Psychometric evaluation of a Spanish language version of the Screen for Caregiver Burden (SCB) in caregivers of patients with mixed, vascular and Alzheimer's dementia.

AIMS AND OBJECTIVES: To validate a Spanish language version of the Screen for Caregiver Burden, the full-length or long (25-item) and short (seven-item) versions in Mexican caregivers of patients with mixed, vascular and Alzheimer's dementia. BACKGROUND: Patients with dementia display impaired executive function and neuropsychiatric symptoms such as behavioural changes and sleep disturbances. These symptoms can make patients become more dependent. The experience of caregiving for patients under these conditions is burdensome. It is important to detect this burden to protect both the caregiver and the patient from negative outcomes. DESIGN: Survey. METHODS: Participants were 143 primary caregivers of patients with dementia and 30 caregivers of older adults without dementia in two hospitals in Mexico City. RESULTS: The internal reliability was Cronbach's α=0·89 and 0·82 for the 25-item and the seven-item versions, respectively. The item-total correlations for two Screen for Caregiver Burden versions were significant from r=0·26 to r=0·77 p<0·001. The test-retest was ICC=0·78 p<0·001; CI 95% (0·55-0·89) and ICC=0·72 p<0·001; CI 95% (0·41-0·86) for the 25-item and the seven-item, respectively. We found from non-significant to highly significant correlations between two Screen for Caregiver Burden versions and other measures ranged. Validity of known groups showed that the caregivers of demented patients experienced more burden than those caring for non-demented patients. CONCLUSIONS: Given these psychometric properties, both versions of the Screen for Caregiver Burden are valid tools and can be reliably used to assess the presence and level of caregiver burden in caregivers of demented patients. RELEVANCE TO CLINICAL PRACTICE: The Screen for Caregiver Burden in the Spanish Language can be used in clinical practice to detect caregiver burden in family members. We recommend using the long or full-length version when the objective is to assess the caregiver burden carefully and the short version (seven-item) as a screening method of caregiver burden that requires attention.

[Hypoglycemia in the elderly with diabetes mellitus]. / Hipoglucemia en el anciano con diabetes mellitus.

Aging is associated with an increasing prevalence of chronic diseases, including type 2 diabetes mellitus and its chronic and acute complications. With changes observed in diabetes mellitus treatment goals and the lower levels of glycosylated hemoglobin recommended, the prevalence of hypoglycemia especially in patients treated with insulin has increased. Aging and changes in the physiologic reserves generate a decreased perception of symptoms associated with hypoglycemia, increasing the risk of unawareness or severe episodes. Traditionally, age was a risk factor for hypoglycemia, but in the population over 60 years, multiple comorbidities like chronic heart failure, malnutrition and renal failure are associated with increased risk of developing this acute complication. It is necessary to train doctors and nurses from all levels of care to recognize the specific clinical manifestation of low blood glucose that allow early detection and treatment, because this complication is associated with an increased hospital and 1-year after discharge mortality, with falls and cognitive impairment that directly affect the independence and functionality of older persons.

[Inflammaging. Aging inflammatory origin]. / Inflammaging. Envejecimiento de origen inflamatorio.

The association between the increase in life expectancy in humans and age-related changes in the immune system promotes that individuals are exposed longer to endogenous and environment antigens which allows an activation of the innate immune system and the subsequent establishment of a low grade chronic inflammation state with an increased expression of proinflammatory cytokines (tumor necrosis factor alpha, interleukin 6, etc.). This inflammatory state referred as inflammaging is characterized by a inflammatory origin of aging given by the activation of cellular systems responsible of gene promotion and suppression as the nuclear factor kappa B, sirtuins, forkhead box O and KLOTHO, who are directly or indirectly involved in cellular mechanisms of resistance to oxidative stress, apoptosis and nucleic acids transcriptional mistakes repair. The activation of these cellular systems is associated with the pathogenesis of several chronic and degenerative diseases such as Alzheimer's disease, late-onset diabetes or cardiovascular diseases. However, we are placed in a crossroad because we can not establish whether this inflammatory state observed in the aging process is responsible of development of degenerative diseases or if the presences of these chronic diseases are responsible for this inflammatory state of aging. Evidence in centenarians who are healthy and have preserved functional status has shown that there is a chronic inflammatory state present among them but is balanced by a higher expression of anti-inflammatory molecules.

[Special considerations for patients over 60 years with asthma]. / Consideraciones especiales en pacientes mayores de 60 años con asma.

The population over 60 years is increasing because of the demographic transition, the aging of the human body and the changes on functional reserve make that the clinical manifestations are different and the tools used for diagnosis may not have the same sensitivity as in younger people. Asthma remains a prevalent disease in the elderly and compromises their functionality and independence. Aging produces that tools such as spirometry and challenge test with bronchodilator provide results than can't be evaluated with those parameters developed in younger people complicating the diagnosis of asthma in this population. Studies in elderly with asthma have shown that the proportion of patients with an atopic component are lower and the kind of symptoms and complications are varied, which makes the differential diagnosis with multiple comorbidities, especially from other heart and lung diseases. Despite the good response to stepped treatment in the elderly, this population requires a deep evaluation of possible drug interactions and potentially inappropriate medication related with the large numbers of drugs they usually consume, making an interdisciplinary treatment imperative.