A nurse-led home-based exercise program for patients with chronic kidney disease.

BACKGROUND: Exercise programs in patients with kidney disease improve functional capacity and health-related quality of life, but the implementation of exercise programs in nephrology services is not an easy task. AIM: To evaluate the effectiveness of a home-based exercise program in patients with chronic kidney disease (CKD) stages 4-5 (with or without dialysis). METHODS: A 12-week prospective observational cohort design study was carried out with patients with renal failure who undertook a home-based exercise program. Registered data included: (a) biochemical parameters; (b) functional capacity tests, that is, short physical performance battery, sit to stand to sit 10, and 6-min walking test; (c) handgrip strength; (d) health-related quality of life; (e) satisfaction; and (f) adherence. The quantitative variables were expressed by means and standard deviation, and qualitative variables, by percentage. The comparison of quantitative data between baseline and at 12 weeks of the same group was carried out using the Wilcoxon test for nonparametric-related variables and the chi-square test for categorical variables using contingency tables. RESULTS: Fifty-three patients were included (mean age = 67.4 years). The functional capacity tests showed a significant improvement in the short physical performance battery (8.3 ± 2.8 vs. 9.5 ± 2.6 points), the sit to stand to sit 10 (35.8 ± 17.7 vs. 31.8 ± 15.3 s), and the 6-min walking test (355.0 ± 106.1 vs. 386.4 ± 113.6 meters), mainly in CKD stage 5. There were no significant differences in handgrip and health-related quality of life. Regarding the degree of program satisfaction, 70% of the patients were very satisfied with being able to participate in the program, and 64% considered that they had more strength after completing the home-based exercise program. LINKING EVIDENCE TO ACTION: The implementation of a home-based exercise program results in improved functional capacity in patients with CKD stage 5. Moreover, this exercise program is safe, and patients were satisfied.

Home-based exercise programs in patients with chronic kidney disease: A systematic review and META-analysis.

BACKGROUND: Intradialysis exercise programs in renal patients result in improved functional capacity, muscle strength, symptoms of depression, and health-related quality of life. Home-based exercise programs are an alternative to overcome logistical and human resource problems. However, the implementation of these programs is not an easy task and there is a lack of knowledge regarding the benefits associated with home-based exercise programs. AIM: To determine whether home-based exercise programs improve functional capacity, health-related quality of life, muscle strength, and symptoms of depression among patients with stage III-V chronic kidney disease. METHODS: A systematic review and meta-analyses following PRISMA guidelines were utilized. Relevant articles were collected and independently assessed for their inclusion eligibility. Effects of home-based exercise were summarized by the standardized mean differences and represented by forest plots (Review Manager 5.4). RESULTS: Eight studies were included, none of which reported any adverse effects. The intervention was usually aerobic, 76% of these programs lasted 3-6 months, and exercise adherence was 60-87.5%. Four studies measured health-related quality of life and found significant improvements in several subscales. Regarding functional capacity, five studies used the six-minute walking test (44.9 meters; 95% CI [30.45, 59.30]; p ≤ .001), three studies used the sit-to-stand-to-sit test (-0.45 seconds; 95% CI [-0.46, -0.26]; p ≤ .001), and two studies used the timed up-and-go test (-0.76 seconds; 95% CI [-1.38, -0.15]; p ≤ .001) and the handgrip strength test (1.16 kg; 95% CI [-2.88, 5.20]; p ≤ .001). LINKING EVIDENCE TO ACTION: Home-based exercise programs are beneficial to renal patients. These interventions are safe and effective to improve health-related quality of life and functional capacity and reduce symptoms of depression among patients with chronic kidney disease.

Impact of measurement timing on reproducibility of testing among haemodialysis patients.

Accurate evaluation of physical function in patients undergoing haemodialysis is crucial in the analysis of the impact of exercise programs in this population. The aim of this study was to evaluate the reproducibility of several physical functional tests, depending on the timing of their implementation (before the HD session vs. non-HD days). This is a prospective, non-experimental, descriptive study. Thirty patients in haemodialysis were evaluated twice, 1 week apart. The test session was performed before the haemodialysis session started and a retest was performed in non-dialysis day. The testing battery included the short physical performance battery, sit-to-stand tests, 6 min walk test, one-leg stand test, timed up and go, and handgrip strength with and without forearm support. The intra-rater reproducibility was determined by the intraclass correlation coefficients and the agreement was assessed by Bland-Altman analysis. The intraclass correlation coefficients values ranged from 0.86 to 0.96, so that all tests showed good to very good relative reliability. The mean differences between trials of sit to stand 10 and 60, timed up and go and all the handgrip tests were close to zero, indicating no systematic differences between trials. Large range of values between trials was observed for the 6 min walk test, gait speed, one-leg stand test and short physical performance battery, indicating a systematic bias for these four tests. In conclusion,  the sit to stand 10 and 60, timed up and go and handgrip tests had good to excellent test-retest reliability in measuring physical function in different dialysis days of patients undertaking haemodialysis. The minimal detectable change values are provided for this population. Bias were found for the 6 min walk test, gait speed, Short physical performance battery or one-leg stand test when the testing day changed.

