Ateneo de actualizacioacuten en geriatriacutea

Valoracioacuten geriaacutetrica integral (VGI)

DRA LEMOS SOFIacuteA

Queacute evaluacutea la VGI

Deterioro cognitivo MMT-ACE

Declinacioacuten funcional AVD-AIVD

Riesgo de depresioacuten GDS

Riesgo caiacutedas Get up and go prueba alcance funcional

Riesgo nutricional MNA

Comorbilidades severas CIRS_G

Medicacioacuten BEERS

Incontinencia

Trastornos sensoriales

Sobrecarga del cuidador Zarit

VGI es un plan de gestioacuten para hacer frente a los problemas del adulto mayor

VGI identifica problemas como la funcionalidad y problemas psicosociales en el adulto mayor que generalmente son

subdiagnosticados

Objetivar mas allaacute de la impresioacuten

Es una evaluacioacuten multi-disciplinaria donde los muacuteltiples problemas de las personas mayores son considerados descriptos y explicados

BMC Med 2012

Aust Fam Physician 2004

Valoracioacuten geriaacutetrica integral

Caiacutedas Disminucioacuten visioacutenMedicamentos

Perdida de pesohellip

Functional Decline in Older AdultsAm Fam Physician Sep 15 2013 88(6) 388ndash394

Cathleen S Coloacuten-Emeric MD MHS Heather E Whitson MD MHS Juliessa Pavon MD and Helen Hoenig MD

SORT KEY RECOMMENDATIONS FOR PRACTICE

Comprehensive geriatric evaluation and treatment programs conducted by an interdisciplinary team should be considered for patients with unexplained or progressive disability

A 41 42 Randomized trial and meta-analysis of randomized trials of geriatric evaluation and management

Comprehensive geriatric assessment for older adults admitted to hospital meta-analysis of randomised controlled trials

A controlled trial of inpatient and outpatient geriatric evaluation and management

Queacute evaluacutea la VGI

Deterioro cognitivo MMT-ACE

Declinacioacuten funcional AVD-AIVD

Riesgo de depresioacuten GDS

Riesgo caiacutedas Get up and go prueba alcance funcional

Riesgo nutricional MNA

Comorbilidades severas CIRS_G

Medicacioacuten BEERS

Incontinencia

Trastornos sensoriales

Sobrecarga del cuidador Zarit

VGI es un plan de gestioacuten para hacer frente a los problemas del adulto mayor

VGI identifica problemas como la funcionalidad y problemas psicosociales en el adulto mayor que generalmente son

subdiagnosticados

Objetivar mas allaacute de la impresioacuten

Es una evaluacioacuten multi-disciplinaria donde los muacuteltiples problemas de las personas mayores son considerados descriptos y explicados

BMC Med 2012

Aust Fam Physician 2004

Valoracioacuten geriaacutetrica integral

Caiacutedas Disminucioacuten visioacutenMedicamentos

Perdida de pesohellip

Functional Decline in Older AdultsAm Fam Physician Sep 15 2013 88(6) 388ndash394

Cathleen S Coloacuten-Emeric MD MHS Heather E Whitson MD MHS Juliessa Pavon MD and Helen Hoenig MD

SORT KEY RECOMMENDATIONS FOR PRACTICE

Comprehensive geriatric evaluation and treatment programs conducted by an interdisciplinary team should be considered for patients with unexplained or progressive disability

A 41 42 Randomized trial and meta-analysis of randomized trials of geriatric evaluation and management

Comprehensive geriatric assessment for older adults admitted to hospital meta-analysis of randomised controlled trials

A controlled trial of inpatient and outpatient geriatric evaluation and management

VGI es un plan de gestioacuten para hacer frente a los problemas del adulto mayor

VGI identifica problemas como la funcionalidad y problemas psicosociales en el adulto mayor que generalmente son

subdiagnosticados

Objetivar mas allaacute de la impresioacuten

Es una evaluacioacuten multi-disciplinaria donde los muacuteltiples problemas de las personas mayores son considerados descriptos y explicados

BMC Med 2012

Aust Fam Physician 2004

Valoracioacuten geriaacutetrica integral

Caiacutedas Disminucioacuten visioacutenMedicamentos

Perdida de pesohellip

Functional Decline in Older AdultsAm Fam Physician Sep 15 2013 88(6) 388ndash394

Cathleen S Coloacuten-Emeric MD MHS Heather E Whitson MD MHS Juliessa Pavon MD and Helen Hoenig MD

SORT KEY RECOMMENDATIONS FOR PRACTICE

Comprehensive geriatric evaluation and treatment programs conducted by an interdisciplinary team should be considered for patients with unexplained or progressive disability

A 41 42 Randomized trial and meta-analysis of randomized trials of geriatric evaluation and management

Comprehensive geriatric assessment for older adults admitted to hospital meta-analysis of randomised controlled trials

A controlled trial of inpatient and outpatient geriatric evaluation and management

Valoracioacuten geriaacutetrica integral

Caiacutedas Disminucioacuten visioacutenMedicamentos

Perdida de pesohellip

Functional Decline in Older AdultsAm Fam Physician Sep 15 2013 88(6) 388ndash394

Cathleen S Coloacuten-Emeric MD MHS Heather E Whitson MD MHS Juliessa Pavon MD and Helen Hoenig MD

SORT KEY RECOMMENDATIONS FOR PRACTICE

Comprehensive geriatric evaluation and treatment programs conducted by an interdisciplinary team should be considered for patients with unexplained or progressive disability

A 41 42 Randomized trial and meta-analysis of randomized trials of geriatric evaluation and management

Comprehensive geriatric assessment for older adults admitted to hospital meta-analysis of randomised controlled trials

A controlled trial of inpatient and outpatient geriatric evaluation and management

Caiacutedas Disminucioacuten visioacutenMedicamentos

Perdida de pesohellip

Functional Decline in Older AdultsAm Fam Physician Sep 15 2013 88(6) 388ndash394

Cathleen S Coloacuten-Emeric MD MHS Heather E Whitson MD MHS Juliessa Pavon MD and Helen Hoenig MD

SORT KEY RECOMMENDATIONS FOR PRACTICE

Comprehensive geriatric evaluation and treatment programs conducted by an interdisciplinary team should be considered for patients with unexplained or progressive disability

A 41 42 Randomized trial and meta-analysis of randomized trials of geriatric evaluation and management

Comprehensive geriatric assessment for older adults admitted to hospital meta-analysis of randomised controlled trials

A controlled trial of inpatient and outpatient geriatric evaluation and management

Functional Decline in Older AdultsAm Fam Physician Sep 15 2013 88(6) 388ndash394

Cathleen S Coloacuten-Emeric MD MHS Heather E Whitson MD MHS Juliessa Pavon MD and Helen Hoenig MD

SORT KEY RECOMMENDATIONS FOR PRACTICE

Comprehensive geriatric evaluation and treatment programs conducted by an interdisciplinary team should be considered for patients with unexplained or progressive disability

A 41 42 Randomized trial and meta-analysis of randomized trials of geriatric evaluation and management

Comprehensive geriatric assessment for older adults admitted to hospital meta-analysis of randomised controlled trials

A controlled trial of inpatient and outpatient geriatric evaluation and management

Deterioro cognitivo

MMT

El MMSE continua siendo el instrumento mas utilizado 14 estudios (n=10185) 883 sensibilidad (95 CI 813 to 929) y 862 especificidad (95 CI 818 to 897) para un punto de corte de 2324 o 2425 en la deteccioacuten de demencia

Much more limited evidence exists for the following instruments to detect MCI MMSE (k=15 n=5758) IQCODE (k=4 n=975) CDT (k=4 n=4191) Mini-Cog (k=3 n=1092) TICS (k=3 n=568) and the Montreal Cognitive Assessment (MoCA) (k=2 n=251) The sensitivity andor specificity of these instruments is generally worse for the detection of MCI compared with dementia

MMSE falla en detectar demencia en los estadios iniciales Esto se debe a dos razones 1) Su escasa sensibilidad para objetivar deacuteficits leves de memoria y de lenguaje como consecuencia del uso de tareas mneacutesicas y linguisticas muy simples 2) Su escasa sensibilidad para objetivar los deacuteficits ejecutivos observados en la demencia frontotemporal Existe consenso sobre la utilidad del MMSE para el seguimiento longitudinal del deterioro cognitivo

ACE

El ACE evaluacutea 6 dominios cognitivos El puntaje maacuteximo obtenible es 100 orientacioacuten atencioacuten memoria fluencia verbal lenguaje y habilidades visuoespaciales A su vez permite calcular los 30 puntos del MMSE ya que estaacuten incluidos en el cuestionario

El coeficiente VLOM del ACE en espantildeolpermite una orientacioacuten para el diagnoacutesticodiferencial entre DTA y DFT

Punto de corteAlta educacioacuten 86

Baja educacioacuten68

Clinical ReviewCognitive assessment of older peopleBMJ 2011343d5042bull Formal detection of these

syndromes may enable identification of treatable conditions is associated with better outcomes for patients and requires routine cognitive assessment

bull Cognitive assessment requires integration of information acquired from observing the patient and talking with carers and from the results of an assessment instrument

bull Cognitive assessment instruments are brief easy to use and sensitive to cognitive impairment

Observacioacuten del pacienteLa informacioacuten del convivienteY el resultado de los test

Escala cliacutenica de la demencia (CDR)

DCL

Funcionalidad AVD_AIVD

AVD indice de Katz (bantildeo vestirse continencia alimentacioacuten transferencia movilidad aseo)

AIVD indice de Lawton y Brody (uso de teleacutefono compras cocinar transporte manejo de medicacioacuten y dinero)

La declinacioacuten funcional es frecuente en ancianos

Multicausal (sociales financieros comorbilidades severas etc)

Riesgo de Caiacutedas

Clin Cases Miner Bone Metab 2013

The prevalence of fall according to the increasing of age

Time get up and go test

ldquolevantarse (sin usar apoyabrazos) camine 3 mts de la vuelta y vuelva a sentarserdquo

gt16seg riesgo de caiacutedas

Prueba de alcance funcional

ldquopararse con el brazo extendido Inclinarse para adelantar el puntildeo lo mas lejos posible sin dar un paso o perder la estabilidadrdquo

lt15cm riesgo de caiacutedas

TUG is not useful for discriminating fallers from non-fallers in healthy high-functioning older people but is of more value in less-healthy lower-functioning older people Multifactorial fall risk screens should be considered to provide additional information for identifying older people at risk of falls

Journal of the American Geriatrics SocietyVolume 61 Issue 2 pages 202ndash208

February 2013

MMT

El MMSE continua siendo el instrumento mas utilizado 14 estudios (n=10185) 883 sensibilidad (95 CI 813 to 929) y 862 especificidad (95 CI 818 to 897) para un punto de corte de 2324 o 2425 en la deteccioacuten de demencia

Much more limited evidence exists for the following instruments to detect MCI MMSE (k=15 n=5758) IQCODE (k=4 n=975) CDT (k=4 n=4191) Mini-Cog (k=3 n=1092) TICS (k=3 n=568) and the Montreal Cognitive Assessment (MoCA) (k=2 n=251) The sensitivity andor specificity of these instruments is generally worse for the detection of MCI compared with dementia

MMSE falla en detectar demencia en los estadios iniciales Esto se debe a dos razones 1) Su escasa sensibilidad para objetivar deacuteficits leves de memoria y de lenguaje como consecuencia del uso de tareas mneacutesicas y linguisticas muy simples 2) Su escasa sensibilidad para objetivar los deacuteficits ejecutivos observados en la demencia frontotemporal Existe consenso sobre la utilidad del MMSE para el seguimiento longitudinal del deterioro cognitivo

ACE

El ACE evaluacutea 6 dominios cognitivos El puntaje maacuteximo obtenible es 100 orientacioacuten atencioacuten memoria fluencia verbal lenguaje y habilidades visuoespaciales A su vez permite calcular los 30 puntos del MMSE ya que estaacuten incluidos en el cuestionario

