el menor riesgo de caída (p=0.037). Dicha correlación no fue observada en las mujeres respecto al grado de autonomía (p=0.232) y fue escasa para el riesgo de caída (p=0.048). Conclusiones: El test de handgrip es una herramienta potencialmente útil para estimar la autonomía funcional e instrumental y el riesgo de caídas, especialmente en varones que sobrepasan los 65 años.

Heel and toe clearance estimation for gait analysis using wireless inertial sensors.

Tripping is considered a major cause of fall in older people. Therefore, foot clearance (i.e., height of the foot above ground during swing phase) could be a key factor to better understand the complex relationship between gait and falls. This paper presents a new method to estimate clearance using a foot-worn and wireless inertial sensor system. The method relies on the computation of foot orientation and trajectory from sensors signal data fusion, combined with the temporal detection of toe-off and heel-strike events. Based on a kinematic model that automatically estimates sensor position relative to the foot, heel and toe trajectories are estimated. 2-D and 3-D models are presented with different solving approaches, and validated against an optical motion capture system on 12 healthy adults performing short walking trials at self-selected, slow, and fast speed. Parameters corresponding to local minimum and maximum of heel and toe clearance were extracted and showed accuracy ± precision of 4.1 ± 2.3 cm for maximal heel clearance and 1.3 ± 0.9 cm for minimal toe clearance compared to the reference. The system is lightweight, wireless, easy to wear and to use, and provide a new and useful tool for routine clinical assessment of gait outside a dedicated laboratory.

Effectiveness of a drug dosing service provided by community pharmacists in polymedicated elderly patients with renal impairment a comparative study

Background: Drug dosing errors are common in renal-impaired patients. Appropriate dosing adjustment and drug selection is important to ensure patients" safety and to avoid adverse drug effects and poor outcomes. There are few studies on this issue in community pharmacies. The aims of this study were, firstly, to determine the prevalence of dosing inadequacy as a consequence of renal impairment in patients over 65 taking 3 or more drug products who were being attended in community pharmacies and, secondly, to evaluate the effectiveness of the community pharmacist"s intervention in improving dosing inadequacy in these patients when compared with usual care. Methods: The study was carried out in 40 Spanish community pharmacies. The study had two phases: the first, with an observational, multicentre, cross sectional design, served to determine the dosing inadequacy, the drug-related problems per patient and to obtain the control group. The second phase, with a controlled study with historical control group, was the intervention phase. When dosing adjustments were needed, the pharmacists made recommendations to the physicians. A comparison was made between the control and the intervention group regarding the prevalence of drug dosing inadequacy and the mean number of drug-related problems per patient. Results: The mean of the prevalence of drug dosing inadequacy was 17.5% [95% CI 14.6-21.5] in phase 1 and 15.5% [95% CI 14.5-16.6] in phase 2. The mean number of drug-related problems per patient was 0.7 [95% CI 0.5-0.8] in phase 1 and 0.50 [95% CI 0.4-0.6] in phase 2. The difference in the prevalence of dosing inadequacy between the control and intervention group before the pharmacists" intervention was 0.73% [95% CI (−6.0) - 7.5] and after the pharmacists" intervention it was 13.5% [95% CI 8.0 - 19.5] (p < 0.001) while the difference in the mean of drug-related problems per patient before the pharmacists" intervention was 0.05 [95% CI( -0.2) - 0.3] and following the intervention it was 0.5 [95% CI 0.3 - 0.7] (p < 0.001). Conclusion: A drug dosing adjustment service for elderly patients with renal impairment in community pharmacies can increase the proportion of adequate drug dosing, and improve the drug-related problems per patient. Collaborative practice with physicians can improve these results.

Delirium in elderly patients hospitalized in an acute care unit.

