GERIATRICS

Author: CRUZ JENTOFT ALFONSO JOSÉ.
Year: 2004.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: HOSPITAL CLÍNICO SAN CARLOS.

Summary: OBJECTIVE: To compare the predictive value in mortality in the short and long-term demographic and clinical data as outlined in the traditional medical evaluation of the functional data, mental and social appear in the geriatric assessment in elderly patients hospitalized for because médica.Estudiar the value of these data predict the entry of these patients in homes and the use of social services in the six months following discharge. MATERIALS AND METHODS: A prospective follow-up study over eleven years of 215 patients older than 65 years hospitalized in a service Geriatrics and Department of Internal Medicine. CONCLUSIONS: functional assessment prior to the entry provides prognostic value with respect to the description of disease in this group of enfermos.La presence of oncological diseases predicts mortality in the short and long plazo.Sólo disease neuropsiquíatricas and infectious bring value pronóstico.La physical disability to carry out activities of daily living (ADL) and instrumental background is an excellent predictor of mortality in the short and long plazo.El deteriodo cognitive is the strongest indicator are just markers of mortality long plazo.La lifestyle or prior use social services are just markers of long-term mortality, but only as markers of physical disability and mental.La physical disability, deteriodo cognitive and mental illness is a predictor of the need for social services and institutionalization within six months post-hospitalization.

Author: SÁNCHEZ LEGAZA M.ELENA.
Year: 2004.
University: MÁLAGA [www.uma.es].
Place of defense: Y OTORRINOLARINGOLOGÍA.
Place of preparation: FACULTAD DE MEDICINA , UNIVERSIDAD DE GRANADA.

Summary: The deafness in the elderly or presbiacusia is the most common cause of hearing loss in the elderly, defined as the progressive deterioration of the hearing related to the age and poor inteligibilidad.Su etiology is unknown and multifctorial.Existen four types of presbiacusia: sensory, neural, estrial, mechanics, whose changes take place predominantly in the ear interno.El diagnosis is mainly clinical (sensorineural hearing loss symmetrical) with a normal exploration ENT, based on the ATL and logoaudiometría (fonémica regression). Treatment consists of a early hearing rehabilitation and individualized, supported in hearing aids and carried out by a multidisciplinary team, excluding any concomitant disease.

Author: Carpente Montero Julia.
Year: 2004.
University: A CORUÑA [www.udc.es].
Place of defense: Facultad de Ciencias de la Salud.
Place of preparation: Facultad de Ciencias de la Salud.

Summary: The aging population that are inmercsas developed societies, including Galicia, is necessary to know the characteristics of the socio older populations, in order to put in place measures that somehow palíen deficits detected. In this regard, the objective of the present thesis that has been the difference between the plaintiffs health care at home versus consultation in a clinic in rural areas, particularly in the municipality of Aranga, A Coruna. To do so, perform epidemiological study descriptivo-prospectivo type cross on a sample, not random probability of 127 people, of whom 44.1% are cared for at home and the rest (55.9%) in consultation. A study subjects were performed comprehensive geriatric assessment, using the following instruments: Barthel Index, Scale for Depression Yesavaje, Mini Review of Cognitive Lobo, Questionnaire Resources Social OARS, as well as complete physical examination, including the Nutrition Screening Initiative, and assisted in the subject home also questionnaire assessment of the environment and accessibility of Zarit and questionnaire to families. As a result of stress, it has been observed that the population served at home presents a significantly higher average age, as well as further deterioration cognitive and functional incapacity, facts highlighted in the international literature but not statistically proven, thinking that such demand health at home it might be an indicator of frailty in the elderly. Moreover, we found that the subjects did not attend consultation on the basis of what we might consider health priorities, and that although prevention is one of the pillars in the agrontar the problems of the people, there has been no demand for health nutritional risk (90% of the people served at home) or to seek advice in the field of accessibility. The thesis, according to the hypothesis put forward to the conclusion that there are significant differences in the social and profile in the population of older people at home vs. served as seeking consultation show.

Author: BAZTAN CORTES JUAN JOSE.
Year: 2004.
University: AUTÓNOMA DE MADRID [www.uam.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA. UNIVERSIDAD AUTONOMA DE MADRID.

