Effectiveness of the SUGAR intervention on hypoglycaemia in elderly patients with type 2 diabetes: A pragmatic randomised controlled trial.

Background: A pharmacist-led, individualised, educational intervention (SUGAR) was formulated to prevent hypoglycaemia among elderly patients with type 2 diabetes mellitus (T2DM) in Jordan.

Objective(s): To evaluate the effectiveness of the SUGAR intervention added to usual care compared with usual care only in preventing hypoglycaemic attacks in elderly patients with T2DM in Jordan.

Methods: A single-centre, pragmatic, open-label, randomised controlled trial with embedded process evaluation was conducted at the outpatient clinics of a hospital in Jordan.

Randomised controlled trial of pharmacist-led patient counselling in controlling hypoglycaemic attacks in older adults with type 2 diabetes mellitus (ROSE-ADAM): A study protocol of the SUGAR intervention.

Introduction: Hypoglycaemia is one of the most serious adverse effects of diabetes treatment. Older adults are at the highest risk to develop hypoglycaemia. Several studies have established the important positive role of educational interventions on achieving glycaemic control and other clinical outcomes, however, there is still a lack in studies that evaluate the impact of such type of interventions on hypoglycaemia risk in elderly patients with type 2 diabetes.

Impact of malnutrition in the embolic-haemorrhagic trade-off of elderly patients with atrial fibrillation.

Aims: Nutrition is an important determinant of health above the age of 80 years. Malnutrition in the elderly is often underdiagnosed. The aim of this study was to report the prevalence and prognostic value of malnutrition in patients ≥80 years old with atrial fibrillation (AF) with and without anticoagulant therapy.

[Characteristics and one-year outcomes in elderly patients hospitalised with heart failure and preserved, mid-range and reduced ejection fraction].

Introduction: The latest European Society of Cardiology Heart Failure (HF) guidelines define three types of HF according to the ejection fraction (EF): HF with reduced EF (HFrEF) when EF<40%, HF with mid-range EF (HFmrEF), when EF 40-49%, and HF with preserved EF (HFpEF) when EF≥50%. The objective of this study was to analyse the characteristics and results of elderly patients hospitalised with HF according to the new classification using EF.

Methods: A prospective study was carried out with 531 HF patients aged ≥75 years classified according to EF, and admitted in the geriatric wards of 6 hospitals in Spain.

[Cross-speciality geriatrics: A health-care challenge for the 21st century].

Increasing numbers of older persons are being treated by specialties other than Geriatric Medicine. Specialists turn to Geriatric Teams when they need to accurately stratify their patients' risk and prognosis, predict the potential impact of their, often, invasive interventions, optimise their clinical status, and contribute to discharge planning. Oncology and Haematology, Cardiology, General Surgery, and other surgical departments are examples where such collaborative working is already established, to a varying extent.

Frailty, disability and comorbidity: different domains lead to different effects after surgical aortic valve replacement in elderly patients.

Objectives: Frailty syndrome predicts adverse outcomes after surgical aortic valve replacement. However, disability or comorbidity is frequently associated with preoperative frailty evaluation. The effects of these domains on early and late outcomes were analysed.

Prognosis of Patients With Severe Aortic Stenosis After the Decision to Perform an Intervention.

Introduction And Objectives: Current therapeutic options for severe aortic stenosis (AS) include transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Our aim was to describe the prognosis of patients with severe AS after the decision to perform an intervention, to study the variables influencing their prognosis, and to describe the determinants of waiting time > 2 months.

Methods: Subanalysis of the IDEAS (Influence of the Severe Aortic Stenosis Diagnosis) registry in patients indicated for TAVI or SAVR.

Safety of Direct Oral Anticoagulants and Vitamin K Antagonists in Oldest Old Patients: A Prospective Study.

Objective: The safety of direct oral anticoagulants (DOACs) in oldest old patients with nonvalvular atrial fibrillation (NVAF) in daily clinical practice has not been systematically assessed. This study examined the safety of DOACs and dicumarol (a vitamin K antagonist) in NVAF geriatric patients.

Design: Prospective study from January 2010 through June 2015, with follow-up through January 2016.

Health Literacy and Health Outcomes in Very Old Patients With Heart Failure.

Introduction And Objectives: Health literacy (HL) has been associated with lower mortality in heart failure (HF). However, the results of previous studies may not be generalizable because the research was conducted in relatively young and highly-educated patients in United States settings. This study assessed the association of HL with disease knowledge, self-care, and all-cause mortality among very old patients, with a very low educational level.

The frailty syndrome is associated with adverse health outcomes in very old patients with stable heart failure: A prospective study in six Spanish hospitals.

Background: Most studies on the association between the frailty syndrome and adverse health outcomes in patients with heart failure (HF) have used non-standard definitions of frailty. This study examined the association of frailty, diagnosed by well-accepted criteria, with mortality, readmission and functional decline in very old ambulatory patients with HF.