Introduction: Delirium is frequent in hospitalized older people, with incidence rate up to 40% in acute care. Delirium is associated with several adverse consequences, including increased mortality and institutionalization. This study aims to investigate the prevalence, incidence, and consequences of delirium in patients hospitalized in an acute care unit for elderly (ACE unit). Methods: Over a 3 months period, every patient (N = 93, mean age 84.1 ± 7.8 years, 66/93(71%) women) admitted to a 28-bed ACE unit were systematically assessed for delirium. Trained nurses used the Confusion Assessment Method (CAM) instrument to determine the presence of delirium at admission and on each subsequent day over patients' stay. Delirium prevalence rate was defined as the proportion of patients with a positive CAM within 24 hours of admission to the ACE unit. Delirium incidence rate was defined as the proportion of patients with a negative CAM at admission whose CAM became positive at least once during their stay. This evaluation was part of a functional assessment, including Basic Activities of Daily Life (Katz BADL, from 0 to 6, higher score indicating better function). Delirium prevention interventions and specific treatment was provided if needed. Results: Overall,25/93(27%)patients had delirium during their stay. Prevalence of delirium at admission was 10/93 (11%), with an incidence of 15/83(18%). Compared with non-delirious patients, those with delirium were more frequently men (10/25(40%) vs 17/68(25%), p <.001) and had reduced functional status at admission(BADL 2.0 ± 1.9 vs 3.6 ± 2.1, p = .004). They tended to be older (86.0 ± 6.7 vs 83.3 ± 8.1 years, p = .110). At discharge, delirium was associated with reduced functional status (BADL 2.0 ± 2.1 vs 4.3 ± 1.9, p <.001), lower rate of home discharge (6/20(30%) vs 28/65 (43%), p = .009) and increased mortality (5/25 (20%) vs 3/68 (5%), p <.001). On average, patients with delirium stayed 5.7 days longer (17.0 ± 9.8 vs 11.31 ± 6.3, p = .011). Conclusion: Delirium occurred in almost a third of these older patients, even though its incidence was relatively low in this frail population. Despite specific management, delirium remained associated with higher risk for adverse outcomes at discharge. These results suggest that early preventive interventions, implemented as soon as possible after hospital admission, might be needed in similar population to achieve better outcomes. Effectiveness of such interventions will be evaluated in future studies.

Prevalence of articular chondrocalcinosis in elderly subjects in a rural area of Catalonia

The occurrence of rheumatic disorders did not differ significantly between subjects with articular chondrocalcinosis and those without. CONCLUSIONS--Articular chondrocalcinosis is an age related disorder, which could partly explain the discrepancies in its prevalence reported in previous studies. In most subjects with articular chondrocalcinosis recruited from an unselected population the clinical manifestations are probably mild or even absent.

Gerogogía: una pedagogía para la etapa post-laboral

Para la Pedagogía de la Tercera Edad, Hartford propone el nombre de Gerología. Tras mencionar los cursos de pre-jubilación, de carácter preventivo, el presente estudio se centra en las aulas de la Tercera Edad existentes en España; se las describe en su programación y planificación, en el desarrollo de sus cursos, en sus categorías de alumnos y en las actitudes de éstos hacia las aulas, exponiéndose los resultados de una encuesta.

Ikääntyvien yksinäisyys - miten sitä on tutkittu gerontologiassa?

Summary: Loneliness among older people - how has it been studied in gerontology?

Experiències poètiques de qualitat a la infància

La poesia és un gènere literari, massa sovint, oblidat a les escoles. No obstant, està demostrat que es pot treballar amb persones de totes les edats, des d’infants ben petits, fins a persones adultes, sempre i quan, les metodologies i les tècniques utilitzades siguin adequades als receptors. Aquest gènere no implica només comprensió del vocabulari i del missatge final, sinó també comporta gaudir del joc de les paraules, dels sons, de la melodia, del ritme... Es pot dir, doncs, que poesia i música, són dues arts que estan estretament relacionades. Quins elements provoquen que una experiència de poesia tingui qualitat? En primer lloc, el “què”, quin tipus de poesia oferim als infants. Així doncs, els podem proporcionar poesia escrita per a infants, però també poesia , en un inici, pensada per a adults. I és que el poema que és bo per a nens/es també ho és per a gent més gran, i a l’inrevés. A més a més, la poesia ha de ser rítmica, melòdica i que busqui constantment el joc sonor de les paraules. En segon lloc, el “qui”, és a dir, quines condicions ha de tenir la persona que escriu i recita poesia, per fer-ho amb la màxima qualitat possible. L’escriptor ha de ser una persona culta, amb un profund lligam artístic. No tothom serveix per a ser un bon escriptor, ja que comporta una gran tasca . Pel que fa a l’art de recitar, és una habilitat que tothom pot adquirir, amb pràctica, voluntat i constància. En tercer i últim lloc, el “com”, la metodologia adequada per presentar la poesia als infants. Aquest gènere literari s’ha de presentar de forma vivencial. El primer que han de fer els infants és estar en contacte amb la llengua i viure la poesia. Només així aprendran a estimar aquest gènere i a creure en ell i en les seves possibilitats.

