PACIENTES CON INSUFICIENCIA CARDÍACA ATENDIDOS EN MEDICINA DE FAMILIA: COMORBILIDAD Y CONSUMO DE ... more PACIENTES CON INSUFICIENCIA CARDÍACA ATENDIDOS EN MEDICINA DE FAMILIA: COMORBILIDAD Y CONSUMO DE RECURSOS SANITARIOS Luis Miguel García Olmos1, Montserrat Carmona Rodríguez2, Ángel Alberquilla Menéndez-Asenjo3, Pilar García-Sagredo4, Fernando López Rodríguez4, Ángel Otero Puime5 1 Unidad Docente Multiprofesional Atención Familiar y Comunitaria Sureste. 2 Hospital Universitario Puerta de Hierro Majadahonda. 3 Unidad Docente de Atención Familiar y Comunitaria Centro. 4 Instituto de Salud Carlos III. 5 Facultad de Medicina. Universidad Autónoma de Madrid. Objetivo: Describir la utilización de recursos de AP por pacientes con insuficiencia cardiaca (IC) y explorar la variabilidad de gestión de estos pacientes por parte de los médicos de familia. Material y métodos: Estudio observacional, descriptivo, transversal. Pacientes, considerando como patología índice IC, atendidos durante un año por 129 médicos de familia con registros clínicos contrastados. Fuentes de datos: historia clínica in...
Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departam... more Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina Preventiva y Salud Pública. Fecha de lectura: 22 de Enero de 2008
We intended to obtain reference population values of the COOP/WONCA charts of health-related qual... more We intended to obtain reference population values of the COOP/WONCA charts of health-related quality of life (HRQOL) among a Spanish urban adult population. Cross sectional study based on data from the Survey of Health of the City of Madrid 2005. 7341 adults were selected by biphasic cluster sampling. The variable HRQOL was measured through COOP/WONCA charts of quality of life (9 dimensions), culturally validated for Spanish people. Other variables included age, sex, marital status, and social class, zone of origin and level of education. Statistical treatment included descriptive statistics for the dimensions and summation of HRQOL, significance tests (Kruskal-Wallis, Mann-Whitney, ANOVA), analysis of internal consistency and correlation. Highest mean values were found in the dimensions Changes in the State of Health, Health Status, Physical Form and Social Support. The average value of the dimensions and the summation of HRQOL increased significantly with age, and in parallel to a...
ABSTRACT Vitamin D and the parathyroid hormone (PTH) response play an important role in hip fract... more ABSTRACT Vitamin D and the parathyroid hormone (PTH) response play an important role in hip fracture patients. This study was carried out to determine the factors associated with the PTH response to different levels of vitamin D deficiency during hospitalization. This was a cross-sectional study of patients over 64 years of age admitted with an acute fragility hip fracture between March 1st 2009 and November 30th 2012. Demographic, clinical, functional, and cognitive function were evaluated at admission and during hospitalization. Levels of 25-hydroxyvitamin D (25-OHD) and PTH were analyzed. Two 25-OHD cut-off points were considered, <12 ng/ml and 12-20 ng/ml. Multivariate logistic regression analysis was used. Mean age of the 607 patients included was 84.7 years (SD 7.10), and 81.9 % were women. The mean 25-OHD level in the total sample was 13.2 (SD 11.1) ng/ml. Levels of 25-OHD <12 ng/ml were present in 347 patients (57.2 %), of whom 158 (45.5 %) had secondary hyperparathyroidism (SHPT) (PTH >65 pg/ml). 25-OHD levels of 12-20 ng/ml were present in 168 (27.7 %) patients, of whom 47 (28 %) had SHPT. Following logistic regression, SHPT was associated in both groups (25-OHD <12 and 12-20 ng/ml) with a greater number of medical problems during hospitalization. In the 25-OHD group <12 ng/ml, SHPT was also associated with poorer glomerular filtration rates. The PTH response to vitamin D deficiency in hip fracture patients may be a marker for patients with higher risk of developing multiple medical problems, both when considering severe (<12 ng/ml) and moderate (12-20 ng/ml) vitamin D deficiency.
