Falls prevention among older people and care providers: Protocol for an integrative review

Aim. To review the evidence about the role of care providers in fall prevention in older adults aged ≥ 65 years, this includes their views, strategies, and approaches on falls prevention and effectiveness of nursing interventions. Background. Some fall prevention programmes are successfully implemented and led by nurses and it is acknowledged the vital role they play in developing plans for fall prevention. Nevertheless, there has not been a systematic review of the literature that describes this role and care providers' views on fall's prevention initiatives. Design. A convergent synthesis of qualitative, quantitative, and mixed methods studies. The eligibility criteria will be based on participants, interventions/exposure, comparisons, and outcomes for quantitative studies and on population, the phenomena of interest and the context, for qualitative studies. To extract data and assess study qualities members of the research team will work in pairs according to their expertise. The review will follow the guidelines for integrative reviews and the proposed methods will adhere to the PRISMA statement checklist complemented by the ENTREQ framework. As qualitative synthesis are emergent, all procedures and changes in procedure will be documented. Discussion. The review has a constructivist drive as studies that combine methods ought to be paradigmatic driven. Review questions are broad to allow issues emerge and have purposefully left the design flexible to allow for adjustments as the review progresses. The review seeks to highlight the roles that care providers play in fall prevention and their views on fall's prevention initiatives.Authors receive funds to conduct this review from the National Institute of Health Carlos III-Ministerio de Economia y Competitividad. Madrid, Spain-Grant PI 15/01351

Protocol for creating a single, holistic and digitally implementable consensus clinical guideline for multiple multi-morbid conditions

Delivery of future healthcare information systems requires systems to support patients with multi-morbidity. Current approaches to computer interoperable guidelines typically consider only a single clinical guideline for a single condition. There is a need to establish a robust protocolized approach to the development of holistic consensus computer interoperable guidelines in the context of multi-morbidity. The presence of mild cognitive impairment (MCI) and dementia adds an additional challenge to the delivery of effective digital health solutions. CAREPATH proposes an ICT-based solution for the optimization of clinical practice in the treatment and management of multi-morbid older adults with mild cognitive impairment or mild dementia. In this manuscript, we present an evidence-based protocol for the development of a single computer interoperable holistic guideline for a collection of multi-morbid conditions. To the best of our knowledge, this is the first published protocol for the production of a consensus interoperable clinical guideline for people with multi-morbidity, with special focus on older adults with MCI or mild dementia. This addresses a still unmet need for such processes which are expected to play a central role for future integrated healthcare information systems

Ensayo clínico piloto de una intervención multicomponente de enfermería para reducir el delirium en ancianos hospitalizados (MID-NURSE-P)