El significado de las ocupaciones en las personas mayores-jóvenes: algunas tendencias

Con la llegada del nuevo paradigma del “envejecimiento activo” planteado por la Organización Mundial de la Salud (OMS, 2002), estamos asistiendo a una nueva manera de enfocar el progresivo envejecimiento de la población. Este enfoque trata de fomentar la consecución de una esperanza de vida saludable y libre de discapacidad, gracias a la promoción de políticas y programas cuyos objetivos principales se centran en la independencia y en la autonomía a lo largo del proceso de envejecimiento. Acorde con este enfoque pensamos que las ocupaciones significativas son una buena herramienta para mantener la autonomía de estas personas al fomentar la prevención y la promoción de su salud, motivo por el cual desarrollamos este estudio. Los objetivos principales del presente estudio son conocer y comprender que ocupaciones adquieren un significado y satisfacción personal en las personas mayores-jóvenes, que han concluido su etapa laboral, que cuentan con buena salud y condiciones psicofísicas favorables y que viven de manera autónoma en la comunidad, así como explorar también si se establece en estas personas alguna vinculación entre las actividades que eligen desarrollar en la actualidad con su perfil e historia ocupacional previa. Por último, este estudio pretende conocer el tipo de gestión que cada persona prefiere para llevar a cabo las actividades cotidianas que les son más significativas, a partir de los contextos en los que se inscribe. El marco teórico se desarrolla a partir de la conceptualización aportada por diversos autores sobre el envejecimiento activo y la ciencia de la ocupación. La metodología utilizada es de carácter cualitativo, enfocado desde un paradigma constructivista. Los resultados del estudio muestran que se inicia tímidamente un cambio de tendencias en la elección y el significado que las personas mayores-jóvenes atribuyen a sus ocupaciones. Muestran también que las ocupaciones elegidas como más significativas por estas personas mantienen una vinculación con las que ya realizaban con anterioridad a la jubilación, con su historia o perfil 6 ocupacional previo. Y finalmente demuestran que el tipo de gestión que eligen para efectuarlas influye en la elección del entorno donde las llevan a término.

Official Positions for FRAX® clinical regarding falls and frailty: can falls and frailty be used in FRAX®? From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

Risk factors for fracture can be purely skeletal, e.g., bone mass, microarchitecture or geometry, or a combination of bone and falls risk related factors such as age and functional status. The remit of this Task Force was to review the evidence and consider if falls should be incorporated into the FRAX® model or, alternatively, to provide guidance to assist clinicians in clinical decision-making for patients with a falls history. It is clear that falls are a risk factor for fracture. Fracture probability may be underestimated by FRAX® in individuals with a history of frequent falls. The substantial evidence that various interventions are effective in reducing falls risk was reviewed. Targeting falls risk reduction strategies towards frail older people at high risk for indoor falls is appropriate. This Task Force believes that further fracture reduction requires measures to reduce falls risk in addition to bone directed therapy. Clinicians should recognize that patients with frequent falls are at higher fracture risk than currently estimated by FRAX® and include this in decision-making. However, quantitative adjustment of the FRAX® estimated risk based on falls history is not currently possible. In the long term, incorporation of falls as a risk factor in the FRAX® model would be ideal.

Elämänviivapiirros iäkkäiden ihmisten tutkimuksessa

Summary: Life-line drawing in studying older people

La salud bucodental de los españoles mayores de 64 años. Impacto en el estado de salud individual

Introducción: los cambios epidemiológicos sufridos en los países occidentales en el siglo XX han propiciado un aumento del número absoluto y de la proporción de ancianos en todos ellos. Pacientes y Método: se realizó un estudio descriptivo transversal de prevalencia de enfermedades bucodentales en una población de 3.460 individuos en 7 Comunidades Autónomas españolas, tanto institucionalizados (10%) como no institucionalizados (90%). Resultados: la edad media de los encuestados fue de 73,6±7 años. Un 31,4% de los individuos del estudio eran desdentados totales. Los individuos dentados presentaban un promedio de 14,8±8 dientes. El CAOD de los individuos de la muestra fue de 20,8±10, siendo de 23,7±9,8 en los institucionalizados. La última visita al dentista había sido de media 4 años y medio antes, pero los institucionalizados hacía 7 años. Discusión: es totalmente inaceptable que la prevención y el tratamiento las enfermedades bucodentales. especialmente entre las personas de edad más avanzada, se sigan considerando como un aspecto totalmente optativo para el mantenimiento de la salud del individuo. Estudios epidemiológicos. bacteriológicos e Inmunológicos demuestran que la enfermedad periodontal o la caries pueden ser las causantes de un importante aumento de la morbi-mortalidad especialmente entre las personas de más edad.