Summary: Objectives: 1.-Describir the structure and activity of the Units and Medium Stay Convalescence existing in our country. 2 .- To know the clinical characteristics, functional, mental and socio-demographic - related outcomes at discharge and at one year of patients admitted in a Geriatric Unit Media ranch. Materials and Methods: 1 .- Survey sent in 1999 to 107 health centers where they could exist geriatric units average stay (UGME). We evaluated the relationship between staffing and health care with efficacy outcomes (functional gain and institutionalization at discharge) and efficiency (average stay and functional efficiency gain). 2 .- Study longitudinal observational of all patients admitted between May 2000 and December 2001 at the UGME Hospital Central Red Cross in Madrid. We evaluated the relationship of clinical factors, functional, mental and social parameters of the entry with the high efficiency and effectiveness, as well as the functional status, mortality and institutionalization of a year high. Results: 1 .- The best strength of therapists and specialists in geriatrics presence were the main factors associated with better structural parameters of efficiency and effectiveness. The monitoring of a process of care that provides for the basic selection of patients admitted, their comprehensive and thorough evaluation in the first 48 hours after admission and meeting at least weekly interdisciplinary team also partnered

Author: GARZÓN RODRÍGUEZ CRISTINA.
Year: 2004.
University: SEVILLA [www.us.es].
Place of defense: FACULTAD DE MEDICINA - UNIVERSIDAD DE SEVILLA.
Place of preparation: UNIVERSIDAD DE SEVILLA.

Summary: JUSTIFICATION changing demographic indicators shows clearly the strong trend towards a major aging population in our country. That are increasingly frequent diseases or disorders of the elderly, one being the problem of insomnia. He was considered a geriatric syndrome because of its high prevalence, etiology has a multi-drug therapy and is not without risk. ASSUMPTIONS Based on the high prevalence of disorders increased and the potential side effects of medication used for treatment, we wanted to investigate the effectiveness dela melatonin as a hypnotic agent naturally. MAIN GOAL determine the effects of melatonin administration in healthy volunteers older than 65 years on the quality and rhythm of sleep-wake. SECONDARY OBJECTIVES Rate capacity stopping treatment hipnótico-sedante during administration of melatonin. To determine its potential impact on Cognitive Function, ABVD, Perception of Quality of Life, Immune System, Metabolic System, Endocrine System and H. Nutrition. Clinical Trial Design crossfire, not sequential, double-blind effect melatonia vs. placebo, repeated measures with the participation of 22 healthy volunteers aged 65 and over. RESULTS None of the contrast was significant at least one risk level of 0.05 when analyzing haematological parameters, biochemical, hormonal and cellular and humoral immunity. There was a significant decrease in sleep disorders among the volunteers, symptoms ansiosa-depresiva and an increase or improvement of the perception of social support to compare the pair basal-melatonina. Neither showed excessive daytime sleepiness or confusion desaconsejara their use for the treatment of insomnia's largest. CONCLUSIONS Melatonin dose of 5mg in making night has proved well tolerated without causing adverse effects or symptoms that might contraindicate use. It has facilitated the discontinuation of medication hipnótico-BDZ group pharmacological not without risk for this age group which is the largest consumer.