Cómo citar este artículo: de Hoyos-Alonso MdC, et al. Calidad del registro del diagnóstico de dem... more Cómo citar este artículo: de Hoyos-Alonso MdC, et al. Calidad del registro del diagnóstico de demencia en atención primaria. La situación en España en el periodo 2002-2011. Aten Primaria. 2015. http://dx.
Objectives: To examine the prognostic value of different profiles of hip fracture patients for re... more Objectives: To examine the prognostic value of different profiles of hip fracture patients for recovery of pre-fracture functional level and for post-fracture mortality. Design: Observational, longitudinal study. Setting: University hospital. Participants: Five hundred and eight patients who received surgery for hip fracture and were followed for 24 months post-fracture. Measuments: Patients were assessed according to age, number of independent activities of daily living (ADLs) and dementia. The probability of recovery of previous ambulation level and mortality was established at 3, 6, 12 and 24 months post-fracture. Patients were first classified according to the seven different profiles previously established by Penrod. A new patient classification system was then created using different patient groups: persons aged 75 or older were first classified based on the number of independent ADLs they could perform (4, 3-2 and 1-0) and were then subdivided according to age (75-84 years and >84 years) and presence of dementia. Results: Mean age was 84.5 (SD 6.3) years. Almost all (90.6%) patients walked independently before the fracture. At 24 months' follow-up, the probability of recovery to previous level of ambulation was 73.6%. The new classification into seven groups had higher prognostic value than Penrod's system. Patients under 75 had 95.1% probability of functional recovery and 9.6% of dying. At the other extreme, those over 84 years with 0-1 independent activities of daily living and dementia had 23.9% probability of recovery and 71.4% of dying. Conclusion: Hip fracture patients can be classified into homogeneous groups with different prognostic profiles based on pre-fracture characteristics. This new classification improves Penrod's previous system by establishing groups of patients hierarchically ordered by the probability of recovery and mortality at 3, 6, 12 and 24 months post-fracture.
Atencion primaria / Sociedad Española de Medicina de Familia y Comunitaria, Jan 28, 2005
To study the process of referral from primary care in a health area in Madrid. The second objecti... more To study the process of referral from primary care in a health area in Madrid. The second objective was to evaluate the trends in the referral process. Observational, descriptive and cross-sectional study. Three urban health centers in the Area 2. All referrals made by 13 doctors during 3 consecutive weeks. The total number of visits attended were 6012. The study was realized between February 2002 and January 2003. Patient, doctor and referral characteristics on every referral. 349 referrals were studied. The rate of referral 5.8% (5.21-6.39). The referred patients, 65.5% women, medium age 50.6+/-21. The specialties that received more referrals are gynecologist, ophthalmology, dermatology, otorhinolaryngology, rehabilitation, orthopedic surgeon and general surgeon. The most common conditions referred, 25.6% of all referrals, are gynecologist check, blindness, other illnesses of subcutaneous cellular tissue, arthrosis, joint pain, diabetes, benign neoplasm of skin, depression and hyp...
To standardize the Spanish version of the 7 Minute screening neurocognitive battery (7MS) in a po... more To standardize the Spanish version of the 7 Minute screening neurocognitive battery (7MS) in a population sample of elderly over 70 years. We examined 416 persons, living at home, participating in elderly the longitudinal study "Aging in Leganes", aged 71 to 99 years old (mean age: 79 +- 9.2 years; 51.7 % women; 10.6 illiterate, 25 % without formal education). In order to do so, we used an extensive clinical survey, general and neurological exam and extensive neuropsychological battery with several cognitive scales, attention, language, memory, visuomotor skill and reasoning tests, Jorm's IQCODE questionnaire, CES-D depression questionnaire and the 7MS including the Benton Orientation Test, Clock Drawing Test, Free and Cued Learning Test and Categorial Verbal Fluency. Dementia was diagnosed according to DSM-IV criteria but independently of the 7MS scores. Several methods to obtain the total score of the 7MS were analyzed and the normative parameters of the test were ob...
Our objective was to study the mortality from the 12 leading causes of death in Spain in 1998. Pr... more Our objective was to study the mortality from the 12 leading causes of death in Spain in 1998. Proportional mortality and death rates according to causes of death in 1998 were estimated. We also calculated death rate trends since 1998. Leading causes of death were cancer heart diseases and cerebrovascular disease. Alzheimer's disease was the 11th leading cause of death. While mortality from Alzheimer's disease in 1998 was 21 times higher than in 1980, cancer-related mortality decreased over the last years.
