ICUs and the elderly

There is concern about the misuse of hospital resources by the elderly, assuming that in many circums-tances, the services received, apart from being disproportionate, may also be more harmful than beneficial. The last post analysed the syndrome of post-hospitalization, a pathology that contracted the vulnerable people by the fact of them having been admitted to a hospital. In the same vein, I would like to comment on a clinical trial carried out in 24 French hospitals, with more than 3,000 people over 75 years of age in a clinically critical situation, of which half entered a program that promoted ICU admission , while the other half simply followed the standard criteria of each centre, without any external pressure. In the observed results, the patients in the intervention group logically entered the critical units (61% versus 34%), but this did not lead them to live longer, since, despite the fact that the gross mortality at 6 months was higher in the group that had observed greater use of ICUs (45% versus 39%), after adjusting the numbers*, relative risk was reduced to 1.05 (not significant).

The post-hospitalization syndrome

Harlan Krumholz (Yale) is a cardiologist who focuses his research on the impact of health services on health outcomes (Center for Outcomes Research and Evaluation - CORE), and on "Post-Hospital Syndrome. An Acquired, Transient Condition of Generalized Risk" focused its attention on readmissions, a problem that affects 20% of people who are discharged in the US. In this context, Krumholz's most prominent finding in the article was that of Jenks and colleagues (with 12 million Medicare discharge records), which enabled them to conclude that patients who had been admitted with decompensations of the most common chronic pathologies: heart failure, pneumonia, COPD or gastrointestinal disorders, if they were readmitted before 30 days, they did so in two-thirds of the time, for reasons other than the diagnosis of the previous admission.

Could the American Health System Become the Best in the World?

Josep M. Picas

The title of this paper is the same as one recently published in the "Perspective" section of The New England Journal of Medicine (NEJM), "From Last to First. Could the U.S. Health Care System Become Best in the World?" This article seemed to me to be an interesting example of introspection and critical analysis, and at the same time an excellent formulation of future challenges. I must confess that I feel admiration and envy for these types of approaches and advances that we frequently observe in the Anglo-Saxon environment.

Focusing on the daily life of frail people

The PACE (Program for All-Inclusive Care for the Elderly) model was born in 1971 when a dentist and a social worker working for the San Francisco Department of Public Health in Chinatown-North Beach realized that older people were reluctant to move to a social residence when, instead, with some complementary services, they could continue to live in their own homes, in a more friendly and stimulating environment. Nearly fifty years later, PACE enjoys good health and "The Commonwealth Fund" has published a "Case Study" analysing its operation and results.