Health state perception of people close to retirement age: Relationship with lifestyle habits and subjects' characteristics.

Aim: Societal ageing increases the need for correct and healthy ageing to ensure the well-being of older adults. Practical strategies are needed to acquire healthy habits for the ageing process. This study aims to analyse the lifestyle habits of subjects who are retired or close to retirement and identify factors that could influence their perceived health and that could be related to these habits. Methods: A Spanish observational, descriptive, cross-sectional study of subjects close to retirement-age. Socio-demographic, family, work, leisure, social, and clinical-psychological indicators were evaluated. Results: 1,700 participants (581 employed; 714 retirees; 405 other-status) were included, average age 63 years, 52% women. Most reported a satisfactory social life (90%), were in live-in relationships (74%), non-smoking (80%), followed a Mediterranean diet (73%), and took medicines daily (70%). Perceived health (EQ-VAS) was 75.9/100, with low disability (12-WHODAS) (7.4/100) and moderate/severe depression. Women reported higher disability (p < 0.001) and depression (p < 0.001), a better social life, and healthier lifestyle, but lower physical/work activity. Retirees reported less depression, better social life, healthier lifestyle, higher physical/work activity, and better sleeping habits. The multivariate model showed a significant association of health-status with disability level, number of chronic diseases, sleep habits, exercise, diet, and alcohol consumption. When depression level was introduced, age and being a woman were also related. Conclusions: Retirement does not mean worse health but rather an opportunity to reinforce favourable health activities and improve lifestyle factors. Incorporating the differences related to gender and employment status in health-perception will facilitate the design of healthy ageing strategies.

Assessing the Pilot Implementation of the Integrated Multimorbidity Care Model in Five European Settings: Results from the Joint Action CHRODIS-PLUS.

Multimorbidity, the coexistence of several chronic conditions in a patient, represents a great challenge for healthcare systems and society. The Integrated Multimorbidity Care Model (IMCM) was recently designed within the Joint Action on chronic diseases and promoting healthy ageing across the life cycle (CHRODIS) to ensure the continuity of care for patients with multimorbidity. The IMCM was implemented in five European pilot sites in Spain, Italy, and Lithuania, within the Joint Action CHRODIS-PLUS. The effect of these pilot interventions was assessed pre- and post-implementation by 17 healthcare managers, using the Assessment of Chronic Illness Care (ACIC) measure, and by 226 patients with the Patient Assessment of Care for Chronic Conditions (PACIC+) survey. The ACIC total score significantly increased (5.23 to 6.71, p = 0.022) after the intervention, with differences across sites. A significant increase in the PACIC+ summary score was found ranging from 3.25 at baseline to 4.03 after the intervention (p < 0.001), and 58% of the sample perceived an improvement in care. Higher PACIC+ scores after the intervention were associated to lower baseline values in the respective PACIC+ dimension and to greater changes in ACIC Part 1 (delivery system organization). The IMCM implementation can help improve the quality of care for patients with multimorbidity.

A Methodological Approach for Implementing an Integrated Multimorbidity Care Model: Results from the Pre-Implementation Stage of Joint Action CHRODIS-PLUS.

Patients with multimorbidity (defined as the co-occurrence of multiple chronic diseases) frequently experience fragmented care, which increases the risk of negative outcomes. A recently proposed Integrated Multimorbidity Care Model aims to overcome many issues related to fragmented care. In the context of Joint Action CHRODIS-PLUS, an implementation methodology was developed for the care model, which is being piloted in five sites. We aim to (1) explain the methodology used to implement the care model and (2) describe how the pilot sites have adapted and applied the proposed methodology. The model is being implemented in Spain (Andalusia and Aragon), Lithuania (Vilnius and Kaunas), and Italy (Rome). Local implementation working groups at each site adapted the model to local needs, goals, and resources using the same methodological steps: (1) Scope analysis; (2) situation analysis-"strengths, weaknesses, opportunities, threats" (SWOT) analysis; (3) development and improvement of implementation methodology; and (4) final development of an action plan. This common implementation strategy shows how care models can be adapted according to local and regional specificities. Analysis of the common key outcome indicators at the post-implementation phase will help to demonstrate the clinical effectiveness, as well as highlight any difficulties in adapting a common Integrated Multimorbidity Care Model in different countries and clinical settings.

Information Sources and Decision-Making in Neurosurgery: Results of a Survey of Members of the Brazilian Neurosurgery Society

Introduction In all surgical disciplines, including neurosurgery, there are questions about the level of evidence supporting surgical practices and the mechanisms and adequacy of knowledge translation. Objectives To assess the perception of Brazilian neurosurgeons of information sources and decision-making mechanisms related to their medical practices. Methods An online questionnaire was sent to the 2,400 members of the Brazilian Neurosurgical Society. Results A total of 32% of the neurosurgeons completed the questionnaire, 53% had more than 10 years experience, 67% had worked in public hospitals, 34% had performed spine surgeries, and 30% had performed brain tumor surgeries. The therapeutic decisions were based mostly on internship learning (54%) and personal professional experience (52%). The most common information sources were scientific abstracts (53%) and the Internet (47%). A total of 89% believed that evidence-based medicine was relevant, 93% believed protocols or guidelines were necessary, and 74% subscribed to a medical journal. Nonetheless, only 43% had protocols implemented in their services, 93% highly valued a surgeon's personal experience, and 63% showed little familiarity with the interpretation of scientific concepts in the literature. Among the respondents, 83% were willing to try an innovative treatment alternative if it was shown to improve clinical outcomes and reduce severe complications. Conclusions The disparity in the responses highlights the need to implement recommendations that improve decision-making mechanisms.