The progressive rise in dementia prevalence increases the need for rapid methods that complement ... more The progressive rise in dementia prevalence increases the need for rapid methods that complement population-based prevalence studies. To estimate the prevalence of dementia in the population aged 65 and older based on use of cholinesterase inhibitors and memantine. Descriptive study of use and prescription of cholinesterase inhibitors and/or memantine in 2011 according to 2 databases: Farm@drid (pharmacy billing records for the Region of Madrid) and BIFAP (database for pharmacoepidemiology research in primary care, with diagnosis and prescription records). We tested the comparability of drug use results from each database using the chi-square test and prevalence ratios. The prevalence of dementia in Madrid was estimated based on the dose per 100 inhabitants/day, adjusting the result for data obtained from BIFAP on combination treatment in the general population (0.37%) and the percentage of dementia patients undergoing treatment (41.13%). Cholinesterase inhibitors and memantine were taken by 2.08% and 0.72% of Madrid residents aged 65 and older was respectively. Both databases displayed similar results for use of these drugs. The estimated prevalence of dementia in individuals aged 65 and older is 5.91% (95% CI%, 5.85-5.95) (52 287 people), and it is higher in women (7.16%) than in men (4.00%). The estimated prevalence of dementia is similar to that found in population-based studies. Analysing consumption of specific dementia drugs can be a reliable and inexpensive means of updating prevalence data periodically and helping rationalise healthcare resources.
This study examines the relations between selfrated health (SRH) at baseline, SRH as a time-depen... more This study examines the relations between selfrated health (SRH) at baseline, SRH as a time-dependent covariate (TDC), and mortality by gender and education in a community-dwelling older population in Spain. The data used are from the longitudinal study ''Aging in Leganes'', launched in 1993, carried out in a community-dwelling representative sample (n = 1,560) of the older population of Leganes (Spain). Mortality was assessed in 2008. Proportional regression models were fitted to examine the association between mortality and baseline SRH, and SRH as a TDC among subjects aged 65-85 at baseline. The multivariate analyses were stratified by gender and education and adjusted for sociodemographic factors, smoking and physical activity, physical and mental morbidity, and ADL disability. SRH and SRH as a TDC were significant predictors of mortality in men and in people with some education, but not in women or in illiterate persons. SRH and declines in SRH were associated with increased mortality risk in older men and in those who can read and write in this Mediterranean population. Given current improvements in education and decreasing gender inequality, health professionals in Spain should pay attention to both current SRH and declines in SRH in their patients regardless of gender and literacy.
Analysing drug consumption in large population groups lets us observe consumption trends and comp... more Analysing drug consumption in large population groups lets us observe consumption trends and compare them between different settings. to analyse the time trends for consumption and costs of specific drugs used to treat dementia in the region of Madrid (Spain) and compare trends by sex and age cohort. Descriptive study of cholinesterase inhibitors (N06DA) and memantine (N06DX01) dispensed in Madrid between 2002 and 2012 and covered by the Spain's national health system. Consumption was calculated by analysing changes in DDD (defined daily doses) to find total and yearly increases. The cost was estimated based on DDD price. To compare consumption rates by age and sex, we calculated DDD per 100 inhabitants/day. Between 2002 and 2012, consumption of drugs used to treat dementia increased sixfold. During this period, cholinesterase inhibitors accounted for 76.70% of the drugs consumed and memantine, 23.30%. The estimated cost rose by a by a factor of 5.7 over 11 years (or by a factor of 4 taking into account the use of generic drugs). In 2012, 2.42% of the patients aged 65 or over consumed cholinesterase inhibitors (women 2.82%, men 1.83%) and 0.90% consumed memantine (women 1.10%, men 0.61%). Consumption increased in age cohorts up to 86 to 90 (5.84% for cholinesterase inhibitors and 2.33% for memantine) and declined thereafter. Consumption of cholinesterase inhibitors and memantine gradually increased, but consumption in 2012 did not reach levels equivalent to dementia prevalence figures. Pharmaceutical expenditure restraint measures may temporarily slow the cost increase temporarily but if the same trend of consumption persists, costs will rise.
