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Nikooie and colleagues systematically reviewed the evidence on treatment of delirium, particularly focusing on antipsychotics. The editorial discusses the findings, why we need to abandon old habits of using antipsychotics to treat delirium, and priorities for future research. 
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Background. anaemia following hip fracture is common and associated with worse outcomes. Intravenous iron is a potential non-transfusion treatment for
Servicio de Geriatría's insight:
CONCLUSIONS: although intravenous iron does stimulate erythropoiesis following hip fracture in older people, the effect is too small and too late to affect transfusion rates. Trial Registry Numbers: ISRCTN:76424792; EuDRACT: 2011-003233-34.
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Abstract. Geriatric medicine is a speciality that has historically relied on team working to best serve patients. The nature of frailty in older people means t
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Articulo disponible en el Grupo Journal Club del Mendeley del Servicio de Geriatría. Este artículo se posiciona como referencia actualizada para la formación del especialista en Geriatría.
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Actualización SEPTIEMBRE 2019 sobre tratamiento antimicrobiano en la NAC. Articulo disponible en Grupo Journal Club Geriatría HGG de Mendeley!
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The aim of the current study was to investigate whether a new functional classification,
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This Medical News article discusses a controversy around limbic-predominant age-related TDP-43 encephalopathy, or LATE, a recently recognized dementia that mimics Alzheimer disease.
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This randomized clinical trial compares a multicomponent home-based physical therapy intervention with an active control on ability to walk in daily life among adults aged 60 years and older who had experienced a nonpathologic, minimal trauma hip fracture.
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Treatment of C difficile infection currently relies on two molecules: vancomycin and fidaxomicin in mild and severe forms of the infection. Metronidazole is no longer recommended, being inferior to vancomycin and fidaxomicin. Fecal microbiota transplantation is the treatment of choice in recurrent disease. We still need clinical trials to have a better idea of the target population for bezlotoxumab.
Servicio de Geriatría's insight:
Revisión exhaustiva y estado del arte actual sobre el Clostridium Difficile CD. Una lectura imprescindible de un problema relevante en nuestro día a día.
BMJ 2019;366:l4609 | doi: 10.1136/bmj.l4609
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This editorial comments on the article by Sobieraj et al.
Servicio de Geriatría's insight:
Los SSRI todavía como primera linea...
Prescribing medications in older adults is a “risk vs risk” calculation: What is the risk of the treatment compared with the risk of not treating the underlying illness?
The findings of Sobieraj et al support the long-standing recommendation to use SSRIs as first-line treatment in older adults given better tolerability.
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This randomized clinical trial compares the effects of continuous intravenous vs subcutaneous sliding scale insulin for treatment of hyperglycemia during acute ischemic stroke on functional outcome in adult patients in the United States.
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This Medical Letter review provides a drug table comparing the 6 classes of drugs (bisphosphonates, anti-RANK ligand antibody, parathyroid hormone receptor agonists, selective estrogen receptor modulator, conjugated estrogens/selective estrogen receptor modulator, and calcitonin) used fo
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La falta de médicos es un asunto objeto de debate desde hace varias décadas que se ha intensificado en los últimos 10años.
En la búsqueda de soluciones posibles se barajan 5 actuaciones: En primer lugar, deben establecerse medidas para flexibilizar el sistema sanitario, con menor burocracia y mayor autonomía, que permita a los médicos ser más resolutivos, eficientes y adaptables a nuevas exigencias. En segundo lugar, deben mejorarse las condiciones laborales y retributivas incorporando nuevas medidas de incentivación para resolver las necesidades de atención sanitaria de la población. En tercer lugar, debe aumentarse ligeramente, como mínimo por un periodo de 5 años, el número de plazas de grado y de formación especializada MIR, así como promover la troncalidad como medida que permita flexibilizar el sistema de especialización. En cuarto lugar, debe favorecerse un sistema de jubilaciones más flexible, capaz de adaptarse tanto a las necesidades organizativas del sistema sanitario como al perfil y la situación de cada profesional concreto. En quinto lugar, el proceso de homologación de los títulos de especialista extracomunitarios debe ser coherente con el proceso de homologación de la titulación de grado, y debe contar con un calendario bien determinado y unas reglas de acceso transparentes, con la inclusión de pruebas de capacidad para el ejercicio.
