ASPECTOS DIFERENCIALES ANCIANOS PLURIPATOLÓGICOS      NICOLÁS MARTÍNEZ VELILLA COMPLEJO HOSPITALARIO DE NAVARRA<br />
COMORBILIDAD<br />
<ul><li>COMORBILIDAD: Enfermedades adicionales a una enfermedad índice
MULTIMORBILIDAD: Múltiples enfermedades en un individuo
IMPACTO MORBILIDAD: Impacto global de la suma de enfermedades + gravedad
COMPLEJIDAD: Impacto global de las diferentes enfermedades en individuo; gravedad de enfermedades – otros aspectos relacio...
PREVALENCIA MULTIMORBILIDAD<br />
Impact of multi-morbidity on physical limitations<br />Kriegsman et al. Disability Rehabilitation 1997;19:71-83<br />
Impact of multimorbidity on 3-year decline in physical functioning<br />Kriegsman et al. J Clin Epidemiol 2004;57:55-65<br />
Multimorbidity and depressive symptoms<br />Penninx et al. J Psychosom Res 1996;40:521-534;<br />Adapted from Kriegsman D,...
Impact of multimorbidity on 3-year mortality<br />Kriegsman & Deeg. In: Autonomy and well-being in the aging population 2 ...
Impact of Multimorbidity on Hospitalization: Hospitalization for Ambulatory Care Sensitive Condition by Number of Chronic ...
Most people with any long term condition have multiple conditions in Scotland<br />
<ul><li>Piedra angular del manejo cotidiano de nuestros pacientes
Comorbilidad como factor de confusión
Exclusión sistemática de los ensayos
Paciente tipo de ensayos no es nuestro paciente habitual
Arch Intern Med. 2011 Mar 28;171(6):550-6. The persistent exclusion of older patients from ongoing clinical trials regardi...
EPOC<br />Heart failure and chronic obstructive pulmonary disease: Two for tea or tea for two? World J Cardiol. 2010 Octob...
FRAGILIDAD / COMORBILIDAD<br />COGNICIÓN<br />SARCOPENIA<br />DETERIORO FUNCIONAL<br />INFLAMACIÓN<br />COMPLEJIDAD DE LAS...
CONSECUENCIAS DE LA ANEMIA<br />DETERIORO FUNCIONAL<br />MORTALIDAD<br />INGRESOS <br />HOSPITALARIOS<br />ANEMIA<br />DET...
DIABETES<br />Diabetes Res Clin Pract. 2011 Jan;91(1):115-20. The association between co-morbidity and the use of antidiab...
OSTEOPOROSIS Y DM<br />World J Diabetes. 2011 Mar 15;2(3):41-8. Osteoporosis in diabetes mellitus: Possible cellular and m...
DEPRESIÓN<br /><ul><li>J ClinPsychiatry. 2011 May;72(5):677-84.Exercise as anaugmentationtreatmentfornonremittedmajor depr...
J Gen Intern Med. 2011 Oct;26(10):1175-82. Depression and medication adherence in the treatment of chronic diseases in the...
Gen Hosp Psychiatry. 2011 May-Jun;33(3):217-23. Prevalence of depressive symptoms in patients with chronic obstructive pul...
Arch Intern Med. 2011 Sep 26;171(17):1571-8. Coffee, caffeine, and risk of depression among women.
J Clin Psychiatry. 2011 Apr;72(4):529-38. The effect of exercise in clinically depressed adults: systematic review and met...
Lancet. 2011 Jul 30;378(9789):403-11. Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multi...
Arch Intern Med. 2010 Nov 22;170(21):1884-91. Bidirectional association between depression and type 2 diabetes mellitus in...
Arch Intern Med. 2008 Nov 10;168(20):2232-7. Antidepressant use, depression, and survival in patients with heart failure.
Stroke. 2011 Aug 25. Increased Frequency of First-Episode Poststroke Depression After Discontinuation of Escitalopram.
J Card Fail. 2011 Sep;17(9):748-54. Effects of sertraline on circulating markers of oxidative stress in depressed patients...
Diabetes Care. 2011 Sep 12. Elevated Depressive Symptoms, Antidepressant Use, and Diabetes in a Large Multiethnic National...
