Pfeiffer Test Research Articles

Geriatric conditions and invasive management in frail patients with NSTEMI. A subgroup analysis of a randomized clinical trial

Introduction and objectivesInvasive management in frail patients with non–ST-segment elevation myocardial infarction (NSTEMI) remains controversial. We investigated the impact of various geriatric conditions. MethodsThe MOSCA-FRAIL trial included 167 adults aged ≥ 70 years with frailty (Clinical Frailty Scale [CFS] ≥ 4 points) and NSTEMI, who were randomized to either an invasive (n=84) or conservative (n=83) strategy. In addition to frailty, we measured activities of daily living (Barthel index), cognitive impairment (Pfeiffer test), and comorbidities (Charlson index). The primary endpoint was the difference (invasive minus conservative) in restricted mean survival time (RMST) for all-cause mortality at a median follow-up of 3.9 years. ResultsA total of 93 patients died. The RMST difference favored invasive management at the CFS 25th percentile (CFS=4; 157 days, 95%CI, 18-295; P=.027), which changed to a nonsignificant effect at the 50th and 75th percentiles. The RMST difference remained nonsignificant, irrespective of the severity of other geriatric assessments. In time-to-event analysis, invasive management was associated with an initially lower life expectancy, peaking at around 1 year, among all subgroups. However, patients with CFS=4 experienced a benefit at the end of follow-up (181 days, 95%CI, 19-343), whereas those with CFS >4 did not (−16 days, 95%CI, −217 to 186; interaction P=.16). Subgroups defined by other geriatric markers showed a similar time-dependent trend, albeit with weaker statistical interaction. ConclusionsAmong adults with frailty and NSTEMI, the CFS might be useful for evaluating the relative risks and benefits of invasive management. A CFS >4 could serve as a valuable threshold for decision-making.

Prognostic role of fragility detection in a heart failure clinic using the vulnerable elderls survey scale 13 (VES-13) and a multimodality assessment

Abstract Background Fragility has repeatedly proved to play a significant prognostic role in HF patients. We recently reported that the Vulnerable Elderls Survey scale 13 (VES-13) was useful and even showed a higher sensitivity for detecting fragility in outpatients with heart failure (HF) than a multimodality assessment used for many years in our Heart Failure Clinic. Concordance between VES-13 and the multimodality assessment was superior to 80%, but Cohen’s Kappa did not reach the suitable level of 0.70. Purpose To assess which of the two approaches (VES-13 scale and a multimodality assessment that includes Barthel index, OARS scale, Pfeiffer test, and abbreviated Yesavage Geriatric Depression Scale of 4 items [GDS]) is superior from the prognostic point of view. Methods Nurses fulfilled the scales with the patients at their first visit. Patients with a scoring ≥3 in the VES-13 scale and the presence of one of the predefined criteria in the multimodality assessment (Barthel <90; OARS score <10 in women and <6 in men; Pfeiffer Test score >3 ± 1, depending on educational level; one positive depression response in abbreviated GDS; and age >85 years or nobody to turn to for help) were considered to have fragility for the purpose of the study. All-cause mortality and the composite of all-cause death or HF hospitalization were the analysed end-points. Results From March 2021 to December 2021, 172 patients were evaluated with the two fragility screening modalities (mean age 69.1 ± 11.4 years, 64% men, 42.4% from ischaemic aetiology, 66.9%/26.2% in NYHA class II/III, LVEF 40.3% ± 13.9). VES-13 identified 68 (39.5%) patients with fragility, while the multimodality assessment detected 61 (35.5%) patients. During a mean follow-up of 15.8 ± 4.8 months, 22 patients (12.8%) died, 18 (10.5%) had at least one HF hospitalization and 37 suffered the composite end-point of all-cause death or HF hospitalization (21.5%). In Cox regression analyses fragility detected by both approaches showed similar prognostic value for all-cause mortality (HR 2.89 [1.24-6.77], p=0.014) using the multimodality approach vs. (HR 2.89 [1.21-6.89], p=0.017) using the VES-13 scale. However, fragility detected by the VES-13 scale revealed to be a more powerful prognostic tool for the composite end-point (HR 2.90 [1.49-5.64], p=0.002) than the multimodality approach (HR 1.47 [0.77-2.81], p=0.248). Conclusions Fragility detected both by the VES-13 and by a multimodality approach showed similar prognostic role for all-cause mortality, but VES-13 showed a higher stratification capacity for the composite end-point of all-cause death or HF hospitalization. Nevertheless neither of the two approaches is actually a prognostic tool. It is necessary to perform a complete geriatric assessment to identify the grade of fragility, the possible prognostic impact and the best intervention to improve outcomes and quality of life.

