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Acute care for elderly patients in a functional impairment prevention unit
Atención aguda a pacientes ancianos en una unidad de prevención del deterioro funcional
J. Martinez-Peromingo, A. Castañeda, A. Muñana, M.E. Baeza, P. de Peralta, C. Fuentes, R. Barba
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Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, Spain
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Martinez-Peromingo, A. Castañeda, A. Muñana, M.E. Baeza, P. de Peralta, C. Fuentes, R. Barba" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Martinez-Peromingo" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Castañeda" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Muñana" ] 3 => array:2 [ "nombre" => "M.E." "apellidos" => "Baeza" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "de Peralta" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Fuentes" ] 6 => array:4 [ "nombre" => "R." "apellidos" => "Barba" "email" => array:1 [ 0 => "raquel.barba@hospitalreyjuancarlos.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Área Médica, Hospital Universitario Rey Juan Carlos, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Atención aguda a pacientes ancianos en una unidad de prevención del deterioro funcional" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 879 "Ancho" => 1500 "Tamanyo" => 70324 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patients included in the study.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Frailty is a biological syndrome that reflects vulnerability to stressful factors and a reduced physiological reserve.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Elderly and frail individuals constitute a high percentage of the patients admitted to hospital emergency departments. When these patients are hospitalized for acute diseases, they have more complex needs and are more susceptible to complications.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> During hospitalization, these patients often experience functional impairment, from which it takes a significant amount of time to recover, frequently requiring home care after their hospital discharge.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Various clinical studies have shown that elderly frail patients could benefit from a specialized unit.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> Although a meta-analysis was unable to show differences in mortality between patients treated in specific units and those treated in conventional care units,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> the loss of function appeared to be less. A recent study showed that the care of elderly patients in a specific unit tended to be associated with lower mortality at 24 months compared with conventional care units.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The key elements of this care include identifying the risk of falls, optimizing the medication, assessing the patient’s nutritional, cognitive and affective state, identifying the social support and community resources, promoting mobilization<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> and preventing delirium. Frailty interventions focused on physical activity have been shown to be effective in delaying and even reversing functional impairment and disability in outpatients.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">After implementing a functional impairment prevention unit (FIPU) at our center in December 2017, we decided to examine whether the acute care provided to elderly patients with moderate dependence who were directly admitted to the FIPU was superior to the care provided by the conventional unit (CU) for acute medical care in terms of dependence and mean stay.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participant selection</span><p id="par0020" class="elsevierStylePara elsevierViewall">The study included patients older than 75 years who required hospital medical treatment, who presented moderate dependence as defined by a Barthel score of 30–70 and who were hospitalized in the Department of Internal Medicine/Geriatric Medicine of University Hospital Rey Juan Carlos between December 2017 and May 2018. The Barthel score was calculated in the emergency department by the nursing team trained for applying this scale. Patients were admitted to the FIPU if there were available beds. Otherwise, patients were admitted to a CU. This distribution was considered randomized.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We excluded patients with criteria for palliative care or with a highly likely or probable need for urgent surgery in the days following admission.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Clinical characteristics, hospital care and mortality</span><p id="par0030" class="elsevierStylePara elsevierViewall">The following data were obtained from the medical records: age, sex, history of diabetes mellitus, kidney failure, heart failure and other comorbidities. We also included the mean stay and all-cause mortality.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Charlson comorbidity index</span><p id="par0035" class="elsevierStylePara elsevierViewall">The patients’ total morbidity burden was measured with the Charlson comorbidity index,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> which has 19 comorbidity categories and predicts patient mortality at 10 years. Each comorbidity is assigned a score of 1, 2, 3 or 6, depending on the mortality risk associated with this condition.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Hospital geriatric intervention versus standard care</span><p id="par0040" class="elsevierStylePara elsevierViewall">The intervention consisted of the management of patients in the FIPU that treated patients according to hospital standards. The FIPU team consisted of 4 physicians (geriatricians or internal medicine specialists), nurses, assistants and an occupational therapist, all of whom followed the standard FIPU protocols. The specific instructions included the following: updating the medical history; performing a physical examination; conducting a screening for geriatric syndromes; assessing the functional, cognitive, affective and nutritional status; assessing the main caregiver’s abilities; and assessing the patient’s social situation. The physicians who cared for the patients in the FIPU could also treat the patients in the CU.