Response rates and associated factors after a multicomponent intervention in frail older adults with diabetes.

BACKGROUND: Type 2 diabetes mellitus (T2DM) and frailty are associated with functional decline in older population. OBJECTIVE: To explore the individual response to a multimodal intervention on functional performance. DESIGN: A cluster-randomised multicentre clinical trial. SETTING: Outpatients in hospital or primary care. SUBJECTS: 843 (77.83 years, 50.65% men) prefrail and frail individuals ≥70 years with T2DM. METHODS: Participants were allocated to usual care group (UCG) or a multicomponent intervention group (IG): 16-week progressive resistance training, seven nutritional and diabetological educational sessions and achievement of glycated haemoglobin (7-8%) and blood pressure (<150 mmHg) targets. Functional performance was assessed with the Short Physical Performance Battery (SPPB) at 1 year. We used multivariate binomial and multinomial logistic regression models to explore the effect of the IG, and adherence on the outcomes studied, in several adjusted models. RESULTS: 53.7% in the IG versus 38.0% in the UCG improved by at least 1 point in their SPPB score [OR (95% CI): 2.07 (1.43, 2.98), P value <0.001]. Age, SPPB score and number of frailty criteria met decreased the probability of improving the SPPB score. Factors associated with worsening were pertaining to IG (decreased), age, SPPB score and the number of frailty criteria (increased). An adherence ≥84% was needed to achieve benefits, reaching the peak in the probability of improving SPPB when this was ≥85% [OR(95%CI): 2.38 (1.29, 4.79), P value 0.014]. CONCLUSIONS: Factors predicting the likelihood of improvement in a multimodal programme in pre-frail and frail older adults with diabetes are age, basal SPPB score, the number of frailty criteria and adherence.

Walking a tightrope: A meta-synthesis from frontline nurses during the COVID-19 pandemic.

Nursing staff plays a key role in the public health response to the COVID-19 pandemic, being in the front line of care. This study sought to synthesise the qualitative literature on care experiences of frontline nurses during the COVID-19 pandemic. A search was conducted on five databases in January 2021. Fifteen qualitative studies met the inclusion criteria and were included in the research, being submitted to interpretive meta-synthesis according to the eMERGe guide. The final synthesis included a line of argument that shows the experiences of frontline nurses during the COVID-19 pandemic, divided into three major themes: 'Instability on the edge of a cliff: unpredictable and unknown context,' 'The price of walking the tightrope: the uncertainty surrounding care,' and 'Finding the balance to reach the other side: dealing with the emotional demands of care.' Although essential in the health response to the COVID-19 pandemic, nurses experienced an emotional impact arising from the hampered care provision. Our results point to need for strengthening the training of nurses and future nurses, creating and promoting measures that contribute to their psycho-emotional well-being, ensuring a safe environment for their clinical practice, and promoting their participation in decision-making processes.

Frailty as a Major Factor in the Increased Risk of Death and Disability in Older People With Diabetes.

OBJECTIVES: To assess the role of frailty in predicting death and incident disability in older adults with type 2 diabetes mellitus. DESIGN: Prospective cohort study. SETTING: Community dwelling. PARTICIPANTS: A total of 1825 individuals ≥65 years old recruited between June 2006 and September 2009 were followed for a median of 5.5 years for mortality and 4.98 years for incident functional disability in activities of daily living. Self-reported diabetes, comorbidities (Charlson index), cardio- and cerebrovascular diseases, drug treatments, Frailty Trait Score (FTS) and Frailty Index (FI), activities of daily living, heart rate, and blood pressure among others were collected at baseline. MAIN OUTCOME MEASURES: Survival analysis (Kaplan-Meier), adjusted Cox proportional-hazards models, and binary logistic regression were used to assess the relationship between frailty, comorbidity, and vascular diseases and time to death and incident disability. RESULTS: A total of 363 people had diabetes. Among them, 83 deaths and 84 cases of incident disability occurred during follow-up. People with diabetes died more frequently than those without diabetes [hazard ratio = 1.36, 95% confidence interval (CI) 1.06-1.75; P = .002], showing a poorer functional status at baseline. Survival analysis showed a relationship between frailty quartiles and the risk of death. In the adjusted Cox-models, only age and frailty indices, but not comorbidity or cardio/cerebrovascular diseases, were associated with the risk of death and incident disability after adjusting for measures of frailty. The hazard ratio for death was 1.51 (95% CI 1.28-1.77) and 1.83 (95% CI 1.49-2·26) for each 10 points increase in the FTS and FI; odds ratio for incident disability was 1·64 (95% CI 1.22-2.20) and 1·35 (95% CI 1.09-1.67) when using FI and FTS, respectively. CONCLUSIONS: Frailty is an important risk factor for death and disability in older adults with diabetes, supporting the recent recommendations that frailty status should be routinely assessed in these patients.

Tratamiento de la hipertensión arterial en el enfermo mayor con nefropatía diabética / Management of elderly hypertensive patients with diabetic nephropathy

La diabetes y la HTA son los factores de riesgo cardiovascular hallados con más frecuencia en los ancianos y los que le confieren un mayor riesgo de enfermedad. Las peculiaridades del terreno sobre el que asienta la enfermedad (el paciente anciano), la frecuente comorbilidad y la peculiaridad de los objetivos terapéuticos propios de estos pacientes (más centrados en la preservación de la autonomía funcional que en la prolongación de la expectativa de vida) plantean una serie de consideraciones diagnósticas y terapéuticas. Estas consideraciones abarcan desde el propio significado pronóstico de la nefropatía hasta la indicación de tratamiento y objetivo de presión arterial del tratamiento hipotensor, pasando por la dificultad diagnóstica en función de las múltiples causas concurrentes que conducen a la nefropatía en las personas mayores, y sus manifestaciones clínicas o la ausencia de ensayos clínicos específicamente diseñados para evaluar el efecto de los fármacos en este grupo de población (AU)

Diabetes and hypertension are the most common cardiovascular risk factors found in the elderly, and are the factors most likely to lead to disease. The particular clinical characteristics of the elderly, the high frequency of comorbid conditions, and the distinctive nature of therapeutic goals in these patients (which focus more on the preservation of functional autonomy than on increasing life expectancy) give rise to a number of diagnostic and therapeutic concerns. These include questions about the true prognostic significance of diabetic nephropathy, appropriate indications for treatment, and the correct blood pressure target for hypertensive treatment. They also include the difficulty of making a diagnosis when there are numerous concurrent conditions in elderly patients that could also lead to nephropathy, the varied clinical manifestations of these conditions, and the lack of clinical trials specifically designed to evaluate the effect of drugs in this age group (AU)