ABSTRACT Introduction Acute hospitalisation can be an opportunity to diagnose dementia if it can ... more ABSTRACT Introduction Acute hospitalisation can be an opportunity to diagnose dementia if it can be guaranteed that confounding factors are taken into account. Objective To study the validity of systematic criteria for the detection of cognitive impairment and of a standardised diagnostic protocol of dementia in elderly patients hospitalised in a geriatric service. Methods Patients were included if they met any of the following criteria: a) previous score on the Red Cross Mental Scale (RCMS) ≥ 2, b) Pfeiffer Questionnaire score ≥ 5 errors and/or c) presence of delirium (Confusion Assessment Method criteria). A geriatrician conducted a cognitive history and physical examination and the following diagnostic protocol was applied: DSM-IV criteria for dementia, Mini Mental State Examination, Clock Drawing Test, Informant Questionnaire, Clinical Dementia Rating Scale, Pfeffer Scale of Instrumental Activities and Laboratory and neuroimaging tests. Each diagnosis was confirmed by another independent geriatrician. Results Seven hundred and fifty-five patients were hospitalised, of which 156 (21%) met the inclusion criteria. The study could be completed during hospitalization in 114 patients (73%). The definitive diagnosis was Alzheimer's disease or mixed dementia in 63 cases (40%), vascular dementia in 17 (11%), mild cognitive impairment in 6 (4%) and delirium without previous decline in 28 (18%). Treatment recommendations were given in all cases. Conclusions Application of systematic detection criteria and a standardised diagnostic protocol made it possible to discover unknown cognitive problems in one of every five hospitalised elders and to diagnose 73% of them. Most of the diagnosis were for established dementia.
Revista Española de Geriatría y Gerontología, 2011
... obs-táculos por el que el paradigma de la fragilidad no se había podido aplicar a la práctica... more ... obs-táculos por el que el paradigma de la fragilidad no se había podido aplicar a la práctica clínica diaria en nuestro medio»4. Esta afir-mación trae a primer ... Jürschik Giménez P, Escobar Bravo MÁ, Nuin Orrio C, Botigué Satorra T. Cri-terios de fragilidad del adulto mayor. ...
PACIENTES CON INSUFICIENCIA CARDÍACA ATENDIDOS EN MEDICINA DE FAMILIA: COMORBILIDAD Y CONSUMO DE ... more PACIENTES CON INSUFICIENCIA CARDÍACA ATENDIDOS EN MEDICINA DE FAMILIA: COMORBILIDAD Y CONSUMO DE RECURSOS SANITARIOS Luis Miguel García Olmos1, Montserrat Carmona Rodríguez2, Ángel Alberquilla Menéndez-Asenjo3, Pilar García-Sagredo4, Fernando López Rodríguez4, Ángel Otero Puime5 1 Unidad Docente Multiprofesional Atención Familiar y Comunitaria Sureste. 2 Hospital Universitario Puerta de Hierro Majadahonda. 3 Unidad Docente de Atención Familiar y Comunitaria Centro. 4 Instituto de Salud Carlos III. 5 Facultad de Medicina. Universidad Autónoma de Madrid. Objetivo: Describir la utilización de recursos de AP por pacientes con insuficiencia cardiaca (IC) y explorar la variabilidad de gestión de estos pacientes por parte de los médicos de familia. Material y métodos: Estudio observacional, descriptivo, transversal. Pacientes, considerando como patología índice IC, atendidos durante un año por 129 médicos de familia con registros clínicos contrastados. Fuentes de datos: historia clínica in...
Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departam... more Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina Preventiva y Salud Pública. Fecha de lectura: 22 de Enero de 2008
We intended to obtain reference population values of the COOP/WONCA charts of health-related qual... more We intended to obtain reference population values of the COOP/WONCA charts of health-related quality of life (HRQOL) among a Spanish urban adult population. Cross sectional study based on data from the Survey of Health of the City of Madrid 2005. 7341 adults were selected by biphasic cluster sampling. The variable HRQOL was measured through COOP/WONCA charts of quality of life (9 dimensions), culturally validated for Spanish people. Other variables included age, sex, marital status, and social class, zone of origin and level of education. Statistical treatment included descriptive statistics for the dimensions and summation of HRQOL, significance tests (Kruskal-Wallis, Mann-Whitney, ANOVA), analysis of internal consistency and correlation. Highest mean values were found in the dimensions Changes in the State of Health, Health Status, Physical Form and Social Support. The average value of the dimensions and the summation of HRQOL increased significantly with age, and in parallel to a...