El coeficiente VLOM del ACE en espantildeolpermite una orientacioacuten para el diagnoacutesticodiferencial entre DTA y DFT

Punto de corteAlta educacioacuten 86

Baja educacioacuten68

Clinical ReviewCognitive assessment of older peopleBMJ 2011343d5042bull Formal detection of these

syndromes may enable identification of treatable conditions is associated with better outcomes for patients and requires routine cognitive assessment

bull Cognitive assessment requires integration of information acquired from observing the patient and talking with carers and from the results of an assessment instrument

bull Cognitive assessment instruments are brief easy to use and sensitive to cognitive impairment

Observacioacuten del pacienteLa informacioacuten del convivienteY el resultado de los test

Escala cliacutenica de la demencia (CDR)

DCL

Funcionalidad AVD_AIVD

AVD indice de Katz (bantildeo vestirse continencia alimentacioacuten transferencia movilidad aseo)

AIVD indice de Lawton y Brody (uso de teleacutefono compras cocinar transporte manejo de medicacioacuten y dinero)

La declinacioacuten funcional es frecuente en ancianos

Multicausal (sociales financieros comorbilidades severas etc)

Riesgo de Caiacutedas

Clin Cases Miner Bone Metab 2013

The prevalence of fall according to the increasing of age

Time get up and go test

ldquolevantarse (sin usar apoyabrazos) camine 3 mts de la vuelta y vuelva a sentarserdquo

gt16seg riesgo de caiacutedas

Prueba de alcance funcional

ldquopararse con el brazo extendido Inclinarse para adelantar el puntildeo lo mas lejos posible sin dar un paso o perder la estabilidadrdquo

lt15cm riesgo de caiacutedas

TUG is not useful for discriminating fallers from non-fallers in healthy high-functioning older people but is of more value in less-healthy lower-functioning older people Multifactorial fall risk screens should be considered to provide additional information for identifying older people at risk of falls

Journal of the American Geriatrics SocietyVolume 61 Issue 2 pages 202ndash208

February 2013

ACE

El ACE evaluacutea 6 dominios cognitivos El puntaje maacuteximo obtenible es 100 orientacioacuten atencioacuten memoria fluencia verbal lenguaje y habilidades visuoespaciales A su vez permite calcular los 30 puntos del MMSE ya que estaacuten incluidos en el cuestionario

El coeficiente VLOM del ACE en espantildeolpermite una orientacioacuten para el diagnoacutesticodiferencial entre DTA y DFT

Punto de corteAlta educacioacuten 86

Baja educacioacuten68

Clinical ReviewCognitive assessment of older peopleBMJ 2011343d5042bull Formal detection of these

syndromes may enable identification of treatable conditions is associated with better outcomes for patients and requires routine cognitive assessment

bull Cognitive assessment requires integration of information acquired from observing the patient and talking with carers and from the results of an assessment instrument

bull Cognitive assessment instruments are brief easy to use and sensitive to cognitive impairment

Observacioacuten del pacienteLa informacioacuten del convivienteY el resultado de los test

Escala cliacutenica de la demencia (CDR)

DCL

Funcionalidad AVD_AIVD

AVD indice de Katz (bantildeo vestirse continencia alimentacioacuten transferencia movilidad aseo)

AIVD indice de Lawton y Brody (uso de teleacutefono compras cocinar transporte manejo de medicacioacuten y dinero)

La declinacioacuten funcional es frecuente en ancianos

Multicausal (sociales financieros comorbilidades severas etc)

Riesgo de Caiacutedas

Clin Cases Miner Bone Metab 2013

The prevalence of fall according to the increasing of age

Time get up and go test

ldquolevantarse (sin usar apoyabrazos) camine 3 mts de la vuelta y vuelva a sentarserdquo

gt16seg riesgo de caiacutedas

Prueba de alcance funcional

ldquopararse con el brazo extendido Inclinarse para adelantar el puntildeo lo mas lejos posible sin dar un paso o perder la estabilidadrdquo

lt15cm riesgo de caiacutedas

TUG is not useful for discriminating fallers from non-fallers in healthy high-functioning older people but is of more value in less-healthy lower-functioning older people Multifactorial fall risk screens should be considered to provide additional information for identifying older people at risk of falls

Journal of the American Geriatrics SocietyVolume 61 Issue 2 pages 202ndash208

February 2013

El ACE evaluacutea 6 dominios cognitivos El puntaje maacuteximo obtenible es 100 orientacioacuten atencioacuten memoria fluencia verbal lenguaje y habilidades visuoespaciales A su vez permite calcular los 30 puntos del MMSE ya que estaacuten incluidos en el cuestionario

El coeficiente VLOM del ACE en espantildeolpermite una orientacioacuten para el diagnoacutesticodiferencial entre DTA y DFT

Punto de corteAlta educacioacuten 86

Baja educacioacuten68

Clinical ReviewCognitive assessment of older peopleBMJ 2011343d5042bull Formal detection of these

syndromes may enable identification of treatable conditions is associated with better outcomes for patients and requires routine cognitive assessment

bull Cognitive assessment requires integration of information acquired from observing the patient and talking with carers and from the results of an assessment instrument

bull Cognitive assessment instruments are brief easy to use and sensitive to cognitive impairment

Observacioacuten del pacienteLa informacioacuten del convivienteY el resultado de los test

Escala cliacutenica de la demencia (CDR)

DCL

Funcionalidad AVD_AIVD

AVD indice de Katz (bantildeo vestirse continencia alimentacioacuten transferencia movilidad aseo)

AIVD indice de Lawton y Brody (uso de teleacutefono compras cocinar transporte manejo de medicacioacuten y dinero)

La declinacioacuten funcional es frecuente en ancianos

Multicausal (sociales financieros comorbilidades severas etc)

Riesgo de Caiacutedas

Clin Cases Miner Bone Metab 2013

The prevalence of fall according to the increasing of age

Time get up and go test

ldquolevantarse (sin usar apoyabrazos) camine 3 mts de la vuelta y vuelva a sentarserdquo

gt16seg riesgo de caiacutedas

Prueba de alcance funcional

ldquopararse con el brazo extendido Inclinarse para adelantar el puntildeo lo mas lejos posible sin dar un paso o perder la estabilidadrdquo

lt15cm riesgo de caiacutedas

TUG is not useful for discriminating fallers from non-fallers in healthy high-functioning older people but is of more value in less-healthy lower-functioning older people Multifactorial fall risk screens should be considered to provide additional information for identifying older people at risk of falls

Journal of the American Geriatrics SocietyVolume 61 Issue 2 pages 202ndash208

February 2013

Clinical ReviewCognitive assessment of older peopleBMJ 2011343d5042bull Formal detection of these

syndromes may enable identification of treatable conditions is associated with better outcomes for patients and requires routine cognitive assessment

bull Cognitive assessment requires integration of information acquired from observing the patient and talking with carers and from the results of an assessment instrument

bull Cognitive assessment instruments are brief easy to use and sensitive to cognitive impairment

Observacioacuten del pacienteLa informacioacuten del convivienteY el resultado de los test

Escala cliacutenica de la demencia (CDR)

DCL

Funcionalidad AVD_AIVD

AVD indice de Katz (bantildeo vestirse continencia alimentacioacuten transferencia movilidad aseo)

AIVD indice de Lawton y Brody (uso de teleacutefono compras cocinar transporte manejo de medicacioacuten y dinero)

La declinacioacuten funcional es frecuente en ancianos

Multicausal (sociales financieros comorbilidades severas etc)

Riesgo de Caiacutedas

Clin Cases Miner Bone Metab 2013

The prevalence of fall according to the increasing of age

Time get up and go test

ldquolevantarse (sin usar apoyabrazos) camine 3 mts de la vuelta y vuelva a sentarserdquo

gt16seg riesgo de caiacutedas

Prueba de alcance funcional

ldquopararse con el brazo extendido Inclinarse para adelantar el puntildeo lo mas lejos posible sin dar un paso o perder la estabilidadrdquo

lt15cm riesgo de caiacutedas

TUG is not useful for discriminating fallers from non-fallers in healthy high-functioning older people but is of more value in less-healthy lower-functioning older people Multifactorial fall risk screens should be considered to provide additional information for identifying older people at risk of falls

Journal of the American Geriatrics SocietyVolume 61 Issue 2 pages 202ndash208

February 2013

Escala cliacutenica de la demencia (CDR)

DCL

Funcionalidad AVD_AIVD

AVD indice de Katz (bantildeo vestirse continencia alimentacioacuten transferencia movilidad aseo)

AIVD indice de Lawton y Brody (uso de teleacutefono compras cocinar transporte manejo de medicacioacuten y dinero)

La declinacioacuten funcional es frecuente en ancianos

Multicausal (sociales financieros comorbilidades severas etc)

Riesgo de Caiacutedas

Clin Cases Miner Bone Metab 2013

The prevalence of fall according to the increasing of age

Time get up and go test

ldquolevantarse (sin usar apoyabrazos) camine 3 mts de la vuelta y vuelva a sentarserdquo

gt16seg riesgo de caiacutedas

Prueba de alcance funcional

ldquopararse con el brazo extendido Inclinarse para adelantar el puntildeo lo mas lejos posible sin dar un paso o perder la estabilidadrdquo

lt15cm riesgo de caiacutedas

TUG is not useful for discriminating fallers from non-fallers in healthy high-functioning older people but is of more value in less-healthy lower-functioning older people Multifactorial fall risk screens should be considered to provide additional information for identifying older people at risk of falls

Journal of the American Geriatrics SocietyVolume 61 Issue 2 pages 202ndash208

February 2013

Funcionalidad AVD_AIVD

AVD indice de Katz (bantildeo vestirse continencia alimentacioacuten transferencia movilidad aseo)

AIVD indice de Lawton y Brody (uso de teleacutefono compras cocinar transporte manejo de medicacioacuten y dinero)

La declinacioacuten funcional es frecuente en ancianos

Multicausal (sociales financieros comorbilidades severas etc)

Riesgo de Caiacutedas

Clin Cases Miner Bone Metab 2013

The prevalence of fall according to the increasing of age

Time get up and go test

ldquolevantarse (sin usar apoyabrazos) camine 3 mts de la vuelta y vuelva a sentarserdquo

gt16seg riesgo de caiacutedas

Prueba de alcance funcional

ldquopararse con el brazo extendido Inclinarse para adelantar el puntildeo lo mas lejos posible sin dar un paso o perder la estabilidadrdquo

lt15cm riesgo de caiacutedas

TUG is not useful for discriminating fallers from non-fallers in healthy high-functioning older people but is of more value in less-healthy lower-functioning older people Multifactorial fall risk screens should be considered to provide additional information for identifying older people at risk of falls

Journal of the American Geriatrics SocietyVolume 61 Issue 2 pages 202ndash208

February 2013

Riesgo de Caiacutedas

Clin Cases Miner Bone Metab 2013

The prevalence of fall according to the increasing of age

Time get up and go test

ldquolevantarse (sin usar apoyabrazos) camine 3 mts de la vuelta y vuelva a sentarserdquo

gt16seg riesgo de caiacutedas

Prueba de alcance funcional

ldquopararse con el brazo extendido Inclinarse para adelantar el puntildeo lo mas lejos posible sin dar un paso o perder la estabilidadrdquo

lt15cm riesgo de caiacutedas

TUG is not useful for discriminating fallers from non-fallers in healthy high-functioning older people but is of more value in less-healthy lower-functioning older people Multifactorial fall risk screens should be considered to provide additional information for identifying older people at risk of falls