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Presentación del VI simposium de atención a las personas mayores: Nicolás Martínez Velilla

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Presentación orue 2011 nicolas martinez slideshare

  1. 1. ASPECTOS DIFERENCIALES ANCIANOS PLURIPATOLÓGICOS NICOLÁS MARTÍNEZ VELILLA COMPLEJO HOSPITALARIO DE NAVARRA<br />
  2. 2. COMORBILIDAD<br />
  3. 3.
  4. 4.
  5. 5. <ul><li>COMORBILIDAD: Enfermedades adicionales a una enfermedad índice
  6. 6. MULTIMORBILIDAD: Múltiples enfermedades en un individuo
  7. 7. IMPACTO MORBILIDAD: Impacto global de la suma de enfermedades + gravedad
  8. 8. COMPLEJIDAD: Impacto global de las diferentes enfermedades en individuo; gravedad de enfermedades – otros aspectos relacionados con la salud</li></ul>No todos los Ancianos son PluripatológicosLa mayoría de Pluripatológicos son Ancianos<br />
  9. 9.
  10. 10. PREVALENCIA MULTIMORBILIDAD<br />
  11. 11.
  12. 12.
  13. 13. Impact of multi-morbidity on physical limitations<br />Kriegsman et al. Disability Rehabilitation 1997;19:71-83<br />
  14. 14. Impact of multimorbidity on 3-year decline in physical functioning<br />Kriegsman et al. J Clin Epidemiol 2004;57:55-65<br />
  15. 15. Multimorbidity and depressive symptoms<br />Penninx et al. J Psychosom Res 1996;40:521-534;<br />Adapted from Kriegsman D, NIA Comorbidity Conference, 2005<br />
  16. 16. Impact of multimorbidity on 3-year mortality<br />Kriegsman & Deeg. In: Autonomy and well-being in the aging population 2 (1997)<br />
  17. 17.
  18. 18. Impact of Multimorbidity on Hospitalization: Hospitalization for Ambulatory Care Sensitive Condition by Number of Chronic Conditions<br />Wolff, J. NIA Comorbidity Conference, 2005<br />
  19. 19.
  20. 20. Most people with any long term condition have multiple conditions in Scotland<br />
  21. 21.
  22. 22.
  23. 23. <ul><li>Piedra angular del manejo cotidiano de nuestros pacientes
  24. 24. Comorbilidad como factor de confusión
  25. 25. Exclusión sistemática de los ensayos
  26. 26. Paciente tipo de ensayos no es nuestro paciente habitual
  27. 27. Arch Intern Med. 2011 Mar 28;171(6):550-6. The persistent exclusion of older patients from ongoing clinical trials regarding heart failure. Despite the recommendations of national and international regulatory agencies, exclusion of older individuals from ongoing trials regarding heart failure continues to be widespread</li></ul>COMORBILIDAD Y ENSAYOS CLÍNICOS<br />
  28. 28.
