Priorización por los pacientes de una serie de componentes habituales en la valoración geriátrica integral realizada en Atención Primaria / Prioritization by patients of a series of common components in the standard comprehensive geriatric assessment in Primary Care

Objetivo: Conocer la priorización por personas ≥ 70 años de una serie de componentes habituales en la valoración geriátrica integral (VGI) realizada en Atención Primaria (AP), según su percepción de la influencia en la salud.Método: Estudio transversal en AP mediante cuestionario a 109 personas, excluyendo a pacientes al final de la vida, o con alteración cognitiva, sensorial o psiquiátrica que dificultase su participación.La variable principal fue una selección de 23 ítems del área físico/clínica, funcional, mental y sociofamiliar, habituales en una VGI en AP. Otras: edad, sexo, cuestionario VIDA de actividades instrumentales de la vida diaria, número de medicamentos, índice de comorbilidad de Charlson.Resultados: Mediana de edad 78 años, percentil 75 de 84; 64,2% mujeres. Cuatro personas (3,7%) tenían alterado el cuestionario VIDA (< 32 puntos). Mediana de 5 medicamentos habituales y 98 (90%) sin comorbilidad relevante según el Charlson. Sin diferencias estadísticamente significativas al contrastar sexo con edad, resultado del VIDA y número de medicamentos.Los ítems mejor valorados según estadísticos de centralización fueron fumar y la memoria, y considerando la mejor puntuación (4-5 sobre 5): medicación adecuada (93,6% de los encuestados, IC del 95%, 87,3-96,8), condiciones de boca/dentadura (92,7%, IC del 95%, 86,2-96,2), estado de ánimo (91,7%, IC del 95%, 85,1-95,6), capacidad para realizar AVD (91,7%, IC del 95%, 85,1-95,6).Conclusiones: Los pacientes consideraban fumar, la memoria, la medicación adecuada, el estado de boca/dentadura y de ánimo, y las AVD como más influyentes en la salud. Ante la importancia de la participación de los pacientes en el contenido de la VGI y la escasez de estos trabajos, se hacen pertinentes nuevos estudios que profundicen este tema. (AU)

Objective: To know the prioritization by people aged ≥70 of a series of common components in the comprehensive geriatric assessment (CGA) in primary care (PC), according to the influence on health.Method: Cross-sectional descriptive study through questionnaire to 109 people, have been excluded those at the end of life or with cognitive, sensory or mental/psychiatric impairment that made collaboration difficult.The main variable was a selection of 23 items of the physical/clinical, functional, mental and social/family, common components on a CGA in PC. Others: age, sex, VIDA questionnaire of instrumental activities of daily living (IADL), number of medications, and Charlson comorbidity index.Results: Median age 78 years, 75 percentile of 84; 64.2% women. Four people (3.7%) had altered VIDA questionnaire (<32 points). Median of 5 chronic medications, and 98 (90%) comorbidity absence considering Charlson index. Without statistically significant differences contrasting gender with age, result in VIDA, nor number of chronic medications.The best scored items according to centralization statistics were smoking and memory, and considering the best score (4–5 out of 5) of the Likert scale: proper medication (93.6% of the people surveyed, 95% CI: 87.3–96.8), mouth/teeth condition (92.7%, 95% CI: 86.2–96.2), mood (91.7%, 95% CI: 85.1–95.6), and capacity for ADL (91.7%, 95% CI:85.1–95.6).Conclusions: Smoking, memory, proper medication, mouth/teeth condition, mood and ADL were considered as the most influential in health by patients. Because of the important of patient participation in the content of the CGA and the scarcity of these kind of studies, new studies that deepen this issue become relevant. (AU)

[Prioritization by patients of a series of common components in the standard comprehensive geriatric assessment in Primary Care]. / Priorización por los pacientes de una serie de componentes habituales en la valoración geriátrica integral realizada en Atención Primaria.