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The following general measures were adopted in the unit:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0050" class="elsevierStylePara elsevierViewall">not performing the analyses during the night shift</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0055" class="elsevierStylePara elsevierViewall">appropriateness of the medication schedule and vital sign readings to ensure night-time rest</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0060" class="elsevierStylePara elsevierViewall">patient’s personal hygiene and measures to promote continence, avoiding the use of diapers for continent patients</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0065" class="elsevierStylePara elsevierViewall">occupational therapy program</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall">early mobilization program and ambulation assistance (patients walk with nursing assistants in a scheduled manner)</p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall">After formulating the treatment plan, the multidisciplinary team meets at least twice a week to review the plan.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The hospitalized patients assigned to the CU underwent all of the typical diagnostic studies and the appropriate treatment approaches for the medical disease that motivated the hospitalization. However, the distinctive characteristic of the FIPU that differentiated it from the CU was the multidisciplinary approach in the FIPU for assessing and managing the patients’ frailty.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Objectives</span><p id="par0085" class="elsevierStylePara elsevierViewall">The analyzed objectives were mean stay, loss of continence and the ability to walk. We also analyzed the differences in mortality during the hospitalization.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">We conducted a pragmatic intervention study whose aim was to determine the intervention’s efficacy in the FIPU. The analyses were performed by intent-to-treat (including the deceased), although for the continence and ambulation variables, we also performed the analysis by protocol (excluding the deceased).</p><p id="par0095" class="elsevierStylePara elsevierViewall">We analyzed the association between the intervention and the outcomes (mean stay, loss of functionality/continence, mortality at admission). The outcomes related to continence and functionality were registered by the nurses of each hospital unit, who were unaware of the study’s implementation. We analyzed the categorical data using the chi-squared test or Fisher's exact test, and the continuous data were compared using Student's t-test. The association between the intervention and the results were examined using a multiple logistic regression model adjusted to the relevant prognostic variables (age, sex and relevant comorbidities, using the score for the Charlson comorbidity index). The statistical analysis was conducted with SPSS version 15.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Characteristics of the study participants</span><p id="par0100" class="elsevierStylePara elsevierViewall">Between December 2017 and May 2018, 466 frail patients were admitted to our center, 280 in the FIPU and 186 in the CU (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Thirty-eight patients (8.1 %) died during the hospitalization (16 [5.7 %] in the intervention group and 22 [11.8 %] in the CU).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The mean age was 86.5 (SD, 5.24) years, and 61.1 % were women. The 2 groups did not differ significantly in terms of age, sex, comorbidities, Charlson score or functional status. The patients in both groups frequently showed associated comorbidities, in particular cardiovascular disease. The mean Charlson index was >5 for both groups. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the baseline characteristics.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">The mean stay of the patients hospitalized in the FIPU was 7.4 days (SD, 5.8), compared with 8.6 (SD, 5.9) days for the patients in the CU. During the hospitalization, 6 patients (2.1 %) in the FIPU lost their continence versus 8 patients (9.7 %) in the CU (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01). In terms of loss of the ability to walk, there were differences between the patients hospitalized in the FIPU and those in the CU (6 [2.1 %] vs. 47 [25.3 %] patients, respectively; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). When excluding the patients who died during the hospitalization, the results are still significant for both indicators: 2.3 % of the patients in the FIPU lost continence versus 11 % of those in the CU, and 2.3 % lost mobility in the FIPU versus 28.7 % in the CU (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001)</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">There were differences in terms of unadjusted mortality (5.7 % patients in the FIPU vs. 11.8 % patients in the CU; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05). After adjusting for potential confounders in the logistic regression analysis such as age, sex, Charlson index and mean stay, there was still a difference in favor of FIPU in terms of lower mortality (OR, 0.46; 95 %<span class="elsevierStyleHsp" style=""></span>CI<span class="elsevierStyleHsp" style=""></span>0.23–0.91).</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">Our results show that the acute care of elderly patients with moderate dependence in an FIPU is superior to the care in a conventional acute medical care unit in terms of mean stay and maintaining the patients’ independence. The patients hospitalized in the FIPU had a day shorter hospital stay than the patients hospitalized in the CU and had a lower probability of losing mobility or continence. The hospital mortality of the FIPU patients was also lower, even after adjusting for potential confounders.</p><p id="par0125" class="elsevierStylePara elsevierViewall">There is growing evidence in favor of special units for treating frail elderly patients.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> These patients’ management and their related care could be considered a “complex intervention”. However, the critical difference between this complex intervention and conventional care (a difference that can benefit frail elderly patients) is early mobilization, a crucial element in our patients’ outcomes. Other studies in Spain<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,12</span></a> have shown that a multicomponent, personalized exercise program improves the functional capacity of frail hospitalized patients and that impairment during hospitalization is associated with an increased mortality risk at 1<span class="elsevierStyleHsp" style=""></span>year.