Atrial fibrillation as a new prognosis factor in chronic patients after hospitalization: the CHRONIBERIA index

A collaborative project in different areas of Spain and Portugal was designed to find out the variables that influence the mortality after discharge and develop a prognostic model adapted to the current healthcare needs of chronic patients in an internal medicine ward. Inclusion criteria were being admitted to an Internal Medicine department and at least one chronic disease. Patients’ physical dependence was measured through Barthel index (BI). Pfeiffer test (PT) was used to establish cognitive status. We conducted logistic regression and Cox proportional hazard models to analyze the influence of those variables on one-year mortality. We also developed an external validation once decided the variables included in the index. We enrolled 1406 patients. Mean age was 79.5 (SD = 11.5) and females were 56.5%. After the follow-up period, 514 patients (36.6%) died. Five variables were identified as significantly associated with 1 year mortality: age, being male, lower BI punctuation, neoplasia and atrial fibrillation. A model with such variables was created to estimate one-year mortality risk, leading to the CHRONIBERIA. A ROC curve was made to determine the reliability of this index when applied to the global sample. An AUC of 0.72 (0.7–0.75) was obtained. The external validation of the index was successful and showed an AUC of 0.73 (0.67–0.79). Atrial fibrillation along with an advanced age, being male, low BI score, or an active neoplasia in chronic patients could be critical to identify high risk multiple chronic conditions patients. Together, these variables constitute the new CHRONIBERIA index.

Fragility influences the impact of self-care behavior on patient-reported outcomes further of psychosocial factors of self-perceived health status in patients with heart failure

Abstract Background Poor self-care behaviour is associated with a higher risk of readmission and mortality in patients with heart failure (HF). Psychosocial factors are key determinants of patient-reported outcomes (PROMs) such as health-realted quality of life (QoL). Little is known about the interplay between self-care and psychosocial factors on PROMs in HF. Purpose To describe the interaction of self-care and psycho-social factors on QoL in a real-world cohort of HF patients. Methods We conducted an observational, prospective, cohort study of 1120 consecutive patients with chronic. We used the modified European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure self-care (inverted and standardised: higher scores indicate better self-care). To assess QoL, we used Minnesota Living with Heart Failure Questionnaire (MLHFQ) (higher scores indicate worse QoL). General linear models (GLM) were constructed to explore the interaction between psychosocial factors and poor self-care (defined as EHFSCBS-9 ≤lower tertile) on adjusted MLHFQ scores. To determine the impact of self-care, multivariate linear regressions models to predict QoL were constructed stratified according to selected psycho-social determinants. All models were adjusted by age, sex and psycho-social determinants of QoL including literacy, cognitive function (Pfeiffer test), dependency (Barthel and Lawton & Brody test), social support (Duke UNC and APGAR Familyfunction), depressive symptoms (15-item Geriatric Depression Scale) and fragility (Barber test scores ≥1). Results A total of 484 patients (43%) were women, mean age was 72±11 years, and mean LVEF was 45±17%. Mean MLHFQ scores were 45±24. Mean EHFSCBS-9 scores were 69±28. There was a significant inverse correlation between EHFScBS-9 and MLHFQ scores (r=−0.158; p-value <0.0001). Fragility was present in 883 patients (79%). In adjusted GLM, poor self-care (F=10.2; p-value=0.001) and fragility (F=17.9; p-value <0.001) were independent predictors of higher adjusted scores in the MLHFQ indicating worse QoL. As shown in Figure 1, the interaction between fragility and self-care was significant (F=6.8; p-value = 0.009). Linear regression models (Table 1) stratified according the absence (panel A) or the presence (panel B) of fragility showed that fragility modulated the association between self-care behaviour and QoL. Only in patients without fragility, self-care were independent predictors of QoL. On the other hand, in patients with fragility, self-care behaviour did not longer influence self-perceived health status in patients with HF. Conclusions We have shown that self-care behaviour is an independent predictor of PROMs in HF regardless the presence of important psycho-social determinants of QoL only when fragility status is taken into account. Fragility modulates the influence of self-care and QoL, including each one of its dimensions. Funding Acknowledgement Type of funding sources: None.

