Pfeiffer Test Research Articles

Prevalence of urinary incontinence and associated factors in nursing home residents.

To determine the prevalence of urinary incontinence (UI) and associated factors in the institutionalized elderly. A cross-sectional study is presented herein, conducted between October and December 2013, in 10 nursing homes in the city of Natal (Northeast Brazil). Individuals over the age of 60, who reside in institutions, were included. Hospitalized individuals and those at end of life were excluded. Data collection included sociodemographic information, UI characterization, as well as variables related to the institution itself and to health conditions (comorbidities, medication, pelvic floor surgery, Barthel Index for functional capacity, and Pfeiffer test for cognitive status). UI was verified through the Minimum Data Set (MDS) version 3.0, which was also used to assess urinary devices and UI toileting programs. The Chi-square test (or Fisher's exact test), the linear Chi-square test, and logistic regression were utilized to model associations. The final sample consisted of 321 elderly, mostly females, with a mean age of 81.5 years. The prevalence of UI was 58.88% (CI 95%: 53.42-64.13) and the final model revealed a statistically significant association between UI and white race, physical inactivity, stroke, mobility impairment, and cognitive decline. The most frequent UI type was functional UI and toileting programs (prompted voiding) were only applied to approximately 8% of residents. It is concluded that UI is a health issue that affects more than half of the institutionalized elderly, and is associated with white race, physical inactivity, stroke, and other geriatric syndromes such as immobility and cognitive disability.

Geriatric Assessment and Prognostic Factors of Mortality in Very Elderly Patients With Community-Acquired Pneumonia

IntroductionTo assess the relationship between the parameters obtained in the geriatric assessment and mortality in elderly people with community-acquired pneumonia in an acute care geriatric unit. MethodsFour hundred fifty-six patients (≥75years). Variables: age, sex, referral source, background, consciousness level, heart rate, breathing rate, blood pressure, laboratory data, pleural effusion, multilobar infiltrates, functional status (activities of daily living) prior to admission [Lawton index (LI), Barthel index (BIp)] prior to and at admission (BIa), cognitive status [Pfeiffer test (PT)], comorbidity [Charlson index (ChI)] and nutrition (total protein, albumin). ResultsA hundred ten patients died (24.2%) during hospitalization. These patients were older (86.6±6.4 vs 85.1±6.4, P<.04), had more comorbidity (ChI 2.35±1.61 vs 2.08±1.38; P<.083), worse functional impairment [(LI: 0.49±1.15 vs 1.45±2.32, P<.001) (BIp: 34.6±32.9 vs 54.0±34.1, P<.001) (BIa: 5.79±12.5 vs 20.5±22.9, P<.001)], a higher percentage of functional loss at admission (85.9±23.2 vs 66.4±28.6; P<.0001), worse cognitive impairment (PT: 7.20±3.73 vs 5.10±3.69, P<.001) and malnutrition (albumin 2.67±0.54 vs 2.99±0.49, P<.001). Mortality was higher with impaired consciousness [49.2% (P<.01)], tachypnea [33.3% (P<.01)], tachycardia [44.4% (P<.002), high urea levels [31.8 (P<.001)], anemia [44.7% (P<.02)], pleural effusion [42.9% (P<.002)], and multilobar infiltrates [43.2% (P<.001)]. In the multivariate analysis, variables associated with mortality were: age≥90years [OR: 3.11 (95% CI: 1.31–7.36)], impaired consciousness [3.19 (1.66–6.15)], hematocrit<30% [2.87 (1.19–6.94)], pleural effusion [3.77 (1.69–8.39)] and multilobar infiltrates [2.76 (1.48–5.16)]. Female sex and a preserved functional status prior (LI≥5) and during admission (BIa≥40) were protective of mortality [0.40 (0.22–0.70), 0.09 (0.01–0.81) and 0.11 (0.02–0.51)]. ConclusionsGeriatric assessment parameters and routine clinical variables were associated with mortality.

New symptom-based predictive tool for survival at seven and thirty days developed by palliative home care teams.

