Geriatría HGG Journal Club

To assess the prevalence of potentially avoidable transfers (PAT) and identify factors associated with these transfers to emergency departments (EDs) among nursing home (NH) residents.

A timely, accurate diagnosis of ad with access to appropriate multidisciplinary support and treatment improves quality of life and reduces carer strain. Biomarkers have the potential to help support this process but should be used as part of a clinical-biological diagnosis by specialists with experience in interpreting the results. Co-pathology is frequent in older adults, and the recent advances in ad biomarker-assisted diagnosis should not be to the detriment of the diagnosis and treatment of other causes of cognitive impairment. The development of new immunological therapies for ad is exciting for patients and professionals alike but the results of current trials should be considered cautiously and their findings’ applicability to more typical patient groups need to be weighed carefully. We believe that a patient-centred- approach using the tenets of CGA remains a robust framework into which new diagnostic tools and treatments can be adopted.

La ecografía a pie de cama es ya una herramienta de gran utilidad para el médico internista, que complementa su exploración física de forma rápida y relativamente sencilla. Así, contribuye amejorar el proceso diagnóstico, ayuda en la toma de decisionesclínicas en tiempo real y facilita la realización de procedimientosinvasivos. Además, al tratarse de una exploración más focalizada que las ecografías regladas, requiere de un entrenamiento menos prolongado.Actualmente, muchos servicios de medicina interna ya cuentan con equipos destinados a la realización de ecografías a pie de cama, y es de esperar que esta técnica se integre cada vez más en la práctica clínica habitual, ante la mayor disponibilidad de dispositivos portátiles y el creciente interés que suscita entre los internistas 

El funcionamiento ejecutivo global fue mejor en los pacientes en DP que en aquellos en HD. Los resultados muestran el efecto positivo de la DP sobre las funciones ejecutivas, lo que debe tenerse en cuenta a la hora de la elección de la TRS. Las asociaciones observadas entre los factores bioquímicos y el rendimiento muestran la importancia de mantener un adecuado estado nutricional en estos pacientes.

The appropriate dose of antidepressant medicine

for older adults with depression is similar to that

for younger adults, and older persons can receive

what might be perceived as a high dose without

negative side effects (Table 1).20 However, older

patients are more prone to adverse effects associated

with antidepressants, especially falls (Table

2).21 Given high reported rates of medication

nonadherence in depression, establishment and

maintenance of a therapeutic alliance to support

adherence surveillance can improve outcomes in

patients with depression

Same day emergency care (SDEC) services are being advocated in the UK for frail, older patients in whom hospitalisation may be associated with harm but there are few data on the ‘ambulatory pathway’. We therefore determined the patient pathways pre- and post-first assessment in a SDEC unit focussed on older people.

SDEC assessment in older, frail patients was associated with a 2-fold increase in frequency of healthcare interactions with complex care pathways involving multiple services. Our findings have implications for the development of admission-avoidance models including cost-effectiveness and optimal delivery of the multi-dimensional aspects of acute geriatric care in the ambulatory setting.

In older or frail patients with T2D and HF, SGLT2Is are consistently linked with a decrease in total mortality and the overall burden of cardiovascular (CV) events, including HHF events and cardiac death, but not protective for macrovascular death or renal events. Adverse events were more difficult to quantify but the risk of diabetic ketoacidosis or acute kidney injury was not significantly increase.

The number of papers on frailty has risen exponentially over the last decade, with an ever-increasing diversity of researchers investigating the role of frailty..

The recognition of frailty as a research priority across a range of conditions is likely to result in a renewed focus on measuring frailty explicitly and prospectively in clinical studies [14]. As with all research, quality of study design and data collection is critical, and the principles and structured approach to formulating a frailty index outlined in this article are likely to prove invaluable to researchers, particularly those evaluating frailty for the first time.

What you need to know

• Cognitive problems are common after acute

SARS-CoV-2 infection and can be disabling and

frightening

• Symptoms tend to improve, but this may take up to

a year. Those with chronically persistent symptoms

lasting more than 12 months have a lower chance of

improving

• Symptoms usually fluctuate

• Assessment should be directed to documenting the

nature and trajectory of the impairment and excluding

alternative diagnoses

• Self-management techniques may help patients

manage their condition

AntecedentesLa prevalencia de malnutrición es elevada entre la población mayor. El

Heart failure with preserved ejection fraction (HFpEF) is increasingly recognised and diagnosed in clinical practice, a trend driven by an ageing population and a rise in contributing comorbidities, such as obesity and diabetes. Representing at least
half of all heart failure cases, HFpEF is recognised as a complex clinical syndrome.
Its diagnosis and management are challenging due to its diverse pathophysiology, varied epidemiological patterns, and evolving diagnostic and treatment approaches. This Seminar synthesises the latest insights on HFpEF, integrating findings from recent clinical trials, epidemiological research, and the latest guideline recommendations.

El fracaso en desarrollar e invertir en atención primaria y comunitaria se sitúa en uno de los fracasos más grandes y duraderos de la política social y sanitaria británica desde hace más de 30 años

A total of 44 publications were finally included, including 12 guidelines, 5 best practices, 4 expert consensus, 5 evidence summaries and 18 systematic reviews. Through the induction and integration of the evidence, the evidence was finally summarised from eight aspects: frailty screening, frailty assessment, exercise intervention, nutrition intervention, multi-domain intervention, drug administration, social support and health education, and 43 best evidences were formed.

This study summarised the best evidence for the prevention and management of frailty from eight aspects, which can provide guidance for clinical or community medical staff to develop and apply frailty intervention and practice programmes for older people and improved the clinical outcome and quality of life of older people.

Nursing home residents with heart failure showed higher one-year mortality which couldbe due to worse functional status, higher comorbidity, and cognitive deterioration.

Over the past more than three decades, the Beers criteria have resonated deeply with clinicians and researchers. They have evolved in terms of the older adults that they apply to, the depth of leadership of the initiative, and the methodology being used. Yet, they have remained consistent in their intent, which is to improve the way we prescribe for older adults. In so doing, the Beers criteria have earned their place as a “household word” in American geriatric medicine.

Decision-making on diagnostic testing for dementia is a multifactorial and preference-guided process for all involved stakeholders, but decisions are often not explicitly jointly made. Development of patient decision aids could facilitate better involvement and more informed choices by patients.

There is limited evidence regarding the needs of older people, including those living with frailty, to inform research priority setting.Obje