ABSTRACT Vitamin D and the parathyroid hormone (PTH) response play an important role in hip fract... more ABSTRACT Vitamin D and the parathyroid hormone (PTH) response play an important role in hip fracture patients. This study was carried out to determine the factors associated with the PTH response to different levels of vitamin D deficiency during hospitalization. This was a cross-sectional study of patients over 64 years of age admitted with an acute fragility hip fracture between March 1st 2009 and November 30th 2012. Demographic, clinical, functional, and cognitive function were evaluated at admission and during hospitalization. Levels of 25-hydroxyvitamin D (25-OHD) and PTH were analyzed. Two 25-OHD cut-off points were considered, <12 ng/ml and 12-20 ng/ml. Multivariate logistic regression analysis was used. Mean age of the 607 patients included was 84.7 years (SD 7.10), and 81.9 % were women. The mean 25-OHD level in the total sample was 13.2 (SD 11.1) ng/ml. Levels of 25-OHD <12 ng/ml were present in 347 patients (57.2 %), of whom 158 (45.5 %) had secondary hyperparathyroidism (SHPT) (PTH >65 pg/ml). 25-OHD levels of 12-20 ng/ml were present in 168 (27.7 %) patients, of whom 47 (28 %) had SHPT. Following logistic regression, SHPT was associated in both groups (25-OHD <12 and 12-20 ng/ml) with a greater number of medical problems during hospitalization. In the 25-OHD group <12 ng/ml, SHPT was also associated with poorer glomerular filtration rates. The PTH response to vitamin D deficiency in hip fracture patients may be a marker for patients with higher risk of developing multiple medical problems, both when considering severe (<12 ng/ml) and moderate (12-20 ng/ml) vitamin D deficiency.
Cómo citar este artículo: de Hoyos-Alonso MdC, et al. Calidad del registro del diagnóstico de dem... more Cómo citar este artículo: de Hoyos-Alonso MdC, et al. Calidad del registro del diagnóstico de demencia en atención primaria. La situación en España en el periodo 2002-2011. Aten Primaria. 2015. http://dx.
Objectives: To examine the prognostic value of different profiles of hip fracture patients for re... more Objectives: To examine the prognostic value of different profiles of hip fracture patients for recovery of pre-fracture functional level and for post-fracture mortality. Design: Observational, longitudinal study. Setting: University hospital. Participants: Five hundred and eight patients who received surgery for hip fracture and were followed for 24 months post-fracture. Measuments: Patients were assessed according to age, number of independent activities of daily living (ADLs) and dementia. The probability of recovery of previous ambulation level and mortality was established at 3, 6, 12 and 24 months post-fracture. Patients were first classified according to the seven different profiles previously established by Penrod. A new patient classification system was then created using different patient groups: persons aged 75 or older were first classified based on the number of independent ADLs they could perform (4, 3-2 and 1-0) and were then subdivided according to age (75-84 years and >84 years) and presence of dementia. Results: Mean age was 84.5 (SD 6.3) years. Almost all (90.6%) patients walked independently before the fracture. At 24 months' follow-up, the probability of recovery to previous level of ambulation was 73.6%. The new classification into seven groups had higher prognostic value than Penrod's system. Patients under 75 had 95.1% probability of functional recovery and 9.6% of dying. At the other extreme, those over 84 years with 0-1 independent activities of daily living and dementia had 23.9% probability of recovery and 71.4% of dying. Conclusion: Hip fracture patients can be classified into homogeneous groups with different prognostic profiles based on pre-fracture characteristics. This new classification improves Penrod's previous system by establishing groups of patients hierarchically ordered by the probability of recovery and mortality at 3, 6, 12 and 24 months post-fracture.