This study sought to develop models to predict survival at 7 and 30 days based on symptoms detected by palliative home care teams (PHCTs). This prospective analytic study included a 6-month recruitment period with patient monitoring until death or 180 days after recruitment. The inclusion criteria consisted of age greater than 18 years, advanced cancer, and treatment provided by participating PHCTs between April and July 2009. The study variables included death at 7 or 30 days, survival time, age, gender, place of residence, type of tumor and extension, presence of 11 signs and symptoms measured with a 0-3 Likert scale, functional and cognitive status, and use of a subcutaneous butterfly needle. The statistics applied included a descriptive analysis according to the percentage or mean±standard deviation. For symptom comparison between surviving and nonsurviving patients, the χ(2) test was used. Classification and regression tree (CART) methodology was used for model development. An internal validation system (cross-validation with 10 partitions) was used to ensure generalization of the models. The area under the receiver operating characteristics (ROC) curve was calculated (with a 95% confidence interval) to assess the validation of the models. A total of 698 patients were included. The mean age of the patients was 73.7±12 years, and 60.3% were male. The most frequent type of neoplasm was digestive (37.6%). The mean Karnofsky score was 51.8±14, the patients' cognitive status according to the Pfeiffer test was 2.6±4 errors, and 8.3% of patients required a subcutaneous butterfly needle. Each model provided 8 decision rules with a probability assignment range between 2.2% and 99.1%. The model used to predict the probability of death at 7 days included the presence of anorexia and dysphagia and the level of consciousness, and this model produced areas under the curve (AUCs) of 0.88 (0.86-0.90) and 0.81 (0.79-0.83). The model used to predict the probability of death at 30 days included the presence of asthenia and anorexia and the level of consciousness, and this model produced AUCs of 0.78 (0.77-0.80) and 0.77 (0.75-0.79). For patients with advanced cancer treated by PHCTs, the use of classification schemes and decision trees based on specific symptoms can help clinicians predict survival at 7 and 30 days.

Cognitive and functional apraisal in a psychogeriatric patient in a short stay psychiatric unit

Psychiatric disorders are present in dementia (Cognitive damage) and they are part of the psychological and behavioral dementias (SPCD), which are present in almost every patient and a very important cause for psychogeriatric patients´admission. Methodology: Cognitive damage was analysed (MEC de Lobo, Pfeiffer test and semantic and verbal fluency) and functional abilities in elderly inpatients, who were older than 65 years old, were also analysed (Barthel test) for 3 months. Relating these to the different sociodemographic variables. Results: Half of the 18 patients who were analyzed and studied, had any type of depressive symptoms and between 22-44% showed some signs of cognitive damage according to the test used to sieve. Discussion/Conclusions: Psychiatric disorders measured with NPI are directly related to the disability degree for AVD´s and at the same time, this is related to the admission span. The different percentages which affect cognitive damage according to the test used, shows the importance of the correct test´s choice depending on the studied population and the type of analysis accomplished.

Cognitive and functional apraisal in a psychogeriatric patient in a short stay psychiatric unit

Psychiatric disorders are present in dementia (Cognitive damage) and they are part of the psychological and behavioral dementias (SPCD), which are present in almost every patient and a very important cause for psychogeriatric patients´admission. Methodology: Cognitive damage was analysed (MEC de Lobo, Pfeiffer test and semantic and verbal fluency) and functional abilities in elderly inpatients, who were older than 65 years old, were also analysed (Barthel test) for 3 months. Relating these to the different sociodemographic variables. Results: Half of the 18 patients who were analyzed and studied, had any type of depressive symptoms and between 22-44% showed some signs of cognitive damage according to the test used to sieve. Discussion/Conclusions: Psychiatric disorders measured with NPI are directly related to the disability degree for AVD´s and at the same time, this is related to the admission span. The different percentages which affect cognitive damage according to the test used, shows the importance of the correct test´s choice depending on the studied population and the type of analysis accomplished.