Journal of the American Geriatrics SocietyVolume 61 Issue 2 pages 202ndash208

February 2013

Time get up and go test

ldquolevantarse (sin usar apoyabrazos) camine 3 mts de la vuelta y vuelva a sentarserdquo

gt16seg riesgo de caiacutedas

Prueba de alcance funcional

ldquopararse con el brazo extendido Inclinarse para adelantar el puntildeo lo mas lejos posible sin dar un paso o perder la estabilidadrdquo

lt15cm riesgo de caiacutedas

TUG is not useful for discriminating fallers from non-fallers in healthy high-functioning older people but is of more value in less-healthy lower-functioning older people Multifactorial fall risk screens should be considered to provide additional information for identifying older people at risk of falls

Journal of the American Geriatrics SocietyVolume 61 Issue 2 pages 202ndash208

February 2013

Riesgo de depresioacuten GDS

Among multimorbid elderly patients depression was associated with

significantly higher health care utilization and costs

A number of empirical studies support for a bidirectional

association between depression and frailty in later life

PLoS One 2014

Int J Geriatr Psychiatry 2012

Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten criterios de BEERS

American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older AdultsThe American Geriatrics Society 2012 Beers Criteria Update Expert Panel

Evitar uso de BDZ en ancianosMayor sensibilidad a las BDZ menor capacidad de metabolizar drogas de

accioacuten larga aumento en el riesgo de deterioro cognitivo delirium y caiacutedas

El objetivo del 2012 AGS Beers Criteria es mejorar el cuidado de los ancianos reduciendo la exposicioacuten a drogas

potencialmente inapropiadas

Adverse Drug Events in Older Patients Admitted as an EmergencyThe Role of Potentially Inappropriate Medication in Elderly People (PRISCUS) Dtsch Arztebl Int Mar 2013

EM+ medication errors leadingTo clinical events

Medication errors

Riesgo nutricional El nivel nutricional es un

factor independiente de caiacutedas en ancianos de la comunidad PLoS One 2014

Hay una fuerte correlacioacuten entre deterioro cognitivo bajo nivel nutricional (Plt0005) declinacioacuten funcional (Plt005) y mortalidad (Plt001) Clin Interv Aging 2014

Existe una relacioacuten

directa entre nivel nutricional y declinacioacuten funcional Nutr J 2009

Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale for Geriatric

CARDIacuteACA 3-IAM 5 antildeos previos prueba de estreacutes anormal antec de angioplastiacutea o CRM derrame pericaacuterdico o pericarditis 4-Restriccioacuten marcada de la actividad secundaria a problema cardiacuteaco (por ej angina inestable o ICC intratable)VASCULAR3-2 o + siacutentomas de ateroesclerosis 2 o + drogas para HTA o HVI 2 o + siacutentomas de enfermedad vascular perifeacuterica 4-Cirugiacutea previa por problema vascular aneurisma aoacutertico gt4 cm

CAacuteNCER3-Requirioacute quimioterapia radioterapia terapia hormonal o procedimiento quiruacutergico para caacutencer en los uacuteltimos 5 antildeos 4-Malignidad recurrente con potencial de amenaza para la vida contencioacuten fallada de malignidad primaria tratamiento paliativo

PSIQUIAacuteTRICA3-Actualmente con depresioacuten mayor o 2 o + episodios de depresioacuten gt en los uacuteltimos 10 antildeos demencia moderada (MMT 15-20) uso actual de medicacioacuten ansioliacutetica actual abuso de sustancia o dependencia requiere medicacioacuten antipsicoacutetica diaria 4-Enfermedad mental actual requiriendo hospitalizacioacuten institucionalizacioacuten o manejo ambulatorio intensivo depresioacuten severa o suicida psicosis aguda o descompensacioacuten psicoacutetica agitacioacuten severa por demencia intoxicacioacuten por sustancias demencia severa (MMTlt15)

ENDOCRINO-METABOacuteLICA Y MAMA3-Cualquier alteracioacuten electroliacutetica que requiere tratamiento hospitalario BMIgt45 DBT regularmente controlada en valores de 300 mgdl con leve retinopatiacutea o neuropatiacutea perifeacuterica 4-DBT laacutebil o pobremente controlada o coma diabeacutetico en el uacuteltimo antildeo requiere terapia de reemplazo adrenal carcinoma adrenal tiroideo o de mama

NEUROLOacuteGICO3-ACV con disfuncioacuten residual leve cualquier procedimiento neurocx enf neurodegenerativa de severidad moderada 4-ACV con hemiparesia o afasia funcional residual enfermedad neurodegenerativa severa

MUSCULO-ESQUELEacuteTICO3- Limitacioacuten severa en AVD x artritis requiere corticoides para condicioacuten artriacutetica fracturas de compresioacuten vertebral por osteoporosis4-Limitado a silla de ruedas deformidad articular severa o uso severamente limitado osteomielitis cualquier carcinoma de hueso o muacutesculo melanoma metastaacutesico

GENITOURINARIO3- Caacutencer prostaacutetico in situ sangrado vaginal carcinoma cervical in situ hematuria urosepsis en el uacuteltimo antildeo incontinencia diaria requiriendo pantildeales o incontinencia nocturna regular ITUs a repeticioacuten en el varoacuten 4-Retencioacuten aguda de orina cualquier carcinoma genitourinario urosepsis actual

HEPATOBILIAR3-Bilirrubina (total gt2)elevacioacuten de transaminasas (gt150 de lo normal) requerimiento de enz pancreaacuteticas para la digestioacuten 4-Obstruccioacuten biliar cualquier carcinoma del aacuterbol biliar colecistitis pancreatitis hepatitis activa

RENAL3-Creatinina seacuterica gt3 o gt 15 en conjuncioacuten con diureacutetico antihipertensivo o tratamiento con bicarbonato pielonefritis actual 4-Requerimiento de diaacutelisis carcinoma renal

GASTRO-INTESTINAL INFERIOR3-Impactacioacuten fecal en el uacuteltimo antildeo uso diario de laxantes estimulantes o enemas4-Hematoquezia impactacioacuten fecal actual diverticulitis antecde obstruccioacuten intestinal caacutencer intestinal

OCULARES OTORRINOLA-RINGOLOacuteGICA3-Parcialmente ciego requiere un acompantildeante para salir incapaz de leer el diario no escucha bien a pesar de audiacutefono 4-Ceguera funcional incapacidad de leer reconocer una cara familiar o desenvolverse en un ambiente nuevo sordera funcional laringectomiacutea requerimiento de intervencioacuten quiruacutergica para veacutertigo

GASTRO-INTESTINAL SUPERIOR3-Ulcera activa SOMF + disglusia o disfagia 4-Cancer gaacutestrico historia de uacutelcera perforada melena o hematoquezia de origen GI superior

RESPIRATORIA3-Deambulacion limitada secundaria a capacidad respiratoria limitada requiere corticoides orales tbq gt40 py nac aguda 4-Requiere oxiacutegeno suplementario al menos un episodio de falla respiratoria requiriendo ARM caacutencer pulmonar

HEMATOPOYEacuteTICA3-Hb mujeres lt8 varones lt10 GBlt2000 4-Leucemia o linfoma

The measures that have been most widely used and for which there is

greatest evidence of validity are the Charlson index disease counts and the ACG System Other measures such as

the CIRS are more complex to administer and their advantages over

easier methods have not been well established Ann Fam Med Mar 2012

The assessment of CIRS-G requires a health professional more skilled on clinical examination all of these indexes have been

shown to have a good predictive value about functional impairment and mortality

Rev Med Inst Mex Seguro Soc 2011

Sobrecarga de cuidador

Factors associated with caregiver burden in patients with Alzheimers disease Psychiatry Investig 2014

47 a 55 sobrecarga leveSensibilidad 851 Especificidad 844

gt55 sobrecarga intensaSensibilidad 906 Especificidad 933

Valoracioacuten social

OARS

CAGE (Alcoholismo)

Valoracioacuten de los cuidadores

Valoracioacuten semi-estructurada Soporte informal (amigos familia)

Soporte formal (bienestar social servicios de salud)

Soporte semiformal (Iglesia centros de jubilados sociedades de fomento)

Valoracioacuten estructurada por asistente social

Herramienta diagnoacutestica multidimensional adaptada

En espantildeol Proporciona informacioacutenacerca de cinco aacutereas estructura familiar y

recursos sociales recursos econoacutemicos

Recomendaciones Sospecha de probable deterioro cognitivo

Estimulacioacuten cognitivaNonpharmacological therapies in Alzheimerrsquos disease

a systematic review of efficacy Dement Geriatr Cogn Disord 2010

The effects of a Cognitive Stimulation Therapy [CST]

programme for people with dementia on family caregiversrsquo health-

BMC Geriatr 2014

Reevaluacioacuten en 6 meses ()

Manejo sobre riesgos de sobrecarga en cuidador

Eventual uso de anti-demenciales

Esfera cognitivaSiacutentomas

conductualesSobrecarga del

cuidador

Recomendaciones Riesgo de caiacutedas

Recomendacioacuten de uso de bastoacuten

Recomendacioacuten de prevencioacuten de caiacutedas en domicilio

Eventual inicio de KNM para rehabilitacioacuten de la marcha Falls prevention for the elderly GMS Health Technol Assess 2012

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care study protocol for a randomised controlled trial (Prevquedas Brazil) BMC Geriatr 2013 Mar

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study) randomised parallel trial BMJ 2012 Aug

Evaluacioacuten de medicacioacuten potencialmente inapropiada por riesgo alto de caiacutedas

Fall risk-increasing drugs and falls a cross-sectional study among elderly patients in primary care BMC Geriatr 2014

Positive associations between fall risk and the total number of drugs (p lt 001) severe falls (p lt 001) and female sex (p = 003)

Pattern Screening and assessment

Intervention

Unstable health conditions Medical assessment Medical management may include geriatrician review medication reviewintervention to increase compliance referral for follow-up of medicalconditions

Under nutrition Setting appropriate screening

Mini Nutritional Assessment

Referral to a dietician for nutritional support educationabout foodsnutrition advice benefits of regular exercise and nutrition supportThe NICE clinical guideline lsquoNutrition Support in Adultsrsquo provides high qualityevidence for oral nutrition support in adults with malnutrition

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

Among multimorbid elderly patients depression was associated with

significantly higher health care utilization and costs

A number of empirical studies support for a bidirectional

association between depression and frailty in later life

PLoS One 2014

Int J Geriatr Psychiatry 2012

Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten criterios de BEERS

American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older AdultsThe American Geriatrics Society 2012 Beers Criteria Update Expert Panel

Evitar uso de BDZ en ancianosMayor sensibilidad a las BDZ menor capacidad de metabolizar drogas de

accioacuten larga aumento en el riesgo de deterioro cognitivo delirium y caiacutedas

El objetivo del 2012 AGS Beers Criteria es mejorar el cuidado de los ancianos reduciendo la exposicioacuten a drogas

potencialmente inapropiadas

Adverse Drug Events in Older Patients Admitted as an EmergencyThe Role of Potentially Inappropriate Medication in Elderly People (PRISCUS) Dtsch Arztebl Int Mar 2013

EM+ medication errors leadingTo clinical events

Medication errors

Riesgo nutricional El nivel nutricional es un

factor independiente de caiacutedas en ancianos de la comunidad PLoS One 2014

Hay una fuerte correlacioacuten entre deterioro cognitivo bajo nivel nutricional (Plt0005) declinacioacuten funcional (Plt005) y mortalidad (Plt001) Clin Interv Aging 2014

Existe una relacioacuten

directa entre nivel nutricional y declinacioacuten funcional Nutr J 2009

Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale for Geriatric

CARDIacuteACA 3-IAM 5 antildeos previos prueba de estreacutes anormal antec de angioplastiacutea o CRM derrame pericaacuterdico o pericarditis 4-Restriccioacuten marcada de la actividad secundaria a problema cardiacuteaco (por ej angina inestable o ICC intratable)VASCULAR3-2 o + siacutentomas de ateroesclerosis 2 o + drogas para HTA o HVI 2 o + siacutentomas de enfermedad vascular perifeacuterica 4-Cirugiacutea previa por problema vascular aneurisma aoacutertico gt4 cm