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The early benefit observed in our study can be attributed to a better recognition of the patient’s clinical condition, which was later used to direct the assessment and management. The interventions that might have most affected the outcomes were the individualized exercise plan, improved drug therapy optimization and the prevention of delirium.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Our study has several limitations: we did not employ a frailty detection scale but rather a functional impairment scale. The main reason for this was the accessibility of the scale in the initial phase of this project, along with the assumption that the patients with functional impairment could benefit from a program to prevent this impairment. We also did not employ a randomized patient selection method; however, patient distribution based on bed availability is a simple method for distributing patients, which enabled us to compare 2 similar groups, given that the data showed no major differences in the baseline characteristics between the patients treated in the intervention group and those in the control group.</p><p id="par0135" class="elsevierStylePara elsevierViewall">This patient distribution method has been employed by other authors in similar studies that considered this method valid and more feasible that performing conventional randomization, which is why this method was employed in our study.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In the cases in which differences were identified, the patients in the intervention group were a little more ill (e.g., presented more heart failure) and were older, with no detectable bias in favor of the intervention group. However, the lack of pure randomization could represent a bias. By performing the analysis per protocol, a number of patients who were admitted to the FIPU could have subsequently been transferred to a CU, so as to provide the patient with an individual room due to their terminal condition, which could represent a bias that could explain some of the differences in mortality. The number of patients who were transferred was not available, but the transfer rates in our center are <3 %, and transfers for other reasons were not performed. The intent-to-treat analysis, excluding the patients who died during the hospitalization, maintained the differences between the FIPU and CU in terms of continence and mobility.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Frail adults have a high risk of adverse clinical outcomes, and the strategies for reducing functional, psychological and general health impairment are still an important field of research.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Care models that aim at improving functional outcomes and reducing disability after hospitalization among frail adults should be actively researched, given the implications on public health and health policies.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,10,15</span></a> Our center’s FIPU can be an example of how to organize the care of frail patients who require hospitalization for acute medical conditions. Given that most of the needs are simply organizational, the cultural change could be extended to the rest of the hospital and become the standard management of patients with these characteristics. As has been advocated by other authors,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> frail elderly patients should be offered a healthcare structure that is more compatible with their needs and aimed at the cooperation of the various practitioners in charge of the patients’ healthcare.</p><p id="par0145" class="elsevierStylePara elsevierViewall">In conclusion, hospital FIPUs can provide substantial benefits for selected groups of elderly patients with functional impairment, compared with the classical hospital approaches.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1432556" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1307712" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1432555" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1307711" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participant selection" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Clinical characteristics, hospital care and mortality" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Charlson comorbidity index" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Hospital geriatric intervention versus standard care" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Objectives" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Results" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Characteristics of the study participants" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-08-05" "fechaAceptado" => "2019-10-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1307712" "palabras" => array:6 [ 0 => "Frailty" 1 => "Elderly" 2 => "Acute care" 3 => "Intervention" 4 => "Acute medical care unit" 5 => "Functional impairment." ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1307711" "palabras" => array:6 [ 0 => "Fragilidad" 1 => "Ancianos" 2 => "Atención aguda" 3 => "Intervención" 4 => "Unidad de atención médica aguda" 5 => "Deterioro funcional." ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The aim of our study was to determine whether the care of patients with moderate dependency who were hospitalised in a functional impairment prevention unit (FIPU) was superior to that of a conventional unit (CU) in terms of functional impairment and mean stay.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We conducted a single-centre, retrospective, controlled intervention study that compared acute treatment in an FIPU and in conventional wards. The study included 466 elderly patients with moderate dependence (Barthel index, 30–70) and older than 75 years. Of these, 280 were included in the intervention group and 186 in the control group. The primary outcomes were loss of functionality attributable to the hospitalisation (measured by the loss of ambulation and urinary continence) and differences in the length of stay.