Factores sociodemográficos y sobrecarga en cuidadores de adultos mayores

The present investigation, whose objective is to determine the sociodemographic factors and their relationship with the burden of caregivers of older adults. This quantitative, descriptive, correlational, cross-sectional investigation; It was carried out in the province of Trujillo, with adult family caregivers of older adults from the home care program (PADOMI) of Es SALUD de Trujillo, during the year 2020, with authorization from the ethics committee. The sample universe was made up of adult caregivers and they were selected by convenience considering the 600 older adults registered in PADOMI and who met the inclusion criteria. The interview was conducted at the participant's home, and the Sociodemographic Profile, Zarit Scale and Pfeiffer Test instrumentswere applied. For data analysis, the statistical program Statistical Package for The Social Sciences -SPSS v. 22.0. It was found that there is a highly significant relationship between the overload of the older adult caregiver with demographic factors such as age, sex, education, marital status, kinship, time of care and there is no significant relationship with the type of disease.

The Predictive Value of Anticholinergic Burden Measures in Relation to Cognitive Impairment in Older Chronic Complex Patients.

Anticholinergic burden (AB) is related to cognitive impairment (CI) and older complex chronic patients (OCCP) are more susceptible. Our objective was to evaluate the predictive value of ten anticholinergic scales to predict a potential CI due to anticholinergic pharmacotherapy in OCCP. An eight-month longitudinal multicentre study was carried out in a cohort of OCCP, in treatment with at least one anticholinergic drug and whose cognition status had been evaluated by Pfeiffer test twice for a period of 6–15 months. CI was considered when the Pfeiffer test increased 2 or more points. AB was detected using ten scales included on the Anticholinergic Burden Calculator. An ROC curve analysis was performed to assess the discriminative capacity of the scales to predict a potential CI and the cut-off point of AB that obtains better validity indicators. 415 patients were included (60.2% female, median age of 85 years (IQR = 11)). 190 patients (45.8%) manifested CI. Only the DBI (Drug Burden Index) showed statistically significant differences in the median AB between patients without CI and with CI (0.5 (1.00) vs. 0.67 (0.65), p = 0.006). At the ROC curve analysis, statistically significant values were obtained only with the DBI (AUC: 0.578 (0.523–0.633), p = 0.006). The cut-off point with the greatest validity selected for the DBI was an AB of 0.41 (moderate risk) (sensitivity = 81%, specificity = 36%, PPV = 51%). The DBI is the scale with the greatest discriminatory power to detect OCCP at risk of CI and the best cut-off point is a load value of 0.41.

Factors of presenting an acute confusional syndrome after a hip fracture

IntroductionAcute confusional syndrome (ACS) is a geriatric syndrome that manifests itself with changes in cognition, attention, underactive or hyperactive motor response, and fluctuation in the level of consciousness after trauma, hospitalisation or surgery. The objective is to know the risk factors and prevention of acute confusional syndrome in the elderly with hip fractures (HF) . MethodsProspective observational cohort study. The inclusion criteria was to be age ≥ 65 and HF operated under selective spinal anesthetic (bupivacaine ≤ 7 mg + fentanyl 10-15 .mu.g) without benzodiazepine, ketamine or propofol. The potential risk factors of ACS were recorded: demographic variables, fracture type, Charlson index, ASA risk, performance of a peripheral nerve block (PNB), and scale scores: Barthel, Fried, Pfeifer, RCMS, MNA and VAS. ACS was diagnosed by the CAM questionnaire. The risk factors were estimated by binary logistic regression. ResultsOf the 133 patients included, 60 (45.11%) developed preoperative ACS, and 25 developed (18.8%) postoperative ACS. Having identified cognitive impairment with ≥ 3 points on the RCMS (OR 11.04 [ 95% ic: 1.3 - 89.1], p <0.001) or Pfeiffer (OR 6.94 [95% ic: 1.07 - 44.69], p <0.0 41) was a risk factor of ACS. Among patients with cognitive impairment or dementia, the increase of surgical delay (OR 1.95 [ 95% CI: 1.2 -2.91], p <0.001) was associated with the increased likelihood of presenting perioperative ACS, while performing a perioperative PNB decreased the likelihood of presenting perioperative ACS (without PNB: 43.8%, with PNB: 4.7%, OR 0.3 [0.2 to 0.43], p <0.001). ConclusionIdentifying patients with HF and cognitive impairment using RCMS or the Pfeiffer test and performing HF surgery within 36 h administering perioperative PNB could reduce the incidence of ACS.