CAacuteNCER3-Requirioacute quimioterapia radioterapia terapia hormonal o procedimiento quiruacutergico para caacutencer en los uacuteltimos 5 antildeos 4-Malignidad recurrente con potencial de amenaza para la vida contencioacuten fallada de malignidad primaria tratamiento paliativo

PSIQUIAacuteTRICA3-Actualmente con depresioacuten mayor o 2 o + episodios de depresioacuten gt en los uacuteltimos 10 antildeos demencia moderada (MMT 15-20) uso actual de medicacioacuten ansioliacutetica actual abuso de sustancia o dependencia requiere medicacioacuten antipsicoacutetica diaria 4-Enfermedad mental actual requiriendo hospitalizacioacuten institucionalizacioacuten o manejo ambulatorio intensivo depresioacuten severa o suicida psicosis aguda o descompensacioacuten psicoacutetica agitacioacuten severa por demencia intoxicacioacuten por sustancias demencia severa (MMTlt15)

ENDOCRINO-METABOacuteLICA Y MAMA3-Cualquier alteracioacuten electroliacutetica que requiere tratamiento hospitalario BMIgt45 DBT regularmente controlada en valores de 300 mgdl con leve retinopatiacutea o neuropatiacutea perifeacuterica 4-DBT laacutebil o pobremente controlada o coma diabeacutetico en el uacuteltimo antildeo requiere terapia de reemplazo adrenal carcinoma adrenal tiroideo o de mama

NEUROLOacuteGICO3-ACV con disfuncioacuten residual leve cualquier procedimiento neurocx enf neurodegenerativa de severidad moderada 4-ACV con hemiparesia o afasia funcional residual enfermedad neurodegenerativa severa

MUSCULO-ESQUELEacuteTICO3- Limitacioacuten severa en AVD x artritis requiere corticoides para condicioacuten artriacutetica fracturas de compresioacuten vertebral por osteoporosis4-Limitado a silla de ruedas deformidad articular severa o uso severamente limitado osteomielitis cualquier carcinoma de hueso o muacutesculo melanoma metastaacutesico

GENITOURINARIO3- Caacutencer prostaacutetico in situ sangrado vaginal carcinoma cervical in situ hematuria urosepsis en el uacuteltimo antildeo incontinencia diaria requiriendo pantildeales o incontinencia nocturna regular ITUs a repeticioacuten en el varoacuten 4-Retencioacuten aguda de orina cualquier carcinoma genitourinario urosepsis actual

HEPATOBILIAR3-Bilirrubina (total gt2)elevacioacuten de transaminasas (gt150 de lo normal) requerimiento de enz pancreaacuteticas para la digestioacuten 4-Obstruccioacuten biliar cualquier carcinoma del aacuterbol biliar colecistitis pancreatitis hepatitis activa

RENAL3-Creatinina seacuterica gt3 o gt 15 en conjuncioacuten con diureacutetico antihipertensivo o tratamiento con bicarbonato pielonefritis actual 4-Requerimiento de diaacutelisis carcinoma renal

GASTRO-INTESTINAL INFERIOR3-Impactacioacuten fecal en el uacuteltimo antildeo uso diario de laxantes estimulantes o enemas4-Hematoquezia impactacioacuten fecal actual diverticulitis antecde obstruccioacuten intestinal caacutencer intestinal

OCULARES OTORRINOLA-RINGOLOacuteGICA3-Parcialmente ciego requiere un acompantildeante para salir incapaz de leer el diario no escucha bien a pesar de audiacutefono 4-Ceguera funcional incapacidad de leer reconocer una cara familiar o desenvolverse en un ambiente nuevo sordera funcional laringectomiacutea requerimiento de intervencioacuten quiruacutergica para veacutertigo

GASTRO-INTESTINAL SUPERIOR3-Ulcera activa SOMF + disglusia o disfagia 4-Cancer gaacutestrico historia de uacutelcera perforada melena o hematoquezia de origen GI superior

RESPIRATORIA3-Deambulacion limitada secundaria a capacidad respiratoria limitada requiere corticoides orales tbq gt40 py nac aguda 4-Requiere oxiacutegeno suplementario al menos un episodio de falla respiratoria requiriendo ARM caacutencer pulmonar

HEMATOPOYEacuteTICA3-Hb mujeres lt8 varones lt10 GBlt2000 4-Leucemia o linfoma

The measures that have been most widely used and for which there is

greatest evidence of validity are the Charlson index disease counts and the ACG System Other measures such as

the CIRS are more complex to administer and their advantages over

easier methods have not been well established Ann Fam Med Mar 2012

The assessment of CIRS-G requires a health professional more skilled on clinical examination all of these indexes have been

shown to have a good predictive value about functional impairment and mortality

Rev Med Inst Mex Seguro Soc 2011

Sobrecarga de cuidador

Factors associated with caregiver burden in patients with Alzheimers disease Psychiatry Investig 2014

47 a 55 sobrecarga leveSensibilidad 851 Especificidad 844

gt55 sobrecarga intensaSensibilidad 906 Especificidad 933

Valoracioacuten social

OARS

CAGE (Alcoholismo)

Valoracioacuten de los cuidadores

Valoracioacuten semi-estructurada Soporte informal (amigos familia)

Soporte formal (bienestar social servicios de salud)

Soporte semiformal (Iglesia centros de jubilados sociedades de fomento)

Valoracioacuten estructurada por asistente social

Herramienta diagnoacutestica multidimensional adaptada

En espantildeol Proporciona informacioacutenacerca de cinco aacutereas estructura familiar y

recursos sociales recursos econoacutemicos

Recomendaciones Sospecha de probable deterioro cognitivo

Estimulacioacuten cognitivaNonpharmacological therapies in Alzheimerrsquos disease

a systematic review of efficacy Dement Geriatr Cogn Disord 2010

The effects of a Cognitive Stimulation Therapy [CST]

programme for people with dementia on family caregiversrsquo health-

BMC Geriatr 2014

Reevaluacioacuten en 6 meses ()

Manejo sobre riesgos de sobrecarga en cuidador

Eventual uso de anti-demenciales

Esfera cognitivaSiacutentomas

conductualesSobrecarga del

cuidador

Recomendaciones Riesgo de caiacutedas

Recomendacioacuten de uso de bastoacuten

Recomendacioacuten de prevencioacuten de caiacutedas en domicilio

Eventual inicio de KNM para rehabilitacioacuten de la marcha Falls prevention for the elderly GMS Health Technol Assess 2012

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care study protocol for a randomised controlled trial (Prevquedas Brazil) BMC Geriatr 2013 Mar

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study) randomised parallel trial BMJ 2012 Aug

Evaluacioacuten de medicacioacuten potencialmente inapropiada por riesgo alto de caiacutedas

Fall risk-increasing drugs and falls a cross-sectional study among elderly patients in primary care BMC Geriatr 2014

Positive associations between fall risk and the total number of drugs (p lt 001) severe falls (p lt 001) and female sex (p = 003)

Pattern Screening and assessment

Intervention

Unstable health conditions Medical assessment Medical management may include geriatrician review medication reviewintervention to increase compliance referral for follow-up of medicalconditions

Under nutrition Setting appropriate screening

Mini Nutritional Assessment

Referral to a dietician for nutritional support educationabout foodsnutrition advice benefits of regular exercise and nutrition supportThe NICE clinical guideline lsquoNutrition Support in Adultsrsquo provides high qualityevidence for oral nutrition support in adults with malnutrition

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten criterios de BEERS

American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older AdultsThe American Geriatrics Society 2012 Beers Criteria Update Expert Panel

Evitar uso de BDZ en ancianosMayor sensibilidad a las BDZ menor capacidad de metabolizar drogas de

accioacuten larga aumento en el riesgo de deterioro cognitivo delirium y caiacutedas

El objetivo del 2012 AGS Beers Criteria es mejorar el cuidado de los ancianos reduciendo la exposicioacuten a drogas

potencialmente inapropiadas

Adverse Drug Events in Older Patients Admitted as an EmergencyThe Role of Potentially Inappropriate Medication in Elderly People (PRISCUS) Dtsch Arztebl Int Mar 2013

EM+ medication errors leadingTo clinical events

Medication errors

Riesgo nutricional El nivel nutricional es un

factor independiente de caiacutedas en ancianos de la comunidad PLoS One 2014

Hay una fuerte correlacioacuten entre deterioro cognitivo bajo nivel nutricional (Plt0005) declinacioacuten funcional (Plt005) y mortalidad (Plt001) Clin Interv Aging 2014

Existe una relacioacuten

directa entre nivel nutricional y declinacioacuten funcional Nutr J 2009

Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale for Geriatric

CARDIacuteACA 3-IAM 5 antildeos previos prueba de estreacutes anormal antec de angioplastiacutea o CRM derrame pericaacuterdico o pericarditis 4-Restriccioacuten marcada de la actividad secundaria a problema cardiacuteaco (por ej angina inestable o ICC intratable)VASCULAR3-2 o + siacutentomas de ateroesclerosis 2 o + drogas para HTA o HVI 2 o + siacutentomas de enfermedad vascular perifeacuterica 4-Cirugiacutea previa por problema vascular aneurisma aoacutertico gt4 cm

CAacuteNCER3-Requirioacute quimioterapia radioterapia terapia hormonal o procedimiento quiruacutergico para caacutencer en los uacuteltimos 5 antildeos 4-Malignidad recurrente con potencial de amenaza para la vida contencioacuten fallada de malignidad primaria tratamiento paliativo

PSIQUIAacuteTRICA3-Actualmente con depresioacuten mayor o 2 o + episodios de depresioacuten gt en los uacuteltimos 10 antildeos demencia moderada (MMT 15-20) uso actual de medicacioacuten ansioliacutetica actual abuso de sustancia o dependencia requiere medicacioacuten antipsicoacutetica diaria 4-Enfermedad mental actual requiriendo hospitalizacioacuten institucionalizacioacuten o manejo ambulatorio intensivo depresioacuten severa o suicida psicosis aguda o descompensacioacuten psicoacutetica agitacioacuten severa por demencia intoxicacioacuten por sustancias demencia severa (MMTlt15)

ENDOCRINO-METABOacuteLICA Y MAMA3-Cualquier alteracioacuten electroliacutetica que requiere tratamiento hospitalario BMIgt45 DBT regularmente controlada en valores de 300 mgdl con leve retinopatiacutea o neuropatiacutea perifeacuterica 4-DBT laacutebil o pobremente controlada o coma diabeacutetico en el uacuteltimo antildeo requiere terapia de reemplazo adrenal carcinoma adrenal tiroideo o de mama

NEUROLOacuteGICO3-ACV con disfuncioacuten residual leve cualquier procedimiento neurocx enf neurodegenerativa de severidad moderada 4-ACV con hemiparesia o afasia funcional residual enfermedad neurodegenerativa severa

MUSCULO-ESQUELEacuteTICO3- Limitacioacuten severa en AVD x artritis requiere corticoides para condicioacuten artriacutetica fracturas de compresioacuten vertebral por osteoporosis4-Limitado a silla de ruedas deformidad articular severa o uso severamente limitado osteomielitis cualquier carcinoma de hueso o muacutesculo melanoma metastaacutesico

GENITOURINARIO3- Caacutencer prostaacutetico in situ sangrado vaginal carcinoma cervical in situ hematuria urosepsis en el uacuteltimo antildeo incontinencia diaria requiriendo pantildeales o incontinencia nocturna regular ITUs a repeticioacuten en el varoacuten 4-Retencioacuten aguda de orina cualquier carcinoma genitourinario urosepsis actual

HEPATOBILIAR3-Bilirrubina (total gt2)elevacioacuten de transaminasas (gt150 de lo normal) requerimiento de enz pancreaacuteticas para la digestioacuten 4-Obstruccioacuten biliar cualquier carcinoma del aacuterbol biliar colecistitis pancreatitis hepatitis activa

