European Journal of Internal Medicine 25 (2014) e55

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Letter to the Editor Nonagenarians: Questions and answers. Reply

To the Editor, We appreciate the letter and comments by Martín-Sánchez et al. [1] wherein they refer to our study. We consider that the research should be commented upon by the scientific community in order to improve the evidence it provides. First of all, we want to explain that our manuscript is a first approach toward the characteristics of nonagenarian patients and the different services that care for them in our hospital. We agree with Martín-Sánchez et al. [1] that it is better to measure mortality at 30 days; however, this was not possible in our study because it was retrospective, performed in the hospital with the data obtained from the hospital inpatient database [2]. Moreover, as it was a retrospective study, we did not include several variables that should be of interest, such as functional and cognitive profiles of the nonagenarians, the complications of hospitalization, and co-morbidities. These variables are not contained in the hospital registry. The suggestion by Martín-Sánchez et al. [1] should be incorporated in a prospective study in nonagenarians with follow-up until 30 days after discharge. We regard that it is important to continue with the research in different fields in nonagenarians [3]. The second main point the authors raise, about whether the attention nonagenarians receive in the short stay unit with fewer days of hospitalization and monitored with home hospitalization is better than the conventional attention after 30 days, is important to explore. About how and where nonagenarian patients are better treated in a general hospital is another line of research. Generating better information about the outcomes and best location for attending these patients is very important. The initial objective of our epidemiological research was to learn how nonagenarian patients are attended and why they are admitted [2]. Following this, and due to the comments by Martinez-Sánchez

et al. [1] and our considerations, we deem to perform prospective studies to resolve the questions proposed. The services of the General Internal Medicine should adapt to current realities, and should improve attending nonagenarian and elderly patients [3] and patients with comorbidity [4]. Conflict of interest The authors declared no conflict of interest related to this manuscript. References [1] Martín-Sánchez FJ, Lázaro Nogal M, González del Castillo J, González Armengol JJ, Ribera Casado JJ. Nonagenarians: questions and answers. Eur J Intern Med 2014;25: e55 [this volume]. [2] Ramos JM, Sánchez-Martínez R, Nieto F, Sastre J, Valero B, Priego M, et al. Characteristics and outcome in nonagenarians admitted in general internal medicine and other specialties. Eur J Intern Med 2013;24:740–4. [3] Conde-Martel A, Hemmersbach-Miller M, Marchena-Gomez J, Saavedra-Santana P, Betancor-Leon P. Five-year survival and prognostic factors in a cohort of hospitalized nonagenarians. Eur J Intern Med 2012;23:513–8. http://dx.doi.org/10.1016/ j.ejim.2012.02.007. [4] Almagro P, López F, Cabrera FJ, Portillo J, Fernández-Ruiz M, Zubillaga E, et al. Grupos de trabajo de EPOC y Paciente Pluripatológico y Edad Avanzada de la Sociedad Española de Medicina Interna (Comorbidities in patients hospitalized due to chronic obstructive pulmonary disease. A comparative analysis of the ECCO and ESMI studies). Rev Clin Esp 2012;212:281–6. http://dx.doi.org/10.1016/j.rce.2012.02.014.

José M. Ramos* Rosario Sánchez-Martínez Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain Department of Medicine, Miguel Hernández University of Elche, San Juan Campus, Spain ⁎Corresponding author at: Servicio de Medicina Interna, Hospital General Universitario de Alicante, c/Pintor Baeza, 12, 03010 Alicante, Spain. Tel.: +34 965933000. E-mail address: [email protected] (J. Ramos).

0953-6205/$ – see front matter © 2013 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ejim.2013.11.008

Nonagenarians: questions and answers. Reply.

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