Preoperative Assessment of Geriatric Surgical Patients: Update on Clinical Scales Used for Elective General and Digestive Surgery.

Higher life expectancy in the general population entails a growing interest in the surgical management of diseases affecting elderly patients. Preoperative assessment when planning surgery needs to carefully evaluate physical and functional status of the patient. This review aims to describe the most commonly used scales in the evaluation of elderly patients scheduled for surgery and provides a useful tool to decide the scales that would be better to assess these specific patients. According to the PRISMA statement of publications published, we have carried out a systematic review focused on elderly patients who underwent surgical procedures in General and Surgery. Using Medline, Embase, and Cochrane library, a systematic search of the literature from 1992 to 2018 was performed. This enabled us to retrieve information from the selected articles on scales to evaluate medical fitness, functional status, or both, in the elderly or frail patients. We reviewed 102 articles and selected the most frequently used assessment scales or indexes. After this extensive analysis, we selected 4 functional scales (Katz Index, Barthel Scale, Karnofsky Performance Score, and Vulnerable Elders Survey), 4 clinical scales (American Society of Anaesthesiologists Index, Charlson Comorbidity Index, Pfeiffer Test, and Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity Scale) and finally, 2 mixed scales (American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator and Edmonton Frail Scale). No consensus on the use of a unified assessment scale for elderly patients exists. However, with this review, we provide a brief guideline about the most useful and used scales to perform a comprehensive assessment of geriatric patients undergoing surgery.

Interatrial block and cognitive impairment in the BAYES prospective registry

BackgroundAn association between interatrial block (IAB) (P wave duration ≥120 ms) and dementia has been suggested. Our objective was to assess the association of IAB with cognitive impairment (CI). MethodsThe prospective BAYES registry included 552 patients ≥70 years with structural heart disease without documented atrial fibrillation. Cognitive ability was assessed at baseline and every 6 months with the Pfeiffer test. The median follow-up was 22 months. ResultsThirty patients (5.4%) had baseline CI, 20 patients with mild CI and 10 with moderate CI. Compared to patients without CI, patients with CI had higher mean age (80.4 ± 6.5 vs. 76.8 ± 5.4 years) and higher prevalence of advanced IAB (with biphasic P-wave ± in inferior leads) (14 [46.7%] vs. 122 [23.4%], p < .01). The prevalence of baseline CI was 2.7% in normal P-wave, 5.1% in partial IAB, and 10.3% in advanced IAB, p < .001. Advanced IAB was independently associated with baseline CI (odds ratio 4.9, 95% confidence interval 1.4–16.5), this was not the case with partial IAB (odds ratio 2.1, 95% confidence interval 0.5–7.4). The independent association with CI at follow-up existed both for partial IAB (hazard ratio 1.98, 95% confidence interval 1.18–3.33) and advanced IAB (hazard ratio 2.04, 95% confidence interval 1.19–3.51). ConclusionIn patients aged 70 years or more with structural heart disease who are in sinus rhythm advanced IAB is associated with baseline CI. There is also an association of partial and advanced IAB with CI during follow-up.

Evaluation and characterization of multimorbidity profiles, resource consumption and healthcare needs in extremely elderly people.

Spanish population lifespan is one of the longest in the world. Moreover, it is known that elderly people have less chronic illnesses associated with aging. Our aims were to determine how Clinical Risk Group (CRG) predicts future use of healthcare resources in extremely elderly people without diabetes (T2DM) and to explore CRG correlation with health conditions. Prospective cross-sectional study. Rio Hortega University Hospital. Hospitalized patients >80years old without T2DM, during 2017. Mental status was evaluated using Pfeiffer test (SPMQS), Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) were estimated using the Older Americans Resources and Services questionnaire. Comorbidity was evaluated using Charlson index (CI) and health-related quality of life (HRQoL) with EuroQoL (EQ5D3L). CRG classification system was obtained from electronic clinical records. Data were analyzed using SPSS v.15.0. In total, 305 patients were identified (59% women), mean age 88±5 and 38% were aged >90. Estimated HRQoL was 0.43±0.33 for EQ5D3L-index-value. Mean dependence level was 6.2±5 for BADLs and 9.2±5 for IADLs. In total, 31.6% of patients had severe cognitive impairment with a mean score of 5.4±3.6 in SPMQS. In total, 30.2% of patients were categorized as G3, and presented high comorbidity more frequently than the rest. Corrected CI mean score was 6.2±1.7. Significant relationship was founded in survival time, number of admissions and CI score. Using predictive risk models like CRG is supposed to assess the complexity of morbidity but in our extremely elderly population partially fail in stratify and predict health resource consumption.

