Paternalism vs. autonomy: are they alternative types of formal care?

This study has been supported by MINECO Project: PSI2014-52464-P-ICESE

A Systematic Review of the Current Evidence from Randomised Controlled Trials on the Impact of Medication Optimisation or Pharmacological Interventions on Quantitative Measures of Cognitive Function in Geriatric Patients

Publisher Copyright: © 2022, The Author(s).Background: Cognitive decline is common in older people. Numerous studies point to the detrimental impact of polypharmacy and inappropriate medication on older people’s cognitive function. Here we aim to systematically review evidence on the impact of medication optimisation and drug interventions on cognitive function in older adults. Methods: A systematic review was performed using MEDLINE and Web of Science on May 2021. Only randomised controlled trials (RCTs) addressing the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in older adults (aged > 65 years) were included. Single-drug interventions (e.g., on drugs for dementia) were excluded. The quality of the studies was assessed by using the Jadad score. Results: Thirteen studies met the inclusion criteria. In five studies a positive impact of the intervention on metric measures of cognitive function was observed. Only one study showed a significant improvement of cognitive function by medication optimisation. The remaining four positive studies tested methylphenidate, selective oestrogen receptor modulators, folic acid and antipsychotics. The mean Jadad score was low (2.7). Conclusion: This systematic review identified a small number of heterogenous RCTs investigating the impact of medication optimisation or pharmacological interventions on cognitive function. Five trials showed a positive impact on at least one aspect of cognitive function, with comprehensive medication optimisation not being more successful than focused drug interventions. More prospective trials are needed to specifically assess ways of limiting the negative impact of certain medication in particular and polypharmacy in general on cognitive function in older patients.Peer reviewe

Evolución de la enseñanza de Geriatría en las facultades de Medicina españolas

Resumen: Objetivo: Determinar la evolución reciente de la enseñanza de la Geriatría en el pregrado en España tras el aumento de facultades de Medicina y el cambio del plan de estudios. Metodología: Se compararon las características de la enseñanza de la Geriatría en las facultades de Medicina españolas mediante dos encuestas nacionales realizadas en 2008 y 2015. En ambos casos se analizaron la inclusión de contenidos de Geriatría, el año y la materia en la que se imparte, las características del profesorado responsable y la duración de la misma. Resultados: La prevalencia de docencia de Geriatría en las facultades de Medicina de las universidades españolas era del 75% en el 2008 y 77,5% en el 2015. Esta docencia se ha ido haciendo con mayor frecuencia obligatoria (66,7 vs. 96,8%, p < 0,005) pero se ha reducido su carácter de asignatura independiente (71,4 vs. 35,5%, p < 0,01). En ambos años aproximadamente el 50% de las facultades contemplaban aspectos teóricos y prácticos y en el 90% las prácticas tenían un carácter obligatorio. Se ha observado un incremento de la participación de los Servicios de Geriatría (27,3 vs. 47,1%) y de los propios geriatras como docentes directos (38,1 vs. 74,2%, p = 0,03). El tiempo medio programado para esta enseñanza era de 36 y 32 h respectivamente. No se han producido cambios significativos en más de la mitad de las facultades existentes en lo que respecta a inclusión de la Geriatría en el plan de estudios de pregrado, docencia independiente, incorporación de contenidos prácticos, estatus de las prácticas y participación de geriatras. Conclusiones: La docencia de Geriatría ha presentado una evolución ligeramente positiva en muchas características, sin lograr una incorporación universal o los niveles alcanzados en otros países de nuestro entorno. Abstract: Objective: To analyse the recent evolution of Geriatric teaching at undergaduate level in Spain after the recent increase in the number of medical schools and the introductions of changes in the offical curricula. Methodology: A comparison of several characteristics of Geriatrics teaching at Spanish medical schools was done through two national surveys carried out in 2008 and 2015. The inclusion of Geriatric contents, the year when they are taught, faculty in charge and teaching hours were compared at both time points. Results: The prevalence of Geriatric training was 75% in 2008 and 77.5% in 2015. This training has become compulsory more frequently (66.7 vs. 96.8%, p < .005) but the independence of Geriatrics related to other matters has decreased (71.4 vs. 35.5%, p < .01). In both surveys 50% of medical schools included theoretical and practical contents and in 90% of practices were compulsory. We found an increased of Geriatrics departments (27.3 vs. 47.1%) and geriatricians (38.1 vs. 74.2%, p= .03) in teaching. The mean duration of this training was 36 and 32 hours respectively. In more than half of the medical schools existing in both years there were no significant changes in any of the characteristics surveyed. Conclusions: The teaching of Geriatrics at pregraduate level shows some positive changes, but universal teaching with standards approaching close countries has not yet been achieved. Palabras clave: Pregrado, Enseñanza, Geriatría, Keywords: Undergraduate, Training, Geriatric