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"Siempre creí que intentábamos tomar un puente demasiado lejos" teniente general Frederick Browning, comandante del Primer Cuerpo Aerotransportado aliado
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Osteoarthritis (OA) is designated the 11th highest contributor of 291 diseases of global disability and the most common cause of chronic disability in elderly people. OA has a devastating impact on quality of life and represents an enormous socio-economic burden. Currently, OA is incurable, and no approved medications, biological therapy, or procedure prevents the progressive destruction of the osteoarthritic knee joint. All current treatments provide symptomatic relief rather than preventative or regenerative results. There is an urgent and compelling need to find, validate, and test new biological therapeutics. Cell-based therapies involving the delivery of mesenchymal stromal cells (MSCs) to the osteoarthritic knee joint have emerged as a potential solution to overcome this clinical shortcoming.
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Acceso gratuito a una revisión que aborda la evidencia clínica, los desafíos y los avances recientes relacionados con el tratamiento de MSC en la OA de rodilla.
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Background: Delirium is an acute disorder marked by impairments in attention and cognition, caused by an underlying medical problem. Antipsychotics are used to prevent delirium, but their benefits and harms are unclear. Purpose: To conduct a systematic review evaluating the benefits and harms o
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No como prevención del delirium!
Current evidence does not support routine use of haloperidol or second-generation antipsychotics for prevention of delirium. There is limited evidence that second-generation antipsychotics may lower the incidence of delirium in postoperative patients, but more research is needed. Future trials should use standardized outcome measures.
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From
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The analysis found that 41% of emergency admissions from care homes were for avoidable conditions that are potentially manageable, treatable, or preventable outside of a hospital setting, or that could have been caused by poor care or neglect.
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Y a pesar de todo ello el colectivo de ancianos institucionalizados, en nuestro entorno, tiene mejor adecuación en las visitas a los servicios de urgencias hospitalarios que la población adulta. Próximamente presentaremos resultados de nuestro estudio de adecuación de las urgencias hospitalarias procedentes de residencias de ancianos y de nuevas propuestas metodologícas para su estudio. Interesados contactar: geriatria@fhag.es
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“Good time managers take a few minutes at the start of their day to prioritise tasks and consider how much time is needed to perform them. It can help to make a list, setting priorities according to urgency. You might think it’s quicker to do everything yourself but appropriate delegation can help you to be more efficient
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AbstractPurpose of the Study. Few studies have recommended the essential domains of healthy aging and their relevant measurement to assess healthy aging compre
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This JAMA Insights Clinical Update reviews what is known and not known about the efficacy and safety of cannabis and cannabinoids for managing medical conditions, distinguishing between FDA-approved indications, nonapproved indications supported by high-quality emerging evidence, and curren
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Rahman H, Khan SU, Nasir F, et al. Optimal duration of aspirin plus clopidogrel after ischemic stroke or transient ischemic attack. Stroke. 2019;50:947-53. 30852971
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This analysis of older patients (aged ≥80 y) in the ARISTOPHANES (Anticoagulants for Reduction in Stroke: Observational Pooled analysis on Health Outcomes and Experience of Patients [NCT03087487]) study aimed to provide complementary information for this underrepresented population by evaluating and comparing the rates of stroke/SE and MB among NVAF patients newly prescribed apixaban, dabigatran, rivaroxaban, or warfarin.
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CONCLUSION: Among very old NVAF patients, NOACs were associated with lower rates of stroke/SE and varying rates of MB compared with warfarin
J Am Geriatr Soc 67:1662–1671, 2019.
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Age and Ageing, Volume 48, Issue 4, July 2019, Pages 478–481,
Abstract. ‘Risk feeding’ policies, for when people continue to eat and drink despite a perceived risk of choking or aspiration have become common in recent years..
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“ Heatstroke Exertional heatstroke, brought on by strenuous activity, is usually seen in young, active people; classic heatstroke, associated with heat waves, is more common in the elderly and ma”
Via Tania Sanchez
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This JAMA Insights Clinical Update reviews approaches to fracture prevention in older adults, including estimating fracture risk and life expectancy, selecting and managing appropriate medications, and understanding nonpharmacologic strategies.
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Una de las consideraciones a la hora de decidir el tratamiento debe de ser la esperanza de vida en este sentido los autores recomiendan en base a modelos económicos demostrando el coste efectividad para reducir las fracturas de cadera de tratar a mujeres con esperanzas de vida tan bajas como de dos años, en cambio si la esperanza de vida es inferior a 1 año el tratamiento farmacológico de la osteoporosis no se debería ofrecer.
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La identificación de pacientes en situación de enfermedad crónica avanzada y complejidad, y la fragmentación de cuidados hacia el final de la vida aconsejan trazar un plan Via Tania Sanchez
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