Subjective psychological impacts during COVID-19 lockdown on older people, risk profiles and coping strategies: Results of an online survey in Spain.

This study explores the psychological impacts of lockdown among older people during the coronavirus disease 2019 pandemic in Spain, and identifies risk profiles and adaptative behaviors. A cross-sectional online survey was disseminated by social networks through snowball sampling (April-June 2020). The survey included ad-hoc questions about psychological impacts on subjective cognitive functioning, emotional distress, and loneliness. Open end-questions were coded according to Lazarus and Folkman's coping strategies framework. Of the 2010 respondents, 76% experienced impact in at least one cognitive function (11% reporting severe effects), 78% frequent sadness and 13% frequent loneliness. Age 80+, women and low education increased the risk of loneliness and severe impact in memory and processing speed. Living alone was an additional risk factor for loneliness and sadness. Lockdown is associated with cognitive impacts, emotional distress, and loneliness being risk profiles related to inequality axes. Coping strategies should inform aging policies to prevent psychological impacts during the lockdown.

Promoting self-management, health literacy and social capital to reduce health inequalities in older adults living in urban disadvantaged areas: protocol of the randomised controlled trial AEQUALIS.

BACKGROUND: Older people living in socio-economic deprived urban areas especially suffer the effects of health inequalities but have been insufficiently targeted. Strategies promoted by local primary health care agents might influence health and social behaviours as intermediate social determinants that are modifiable and thus can potentially mitigate health inequalities. Therefore, we aim to develop and assess the effectiveness of a complex intervention based on a community programme that promotes self-management, health literacy and social capital targeting older people from urban socioeconomically disadvantaged areas in order to improve their self-perceived health as an indicator of health inequality reduction. METHODS/DESIGN: Design: A pragmatic multicentre, parallel, randomised controlled trial will be implemented in 16 primary health care centres from six urban areas in neighbourhoods with low-socioeconomic level. TARGET: community-dwelling aged 60 years or above who perceive their health as fair or poor. The programme is called "Sentir-nos Bé" ("Feeling well") and comprises 12 two-hour sessions held once a week in groups of 12-15 people. Group dynamics are designed to promote mutual support, social participation and new knowledge on health literacy and self-management, resulting in meaningful changes in their daily life that positively affect their health and wellbeing. A sample size of 390 participants, randomised to the intervention or the control group, will be needed to detect a clinically relevant benefit in the primary outcome self-perceived health after 3-month intervention. A follow-up will be conducted at 9 months post-intervention. Participants in the control group will receive usual care and remain in a waiting-list to join the programme once the trial ends. A process evaluation will provide greater confidence in the conclusions about the effectiveness of the intervention. Ethics approval: Clinical Investigation Ethics Committee of the IDIAP Jordi Gol (P15/031). Dissemination: Findings will be disseminated through conference presentations and open-access journals. DISCUSSION: The project will promote the implementation of evidence-based intervention procedures in future health policy strategies targeting older people while considering the social aspects of inequality. TRIAL REGISTRATION: NCT02733523 . Retrospectively registered. Date of registration: April 11, 2016.

Ensayo clínico aleatorizado de una estrategia de prevención de caídas en ancianos institucionalizados basada en el Mini Falls Assessment Instrument

Introducción. El Mini Falls Assessment Instrument (MFAI) identifica factores de riesgo de caídas de un individuo y los vincula a intervenciones específicas. El objetivo de este estudio fue evaluar la eficacia del MFAI como base de una estrategia de prevención de caídas en ancianos institucionalizados. Material y métodos. Ensayo aleatorizado por conglomerados (identificador NCT00888953). Se aleatorizaron 16 residencias a aplicar el MFAI (intervención) o una versión modificada no vinculada a acciones (control). La variable principal fue la ocurrencia de caídas durante el seguimiento (12 meses). Otras variables evaluadas: número total de caídas, función física, calidad de vida, estado funcional y efectos adversos. Resultados. Se analizaron datos de 330 participantes (197 intervención, 137 control). Ambos grupos presentaron un número similar de factores de riesgo: 7 en el grupo intervención (rango 1-12) y 8 en el grupo control (1-13). En el grupo intervención cayeron más personas (49% vs 38%), y el número de caídas (315 vs 109) y la tasa por 100 personas-año fueron mayores (192,5 vs 179,8) que en el grupo control. En el análisis multivariable no hay diferencias significativas en el riesgo de caída (odds ratio = 1,45; intervalo de confianza [IC] del 95%: 0,67 a 3,14; p = 0,350), aunque la tasa de incidencia es significativamente mayor en el grupo intervención (razón de tasas de incidencia = 2,23; IC 95%: 1,43 a 3,48; p < 0,001). Conclusiones. Los resultados del MFAI como estrategia para la prevención de caídas no son concluyentes. Se necesitan estudios adicionales que proporcionen evidencia de calidad (AU)