FACTORES ASOCIADOS A MAL ESTADO DE SALUD PERCIBIDO O A MALA CALIDAD DE VIDA EN PERSONAS MAYORES DE 65 AÑOS

Fundamento: Hoy en d a, en los pa ses desarrollados, llegar a una edad avanzada ha dejado de ser algo excepcional, sin embargo muchas personas no logran envejecer con una buena calidad de vida. El presente trabajo tiene como objetivos, contribuir a un mejor conocimiento de los principales factores que influyen en la calidad de vida y la percepci n de la salud de los mayores de 65 a os, as como determinar qu ventajas y desventajas presenta cada uno de los tres instrumentos de medida de la salud y la calidad de vida frente a los otros dos instrumentos utilizados. M todos: A partir de 911 encuestas a personas mayores de 65 a os no institucionalizadas, realizadas a domicilio, se hizo un an lisis multivariante mediante regresi n log stica, poniendo en relaci n los resultados obtenidos en el Perfil de Salud de Nottingham (PSN), el Euroqol y el EAS con las caracter siticas sociodemogr ficas, el nivel de recursos econ micos, el grado de apoyo sociofamiliar, el estado de salud f sica y mental y la capacidad funcional. Resultados: Los principales factores que se asocian con la percepci n de un mal estado de salud y mala calidad de vida en el Euroqol y el PSN son los trastornos de ansiedad (Odd Ratios entre 1,8 (IC:1,2-2,8) para movilidad y 7,9 (IC:4,5-13,9) para Perfil 11111), trastornos depresivos (OR:1,8 (IC:1,3-2,6) para dolor/malestar ?3,3 (IC:2,1-5,1) para aislamiento social), falta de ejercicio (OR:1,4 (IC:1-2,1) para ansiedad/depresi n ?3,9 (IC:2,5-6,2) para actividades cotidianas), dependencia para las actividades b sicas de la vida diaria (OR:0,5 (IC:0,3-0,9) para reacci n emocional ?4,8 (IC:3-7,6) para actividades cotidianas) y dependencia para las actividades instrumentales de la vida diaria (OR:1,5 (IC:1,1-2,1) para Escala Visual Anal gicac < 70 ? 7,1 (IC:2,9-17,2) para cuidado personal). Conclusiones: La salud mental y la capacidad funcional son los factores que m s influyen en la percepci n del estado de salud y la calidad de vida de las personas mayores. Dado que los tres instrumentos utilizados han obtenido resultados semejantes, el Euroqol ofrece ventajas por su brevedad, incluyendo una valoraci n global y por dimensiones

Development and validation of a paternalism and autonomist care assessment

Aim: There is a need for a validated instrument to measure the type of care (paternalism or person-centred) provided for older adults. Since paternalism and person-centred care are the most important caregiving styles in the field of care and as they are usually opposed, the study aims to develop and establish psychometrics data of an instrument to identify paternalistic and autonomist behaviours in older adults care contexts, which can help to enhance care practice. Design: Instrument development. Methods: After observing and standardizing behaviours in formal care contexts in 2016, an instrument was developed and proceeding to a first validation using standard validation techniques among caregivers in two care settings during 2016-2017: senior citizen centres and older adult day care centres. Results: The Paternalist/Autonomist Care Assessment (PACA) is a 30-item, behaviour-based instrument which measures both the appraisal of caregivers on elements of care (Care Appraisal Scale- PACA-Appraisal) and the occurrence of behaviours (Occurrence of Care in Context- PACA-Occurrence). The Paternalist/Autonomist Care Assessment (PACA) was validated in 160 professional caregivers and was able to discriminate two factors: paternalistic or overprotective behaviours and autonomist behaviours. However, these factors were not fully dichotomous and were shown to coexist to some degree. Conclusion: The instrument displayed good psychometric properties to measure paternalism and autonomy in older adult care. Moreover, it showed that the two types of care are not antagonistic and can coexist, with overprotective behaviours being more frequent in contexts of care for more dependent persons. Impact: There are no validated instruments to measure paternalism and person-centred behaviour in care contexts. The two measures yielded by the PACA show good construct and concurrent empirical validity, internal consistency, and convergent and discriminant validity. Family caregiver, professional caregivers, nurses, older adults.MINECO Project: PSI2014-52464-P-ICESEN.2.561 JCR (2019) Q2, 6/123 Nursing1.027 SJR (2019) Q1, 10/151 Nursing (miscellaneous)No data IDR 2019UE