Componentes de la valoración geriátrica y adherencia terapéutica en el paciente anciano con infarto agudo de miocardio / Components of geriatric assessment and therapeutic adherence in elderly patients with acute myocardial infarction

Antecedentes y objetivo: La mala adherencia terapéutica tras un infarto agudo de miocardio (IAM) puede conllevar complicaciones graves precoces. La información sobre el impacto de la valoración geriátrica en la adherencia es escasa. El objetivo de este estudio fue analizar, en pacientes mayores con IAM, el impacto de la valoración geriátrica en la adherencia terapéutica 12 meses tras el ingreso.Materiales y métodos: Un estudio previo aleatorizó a pacientes de edad>75 años que habían presentado un IAM a un programa de educación sanitaria de enfermería o manejo convencional. Se evaluó el impacto de dicha intervención en la adherencia terapéutica tras 12 meses. Se realizó valoración geriátrica intrahospitalaria. Para este subestudio se analizaron los predictores de adherencia mediante regresión logística binaria. Se consideró adherentes a aquellos pacientes que lo resultaron en las 4 herramientas: el test de Morisky-Green, Haynes-Sackett, asistencia a visitas y correcta retirada de fármacos de farmacia.Resultados: Se incluyó a 119 pacientes, con una edad media de 82,2 años. Al año, un total de 42 pacientes (35,3%) fueron adherentes. Los predictores de mala adherencia en el modelo final fueron el sexo masculino, el peor filtrado glomerular, el deterioro cognitivo, el riesgo nutricional, el hecho de no vivir solo y no haber participado en el grupo de intervención.Conclusiones: Los datos de esta serie muestran una baja adherencia terapéutica en las personas mayores después de un IAM. El deterioro cognitivo o el riesgo nutricional se asociaron de forma significativa con una peor adherencia, de forma contraria a una intervención de enfermería, lo que pone de relieve la importancia de la educación sanitaria y la supervisión en pacientes de alto riesgo. (AU)

Background and objective: Poor therapeutic adherence after acute myocardial infarction (AMI) can lead to early serious complications. Information on the impact of geriatric assessment on adherence is scarce. The objective of this study was to analyze, in older patients with AMI, the impact of geriatric assessment on therapeutic adherence 12 months after admission.Materials and methods: A previous study randomized patients aged >75 years who had presented an AMI to a nursing health education program versus conventional management, evaluating the impact of this intervention on therapeutic adherence after 12 months. In-hospital geriatric assessment was performed. For this substudy, the adherence predictors were analyzed using binary logistic regression. Those patients who obtained adherence in the 4 tools were considered adherent: the Morisky-Green, Haynes-Sackett test, attendance at visits and correct withdrawal of drugs from the pharmacy.Results: A total of 119 patients with a mean age of 82.2 years were included. At one year, a total of 42 patients (35.3%) were adherent. The predictors of poor adherence in the final model were male sex, worse glomerular filtration rate, cognitive impairment, nutritional risk, not living alone and not belonging to the intervention group.Conclusions: The data of this series show a low therapeutic adherence in the elderly after an AMI. Cognitive impairment or nutritional risk was significantly associated with poorer adherence, contrary to a nursing intervention, which highlights the importance of health education and supervision in high-risk patients. (AU)

[Components of geriatric assessment and therapeutic adherence in elderly patients with acute myocardial infarction]. / Componentes de la valoración geriátrica y adherencia terapéutica en el paciente anciano con infarto agudo de miocardio.