Validación en español del test TYM para cribado de demencia en una población argentina

The aim of this study is the validation and identification of cut-off scores for a fast neurocognitive test, called TYM (Test Your Memory) which goal is dementia screening. It was translated and adapted to meet a sample profiles that dwell in Rosario. Results between patients and normal controls matched for age and gender were compared. To establish cut-off points the TYM test was compared against other standardized well-known test (Test de Lobo or MEC, Addenbrook Cognitive Test in Spanish -Revised or ACE-R and -Pfeiffer Test or PFAQ) in two samples of subjects with 50 demented patients and 100 normal controls each one. Patients with dementia completed the TYM with a mean score of 37/50 and controls scored 47/50. Correlation with the other tests was good. A score of

Fragility is a key determinant of survival in heart failure patients

BackgroundHeart failure (HF) is a chronic condition with poor prognosis, and has a high prevalence among older adults. Due to older age, fragility is often present among HF patients. However, even young HF patients show a high degree of fragility. The effect of fragility on long-term prognosis in HF patients, irrespective of age, remains unexplored. The aim of this study was to assess the influence of fragility on long-term prognosis in outpatients with HF. Methods and resultsAt least one abnormal evaluation among four standardized geriatric scales was used to identify fragility. Predefined criteria for such scales were: Barthel Index, <90; OARS scale, <10 in women and <6 in men; Pfeiffer Test, >3 (±1, depending on educational grade); and ≥1 positive response for depression on the abbreviated Geriatric Depression Scale (GDS). We assessed 1314 consecutive HF outpatients (27.8% women, mean age years 66.7±12.4years with different etiologies. Fragility was detected in 581 (44.2%) patients. 626 deaths occurred during follow-up; the median follow-up was 3.6years [P25–P75: 1.8–6.7] for the total cohort, and 4.9years [P25–P75: 2.5–8.4] for living patients. Fragility and its components were significantly associated with decreased survival by univariate analysis. In a comprehensive multivariable Cox regression analysis, fragility remained independently associated with survival in the entire cohort, and in age and left ventricular ejection fraction subgroups. ConclusionFragility is a key determinant of survival in ambulatory patients with HF across all age strata.

Intervention to improve social and family support for caregivers of dependent patients: ICIAS study protocol

BackgroundDespite the existence of formal professional support services, informal support (mainly family members) continues to be the main source of eldercare, especially for those who are dependent or disabled. Professionals on the primary health care are the ideal choice to educate, provide psychological support, and help to mobilize social resources available to the informal caregiver.Controversy remains concerning the efficiency of multiple interventions, taking a holistic approach to both the patient and caregiver, and optimum utilization of the available community resources. .For this reason our goal is to assess whether an intervention designed to improve the social support for caregivers effectively decreases caregivers burden and improves their quality of life.Methods/designDesign: Controlled, multicentre, community intervention trial, with patients and their caregivers randomized to the intervention or control group according to their assigned Primary Health Care Team (PHCT).Study area: Primary Health Care network (9 PHCTs).Study participants: Primary informal caregivers of patients receiving home health care from participating PHCTs.Sample: Required sample size is 282 caregivers (141 from PHCTs randomized to the intervention group and 141 from PHCTs randomized to the control group.Intervention: a) PHCT professionals: standardized training to implement caregivers intervention. b) Caregivers: 1 individualized counselling session, 1 family session, and 4 educational group sessions conducted by participating PHCT professionals; in addition to usual home health care visits, periodic telephone follow-up contact and unlimited telephone support.Control: Caregivers and dependent patients: usual home health care, consisting of bimonthly scheduled visits, follow-up as needed, and additional attention upon request.Data analysisDependent variables: Caregiver burden (short-form Zarit test), caregivers’ social support (Medical Outcomes Study), and caregivers’ reported quality of life (SF-12)Independent variables: a) Caregiver: sociodemographic data, Goldberg Scale, Apgar family questionnaire, Holmes and Rahe Psychosocial Stress Scale, number of chronic diseases. b) Dependent patient: sociodemographic data, level of dependency (Barthel Index), cognitive impairment (Pfeiffer test).DiscussionIf the intervention intended to improve social and family support is effective in reducing the burden on primary informal caregivers of dependent patients, this model can be readily applied throughout usual PHCT clinical practice.Trial registrationClinical trials registrar: NCT02065427

Valoración geriátrica y factores pronósticos de mortalidad en pacientes muy ancianos con neumonía extrahospitalaria