OBJECTIVE: To know the prioritization by people aged ≥70 of a series of common components in the comprehensive geriatric assessment (CGA) in primary care (PC), according to the influence on health. METHOD: Cross-sectional descriptive study through questionnaire to 109 people, have been excluded those at the end of life or with cognitive, sensory or mental/psychiatric impairment that made collaboration difficult. The main variable was a selection of 23 items of the physical/clinical, functional, mental and social/family, common components on a CGA in PC. Others: age, sex, VIDA questionnaire of instrumental activities of daily living (IADL), number of medications, and Charlson comorbidity index. RESULTS: Median age 78 years, 75 percentile of 84; 64.2% women. Four people (3.7%) had altered VIDA questionnaire (<32 points). Median of 5 chronic medications, and 98 (90%) comorbidity absence considering Charlson index. Without statistically significant differences contrasting gender with age, result in VIDA, nor number of chronic medications. The best scored items according to centralization statistics were smoking and memory, and considering the best score (4-5 out of 5) of the Likert scale: proper medication (93.6% of the people surveyed, 95% CI: 87.3-96.8), mouth/teeth condition (92.7%, 95% CI: 86.2-96.2), mood (91.7%, 95% CI: 85.1-95.6), and capacity for ADL (91.7%, 95% CI:85.1-95.6). CONCLUSIONS: Smoking, memory, proper medication, mouth/teeth condition, mood and ADL were considered as the most influential in health by patients. Because of the important of patient participation in the content of the CGA and the scarcity of these kind of studies, new studies that deepen this issue become relevant.

Herramienta informática VALINTAN (www. valintan. com) de valoración geriátrica para atención primaria / Computerized geriatric assessment tool VALINTAN (www. valintan. com) for primary care

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Validez predictiva del cuestionario VIDA considerando pérdida funcional, institucionalización o muerte en pacientes pluripatológicos / Predictive validity of the VIDA questionnaire on functional decline, institutionalisation or death in patients with multiple morbidities

INTRODUCCIÓN: El cuestionario español VIDA valora actividades instrumentales de la vida diaria (AIVD) en mayores, con adecuada validez de contenido, constructo y fiabilidad. El objetivo era analizar su validez predictiva, en pacientes pluripatológicos ≥65 años sin dependencia severa/total en actividades básicas de la vida diaria (ABVD, índice de Barthel ≥60 puntos), considerando el cambio a este grado de dependencia severa/total, institucionalización o muerte a 8 y 18 meses de seguimiento. MATERIALES Y MÉTODOS: Estudio prospectivo de prueba diagnóstica. Se consideraron 197 pacientes (a 8 meses) y 185 pacientes (a 18 meses) incluidos en el programa de pluripatológicos según estratificación por Adjusted Clinical Groups (ACG) o cumpliendo criterios de Ollero, excluyendo institucionalizados, al final de la vida o en diálisis, con un índice de Barthel basal ≥60 puntos; se les pasó el cuestionario VIDA al inicio. Otras variables basales fueron: edad, sexo, índice de Charlson, número de medicamentos, índice de Lawton-Brody. El evento de resultado era pasar a un índice de Barthel <60, o institucionalización, o muerte en cada periodo. RESULTADOS: La mediana de edad fue de 81 años (RIC: 74,5-85); el 45,2% eran mujeres. A 8 meses, el mejor punto de corte del VIDA fue ≤31 puntos (sensibilidad [S]: 81,5% [IC95%: 61,2-93]; especificidad [E]: 58,2% [IC95%: 50,4-65,7]; VPP: 23,7%; VPN: 95,2%), ≤30 en mujeres, ≤34 en hombres; a 18 meses, fue ≤29 puntos (S: 61,4 [IC95%: 47,6-73,7]; E: 76,6 [IC95%: 68,1-83,4]; VPP: 53,9; VPN: 81,7). CONCLUSIONES: Se aportan puntos de corte, global y por sexo, para predecir el paso a dependencia severa/total en ABVD, o institucionalización o muerte en pacientes pluripatológicos. Parece mejor para detectar eventos a corto plazo y descartarlos a largo plazo

INTRODUCTION: The VIDA Spanish questionnaire assesses instrumental activities of daily living (IADL) in elderly people, and has shown to have adequate content, construct validity, and reliability. The objective was to analyse its predictive validity in patients with multiple morbidities aged ≥65 years without severe/total dependence in basic activities (BADL, Barthel index ≥60 points), by measuring any changes in this severe/total level of dependence, institutionalisation, or death at 8 and 18 months of follow-up. METHODS: A prospective study of a diagnostic test was conducted on 197 patients (8 months) and 185 (18 months) included in the multiple morbidities program according to stratification by Adjusted Clinical Groups (ACG) or by fulfilling the Ollero criteria. Patients that were institutionalised, at the end of life, or on dialysis, or with a baseline Barthel index ≥60 points were excluded. The VIDA questionnaire was applied at baseline. The other baseline variables included age, gender, Charlson index, number of drugs, and Lawton-Brody index. The outcome event was changing the Barthel index to <60, or institutionalisation, or death, in each follow-up period. RESULTS: The median age was 81 years (IQR 74.5-85), and 45.2% were women. At 8 months, the best cut-off point for VIDA was ≤31 points (Sensitivity [S] 81.5%, [95% CI; 61.2-93.0]; Specificity (Sp) 58.2% [95% CI; 50.4-65.7], PPV 23.7%; NPV 95.2%), ≤30 in women, ≤34 in men. And at 18 months, ≤29 points (S 61.4 [95% CI; 47.6-73.7]; Sp 76.6 [95% CI; 68.1-83.4]; PPV 53.9; NPV 81.7). CONCLUSIONS: Overall cut-off points are provided as well as those for gender, predicting severe/total BADL decline, or institutionalization or death in patients with multiple morbidities. It seems to detect short-term events better and rules them out in the long term