RENAL3-Creatinina seacuterica gt3 o gt 15 en conjuncioacuten con diureacutetico antihipertensivo o tratamiento con bicarbonato pielonefritis actual 4-Requerimiento de diaacutelisis carcinoma renal

GASTRO-INTESTINAL INFERIOR3-Impactacioacuten fecal en el uacuteltimo antildeo uso diario de laxantes estimulantes o enemas4-Hematoquezia impactacioacuten fecal actual diverticulitis antecde obstruccioacuten intestinal caacutencer intestinal

OCULARES OTORRINOLA-RINGOLOacuteGICA3-Parcialmente ciego requiere un acompantildeante para salir incapaz de leer el diario no escucha bien a pesar de audiacutefono 4-Ceguera funcional incapacidad de leer reconocer una cara familiar o desenvolverse en un ambiente nuevo sordera funcional laringectomiacutea requerimiento de intervencioacuten quiruacutergica para veacutertigo

GASTRO-INTESTINAL SUPERIOR3-Ulcera activa SOMF + disglusia o disfagia 4-Cancer gaacutestrico historia de uacutelcera perforada melena o hematoquezia de origen GI superior

RESPIRATORIA3-Deambulacion limitada secundaria a capacidad respiratoria limitada requiere corticoides orales tbq gt40 py nac aguda 4-Requiere oxiacutegeno suplementario al menos un episodio de falla respiratoria requiriendo ARM caacutencer pulmonar

HEMATOPOYEacuteTICA3-Hb mujeres lt8 varones lt10 GBlt2000 4-Leucemia o linfoma

The measures that have been most widely used and for which there is

greatest evidence of validity are the Charlson index disease counts and the ACG System Other measures such as

the CIRS are more complex to administer and their advantages over

easier methods have not been well established Ann Fam Med Mar 2012

The assessment of CIRS-G requires a health professional more skilled on clinical examination all of these indexes have been

shown to have a good predictive value about functional impairment and mortality

Rev Med Inst Mex Seguro Soc 2011

Sobrecarga de cuidador

Factors associated with caregiver burden in patients with Alzheimers disease Psychiatry Investig 2014

47 a 55 sobrecarga leveSensibilidad 851 Especificidad 844

gt55 sobrecarga intensaSensibilidad 906 Especificidad 933

Valoracioacuten social

OARS

CAGE (Alcoholismo)

Valoracioacuten de los cuidadores

Valoracioacuten semi-estructurada Soporte informal (amigos familia)

Soporte formal (bienestar social servicios de salud)

Soporte semiformal (Iglesia centros de jubilados sociedades de fomento)

Valoracioacuten estructurada por asistente social

Herramienta diagnoacutestica multidimensional adaptada

En espantildeol Proporciona informacioacutenacerca de cinco aacutereas estructura familiar y

recursos sociales recursos econoacutemicos

Recomendaciones Sospecha de probable deterioro cognitivo

Estimulacioacuten cognitivaNonpharmacological therapies in Alzheimerrsquos disease

a systematic review of efficacy Dement Geriatr Cogn Disord 2010

The effects of a Cognitive Stimulation Therapy [CST]

programme for people with dementia on family caregiversrsquo health-

BMC Geriatr 2014

Reevaluacioacuten en 6 meses ()

Manejo sobre riesgos de sobrecarga en cuidador

Eventual uso de anti-demenciales

Esfera cognitivaSiacutentomas

conductualesSobrecarga del

cuidador

Recomendaciones Riesgo de caiacutedas

Recomendacioacuten de uso de bastoacuten

Recomendacioacuten de prevencioacuten de caiacutedas en domicilio

Eventual inicio de KNM para rehabilitacioacuten de la marcha Falls prevention for the elderly GMS Health Technol Assess 2012

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care study protocol for a randomised controlled trial (Prevquedas Brazil) BMC Geriatr 2013 Mar

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study) randomised parallel trial BMJ 2012 Aug

Evaluacioacuten de medicacioacuten potencialmente inapropiada por riesgo alto de caiacutedas

Fall risk-increasing drugs and falls a cross-sectional study among elderly patients in primary care BMC Geriatr 2014

Positive associations between fall risk and the total number of drugs (p lt 001) severe falls (p lt 001) and female sex (p = 003)

Pattern Screening and assessment

Intervention

Unstable health conditions Medical assessment Medical management may include geriatrician review medication reviewintervention to increase compliance referral for follow-up of medicalconditions

Under nutrition Setting appropriate screening

Mini Nutritional Assessment

Referral to a dietician for nutritional support educationabout foodsnutrition advice benefits of regular exercise and nutrition supportThe NICE clinical guideline lsquoNutrition Support in Adultsrsquo provides high qualityevidence for oral nutrition support in adults with malnutrition

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

El objetivo del 2012 AGS Beers Criteria es mejorar el cuidado de los ancianos reduciendo la exposicioacuten a drogas

potencialmente inapropiadas

Adverse Drug Events in Older Patients Admitted as an EmergencyThe Role of Potentially Inappropriate Medication in Elderly People (PRISCUS) Dtsch Arztebl Int Mar 2013

EM+ medication errors leadingTo clinical events

Medication errors

Riesgo nutricional El nivel nutricional es un

factor independiente de caiacutedas en ancianos de la comunidad PLoS One 2014

Hay una fuerte correlacioacuten entre deterioro cognitivo bajo nivel nutricional (Plt0005) declinacioacuten funcional (Plt005) y mortalidad (Plt001) Clin Interv Aging 2014

Existe una relacioacuten

directa entre nivel nutricional y declinacioacuten funcional Nutr J 2009

Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale for Geriatric

CARDIacuteACA 3-IAM 5 antildeos previos prueba de estreacutes anormal antec de angioplastiacutea o CRM derrame pericaacuterdico o pericarditis 4-Restriccioacuten marcada de la actividad secundaria a problema cardiacuteaco (por ej angina inestable o ICC intratable)VASCULAR3-2 o + siacutentomas de ateroesclerosis 2 o + drogas para HTA o HVI 2 o + siacutentomas de enfermedad vascular perifeacuterica 4-Cirugiacutea previa por problema vascular aneurisma aoacutertico gt4 cm

CAacuteNCER3-Requirioacute quimioterapia radioterapia terapia hormonal o procedimiento quiruacutergico para caacutencer en los uacuteltimos 5 antildeos 4-Malignidad recurrente con potencial de amenaza para la vida contencioacuten fallada de malignidad primaria tratamiento paliativo

PSIQUIAacuteTRICA3-Actualmente con depresioacuten mayor o 2 o + episodios de depresioacuten gt en los uacuteltimos 10 antildeos demencia moderada (MMT 15-20) uso actual de medicacioacuten ansioliacutetica actual abuso de sustancia o dependencia requiere medicacioacuten antipsicoacutetica diaria 4-Enfermedad mental actual requiriendo hospitalizacioacuten institucionalizacioacuten o manejo ambulatorio intensivo depresioacuten severa o suicida psicosis aguda o descompensacioacuten psicoacutetica agitacioacuten severa por demencia intoxicacioacuten por sustancias demencia severa (MMTlt15)

ENDOCRINO-METABOacuteLICA Y MAMA3-Cualquier alteracioacuten electroliacutetica que requiere tratamiento hospitalario BMIgt45 DBT regularmente controlada en valores de 300 mgdl con leve retinopatiacutea o neuropatiacutea perifeacuterica 4-DBT laacutebil o pobremente controlada o coma diabeacutetico en el uacuteltimo antildeo requiere terapia de reemplazo adrenal carcinoma adrenal tiroideo o de mama

NEUROLOacuteGICO3-ACV con disfuncioacuten residual leve cualquier procedimiento neurocx enf neurodegenerativa de severidad moderada 4-ACV con hemiparesia o afasia funcional residual enfermedad neurodegenerativa severa

MUSCULO-ESQUELEacuteTICO3- Limitacioacuten severa en AVD x artritis requiere corticoides para condicioacuten artriacutetica fracturas de compresioacuten vertebral por osteoporosis4-Limitado a silla de ruedas deformidad articular severa o uso severamente limitado osteomielitis cualquier carcinoma de hueso o muacutesculo melanoma metastaacutesico

GENITOURINARIO3- Caacutencer prostaacutetico in situ sangrado vaginal carcinoma cervical in situ hematuria urosepsis en el uacuteltimo antildeo incontinencia diaria requiriendo pantildeales o incontinencia nocturna regular ITUs a repeticioacuten en el varoacuten 4-Retencioacuten aguda de orina cualquier carcinoma genitourinario urosepsis actual

HEPATOBILIAR3-Bilirrubina (total gt2)elevacioacuten de transaminasas (gt150 de lo normal) requerimiento de enz pancreaacuteticas para la digestioacuten 4-Obstruccioacuten biliar cualquier carcinoma del aacuterbol biliar colecistitis pancreatitis hepatitis activa

RENAL3-Creatinina seacuterica gt3 o gt 15 en conjuncioacuten con diureacutetico antihipertensivo o tratamiento con bicarbonato pielonefritis actual 4-Requerimiento de diaacutelisis carcinoma renal

GASTRO-INTESTINAL INFERIOR3-Impactacioacuten fecal en el uacuteltimo antildeo uso diario de laxantes estimulantes o enemas4-Hematoquezia impactacioacuten fecal actual diverticulitis antecde obstruccioacuten intestinal caacutencer intestinal

OCULARES OTORRINOLA-RINGOLOacuteGICA3-Parcialmente ciego requiere un acompantildeante para salir incapaz de leer el diario no escucha bien a pesar de audiacutefono 4-Ceguera funcional incapacidad de leer reconocer una cara familiar o desenvolverse en un ambiente nuevo sordera funcional laringectomiacutea requerimiento de intervencioacuten quiruacutergica para veacutertigo

GASTRO-INTESTINAL SUPERIOR3-Ulcera activa SOMF + disglusia o disfagia 4-Cancer gaacutestrico historia de uacutelcera perforada melena o hematoquezia de origen GI superior

RESPIRATORIA3-Deambulacion limitada secundaria a capacidad respiratoria limitada requiere corticoides orales tbq gt40 py nac aguda 4-Requiere oxiacutegeno suplementario al menos un episodio de falla respiratoria requiriendo ARM caacutencer pulmonar

HEMATOPOYEacuteTICA3-Hb mujeres lt8 varones lt10 GBlt2000 4-Leucemia o linfoma

The measures that have been most widely used and for which there is

greatest evidence of validity are the Charlson index disease counts and the ACG System Other measures such as

the CIRS are more complex to administer and their advantages over

easier methods have not been well established Ann Fam Med Mar 2012

The assessment of CIRS-G requires a health professional more skilled on clinical examination all of these indexes have been

shown to have a good predictive value about functional impairment and mortality

Rev Med Inst Mex Seguro Soc 2011

Sobrecarga de cuidador

Factors associated with caregiver burden in patients with Alzheimers disease Psychiatry Investig 2014

47 a 55 sobrecarga leveSensibilidad 851 Especificidad 844

gt55 sobrecarga intensaSensibilidad 906 Especificidad 933

Valoracioacuten social

OARS

CAGE (Alcoholismo)

Valoracioacuten de los cuidadores

Valoracioacuten semi-estructurada Soporte informal (amigos familia)

Soporte formal (bienestar social servicios de salud)

Soporte semiformal (Iglesia centros de jubilados sociedades de fomento)

Valoracioacuten estructurada por asistente social

Herramienta diagnoacutestica multidimensional adaptada

En espantildeol Proporciona informacioacutenacerca de cinco aacutereas estructura familiar y

recursos sociales recursos econoacutemicos

Recomendaciones Sospecha de probable deterioro cognitivo

Estimulacioacuten cognitivaNonpharmacological therapies in Alzheimerrsquos disease

a systematic review of efficacy Dement Geriatr Cogn Disord 2010

The effects of a Cognitive Stimulation Therapy [CST]

programme for people with dementia on family caregiversrsquo health-

BMC Geriatr 2014

Reevaluacioacuten en 6 meses ()

