Evolution of physical function, cognition, depressive mood, and quality of life during the Covid-19 pandemic in prefrail elderly people: A longitudinal cohort study (Covid-Mefap)

Confinement due to the COVID-19 pandemic has had a major impact on the living habits and health of the population, notably in the pre-frail elderly. This study aimed to study the effect of the COVID-19 pandemic on the physical function, mental function (cognition and mood), and quality of life of pre-frail elderly individuals over 70 years of age following confinement as well as to analyze the variables associated with the observed changes. Methods: Observational study of a cohort of pre-frail community-dwelling older adults over 70 years of age during the COVID-19 pandemic conducted in primary care. Variables: The main outcome variables were recorded during face-to-face interviews between December 14 of 2020 and August 12 of 2021 using scales for the evaluation of physical function (Short Physical Performance Battery), cognition (Lobo's Mini-Examen Cognoscitivo), depressive mood (Geriatric Depression Scale), and quality of life (EuroQol-5D-3L). Covariates: sociodemographic data and variables related to the pandemic and general health (social support network, COVID-19 infection, exercising, and leisure activities) were also collected. Analysis: The Student's t-test for paired samples and multivariate linear regression models were employed for the statistical analyses. Results: Ninety-two subjects were included in the study. Physical function, cognition, and depressive mood improved during the pandemic, whereas no changes were observed in quality of life. Suffering from COVID-19 was associated with deterioration of the cognitive function (−1.460; CI95%: −2.710 to −0.211). Conclusion: Confinement due to the COVID-19 pandemic was not associated with a decline in physical function, cognition, depressive mood, or quality of life in pre-frail individuals over 70 years of ageThis study has been partially funded by the Instituto de Salud Carlos III (ISCIII) (project ref.: PI17/01887) and co-funded by the European Union. The study also received funds from the Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP) and the Regional Health Ministry of the Community of Madrid through non-refundable grants from the credits awarded to the Community of Madrid by the Spanish Government Fund COVID-19, included in Law HAC/667/2020. The funders had no role in the study design or decision to publish this articl

Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences

BACKGROUND: This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response. METHODS: Health-state preferences, measured by EuroQol (EQ-5D-3L), were combined with WTP for recovering a perfect health state. WTP was assessed using close-ended, iterative bidding, contingent valuation method. Data on demographic and socioeconomic characteristics, as well as usage of health services by the subjects were collected. The attitude towards risk was evaluated by collecting risky behaviors data, by the subject’s self-evaluation, and through lottery games. RESULTS: Six hundred and sixty two subjects participated and 449 stated a utility inferior to 1. WTP/QALY ratios varied significantly when payments with personal money (mean €10,119; median €673) or through taxes (mean €28,187; median €915) were suggested. Family income, area income, higher education level, greater use of healthcare services, and the number of co-inhabitants were associated with greater WTP/QALY ratios. Age and female gender were associated with lower WTP/QALY ratios. Risk inclination was independently associated with a greater WTP/QALY when “out of pocket” payments were suggested. Clear discrepancies were demonstrated between linearity and neutrality towards risk assumptions and experimental results. CONCLUSIONS: WTP/QALY ratios vary noticeably based on demographic and socioeconomic characteristics of the subject, but also on their attitude towards risk. Knowing the expression of preferences by patients from this outcome measurement can be of interest for health service planning

Trends in urinary tract infection hospitalization in older adults in Spain from 2000-2015