BACKGROUND AND OBJECTIVE: Poor therapeutic adherence after acute myocardial infarction (AMI) can lead to early serious complications. Information on the impact of geriatric assessment on adherence is scarce. The objective of this study was to analyze, in older patients with AMI, the impact of geriatric assessment on therapeutic adherence 12 months after admission. MATERIALS AND METHODS: A previous study randomized patients aged >75 years who had presented an AMI to a nursing health education program versus conventional management, evaluating the impact of this intervention on therapeutic adherence after 12 months. In-hospital geriatric assessment was performed. For this substudy, the adherence predictors were analyzed using binary logistic regression. Those patients who obtained adherence in the 4 tools were considered adherent: the Morisky-Green, Haynes-Sackett test, attendance at visits and correct withdrawal of drugs from the pharmacy. RESULTS: A total of 119 patients with a mean age of 82.2 years were included. At one year, a total of 42 patients (35.3%) were adherent. The predictors of poor adherence in the final model were male sex, worse glomerular filtration rate, cognitive impairment, nutritional risk, not living alone and not belonging to the intervention group. CONCLUSIONS: The data of this series show a low therapeutic adherence in the elderly after an AMI. Cognitive impairment or nutritional risk was significantly associated with poorer adherence, contrary to a nursing intervention, which highlights the importance of health education and supervision in high-risk patients.

Can an individualized adherence education program delivered by nurses improve therapeutic adherence in elderly people with acute myocardial infarction?: A randomized controlled study.

BACKGROUND: The ageing of the population is leading to an increase in the number of elderly patients with acute myocardial infarction. These patients are at higher risk for complications and poor medication adherence, which in turn are associated with higher healthcare resource expenditures. Nursing programmes might help to improve adherence in these complex patients. OBJECTIVE: The objective of this study was to assess the impact of a nursing intervention on therapeutic adherence in elderly patients after myocardial infarction compared to a control group. DESIGN: A single-blind, randomized controlled trial. SETTINGS: Heart disease institute of a tertiary care hospital. PARTICIPANTS: Patients aged ≥75 years with myocardial infarction undergoing percutaneous coronary intervention. METHODS: A comprehensive geriatric assessment was performed during the admission in all patients (N=143). Patients were randomly allocated to a nursing intervention group (n=68) or a usual care group (n=75). In patients from the intervention group, a nursing intervention programme was performed 3 months after admission based on education support and patient monitoring to improve therapeutic adherence. The main outcome measured was 12-months therapeutic adherence, as defined by a combination of measurement tools (Morisky-Green and Hayness-Sacket scales, attendance at visits and withdrawal of medication from the pharmacy). Therapeutic adherence was assessed by nurses blinded to the assignment group. RESULTS: The mean age was 82.2 years. The proportion of comorbidities was significant (diabetes mellitus 51/143 (35.7%), hypertension 110/143 (76.9%), prior stroke 22/143 (15.4%)). Likewise, the proportion of geriatric syndromes was noticeable (frailty 26/143 (18.2%), risk of malnutrition 38/143 (26.6%), cognitive impairment 28/143 (19.6%)). Most patients (92.3%) had a low educational level. A total of 119 patients achieved 12-month assessment adherence. Among these patients, the proportions of adherence were as follows: Morisky-Green test: 76/119 (63.9%), Haynes-Sackett test 99/119 (83.2%), medical visits compliance 95/119 (79.8%), and correct acquisition of drugs in the pharmacy 74/119 (62.2%). A total of 42/119 patients (35.3%) were adherent as defined by the combination of the 4 measures. Therapeutic adherence at 12 months was achieved in a significantly higher proportion of patients from the nursing intervention group (51.9% vs 21.5%, p<0.001). CONCLUSION: A significant proportion of elderly patients with myocardial infarction were non-adherent at 12 months. The proportion of adherent patients was highly variable according to the different tools used. A structured nursing intervention was independently associated with a higher adherence rate, as assessed by a multidimensional measurement, in this subset of complex high-risk elderly patients with myocardial infarction. TRIAL REGISTRATION: Registered with www.clinicaltrials.gov (NCT04662762).

The Relationship between Physical Activity Levels and Functional Capacity in Patients with Advanced Chronic Kidney Disease.

The purpose of this study is to assess whether the functional capacity of patients with chronic kidney disease stage V (CKD-5D) is different depending on their physical activity levels. We also compared functional capacity, quality of life, and symptoms of depression depending on treatment modalities (HD vs. PD). A Cross-sectional study included 52 patients (35HD and 17PD; males 61.5%, mean age 71 years). The main measurements were physical activity level using the Human Activity Profile questionnaire (HAP), muscle strength, functional capacity, health-related quality of life (HRQoL), and depressive symptomatology. The functional tests and physical activity levels correlated significantly. Participants on HD with low physical activity levels were older (*p ≤ .039) and had worst physical function (*p ≤ .01). The HAP is a useful tool to detect subjects with low functional capacity; there were no differences between the therapy modalities in terms of functional capacity, HRQoL, or depressive symptomatology.