Manejo sobre riesgos de sobrecarga en cuidador

Eventual uso de anti-demenciales

Esfera cognitivaSiacutentomas

conductualesSobrecarga del

cuidador

Recomendaciones Riesgo de caiacutedas

Recomendacioacuten de uso de bastoacuten

Recomendacioacuten de prevencioacuten de caiacutedas en domicilio

Eventual inicio de KNM para rehabilitacioacuten de la marcha Falls prevention for the elderly GMS Health Technol Assess 2012

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care study protocol for a randomised controlled trial (Prevquedas Brazil) BMC Geriatr 2013 Mar

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study) randomised parallel trial BMJ 2012 Aug

Evaluacioacuten de medicacioacuten potencialmente inapropiada por riesgo alto de caiacutedas

Fall risk-increasing drugs and falls a cross-sectional study among elderly patients in primary care BMC Geriatr 2014

Positive associations between fall risk and the total number of drugs (p lt 001) severe falls (p lt 001) and female sex (p = 003)

Pattern Screening and assessment

Intervention

Unstable health conditions Medical assessment Medical management may include geriatrician review medication reviewintervention to increase compliance referral for follow-up of medicalconditions

Under nutrition Setting appropriate screening

Mini Nutritional Assessment

Referral to a dietician for nutritional support educationabout foodsnutrition advice benefits of regular exercise and nutrition supportThe NICE clinical guideline lsquoNutrition Support in Adultsrsquo provides high qualityevidence for oral nutrition support in adults with malnutrition

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

Riesgo nutricional El nivel nutricional es un

factor independiente de caiacutedas en ancianos de la comunidad PLoS One 2014

Hay una fuerte correlacioacuten entre deterioro cognitivo bajo nivel nutricional (Plt0005) declinacioacuten funcional (Plt005) y mortalidad (Plt001) Clin Interv Aging 2014

Existe una relacioacuten

directa entre nivel nutricional y declinacioacuten funcional Nutr J 2009

Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale for Geriatric

CARDIacuteACA 3-IAM 5 antildeos previos prueba de estreacutes anormal antec de angioplastiacutea o CRM derrame pericaacuterdico o pericarditis 4-Restriccioacuten marcada de la actividad secundaria a problema cardiacuteaco (por ej angina inestable o ICC intratable)VASCULAR3-2 o + siacutentomas de ateroesclerosis 2 o + drogas para HTA o HVI 2 o + siacutentomas de enfermedad vascular perifeacuterica 4-Cirugiacutea previa por problema vascular aneurisma aoacutertico gt4 cm

CAacuteNCER3-Requirioacute quimioterapia radioterapia terapia hormonal o procedimiento quiruacutergico para caacutencer en los uacuteltimos 5 antildeos 4-Malignidad recurrente con potencial de amenaza para la vida contencioacuten fallada de malignidad primaria tratamiento paliativo

PSIQUIAacuteTRICA3-Actualmente con depresioacuten mayor o 2 o + episodios de depresioacuten gt en los uacuteltimos 10 antildeos demencia moderada (MMT 15-20) uso actual de medicacioacuten ansioliacutetica actual abuso de sustancia o dependencia requiere medicacioacuten antipsicoacutetica diaria 4-Enfermedad mental actual requiriendo hospitalizacioacuten institucionalizacioacuten o manejo ambulatorio intensivo depresioacuten severa o suicida psicosis aguda o descompensacioacuten psicoacutetica agitacioacuten severa por demencia intoxicacioacuten por sustancias demencia severa (MMTlt15)

ENDOCRINO-METABOacuteLICA Y MAMA3-Cualquier alteracioacuten electroliacutetica que requiere tratamiento hospitalario BMIgt45 DBT regularmente controlada en valores de 300 mgdl con leve retinopatiacutea o neuropatiacutea perifeacuterica 4-DBT laacutebil o pobremente controlada o coma diabeacutetico en el uacuteltimo antildeo requiere terapia de reemplazo adrenal carcinoma adrenal tiroideo o de mama

NEUROLOacuteGICO3-ACV con disfuncioacuten residual leve cualquier procedimiento neurocx enf neurodegenerativa de severidad moderada 4-ACV con hemiparesia o afasia funcional residual enfermedad neurodegenerativa severa

MUSCULO-ESQUELEacuteTICO3- Limitacioacuten severa en AVD x artritis requiere corticoides para condicioacuten artriacutetica fracturas de compresioacuten vertebral por osteoporosis4-Limitado a silla de ruedas deformidad articular severa o uso severamente limitado osteomielitis cualquier carcinoma de hueso o muacutesculo melanoma metastaacutesico

GENITOURINARIO3- Caacutencer prostaacutetico in situ sangrado vaginal carcinoma cervical in situ hematuria urosepsis en el uacuteltimo antildeo incontinencia diaria requiriendo pantildeales o incontinencia nocturna regular ITUs a repeticioacuten en el varoacuten 4-Retencioacuten aguda de orina cualquier carcinoma genitourinario urosepsis actual

HEPATOBILIAR3-Bilirrubina (total gt2)elevacioacuten de transaminasas (gt150 de lo normal) requerimiento de enz pancreaacuteticas para la digestioacuten 4-Obstruccioacuten biliar cualquier carcinoma del aacuterbol biliar colecistitis pancreatitis hepatitis activa

RENAL3-Creatinina seacuterica gt3 o gt 15 en conjuncioacuten con diureacutetico antihipertensivo o tratamiento con bicarbonato pielonefritis actual 4-Requerimiento de diaacutelisis carcinoma renal

GASTRO-INTESTINAL INFERIOR3-Impactacioacuten fecal en el uacuteltimo antildeo uso diario de laxantes estimulantes o enemas4-Hematoquezia impactacioacuten fecal actual diverticulitis antecde obstruccioacuten intestinal caacutencer intestinal

OCULARES OTORRINOLA-RINGOLOacuteGICA3-Parcialmente ciego requiere un acompantildeante para salir incapaz de leer el diario no escucha bien a pesar de audiacutefono 4-Ceguera funcional incapacidad de leer reconocer una cara familiar o desenvolverse en un ambiente nuevo sordera funcional laringectomiacutea requerimiento de intervencioacuten quiruacutergica para veacutertigo

GASTRO-INTESTINAL SUPERIOR3-Ulcera activa SOMF + disglusia o disfagia 4-Cancer gaacutestrico historia de uacutelcera perforada melena o hematoquezia de origen GI superior

RESPIRATORIA3-Deambulacion limitada secundaria a capacidad respiratoria limitada requiere corticoides orales tbq gt40 py nac aguda 4-Requiere oxiacutegeno suplementario al menos un episodio de falla respiratoria requiriendo ARM caacutencer pulmonar

HEMATOPOYEacuteTICA3-Hb mujeres lt8 varones lt10 GBlt2000 4-Leucemia o linfoma

The measures that have been most widely used and for which there is

greatest evidence of validity are the Charlson index disease counts and the ACG System Other measures such as

the CIRS are more complex to administer and their advantages over

easier methods have not been well established Ann Fam Med Mar 2012

The assessment of CIRS-G requires a health professional more skilled on clinical examination all of these indexes have been

shown to have a good predictive value about functional impairment and mortality

Rev Med Inst Mex Seguro Soc 2011

Sobrecarga de cuidador

Factors associated with caregiver burden in patients with Alzheimers disease Psychiatry Investig 2014

47 a 55 sobrecarga leveSensibilidad 851 Especificidad 844

gt55 sobrecarga intensaSensibilidad 906 Especificidad 933

Valoracioacuten social

OARS

CAGE (Alcoholismo)

Valoracioacuten de los cuidadores

Valoracioacuten semi-estructurada Soporte informal (amigos familia)

Soporte formal (bienestar social servicios de salud)

Soporte semiformal (Iglesia centros de jubilados sociedades de fomento)

Valoracioacuten estructurada por asistente social

Herramienta diagnoacutestica multidimensional adaptada

En espantildeol Proporciona informacioacutenacerca de cinco aacutereas estructura familiar y

recursos sociales recursos econoacutemicos

Recomendaciones Sospecha de probable deterioro cognitivo

Estimulacioacuten cognitivaNonpharmacological therapies in Alzheimerrsquos disease

a systematic review of efficacy Dement Geriatr Cogn Disord 2010

The effects of a Cognitive Stimulation Therapy [CST]

programme for people with dementia on family caregiversrsquo health-

BMC Geriatr 2014

Reevaluacioacuten en 6 meses ()

Manejo sobre riesgos de sobrecarga en cuidador

Eventual uso de anti-demenciales

Esfera cognitivaSiacutentomas

conductualesSobrecarga del

cuidador

Recomendaciones Riesgo de caiacutedas

Recomendacioacuten de uso de bastoacuten

Recomendacioacuten de prevencioacuten de caiacutedas en domicilio

Eventual inicio de KNM para rehabilitacioacuten de la marcha Falls prevention for the elderly GMS Health Technol Assess 2012

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care study protocol for a randomised controlled trial (Prevquedas Brazil) BMC Geriatr 2013 Mar

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study) randomised parallel trial BMJ 2012 Aug

Evaluacioacuten de medicacioacuten potencialmente inapropiada por riesgo alto de caiacutedas

Fall risk-increasing drugs and falls a cross-sectional study among elderly patients in primary care BMC Geriatr 2014

Positive associations between fall risk and the total number of drugs (p lt 001) severe falls (p lt 001) and female sex (p = 003)

Pattern Screening and assessment

Intervention

Unstable health conditions Medical assessment Medical management may include geriatrician review medication reviewintervention to increase compliance referral for follow-up of medicalconditions

Under nutrition Setting appropriate screening

Mini Nutritional Assessment

Referral to a dietician for nutritional support educationabout foodsnutrition advice benefits of regular exercise and nutrition supportThe NICE clinical guideline lsquoNutrition Support in Adultsrsquo provides high qualityevidence for oral nutrition support in adults with malnutrition

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale for Geriatric

CARDIacuteACA 3-IAM 5 antildeos previos prueba de estreacutes anormal antec de angioplastiacutea o CRM derrame pericaacuterdico o pericarditis 4-Restriccioacuten marcada de la actividad secundaria a problema cardiacuteaco (por ej angina inestable o ICC intratable)VASCULAR3-2 o + siacutentomas de ateroesclerosis 2 o + drogas para HTA o HVI 2 o + siacutentomas de enfermedad vascular perifeacuterica 4-Cirugiacutea previa por problema vascular aneurisma aoacutertico gt4 cm

CAacuteNCER3-Requirioacute quimioterapia radioterapia terapia hormonal o procedimiento quiruacutergico para caacutencer en los uacuteltimos 5 antildeos 4-Malignidad recurrente con potencial de amenaza para la vida contencioacuten fallada de malignidad primaria tratamiento paliativo

PSIQUIAacuteTRICA3-Actualmente con depresioacuten mayor o 2 o + episodios de depresioacuten gt en los uacuteltimos 10 antildeos demencia moderada (MMT 15-20) uso actual de medicacioacuten ansioliacutetica actual abuso de sustancia o dependencia requiere medicacioacuten antipsicoacutetica diaria 4-Enfermedad mental actual requiriendo hospitalizacioacuten institucionalizacioacuten o manejo ambulatorio intensivo depresioacuten severa o suicida psicosis aguda o descompensacioacuten psicoacutetica agitacioacuten severa por demencia intoxicacioacuten por sustancias demencia severa (MMTlt15)

