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ResumenLa utilización inapropiada de medicamentos en los adultos mayores conlleva frecuentemente la génesis de reacciones adversas debido a los cambios fisiológicos asociados a la edad. Esto aumenta la morbimortalidad determinando un mayor número de admisiones hospitalarias, con incremento de la utilización de recursos sanitarios y gastos en salud. Para poder optimizar la prescripción de medicamentos en los ancianos se han desarrollado en los últimos años herramientas implícitas y explicitas. Los criterios explícitos STOPP-START publicados en el 2008 se han impuesto como referencia en Europa aplicándose en diferentes ámbitos asistenciales. En este artículo se presenta una actualización de estos criterios realizada en el año 2014.

The EIP for the surgical team significantly improved their adherence but only in the colon-rectal surgeries. The adherence to the recommended guidelines is still low. Reasons could be the subjective perception of elevated bleeding risk and the variable grade of recommendation in different guidelines.

Introduction The evidence of effectiveness of integrated care initiatives for home-dwelling frail older persons is still inconclusive. There is a need for more studies, especially in developing countries. Our objective was to assess the effectiveness of a health and social care integration programme versus the best standard of care to date in this population. Methods Quasi-experimental study performed in patients' homes in Buenos Aires, Argentina. The intervention arm had a health and social care counsellor that systematically reviewed the social and biological situation following a structured process, evaluating: functionality, nutrition, mobility, pain, cognition, medication reconciliation and adherence, need for care, quality of care, and environmental safety. The control group received the best standard of care to date, with access to the same health or social care services, but without the counsellor and related processes. The main outcome was the adjusted hazard ratio for hospitalizations after one year using a Cox-proportional hazards model. Results We recruited 121 persons in each group. The crude hazard ratio for hospital admissions, comparing the intervention to the control group was 0.622 (95% CI: 0.427–0.904; p = 0.013). The adjusted hazard ratio (aHR) was 0.503 (95% CI: 0.340–0.746; p = 0.001). The aHR for death was 0.993 (95% CI: 0.492–2.002; p = 0.984). The absolute difference in the quality of life was 16.59 points (95% CI: 12.03–21.14; p < 0.001). Discussion The integration programme had lower hospital admissions and better quality of life than the usual care. There was no significant difference in death rates.

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