Methods: Prospective study with 497 patients in six Spanish hospitals and followed up during one year.

The frailty syndrome and mortality among very old patients with symptomatic severe aortic stenosis under different treatments.

Background: The role of frailty as a prognostic factor in non-selected patients with symptomatic severe aortic stenosis (SAS) is still uncertain. This study aims to examine the association between the frailty syndrome and mortality among very old patients with symptomatic SAS, and to assess whether the association varies with the type of SAS treatment.

Methods And Results: Prospective study of 606 patients aged ≥75years with symptomatic SAS, recruited from February 2010 to January 2015, who were followed up through June 2015.

Comorbidity and intervention in octogenarians with severe symptomatic aortic stenosis.

Background: The benefit from intervention in elderly patients with symptomatic severe aortic stenosis (AS) and high comorbidity is unknown. Our aims were to establish the correlation between the Charlson comorbidity index and the prognosis of octogenarians with symptomatic sever AS and to identify patients who might not benefit from intervention.

Methods: We used the data from PEGASO (Pronóstico de la Estenosis Grave Aórtica Sintomática del Octogenario--Prognosis of symptomatic severe aortic stenosis in octogenarians), a prospective registry that included consecutively 928 patients aged ≥ 80 years with severe symptomatic AS.

Comprehensive geriatric assessment and 2-year mortality in elderly patients hospitalized for heart failure.

Background: In older adults hospitalized for heart failure, a poor score on a comprehensive geriatric assessment (CGA) is associated with worse prognosis during hospitalization and at 1 month after discharge. However, the association between the CGA score and long-term mortality is uncertain.

Methods And Results: This is a prospective study of 487 patients aged ≥75 years admitted for decompensated heart failure.

Comprehensive geriatric assessment and hospital mortality among older adults with decompensated heart failure.

Background: The aim of this study is to assess whether a simple comprehensive geriatric assessment (CGA) score predicts hospital mortality among very elderly patients admitted with heart failure (HF).

Methods: This is a prospective follow-up of 581 individuals aged ≥75 years admitted for decompensated HF to an acute geriatric unit from October 2006 to September 2009. A CGA score (range, 0-10) was constructed using baseline individual data on 5 domains: dependence in activities of daily living (Katz index), mobility (qualitative mobility scale), cognition (Mini-Mental State Examination), comorbidity (Charlson index), and number of prescribed medications.

Rationale and methods of the multicenter randomised trial of a heart failure management programme among geriatric patients (HF-Geriatrics).

Background: Disease management programmes (DMPs) have been shown to reduce hospital readmissions and mortality in adults with heart failure (HF), but their effectiveness in elderly patients or in those with major comorbidity is unknown. The Multicenter Randomised Trial of a Heart Failure Management Programme among Geriatric Patients (HF-Geriatrics) assesses the effectiveness of a DMP in elderly patients with HF and major comorbidity.

Methods/design: Clinical trial in 700 patients aged ≥ 75 years admitted with a primary diagnosis of HF in the acute care unit of eight geriatric services in Spain.

Quality of life, characteristics and metabolic control in diabetic geriatric patients.

Objectives: To describe the characteristics, metabolic control and health-related quality of life (HRQL) of type 2 diabetes mellitus (T2DM) geriatric patients.

Study Design: Cross-sectional descriptive study of consecutive patients attended at a geriatric outpatient clinic in a tertiary hospital over three months. Sociodemographic, geriatric assessment variables, HRQL (using the EuroQol instrument) and comorbidity (Charlson and CIRS-G indexes) were measured.

Housing conditions and mortality in older patients hospitalized for heart failure.

Background: Although decent housing is recognized as a prerequisite for good health, very few studies in developed countries have examined the influence of housing characteristics on disease prognosis. This work examined whether housing conditions predict mortality in older adults with heart failure (HF).

Methods: This is a cohort study comprising 433 patients hospitalized for HF-related emergencies in 4 Spanish hospitals between January 1, 2000, and June 30, 2001.

Generic and disease-specific quality of life as a predictor of long-term mortality in heart failure.

Aims: Although the vital prognosis of heart failure (HF) is generally poor, it varies substantially between patients. This study examined whether health-related quality of life (HRQoL) predicts long-term mortality in HF. It also evaluated the role of generic and disease-specific HRQoL questionnaires.

Mechanisms of the association between depressive symptoms and long-term mortality in heart failure.

Background: The long-term prognostic influence of depression on patients hospitalized for heart failure (HF) is unknown. No previous study has examined systematically the mechanisms of the relationship between depression and mortality in HF.

Methods: Prospective study of 433 patients hospitalized for HF-related emergencies in 4 Spanish hospitals.