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The patients hospitalised in the FIPU showed less functional impairment as determined by the loss of urinary continence (2.1 % of the FIPU patients vs. 9.7 % of the CU patients; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01) and the loss of walking ability (2.1 % vs. 25.3 %; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.01). The patients hospitalised in the FIPU had a shorter mean stay (7.4 vs. 8.5 days; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05), with 1 day less of stay than the CU patients.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The acute care of elderly patients with moderate dependency in an FIPU was independently associated with less functional decline and shorter stays.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El objetivo de nuestro estudio fue determinar si el cuidado de los pacientes con un moderado grado de dependencia ingresados en una unidad de Prevención del Deterioro Funcional (UPDF) era superior al cuidado en una unidad convencional (UC) en términos de deterioro funcional y estancia media.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo, controlado, de intervención en un solo centro que compara el tratamiento agudo en una UPDF y en plantas convencionales. 466 pacientes ancianos con un grado moderado de dependencia (Barthel 30–70), mayores de 75 años. De estos, 280 pacientes se incluyeron en el grupo de intervención y 186 en el grupo control. Los resultados primarios fueron la perdida de funcionalidad achacable al ingreso (medida por perdida de deambulación y continencia urinaria) y las diferencias en la duración de la estancia.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los pacientes ingresados en la UPDF presentaron un menor deterioro funcional determinado por la pérdida de la continencia urinaria (2.1 % de pacientes en UPDF versus 9,7 % en UC; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,01) y la pérdida de la capacidad de deambular (2,1 % de pacientes en UPDF versus 25.3 %; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,01). Los pacientes ingresados en la UPDF tuvieron una estancia media más corta (7,4 vs 8,5; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05), con un día menos de estancia que los pacientes en la unidad de atención convencional.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La atención aguda de pacientes ancianos con un grado moderado de dependencia en una unidad de prevención del deterioro funcional se asoció de forma independiente con un menor deterioro funcional y una menor estancia.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martinez-Peromingo J et al. Atención aguda a pacientes ancianos en una unidad de prevención del deterioro funcional. Rev Clin Esp. 2020;220:548–552.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 879 "Ancho" => 1500 "Tamanyo" => 70324 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0075" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patients included in the study.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0080" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Functional impairment prevention unit (FIPU)(n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>280) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conventional unit (CU)(n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>186) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female sex, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">174 (62.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">111 (59.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.9 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.8 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Barthel index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50.52 (15.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.76 (14.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Charlson index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.70 (1.59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.69 (1.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes mellitus, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (14.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (15.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heart failure, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 (25.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 (25.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dementia, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (5.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neoplasia, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (7.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">COPD, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 (21) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Depression, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (2.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2463162.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Baseline patient characteristics.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0085" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Functional impairment prevention unit (FIPU)(n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>280) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Conventional unit (CU)(n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>186) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR (95 % CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospital stay, days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.4 (5.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.5 (5.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Loss of continence, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (9.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.20 (0.08–0.52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Loss of ambulation, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 (25.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.06 (0.02–0.15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Death, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (11.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.45 (0.23–0.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.024 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2463163.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Indicators at hospital discharge.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frailty: an emerging research and clinical paradigm – issues and controversies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. 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