Multimorbidity gender patterns in hospitalized elderly patients.

Patients with multimorbidity and complex health care needs are usually vulnerable elders with several concomitant advanced chronic diseases. Our research aim was to evaluate differences in patterns of multimorbidity by gender in this population and their possible prognostic implications, measured as in-hospital mortality, 1-month readmissions, and 1-year mortality. We focused on a cohort of elderly patients with well-established multimorbidity criteria admitted to a specific unit for chronic complex-care patients. Multimorbidity criteria, the Charlson, PROFUND and Barthel indexes, and the Pfeiffer test were collected prospectively during their stays. A total of 843 patients (49.2% men) were included, with a median age of 84 [interquartile range (IQR) 79-89] years. The women were older, with greater functional dependence [Barthel index: 40 (IQR:10-65) vs. 60 (IQR: 25-90)], showed more cognitive deterioration [Pfeiffer test: 5 (IQR:1-9) vs. 1 (0-6)], and had worse scores on the PROFUND index [15 (IQR:9-18) vs. 11.5 (IQR: 6-15)], all p <0.0001, while men had greater comorbidity measured with the Charlson index [5 (IQR: 3-7) vs. 4 (IQR: 3-6); p = 0.002]. In the multimorbidity criteria scale, heart failure, autoimmune diseases, dementia, and osteoarticular diseases were more frequent in women, while ischemic heart disease, chronic respiratory diseases, and neoplasms predominated in men. In the analysis of grouped patterns, neurological and osteoarticular diseases were more frequent in females, while respiratory and cancer predominated in males. We did not find gender differences for in-hospital mortality, 1-month readmissions, or 1-year mortality. In the multivariate analysis age, the Charlson, Barthel and PROFUND indexes, along with previous admissions, were independent predictors of 1-year mortality, while gender was non-significant. The Charlson and PROFUND indexes predicted mortality during follow-up more accurately in men than in women (AUC 0.70 vs. 0.57 and 0.74 vs. 0.62, respectively), with both p<0.001. In conclusion, our study shows differing patterns of multimorbidity by gender, with greater functional impairment in women and more comorbidity in men, although without differences in the prognosis. Moreover, some of these prognostic indicators had differing accuracy for the genders in predicting mortality.

Older People Living in Nursing Homes: An Oral Health Screening Survey in Florence, Italy.

The oral health state plays an important role in the concept of ‘elderly frailty’, since institutionalized older people are prone to suffering from bad oral conditions. The aim of this study is to assess the state of oral health in the older residents of nursing homes and to measure its potential association with the cognitive state, the degree of functional autonomy, and the malnutrition risk. Methods: We enrolled 176 subjects from 292 residents in five nursing homes in Florence. For each subject, we performed the Malnutrition Universal Screening Tool, the Pfeiffer test, the Minimum Data Set—Long Form, a dental examination, and the Geriatric Oral Health Assessment Index questionnaire. The results show that the oral condition was poor in 43.8% of cases, medium in 38.1%, and good in 18.2%. A worse oral health state was significantly associated (p < 0.05) with a worse cognitive state and with a higher dependency in daily living activities. The malnutrition score among the older people was unrelated to the oral health condition (p = 0.128). It can be concluded that the oral health condition in older institutionalized subjects is an open challenge for the public healthcare system, since the maintenance of adequate good oral health is an essential element of good physical as well as cognitive and psychological health.