Author: LORENTE MIRALLAS MARIA DEL CARMEN.
Year: 2004.
University: ZARAGOZA [www.unizar.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: INTRODUCTION: Defining Day Center: Service social welfare and family support, which provides day care for the basic personal needs, therapeutic and sociocultural of older people affected by different degrees of dependency, promoting their autonomy and stay in their usual environment . SCENARIOS FOR WORK: The quality of life for the elderly is lower in the presence of a higher level of dependency for the basic activities of daily living (ABVD), greater cognitive impairment and social problems. Similarly the quality of life of their caregivers is lower when they have to take care of an elderly dependent. The use of C. Day is higher in older people with high levels of dependence and the high level of overload their caregivers. The comprehensive geriatric assessment (VGI) done to the users of C. Day as well as evaluating their caregivers allows us to identify problems and prioritize strategies for action. OBJECTIVES:-Describe the profile of the user and his carer - Demonstrate that the VGI improves the quality of care among users-Demonstrate that the aid provided by C. Day by caregivers influences the social environment of the same and helps them overcome their dependence on family and avoid institutionalization MATERIAL AND METHODS: The study area has been the C. Day "sources" of Zaragoza. This is an observational study lungitudinal Prospective two cohorts, users and their carers. The study two measurements for each cohort, the first takes place on both the user's income and the second a year's stay. The total sample for the study is 79 users and 79 caregivers. Variables that has been collected information on the users are: sociodemographic, valuation of geriatric syndromes, assessment of the level of dependency for ABVD (using the Barthel Index), cognitive appraisal (using test Pfeiffer and test reporting ), social value (OARS scale). Variables that has been collected information on the caregivers are: sociodemographic, scale overload of Zarit and caregiver satisfaction scale family Minguez. The information was entered into a database and analyzed using SPSS statistical package. Statistical analysis univariate and bivariate. There has been a descriptive and an analytical study. RESULTS: Regarding users 67.09% are women, with an average age of 81.61 years; paid work without the 68.35%, a 36.71% submitted application for membership in residence at the same time the C. Day, the marital status of users was a 56.96% widowed; economic returns in a 45.57% were between 300-360â ¬; cultural level of users in a 88.60% was incomplete primary education; the prevalence of dependence for ABVD was of 93.07%, the prevalence of cognitive impairment moderado-severo was 83.05%; social resources are deteriorating every year taking the income a 30.38% of users excellent resources to 27.85% annually, the average number of users per geriatric syndromes income is 6.43, a year is 5.33. With regard to the 82.05% of caregivers are women, with an average age of 58.28 years and a standard deviation of 13.80, the 76.92% are married; with income below 900â ¬ at 79, 49%; cultural level is of primary incomplete in a 61.54%; income the 25.64% had paid work, a year what are 37.18%, 42.31% have family support to care for the elderly ; scale overload carer is much lower than year income. CONCLUSIONS: - The profile of users is: mostly women, average age 81.61 years; widows; low economic resources, cultural level of primary school incomplete; 83.29% cognitive impairment between moderate and severe. - The profile of caregivers is: mostly women, average age 58.28 years; married; low economic resources incomplete primary school education; high degree of physical and mental; at the end of the study 9 carers of younger women have been able to join the world lab 8 oral com 50c or result from the discharge provided by the C. Day. - VGI done to users improved indicators of quality of care for the elderly-found correlation between increasing deterioration of the user and / or their caregiver with the institutionalization - consider it essential to caring for the elderly dependent caregiver to increase the quality of life both, providing the C. Day external support to help them overcome the dependency of the elderly, while avoiding the higher costs associated with institutionalization and family separation. So we increase the quality of life of elderly dependent as their primary caregiver.

Author: GARCÍA HERRERO JULIO CÉSAR.
Year: 2004.
University: ZARAGOZA [www.unizar.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Objectives: 1. Assess the extent to which the structural characteristics of the social network determine the functional aspects of support. 2. Knowing the degree of association between the socio-demographic characteristics (SD), social support and various dimensions of health. 3. To determine the extent to which the use of health services is dependent on the state of health, the factors SD, and their level of social support. 4. Valuing the level at which the religious dimension of the individual takes effect perse, ie regardless of the size of social support on the various dimensions of health. 5. Know the weight that different groups of factors are at the accidentabilidad the elderly. Methodology: observational study, cross-sectional. Inquiry home with structured questionnaire. Population study: people aged 60 years and older, residents in the historical area of Zaragoza. Marco sample: Padron Municipal Inhabitants 1996. Sample: stratified random sampling by sex and age (n = 593). Statistical treatment: 1. Description univariate. 2. Test deindependencia peer variables:? 2. 3. Logistic regression. Results: The structural features (social network) have not shown a strong association with functional. Especially noteworthy is the lack of association between marital status and perceived availability of support (tangible and emotional), both men and women. - Men score more in all state variables of health and functional capacity used (eliminating the effect of age and other variables SD). Have shown a better health status perceived men, people with a higher level instruction, and those with lower morbidity declared, better mood and improved functional capacity for the ADL. - They have shown a better mood men (mediated, in large part, by improved capacity for activities involving relationship with the environment), those with lower morbidity, better health and better perceived functional capacity to the ADL, and those who are involved in more social activities. The variable-religiosity shows, in essence, conduct very similar to variable participation in social activities, as they relate to the various dimensions of health. - - The variables in determining the use of primary care and the occurrence of hospitalization has been the block health status (particularly morbidity declared and perceived health status). The use of primary care, in addition, has been found associated in a positive way with the perceived availability of emotional support. - There is a higher prevalence of accidents in women, those with mobility difficulties, with worse health status and a moderate decrease of functional capabilities.