Resultados de un programa de ejercicio físico domiciliario en pacientes con enfermedad renal / Results of a home physical exercise program in patients with kidney disease

INTRODUCCIÓN: Cada vez es más frecuente la literatura que nos muestra los beneficios de los programas de ejercicio físico para mejorar la capacidad funcional y la calidad de vida relacionada con la salud de los pacientes con enfermedad renal crónica. Sin embargo, la implementación de estos programas no es una tarea fácil. OBJETIVO: Evaluar la efectividad de un programa de ejercicio físico domiciliario sobre la fuerza de agarre de las manos, capacidad funcional y calidad de vida en pacientes con enfermedad renal crónica avanzada en estadíos 4-5. MATERIAL Y MÉTODO: Estudio prospectivo experimental. Los pacientes realizaron un programa completo de ejercicio domiciliario de 3 sesiones semanales durante 12 semanas. Principales datos analizados: dinamometría manual (HG) y la prueba Short Physical Performance Battery (SPPB) y calidad de vida mediante el Euroqol 5D. RESULTADOS: 62 pacientes incluidos. 34 eran hombres con una edad media 67,4±14,9 años. La velocidad de la marcha en 4 metros aumentó en 0,18 m/s (IC95%: 0,08-0,28). Los resultados del SPPB aumentaron en 1,4 puntos (IC95%: 0,6-2,2 puntos). No se observan cambios significativos ni en la dinamometría manual (de 26,1Kg a 26,4Kg) ni en la calidad de vida relacionada con la salud (de 67,8 a 71,3 puntos). CONCLUSIÓN: Un programa de ejercicio físico domiciliario de 12 semanas de duración fue seguro y mejoró la capacidad funcional de los pacientes en enfermedad renal crónica avanzada en estadíos 4-5

INTRODUCTION: Scientific evidence is greater on the benefits of physical exercise programs to improve functional capacity and health-related quality of life of patients with chronic kidney disease. However, implementing these programs is not an easy task. OBJECTIVE: To evaluate the effectiveness of a home physical exercise program on hand grip strength, functional capacity and quality of life in patients with advanced chronic kidney disease in stages 4-5. MATERIAL AND METHOD: Prospective experimental study. The patients performed a complete home exercise program of 3 weekly sessions for 12 weeks. The main data analyzed were manual dynamometry, the Short Physical Performance Battery (SPPB) test, and the EuroQoL 5D questionnaire to assess quality of life. RESULTS: Sixty-two patients were included, 34 men and with a mean age of 67.4±14.9 years. The 4-meter gait speed increased by 0.18 m/s (95%CI: 0.08-0.28). The SPPB results increased by 1.4 points (95%CI: 0.6-2.2 points). No significant changes were observed either in manual dynamometry (from 26.1 to 26.4Kg) or in health-related quality of life (from 67.8 to 71.3 points). CONCLUSION: A 12-week home physical exercise program was safe and improved the functional capacity of patients with advanced chronic kidney disease in stages 4-5

Frailty in elderly patients undergoing primary percutaneous coronary intervention.

BACKGROUND: The prevalence of frailty, cognitive impairment and disability and its prognostic impact in patients with myocardial infarction undergoing primary percutaneous coronary intervention is unknown. AIMS: The aim of this study was to assess the prevalence of frailty and other ageing-related variables and their association with inhospital mortality in consecutive elderly ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention in a tertiary care hospital. METHODS: We prospectively included patients aged 75 years or older with STEMI undergoing primary percutaneous coronary intervention. The nursing team provided pre-discharge, standardised questionnaires and tests to each patient to study the presence of frailty (FRAIL scale), comorbidity (Charlson index), disability (Barthel test, Lawton-Brody index), nutritional risk (MNA-SF test) and cognitive status (Pfeiffer test). The association between ageing-related variables and mortality was assessed by binary logistic regression. RESULTS: A total of 259 patients were included with a mean age of 82.6±6 years, 57.9% men. A total of 51 patients (19.7%) were frail, 26 presented with moderate or severe disability (10%), and 82 were at risk of malnutrition (31.7%). Frailty was associated with a higher prevalence of diabetes, hypertension and previous stroke, and a higher inhospital mortality (21.6% vs. 3.4%; P<0.001). After adjusting for potential confounders, this association remained significant (odds ratio 3.96; 95% confidence interval 1.16-13.56; P=0.028). CONCLUSION: A not negligible proportion of elderly patients with STEMI fulfilled the frailty criteria. Frailty was independently associated with mortality. A very simple, feasible geriatric assessment by trained nurses can contribute to predict mortality.