  29. 29. EPOC<br />Heart failure and chronic obstructive pulmonary disease: Two for tea or tea for two? World J Cardiol. 2010 October 26; 2(10): 305–307.<br />Respir Care. 2011 May;56(5):644-52. Epub 2011 Jan 27.Anemia in COPD: a systematic review of the prevalence, quality of life, and mortality.<br />Chronic respiratory disease and multimorbidity: Prevalence and impact in a general practice setting. Respir Med. 2011 Feb;105(2):236-42.<br />Lung. 2010 Aug;188(4):321-9. Comorbidity, hospitalization, and mortality in COPD: results from a longitudinal study.<br />Treatment of Chronic Obstructive Pulmonary Disease and Its Comorbidities. The Proceedings of the American Thoracic Society 5:848-856 (2008)<br />J Card Fail. 2010 Mar;16(3):225-9. COPD predicts mortality in HF: the Norwegian Heart Failure Registry.<br />
  30. 30. FRAGILIDAD / COMORBILIDAD<br />COGNICIÓN<br />SARCOPENIA<br />DETERIORO FUNCIONAL<br />INFLAMACIÓN<br />COMPLEJIDAD DE LAS INTERACCIONES<br />ANEMIA<br />
  31. 31. CONSECUENCIAS DE LA ANEMIA<br />DETERIORO FUNCIONAL<br />MORTALIDAD<br />INGRESOS <br />HOSPITALARIOS<br />ANEMIA<br />DETERIORO COGNITIVO<br />CALIDAD DE VIDA<br />EMPEORAMIENTO DE <br />COMORBILIDAD<br />
  32. 32. DIABETES<br />Diabetes Res Clin Pract. 2011 Jan;91(1):115-20. The association between co-morbidity and the use of antidiabetics or adjunctive cardiovascular medicines in Australian veterans with diabetes. <br />PLoS One. 2010 Nov 17;5(11):e14024. Influence of comorbidities on therapeutic progression of diabetes treatment in Australian veterans: a cohort study.<br />Diabet Med. 2010 Jan;27(1):65-71. Co-morbidity and the utilization of health care for Australian veterans with diabetes.<br />Endocr Pract. 2011 Sep 22:1-16. The Effect of Metformin Therapy on Vitamin D and B12 Levels in Patients with Diabetes Mellitus Type 2.<br />Lancet. 2011 Jul 9;378(9786):129-39. Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial.<br />.Cardiovasc Diabetol. 2011 May 21;10:43.Therapeutic potential of N-acetylcysteine as an antiplatelet agent in patients with type-2 diabetes.<br />Diabetes Res Clin Pract. 2010 Mar;87(3):385-93. Comorbidity in the elderly with diabetes: Identification of areas of potential treatment conflicts.<br />
  33. 33. OSTEOPOROSIS Y DM<br />World J Diabetes. 2011 Mar 15;2(3):41-8. Osteoporosis in diabetes mellitus: Possible cellular and molecular mechanisms.<br />
  34. 34. DEPRESIÓN<br /><ul><li>J ClinPsychiatry. 2011 May;72(5):677-84.Exercise as anaugmentationtreatmentfornonremittedmajor depressivedisorder: a randomized, paralleldosecomparison.Trivedi MH, Greer TL, Church TS, Carmody TJ, Grannemann BD, Galper DI, Dunn AL, Earnest CP, Sunderajan P, Henley SS, Blair SN.
  35. 35. J Gen Intern Med. 2011 Oct;26(10):1175-82. Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis.
  36. 36. Gen Hosp Psychiatry. 2011 May-Jun;33(3):217-23. Prevalence of depressive symptoms in patients with chronic obstructive pulmonary disease: a systematic review, meta-analysis and meta-regression.
  37. 37. Arch Intern Med. 2011 Sep 26;171(17):1571-8. Coffee, caffeine, and risk of depression among women.
  38. 38. J Clin Psychiatry. 2011 Apr;72(4):529-38. The effect of exercise in clinically depressed adults: systematic review and meta-analysis of randomized controlled trials.
  39. 39. Lancet. 2011 Jul 30;378(9789):403-11. Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial.
  40. 40. Arch Intern Med. 2010 Nov 22;170(21):1884-91. Bidirectional association between depression and type 2 diabetes mellitus in women.</li></li></ul><li>DEPRESIÓN<br /><ul><li>Cochrane DatabaseSyst Rev. 2010 Apr 14;(4):CD006117. Sertraline versus otherantidepressiveagentsfor depression.
  41. 41. Arch Intern Med. 2008 Nov 10;168(20):2232-7. Antidepressant use, depression, and survival in patients with heart failure.
  42. 42. Stroke. 2011 Aug 25. Increased Frequency of First-Episode Poststroke Depression After Discontinuation of Escitalopram.
  43. 43. J Card Fail. 2011 Sep;17(9):748-54. Effects of sertraline on circulating markers of oxidative stress in depressed patients with chronic heart failure: a pilot study
  44. 44. Diabetes Care. 2011 Sep 12. Elevated Depressive Symptoms, Antidepressant Use, and Diabetes in a Large Multiethnic National Sample of Postmenopausal Women.
  45. 45. Diabetologia. 2011 Aug 3. Use of antidepressant medication and risk of type 2 diabetes: results from three cohorts of US adults.
