Open Access
Pharmacological treatment optimization in older patients
(2019) Gutiérrez Valencia, Marta; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak
El uso de medicamentos en ancianos es un asunto complejo influido por muchos factores tanto relacionados como ajenos al ámbito de la salud. La terapia farmacológica es una de las herramientas más importantes de las que disponemos para conservar o mejorar la salud. Sin embargo, la polifarmacia y el uso inadecuado de medicamentos pueden implicar efectos adversos y situaciones de vulnerabilidad que condicionen resultados negativos en salud. En el siguiente trabajo se pretende estudiar este fenómeno en distintos ámbitos ―a nivel poblacional o comunitario, en pacientes institucionalizados y hospitalizados―, analizando su relación con distintos factores que pueden ser de interés en el paciente mayor, y especialmente con la fragilidad. Finalmente se centra en los ancianos hospitalizados, uno de los sectores más vulnerables a la iatrogenia farmacológica, indagando en el impacto de la hospitalización sobre la terapia farmacológica, revisando las distintas estrategias que se han propuesto para la optimización farmacológica en estos pacientes y explorando la utilidad de una intervención específicamente adaptada a estos pacientes en nuestro medio.
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
Polypharmacy in older people: time to take action
(Springer International Publishing, 2019) Gutiérrez Valencia, Marta; Martínez Velilla, Nicolás; Vilches Moraga, A.; Ciencias de la Salud; Osasun Zientziak
The management of polypharmacy in older patients involves a paradigm shift that abandons the disease as the axis of health care towards an integral approach linked to multidisciplinary work, dedication and specifc preparation for medication prescribing in these patients, and a focus on medication reconciliation in transitions of care. Knowing how to face the challenge of polypharmacy and its consequences for patients, healthcare systems and society is everyone’s responsibility and its success will depend on the involvement of all professionals.
Open Access
Solo 'potencialmente' inadecuados
(Elsevier, 2019) Gutiérrez Valencia, Marta; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak
Los psicofármacos se asocian con frecuencia a efectos adversos en pacientes mayores, y es lógica su amplia inclusión como PPI en criterios como los STOPP-START, especialmente en algunas circunstancias; sin embargo, la interpretación y aplicación de este tipo de criterios se debe individualizar, para discernir si su uso es adecuado en cada caso concreto, sin que esto reste validez a estas herramientas.

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