Mortalidad y factores asociados de los pacientes con enfermedades crónicas complejas del ámbito rural y zonas de transformación social en Andalucía

Objective: To determine one-year mortality and associated factors in patients with complex chronic diseases (CCP) in rural health centres and social transformation needs areas (STNA) in Primary Health Care (PHC) in Andalusia.Material and Methods: Design: 1-Year longitudinal observational prospective open study. Setting: 40 health centre. Subjects: consenting subjects over 18yr according multiple health condition criteria.Sample Size: 814 subjects (confidence interval 95%, alpha risk 0.03%, p=.2; 20% of sample increase due to possible losses).End-point: 1-year Mortality. Independent variables: socio-demographic, socio-familial, clinical, functional (Barthel Index –BI-, Lawton-Brody Index), cognitive (Pfeiffer Test), prescribed drugs, social healthcare resources consumption, and quality of life (EQ-5D). Data source: Interview and computerised clinical historyResults: A total of 832 CCP were included (48.8% women). One-year mortality was 17.8% (n=148). Logistic regression model for mortality included: aged 85 and over, having a caregiver, haemoglobin level less 10g/L, hospital admission in last year, BI under 60 points, and active neoplasia. The calibration obtained from model was good (p=.85 in the Hosmer–Lemeshow goodness-of-fit test), and the discrimination power also good (AUC=0.772 [0.68–0.77] in ROC curve).Conclusions: 1-year mortality of CCP in rural centres and STNA in PHC was 17.8%. Knowledge of the factors related to the mortality of CCP helps to approach the needs and social-health resources management.

Anthropometric Measurements and Cognitive Impairment Rather Than Nutrition Status Are Associated With Sarcopenia in Long-Term Care Residents.

Sarcopenia is an important health problem in older adults. The aim was to study the association of anthropometric measurements, functional capacity, cognitive impairment, and nutrition status with sarcopenia in institutionalized older adults. A cross-sectional study was undertaken, determining the calf circumference (CC), mid-upper arm muscle circumference (MUAMC), and body mass index (BMI) and administering the Pfeiffer test and Mini Nutritional Assessment Short Form (MNA-SF). Sarcopenia was diagnosed following criteria of the European Working Group on Sarcopenia in Older People. After bivariate analyses, a multivariate logistic regression model was constructed to determine the association of study variables with sarcopenia. The study group comprised 249 residents (mean age 84.9 ± 6.7years). The prevalence of sarcopenia was 63%. The multivariate analysis with adjusted odds ratios (ORs) indicated that the risk of sarcopenia was significantly increased by being female (OR = 2.8; 95% CI 1.3-6.2), having moderate or severe cognitive impairment (Pfeiffer test score of 5-10) (OR = 2.4; 95% CI 0.9-6.4), and having a BMI < 22kg/m2 (OR = 22.4; 95% CI 6.7-75.0). Moreover, a low CC (OR = 6.5; 95% CI 3.0-14.0) or MUAMC (OR = 3.9; 95% CI 1.7-9.3) also significantly increased the risk of sarcopenia. A negative association was observed between sarcopenia and MNA-SF, although it did not remain statistically significant in the multivariate analysis. The variables identified as risk factors for sarcopenia can assist in detecting individuals at higher risk who require special clinical attention.

Neurological monitoring as a safety system in patients undergoing cardiac surgery with cardiopulmonary bypass

Objective: to evaluate the adequate cerebral perfusion in patients who underwent cardiac surgery with cardiopulmonary bypass. Methods: an observational, analytical, prospective and multicentric study was conducted. All adults patients scheduled for cardiac surgery with cardiopulmonary bypass were included, with hospital admission at least the day before the intervention, with a negative Pfeiffer test, without communication problems, and with informed consent. Cerebral monitoring with Masimo ROOT 03® was used with encephalogram measurement (4 channels), cerebral oximetry and anesthetic depth. As a pre and postoperative cognitive assessment instrument we used the Pfeiffer test. Results: 19 patients with a mean age of 64.8 ± 11.5 years were included. The postoperative Pfeiffer test showed no cognitive impairment in 78.9% of the cases. While the remaining 21.1% had mild cognitive impairment (1 patient had ischemic damage). In this group, all were valvular patients, older than 65 years of age, and had maximum glycemias greater than 180 mg/dL. In 75% of the patients with cognitive impairment, the baseline SrO2 was less than 57%, there was sustained hypotension at sometime during surgery and it had a decrease of more than 20% of its basal SrO2. Conclusions: Continuous brain monitoring (electroencephalogram, cerebral oxygen saturation, anesthetic depth, suppression rate) during cardiac surgery with cardiopulmonary bypass is a reliable, valid and necessary safety measure to improve the quality of perfusion and surgical patient care.

