Factores relacionados con el insomnio en ancianos internados en un centro sociosanitario / Factors associated to insomnia among institutionalized elderly in a nursing home

Objetivos: Describir las características del sueño de los ancianos internados en un centro sociosanitario tanto en relación con la presencia de insomnio como mediante la calidad del sueño. Metodología: Estudio descriptivo y transversal sobre 100 sujetos de 65 años o más, internados en la residencia Núñez de Balboa (Albacete). Variables: características sociodemográficas, comorbilidad, consumo de psicofármacos, diagnóstico de insomnio según el Manual diagnóstico y estadístico de los trastornos mentales V (DSM-V), dolor, Escala de depresión de Yesavage, Minimental State Examination, Índice de Barthel, Índice de calidad del sueño Pittsburgh (ICSP), y Mini Nutritional Assessment. Resultados: La prevalencia de insomnio fue del 15% y de "malos dormidores", del 77%. Destaca una latencia en la conciliación del sueño superior a 30 minutos en el 35% de los casos, una eficiencia del sueño inferior al 65% en el 42%, y en contraposición, una calidad subjetiva del sueño de muy buena o bastante buena en un 77%. Las puntuaciones más altas del ICSP se asociaron con peor estado funcional (r = -0,22; p < 0,05), mayor riesgo de depresión (r = 0,33; p < 0,001), peor estado nutricional (r = -0,25; p < 0,05), polifarmacia (r = 0,22; p < 0,05) y dolor (p < 0,05). Conclusiones: Nuestra muestra presenta una baja prevalencia de trastorno de insomnio frente a una alta frecuencia de "malos dormidores", principalmente en sujetos con mayor nivel de dependencia, con mayor riesgo de depresión, con peor estado nutricional, con dolor y polifarmacia (AU)

Objectives: To describe sleep characteristics in institutionalized older adults: insomnia prevalence and sleep quality and disturbances. Methodology: Cross-sectional descriptive study of 100 subject aged 65 or older institutionalized in the nursing home Núñez de Balboa (Albacete). Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI) and diagnosis of insomnia was assessed according to Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-V) criteria. Covariables: sociodemographic characteristics, comorbidity, use of psychoactive drugs, pain, Geriatric Depression Scale, Mini-Mental State Examination, Barthel Index, and Mini Nutritional Assessment. Results: The prevalence of insomnia was 15% and for the "poor sleepers" was 77%. We can highlight that the sleep latency was over 30 minutes in 35% of the cases and 42% had sleep efficiency under 65%. Subjective sleep quality was "really good or very good" in 77%. Highest PSQI scores were associated with worse functional status (r=-0.22; p<0.05), higher risk of depression (r=0.33; p<0.001), poorer nutritional status (r=-0.25; p<0.05), polypharmacy (r=0.22; p<0.05) and pain (p<0.05). Conclusions: Our sample presents a low prevalence of insomnia but high frequency of "poor sleepers". Worse sleep quality relates with high level of dependence, high risk of depression, poor nutritional status, pain and polypharmacy (AU)

"Falls prevention among older people and care providers: protocol for an integrative review".

AIM: To review the evidence about the role of care providers in fall prevention in older adults aged ≥ 65 years, this includes their views, strategies, and approaches on falls prevention and effectiveness of nursing interventions. BACKGROUND: Some fall prevention programmes are successfully implemented and led by nurses and it is acknowledged the vital role they play in developing plans for fall prevention. Nevertheless, there has not been a systematic review of the literature that describes this role and care providers' views on fall's prevention initiatives. DESIGN: A convergent synthesis of qualitative, quantitative, and mixed methods studies. The eligibility criteria will be based on participants, interventions/exposure, comparisons, and outcomes for quantitative studies and on population, the phenomena of interest and the context, for qualitative studies. To extract data and assess study qualities members of the research team will work in pairs according to their expertise. The review will follow the guidelines for integrative reviews and the proposed methods will adhere to the PRISMA statement checklist complemented by the ENTREQ framework. As qualitative synthesis are emergent, all procedures and changes in procedure will be documented. DISCUSSION: The review has a constructivist drive as studies that combine methods ought to be paradigmatic driven. Review questions are broad to allow issues emerge and have purposefully left the design flexible to allow for adjustments as the review progresses. The review seeks to highlight the roles that care providers play in fall prevention and their views on fall's prevention initiatives.

