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Bielza Galindo R, Llorente Gutiérrez J, Pérez González JL, Mora Casado A, Blanco Díaz D, Escalera Alonso J, Morales Fernández A, Molano Ortiz C, García López BE, Del Amo Del Arco N, Barro Ordovas JP, Arias Muñana E, Neira Álvarez M, Sanz Rosa D, Gómez Cerezo JF. [Intravenous iron, functional recovery and delirium in patients with hip fracture. FEDEREF study. Single-centre randomised, placebo-controlled, and double-blind clinical trial. 2014-001923-53: EudraCT number]. Rev Esp Geriatr Gerontol 2018; 53:38-44. [PMID: 28292532 DOI: 10.1016/j.regg.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/17/2016] [Accepted: 01/16/2017] [Indexed: 06/06/2023]
Abstract
INTRODUCTION There are no previous studies evaluating the effect of intravenous iron therapy on functional and cognitive status of patients with hip fracture (HF). MATERIAL AND METHODS A single-centre randomised, placebo-controlled, double-blind and parallel treatment, clinical trial has been designed to assess the efficacy of intravenous iron therapy during the peri-operative period in elderly patients suffering from a HF. Blinding will be ensured by the packaging of the drug infusion system. On days 1, 3, and 5 from admission, the intervention group will receive 200mg Venofer® (iron sucrose) diluted in 100ml saline, and the control group 100ml saline, also on days 1, 3 and 5. Patients will received conventional treatment in ortho-geriatric unit of the Hospital Infanta Sofia. Functional variables (activities of daily living and walking), cognitive (cognitive status and delirium), surgical, demographic and clinical characteristics will be collected during admission in order to assess the impact of treatment. A safety analysis of the treatment will also performed. Patients will be followed-up at 3, 6, and 12 months. RESULTS The study will attempt to provide evidence on the impact of the intravenous iron administration on functional recovery. It will be determined whether iron therapy negatively affects the incidence of post-operative delirium. Finally, report will be presented on the safety data of intravenous iron in elderly HF patients, as well as the impact on allogenic blood transfusion savings. CONCLUSIONS The inclusion of elderly HF patients admitted to an ortho-geriatric unit, in a clinical trial, will help to improve the knowledge of the treatment impact on a usual scenario, and provide useful data for use in other units.
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Affiliation(s)
- Rafael Bielza Galindo
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España.
| | - Jesús Llorente Gutiérrez
- Sección de Farmacología. Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - José Luis Pérez González
- Servicio de Traumatología, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Asunción Mora Casado
- Sección de Hematología, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - David Blanco Díaz
- Servicio de Traumatología, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Javier Escalera Alonso
- Servicio de Traumatología, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Adoración Morales Fernández
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Cristina Molano Ortiz
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | | | - Nazaret Del Amo Del Arco
- Análisis Clínicos, Laboratorio de Urgencias, Hospital Infanta Sofía- BR Salud, San Sebastián de los Reyes, España
| | - Juan Pablo Barro Ordovas
- Sección de Farmacología. Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Estefanía Arias Muñana
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - Marta Neira Álvarez
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
| | - David Sanz Rosa
- Escuela de Doctorado e Investigación, Universidad Europea de Madrid, España
| | - Jorge Fco Gómez Cerezo
- Área de Geriatría, Servicio de Medicina Interna y Geriatría, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, San Sebastián de los Reyes, España
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Rojano I Luque X, Sánchez Ferrin P, Salvà A. [Hospital complications in the elderly]. Med Clin (Barc) 2016; 146:550-4. [PMID: 26961393 DOI: 10.1016/j.medcli.2015.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 01/02/2023]
Affiliation(s)
- Xavier Rojano I Luque
- Fundació Salut i Envelliment Universitat Autònoma de Barcelona, Institut d'Investigació Biomèdica Sant Pau, Barcelona, España.
| | - Pau Sánchez Ferrin
- Pla director sociosanitari, Departament de Salut, Generalitat de Catalunya, Barcelona, España
| | - Antoni Salvà
- Fundació Salut i Envelliment Universitat Autònoma de Barcelona, Institut d'Investigació Biomèdica Sant Pau, Barcelona, España
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Velilla NM, Bouzon CA, Contin KC, Beroiz BI, Herrero AC, Renedo JA. Different functional outcomes in patients with delirium and subsyndromal delirium one month after hospital discharge. Dement Geriatr Cogn Disord 2013. [PMID: 23208559 DOI: 10.1159/000345609] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Subsyndromal delirium has an increasing relevance in the medical literature. There are only three studies in hospitalized elderly patients. Our goal is to demonstrate the importance of this syndrome in a population with more complexity and cognitive impairment than in previous studies. METHODS Prospective multicentre study in three tertiary hospitals. The health outcomes recorded in the follow-up at 1 month were the persistence of delirium, hospital readmission, discharge destination, death, Barthel index and the Delirium Rating Scale Revised 98. To assess the impact of delirium in the Barthel index at 30 days, we adjusted univariate and multivariate linear regression models. RESULTS 85 patients were enrolled; 75.3% of the patients had at least 1 positive item in the Confusion Assessment Method; 45 patients (53%) were diagnosed with delirium and 19 (22.3%) with subsyndromal delirium (SSD). The 30-day risk of death was associated with lower levels of albumin (p = 0.021) and the Cumulative Illness Rating Scale in Geriatrics (CIRS-G; p = 0.003). Adjusting for CIRS-G and the initial Barthel index, the diagnosis of delirium appears to be related to a lower Barthel index at 30 days (p = 0.019), showing a significant linear gradient (p < 0.005). CONCLUSION SSD could help get more accurate diagnoses as well as improve patient management.