The effects of different types of physical exercise on physical and cognitive function in frail institutionalized older adults with mild to moderate cognitive impairment. A randomized controlled trial

BackgroundThe continuous increase in the life expectancy of older adults (elderly people) has generated interest in research into frail-aged people and their physical and mental well-being. ObjectivesTo verify the different effects of two programs of physical exercise (strength training-TG, and callisthenic training-MG) on the cognitive state, functionality, stability and general health of frail-aged institutionalized older adults. DesignThis study was a block randomized controlled trial. SettingThe study was conducted in geriatric units of the San Rosendo Foundation. ParticipantsA total of 77 institutionalized frail-aged people (70.1% female, aged 84.8±7.9) took part. InterventionsThe TG carried out a strength program with therabands®; The MG performed an exercise program of multi-callisthenics, and the CG did not carry out any physical exercise. MeasurementsThe following measurements were used: Minimental test, Pfeiffer test, SF-12, Barthel test, Five times sit-to-stand and a pressure platform. ResultsThe TG program generated some improvement in cognitive state and functional independence, while in the physical and mental component of the S-12, significant improvement was generated. The program undertaken by MG demonstrated a tendency to the stabilization of the above mentioned parameters, while the GC demonstrated a tendency to deterioration. ConclusionPhysical exercise, whether it be the strength program, or the multi-calisthenics program, is an effective method for improving and maintaining health, cognitive state, functional independence and stability in frail-aged institutionalized people.

Association Between Drug Burden Index and Functional and Cognitive Function in Patients with Multimorbidity

Anticholinergic and sedative drugs are associated with adverse events such as cognitive and functional impairment in elderly. The Drug Burden Index (DBI) is a measure of an individual's total exposure to anticholinergic and sedative drugs. Objetive: The study aimed to evaluate the association between the total DBI and cognitive and functional impairment in patients with multimorbidity. Patients with multimorbidity enrolled in the IMPACTO project. Cross-sectional observational study. The anticholinergic and sedative exposure was calculated using DBI. The Pfeiffer Test (PT) was used for cognitive status and the Barthel Index (BI) for functional status. 336 patients were included (mean age 77.6 ± 8.7 years, 54.2% men and a mean of 11.5 ± 3.7 prescribed drugs). 180 patients (53.6%) exposed to anticholinergic and/or sedative drugs were identified. The median score obtained in PT was slightly higher in exposed patients (1 (IQR 0-2) and 2 (IQR 0-4), p = 0.082 in "non-exposed" and "exposed", respectively). The bivariate analysis showed an association [0.544 (95% CI 0.044-1.063, p = 0.03)]. The median obtained in the BI analysis was 85.0 (IQR 30.0) and 75.5 (IQR 42.5) p = 0.002, in "nonexposed" and "exposed", respectively. After the adjusted analysis, a relationship was obtained between both the variables [-9,558 (95% CI-15,794; -3,321, p = 0.03)]. Higher DBI is associated with the impairment of functional status and, slightly to the deterioration of cognitive function in patients with multimorbidity. DBI should be considered in patients with multimorbidity to optimize the pharmacological treatment of a group of special interest due to its vulnerability.

Frailty in elderly patients undergoing primary percutaneous coronary intervention.

The prevalence of frailty, cognitive impairment and disability and its prognostic impact in patients with myocardial infarction undergoing primary percutaneous coronary intervention is unknown. The aim of this study was to assess the prevalence of frailty and other ageing-related variables and their association with inhospital mortality in consecutive elderly ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention in a tertiary care hospital. We prospectively included patients aged 75 years or older with STEMI undergoing primary percutaneous coronary intervention. The nursing team provided pre-discharge, standardised questionnaires and tests to each patient to study the presence of frailty (FRAIL scale), comorbidity (Charlson index), disability (Barthel test, Lawton-Brody index), nutritional risk (MNA-SF test) and cognitive status (Pfeiffer test). The association between ageing-related variables and mortality was assessed by binary logistic regression. A total of 259 patients were included with a mean age of 82.6±6 years, 57.9% men. A total of 51 patients (19.7%) were frail, 26 presented with moderate or severe disability (10%), and 82 were at risk of malnutrition (31.7%). Frailty was associated with a higher prevalence of diabetes, hypertension and previous stroke, and a higher inhospital mortality (21.6% vs. 3.4%; P<0.001). After adjusting for potential confounders, this association remained significant (odds ratio 3.96; 95% confidence interval 1.16-13.56; P=0.028). A not negligible proportion of elderly patients with STEMI fulfilled the frailty criteria. Frailty was independently associated with mortality. A very simple, feasible geriatric assessment by trained nurses can contribute to predict mortality.