IntroductionTo assess the relationship between the parameters obtained in the geriatric assessment and mortality in elderly people with community-acquired pneumonia in an acute care geriatric unit. MethodsFour hundred fifty-six patients (≥75years). Variables: age, sex, referral source, background, consciousness level, heart rate, breathing rate, blood pressure, laboratory data, pleural effusion, multilobar infiltrates, functional status (activities of daily living) prior to admission [Lawton index (LI), Barthel index (BIp)] prior to and at admission (BIa), cognitive status [Pfeiffer test (PT)], comorbidity [Charlson index (ChI)] and nutrition (total protein, albumin). ResultsA hundred ten patients died (24.2%) during hospitalization. These patients were older (86.6±6.4 vs 85.1±6.4, P<.04), had more comorbidity (ChI 2.35±1.61 vs 2.08±1.38; P<.083), worse functional impairment [(LI: 0.49±1.15 vs 1.45±2.32, P<.001) (BIp: 34.6±32.9 vs 54.0±34.1, P<.001) (BIa: 5.79±12.5 vs 20.5±22.9, P<.001)], a higher percentage of functional loss at admission (85.9±23.2 vs 66.4±28.6; P<.0001), worse cognitive impairment (PT: 7.20±3.73 vs 5.10±3.69, P<.001) and malnutrition (albumin 2.67±0.54 vs 2.99±0.49, P<.001). Mortality was higher with impaired consciousness [49.2% (P<.01)], tachypnea [33.3% (P<.01)], tachycardia [44.4% (P<.002), high urea levels [31.8 (P<.001)], anemia [44.7% (P<.02)], pleural effusion [42.9% (P<.002)], and multilobar infiltrates [43.2% (P<.001)]. In the multivariate analysis, variables associated with mortality were: age ≥90years [OR: 3.11 (95%CI: 1.31 to 7.36)], impaired consciousness [3.19 (1.66 to 6.15)], hematocrit <30% [2.87 (1.19 to 6.94)], pleural effusion [3.77 (1.69 to 8.39)] and multilobar infiltrates [2.76 (1.48 to 5.16)]. Female sex and a preserved functional status prior (LI≥5) and during admission (BIa≥40) were protective of mortality [0.40 (0.22 to 0.70), 0.09 (0.01 to 0.81) and 0.11 (0.02 to 0.51)]. ConclusionsGeriatric assessment parameters and routine clinical variables were associated with mortality.

Valoración geriátrica y factores asociados a mortalidad en ancianos con insuficiencia cardíaca ingresados en una unidad de geriatría de agudos

Introduction and objectivesHeart failure (HF) is very prevalent in older adults, and is associated with a high mortality. The prediction of the outcome of HF and the identification of patients in advanced stages is difficult. The present work aims at identifying variables of the geriatric assessment and other clinical variables associated with an increased risk of death at one year in older adults with HF. Material and methodsProspective study of 101patients (mean age, 85.9±6.3years, 81% women) admitted during 2006 to an Acute Geriatric Unit, with principal diagnosis of HF. We recorded: demographic data, predisposing heart disease, main trigger of exacerbation, comorbidity, number of prescriptions at discharge and specific treatment of HF, average length-of-stay, readmissions, and mortality at one year after discharge. Geriatric assessment included: disability in basic (Barthel index) and instrumental (Lawton index) activities of daily living, cognitive function (Pfeiffer test), comorbidity (Charlson index), and geriatric syndromes. ResultsIn a multivariable logistic regression model, previous disability (lower Barthel index) (OR [95%CI]=1.03 [1.01-1.06]; P=.040) and higher number of re-admissions (OR [95%CI]=3.53 [1.19-10.44]; P=.023) were associated with 1-year mortality. Female sex had a protective effect (OR [95%CI]=0.15 [0.04-0.59]; P=.007). ConclusionsDisability in the basic activities of daily living and re-admissions were associated with increased 1-year mortality in older adults, whereas female sex was protective. If confirmed in further studies, these data could reinforce the need for a systematic comprehensive geriatric assessment in older adults with HF.