Introdução Em todas as disciplinas cirúrgicas, incluindo a neurocirurgia, existem questões sobre o nível de evidência que apoia as práticas cirúrgicas e os mecanismos e adequação da translação do conhecimento. Objetivos Avaliar a percepção de fontes de informação e mecanismos de tomada de decisão dos neurocirurgiões brasileiros em relação às práticas médicas. Métodos Um questionário on-line foi enviado aos 2.400 membros da Sociedade Brasileira de Neurocirurgia. Resultados Um total de 32% dos neurocirurgiões preencheram o questionário, 53% tinham mais de 10 anos de experiência, 67% trabalharam em hospitais públicos, 34% realizaram cirurgia de coluna, e 30%, de cérebro. As decisões terapêuticas basearam-se principalmente no aprendizado de estágio (54%) e na experiência profissional pessoal (52%). As fontes de informação mais comuns foram resumos científicos (53%) e a Internet (47%). Um total de 89% acreditava que a medicina baseada em evidências era relevante, 93% acreditavam que protocolos ou diretrizes eram necessários, e 74% tinham assinaturas de uma revista médica. No entanto, apenas 43% apresentaram protocolos implementados em seus serviços, 93% valorizaram a experiência pessoal de um cirurgião, e 63% mostraram pouca familiaridade com a interpretação de conceitos científicos na literatura. Entre os respondentes, 83% estavam dispostos a tentar uma alternativa de tratamento inovador se este demonstrasse melhorar os resultados clínicos e reduzir as complicações graves. Conclusões A disparidade nas respostas destaca a necessidade de implementar recomendações que melhorem os mecanismos de tomada de decisão.

Calidad de vida y estado de salud en personas mayores de 60 años con demencia institucionalizadas / Quality of Life and Health Status in Institutionalized Elderly with Dementian

Fundamentos: Es necesario profundizar en los distintos aspectos que componen la calidad de vida (CdV) en las personas con demencia que viven en residencias. El objetivo de este estudio fue describir la CdV e identificar los factores relacionados con ella. Métodos: Muestra compuesta por 525 personas con demencia mayores de 60 años en 14 residencias de España. La CdV se evaluó mediante el EQ-5D (índice y escala visual analógica, EQ-EVA) y Quality of Life in Alzheimer’s Disease (QoL-AD versiones residente y cuidador). También se utilizaron Clinical Dementia Rating Scale (CDR), el índice de Barthel, la escala Cornell de depresión en demencia (CSDD), una versión adaptada de la Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Short Portable Mental Status Questionnaire (SPMSQ) y el Mini Examen Cognoscitivo (MEC). Para determinar la asociación entre variables se utilizó el coeficiente de correlación de Pearson y la prueba t de Student. Resultados: Las escalas presentaron entre ellas correlaciones de 0,17 a 0,50. La puntuación QoL-AD cuidador fue mejor en varones con menos discapacidad y depresión (28,94±4,91, 29,91±4,74 y 28,44±4,94, respectivamente; (p<0,01) y correlacionó con el índice de Barthel 0,45 y con la CSDD -0,36. El QoL-AD residente fue mejor en ausencia de depresión (29,29±6,03). El índice EQ-5D fue mayor en varones (0,19±0,33) con menos discapacidad (0,42±0,32) y su coeficiente de correlación con el índice de Barthel fue de 0,79. Conclusiones: En personas mayores con demencia institucionalizadas en residencias la calidad de vida se relaciona con el estado funcional y la depresión (AU)

Background: Studies that deepen in the aspects related to quality of life (QoL) of elderly with dementia living in nursing homes in Spain are needed. The aim of this study is to describe the QoL and related aspects in this population. Methods: Sample of 525 people with dementia older than 60 years in 14 nursing homes. QoL was assessed with EQ-5D (both index and visual analogue Scale, EQ-VAS) and Quality of Life in Alzheimer’s Disease (QoL-AD, resident and caregiver versions). Other scales were also applied: Clinical Dementia Rating Scale (CDR), Barthel Index, Cornell Scale for Depression in Dementia (CSDD), modified version of the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Short Portable Mental Status Questionnaire (SPMSQ) and Cognitive Mini-exam (MEC). To determine the relationship between the variables of interest, Pearson’s correlation coefficient and the analysis of variance (Student’s t test) were used. Results: QoL scales displayed correlations from 0.17 to 0.50 between them. Qol-AD-caregiver scored higher in men with lower disability and depression 28.94±4.91, 29.91±4.74 and 28.44±4.94, respectively; (p<0.01), and correlated 0.45 with Barthel Index and -0.36 with CSDD. Qol-AD-resident scored higher in absence of depression (29.29±6.03). EQ-5D Index scored higher in men (0.19±0.33) with less disability (0.42±0.32) and its coefficient of correlation with Barthel Index was 0.79. Conclusions: Functional state and depression are associated with quality of life in older people with dementia living in nursing homes (AU)