Pilot study of a preventive multicomponent nurse intervention to reduce the incidence and severity of delirium in hospitalized older adults: MID-Nurse-P.

BACKGROUND: Although multicomponent interventions are the gold standard for delirium management, few nurse-led interventions in Acute Geriatric Units (AGU) are described. OBJECTIVES: To analyze if a preventive multicomponent non-pharmacologic nurse-led intervention randomized clinical trial (MID-Nurse Study) is feasible (pilot study), and can reduce the incidence, duration, and severity of delirium in hospitalized older adults in an AGU. DESIGN: Parallel-group double-blind randomized clinical trial (pilot Study). SETTING: AGU Complejo Hospitalario Universitario, Albacete (Spain). PARTICIPANTS: 50 patients ≥65 years hospitalized in the AGU. Intervention group (IG) 21, control group (CG) 29. INTERVENTION: After risk factor analysis, all participants in the IG received a daily multicomponent non-pharmacologic intervention (orientation, sensorial deficit, sleep, mobilization, hydration, nutrition, drug chart review, elimination, oxygenation, pain) by the intervention nurses. The CG received usual care. MEASUREMENTS: Daily delirium presence with the Confusion Assessment Method (CAM), and severity with the Delirium Rating Scale-Revised-98 (DRS). Outcome measures were delirium incidence, prevalence, severity, and number of days with delirium, mortality, length of stay, use of physical restraint measures, and use of drugs for delirium control. RESULTS: Mean age 86.5 (48% women). 21 participants presented delirium during hospitalization (14CG and 7 IG). Process, resources, management, and scientific objectives were considered positive, making the study feasible. Delirium prevalence (33.3% vs 48.3%) and incidence (14.3% vs 41.4%; p=0.039) were reduced in the IG compared to CG. Total delirium severity was lower in the IG compared to the CG (35.0 vs 65.0; p=0.040). Mortality was not different between groups (CG 17.2% vs IG 19.0%). CONCLUSION: The MID-Nurse Study is feasible, and a multicomponent nurse-led intervention on patients with delirium in an AGU can reduce delirium prevalence, incidence, and severity. The clinical trial registration number ClinicalTrials.gov ID: NCT02558777.

Frailty and mortality or incident disability in institutionalized older adults: the FINAL study.

BACKGROUND: Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic. OBJECTIVES: To determine the association between frailty and mortality or incident disability in basic activities of daily living (BADL) in institutionalized Spanish older adults. DESIGN: Concurrent cohort study. SETTING: Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain. PARTICIPANTS: Of the 324 institutionalized adults older than 65 years enrolled at baseline, 21 (5.5%) were lost during the one-year follow-up. Of the 303 remaining, 63 (20.8%) died, 91 (30.0%) developed incident disability, and 140 (49.2%) were free of both events. 16 participants were not suitable for analysis due to incomplete data. MEASUREMENTS: Frailty was defined by the presence of three or more Fried criteria: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Incident disability in BADL was considered when new onset disability in bathing, grooming, toileting, dressing, eating or transferring was detected with the Barthel index. Logistic regression models were constructed adjusted for age, sex, body mass index (BMI), previous Barthel index and Minimental State Examination (MMSE), and high comorbidity (Charlson index ≥3). RESULTS: 287 participants with valid data. Mean age 84.2 (SD 6.8), with 187 (65.2%) women. 199 (69.3%) were frail, and 72 (25.1%) had high comorbidity. Mean BMI 27.6 (SD 5.2), Barthel index 53.4 (SD 37.1), and MMSE 14.2 (SD 9.7). At follow-up, 43 (21.6%) frail participants and 15 (17.0%) non-frail ones died. 73 (46.8%) frail participants and 16 (21.9%) non-frail ones developed incident disability in BADL (p<0.001). Frailty was associated with incident disability or mortality (OR 3.3; 95% CI 1.7-6.6) adjusted for all study covariables. CONCLUSION: In a cohort of institutionalized older adults, frailty was associated with mortality or incident disability in BADL.