Effect of Fragility on Quality of Life in Patients With Heart Failure

Heart failure (HF) is a chronic disease that frequently causes quality of life (QoL) impairment. We aimed to evaluate whether fragility affects QoL perception in outpatients with HF across age strata. The Minnesota Living with Heart Failure Questionnaire (MLWHFQ) was used to assess QoL, and fragility was defined according to basic standardized geriatric scales. Predefined criteria for such scales were scores of Barthel index <90, Older Americans' Resources and Services scale <10 in women and <6 in men, and Pfeiffer test >3 (±1 depending on educational grade) and ≥1 positive depression response on the abbreviated Geriatric Depression Scale. We evaluated 1,405 consecutive outpatients with HF (27.8% women, median age 69years [twenty-fifth to seventy-fifth percentiles: 59 to 76years]). Fragility, defined as at least 1 abnormal evaluation, was detected in 621 patients (44.2%). A positive depression response on the abbreviated Geriatric Depression Scale was the most prevalent (31.2%) component of fragility. We found a strong correlation between MLWHFQ score and the presence of fragility and all fragility components (all p <0.001). These associations prevailed in both younger (<75years) and older patients (≥75years; all pvalues <0.001 except for Pfeiffer test in younger patients [p= 0.007]). In multivariate regression analysis, QoL remained significantly associated with fragility after adjustment for age, gender, etiology of HF, left ventricular ejection fraction, New York Heart Association functional class, co-morbidities, and HF treatment, in both younger and older patients (p<0.001). In conclusion, MLWHFQ, a specific HF QoL questionnaire, is significantly influenced by fragility regardless of age.

Quality of life and frailty in an outpatient population with heart failure

Introduction: Heart failure (HF) is one of the most important chronic diseases that cause quality of life (QOL) impairment. The Minnesota Living with Heart Failure Questionnaire (MLWHFQ) is probably the most comprehensively used tool for studying QoL in HF patients. It is a disease-specific questionnaire, but it can be related to frailty, as we previously observed in elderly patients. Geriatric evaluations have been applied successfully to general population regardless the age. Objective and methods: To assess the relationship between the MLWHFQ score and the results obtained in a basic geriatric evaluation with standardised geriatric scales such as Barthel Index, OARS Scale, Pfeiffer Test, and abbreviate Geriatric Depression Scale (GDS), in a general population admitted to a HF Unit. The MLWHFQ and the basic geriatric evaluation were performed at the first visit to the Unit. Predefined criteria (Barthel 3 (±1 depending on educational grade) and 1 positive depression response in abbreviate GDS), were considered abnormal. Every patient having at least one abnormal evaluation was considered frail. Results: 1405 patients were evaluated (1015 men and 390 women). Median age was 69 years (P25-75 59-76). 44.2% of patients (621) fulfilled frailty criteria. Two hundred and eighty six patients (20.4%) had a Barthel Index <90; 183 patients (13%) had an anomalous OARS Scale; the score in Pfeiffer Test was abnormal in 71 patients (5.1%); and 439 patients (31.2%) had a positive depression response in abbreviate GDS. We found a strong correlation between the MLWHFQ score and the presence of frailty and also with all of its components (all p<0.001). This relationship was found both in patients younger and older than 75 years. All relationships showed a p value < 0.001 except for the Pfeiffer test in younger patients (< 75 years; p=0.007). In the multivariable regression analysis QoL (logarithmic form of MLWHFQ) remained significantly associated with frailty after adjustment for age, sex, etiology of HF, NYHA functional class, diabetes mellitus and LVEF, both in younger and older patients (p<0.001). Conclusions: Although designed as a specific QoL questionnaire for patients with HF, the MLWHQ score showed a high relationship with several parameters of frailty assessed with a basic geriatric evaluation, using standardised geriatric scales, in a general HF population regardless the age.

Nurse-based educational intervention in a heart failure unit improves outcomes in self-care, quality of life and depression of high-risk patients with chronic heart failure