Author: GUERRERO LOZANO ENRIQUE.
Year: 2005.
University: MURCIA [www.um.es].
Place of defense: FACULTAD DE PSICOLOGÍA.
Place of preparation: FACULTAD DE PSICOLOGÍA.

Summary: Our study has two main objectives: first, from an empirical perspective describe different aspects of the functionality and quality of visa for the elderly. On the other, establish a typology of thumb, which allows for a quick way to identify the quality of life in the shaft (health física-salud mental) health status of a subject. The sample consisted of 106 men and 79 women who came to a Day Center located in the town of Cartagena. The sample was administered two questionnaires, namely OARS and SF-36. We sought to ascertain whether there were profiles defined in the subjects of our study, and to that end, we used clustering techniques with different variables questionnaire OARS. The results we obtained indicated that there was no variables that have a significant relevance. Subsequently, we conducted an analysis cluster with the different scales of the questionnaire health SF-36 that we threw 4 types of subjects according to their state of health (high quality of life, healthy quality of life, quality of life deteriorated and poor quality of life) . In order to know in which group could classify a subject, we conducted discriminant. We proceeded to set as a dependent variable, the resulting factor clustering analysis cluster, and as independent variables, specifying the different scales of Sf-36. Taken together all the independent variables, the resulting model was statistically significant (lambda = 0.0118; F25, 500 = 66.0859, p = 0.0000), which allowed us to justify a classification system. The model "total" got a correct classification in 99% of cases, introducing a high efficiency. Subsequently, we conducted a second stepwise discriminant analysis to select those variables with greater predictive power and eliminate those that make us scale or no information to discrimination. We note that a 98% of cases classified correctly that the reduction of the variables eliminated had not alleged any loss of efficiency in the prediction model. This model gives us a high applicability empirical and therefore, propose and recommend its use in clinical programs and psychosocial intervention.

Author: CASTRO MARTIN ESTRELLA.
Year: 2005.
University: CÓRDOBA [www.uco.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: INTRODUCTION The magnitude of the falls, its risk factors and their impact on the elderly, despite the studies to date do not know enough yet. The Fall represent one of the most important problems in the pathology. OBJECTIVE Knowing the prevalence of falls in older people, their characteristics, consequences and associated factors. Knowing the basic sociodemographic characteristics, health problems, functional ability of this population. Evaluate the quality of life associated with the health of the elderly population. DESIGN Descriptive cross by personal interview. Location. Three Areas Basic Health Cordoba: Lift North, West and Polygon of the Guadalquivir. PARTICIPANTS People were studied a sample of 362 subjects, calculated using the formula for estimating a proportion to the program EPIDAT 3.0, for an estimated fall of 30% (p = 0.3), a mistake an alpha of 5% accuracy + -0.05 and the rate of expected losses by 10%. To obtain a representative sample used a random sampling polietápico. MEASUREMENTS We conducted an assessment in the study of the fallers with a questionnaire specific to the WHO, and their quality of life, with Euroqol-5D. We performed a multivariate analysis uni-bivariado and (p greater 0.05). Prevalence of falls RESULTS: 31.78% (95% CI: 26,99-36,6%). A 12.98% more than a drop in the last year. The 55.3% occurred at home. The 71.8% suffered physical injuries, with a 7.8% of fractures. The 44.7% had fear of a further drop, and 22% limited his mobility since the fall. The 30% contacted the health system, and a 3.3% required hospitalization. The factors that were associated with increased risk of falls were having older, being a woman, being widowed / a, uneducated, present difficulty to move both upper limbs and orient themselves in space, consume more drugs, and worse perceived health status. CONCLUSIONS 1, - One of every three people 70 years or older living in the community have suffered at least one fall during the past year. 2 - The majority of the elderly who suffer falls occur at home, a place familiar to the elderly during the morning and encontrándose them alone. 3 - The socio-demographic factors that most closely relate to the falls are age, being a woman, being widowed, and the studies have not belong to a disadvantaged social class. 4-Only one-third of patients who suffer from fall contact with the health system, so this is a health problem infradiagnosticado. 5-This problem originates restrictions on mobility, decreased ability to perform activities of daily living and have an impact on those who are suffering, both physical and psychological. 6, - With regard to the functional capacity, the elderly who fall more are the ones most difficult to walk, stand and stand up for the day, using both hands, effort, memorize, guided by time and space, as well as fall most of those who leave home alone and those who have difficulty in understanding the road signs. 7-health problems that are more often the elderly who fall are neurological diseases of the eye and mental (anxiety and depression), foot problems, difficulty walking, to conduct their daily activities and care Personal. 8 - The number of drugs consumed is also higher in the elderly who fall and they are more often antihypertensives, antidepressants and anisolíticos. KEY WORDS: Falls, Elders and Prevalence.