El Delirium es considerado uno de los grandes Síndromes Geriátricos, siendo una de las complicaciones más frecuentes en ancianos hospitalizados. Es fundamental conocer este síndrome, saber cómo detectarlo y manejarlo durante la hospitalización. En los últimos años, en los artículos publicados existe un gran interés por la prevención del delirium durante la hospitalización al considerarse un indicador de calidad de salud. Lo más importante es que un 30-40% de los casos son prevenibles. La prevención del delirium no farmacológica ha demostrado ser la más eficaz y coste-efectiva. Aunque las intervenciones multicomponentes son el patrón oro para el tratamiento del delirium, se describen pocas intervenciones dirigidas por enfermeras en Unidades Geriátricas de Agudos (UGA). Las enfermeras entre sus roles presentan el de la prevención, por tanto, deben estar capacitadas para detectar los diferentes factores de riesgo del delirium y saber reconocer este síndrome. Por todo ello nos planteamos la necesidad de realizar un estudio de investigación para valorar la eficacia de una intervención multicomponente de enfermería en el manejo preventivo del delirium en población anciana hospitalizada. El estudio de investigación lo hemos denominado estudio MID-Nurse-P (Multicomponent Intervention Delirium-Nurse-Pilot). Objetivo principal: analizar si una intervención multicomponente de enfermería reduce la incidencia, duración y gravedad del delirium en ancianos hospitalizados en una UGA. Diseño: ensayo clínico piloto aleatorizado simple ciego de grupos paralelos . Ámbito de estudio: Hospital Perpetuo Socorro de Albacete. Complejo Hospitalario Universitario, Albacete (España). Participantes: se incluyeron 50 pacientes ? 65 años hospitalizados en la UGA. En el grupo de intervención (GI) se asignaron 21 sujetos, y al grupo de control (GC) 29. Intervención: han participado dos roles de personal investigador para llevar a cabo el estudio de intervención; enfermeras con rol de interventora y enfermeras con rol de evaluadora. Después del análisis de los factores de riesgo, todos los participantes en el GI recibieron una intervención diaria multicomponente no farmacológica (orientación, déficit sensorial, sueño, movilización, hidratación, nutrición, revisión de fármacos, eliminación, oxigenación y dolor) por las enfermeras con rol de interventora. El GC recibió práctica habitual. Las enfermeras con rol de evaluadoras, realizaron valoración diaria de todos los factores de riesgo y valoración de presencia de delirium. Variables: se recogieron variables sociodemográficas, factores de riesgo de delirium, presencia diaria de delirium con escala CAM (Confussion Assesment Method) y gravedad de delirium con escala DRS (Delirium Rating Scale). Las variables de resultado fueron la incidencia del delirium, la prevalencia, la gravedad y el número de días con delirium, mortalidad, duración de la estancia hospitalaria, uso de medidas de contención física y uso de medicamentos para el control del delirium. Resultados: la edad media fue de 86.5 años (48% mujeres). 21 participantes presentaron delirium durante la hospitalización (14 GC y 7 GI). El proceso, los recursos, la gestión y los objetivos científicos se consideraron positivos, lo que hizo posible el estudio piloto. La prevalencia del delirium (33.3% vs 48.3%) y la incidencia (14.3% vs 41.4%; p = 0.039) se redujeron en el GI en comparación con el GC. La gravedad del delirium total fue menor en el GI en comparación con el GC (35.0 vs 65.0; p = 0.040). La mortalidad no fue diferente entre los grupos (GC17.2% versus GI 19.0%). Conclusión: el estudio MID-Nurse-P es factible, y una intervención multicomponente dirigida por enfermeras en pacientes con delirium en una UGA puede reducir la prevalencia, incidencia y gravedad del delirium

Factores relacionados con el insomnio en ancianos internados en un centro sociosanitario

Resumen: Objetivos: Describir las características del sueño de los ancianos internados en un centro sociosanitario tanto en relación con la presencia de insomnio como mediante la calidad del sueño. Metodología: Estudio descriptivo y transversal sobre 100 sujetos de 65 años o más, internados en la residencia Núñez de Balboa (Albacete). Variables: características sociodemográficas, comorbilidad, consumo de psicofármacos, diagnóstico de insomnio según el Manual diagnóstico y estadístico de los trastornos mentales V (DSM-V), dolor, Escala de depresión de Yesavage, Minimental State Examination, Índice de Barthel, Índice de calidad del sueño Pittsburgh (ICSP), y Mini Nutritional Assessment. Resultados: La prevalencia de insomnio fue del 15% y de “malos dormidores”, del 77%. Destaca una latencia en la conciliación del sueño superior a 30 minutos en el 35% de los casos, una eficiencia del sueño inferior al 65% en el 42%, y en contraposición, una calidad subjetiva del sueño de muy buena o bastante buena en un 77%. Las puntuaciones más altas del ICSP se asociaron con peor estado funcional (r = -0,22; p < 0,05), mayor riesgo de depresión (r = 0,33; p < 0,001), peor estado nutricional (r = -0,25; p < 0,05), polifarmacia (r = 0,22; p < 0,05) y dolor (p < 0,05). Conclusiones: Nuestra muestra presenta una baja prevalencia de trastorno de insomnio frente a una alta frecuencia de “malos dormidores”, principalmente en sujetos con mayor nivel de dependencia, con mayor riesgo de depresión, con peor estado nutricional, con dolor y polifarmacia

The Functional Continuum Scale in Relation to Hospitalization Density in Older Adults: The FRADEA Study: The FRADEA Study