Evaluación de la fiabilidad en instrumentos de valoración funcional en pacientes en hemodiálisis / Evaluation of reliability in functional assessment tools in patients on hemodialysis

Introducción: Cada vez es más frecuente promocionar programas de ejercicio físico en pacientes en hemodiálisis. Se puede valorar la condición física de estos pacientes y el resultado de dichos programas con diferentes pruebas funcionales. Objetivo: Valorar la fiabilidad en términos de concordancia interobservador de las mediciones de capacidad funcional y fuerza muscular en pacientes en hemodiálisis. Material y Método: 30 pacientes en hemodiálisis realizaron una batería de pruebas funcionales en dos fases: Short Physical Performance Battery, equilibrio estático monopodal, Timed Up and Go, Test Sit-to-stand-To-Sit-5, Sit-to-stand-To-Sit-10, Sit-to-stand-To-Sit-60, fuerza de tríceps sural, 6 minutos marcha y dinamometría de la mano. Resultados: El índice de correlación intraclase para la fiabilidad interobservador fue para el test Sit-to-stand-To-Sit-5: 0,779; velocidad en 4 metros: 0,820; puntuación total Short Physical Performance Battery: 0,807; Sit-to-stand-To-Sit-10: 0,908; Sit-to-stand-To-Sit-60: 0,865; 6 minutos marcha: 0,897; Equilibrio monopodal: 0,925; Timed Up and Go: 0,918; Fuerza de tríceps sural derecho: 0,702; Fuerza de tríceps sural izquierdo: 0,995; dinamometría mano derecha con apoyo: 0,952; dinamometría mano izquierda con apoyo: 0,897; dinamometría mano derecha sin apoyo: 0,973; dinamometría mano izquierda con apoyo: 0,964. Conclusiones: La fiabilidad interobservador en la mayoría de las pruebas es alta, por lo que se puede aceptar que la valoración del estado funcional del paciente y de los resultados de los programas destinados a promocionar el ejercicio lo lleven a cabo diferentes observadores experimentados, lo que facilitaría el seguimiento de los pacientes

Introduction: It is increasingly common to promote physical exercise programs in hemodialysis patients. The physical condition of patients and the result of these programs with different functional tests can be assessed. Objective: To assess the reliability in terms of interobserver reliability of functional capacity and muscle strength measurements in hemodialysis patients. Material and Method: 30 patients on hemodialysis performed several functional tests in two phases: Short Physical Performance Battery, static monopodal equilibrium, Timed Up and Go, Test Sit-to-stand-To-Sit-5, Sit-to-stand-To-Sit-10, Sit-to-stand-To-Sit-60, strength of triceps sural, 6 minutes walking and dynamometry of the hand. Results: The intraclass correlation coefficient for interobserver reliability was for the Sit-to-stand-To-Sit-5 test: 0.779; speed in 4 meters: 0.820; Total score Short Physical Performance Battery: 0.807; Sit-to-stand-To-Sit-10: 0.908; Sit-to-stand-To-Sit-60: 0.865; 6 minutes march: 0.897; Monopodal equilibrium: 0.925; Timed Up and Go: 0.918; Right triceps sural force: 0.702; Left triceps sural force: 0.995; Right hand dynamometry with support: 0.952; Left hand dynamometry with support: 0.897; right hand dynamometry without support: 0.973; left hand dynamometry with support: 0.964. Conclusions: The interobserver reliability, in most tests is high, so it can be accepted that the assessment of the patient’s functional status and the results of the programs designed to promote the exercise is carried out by different experienced observers, which would facilitate the follow-up of patients

Grado de dependencia de las personas sometidas a hemodiálisis en Cataluña y evolución de su mortalidad / Level of dependence in patients on haemodialysis in Catalonia and evolution of mortality rates