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Affiliation(s)
- N Martínez Velilla
- Geriatric Department, Complejo Hospitalario de Navarra, Pamplona, Spain.
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[Delirium prevention and treatment in elderly hip fracture]. Med Clin (Barc) 2013; 142:365-9. [PMID: 23790577 DOI: 10.1016/j.medcli.2013.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 04/14/2013] [Accepted: 04/18/2013] [Indexed: 12/28/2022]
Abstract
The fracture of the proximal femur or hip fracture in the elderly usually happens after a fall and carries a high morbidity and mortality. One of the most common complications during hospitalization for hip fracture is the onset of delirium or acute confusional state that in elderly patients has a negative impact on the hospital stay, and prognosis, worsening functional ability, cognitive status and mortality. Also the development of delirium during hospitalization increases health care costs. Strategies to prevent and treat delirium during hospitalization for hip fracture have been less studied. In this context, this paper aims to conduct a review of the literature on strategies that exist in the prevention and treatment of delirium in elderly patients with hip fracture.
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Martinez Velilla N, Franco JG. [Subsyndromal delirium in elderly patients: a systematic review]. Rev Esp Geriatr Gerontol 2013; 48:122-129. [PMID: 23473583 DOI: 10.1016/j.regg.2012.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 11/15/2012] [Indexed: 06/01/2023]
Abstract
In this systemic review, the articles published between 1990 and November 2012 on subsyndromal delirium (SSD), and specifically those with reference to geriatric patients, were analysed. In SSD, symptoms from the three nuclear domains of delirium (cognitive, circadian and higher order thinking) are simultaneously present, with mild to moderate severity. Although the search for these clinical characteristics is a useful guide, there are no universally accepted diagnostic criteria for SSD. Regardless of the criteria used for diagnosis, SSD is persistently associated with poor functional and cognitive outcome, longer hospital stay, institutionalisation, and increased mortality. Studies are needed on the physiopathology, treatment and prevention in the field of SSD, which is a particularly important clinical condition in geriatric patients.
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Martínez Velilla N, Alonso Bouzon C, Cambra Contin K, Ibáñez Beroiz B, Alonso Renedo J, Casas Herrero A. [Delirium and subsyndromal delirium: prevalence of a disease spectrum]. Rev Esp Geriatr Gerontol 2012; 47:158-161. [PMID: 22578386 DOI: 10.1016/j.regg.2011.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 11/26/2011] [Accepted: 11/29/2011] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Subsyndromal delirium (SSD) is a developing concept of disease with a spectrum beyond the diagnostic dichotomy of delirium with standard criteria. MATERIAL AND METHODS To study the prevalence and significance of SSD we have conducted a cross-sectional prospective multicenter study of all patients admitted to three Geriatric Departments in tertiary hospitals. The SSD diagnostic criteria used were based on Marcantoniós criteria, and the DRS-R-98 scale was also used as a continuous variable of the degree of delirium. RESULTS We studied 85 patients, 56% women, Barthel 62 (SD: 32), age 87 (SD: 6), CIRS-G 24 (SD: 6.85). Three quarters (75.3%) of patients had at least one CAM positive item, and half of them with at least 13 points in the DRS-R-98 scale. The prevalence of delirium was 53% and 22.3% for SSD. The degree of delirium-DSS was associated with different geriatric syndromes, levels of malnutrition, and degree of functional and cognitive impairment, with a significant linear trend between groups. Patients without delirium have higher levels than those with subsyndromal delirium, and these in turn are higher than those without diagnosed delirium. There is also a tendency in the degree of delirium measured by the DRS-R-98. CONCLUSION Beyond the dichotomous concept of the presence or absence of delirium, this study suggests the probable continuity of cognitive processes and the possibility of more effective and earlier diagnostic and therapeutic measures.
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Martínez-Velilla N, Alonso Bouzón C, Ripa Zazpe C, Sánchez-Ostiz R. [Acute postoperative confusional syndrome in the elderly patient]. Cir Esp 2011; 90:75-84. [PMID: 22176651 DOI: 10.1016/j.ciresp.2011.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 09/05/2011] [Accepted: 09/06/2011] [Indexed: 11/15/2022]
Abstract
With the progressive aging of the population surgical candidates have more comorbidities resulting in a higher risk to develop postoperative complications. One of the most frequent postoperative complications in the elderly is acute confusional state or delirium, which may have devastating consequences: higher mortality, and risk of medical complications during admission and, a higher risk of functional decline, institutionalization, and cognitive impairment at discharge. For all these reasons and with the aim of optimising surgical procedures, it is essential to identify patients at risk of delirium in order to take appropriate preventive action and provide early treatment. In the present article we review the current evidence on the management of postoperative delirium in the elderly.
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