[Predictive validity of the VIDA questionnaire on functional decline, institutionalisation or death in patients with multiple morbidities]. / Validez predictiva del cuestionario VIDA considerando pérdida funcional, institucionalización o muerte en pacientes pluripatológicos.

INTRODUCTION: The VIDA Spanish questionnaire assesses instrumental activities of daily living (IADL) in elderly people, and has shown to have adequate content, construct validity, and reliability. The objective was to analyse its predictive validity in patients with multiple morbidities aged ≥65 years without severe/total dependence in basic activities (BADL, Barthel index ≥60 points), by measuring any changes in this severe/total level of dependence, institutionalisation, or death at 8 and 18 months of follow-up. METHODS: A prospective study of a diagnostic test was conducted on 197 patients (8 months) and 185 (18 months) included in the multiple morbidities program according to stratification by Adjusted Clinical Groups (ACG) or by fulfilling the Ollero criteria. Patients that were institutionalised, at the end of life, or on dialysis, or with a baseline Barthel index ≥60 points were excluded. The VIDA questionnaire was applied at baseline. The other baseline variables included age, gender, Charlson index, number of drugs, and Lawton-Brody index. The outcome event was changing the Barthel index to <60, or institutionalisation, or death, in each follow-up period. RESULTS: The median age was 81 years (IQR 74.5-85), and 45.2% were women. At 8 months, the best cut-off point for VIDA was ≤31 points (Sensitivity [S] 81.5%, [95% CI; 61.2-93.0]; Specificity (Sp) 58.2% [95% CI; 50.4-65.7], PPV 23.7%; NPV 95.2%), ≤30 in women, ≤34 in men. And at 18 months, ≤29 points (S 61.4 [95% CI; 47.6-73.7]; Sp 76.6 [95% CI; 68.1-83.4]; PPV 53.9; NPV 81.7). CONCLUSIONS: Overall cut-off points are provided as well as those for gender, predicting severe/total BADL decline, or institutionalization or death in patients with multiple morbidities. It seems to detect short-term events better and rules them out in the long term.

Functional decline, mortality and institutionalization after 18 months in multimorbid older persons living in the community: the FUNCIPLUR longitudinal study.

INTRODUCTION: Studying functional decline in multimorbidity patients is important for improving patient management. We sought to analyse long-term functional decline, mortality and institutionalization and associated factors in over-65-year-olds with multimorbidity, comparing with previous short-term results. METHODS: A prospective study was conducted in three primary care centres, over 18 months, in a random sample of patients (n = 241) ≥ 65 years on a clinical care programme for multimorbidity. Primary outcomes were decrease in functional status category (Barthel or Lawton scales), alone and together with death and institutionalization. Other variables were sociodemographic characteristics, comorbidity, medications and hospitalisation. RESULTS: Patients initially included had five chronic conditions (IQR 4-6) and were on 11 (IQR 9-14) chronic medications; their median age was 82 years (75th percentile 86); 38.2% had impaired function at baseline. Of the 216 patients included in the analysis, 47 died; 11 were institutionalized; and 158 completed follow-up, but of these, 81 (51.3%, 95% CI 43.5-58.9) experienced functional decline. That is, 139/216 (64.4%, 95% CI 57.8-70.4%) had outcome events and these were associated with older age (OR 1.1, 95% CI 1.0-1.1, p = 0.002) and having ≥ 1 admission during follow-up (OR 4.1, 95% CI 2.1-8.9%, p < 0.001). Considering all 241 patients, there were 234 admissions during follow-up, in 117 patients. CONCLUSIONS: Two-thirds of patients showed functional decline, died or were institutionalized. The factors associated with loss of function at 18 months were similar to those observed at 8 months, notably previous hospital admissions. These findings are important as they indicate functional decline and increasing care needs are potentially predictable/modifiable.