Author: PEREA UNCETA LUIS.
Year: 2005.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA (UCM).

Summary: It examines the outcome of the administration of a mineral water to be dispensed at retail pharmacies in small doses, as an adjuvant for physiological elderly. EQUIPMENT The material used is water Carabaña (Water minero-medicinal: hypertonic, sulfatada-sódica and sulfur) and the study population, of a residence for elderly de la Comunidad de Madrid, mixed residential center (valid and assisted) with 91 residents. METHODOLOGY A-DESIGN EPIDEMIOLÓGICO, it is a longitudinal study, prospective, open, randomized and analytical. B-CRITERIA FOR INCLUSION, internal to the institution willing to cooperate after informed consent (no resident refused to be included in the study). C-CRITERIA OF EXCLUSION, inability to adequately complete the requirements of the protocol and / or patients for their pathology discouraged inclusion in the study (severe liver disease, a gastrointestinal malignancy, chronic diarrhea ..). Of the 91 inmates, 8 are excluded from the study for various reasons. For the 83 remaining were randomly assigned treatment with a 3 / 1. It keeps track of residents for 3 months, who were given 5 ml a day Water Carabaña fasting before breakfast. The statistical analysis of the data is done via the SAS statistical program, in the version 6.12. Major conclusions can be summarized as follows: The administration of water minero-medicinal of Carabaña the form above, is associated with a strong laxative effect with an increasing number of depositions daily and a significant reduction in the consumption of drugs laxatives. Objective is a decline in the consumption of antihypertensive medications. The reduction in the consumption of drugs of the groups mentioned, determines a significant savings in pharmaceutical expenditure. It shows an absence of adverse effects with a good tolerance of the product to the dose used. We have not found any changes in serum sodium, potassium and chlorine. There has been no elevated levels of pressure or heart rate changes. There has been no renal or hepatic used in the analytical tests. There are, for all that, contraindications for use in patients with hypertension or diabetes. It highlights good response found in residents and between staff assistant clinical has tested as decreasing the use of rectal enemas. KEYWORDS Constipation, laxatives, elderly, nursing home, agua-mineromedicinal.

Author: ALONSO FORMENTO JOSÉ ENRIQUE.
Year: 2005.
University: ZARAGOZA [www.unizar.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA.