Background: There is a need to know the relationship between function and hospitalization risk in older adults. We aimed at investigating whether the Functional Continuum Scale (FCS), based on basic (BADL) and instrumental (IADL) activities of daily living and frailty, is associated with hospitalization density in older adults across 12 years of follow-up. Methods: Cohort study, with a follow-up of 12 years. A total of 915 participants aged 70 years and older from the Frailty and Dependence in Albacete (FRADEA) study, a population-based study in Spain, were included. At baseline, the FCS, sociodemographic characteristics, comorbidity, number of medications, and place of residence were assessed. Associations with first hospitalization, number of hospitalizations, and 12-year density of hospitalizations were assessed using Kaplan-Meier curves, Poisson regression analyses, and density models. Results: The median time until the first hospitalization was shorter toward the less functionally independent end of the FCS, from 3917 days (95% confidence interval [CI] 3701-3995) to 1056 days (95% CI 785-1645) (p <. 001). The incidence rate ratio (IRR) for all hospitalizations increased from the robust category until the frail one (IRR 1.89), and thereafter it decreased until the worse functional category. Those who were BADL dependent presented an increased hospitalization density in the first 4 follow-up years (58%), those who were frail in the third-to-sixth follow-up years (55%), while in those prefrail or robust the hospitalization density was homogeneous during the complete follow-up. Conclusions: The FCS is useful for stratifying the risk of hospitalization and for predicting the density of hospitalizations in older adults

Resting metabolic rate in relation to incident disability and mobility decline among older adults: the modifying role of frailty

Background: Alterations in resting metabolic rate (RMR), the largest component of daily total energy expenditure, with aging have been shown in various studies. However, little is known about the associations between RMR and health outcomes in later life. Aims: To analyze whether RMR is associated with incident disability and mobility decline in a 10-year longitudinal study, as well as the moderating role of frailty in these associations. Methods: Data from 298 older adults aged 70 and over from the Frailty and Dependence in Albacete (FRADEA) study in Spain were used, including a baseline measurement in 2007–2009 and a follow-up measurement 10 years later. RMR was measured by indirect calorimetry. Outcomes were incident disability in basic activities of daily living (BADL, Barthel Index), incident disability in instrumental ADL (IADL, Lawton index), and mobility decline (Functional Ambulation Categories scores). Fried’s frailty phenotype was used as an indicator of frailty. Logistic regression analyses were conducted. Results: Fully adjusted and stratified analyses revealed that only in the pre-frail/frail group, a higher RMR was associated with a lower risk of incident BADL disability (OR = 0.47, 95% CI = 0.23–0.96, p = 0.037), incident IADL disability (OR = 0.39, 95% CI = 0.18–0.84, p = 0.017), and mobility decline (OR = 0.30, 95% CI = 0.14–0.64, p = 0.002). Conclusions: To our knowledge, this is the first study looking at the associations between RMR and functional health using a longitudinal research design. The results suggest that RMR could be used as an early identifier of a specific resilient group within the pre-frail and frail older population, with a lower risk of further health decline

Development of Continuous Assessment of Muscle Quality and Frailty in Older Patients Using Multiparametric Combinations of Ultrasound and Blood Biomarkers: Protocol for the ECOFRAIL Study