Introducción: La edad y las comorbilidades asociadas de muchos pacientes en hemodiálisis dificultan su autonomía funcional. Nuestros objetivos fueron conocer el grado de dependencia de las personas en hemodiálisis (HD) según criterios de la Ley sobre Promoción de la Autonomía Personal y Atención a las personas en situación de dependencia o Ley de Dependencia (LD) y su asociación con la mortalidad a tres años. Método: Estudio descriptivo transversal, realizado entre octubre de 2007 y enero de 2008. De 3702 pacientes de 40 unidades de Cataluña se seleccionó como posibles dependientes a 806, según el criterio del personal sanitario que los atendía. Se valoraron: grado de dependencia según los criterios de la LD, edad, tiempo en HD, patología asociada, características del tratamiento, situación familiar y supervivencia de 2009 a 2011. Resultados: Según la LD, no presentaban dependencia 137 pacientes, 350 presentaban dependencia de grado 1; 237 de grado 2, y 82 de grado 3. Residían en una institución 121. La media de edad fue de 74,9 ± 18,2 años y la mediana del tiempo en diálisis, de 36 meses. Destaca la prevalencia de diabetes (35,7%) y enfermedad cardiovascular (29,1%); las alteraciones musculoesqueléticas (87%) y neurológicas (38%) fueron las principales causas de dependencia. Eran portadores de catéter como acceso vascular el 64,2%. El 34,9% de los pacientes sobrevivieron a los 3 años, presentando menor grado de dependencia del que tenían los fallecidos antes del óbito, sin que existieran diferencias en el grado de dependencia entre los fallecidos en el primer, segundo o tercer año de supervivencia. Conclusiones: Según la LD, la prevalencia de pacientes con dependencia es elevada en Cataluña (18,07%). Estos pacientes presentan una elevada mortalidad a los 3 años (AU)

Introduction: Age as well as associated comorbilities of ESRD patients under maintenance haemodialysis, (HD) result in an impairment of their functional autonomy. Our aims were to assess the level of dependence in patients under HD as well as their mortality rate after three years. To do so, we followed the criteria established by the "Ley de Promoción de la Autonomía Personal y Atención a las Personas en situación de dependencia", the Spanish Law of Dependence (LD). Methods: Cross-sectional descriptive study done between October 2007 and January 2008. From 3702 patients in 40 Units in Catalonia, 806 were selected as potential dependent individuals according to the criteria of their healthcare givers. Variables studied included: level of dependence according to the criteria of the LD, age, time under HD, associated pathology, treatment characteristics, family circumstances and survival from 2009 to 2011. Results: According to the LD, 137 did not present dependence, 350 had a dependence level of grade 1, 237 of grade 2, and 82 of grade 3. 121 were living in an Institution. The mean age was 74,9?±18,2 years and the median time under HD was 36 months. The prevalence of remarkable pathologies were: diabetes (35,7%) and cardiovascular disease (29,1%). Musculoskeletal alterations (87%) and neurological disorders (38%) were the main causes of dependence. 64,2% patients were harbouring a catheter as a vascular access. 34,9% of patients survived after three years, and they had a lower level of dependence when compared to those patients who died, with no statistically significant differences within those three years. Conclusions: According to the LD, the prevalence of patients with dependence in Catalonia is relevant (18,07%). These patients present a high mortality rate after three years (AU)

Level of dependence in patients on haemodialysis in Catalonia and evolution of mortality rates.

INTRODUCTION: Age and the comorbidities associated with ESRD impair the functional autonomy of patients on haemodialysis (HD). Our objectives were to assess the level of dependence in patients on HD and their mortality rates after three years of treatment. To do so, we followed the criteria established by the "Ley de Promoción de la Autonomía Personal y Atención a las Personas en situación de dependencia", the Spanish Law of Dependence (LD). METHODS: We carried out a cross-sectional descriptive study between October 2007 and January 2008. From 3702 patients in 40 dialysis units in Catalonia, 806 were selected as potential dependent individuals according to the criteria of their healthcare providers. Variables studied included: level of dependence according to the LD criteria, age, time on HD, associated pathology, treatment characteristics, family circumstances, and survival from 2009 to 2011. RESULTS: According to the LD, 137 were not dependent, 350 had a grade 1 dependence level, 237 grade 2, and 82 grade 3. In addition, 121 were living in an institution. The mean age was 74.9 ± 18.2 years and the median time on HD was 36 months. The prevalence of common pathologies was: diabetes (35.7%) and cardiovascular disease (29.1%). Musculoskeletal alterations (87%) and neurological disorders (38%) were the main causes of dependence. 64.2% of patients had a catheter as a vascular access. 34.9% of patients survived after three years, and these had a lower level of dependence when compared to those patients who had died, with no statistically significant differences within those three years. CONCLUSIONS: According to the LD, the prevalence of dependent patients in Catalonia is substantial (18.07%). These patients have a high mortality rate after three years.

