[Impact of COVID-19 on long term care: the case of residential facilities. SESPAS Report 2022]. / Impacto de la COVID-19 en la atención sociosanitaria: el caso de las residencias. Informe SESPAS 2022.

Facilities have been the focus of the greatest impact of COVID-19 in terms of mortality and extreme situations, along with health centers. The main objective of this article is to describe how the arrival of SARS-CoV-2 affected facilities, focusing on Spain during the first pandemic months, and to point out lessons learned. Despite the measures and regulations approved in the first weeks of March 2020, these centers were not prepared for the arrival of an epidemic such as the one experienced. The clearest indicator of this is a strong impact on mortality in residential facilities. The excess of deaths in residences has been estimated at 26,448 people between March 2020 and May 2021 (10.6% of the total number of dependents cared for in residences, with an excess mortality of 43.5%), with deaths concentrated in the first months of the pandemic. However, there are other effects to be considered such as those that affect the mental health and quality of life of residents, family members, and residential facilities staff. Assuming that no two pandemics are possibly alike, it is essential to draw lessons from lived experience that may be useful to prepare for similar future situations and strengthen a long-term care system that was already frail before the arrival of SARS-CoV-2.

Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus.

BACKGROUND: Type 2 diabetes, a highly prevalent chronic disease, is associated with increasing frailty and functional decline in older people. We aimed to evaluate the effectiveness of a multimodal intervention on functional performance in frail and pre-frail participants aged ≥70 years with type 2 diabetes mellitus. METHODS: The MID-Frail study was a cluster-randomized multicenter clinical trial conducted in 74 trial sites across seven European countries. The trial recruited 964 participants who were aged >70 years [mean age in intervention group, 78.4 (SD 5.6) years, 49.2% male and 77.6 (SD 5.29) years, 52.4% male in usual care group], with type diabetes mellitus and determined to be frail or pre-frail using Fried's frailty phenotype. Participants were allocated by trial site to follow either usual care (UCG) or intervention procedures (IG). Intervention group participants received a multimodal intervention composed of (i) an individualized and progressive resistance exercise programme for 16 weeks; (ii) a structured diabetes and nutritional educational programme over seven sessions; and (iii) Investigator-linked training to ensure optimal diabetes care. Short Physical Performance Battery (SPPB) scores were used to assess change in functional performance at 12 months between the groups. An analysis of the cost-effectiveness of the intervention was undertaken using the incremental cost-effectiveness ratio (ICER). Secondary outcomes included mortality, hospitalization, institutionalization, quality of life, burden on caregivers, the frequency and severity of hypoglycaemia episodes, and the cost-effectiveness of the intervention. RESULTS: After 12 months, IG participants had mean SPPB scores 0.85 points higher than those in the UCG (95% CI, 0.44 to 1.26, P < 0.0001). Dropouts were higher in frail participants and in the intervention group, but significant differences in SPPB between treatment groups remained consistent after sensitivity analysis. Estimates suggest a mean saving following intervention of 428.02 EUR (2016) per patient per year, with ICER analysis indicating a consistent benefit of the described health care intervention over usual care. No statistically significant differences between groups were detected in any of the other secondary outcomes. CONCLUSIONS: We have demonstrated that a 12 month structured multimodal intervention programme across several clinical settings in different European countries leads to a clinically relevant and cost-effective improvement in the functional status of older frail and pre-frail participants with type 2 diabetes mellitus.

Use of health resources and healthcare costs associated with nutritional risk: The FRADEA study.

BACKGROUND: In spite of its high prevalence and its clinical relevance, the economic impact of malnutrition has not been sufficiently explored. OBJECTIVE: To study whether malnutrition predicts total hospital healthcare costs and costs related to specialist visits, emergency department visits and hospitalization in older adults. METHODS: Concurrent cohort study in Albacete City, Spain. The study sample included 827 subjects aged 70 and over from the FRADEA Study. Mini Nutritional Assessment®-Short Form (MNA®-SF) was recorded at baseline. Use of hospital resources (hospital admissions, emergency visits, and specialist visits), and hospital healthcare costs were recorded at follow-up. Generalized linear models (GLM) adjusted for age, sex, comorbidity, polypharmacy, and disability in basic activities of daily living were used to estimate the impact of nutritional factors on total healthcare costs per person/year (€ base year 2013) as well as specialist visit costs, emergency department visit costs and hospitalization costs. RESULTS: The average cost associated with the use of health resources was 1922€/year. Subjects with MNA®-SF between 0 and 7 had an average total health cost of 3492€/year, 2744€/year in those with MNA®-SF between 8 and 11, and 1542€/year in those with MNA®-SF between 12 and 14. Of the total health cost, 67.2% was associated with hospital admission costs. Adjusted healthcare costs were 714€/year greater in subjects with malnutrition or nutritional risk. Subjects with malnutrition or nutritional risk presented an increased adjusted risk of hospitalization (OR1.72, 95% CI 1.22-2.43). CONCLUSIONS: Malnutrition assessed by MNA®-SF is a prognostic factor of high healthcare cost and use of resources in older adults.

Labour productivity losses caused by premature death associated with hepatitis C in Spain.

BACKGROUND AND AIMS: Hepatitis C virus (HCV) infection places a huge burden on healthcare systems. There is no study assessing the impact of HCV infection on premature deaths in Spain. The aim of this study was to estimate productivity losses because of premature deaths attributable to hepatitis C occurring in Spain during 2007-2011. MATERIALS AND METHODS: We use data from several sources (Registry of Deaths, Labour Force Survey and Wage Structure Survey) to develop a simulation model based on the human capital approach and to estimate the flows in labour productivity losses in the period considered. The attributable fraction method was used to estimate the numbers of deaths associated with HCV infection. Two sensitivity analyses were developed to test the robustness of the results. RESULTS: Our model shows total productivity losses attributable to HCV infection of 1054.7 million euros over the period analysed. The trend in productivity losses is decreasing over the period. This result is because of improvements in health outcomes, reflected in the reduction of the number of years of potential productive life lost. Of the total estimated losses, 18.6% were because of hepatitis C, 24.6% because of hepatocellular carcinoma, 30.1% because of cirrhosis, 15.9% because of other liver diseases and 10.7% because of HIV-HCV coinfection. CONCLUSION: The results show that premature mortality attributable to hepatitis C involves significant productivity losses. This highlights the need to extend the analysis to consider other social costs and obtain a more complete picture of the actual economic impact of hepatitis C infection.