Introduction. The Mini Falls Assessment Instrument (MFAI) identifies risk factors for falls in an individual and links them to specific interventions. This study evaluates the effectiveness of MFAI as the basis for a falls prevention strategy in institutionalized elderly. Material and methods. A cluster randomized clinical trial (identifier NCT00888953) was conducted in 16 nursing homes randomized to apply MFAI (intervention) or a modified version not linked to actions (control). The primary endpoint was the occurrence of falls during follow-up (12 months). Secondary variables were total number of falls, physical function, quality of life, functional status, and adverse effects. Results. Data from 330 participants (197 intervention, 137 control) were analyzed. Both groups had a similar number of risk factors: 7 in the intervention group (range 1-12) and 8 (1-13) in the control group. In the intervention group there were more fallers (49% vs. 38%), and higher number of falls (315 vs. 109), and fall rate per 100 person-years (192.5 vs. 179.8) than the control group. In the multivariate analysis, there were no significant differences in fall risk (odds ratio = 1.45; 95% confidence interval [CI]: .67 to 3.14; P = .350), but the incidence rate is significantly higher in the intervention group (Incidence rate ratio = 2.23; 95% CI: 1.43 to 3.48; P < .001). Conclusions. The results on the efficacy of the MFAI as a fall prevention strategy are inconclusive. Additional studies are needed in order to provide good quality evidence (AU)

[Randomized clinical trial of a fall-prevention strategy for institutionalized elderly based on the Mini Falls Assessment Instrument]. / Ensayo clínico aleatorizado de una estrategia de prevención de caídas en ancianos institucionalizados basada en el Mini Falls Assessment Instrument.

INTRODUCTION: The Mini Falls Assessment Instrument (MFAI) identifies risk factors for falls in an individual and links them to specific interventions. This study evaluates the effectiveness of MFAI as the basis for a falls prevention strategy in institutionalized elderly. MATERIAL AND METHODS: A cluster randomized clinical trial (identifier NCT00888953) was conducted in 16 nursing homes randomized to apply MFAI (intervention) or a modified version not linked to actions (control). The primary endpoint was the occurrence of falls during follow-up (12 months). Secondary variables were total number of falls, physical function, quality of life, functional status, and adverse effects. RESULTS: Data from 330 participants (197 intervention, 137 control) were analyzed. Both groups had a similar number of risk factors: 7 in the intervention group (range 1-12) and 8 (1-13) in the control group. In the intervention group there were more fallers (49% vs. 38%), and higher number of falls (315 vs. 109), and fall rate per 100 person-years (192.5 vs. 179.8) than the control group. In the multivariate analysis, there were no significant differences in fall risk (odds ratio=1.45; 95% confidence interval [CI]: .67 to 3.14; P=.350), but the incidence rate is significantly higher in the intervention group (Incidence rate ratio=2.23; 95% CI: 1.43 to 3.48; P<.001). CONCLUSIONS: The results on the efficacy of the MFAI as a fall prevention strategy are inconclusive. Additional studies are needed in order to provide good quality evidence.

Falls and risk factors for falls in community-dwelling adults with dementia (NutriAlz trial).

To estimate the number of fallers and risk factors for falls in a cohort with dementia, we did a secondary analysis of a cluster-randomized controlled trial (NutriAlz) in 11 outpatient and day care centers in Catalonia (Spain) including 626 community-dwelling patients with dementia, followed for 12 months. Participants' characteristics were assessed at baseline, at 6 and 12 months [fall in the earlier 6 mo, anthropometric data, comorbidities, Mini-Mental State Examination, Clinical Dementia Rating, Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living, Neuropsychiatric Inventory Questionnaire, Zarit Caregiver Burden Interview and Mini-Nutritional Assessment]. Multivariate logistic regression models and generalized linear models were used to explore risk factors for falls and changes in health and function. Two hundred twenty-three participants fell during the 12 months follow-up (35.62%). Risk factors identified for falls were age (odds ratio (OR)=1.03, 95% confidence interval (CI), 1.00-1.05), BADL (OR=1.18, 95% CI, 1.05-1.32), and earlier fall (OR=2.30, 95% CI, 1.57-3.35). Fallers had worse health than nonfallers, and their dependence increased significantly more in BADL during the study, compared with nonfallers. Dependence in BADL is a risk factor and a consequence of falls; interventions aimed at preventing falls in dementia patients could promote autonomy in BADL and slow its decline.