Características del cuidado familiar a pacientes dependientes en programa de hemodiálisis / No disponible

No disponible

Valoración de pacientes tratados con hemodiálisis según la Ley de Promoción de la Autonomía Personal y Atención a las personas en situación de dependencia / Evaluation of patients treated with haemodialysis according to the act for the promotion of personal autonomy and attention to persons in a situation of dependency

La valoración del grado de dependencia de los pacientes en diálisis ha sido objeto de interés como indicador clínico y organizativo. El objetivo del estudio es conocer el grado de dependencia que presentan las personas sometidas a tratamiento con diálisis en Catalunya, según los criterios de la Ley sobre Promoción de la Autonomía Personal y Atención a las personas en situación de dependencia. Se ha realizado un estudio descriptivo transversal en 42 centros de Cataluña sobre el grado de dependencia de los pacientes en hemodiálisis. La recogida de datos se hizo mediante una encuesta basada en el baremo de la Ley más datos sociodemográfico y características del tratamiento. De los pacientes que componían la población renal de Cataluña fueron considerados por los profesionales sanitarios con algún grado de dependencia 806, de ellos 425 eran hombres y 381 mujeres; un 61% tienen edades superiores a 70 años. El 53% viven en pareja y el 80,1% tenían uno o más hijos. El 77,4 % de los pacientes habían sido trabajadores no cualificados, y el 65,4% dijeron no tener estudios. Se consideraron no dependientes 137 pacientes, con dependencia moderada 350, con dependencia importante 237 y con gran dependencia 82. Fue significativa (p<0,005) la relación de la dependencia con la edad, la movilidad y en los grandes dependientes la incapacidad para tomar decisiones. No tuvo significación estadística el tiempo de permanencia en hemodiálisis. Aunque el baremo de la Ley rebaja la valoración de dependencia realizada por los profesionales, los centros de hemodiálisis están atendiendo a un 19% de pacientes dependientes (AU)

The evaluation of the degree of dependency of patients on haemodialysis is a clinical and organizational indicator. The aim of the study is to determine the degree of dependency of people undergoing haemodialysis in Catalonia, according to the criteria established by the Act for the Promotion of Personal autonomy and Attention to Persons in a Situation of Dependency. A transversal descriptive study was carried out in 42 centres in Catalonia on the degree of dependency of patients on haemodialysis. The data were collected through a survey based on the scale established by the Act plus sociodemographic data and treatment characteristics. Of the patients who made up the renal population of Catalonia (3868), 806 were considered by the healthcare professionals to have a high degree of dependency, of whom 425 were men and 381 were women; 61% were older than 70. 53% live with a partner and 80.1% had one or more children. 77.4% of the patients had been unskilled workers, and 65.4% stated that they had no educational qualifications. 137 patients were considered not dependent, 350 were considered to have moderate dependency, 237 with significant dependency and 82 with a high dependency. There was a significant (p<0.005) relationship between dependency and age, mobility and, in those with high dependency, with the inability to make decisions. The time they had been on haemodialysis was not statistically signifi cant. Although the scale established by the Act reduces the evaluation of dependency carried out by the professionals, 19% of the patients being treated by the haemodialysis centres have a clear lack of personal autonomy (AU)

Valoración del grado de autonomía funcional de pacientes renales crónicos según índices de Barthel, Lawton y baremo de Ley de Dependencia / Evaluation of the degree of functional autonomy of chronic renal patients according to Barthel, Lawton indices and the scale of the Dependence Act

La dependencia es un estado en el que se encuentran las personas que por razones ligadas a la falta o pérdida de autonomía física, psíquica o intelectual, tienen necesidad de asistencia y/o ayudas importantes a fin de realizar las actividades básicas de la vida diaria. La Ley 39/2006, de Promoción de la Autonomía Personal y Atención a las personas en situación de dependencia incluye un baremo mediante el cual se determina el grado y nivel de dependencia de la persona a valorar. En el proceso enfermero, para la valoración del grado de autonomía se utilizan habitualmente instrumentos como los índices de Barthel o Lawton. Se comparan los resultados obtenidos al utilizar como instrumentos de valoración los índices de Barthel, de Lawton y el baremo de la Ley de Dependencia mediante un estudio transversal y prospectivo (octubre 2007- febrero 2008) realizado en la Unidad Nefrológica del Consorcio Hospitalario de Vic (Barcelona) en el que se han incluido todos los pacientes mayores de 65 años, sometidos a programa de hemodiálisis periódica. Se valoró a los pacientes con los índices de Barthel y Lawton; y posteriormente se realizó la valoración utilizando el baremo de la Ley de Dependencia. El análisis delos datos se llevó a cabo con el paquete estadístico SPSS 14.0, para comparar medidas se utilizó la t de Student. Para la posible correlación entre variables se usó el método de regresión simple (Person) y los porcentajes se compararon utilizando el test de McNemar. De 91 pacientes, 52 pacientes (23 hombres) son mayores de 65 (57,14%) de ellos 34 son mayores de 80 años. Según el baremo de la Ley de Dependencia,32 pacientes son independientes, 16 presentan una dependencia moderada, 6 severa y 1máxima. Según el índice de Barthel 19 son independientes,29 presentaban dependencia leve, moderada4 y severa 1. Según el índice de Lawton 14eran independientes, 19 tenían una dependencia leve, 15 severa y 4 máxima (AU)