Comorbidities, Fragility, and Quality of Life in Heart Failure Patients With Midrange Ejection Fraction

ObjectiveTo assess the effects of comorbidities, fragility, and quality of life (QOL) on long-term prognosis in ambulatory patients with heart failure (HF) with midrange left ventricular ejection fraction (HFmrEF), an unexplored area.Patients and MethodsConsecutive patients prospectively evaluated at an HF clinic between August 1, 2001, and December 31, 2015, were retrospectively analyzed on the basis of left ventricular ejection fraction category. We compared patients with HFmrEF (n=185) to those with reduced (HFrEF; n=1058) and preserved (HFpEF; n=162) ejection fraction. Fragility was defined as 1 or more abnormal evaluations on 4 standardized geriatric scales (Barthel Index, Older Americans Resources and Services scale, Pfeiffer Test, and abbreviated-Geriatric Depression Scale). The QOL was assessed with the Minnesota Living with Heart Failure Questionnaire. A comorbidity score (0-7) was constructed. All-cause death, HF-related hospitalization, and the composite end point of both were assessed.ResultsComorbidities and QOL scores were similar in HFmrEF (2.41±1.5 and 30.1±18.3, respectively) and HFrEF (2.30±1.4 and 30.8±18.5, respectively) and were higher in HFpEF (3.02±1.5, P<.001, and 36.5±20.7, P=.003, respectively). No statistically significant differences in fragility between HFmrEF (48.6%) and HFrEF (41.9%) (P=.09) nor HFpEF (54.3%) (P=.29) were found. In univariate analysis, the association of comorbidities, QOL, and fragility with the 3 end points was higher for HFmrEF than for HFrEF and HFpEF. In multivariate analysis, comorbidities were independently associated with the 3 end points (P≤.001), and fragility was independently associated with all-cause death and the composite end point (P<.001) in HFmrEF.ConclusionComorbidities and fragility are independent predictors of outcomes in ambulatory patients with HFmrHF and should be considered in the routine clinical assessment of HFmrEF.

Diagnosis of Sarcopenia in Long-Term Care Homes for the Elderly: the Sensitivity and Specificity of Two Simplified Algorithms with Respect to the EWGSOP Consensus.

To analyze the prevalence of sarcopenia in elderly care homes using the algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP) and to evaluate the applicability, sensitivity, and specificity of two simplified algorithms that do not include gait speed measurement. Cross-sectional study. Long-term care homes. 249 residents (187 females and 62 males) with a mean age of 84.9 ± 6.7 years (range, 70-106 yrs). Cognitive impairment was evaluated with the Pfeiffer test, functional capacity with the Barthel index, walking ability by the Functional Ambulation Classification, muscle mass by bioelectrical impedance analysis, muscle strength by handgrip dynamometry and, gait speed over a distance of 4 m. Sarcopenia was assessed using the EWGSOP-recommended algorithm and two simplified algorithms (A and B). Algorithms A and B were validated with respect to the EWGSOP algorithm using the MacNemar test and obtaining the sensitivity and specificity, kappa coefficient, and area under the receiver operating characteristic curve (AUC). Total or severe dependence was recorded in 67% of the 249 residents, severe or moderate cognitive impairment in 64%, inability to walk in 49%, and capacity to walk only with the aid of an ambulator or two people in 21%. The prevalence of sarcopenia was 63.0% by the EWGSOP algorithm, 62.9% by algorithm A and 63.2% by algorithm B (P = 1.000); 143 participants were diagnosed with sarcopenia by all three methods (P =1.000, K = 1.000). Further studies that include residents with functional and/or cognitive impairment are required to validate these results, comparing the diagnostic performance of the EGWSOP algorithm with that of the simplified algorithms validated in the present report.