  46. 46. Age Ageing. 2010 Jul;39(4):488-94. Comorbidity of chronic disease and potential treatment conflicts in older people dispensed antidepressants.
  47. 47. Arch Intern Med. 2000 Nov 27;160(21):3278-85. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs.</li></li></ul><li>
  48. 48. HIPERTENSIÓN ARTERIAL<br />Cochrane Database Syst Rev. 2011 Jul 6;(7):CD009217. Reduced dietary salt for the prevention of cardiovascular disease.<br />Am J Hypertens. 2011 Aug;24(8):843-53. doi: 10.1038/ajh.2011.115. Reduced dietarysalt forthe prevention of cardiovascular disease: a meta-analysis of randomizedcontrolledtrials (Cochrane review)<br />BMJ. 2011 Jul 26;343:d4366. doi: 10.1136/bmj.d4366.Moderate dietarysodiumrestrictionaddedtoangiotensinconvertingenzymeinhibitioncomparedwith dual blockade in lowering proteinuria and bloodpressure: randomisedcontrolled trial.<br />J Hypertens. 2011 Nov;29(11):2084-90.<br />The contribution of depression to mortality among elderly with self-reported hypertension: analysis using a nationalrepresentative longitudinal survey.<br />A recent Cochrane Review by Rod Taylor and colleagues, published simultaneously in The Cochrane Library and the American Journal of Hypertension, stated in the plain language summary that “Cutting down on the amount of salt has no clear benefits in terms of likelihood of dying or experiencing cardiovascular disease”. The Cochrane Library’s own press release headline included this statement: “Cutting down on salt does not reduce your chance of dying”.<br />
  49. 49. DEMENCIA<br />J Am Med Dir Assoc. 2011 Oct;12(8):565-72. Associations between the anticholinergic risk scale score and physical function: potential implications for adverse outcomes in older hospitalized patients.<br />J Am Geriatr Soc. 2011 Aug;59(8):1477-83. doi: 10.1111/j.1532-5415.2011.03491.x. Epub 2011 Jun 24. Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study.<br />J Clin Pharmacol. 2011 Feb;51(2):256-63. Anticholinergic drug use and mortality among residents of long-term care facilities: a prospective cohort study.<br />Arch Intern Med. 2011 Jul 25;171(14):1244-50. Physical activity and cognition in women with vascular conditions.<br />Arch Intern Med. 2011 Jul 25;171(14):1251-7 Activity energy expenditure and incident cognitive impairment in older adults.<br />Ann Intern Med. 2011 Sep 6;155(5):300-8.Cognitive impairment: an independent predictor of excess mortality: a cohort study<br />
  50. 50. NEUROLÉPTICOS<br />J Clin Psychiatry. 2004 Jan;65(1):114-9. A 3-month, randomized, placebo-controlled, neuroleptic discontinuation study in 100 people with dementia: the neuropsychiatric inventory median cutoff is a predictor of clinical outcome. Ballard CG, Thomas A, Fossey J, Lee L, Jacoby R, Lana MM, Bannister C, McShane R, Swann A, Juszczak E, O'Brien JT.<br />PLoS Med. 2008 Apr 1;5(4):e76. A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial). Ballard C, Lana MM, Theodoulou M, Douglas S, McShane R, Jacoby R, Kossakowski K, Yu LM, Juszczak E; Investigators DART AD.<br />JAMA. 2011 Sep 28;306(12):1359-69. Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults: a systematic review and meta-analysis.<br />
  51. 51.
  52. 52. CANCER<br /><ul><li>ArchInternMed 2011;171(8):779-781 Treatment with β-blockers and reduced disease progression in patients with thick melanoma.
  53. 53. Journal of Cardiac faillure, 2011, Rohrer CK et al Carvedilol for the treatment of benign prostatic hypertrophy in patients with heart failure?
  54. 54. Diabetes Care. 2011 Jun;34(6):1369-71. Epub 2011 Apr 22.Assessing theassociation of pioglitazone use and bladdercancerthroughdrug adverse eventreporting.
  55. 55. Gut. 2011 Oct 13. Primaryprevention of colorectalcancerwithlow-doseaspirin in combinationwithendoscopy: a cost-effectivenessanalysis.