BackgroundFrailty resulting from the loss of muscle quality can potentially be delayed through early detection and physical exercise interventions. There is a demand for cost-effective tools for the objective evaluation of muscle quality, in both cross-sectional and longitudinal assessments. Literature suggests that quantitative analysis of ultrasound data captures morphometric, compositional, and microstructural muscle properties, while biological assays derived from blood samples are associated with functional information. ObjectiveThis study aims to assess multiparametric combinations of ultrasound and blood-based biomarkers to offer a cross-sectional evaluation of the patient frailty phenotype and to track changes in muscle quality associated with supervised exercise programs. MethodsThis prospective observational multicenter study will include patients aged 70 years and older who are capable of providing informed consent. We aim to recruit 100 patients from hospital environments and 100 from primary care facilities. Each patient will undergo at least two examinations (baseline and follow-up), totaling a minimum of 400 examinations. In hospital environments, 50 patients will be measured before/after a 16-week individualized and supervised exercise program, while another 50 patients will be followed up after the same period without intervention. Primary care patients will undergo a 1-year follow-up evaluation. The primary objective is to compare cross-sectional evaluations of physical performance, functional capacity, body composition, and derived scales of sarcopenia and frailty with biomarker combinations obtained from muscle ultrasound and blood-based assays. We will analyze ultrasound raw data obtained with a point-of-care device, along with a set of biomarkers previously associated with frailty, using quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay. Additionally, we will examine the sensitivity of these biomarkers to detect short-term muscle quality changes and functional improvement after a supervised exercise intervention compared with usual care. ResultsAt the time of manuscript submission, the enrollment of volunteers is ongoing. Recruitment started on March 1, 2022, and ends on June 30, 2024. ConclusionsThe outlined study protocol will integrate portable technologies, using quantitative muscle ultrasound and blood biomarkers, to facilitate an objective cross-sectional assessment of muscle quality in both hospital and primary care settings. The primary objective is to generate data that can be used to explore associations between biomarker combinations and the cross-sectional clinical assessment of frailty and sarcopenia. Additionally, the study aims to investigate musculoskeletal changes following multicomponent physical exercise programs. Trial RegistrationClinicalTrials.gov NCT05294757; https://clinicaltrials.gov/ct2/show/NCT05294757 International Registered Report Identifier (IRRID)DERR1-10.2196/5032

CAREPATH methodology for development of computer interpretable, integrated clinical guidelines

The process of developing a computer interpretable, integrated clinical guideline requires multiple considerations and decisions. As part of the CAREPATH project, a holistic approach to comorbidity has been adopted using an integrated clinical guideline for the management of multimorbid patients with mild cognitive impairment or mild dementia. The project’s clinical and technical teams would later interpret and implement the integrated clinical guideline into the CAREPATH holistic computer interpretable guideline. Three phases should be completed to accomplish the patient-centered computer interpretable guideline modelling, which include the conceptual modelling, interpretable modelling and localization phases, respectively. This paper describes the methodological viewpoints of this process and the relevant considerations

CAREPATH : developing digital integrated care solutions for multimorbid patients with dementia

CAREPATH project is focusing on providing an integrated solution for sustainable care for multimorbid elderly patients with dementia or mild cognitive impairment. The project has a digitally enhanced integrated patient-centered care approach clinical decision and associated intelligent tools with the aim to increase patients’ independence, quality of life and intrinsic capacity. In this paper, the conceptual aspects of the CAREPATH project, in terms of technical and clinical requirements and considerations, are presented

COVID-19 outbreak in long-term care facilities from Spain. Many lessons to learn.

Background/objectivesTo analyze mortality, costs, residents and personnel characteristics, in six long-term care facilities (LTCF) during the outbreak of COVID-19 in Spain.DesignEpidemiological study.SettingSix open LTCFs in Albacete (Spain).Participants198 residents and 190 workers from LTCF A were included, between 2020 March 6 and April 5. Epidemiological data were also collected from six LTCFs of Albacete for the same period of time, including 1,084 residents.MeasurementsBaseline demographic, clinical, functional, cognitive and nutritional variables were collected. 1-month and 3-month mortality was determined, excess mortality was calculated, and costs associated with the pandemics were analyzed.ResultsThe pooled mortality rate for the first month and first three months of the outbreak were 15.3% and 28.0%, and the pooled excess mortality for these periods were 564% and 315% respectively. In facility A, the percentage of probable COVID-19 infected residents were 33.6%. Probable infected patients were older, frail, and with a worse functional situation than those without COVID-19. The most common symptoms were fever, cough and dyspnea. 25 residents were transferred to the emergency department, 21 were hospitalized, and 54 were moved to the facility medical unit. Mortality was higher upon male older residents, with worse functionality, and higher comorbidity. During the first month of the outbreak, 65 (24.6%) workers leaved, mainly with COVID-19 symptoms, and 69 new workers were contracted. The mean number of days of leave was 19.2. Costs associated with the COVID-19 in facility A were estimated at € 276,281/month, mostly caused by resident hospitalizations, leaves of workers, staff replacement, and interventions of healthcare professionals.ConclusionThe COVID-19 pandemic posed residents at high mortality risk, mainly in those older, frail and with worse functional status. Personal and economic costs were high