Frailty in INstitutionalized older adults from ALbacete. The FINAL Study: rationale, design, methodology, prevalence and attributes.

BACKGROUND: Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic. OBJECTIVES: To determine the prevalence and attributes of frailty in institutionalized Spanish older adults. DESIGN: Cross-sectional analysis of basal data of a concurrent cohort study. SETTING: Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain. PARTICIPANTS: 331 institutionalized adults older than 65 years. MEASUREMENTS: Frailty was defined by the presence of 3 or more Fried criteria and prefrailty by the presence of 1 or 2: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Covariables were sociodemographic, anthropometric, functional, cognitive, affective and of comorbidity. Hospitalization, emergency visits and falls in the 6 previous months was recorded. Differences between non-frail and prefrail as one group and frail participants were analyzed using χ(2) tests, t-Student and logistic regression. RESULTS: Mean age 84.1 (SD 6.7), with 209 (65.1%) women. 68.8% were frail, 28.4% pre-frail, 2.8% non-frail, and in 2.2% three criteria were not available to determine frailty status. Women were more frequently frail than men (77.1% vs. 22.9%; p<0.001), and frail participants were older (85.1 vs. 82.3; p<0.001) than non-frail ones. Female sex (OR 2.7 95%CI 1.2-6.2), Barthel index (OR 2.2 95%CI 1.2-4.4), depression risk (OR 2.2 95%CI 1.0-4.9) and Short Physical Performance Battery scores (0.7 95%CI 0.6-0.8) were independently associated with frailty status. Frailty had a non-significant association with hospitalization (OR 1.9 95%CI 0.8-4.5) and emergency visits (OR 1.5 95%CI 0.7-3.2) in the previous 6 months. CONCLUSION: In a cohort of institutionalized older adults the prevalence of frailty was 68.8% and was associated with adverse health geriatric outcomes.

Uso de las sondas de alimentación en el paciente con demencia avanzada. Revisión sistemática / Use of feeding tubes in patients with advanced dementia. Systematic review

Introducción: La aparición de disfagia es marcador de la fase final de la demencia. Estudios hasta el 2000 ponían en entredicho los objetivos que justifican la colocación de sondas de alimentación, pero ésta sigue siendo una intervención frecuente en demencias avanzadas. Objetivos: Responder a las siguientes cuestiones según la evidencia disponible: La alimentación por sonda PEG en demencias avanzadas: ¿previene aspiraciones?, ¿previene desnutrición?, ¿aumenta la supervivencia?, ¿se tratan de manera paliativa? Metodología: Revisión bibliográfica. Estudios publicados 2000-2012. Inglés y castellano. Bases de datos: Pubmed, Google Scholar, Cochrane. Mesh: Dementia, Enteral nutrition, Nutritional support, Endoscopic gastrostomy, Tube feeding, Peg, Enteral feeding, Ethics, Quality of life, Palliative care, Dysphagia y Make decisions. Resultados: 96 artículos cumplían criterios para incluir en este estudio. 24 españoles, 72 publicaciones extranjeras. Las sonda nasogástrica y sonda PEG no están indicadas en pacientes con riesgo de broncoaspiraciones; las indicadas por la ESPEN tampoco las previenen. La guía ESPEN no considera indicado usar sondas de alimentación en la última fase de la demencia; la pérdida de peso es consecuencia de la enfermedad. Estudios señalan factores que afectan negativamente a la supervivencia. La mortalidad en los primeros 30 días tras la colocación de la sonda es muy elevada. La demencia no es asumida como enfermedad terminal, provocando ambivalencia en la toma de decisiones al final de la vida. La formación en cuidados paliativos no oncológicos es muy escasa, hecho que favorece instauración de tratamientos desproporcionados. Conclusiones: La alimentación enteral en la demencia avanzada sigue siendo una intervención frecuente, no hay evidencia que establezca que la alimentación por sondas prevengan las aspiraciones, ni se logre una mejora en el estado nutricional, prevenga la desnutrición o sus consecuencias. Tampoco se logra un aumento de la supervivencia, incluso hay estudios que plantean una disminución de la supervivencia. Estos pacientes no se benefician de cuidados paliativos, porque la demencia severa tradicionalmente no ha sido considerada como enfermedad terminal, aunque muchos estudios aseguran que se lograría una mejora de la calidad de vida en la fase final de la enfermedad (AU)