ENDOCRINO-METABOacuteLICA Y MAMA3-Cualquier alteracioacuten electroliacutetica que requiere tratamiento hospitalario BMIgt45 DBT regularmente controlada en valores de 300 mgdl con leve retinopatiacutea o neuropatiacutea perifeacuterica 4-DBT laacutebil o pobremente controlada o coma diabeacutetico en el uacuteltimo antildeo requiere terapia de reemplazo adrenal carcinoma adrenal tiroideo o de mama

NEUROLOacuteGICO3-ACV con disfuncioacuten residual leve cualquier procedimiento neurocx enf neurodegenerativa de severidad moderada 4-ACV con hemiparesia o afasia funcional residual enfermedad neurodegenerativa severa

MUSCULO-ESQUELEacuteTICO3- Limitacioacuten severa en AVD x artritis requiere corticoides para condicioacuten artriacutetica fracturas de compresioacuten vertebral por osteoporosis4-Limitado a silla de ruedas deformidad articular severa o uso severamente limitado osteomielitis cualquier carcinoma de hueso o muacutesculo melanoma metastaacutesico

GENITOURINARIO3- Caacutencer prostaacutetico in situ sangrado vaginal carcinoma cervical in situ hematuria urosepsis en el uacuteltimo antildeo incontinencia diaria requiriendo pantildeales o incontinencia nocturna regular ITUs a repeticioacuten en el varoacuten 4-Retencioacuten aguda de orina cualquier carcinoma genitourinario urosepsis actual

HEPATOBILIAR3-Bilirrubina (total gt2)elevacioacuten de transaminasas (gt150 de lo normal) requerimiento de enz pancreaacuteticas para la digestioacuten 4-Obstruccioacuten biliar cualquier carcinoma del aacuterbol biliar colecistitis pancreatitis hepatitis activa

RENAL3-Creatinina seacuterica gt3 o gt 15 en conjuncioacuten con diureacutetico antihipertensivo o tratamiento con bicarbonato pielonefritis actual 4-Requerimiento de diaacutelisis carcinoma renal

GASTRO-INTESTINAL INFERIOR3-Impactacioacuten fecal en el uacuteltimo antildeo uso diario de laxantes estimulantes o enemas4-Hematoquezia impactacioacuten fecal actual diverticulitis antecde obstruccioacuten intestinal caacutencer intestinal

OCULARES OTORRINOLA-RINGOLOacuteGICA3-Parcialmente ciego requiere un acompantildeante para salir incapaz de leer el diario no escucha bien a pesar de audiacutefono 4-Ceguera funcional incapacidad de leer reconocer una cara familiar o desenvolverse en un ambiente nuevo sordera funcional laringectomiacutea requerimiento de intervencioacuten quiruacutergica para veacutertigo

GASTRO-INTESTINAL SUPERIOR3-Ulcera activa SOMF + disglusia o disfagia 4-Cancer gaacutestrico historia de uacutelcera perforada melena o hematoquezia de origen GI superior

RESPIRATORIA3-Deambulacion limitada secundaria a capacidad respiratoria limitada requiere corticoides orales tbq gt40 py nac aguda 4-Requiere oxiacutegeno suplementario al menos un episodio de falla respiratoria requiriendo ARM caacutencer pulmonar

HEMATOPOYEacuteTICA3-Hb mujeres lt8 varones lt10 GBlt2000 4-Leucemia o linfoma

The measures that have been most widely used and for which there is

greatest evidence of validity are the Charlson index disease counts and the ACG System Other measures such as

the CIRS are more complex to administer and their advantages over

easier methods have not been well established Ann Fam Med Mar 2012

The assessment of CIRS-G requires a health professional more skilled on clinical examination all of these indexes have been

shown to have a good predictive value about functional impairment and mortality

Rev Med Inst Mex Seguro Soc 2011

Sobrecarga de cuidador

Factors associated with caregiver burden in patients with Alzheimers disease Psychiatry Investig 2014

47 a 55 sobrecarga leveSensibilidad 851 Especificidad 844

gt55 sobrecarga intensaSensibilidad 906 Especificidad 933

Valoracioacuten social

OARS

CAGE (Alcoholismo)

Valoracioacuten de los cuidadores

Valoracioacuten semi-estructurada Soporte informal (amigos familia)

Soporte formal (bienestar social servicios de salud)

Soporte semiformal (Iglesia centros de jubilados sociedades de fomento)

Valoracioacuten estructurada por asistente social

Herramienta diagnoacutestica multidimensional adaptada

En espantildeol Proporciona informacioacutenacerca de cinco aacutereas estructura familiar y

recursos sociales recursos econoacutemicos

Recomendaciones Sospecha de probable deterioro cognitivo

Estimulacioacuten cognitivaNonpharmacological therapies in Alzheimerrsquos disease

a systematic review of efficacy Dement Geriatr Cogn Disord 2010

The effects of a Cognitive Stimulation Therapy [CST]

programme for people with dementia on family caregiversrsquo health-

BMC Geriatr 2014

Reevaluacioacuten en 6 meses ()

Manejo sobre riesgos de sobrecarga en cuidador

Eventual uso de anti-demenciales

Esfera cognitivaSiacutentomas

conductualesSobrecarga del

cuidador

Recomendaciones Riesgo de caiacutedas

Recomendacioacuten de uso de bastoacuten

Recomendacioacuten de prevencioacuten de caiacutedas en domicilio

Eventual inicio de KNM para rehabilitacioacuten de la marcha Falls prevention for the elderly GMS Health Technol Assess 2012

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care study protocol for a randomised controlled trial (Prevquedas Brazil) BMC Geriatr 2013 Mar

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study) randomised parallel trial BMJ 2012 Aug

Evaluacioacuten de medicacioacuten potencialmente inapropiada por riesgo alto de caiacutedas

Fall risk-increasing drugs and falls a cross-sectional study among elderly patients in primary care BMC Geriatr 2014

Positive associations between fall risk and the total number of drugs (p lt 001) severe falls (p lt 001) and female sex (p = 003)

Pattern Screening and assessment

Intervention

Unstable health conditions Medical assessment Medical management may include geriatrician review medication reviewintervention to increase compliance referral for follow-up of medicalconditions

Under nutrition Setting appropriate screening

Mini Nutritional Assessment

Referral to a dietician for nutritional support educationabout foodsnutrition advice benefits of regular exercise and nutrition supportThe NICE clinical guideline lsquoNutrition Support in Adultsrsquo provides high qualityevidence for oral nutrition support in adults with malnutrition

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

The measures that have been most widely used and for which there is

greatest evidence of validity are the Charlson index disease counts and the ACG System Other measures such as

the CIRS are more complex to administer and their advantages over

easier methods have not been well established Ann Fam Med Mar 2012

The assessment of CIRS-G requires a health professional more skilled on clinical examination all of these indexes have been

shown to have a good predictive value about functional impairment and mortality

Rev Med Inst Mex Seguro Soc 2011

Sobrecarga de cuidador

Factors associated with caregiver burden in patients with Alzheimers disease Psychiatry Investig 2014

47 a 55 sobrecarga leveSensibilidad 851 Especificidad 844

gt55 sobrecarga intensaSensibilidad 906 Especificidad 933

Valoracioacuten social

OARS

CAGE (Alcoholismo)

Valoracioacuten de los cuidadores

Valoracioacuten semi-estructurada Soporte informal (amigos familia)

Soporte formal (bienestar social servicios de salud)

Soporte semiformal (Iglesia centros de jubilados sociedades de fomento)

Valoracioacuten estructurada por asistente social

Herramienta diagnoacutestica multidimensional adaptada

En espantildeol Proporciona informacioacutenacerca de cinco aacutereas estructura familiar y

recursos sociales recursos econoacutemicos

Recomendaciones Sospecha de probable deterioro cognitivo

Estimulacioacuten cognitivaNonpharmacological therapies in Alzheimerrsquos disease

a systematic review of efficacy Dement Geriatr Cogn Disord 2010

The effects of a Cognitive Stimulation Therapy [CST]

programme for people with dementia on family caregiversrsquo health-

BMC Geriatr 2014

Reevaluacioacuten en 6 meses ()

Manejo sobre riesgos de sobrecarga en cuidador

Eventual uso de anti-demenciales

Esfera cognitivaSiacutentomas

conductualesSobrecarga del

cuidador

Recomendaciones Riesgo de caiacutedas

Recomendacioacuten de uso de bastoacuten

Recomendacioacuten de prevencioacuten de caiacutedas en domicilio

Eventual inicio de KNM para rehabilitacioacuten de la marcha Falls prevention for the elderly GMS Health Technol Assess 2012

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care study protocol for a randomised controlled trial (Prevquedas Brazil) BMC Geriatr 2013 Mar

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study) randomised parallel trial BMJ 2012 Aug

Evaluacioacuten de medicacioacuten potencialmente inapropiada por riesgo alto de caiacutedas

Fall risk-increasing drugs and falls a cross-sectional study among elderly patients in primary care BMC Geriatr 2014

Positive associations between fall risk and the total number of drugs (p lt 001) severe falls (p lt 001) and female sex (p = 003)

Pattern Screening and assessment

Intervention

Unstable health conditions Medical assessment Medical management may include geriatrician review medication reviewintervention to increase compliance referral for follow-up of medicalconditions

Under nutrition Setting appropriate screening

Mini Nutritional Assessment

Referral to a dietician for nutritional support educationabout foodsnutrition advice benefits of regular exercise and nutrition supportThe NICE clinical guideline lsquoNutrition Support in Adultsrsquo provides high qualityevidence for oral nutrition support in adults with malnutrition

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

Sobrecarga de cuidador

Factors associated with caregiver burden in patients with Alzheimers disease Psychiatry Investig 2014

47 a 55 sobrecarga leveSensibilidad 851 Especificidad 844

gt55 sobrecarga intensaSensibilidad 906 Especificidad 933

Valoracioacuten social

OARS

CAGE (Alcoholismo)

Valoracioacuten de los cuidadores

Valoracioacuten semi-estructurada Soporte informal (amigos familia)

Soporte formal (bienestar social servicios de salud)

Soporte semiformal (Iglesia centros de jubilados sociedades de fomento)

Valoracioacuten estructurada por asistente social

Herramienta diagnoacutestica multidimensional adaptada

En espantildeol Proporciona informacioacutenacerca de cinco aacutereas estructura familiar y

recursos sociales recursos econoacutemicos

Recomendaciones Sospecha de probable deterioro cognitivo

Estimulacioacuten cognitivaNonpharmacological therapies in Alzheimerrsquos disease

a systematic review of efficacy Dement Geriatr Cogn Disord 2010

The effects of a Cognitive Stimulation Therapy [CST]

programme for people with dementia on family caregiversrsquo health-

BMC Geriatr 2014

Reevaluacioacuten en 6 meses ()

Manejo sobre riesgos de sobrecarga en cuidador

Eventual uso de anti-demenciales

Esfera cognitivaSiacutentomas

conductualesSobrecarga del

cuidador

Recomendaciones Riesgo de caiacutedas

Recomendacioacuten de uso de bastoacuten

Recomendacioacuten de prevencioacuten de caiacutedas en domicilio

Eventual inicio de KNM para rehabilitacioacuten de la marcha Falls prevention for the elderly GMS Health Technol Assess 2012

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care study protocol for a randomised controlled trial (Prevquedas Brazil) BMC Geriatr 2013 Mar

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study) randomised parallel trial BMJ 2012 Aug

Evaluacioacuten de medicacioacuten potencialmente inapropiada por riesgo alto de caiacutedas

Fall risk-increasing drugs and falls a cross-sectional study among elderly patients in primary care BMC Geriatr 2014

Positive associations between fall risk and the total number of drugs (p lt 001) severe falls (p lt 001) and female sex (p = 003)

Pattern Screening and assessment

Intervention

Unstable health conditions Medical assessment Medical management may include geriatrician review medication reviewintervention to increase compliance referral for follow-up of medicalconditions