Functional decline and associated factors in patients with multimorbidity at 8 months of follow-up in primary care: the functionality in pluripathological patients (FUNCIPLUR) longitudinal descriptive study.

OBJECTIVE: To analyse short-term functional decline and associated factors in over 65-year-olds with multimorbidity. DESIGN AND SETTING: Prospective multicentre study conducted in three primary care centres, over an 8-month period. During this period, we also analysed admissions to two referral hospitals. PARTICIPANTS: Of 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 VARIABLES: The 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. RESULTS: Patients 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. CONCLUSIONS: A 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.

Medidas no farmacológicas en personas hipertensas atendidas en una consulta de Enfermería en Atención Primaria / Non-pharmacological measures in persons with hypertension seen at a Primary Care Nursing Unit

OBJETIVO: describir los estilos de vida (actividad física, tabaco, alcohol, alimentación saludable, restricción en la ingesta de sal y peso) en personas con hipertensión arterial (HTA), teniendo en cuenta las recomendaciones de salud; y explorar su percepción sobre el consejo sanitario dado por su médico o enfermera para la realización de estas medidas no farmacológicas. MÉTODO: estudio descriptivo transversal. Se estudiaron 128 sujetos elegidos al azar de 191 personas con hipertensión en Atención Primaria. VARIABLES: actividad física; consumo de tabaco; consumo de alcohol; dieta mínima saludable; consumo sal común; índice de masa corporal (IMC); percepción del peso y estilos de vida; estilos vida saludables; consejo sanitario recibido. RESULTADOS: participaron 121 personas. Actividad física mínima saludable: 60% (IC95%:51-69%); realizaba la deseada un 33% y un 70% declaró consejo sanitario. No fumaba el 89% (IC95%: 83- 95%); consejo sanitario en un 83%. Un 75% (IC95%: 67-83) declaró ser 'no bebedor de riesgo', un 76% había recibido consejo sanitario; en los bebedores con riesgo, un 47% había disminuido el consumo. La dieta mínima saludable era seguida por un 43% (IC95%: 32-52%). Un 74% (IC95%:65-82%) decía hacer un consumo de sal común menor de 5 g/día para cocinar, y un 82% había recibido consejo sanitario; un 28% hacía un consumo de alimentos con sal oculta 28%. El 64% (IC95%: 55-73) no tenía obesidad y un 75% había recibido consejo sanitario; el 40% percibía adecuado su peso. El 11% tenía estilos de vida saludables. CONCLUSIONES: más de la mitad de las personas con HTA tienen estilos de vida saludables, excepto en dieta mínima saludable, pero solo un 11% tenía todos los estilos de vida saludables. Los pacientes confirman que escuchan las recomendaciones de los profesionales. Este trabajo ha permitido comprobar la contribución de la enfermera en Atención Primaria

OBJECTIVE: to describe lifestyles (physical activity, smoking, alcohol, healthy diet, restriction in the intake of salt, and weight) in persons with hypertension (HT), taking into account health recommendations; and to explore their perception about the health advice given by their doctor or nurse for conducting these non-pharmacological measures. METHOD: a transversal descriptive study, including 128 subjects randomly selected from 191 persons with hypertension seen at Primary Care. VARIABLES: physical activity; smoking; alcohol intake; minimum healthy diet; common salt intake; BMI; perception of weight and lifestyles; healthy lifestyles: healthcare advice received. RESULTS: the study included 121 persons. Minimum healthy physical activity: 60% (CI95%:51-69%); 33% conducted the desired activity, and 70% declared healthcare advice. There was 89% of non-smokers (CI95%: 83-95%); healthcare advice in 83%. 75% of the participants (CI95%: 67-83) declared not being 'highrisk drinkers'. 76% had received healthcare advice; 47% of highrisk drinkers had reduced their alcohol intake. The minimum healthy diet was followed by 43% (CI95%: 32-52%); 74% (CI95%:65- 82%) stated that their intake of common salt was below 5 g/day for cooking, and 82% had received healthcare advice; 28% ate food with hidden salt. There was a 64% (CI95%: 55-73) of participants without obesity, and 75% had received healthcare advice; 40% of them perceived their weight as adequate. 11% of participants led healthy lifestyles. CONCLUSIONS: over half of persons with HT led healthy lifestyles, except in terms of minimum health diet, but only 11% showed all healthy lifestyles. Patients confirmed that they listen to the recommendations by professionals. This study has allowed to confirm the contribution by the Primary Care nurse