Introduction: The onset of dysphagia is a sign of the final stage of dementia. Studies up to the year 2000 called into question the objectives which justify the insertion of a feeding tube, but this continues to be a frequent intervention in advanced dementias. Objectives: To answer the following questions based on available evidence: Does feeding by PEG tubes in advanced dementia prevent aspiration? Does it prevent malnutrition? Does it increase survival rates? Are they treated palliatively? Methodology: Bibliographic research. Studies published 2000-2012. English and Spanish. Databases: Pubmed, Google Scholar, Cochrane. MeSH: Dementia, Enteral nutrition, Nutritional support, Endoscopic gastrostomy, Tube feeding, PEG, Enteral feeding, Ethics, Quality of life, Palliative care, Dysphagia and Making decisions. Results: 96 articles met criteria to be included in this study. 24 Spanish, 72 in international publications. Nasogastric and PEG tubes are not indicated in patients at risk of bronchoaspirations; neither do those indicated by ESPEN prevent them. The ESPEN guide does not consider the use of feeding tubes to be suitable in the final stage of dementia; weight loss is a consequence of the disease. Studies suggest factors which affect survival negatively. Mortality in the first 30 days after insertion of the tube is very high. Dementia is not accepted as a terminal disease, causing ambivalence in decision taking at the end of life. Training in non-oncological palliative care is very limited, a fact which can increase the establishment of disproportionate treatments. Conclusions: Enteral feeding in advanced dementia continues to be a frequent intervention; there is no evidence which establishes that tube feeding prevents aspirations, or that an improvement in nutritional status is achieved, or that it prevents malnutrition or its consequences. Neither are higher survival rates achieved; there are even studies which suggest lower survival rates. These patients are not benefited by palliative care because severe dementia has not traditionally been considered a terminal disease, despite the fact that many studies claim that a higher quality of life would be achieved in the final stage of the illness (AU)

Fragilidad y dependencia en Albacete (estudio FRADEA): razonamiento, diseño y metodología / Frailty and dependence in Albacete (FRADEA study): reasoning, design and methodology

