ObjectiveTo analyse short-term functional decline and associated factors in over 65-year-olds with multimorbidity.Design and settingProspective multicentre study conducted in three primary care centres, over an 8-month period. During this period, we also analysed admissions to two referral hospitals.ParticipantsOf the 241 patients ≥65 years included randomly in the study, 155 were already part of a multimorbidity programme (stratified by ‘Adjusted Clinical Groups’) and 86 were newly included (patients who met Ollero’s criteria and with ≥1 hospital admission the previous year). Patients who were institutionalised, unable to complete follow-up or receiving dialysis were excluded.Outcomes and variablesThe primary outcome was the decrease in functional status category (Barthel Index or Lawton Scale). Other variables considered were sociodemographic characteristics, comorbidity, medications, number of admissions and functional status on discharge.ResultsPatients had a median age of 82 years (P75 86) and of five selected chronic conditions (IQR 4–6), and took 11 (IQR 9–14) regular medications; 46.9% were women; 38.2% had impaired function at baseline.Overall, 200 persons completed the follow-up; 10.4% (n=25) of the initial sample died within the 8 months. In 20.5% (95% CI 15.5% to 26.6%) of them we recorded a decrease in functionality, associated with older age (OR 1.1, 95% CI 1.0 to 1.2) and with having ≥1 admission during the follow-up (OR 3.6, 95% CI 1.6 to 7.7). There were 133 hospital admissions in total during the follow-up considering all the patients included, and a functional decline was observed in 35.5% (95% CI 25.7% to 46.7%) of the 76 discharges in which functional status was assessed.ConclusionsA fifth of patients showed functional decline or loss of independence in just 8 months. These findings are important as functional decline and the increasing care needs are potentially predictable and modifiable. Age and hospitalisation were closely associated with this decline

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INTRODUCCION: La neumonía es la inflamación del parénquima pulmonar debida a un agente infeccioso.Cuando afecta a la población no ingresada en un hospital, se denomina neumonía adquirida en la comunidad(NAC). La NAC grave suele representar entre el 3 y 18% de las NAC hospitalizadas con una mortalidadentre el 21 y 54%. Para evaluar la gravedad de la NAC se utilizan los criterios PSI (Pneumonia severityIndex). Los corticoesteroides son hormonas esteroideas, participan en diferentes procesos regulando lainflamación, el sistema inmunitario, así como la respuesta del organismo al estrés, etc. Los corticoidessintéticos y semisintéticos se utilizan en numerosos procesos patológicos.METODOLOGÍA: Desde la exposición de un escenario clínico, se planteó una pregunta estructurada paraluego realizar una búsqueda bibliográfica, con el objetivo de dar respuesta a la pregunta sobre si el uso decorticoterapia adyuvante en pacientes con NAC grave disminuye la mortalidad y la necesidad de asistenciarespiratoria mecánica.Se realizó una búsqueda en PubMed y se seleccionó el artículo: “Efficacy and safety of glucocorticoids inthe treatment of severe community-acquired pneumonia”ANALISIS DEL ARTICULO: Se realizó un análisis definiendo los valores de riesgo absoluto, riesgorelativo y el número necesario a tratar del grupo problema y grupo control tomando en cuenta las variablesmortalidad y necesidad de asistencia respiratoria mecánica. Por otro lado, se determinó el odds ratio con surespectivo intervalo de confianza del 95%.RECOMENDACIÓN FINAL: se recomienda el uso de corticoterapia adyuvante como tratamiento contrala NAC grave.