Summary: Background: Although several studies objetivan a high consumption psicótropos in elderly Spain in the real prevalence is unknown. No epidemiological studies have found community with an appropriate methodology, on the consumption of psicótropos in connection with the formal psychiatric diagnoses in these subjects. Objectives: To determine the prevalence and pattern of consumption of drugs, psychotropics especially in a representative sample of the póblación geriatric and pregeriátrica of the city of Zaragoza, and linking consumption with psychopathology, insomnia and excessive consumption alcohol. Materials and Methods: The data from this study are in the first phase of Project Zarademp, which is a study of community health in a sample of the population above 55 years of Zaragoza from the 1991 census. This uses the Interview ZARADEMP-I, which is a personal interview where data are collected socio-demographic, psychopathology, pattern of sleep, alcohol consumption, and consumption of medication in the last four weeks including consumption on their own initiative. Results: The frequency of consumption of drugs in our sample was 82.3%, with an average of 2.9 drugs per subject. The frequency of "Polifarmacia" is 15.2%. The ATC group of drugs is the most frequently consumed Cardiovascular Apparatus, followed by the Nervous System. There is a higher consumption among women, subjects were older, widowed, illiterate people, housewives and unemployed subjects or inability to work, and people living alone. There is also a higher consumption in subjects with low economic level, but without statistically significant differences exist. The frequency of consumption of psychoactive drugs in our sample was 24.7%, with an average of 1.21 psicótropos by subject. Consumption is daily or almost daily e176, 6% of the cases. A 1.6% take psychoactive drugs on their own initiative. The group is the most consumed of anxiolytics (mostly benzodiazepines average life long), the second of antidepressants and the third of the neuroleptics. Consumption is higher in women, the elderly, widows and housewives or unemployed, and lower in subjects living with a spouse or partner. There is also a higher consumption in subjects illiterate and those with high economic level, but without statistically significant differences exist. As expected, subjects with psychopathology have a higher consumption of drugs, especially those with major depression, anxiety, subcaso depression, minor depression and dementia. Also as expected, subjects with psychopathology have a higher consumption of psychoactive drugs, especially those with major depression, subcaso of depression, anxiety and minor depression. Broadly speaking notes and a high consumption of anxiolytic psychopathology in subjects with a low consumption of antidepressants in all diagnoses, including depression, and a high consumption of neuroleptics in subjects with depression and dementia. Stresses that e160, 5% of subjects with a psychiatric diagnosis does not consume any psychopharmacological. Predictably, this is essentially sub, but also cases of dementia and depression lower. There is also a 5.5% Subjects psychopathology without consuming any psicotropo. In these cases are the group most commonly used neuroleptics. Subjects with insomnia have a higher consumption of drugs and psychoactive drugs, especially anxiolytics. Contrary to our hypothesis, subjects with excessive consumption of alcohol use less drugs and psychoactive drugs. In subjects living in residences the frequency of use of psychoactive drugs and is higher than the total sample. The most consumed the remains of anxiolytics, but continued in 8 this case the 50th or neuroleptics. Consumption daily or almost daily psychoactive drugs is also higher, and all subjects manifest use by prescription. The use of psychoactive drugs in Residences bears no relation to such diagnoses psicopatológicos as in the total sample. Conclusions: The results in this sample population representative suggests that there is a high consumption of drugs and psychotropics, with evidence of inappropriate prescribing and serious timely investigate the adequacy of the requirements and suggestions even more important inappropriate prescribing in institutionalized subjects .

Author: ALONSO FERNANDEZ PATRICIA.
Year: 2005.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE MEDICINA - UNIVERSIDAD COMPLUTENSE DE MADRID.

Summary: In this thesis has been carried out a study on changes with age in immune function, with particular emphasis on what happens in individuals who reach very advanced age, centenarians. This would have appreciated a wide range of functions in the peripheral blood leukocytes (grip, chemo, phagocytosis, d nation superoxide production, proliferation activity of NK cells, producing interleluquinas), as well as various parameters of oxidative stress (levels glutathione, superoxide dismutase, catalase and malondialdehyde) in individuals three decades different (30, 70 and 100 years). It was found that individuals centenarians have been able to maintain proper immune function in virtually all parameters studied, maintaining a level similar to the group of young adults (30 years), or at least better than adults mature (70 years ).

Author: LARRAGA ALAYETO LAURA.
Year: 2005.
University: ZARAGOZA [www.unizar.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: FACULTAD DE CIENCIAS DE LA SALUD Y EL DEPORTE (HUESCA).