Objetivo. Obtener una cohorte de sujetos con edad igual o mayor a 70 años, representativa de una población urbana española, para estimar la prevalencia de fragilidad y seguirla en el tiempo para analizar factores asociados. Material y métodos. Estudio de cohortes concurrente de base poblacional. Sobre un universo de 18.137 ancianos, se realizó un muestreo aleatorio estratificado para obtener una muestra representativa de 1.172. Aceptaron participar 993 personas (84,7%). Se recogieron variables sociodemográficas, de comorbilidad, funcionales (n=825), cognitivas, afectivas y de calidad de vida. A los sujetos que aceptaron se les determinó la composición corporal por bioimpedanciometría (n=557), el gasto energético basal por calorimetría indirecta (n=450) y se obtuvo muestra de sangre para la determinación de biomarcadores (n=859). La fragilidad se definió por la presencia de 3 o más de los criterios Fried: pérdida de peso no intencionada, baja fuerza, cansancio, lentitud al caminar y baja actividad física. La cohorte será seguida en el tiempo hasta el fallecimiento de los sujetos. Resultados. Edad media±desviación estándar 79,4±6,4 años, con 601 (60,5%) mujeres. Institucionalizados el 21,3%. Fueron frágiles el 16,9%, prefrágiles 48,5%, no frágiles 21,8%, y no se dispuso de 3 criterios para poder determinar su estado en el 12,8%, de los cuales el 9,5% tenía una discapacidad moderada-severa, por lo que la prevalencia de fragilidad podría aumentar hasta el 26,4%. Conclusiones. Se ha construido la cohorte FRADEA, representativa de los mayores de una población urbana de España. La prevalencia de fragilidad en la cohorte fue del 16,9%(AU)

Objective. To obtain a cohort of subjects of equal to or greater than 70 years, representative of a Spanish urban population, to estimate the prevalence of frailty and follow it up over time to analyse associated factors. Material and methods. A prospective, population-based cohort study. From a population of 18,137 elderly persons, a representative sample of 1172 was randomly stratified, of which 993 (84.7%) agreed to take part. The variables collected were; sociodemographic, comorbidity, functional (n=825), cognitive, affective and quality of life. On the patients who agreed, body composition was determined by bioimpedance analysis (n=557), basal metabolic rate by indirect calorimetry (n=450) and a blood sample was obtained for biomarkers (n=859). Frailty was defined by the presence of 3 or more Fried criteria: unintentional weight loss, low energy, exhaustion, slow walking, and low physical activity. The cohort will be followed up over time until the death of the subjects. Results. Mean age 79.4 (SD 6.4) years, with 601 (60.5%) women. A total of 21.3% were institutionalised; 16.9% were frail, 48.5% pre-frail, 21.3% non-frail, and 12.8% did not have the 3 criteria to be able to determine their state, of which 9.5% had moderate-severe incapacity, which would increase the prevalence of frailty to 26.4%. Conclusions. A FRADEA cohort has been constructed, representative of an urban population in Spain. The prevalence of frailty in the cohort was 16.9%(AU)

[Frailty and dependence in Albacete (FRADEA study): reasoning, design and methodology]. / Fragilidad y dependencia en Albacete (estudio FRADEA): razonamiento, diseño y metodología.

OBJECTIVE: To obtain a cohort of subjects of equal to or greater than 70 years, representative of a Spanish urban population, to estimate the prevalence of frailty and follow it up over time to analyse associated factors. MATERIAL AND METHODS: A prospective, population-based cohort study. From a population of 18,137 elderly persons, a representative sample of 1172 was randomly stratified, of which 993 (84.7%) agreed to take part. The variables collected were; sociodemographic, comorbidity, functional (n=825), cognitive, affective and quality of life. On the patients who agreed, body composition was determined by bioimpedance analysis (n=557), basal metabolic rate by indirect calorimetry (n=450) and a blood sample was obtained for biomarkers (n=859). Frailty was defined by the presence of 3 or more Fried criteria: unintentional weight loss, low energy, exhaustion, slow walking, and low physical activity. The cohort will be followed up over time until the death of the subjects. RESULTS: Mean age 79.4 (SD 6.4) years, with 601 (60.5%) women. A total of 21.3% were institutionalised; 16.9% were frail, 48.5% pre-frail, 21.3% non-frail, and 12.8% did not have the 3 criteria to be able to determine their state, of which 9.5% had moderate-severe incapacity, which would increase the prevalence of frailty to 26.4%. CONCLUSIONS: A FRADEA cohort has been constructed, representative of an urban population in Spain. The prevalence of frailty in the cohort was 16.9%.