[Medical prescription and informed consent for the use of physical restraints in nursing homes in the Canary Islands (Spain)]. / Prescripción facultativa y consentimiento informado ante el uso de restricciones físicas en centros geriátricos de las Islas Canarias.

OBJECTIVE: To identify the frequency of completion of informed consent and medical prescription in the clinical records of older patients subject to physical restraint, and to analyse the association between patient characteristics and the absence of such documentation. METHODS: A cross-sectional and descriptive multicentre study with direct observation and review of clinical records was conducted in nine public nursing homes, comprising 1,058 beds. RESULTS: 274 residents were physically restrained. Informed consent was not included in 82.5% of cases and was incomplete in a further 13.9%. There was no medical prescription in 68.3% of cases and it was incomplete in a further 12.0%. The only statistical association found was between the lack of prescription and the patients' advanced age (PR=1.03; p <0.005). CONCLUSIONS: Failure to produce this documentation contravenes the law. Organisational characteristics, ignorance of the legal requirements or the fact that some professionals may consider physical restraint to be a risk-free procedure may explain these results.

[Hospital emergencies arising from nursing homes in a region: evolution, characteristics and appropriateness]. / Urgencias hospitalarias procedentes de residencias geriátricas de una comarca: evolución, características y adecuación.

OBJECTIVE: Hospital emergencies (HE) arising from nursing homes (NH) are on the rise. We analyse the evolution, characteristics and appropriateness of HE of NH residents in a region, as well as resulting hospital admissions. METHOD: Retrospective descriptive study between 2010 and 2013 of institutionalised residents of 11 NH located in Baix Empordà (704 beds) and Palamós Hospital. VARIABLES: Gender, age, morbidity and relative weight according to clinical risk groups (CRG), NH, length of stay, diagnosis of the emergency, appropriateness of HE according to Bermejo's criteria and the HE appropriateness protocol (HEAP), and appropriateness of hospitalisations according to the Appropriateness Evaluation Protocol (AEP). Sample to evaluate appropriateness: 159 HE and 91 hospitalisations. STATISTICAL ANALYSIS: frequency, mean, standard deviation, percentiles, Fisher's exact test and ANOVA, with a confidence interval of 95% and using IBM SPSS Statistics 23. RESULTS: 1,474 people were enrolled, of which 73% were women. Group ≥85 years increased to 60.3% and the mean weight of morbidity was 3.2 to 4.0 (p <0.001). 1,805 HE were generated. The annual rate per 1,000 stays arising from NH increased from 1.64 to 2.05, of which 90.6% were appropriate according to Bermejo's criteria and 93.7% according to the HEAP. Of these, 502 involved hospitalisation. The annual rate per 10 emergencies fell from 2.96 to 2.64 and 98.9% were appropriate according to the AEP. CONCLUSIONS: Hospital emergencies and hospitalisations of NH residents are increasing and are appropriate. Increasing age and disease burden could explain this phenomenon. NH and hospitals should react appropriately, considering the specific needs of this population sector.

Implementación y funcionamiento de hogares protegidos para personas con trastornos mentales graves en Iquitos, Perú (2013-2016) / Implementation and operation of protected residences for people with serious mental illness in Iquitos, Peru (2013-2016) / Implementação e funcionamento de residências terapêuticas para pessoas com transtornos mentais graves em Iquitos, Peru (2013-2016)

RESUMEN Objetivo Evaluar el proceso de implementación y funcionamiento de los hogares protegidos para las personas con trastornos mentales graves en Iquitos, con base en el beneficio y la mejora en la calidad de vida percibida. Métodos Estudio con enfoque cualitativo y transversal. Se realizaron 36 entrevistas a profundidad a residentes del hogar, cuidadores, vecinos y profesionales de salud. Se llenó una ficha sociodemográfica y clínica por cada residente y una ficha de procesos de gestión por cada hogar protegido. Se realizaron grupos focales con gestores y cuidadores. Resultados El tiempo de estancia prolongada manicomial previa de los residentes de hogares protegidos fue de 7 años y 3 meses. Solo 28 % habían presentado recaída clínica durante el último año. Los residentes percibieron mejoría en su calidad de vida y mayor satisfacción en la estancia en hogar protegido respecto a la estancia manicomial previa. Los hogares evaluados se encuentran en lugares accesibles a servicios sociales y comunitarios, con adecuado acceso a medios de transporte. Se realizaron supervisiones periódicas a los cuidadores, infraestructura y mantenimiento del hogar. Conclusiones Existe percepción favorable de cuidadores, gestores, residentes y vecinos sobre el funcionamiento de los hogares protegidos.

ABSTRACT Objective Evaluate the implementation and operation of protected residences for people with serious mental illness in Iquitos, based on the benefits and perceived improvement in their quality of life. Methods Qualitative and cross-cutting study. Thirty-six in-depth interviews of residents, caregivers, neighbors, and health professionals were conducted. A sociodemographic and clinical file was completed for each resident, along with a file on managerial processes for each facility. Focus groups were conducted with managers and caregivers. Results Residents' previous length of stay in a psychiatric hospital was 7 years and 3 months. Only 28 % had suffered a clinical relapse in the past year. Residents reported an improvement in their quality of life and greater satisfaction with their stay in the facility compared with their stay in the psychiatric hospital. The residences evaluated are located in areas accessible to social and community services, with adequate access to transportation. Periodic supervision of caregivers, infrastructure, and residence maintenance was performed. Conclusions Caregivers, managers, residents, and neighbors have a positive view of residence operations.

RESUMO Objetivo Avaliar o processo de implementação e funcionamento de residências terapêuticas ("pensões protegidas") para pessoas portadoras de transtornos mentais graves segundo a percepção de benefício e melhoria da qualidade de vida. Métodos Trata-se de um estudo transversal qualitativo realizado em Iquitos, no Peru. Trinta e seis entrevistas em profundidade foram conduzidas com os moradores de residências terapêuticas, cuidadores, vizinhos e profissionais de saúde. Foi feito o preenchimento de uma ficha sociodemográfica e clínica para cada morador e uma ficha do processo de gestão por residência. Foram realizados grupos de discussão com gestores e cuidadores. Resultados A permanência prolongada anterior em instituição manicomial dos moradores das residências foi de 7 anos e 3 meses. Apenas 28% tiveram recaída clínica no último ano. Os moradores perceberam melhoria da qualidade de vida e informaram um nível maior de satisfação com a permanência nas residências terapêuticas em comparação à permanência anterior em instituição manicomial. As residências estudadas se situavam em locais acessíveis aos funcionários dos serviços sociais e comunitários, com acesso adequado ao transporte público. O trabalho dos cuidadores e a infraestrutura e manutenção das residências receberam supervisão periódica. Conclusões O funcionamento das residências terapêuticas é percebido favoravelmente por cuidadores, gestores, moradores e vizinhos.