Summary: Goals: I. Standardize the scale EURO-D as a method of detection of depression in the elderly population Spanish. II. Describe the depressive symptoms according to the characteristics (sociodemographic, psychopathological and performance activities in daily life). III. Knowing the ability of the scale EURO-D to predict the development or chronicity of depression after two years of monitoring, and related variables. Methods: We used 2 samples collected from 2 epidemiological studies in phases: Study Zaragoza (N = 1080) and Project ZARADEMP (N = 3715). Subjects in both samples were 65 or more years, were taken from the municipal census Zaragoza yaleatorizados and stratified by age and sex. They used Spanish versions of the instruments: Geriatric Mental State (GMS), Review Cognitive Mini-Mental (ECMM), History and Aetiology Schedule (HAS), Scale Instrumentales Activities of daily living Lawton & Brody, and the index Katz scale EURO-D, which derives entirely from 12 items belonging to the GMS. Diagnostic Criteria: DSM-III-R (issued by psychiatrists at the stage of diagnosis) and GMS-AGECAT (computerized system that emits diagnoses obtained using GMS). Result: a) I It has obtained a high internal consistency in both phases of the study (alpha = 0.75, alpha = 0.79, respectively); test-retest reliability (kappa = 0.60); Validity: corte-punto optimum has been 3 / 4, with a sensitivity of 91.8% and a specificity of 76.6%; area under the ROC curve has been obtained for 0.92 [95% CI (0.89-0.95)] for the prediction of depression with DSM-III-R criteria. B) II. The overall prevalence of "probable cases of depression," according to the scale EURO-D, was 14.9% in the sample studied and depressive symptoms are more frequent, in this order: "insomnia" (37.1%) "fatigue" (23.7%), "dysphoric mood" (18.4%) and "crying" (17.8%). There is a percentage significantly higher in women than men who rate them as "probable cases" on the scale, the percentages are higher in the age groups most advanced regard to the youngest; widowers in respect to other categories of state civil groups and the low educational level of respect to those who have a higher educational level. A 35.1% of cases of dementia (and percentages similar criteria MEC) and 25.4% of cases of anxiety, score above the cutoff point on the scale, suggesting co-morbilidad.El percentage elder probably depressed is significantly higher in individuals dependent on activities of daily living (36.3%) compared with those who are independent (10.7%). C) III. The "probable cases of depression," according to the scale EURO-D, and who did not meet criteria for depression AGECAT in the baseline study, have, however, increased risk of developing depression "incident" (criteria AGECAT) within two years of follow-up (OR = 5.20, 95% CI = 2.76-9.82). Individuals with scores above the cutoff point in the scale and also met criteria for depression AGECAT in the baseline study, have a higher risk of continuing depressed (chronic) at follow-up at two years (OR = 38.85; 95% CI = 22.20-67.97). Conclusions: I. The scale of EURO-D is a reliable and valid instrument for identifying probable cases of depression in the elderly in Spain. II. It has been documented their ability descriptive in relation to the prevalence of symptoms and profiles as different variables relevant. III. In support of the clinical utility and research of the scale, it has documented, using models demanding analysis adjusted with relevant variables, a significant predictive capacity and the impact of chronic depression in the elderly.

Author: SAGARDUI VILLAMOR JON KOLDO.
Year: 2005.
University: AUTÓNOMA DE MADRID [www.uam.es].
Place of defense: FACULTAD DE MEDICINA DE LA UNVIERSIDAD AUTÓNOMA DE MADRID.
Place of preparation: MEDICINA PREVENTIVA Y SALUD PÚBLICA.

Summary: OBJECTIVES This dissertation deals with the study of disability in the elderly Spaniards with three specific objectives: 1-To describe recent trends in the prevalence of disability and life expectancy free of disability (EVLD). 2-examine the association between waist circumference (CC) autorreportada with disabilities. 3-Valuing cumulative effect over the lifetime of adverse socio-economic conditions, obesity and chronic diseases on the decline in physical function. PEOPLE AND METHODS To meet the first objective was comparing the two National Surveys on Disabilities, and Handicaps Deficiencies in 1986 and 1999. We studied the severely disabled and included disabilities overcome through technical help from outside. To answer the second and third goal we conducted a cross-sectional study combined with a prospective study. It employed a cohort of 3235 people representative of the Spanish population non-institutionalized population aged 60 and over age studied from 2001 to 2003. At the beginning of the study, information was collected at home by telephone interview. The measures of physical function were mobility, agility, the restriction of activities of daily living, instrumental activities of daily living, and self-care activities (bathing and clothing). The socioeconomic trajectory was evaluated using three measures: social class in childhood, the highest educational attainment, and social class adult. The partnership interest was summarized by odds ratios obtained by logistic regression for the CC and through reasons prevalence (RP) adjusted for age and sex, obtained by regression bionomial for socioeconomic trajectory. RESULTS The period 1986 to 1999 in men, there was a relative decline of 3.7% annually throughout the disability. The decline was slightly smaller women, in the subjects 72 years and older, and those with lower education. In men, the decline was slightly more than 3% of disability and to move in the hearing, less than 1% of disability to see and the cognitive and there was a slight increase in disability for personal care. In women, resutlados are similar even though they disability for personal care increased by 1.78%. Life expectancy EV and EVLD have increased in both sexes and all age groups. While the EV is higher in women, a higher percentage of living that EVD EV with disabilities. Reducing the EVD was observed even in persons 80 years and older. For people with disabilities who had not reported in 2001, CA predicted the onset of disability two years later. After adjusting for age, education level, snuff, alcohol and physical activity, the men in the highest quintile CC had 2.17 times higher risk of disability mobility and 4.76 times higher risk of disability with agility the lowest quintile. The association declined only slightly to adjust further by body mass index, chronic disease and cognitive function. The results were similar for women. The deterioration of physical function showed a gradient of the growing category that accumulates more exhibitions unfavorable (worst social class in childhood and adulthood, low educational level and the presence of obesity and chronic diseases). The results were similar when examined the incidence of limited physical function after two years of tracking people without limitation physics at the beginning of it. CONCLUSIONS In the period 1986 a1 9999, the prevalence of severe disability among the elderly population Spanish declined substantially. The decline was smaller in women, in 8 s subject 56e s with the worst educational level and in subjects 72 years and older in both sexes. There was a slight increase in disability for personal care, which was higher in women. It increased the EV and EVLD. Besides reduced EVD, so that the disability begins at an older and closer to death. The CC predicts over the years, the onset of disability of mobility and agility in older population of both sexes in Spain. If we avoid the higher values of CC could reduce the risk of disability in the older population Spanish. There is a cumulative effect over the life of social class in childhood, education, social class in adulthood, obesity and chronic diseases on the decline in physical function in elderly Spaniards. This risk increased gradually with the increasing number of exhibitions, regardless of whether they are independent or exhibits added.