Purpose: Self-care management is an important part of Heart Failure (HF) treatment. Multidisciplinary management programmes in Heart Failure Units (HFU) have been encouraged by the latest European Guidelines on Chronic HF. However, no clear interventions have been proved to be effective and tailored different programmes are used in every country. The purpose of this study was to evaluate the impact of a nurse-based educational intervention (NEI) on quality of life of high-risk patients with Chronic HF. Methods: We included patients admitted at our HFU after a HF episode that required hospitalization from February 2011 to October 2012. After discharge and treatment optimization, patients and their carers were offered a 4-weeks NEI. Patients with motility limitations or no possible self-access to our centre were excluded. Standardized tests to measure performance in activities of daily living, cognitive impairment and co-morbidity were performed. Self-care (The European Heart Failure Self-care Behavior (ESS)), quality of life (Minnesota living with heart failure questionnaire (MQ)) and degree of depression, (Yessavage's Geriatric Scale (YS)) were measured and compared pre and 3 months post-NEI. NEI consisted of four weekly consecutive sessions with brochures and audio-visual support that included topics as promoting self-care, recognition of alarm signs and symptoms, flexible diuretic regimen, diet/regular exercise aspects, pharmacological treatment, importance of psychological aspects etc. Results: From 408 patients visited in our HFU during this time, 107 patients (26%) were included in our NEI. 74% were men, mean age was nearly 70 years (range 43-89 years). Mean left ventricle ejection fraction was 31±8%, 91% were on NYHA class II-III and 97% were on ECA-inhibitors/ARB. Included patients were mostly independent in daily living (Barthel mean score (MS):98,5±5,8), without significant cognitive impairment (Pfeiffer's test MS: 0,94±0,52) and with moderate degree of co-morbidities (Charlson co-morbidity index MS: 5,27±2,27). After NEI, our patients showed a statistically significant improvement in quality of life (MQ MS reduction: 3,79, p<000,1), a better self-care (ESS MS reduction: 6,12, p<0,001) and lesser degree of depression (YS MS reduction: 3,36 p=0,001). Conclusions: NEI improved self-management, quality of life and depression symptoms in patients with Chronic HF. This is an important benefit for this special, high-mortality, easily-decompensated population that can suppose an economical cost-reduction for health-care systems. NEI should be promoted to benefit these patients.

Incidence and predictive factors of delirium in hospitalised neurological patients

Abstract Introduction Delirium is a condition with a high prevalence in hospitalised patients (10–30%), and it has important prognostic implications. There are few prospective studies of the incidence of delirium in Spain, and most of these were carried out in surgical wards or intensive care units. Our objective is to calculate the incidence of delirium in a neurological department and describe characteristics of affected patients. Methods Longitudinal descriptive study including all patients admitted to the neurology department in an 8-week period. The CAM score for diagnosing delirium was recorded on the first, second and fifth day of hospitalisation and we recorded demographic data, medical history, analytical data (including inflammatory markers), use of anticholinergic treatments, cognitive and functional state at admission, reason for admission, length of stay, and other events during hospitalisation. Results We studied 115 patients and found an incidence of delirium of 16.52%. There was a significant correlation between delirium and age, cognitive state at admission according to the Pfeiffer test, functional situation at admission according to the Canadian Neurological Scale, kidney failure, history of stroke, anticholinergic treatment, erythrocyte sedimentation rate, and C-reactive protein. These patients were also hospitalised for longer periods of time. Conclusions These results confirm a high incidence of delirium in our geographical area. Although additional studies with larger samples are needed, we would like to emphasise the importance of several risk factors which may enable early detection of patients who are at risk for developing delirium during hospitalisation. This would permit preventive action and early treatment for these patients.

AB0613 Study on the relationship between the preoperative stay and morbimortality in patients with hip fracture

BackgroundThe preoperative stay (PS) in patients with hip fracture has been classically associated with the resultant morbimortality of the process. As a consequence, current clinical guidelines recommend that surgery be...

SAT0357 Prognostic factors of morbimortality in patients with hip fracture

BackgroundHip fracture determines a high morbimortality in old population.ObjectivesTo analyze the determinants of morbimortality in patients with hip fracture.MethodsFrom March 1, 2009 to December 31, 2010, all patients admitted with...

SAT0371 The previous functional status of patients with hip fracture determines the type of fracture

BackgroundClassically, medical literature has described the association between the type of hip fracture with functional outcome to short and mid-term. To our knowledge, no previous study has been carried out...