Under nutrition Setting appropriate screening

Mini Nutritional Assessment

Referral to a dietician for nutritional support educationabout foodsnutrition advice benefits of regular exercise and nutrition supportThe NICE clinical guideline lsquoNutrition Support in Adultsrsquo provides high qualityevidence for oral nutrition support in adults with malnutrition

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

47 a 55 sobrecarga leveSensibilidad 851 Especificidad 844

gt55 sobrecarga intensaSensibilidad 906 Especificidad 933

Valoracioacuten social

OARS

CAGE (Alcoholismo)

Valoracioacuten de los cuidadores

Valoracioacuten semi-estructurada Soporte informal (amigos familia)

Soporte formal (bienestar social servicios de salud)

Soporte semiformal (Iglesia centros de jubilados sociedades de fomento)

Valoracioacuten estructurada por asistente social

Herramienta diagnoacutestica multidimensional adaptada

En espantildeol Proporciona informacioacutenacerca de cinco aacutereas estructura familiar y

recursos sociales recursos econoacutemicos

Recomendaciones Sospecha de probable deterioro cognitivo

Estimulacioacuten cognitivaNonpharmacological therapies in Alzheimerrsquos disease

a systematic review of efficacy Dement Geriatr Cogn Disord 2010

The effects of a Cognitive Stimulation Therapy [CST]

programme for people with dementia on family caregiversrsquo health-

BMC Geriatr 2014

Reevaluacioacuten en 6 meses ()

Manejo sobre riesgos de sobrecarga en cuidador

Eventual uso de anti-demenciales

Esfera cognitivaSiacutentomas

conductualesSobrecarga del

cuidador

Recomendaciones Riesgo de caiacutedas

Recomendacioacuten de uso de bastoacuten

Recomendacioacuten de prevencioacuten de caiacutedas en domicilio

Eventual inicio de KNM para rehabilitacioacuten de la marcha Falls prevention for the elderly GMS Health Technol Assess 2012

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care study protocol for a randomised controlled trial (Prevquedas Brazil) BMC Geriatr 2013 Mar

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study) randomised parallel trial BMJ 2012 Aug

Evaluacioacuten de medicacioacuten potencialmente inapropiada por riesgo alto de caiacutedas

Fall risk-increasing drugs and falls a cross-sectional study among elderly patients in primary care BMC Geriatr 2014

Positive associations between fall risk and the total number of drugs (p lt 001) severe falls (p lt 001) and female sex (p = 003)

Pattern Screening and assessment

Intervention

Unstable health conditions Medical assessment Medical management may include geriatrician review medication reviewintervention to increase compliance referral for follow-up of medicalconditions

Under nutrition Setting appropriate screening

Mini Nutritional Assessment

Referral to a dietician for nutritional support educationabout foodsnutrition advice benefits of regular exercise and nutrition supportThe NICE clinical guideline lsquoNutrition Support in Adultsrsquo provides high qualityevidence for oral nutrition support in adults with malnutrition

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

Valoracioacuten social

OARS

CAGE (Alcoholismo)

Valoracioacuten de los cuidadores

Valoracioacuten semi-estructurada Soporte informal (amigos familia)

Soporte formal (bienestar social servicios de salud)

Soporte semiformal (Iglesia centros de jubilados sociedades de fomento)

Valoracioacuten estructurada por asistente social

Herramienta diagnoacutestica multidimensional adaptada

En espantildeol Proporciona informacioacutenacerca de cinco aacutereas estructura familiar y

recursos sociales recursos econoacutemicos

Recomendaciones Sospecha de probable deterioro cognitivo

Estimulacioacuten cognitivaNonpharmacological therapies in Alzheimerrsquos disease

a systematic review of efficacy Dement Geriatr Cogn Disord 2010

The effects of a Cognitive Stimulation Therapy [CST]

programme for people with dementia on family caregiversrsquo health-

BMC Geriatr 2014

Reevaluacioacuten en 6 meses ()

Manejo sobre riesgos de sobrecarga en cuidador

Eventual uso de anti-demenciales

Esfera cognitivaSiacutentomas

conductualesSobrecarga del

cuidador

Recomendaciones Riesgo de caiacutedas

Recomendacioacuten de uso de bastoacuten

Recomendacioacuten de prevencioacuten de caiacutedas en domicilio

Eventual inicio de KNM para rehabilitacioacuten de la marcha Falls prevention for the elderly GMS Health Technol Assess 2012

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care study protocol for a randomised controlled trial (Prevquedas Brazil) BMC Geriatr 2013 Mar

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study) randomised parallel trial BMJ 2012 Aug

Evaluacioacuten de medicacioacuten potencialmente inapropiada por riesgo alto de caiacutedas

Fall risk-increasing drugs and falls a cross-sectional study among elderly patients in primary care BMC Geriatr 2014

Positive associations between fall risk and the total number of drugs (p lt 001) severe falls (p lt 001) and female sex (p = 003)

Pattern Screening and assessment

Intervention

Unstable health conditions Medical assessment Medical management may include geriatrician review medication reviewintervention to increase compliance referral for follow-up of medicalconditions

Under nutrition Setting appropriate screening

Mini Nutritional Assessment

Referral to a dietician for nutritional support educationabout foodsnutrition advice benefits of regular exercise and nutrition supportThe NICE clinical guideline lsquoNutrition Support in Adultsrsquo provides high qualityevidence for oral nutrition support in adults with malnutrition

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

Recomendaciones Sospecha de probable deterioro cognitivo

Estimulacioacuten cognitivaNonpharmacological therapies in Alzheimerrsquos disease

a systematic review of efficacy Dement Geriatr Cogn Disord 2010

The effects of a Cognitive Stimulation Therapy [CST]

programme for people with dementia on family caregiversrsquo health-

BMC Geriatr 2014

Reevaluacioacuten en 6 meses ()

Manejo sobre riesgos de sobrecarga en cuidador

Eventual uso de anti-demenciales

Esfera cognitivaSiacutentomas

conductualesSobrecarga del

cuidador

Recomendaciones Riesgo de caiacutedas

Recomendacioacuten de uso de bastoacuten

Recomendacioacuten de prevencioacuten de caiacutedas en domicilio

Eventual inicio de KNM para rehabilitacioacuten de la marcha Falls prevention for the elderly GMS Health Technol Assess 2012

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care study protocol for a randomised controlled trial (Prevquedas Brazil) BMC Geriatr 2013 Mar

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study) randomised parallel trial BMJ 2012 Aug

Evaluacioacuten de medicacioacuten potencialmente inapropiada por riesgo alto de caiacutedas

Fall risk-increasing drugs and falls a cross-sectional study among elderly patients in primary care BMC Geriatr 2014

Positive associations between fall risk and the total number of drugs (p lt 001) severe falls (p lt 001) and female sex (p = 003)

Pattern Screening and assessment

Intervention

Unstable health conditions Medical assessment Medical management may include geriatrician review medication reviewintervention to increase compliance referral for follow-up of medicalconditions

Under nutrition Setting appropriate screening

Mini Nutritional Assessment

Referral to a dietician for nutritional support educationabout foodsnutrition advice benefits of regular exercise and nutrition supportThe NICE clinical guideline lsquoNutrition Support in Adultsrsquo provides high qualityevidence for oral nutrition support in adults with malnutrition

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

Recomendaciones Riesgo de caiacutedas

Recomendacioacuten de uso de bastoacuten

Recomendacioacuten de prevencioacuten de caiacutedas en domicilio

Eventual inicio de KNM para rehabilitacioacuten de la marcha Falls prevention for the elderly GMS Health Technol Assess 2012

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care study protocol for a randomised controlled trial (Prevquedas Brazil) BMC Geriatr 2013 Mar

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study) randomised parallel trial BMJ 2012 Aug

Evaluacioacuten de medicacioacuten potencialmente inapropiada por riesgo alto de caiacutedas

Fall risk-increasing drugs and falls a cross-sectional study among elderly patients in primary care BMC Geriatr 2014

Positive associations between fall risk and the total number of drugs (p lt 001) severe falls (p lt 001) and female sex (p = 003)

Pattern Screening and assessment

Intervention

Unstable health conditions Medical assessment Medical management may include geriatrician review medication reviewintervention to increase compliance referral for follow-up of medicalconditions

Under nutrition Setting appropriate screening

Mini Nutritional Assessment

Referral to a dietician for nutritional support educationabout foodsnutrition advice benefits of regular exercise and nutrition supportThe NICE clinical guideline lsquoNutrition Support in Adultsrsquo provides high qualityevidence for oral nutrition support in adults with malnutrition

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

Pattern Screening and assessment

Intervention

Unstable health conditions Medical assessment Medical management may include geriatrician review medication reviewintervention to increase compliance referral for follow-up of medicalconditions

Under nutrition Setting appropriate screening

Mini Nutritional Assessment

Referral to a dietician for nutritional support educationabout foodsnutrition advice benefits of regular exercise and nutrition supportThe NICE clinical guideline lsquoNutrition Support in Adultsrsquo provides high qualityevidence for oral nutrition support in adults with malnutrition

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

Pattern Screening and assessment

intervention

Psychological factors Geriatric Depression Scale (short form)

Frail older depressed patients are particularly susceptible to side effects ofantidepressant medication Antidepressant is effective inthe treatment of older peopleThe NICE clinical guideline lsquoOccupational therapy interventions and physicalactivity interventions to promote the mental wellbeing of older people inprimary care and residential carersquo

Impaired cognition Mini Mental Status Examination (MMSE)

Impaired visionhearing

Brief clinical assessment Referral for specialist Facilitate self-management of aids for visionhearing

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

Patterns Screening and assessment

intervention

Decreased mobility Timed 4 m walkTimed Up and GoLower limb strength Timed sit to standBalance 4-point balance testFalls risk Physiological Profile Assessment

Appropriately designed exercise interventions are effective in preventing falls in older people living in both the community and nursing care settings Exercise should be under-taken at least two hours per week Home safety inter-ventions reduce falls rate in this high-risk frail group andmultifactorial falls assess-ment and intervention are also effective

Problems withservices or supportsystems

Clinical assessment Support and education of formal and informal carers Caregivers and family should be taught about frailty interventions to optimize function and be involved in planning and development of manage-ment plans

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI

Queacute deberiacutea formar parte de la VGI

Calidad de vida Older Peoples Quality of Life (OPQOL) scores and adverse health outcomes at a one-year follow-up A

prospective cohort study on older outpatients living in the community in Italy Health and Quality of Life Outcomes 2011

Baja calidad de vida referida por los ancianos como factor predictor independiente del desarrollo de eventos adversos (institucionalizacioacuten y mortalidad) al antildeo de seguimiento

The lowest score-based quartile of the health-related OPQOL sub-score was associated with a greater risk of any fall as well as of nursing home placement (OR 1003 95 [CI] 125-8054 P = 0030) and death (OR 423 95 CI 106-1681 P = 0041)

• Ateneo de actualizacioacuten en geriatriacutea Valoracioacuten geriaacutetrica in
• Queacute evaluacutea la VGI
• Slide 3
• Slide 4
• Slide 5
• Functional Decline in Older Adults Am Fam Physician Sep 15 20
• Deterioro cognitivo
• MMT
• Slide 9
• ACE
• Slide 11
• Slide 12
• Slide 13
• Clinical Review Cognitive assessment of older people BMJ 20113
• Escala cliacutenica de la demencia (CDR)
• Funcionalidad AVD_AIVD
• Slide 17
• Riesgo de Caiacutedas
• Slide 19
• Riesgo de depresioacuten GDS
• Slide 21
• Polifarmacia y medicacioacuten potencialmente inapropiada seguacuten crit
• Slide 23
• Riesgo nutricional
• Comorbilidades Escala CIRS_G Cumulative Illness Rating Scale
• Slide 26
• Sobrecarga de cuidador
• Slide 28
• Valoracioacuten social
• Slide 30
• Recomendaciones
• Slide 32
• Recomendaciones
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Queacute deberiacutea formar parte de la VGI