Author: MARTÍN LÓPEZ FÉLIX MARIANO.
Year: 2006.
University: COMPLUTENSE DE MADRID [www.ucm.es].
Place of defense: FACULTAD DE MEDICINA.

Summary: As a result of advances in the treatment of different diseases, life expectancy has increased dramatically, which has resulted in an increase in the geriatric population, among other requirements, require assistance before their problems including oral surgery exodoncia . In elderly patients there are potential risks associated with surgery in connection with the physiological changes that occur in age, polimedicación and diseases suffered basis, with the most prevalent cardiovascular. The purpose of this study was to investigate the response of the cardiovascular geriatric population under exodoncia surgery, so patients 65 years and older were monitored by Holter has been studied and the presence of arrhythmias, pressure ST segment, variability the heart rate, blood pressure changes, diseases and synthetic base similar complications during surgery and post-operatively than those of young, and do not pay a higher incidence of arrhythmia and cardiac ischemia. In addition, the heart rate appears on the minimum recovery period and the maximum during surgery increased with age it the same as systolic blood pressure. The variability of the heart rate in patients undergoing oral surgery decreases with the age.

Author: GARCÍA ALBERCA JOSÉ MARÍA.
Year: 2006.
University: MÁLAGA [www.uma.es].
Place of defense: FACULTAD DE MEDICINA.
Place of preparation: CENTRO DE INVESTIGACIONES MÉDICO-SANITARIAS Y FACULTAD DE MEDICINA.

Summary: This work has been conducted in a large group of 125 patients of Alzehimer they met the DSM-IV-TR criteria and the criteria NINCDS-ADRDA for probable Alzheimer's disease. It has studied the presence of behavioral and psychological symptoms SCP and their relationship to the time and stage of evolution of dementia, with executive cognitive functions and verbal memory, with the functional ability of patients to the activities of daily living and various indicators of the burden and suffering carer. The percentage of patients who presented SCP was very high, 98% (122 of 125 subjects), with an average number of 5 symptoms per patient. The most frequent symptoms were apathy (73.6%), irritability (65.6%) depression (60%), agitation (55.2%), anxiety (53.6%) and motor behavior aberrant (47%). The SCP demonstrates a direct and significant cognitive impairment in executive function and verbal memory and the deterioration in the capacity for the activities of daily living. At the same time, these cognitive impairment, functional, behavioral and psychological increased significantly over time and stage of development of dementia which suggests the presence of interactions and mechanisms common in the systems responsible for their demonstrations. In the group of caregivers of Alzheimer's, the frequency and severity of genetic SCP influenced significantly the burden on the caregiver. The greater frequency and severity of these symptoms, the greater number of hours of care for the activities of daily living and the increased presence of suffering, anxiety and depression in the caregiver. Similarly, the higher cognitive impairment in executive function and verbal memory and further deterioration in the capacity for the activities of daily living increased presence of cargo, suffering, anxiety and depression in the caregiver. These results show the importance and deal adequately SCP to improve the general state of suffering from Alzheimer's and lessen the burden and suffering carer.