Dependence is a state in which people find them selves when, for reasons related to the lack or loss of physical, psychic or intellectual autonomy, they need important assistance and/or help in order to carry out basic activities of daily life. Act 39/2006, on Promotion of Personal Autonomy and Attention to People in a Situation of Dependence includes a scale that determines the degree and level of dependence of the person to be evaluated. In the nursing process, in order to evaluate the degree of autonomy, instruments such as Barthel or Lawton indices are commonly used. The results obtained using the Barthel and Lawton indices and the Dependence Act scale are compared through a transversal, prospective study (October 2007 – February 2008) carried out in the Nephrology Unit of the Vic Hospital Consortium (Barcelona)which included all patients aged over 65, undergoing periodic haemodialysis. The patients were evaluated using the Barthel and Lawton indices; and subsequently the evaluation was carried out using the scale of the Dependence Act. The data were analysed using the statistical package SPSS 14.0, to compare measurements the Student’s t-test was used. To determine the possible correlation between variables, the simple regression (Pearson) method was used and the percentages were compared using the McNemartest. Of 91 patients, 52 (23 men) are over 65 years of age (57.14%) and of these 34 are over 80 years of age. According to the scale defined in the Dependence Act, 32 patients are independent, 16 show moderate dependence, 6 show severe dependence and 1 shows maximum dependence. According to the Barthel index,19 are independent, 29 show mild dependence, 4show moderate and 1 shows severe dependence. According to the Lawton index, 14 were independent,19 had mild dependence, 15 severe and 4 maximum dependence (AU)

Eficacia de diálisis peritoneal con modalidad Tidal / No disponible

No disponible

Visión enfermera de las necesidades psicosociales de los cuidadores de personas en tratamiento con Diálisis Peritoneal / Nursing view of the psychosocial needs of carers of people undergoing Peritoneal Dialysis

Debido a la edad o a patologías interrecurrentes muchas personas en programa de Diálisis Peritoneal Ambulatoria, necesitan total o parcialmente de la ayuda de un cuidador por lo que la visión delos profesionales respecto al cuidador y sus necesidades es fundamental para ofrecer unos cuidados de salud adecuados. Con el objetivo de identificar y describir la visión de la enfermería responsable de los programas de diálisis peritoneal respecto a las necesidades psicosociales de los cuidadores principales de las personas sometidas a esta forma de tratamiento se realizó a 7 profesionales de enfermería nefrológica entrevistas semiestructuradas con un guión previo con preguntas abiertas. El análisis cualitativo de sus respuestas sugiere que para poder implementar eficazmente la participación familiar en los cuidados es imprescindible la organización personalizada y el soporte institucional; que la atención a la familia es una de las actividades de enfermería que no se suele valorar y para la que los responsables de la DP se sienten en ocasiones solos y faltos de recursos. Para los grandes problemas, como el cansancio del cuidador, se apuntan soluciones como buscar lugares fuera del hogar donde se le pueda realizar al paciente la técnica temporalmente (AU)

Due to age and recurrent pathologies, many people on the Ambulatory Peritoneal Dialysis programme need the full or part-time assistance of a carer, and therefore the view of professionals in relation to the carer and his or her needs is fundamental in order to offer adequate healthcare. In order to identify and describe the view of nursing staff responsible for the peritoneal dialysis programmes with regard to the psychosocial needs of the main carers of people who undergo this form of treatment, semi-structured interviews of 7renal nursing professionals were carried out, using a guideline with open questions. The qualitative analysis of their responses suggests that in order to implement family participation in care efficiently, personalized organization and institutional support are essential; attention to the family is one of the nursing activities that is not usually valued and for which staff responsible for PD sometimes feel alone and with insufficient resources. For major problems, such as tiredness of the carer, solutions were indicated such as seeking places outside the home where the patient can undergo the technique temporarily (AU)