  56. 56. ArchInternMed. 2011 Apr 11;171(7):686-91.Opioid dose and drug-relatedmortality in patientswithnonmalignantpain.</li></li></ul><li>INSUF CARDIACA<br />.Am J Med. 2011 May;124(5):418-25. Osteoporotic fractures and heart failure in the community.<br />Am Heart J. 2011 Aug;162(2):246-53. Plasma vitamin C predicts incident heart failure in men and women in European Prospective Investigation into Cancer and Nutrition-Norfolk prospective study.<br />Am J Med. 2011 Feb;124(2):136-43. Trends in comorbidity, disability, and polypharmacy in heart failure<br />Arch Intern Med. 2010 Nov 22;170(21):1876-83. Subclinical thyroid dysfunction and incident hip fracture in older adults.<br />Am J Med. 2011 Apr;124(4):334-41)Abnormalspirometricfindings in olderadultswithoutclinicallungdisease are associatedwithincreasedheartfailurerisk<br />
  57. 57. EPOC<br />Respir Med. 2011 Mar;105(3):461-9. Falls in people with chronic obstructive pulmonary disease: an observational cohort study. Patients with COPD have a high susceptibility to falls, which is associated with a worsening of dyspnea perception as related to HRQoL. Fall prevention programs in COPD are recommended.<br />Respir Med. 2011 Feb;105(2):236-42. Chronic respiratory disease and multimorbidity: prevalence and impact in a general practice setting. The majority of patients with chronic respiratory disease have multimorbidity. Clinical guidelines based on single disease entities and outcomes are not as easy to implement and may not be as effective in this group.<br />Eur J Clin Invest. 2011 May;41(5):507-12. doi: 10.1111/j.1365-2362.2010.02434.x. Statin use in patients with asthma: a nationwide population-based study.<br />
  58. 58.
  59. 59.
  60. 60.
  61. 61.
  62. 62. CAFÉ Y TÉ<br />Am J ClinNutr. 2010 Nov;92(5):1145-50. Coffee and tea intake and risk of brain tumors in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study.<br />Am J ClinNutr. 2010 Apr;91(4):1002-12. Differential effects of coffee on the risk of type 2 diabetes according to meal consumption in a French cohort of women: the E3N/EPIC cohort study.<br />Cancer Epidemiol Biomarkers Prev. 2010 Jan;19(1):39-47. Coffee, tea, caffeine intake, and risk of adult glioma in three prospective cohort studies.<br />Breast Cancer Res Treat. 2010 Jun;121(2):461-7. Coffee and tea intake and risk of breast cancer<br />Osteoporos Int. 2006;17(7):1055-64. Coffee, tea and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women.<br />J Natl Cancer Inst. 2005 Feb 16;97(4):282-92. Coffee, tea, and caffeine consumption and incidence of colon and rectal cancer.<br />Arch Intern Med. 2006 Jun 26;166(12):1311-6.Coffee consumption and risk of type 2 diabetes mellitus: an 11-year prospective study of 28 812 postmenopausal women.<br />Ann Oncol. 2011 Mar;22(3):536-44. Coffee and cancers of the upper digestive and respiratory tracts: meta-analyses of observational studies.<br />
  63. 63. CHOCOLATE<br />J Intern Med. 2009 Sep;266(3):248-57.Chocolate consumption and mortality following a first acute myocardial infarction: the Stockholm Heart Epidemiology Program.<br />BMJ. 2011 Aug 26;343:d4488. doi: 10.1136/bmj.d4488.Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis.<br />Circ Heart Fail. 2010 Sep 1;3(5):612-6. Epub 2010 Aug 16.Chocolate intake and incidence of heart failure: a population-based prospective study of middle-aged and elderly women.<br />J Nutr. 2010 Sep;140(9):1582-7. Epub 2010 Jul 21.Blueberries decrease cardiovascular risk factors in obese men and women with metabolic syndrome.<br />Maturitas. 2011 Aug;69(4):312-21. Epub 2011 Jun 12.The impact of chocolate on cardiovascular health.<br />Relative risks for cardiovascular disease, heart failure, and stroke in adults with higher levels of chocolate <br />consumption compared with lower levels<br />

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