Atencion primaria / Sociedad Española de Medicina de Familia y Comunitaria, Jan 28, 2005
To study the process of referral from primary care in a health area in Madrid. The second objecti... more To study the process of referral from primary care in a health area in Madrid. The second objective was to evaluate the trends in the referral process. Observational, descriptive and cross-sectional study. Three urban health centers in the Area 2. All referrals made by 13 doctors during 3 consecutive weeks. The total number of visits attended were 6012. The study was realized between February 2002 and January 2003. Patient, doctor and referral characteristics on every referral. 349 referrals were studied. The rate of referral 5.8% (5.21-6.39). The referred patients, 65.5% women, medium age 50.6+/-21. The specialties that received more referrals are gynecologist, ophthalmology, dermatology, otorhinolaryngology, rehabilitation, orthopedic surgeon and general surgeon. The most common conditions referred, 25.6% of all referrals, are gynecologist check, blindness, other illnesses of subcutaneous cellular tissue, arthrosis, joint pain, diabetes, benign neoplasm of skin, depression and hyp...
To standardize the Spanish version of the 7 Minute screening neurocognitive battery (7MS) in a po... more To standardize the Spanish version of the 7 Minute screening neurocognitive battery (7MS) in a population sample of elderly over 70 years. We examined 416 persons, living at home, participating in elderly the longitudinal study "Aging in Leganes", aged 71 to 99 years old (mean age: 79 +- 9.2 years; 51.7 % women; 10.6 illiterate, 25 % without formal education). In order to do so, we used an extensive clinical survey, general and neurological exam and extensive neuropsychological battery with several cognitive scales, attention, language, memory, visuomotor skill and reasoning tests, Jorm's IQCODE questionnaire, CES-D depression questionnaire and the 7MS including the Benton Orientation Test, Clock Drawing Test, Free and Cued Learning Test and Categorial Verbal Fluency. Dementia was diagnosed according to DSM-IV criteria but independently of the 7MS scores. Several methods to obtain the total score of the 7MS were analyzed and the normative parameters of the test were ob...
Our objective was to study the mortality from the 12 leading causes of death in Spain in 1998. Pr... more Our objective was to study the mortality from the 12 leading causes of death in Spain in 1998. Proportional mortality and death rates according to causes of death in 1998 were estimated. We also calculated death rate trends since 1998. Leading causes of death were cancer heart diseases and cerebrovascular disease. Alzheimer's disease was the 11th leading cause of death. While mortality from Alzheimer's disease in 1998 was 21 times higher than in 1980, cancer-related mortality decreased over the last years.
The progressive rise in dementia prevalence increases the need for rapid methods that complement ... more The progressive rise in dementia prevalence increases the need for rapid methods that complement population-based prevalence studies. To estimate the prevalence of dementia in the population aged 65 and older based on use of cholinesterase inhibitors and memantine. Descriptive study of use and prescription of cholinesterase inhibitors and/or memantine in 2011 according to 2 databases: Farm@drid (pharmacy billing records for the Region of Madrid) and BIFAP (database for pharmacoepidemiology research in primary care, with diagnosis and prescription records). We tested the comparability of drug use results from each database using the chi-square test and prevalence ratios. The prevalence of dementia in Madrid was estimated based on the dose per 100 inhabitants/day, adjusting the result for data obtained from BIFAP on combination treatment in the general population (0.37%) and the percentage of dementia patients undergoing treatment (41.13%). Cholinesterase inhibitors and memantine were taken by 2.08% and 0.72% of Madrid residents aged 65 and older was respectively. Both databases displayed similar results for use of these drugs. The estimated prevalence of dementia in individuals aged 65 and older is 5.91% (95% CI%, 5.85-5.95) (52 287 people), and it is higher in women (7.16%) than in men (4.00%). The estimated prevalence of dementia is similar to that found in population-based studies. Analysing consumption of specific dementia drugs can be a reliable and inexpensive means of updating prevalence data periodically and helping rationalise healthcare resources.
This study examines the relations between selfrated health (SRH) at baseline, SRH as a time-depen... more This study examines the relations between selfrated health (SRH) at baseline, SRH as a time-dependent covariate (TDC), and mortality by gender and education in a community-dwelling older population in Spain. The data used are from the longitudinal study ''Aging in Leganes'', launched in 1993, carried out in a community-dwelling representative sample (n = 1,560) of the older population of Leganes (Spain). Mortality was assessed in 2008. Proportional regression models were fitted to examine the association between mortality and baseline SRH, and SRH as a TDC among subjects aged 65-85 at baseline. The multivariate analyses were stratified by gender and education and adjusted for sociodemographic factors, smoking and physical activity, physical and mental morbidity, and ADL disability. SRH and SRH as a TDC were significant predictors of mortality in men and in people with some education, but not in women or in illiterate persons. SRH and declines in SRH were associated with increased mortality risk in older men and in those who can read and write in this Mediterranean population. Given current improvements in education and decreasing gender inequality, health professionals in Spain should pay attention to both current SRH and declines in SRH in their patients regardless of gender and literacy.
