Open Access
Effect of exercise intervention on functional decline in very elderly patients during acute hospitalization: a randomized clinical trial
(American Medical Association, 2018) Martínez Velilla, Nicolás; Casas Herrero, Álvaro; Zambom Ferraresi, Fabrício; López Sáez de Asteasu, Mikel; Lucía, Alejandro; Galbete Jiménez, Arkaitz; García Baztán, Agurne; Alonso Renedo, Javier; González Glaría, Belén; Gonzalo Lázaro, María; Apezteguía Iráizoz, Itziar; Gutiérrez Valencia, Marta; Rodríguez Mañas, Leocadio; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Importance: Functional decline is prevalent among acutely hospitalized older patients. Exercise and early rehabilitation protocols applied during acute hospitalization can prevent functional and cognitive decline in older patients. Objective: To assess the effects of an innovative multicomponent exercise intervention on the functional status of this patient population. Design, Setting, and Participants: A single-center, single-blind randomized clinical trial was conducted from February 1, 2015, to August 30, 2017, in an acute care unit in a tertiary public hospital in Navarra, Spain. A total of 370 very elderly patients undergoing acute-care hospitalization were randomly assigned to an exercise or control (usual-care) intervention. Intention-to-treat analysis was conducted. Interventions: The control group received usual-care hospital care, which included physical rehabilitation when needed. The in-hospital intervention included individualized moderate-intensity resistance, balance, and walking exercises (2 daily sessions). Main Outcomes and Measures: The primary end point was change in functional capacity from baseline to hospital discharge, assessed with the Barthel Index of independence and the Short Physical Performance Battery (SPPB). Secondary end points were changes in cognitive and mood status, quality of life, handgrip strength, incident delirium, length of stay, falls, transfer after discharge, and readmission rate and mortality at 3 months after discharge. Results: Of the 370 patients included in the analyses, 209 were women (56.5%); mean (SD) age was 87.3 (4.9) years. The median length of hospital stay was 8 days in both groups (interquartile range, 4 and 4 days, respectively). Median duration of the intervention was 5 days (interquartile range, 0); there was a mean (SD) of 5 (1) morning and 4 (1) evening sessions per patient. No adverse effects were observed with the intervention. The exercise intervention program provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 2.2 points (95% CI, 1.7-2.6 points) on the SPPB scale and 6.9 points (95% CI, 4.4-9.5 points) on the Barthel Index over the usual-care group. Hospitalization led to an impairment in functional capacity (mean change from baseline to discharge in the Barthel Index of -5.0 points (95% CI, -6.8 to -3.2 points) in the usual-care group, whereas the exercise intervention reversed this trend (1.9 points; 95% CI, 0.2-3.7 points). The intervention also improved the SPPB score (2.4 points; 95% CI, 2.1-2.7 points) vs 0.2 points; 95% CI, -0.1 to 0.5 points in controls). Significant intervention benefits were also found at the cognitive level of 1.8 points (95% CI, 1.3-2.3 points) over the usual-care group. Conclusions and Relevance: The exercise intervention proved to be safe and effective to reverse the functional decline associated with acute hospitalization in very elderly patients. Trial Registration: ClinicalTrials.gov identifier: NCT02300896.
Open Access
Impact of a multidisciplinary approach to polypharmacy management in community-dwelling older adults: insights from a specialized outpatient clinic
(Wiley, 2025-02-18) Roncal Belzunce, Victoria; Gutiérrez Valencia, Marta; Cedeño Veloz, Bernardo Abel; San Miguel Elcano, Ramón; Marín Epelde, Itxaso; Galbete Jiménez, Arkaitz; Preciado Goldaracena, Javier; Ezpeleta, María Irache; Garaioa-Aramburu, Karmele; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak
Objectives: The increase in polypharmacy among older adults increases the risk of drug-related problems, making multidisci-plinary interventions essential. This study evaluated the impact of a multidisciplinary polypharmacy consultation on medicationmanagement and outcomes in older outpatients.Methods: This prospective observational study at a Spanish teaching hospital involved geriatricians, clinical pharmacists, andnurses. Older adults (≥ 75 years) with polypharmacy underwent medication review at baseline and at 3 and 6 months. Data onmedication use, adherence to Screening Tool of Older Person's Prescriptions (STOOP) criteria, and anticholinergic burden wereanalyzed.Results: The study included 104 older adults (mean age 86.2 years; 66% female). An average of 3.6 recommendations per par-ticipant was made (63.8% acceptance rate). Common drug-related problems were adverse effects (20%), non-adherence (18.1%), and incorrect dose/regimen (14.4%). Interventions led to an average reduction of 1.7 medications per patient, with 1.3 dosage orregimen changes and 1.1 new prescriptions. The mean number of medications decreased from 9.6 at baseline to 8.9 at 3 months(p < 0.001) and remained below baseline at 6 months. STOPP criteria violations per patient dropped from 1.2 to 1.0 (p = 0.036). Of the 126 medications flagged by STOPP criteria, 68.3% were addressed, 24.6% discontinued, mainly psychotropics, and 89.3%of these discontinuations were maintained. The anticholinergic burden decreased from 1.3 to 1.1 at 3 months (p = 0.036) andremained below baseline at 6 months.Conclusions: A multidisciplinary clinic effectively managed polypharmacy in older adults by reducing medication load andimproving appropriateness per STOPP criteria, highlighting the importance of proactive medication management.Trial Registration: ClinicalTrials.gov: NCT05408598 (March 1, 2022).

Gutiérrez Valencia, Marta

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