Effectiveness of a drug dosing service provided by community pharmacists in polymedicated elderly patients with renal impairment a comparative study

Background: Drug dosing errors are common in renal-impaired patients. Appropriate dosing adjustment and drug selection is important to ensure patients" safety and to avoid adverse drug effects and poor outcomes. There are few studies on this issue in community pharmacies. The aims of this study were, firstly, to determine the prevalence of dosing inadequacy as a consequence of renal impairment in patients over 65 taking 3 or more drug products who were being attended in community pharmacies and, secondly, to evaluate the effectiveness of the community pharmacist"s intervention in improving dosing inadequacy in these patients when compared with usual care. Methods: The study was carried out in 40 Spanish community pharmacies. The study had two phases: the first, with an observational, multicentre, cross sectional design, served to determine the dosing inadequacy, the drug-related problems per patient and to obtain the control group. The second phase, with a controlled study with historical control group, was the intervention phase. When dosing adjustments were needed, the pharmacists made recommendations to the physicians. A comparison was made between the control and the intervention group regarding the prevalence of drug dosing inadequacy and the mean number of drug-related problems per patient. Results: The mean of the prevalence of drug dosing inadequacy was 17.5% [95% CI 14.6-21.5] in phase 1 and 15.5% [95% CI 14.5-16.6] in phase 2. The mean number of drug-related problems per patient was 0.7 [95% CI 0.5-0.8] in phase 1 and 0.50 [95% CI 0.4-0.6] in phase 2. The difference in the prevalence of dosing inadequacy between the control and intervention group before the pharmacists" intervention was 0.73% [95% CI (−6.0) - 7.5] and after the pharmacists" intervention it was 13.5% [95% CI 8.0 - 19.5] (p < 0.001) while the difference in the mean of drug-related problems per patient before the pharmacists" intervention was 0.05 [95% CI( -0.2) - 0.3] and following the intervention it was 0.5 [95% CI 0.3 - 0.7] (p < 0.001). Conclusion: A drug dosing adjustment service for elderly patients with renal impairment in community pharmacies can increase the proportion of adequate drug dosing, and improve the drug-related problems per patient. Collaborative practice with physicians can improve these results.

Effectiveness of a drug dosing service provided by community pharmacists in polymedicated elderly patients with renal impairment a comparative study

Background: Drug dosing errors are common in renal-impaired patients. Appropriate dosing adjustment and drug selection is important to ensure patients" safety and to avoid adverse drug effects and poor outcomes. There are few studies on this issue in community pharmacies. The aims of this study were, firstly, to determine the prevalence of dosing inadequacy as a consequence of renal impairment in patients over 65 taking 3 or more drug products who were being attended in community pharmacies and, secondly, to evaluate the effectiveness of the community pharmacist"s intervention in improving dosing inadequacy in these patients when compared with usual care. Methods: The study was carried out in 40 Spanish community pharmacies. The study had two phases: the first, with an observational, multicentre, cross sectional design, served to determine the dosing inadequacy, the drug-related problems per patient and to obtain the control group. The second phase, with a controlled study with historical control group, was the intervention phase. When dosing adjustments were needed, the pharmacists made recommendations to the physicians. A comparison was made between the control and the intervention group regarding the prevalence of drug dosing inadequacy and the mean number of drug-related problems per patient. Results: The mean of the prevalence of drug dosing inadequacy was 17.5% [95% CI 14.6-21.5] in phase 1 and 15.5% [95% CI 14.5-16.6] in phase 2. The mean number of drug-related problems per patient was 0.7 [95% CI 0.5-0.8] in phase 1 and 0.50 [95% CI 0.4-0.6] in phase 2. The difference in the prevalence of dosing inadequacy between the control and intervention group before the pharmacists" intervention was 0.73% [95% CI (−6.0) - 7.5] and after the pharmacists" intervention it was 13.5% [95% CI 8.0 - 19.5] (p < 0.001) while the difference in the mean of drug-related problems per patient before the pharmacists" intervention was 0.05 [95% CI( -0.2) - 0.3] and following the intervention it was 0.5 [95% CI 0.3 - 0.7] (p < 0.001). Conclusion: A drug dosing adjustment service for elderly patients with renal impairment in community pharmacies can increase the proportion of adequate drug dosing, and improve the drug-related problems per patient. Collaborative practice with physicians can improve these results.

La generatividad en la vejez y su relación con el bienestar: ¿Quién más contribuye es quien más se beneficia?

El objetivo de la investigación fue la adaptación al español de las escalas de interés y comportamientos generativos de McAdams, así co-mo el estudio de la generatividad en la vejez y su relación con el bienestar. La muestra estuvo compuesta por 165 voluntarios mayores de 65 años que, además de las versiones españolas de las escalas de generatividad, completa-ron instrumentos para evaluar satisfacción con la vida y orientación al futu-ro. Los resultados indicaron que la fiabilidad de las versiones españolas de las escalas de generatividad fue aceptable y similar a las originales en inglés. Mientras el interés generativo se relacionó con la satisfacción con la vida, los comportamientos generativos no lo hicieron. Sin embargo, ambas esca-las sí se relacionaron con la orientación al futuro, aunque esta relación no se confirmó en un análisis multivariable. Los resultados resaltan la importancia de la generatividad en la vejez y de distinguir entre interés y acción generati-va, ya que sus beneficios podrían ser muy diferentes.