Analysing drug consumption in large population groups lets us observe consumption trends and comp... more Analysing drug consumption in large population groups lets us observe consumption trends and compare them between different settings. to analyse the time trends for consumption and costs of specific drugs used to treat dementia in the region of Madrid (Spain) and compare trends by sex and age cohort. Descriptive study of cholinesterase inhibitors (N06DA) and memantine (N06DX01) dispensed in Madrid between 2002 and 2012 and covered by the Spain's national health system. Consumption was calculated by analysing changes in DDD (defined daily doses) to find total and yearly increases. The cost was estimated based on DDD price. To compare consumption rates by age and sex, we calculated DDD per 100 inhabitants/day. Between 2002 and 2012, consumption of drugs used to treat dementia increased sixfold. During this period, cholinesterase inhibitors accounted for 76.70% of the drugs consumed and memantine, 23.30%. The estimated cost rose by a by a factor of 5.7 over 11 years (or by a factor of 4 taking into account the use of generic drugs). In 2012, 2.42% of the patients aged 65 or over consumed cholinesterase inhibitors (women 2.82%, men 1.83%) and 0.90% consumed memantine (women 1.10%, men 0.61%). Consumption increased in age cohorts up to 86 to 90 (5.84% for cholinesterase inhibitors and 2.33% for memantine) and declined thereafter. Consumption of cholinesterase inhibitors and memantine gradually increased, but consumption in 2012 did not reach levels equivalent to dementia prevalence figures. Pharmaceutical expenditure restraint measures may temporarily slow the cost increase temporarily but if the same trend of consumption persists, costs will rise.
ABSTRACT Introduction Acute hospitalisation can be an opportunity to diagnose dementia if it can ... more ABSTRACT Introduction Acute hospitalisation can be an opportunity to diagnose dementia if it can be guaranteed that confounding factors are taken into account. Objective To study the validity of systematic criteria for the detection of cognitive impairment and of a standardised diagnostic protocol of dementia in elderly patients hospitalised in a geriatric service. Methods Patients were included if they met any of the following criteria: a) previous score on the Red Cross Mental Scale (RCMS) ≥ 2, b) Pfeiffer Questionnaire score ≥ 5 errors and/or c) presence of delirium (Confusion Assessment Method criteria). A geriatrician conducted a cognitive history and physical examination and the following diagnostic protocol was applied: DSM-IV criteria for dementia, Mini Mental State Examination, Clock Drawing Test, Informant Questionnaire, Clinical Dementia Rating Scale, Pfeffer Scale of Instrumental Activities and Laboratory and neuroimaging tests. Each diagnosis was confirmed by another independent geriatrician. Results Seven hundred and fifty-five patients were hospitalised, of which 156 (21%) met the inclusion criteria. The study could be completed during hospitalization in 114 patients (73%). The definitive diagnosis was Alzheimer's disease or mixed dementia in 63 cases (40%), vascular dementia in 17 (11%), mild cognitive impairment in 6 (4%) and delirium without previous decline in 28 (18%). Treatment recommendations were given in all cases. Conclusions Application of systematic detection criteria and a standardised diagnostic protocol made it possible to discover unknown cognitive problems in one of every five hospitalised elders and to diagnose 73% of them. Most of the diagnosis were for established dementia.
Revista Española de Geriatría y Gerontología, 2011
... obs-táculos por el que el paradigma de la fragilidad no se había podido aplicar a la práctica... more ... obs-táculos por el que el paradigma de la fragilidad no se había podido aplicar a la práctica clínica diaria en nuestro medio»4. Esta afir-mación trae a primer ... Jürschik Giménez P, Escobar Bravo MÁ, Nuin Orrio C, Botigué Satorra T. Cri-terios de fragilidad del adulto mayor. ...
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