[Post-transplantation vaccination of bone-marrow transplant recipients]. / Vacunación de pacientes receptores de trasplante de progenitores hematopoyéticos.

BACKGROUND: Patients subject to bone marrow transplantation (BMT) and other blood stem cell transplantations are severely immunocompromised after transplantation. Some studies have suggested that post-transplantation loss of acquired immunity may play a role. The objective of this study was to determine the susceptibility to vaccine-preventable diseases in people subject to BMT and the serologic response after vaccination. PATIENTS AND METHOD: Study population was people subject to transplantation at least 6 months before initiating vaccination and without immunosuppressive treatment at that time. A prevaccination serologic analysis was carried out, and the hepatitis B, the adult tetanus-diphtheria (Td), the IPV, the influenza and the pneumococccal vaccines were administered in accordance with standard guidelines Depending on the immune status of the patient according to the serologic analysis, the MMR vaccine was administered no sooner than 18 months after transplantation. After vaccination, a serologic analysis was carried out to determine the response. RESULTS: The mean time SD between transplant and the initiation of vaccination was 3.2 2.9 years. Of the 122 recipients of BMT (average age 35.8 13 years; 54.2% male), 51.7% received an allogenic and 48.3% an autologous transplant. Before vaccination, the susceptibility was 48.2% for tetanus, 66.7% for diphtheria, 74.1% for pertussis, 85.9% for hepatitis B, 13.4% for measles, 36.7% for rubella and 9.2% for mumps. The rates of seroconversion with protective titers after vaccination for tetanus, diphtheria and hepatitis B were 94%, 67% and 75% respectively. The response to the MMR vaccine was greater than 70%, with a second dose of the vaccine being needed in 26% of patients. CONCLUSIONS: Susceptibility to vaccine-preventable diseases in transplanted patients is high. The acceptable response to vaccination justifies the development of specific programs. Given the special characteristics of this group of patients, vaccination programs must be simple and flexible.

Vacunación de pacientes receptores de trasplante de progenitores hematopoyéticos / Post-transplantation vaccination of bone-marrow transplant recipients

FUNDAMENTO: Las personas que reciben un trasplante de médula ósea y otros progenitores hematopoyéticos (TPH) están intensamente inmunodeprimidas después del trasplante. Algunos estudios sugieren la pérdida de la inmunidad adquirida antes del trasplante. El objetivo de este trabajo es determinar la susceptibilidad a enfermedades prevenibles por vacunación en receptores de TPH y conocer la respuesta serológica tras la vacunación. PACIENTES Y MÉTODO: La población de estudio estaba constituida por personas que habían sido trasplantadas, como mínimo, 6 meses antes del inicio de la vacunación y sin tratamiento inmunodepresor en el momento de su inicio. Se realizó una determinación serológica prevacunal y se administraron vacunas antihepatitis B, antitétanos-difteria tipo adulto (Td), antipoliomielítica tipo Salk, así como las antigripal y antineumocócica. En función de los resultados serológicos se administró la vacuna triple viral transcurridos al menos 18 meses desde el trasplante. Tras completar la vacunación se realizó una determinación serológica para valorar la respuesta. RESULTADOS: La media (DE) de tiempo transcurrido entre el trasplante y el inicio de la vacunación fue de 3,2 (2,9) años. De los 122 receptores de TPH (edad media, 35,8 [13] años), el 51,7 por ciento había recibido un trasplante alogénico y el 48,3 por ciento, autogénico. El 54,1 por ciento eran varones. Antes de la vacunación, la susceptibilidad era del 48,2 por ciento para tétanos, del 66,7 por ciento para difteria, del 74,1 por ciento para tos ferina y del 85,9 por ciento para hepatitis B. La susceptibilidad a sarampión, rubéola y parotiditis era del 13,4 por ciento, 36,7 por ciento y 9,2 por ciento, respectivamente. Las tasas de seroconversión tras las vacunas de tétanos, difteria y hepatitis B fué de 94 por ciento, 67 por ciento y 75 por ciento respectivamente. La respuesta a la vacuna triple viral fue superior al 70 por ciento, por lo que un 26 por ciento de los pacientes precisó una segunda dosis de vacuna. CONCLUSIONES: La susceptibilidad a varias enfermedades prevenibles mediante vacunación en los pacientes trasplantados es elevada. La respuesta aceptable a la vacunación justifica el desarrollo de programas específicos. Dadas las peculiares características de estos pacientes, los programas de vacunación han de ser sencillos y flexibles. (AU)