Incidencia y factores predictivos del delírium en pacientes neurológicos hospitalizados

IntroductionDelirium is a condition with a high prevalence in hospitalised patients (10%-30%), and it has important prognostic implications. There are few prospective studies of the incidence of delirium in Spain, and most of these were carried out in surgical wards or intensive care units. Our objective is to calculate the incidence of delirium in a neurological department and describe characteristics of affected patients. MethodsLongitudinal descriptive study including all patients admitted to the neurology department in an 8-week period. The CAM score for diagnosing delirium was recorded on the first, second and fifth day of hospitalisation and we recorded demographic data, medical history, analytical data (including inflammatory markers), use of anticholinergic treatments, cognitive and functional state at admission, reason for admission, length of stay, and other events during hospitalisation. ResultsWe studied 115 patients and found an incidence of delirium of 16.52%. There was a significant correlation between delirium and age, cognitive state at admission according to the Pfeiffer test, functional situation at admission according to the Canadian Neurological Scale, kidney failure, history of stroke, anticholinergic treatment, erythrocyte sedimentation rate, and C-reactive protein. These patients were also hospitalised for longer periods of time. ConclusionsThese results confirm a high incidence of delirium in our geographical area. Although additional studies with larger samples are needed, we would like to emphasise the importance of several risk factors which may enable early detection of patients who are at risk for developing delirium during hospitalisation. This would permit preventive action and early treatment for these patients.

Utilización de benzodiacepinas según el motivo de ingreso

Background and objectiveChronic consumption of benzodiazepines is common in elderly patients. The aim of the study was to analyse the possible differences between patients taking benzodiazepines and those without them. We also determined, among patients on benzodiazepines, if any differences were related to medical or surgical admissions. Patients and methodsWe performed a prospective and multicentre study of 393 patients admitted consecutively for medical reasons to 6 geriatrics acute units; these patients were compared to 1,225 patients hospitalized for a hip fracture. We collected sociodemographic data, functional capacity by the Barthel's index (BI), comorbidity by the Charlson's index and cognitive impairment by the Pfeiffer test. ResultsWe evaluated 1,618 patients, with a median age of 82.9 (6.5) years. Among patients admitted for medical causes, 581 (35.9%) were taking benzodiazepines chronically as did 449 (36.6%) patients in the hip fracture group (p=0.27). In the multivariate analysis, factors associated with the use of benzodiazepines included older age, institutionalization and a higher number of drug consumption. Differences according to the admission reason showed that patients admitted for medical causes lived more frequently in the community and had less falls, worse BI as well as a higher number of comorbidities and polypharmacy. ConclusionsMore than one third of elderly patients hospitalized for medical or traumatology causes were taking benzodiazepines chronically. Different patients’ profiles can be observed according to whether they are or not taking benzodiazepines and to the admission's cause in the subgroup of patients on benzodiazepines.

Nutrition education intervention for dependent patients: protocol of a randomized controlled trial

BackgroundMalnutrition in dependent patients has a high prevalence and can influence the prognosis associated with diverse pathologic processes, decrease quality of life, and increase morbidity-mortality and hospital admissions.The aim of the study is to assess the effect of an educational intervention for caregivers on the nutritional status of dependent patients at risk of malnutrition.Methods/DesignIntervention study with control group, randomly allocated, of 200 patients of the Home Care Program carried out in 8 Primary Care Centers (Spain). These patients are dependent and at risk of malnutrition, older than 65, and have caregivers. The socioeconomic and educational characteristics of the patient and the caregiver are recorded. On a schedule of 0–6–12 months, patients are evaluated as follows: Mini Nutritional Assessment (MNA), food intake, dentures, degree of dependency (Barthel test), cognitive state (Pfeiffer test), mood status (Yesavage test), and anthropometric and serum parameters of nutritional status: albumin, prealbumin, transferrin, haemoglobin, lymphocyte count, iron, and ferritin.Prior to the intervention, the educational procedure and the design of educational material are standardized among nurses. The nurses conduct an initial session for caregivers and then monitor the education impact at home every month (4 visits) up to 6 months. The North American Nursing Diagnosis Association (NANDA) methodology will be used. The investigators will study the effect of the intervention with caregivers on the patient’s nutritional status using the MNA test, diet, anthropometry, and biochemical parameters.Bivariate normal test statistics and multivariate models will be created to adjust the effect of the intervention.The SPSS/PC program will be used for statistical analysis.DiscussionThe nutritional status of dependent patients has been little studied. This study allows us to know nutritional risk from different points of view: diet, anthropometry and biochemistry in dependent patients at nutritional risk and to assess the effect of a nutritional education intervention. The design with random allocation, inclusion of all patients, validated methods, caregivers’ education and standardization between nurses allows us to obtain valuable information about nutritional status and prevention.Trial Registration numberClinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01360775