Objective: To analyze trends in urinary tract infection hospitalization (cystitis, pyelonephritis, prostatitis and non-specified UTI) among patients over 65 years in Spain from 2000-2015. Methods: We conducted a retrospective observational study using the Spanish Hospitalization Minimum Data Set (CMBD), with codifications by the International Classification of Diseases (ICD-9). We collected data on sex, age, type of discharge, main diagnosis, comorbid diagnosis, length of stay, and global cost. All the hospitalizations were grouped by age into three categories: 65-74 years old, 75-84 years old, and 85 years old and above. In the descriptive statistical analysis, crude rates were defined as hospitalizations per 1,000 inhabitants aged ≥65. To identify trends over time, we performed a Joinpoint regression. Results: From 2000-2015, we found 387,010 hospitalizations coded as UTIs (54,427 pyelonephritis, 15,869 prostatitis, 2643 cystitis and 314,071 non-specified UTI). The crude rate of hospitalization for UTIs between 2000 and 2015 ranged from 2.09 in 2000 to 4.33 in 2015 Rates of hospitalization were higher in men than in women, except with pyelonephritis. By age group, higher rates were observed in patients aged 85 years or older, barring prostatitis-related hospitalizations. Joinpoint analyses showed an average annual percentage increase (AAPC) in incidence rates of 4.9% (95% CI 3.2;6.1) in UTI hospitalizations. We observed two joinpoints, in 2010 and 2013, that found trends of 5.5% between 2000 and 2010 (95% CI 4.7;6.4), 1.5% between 2010 and 2013 (95% CI -6.0;9.6) and 6.8% between 2013 and 2015 (95% CI -0.3;14.4). Conclusions: The urinary infection-related hospitalization rate in Spain doubled during the period 2000-2015. The highest hospitalization rates occurred in men, in the ≥85 years old age group, and in non-specified UTIs. There were increases in all types of urinary tract infection, with non-specified UTIs having the greatest growth. Understanding these changing trends can be useful for health planning.This study has been funded by Instituto de Salud Carlos III through the project “PI19/01700”, as part of the Plan Estatal de I+D+I 2017-2020 co-funded by European Regional Development Fund (ERDF) “A way of shaping Europe”. In addition, the principal investigator JRS received support to increase his research activities and to publish this manuscript from the 2020 funding program of the Fundación de Investigación e Innovación Biosanitaria en Atención Primaria (FIIBAP), Community of Madrid.S

Quality of life and physical activity in prefrail individuals over 70 years in primary care

[ES] Fundamentos: La fragilidad es un problema de creciente magnitud entre los mayores que afecta en mayor proporción a mujeres. La actividad física mejora tanto la funcionalidad como la calidad de vida. Dadas las diferencias en la percepción de la calidad de vida y en la práctica de actividad física entre hombres y mujeres, se planteó como objetivo analizar la asociación entre calidad de vida y actividad física en mayores de 70 años prefrágiles y su relación con el sexo. Métodos: Estudio descriptivo en mayores de 70 años prefrágiles realizado entre junio de 2018 y marzo de 2020 en 12 centros de salud de Madrid. Se recogieron mediante entrevista clínica, variables de actividad física (cuestionario de Yale), calidad de vida (Euroqol-5D); variables sociodemográficas y de salud (comorbilidad, depresión y dolor). Se realizó análisis descriptivo y modelos de regresión lineal múltiple con calidad de vida como variable dependiente (total población y por sexo). Resultados: Participaron en el estudio 206 individuos (152 mujeres), con una edad media de 78 años. Las mujeres presentaron menos comorbilidad (32,3% versus 55,6%) y más dolor (60,5% versus 44,4%) que los hombres. La media de actividad física fue de 40 puntos (55,9% de la puntuación corresponde a pasear relajadamente). La calidad de vida fue de 0,74 según utilidades y de 68 en la EVA-EQ5D, sin diferencias según sexo. Pasear más de 5 horas/semana se asoció a mejor calidad de vida según utilidades (0,08, IC95%: 0,03 a 0,14), y según EVA (5,38, IC95%: 0,25 a 10,51). Conclusiones: La actividad física se asoció a una mejor calidad de vida en población prefrágil mayor de 70 años. [EN] Background: Frailty is an increasing problem among the elderly people and it is more frequent in women. Physical activity improves either the function and quality of life. Given the diferences reported by the literature about the quality of life perception and the physical activity practice between men and women, the aim of this study is to analyze the association between health related quality of life (HRQoL) and physical activity in a pre-frail population and to study its relationship with gender. Methods: Descriptive study in pre-frail individuals over 70 years old assigned to twelve primary care health centers carried out between 2018 Jun and 2020 March in Madrid. The studied variables were registered by clinical interview: Physical activity (Yale), HRQoL (EQ-5D-3L), sociodemographic and clinical variables (comorbidity, depression and pain). Descriptive analysis and multiple linear regression for the whole population and stratified by gender, using the quality of life as dependent variable. Results: The study involved 206 pre-frail individuals (152 women) wih an average age of 78 years. Women had less comorbidity (32.3% versus 55.6%) but more pain (60.5% versus 44.4%) than men. The median of physical activity was 40 points (55.9% of that score was attributable to relaxed walk). HRQoL was 0.74 in utility score and 68 in the EQ-VAS. No differences were found by gender. To walk more than 5 hours a week was found associated with better quality of life by EQ-5D utility score (0.08, IC95%: 0.03 to 0.14), and by EQ-VAS score (5.38, IC95%: 0.25 to 10.51). Conclusions: Physical activity was associated to better quality of life in a pre-frail population of individuals older than 70 years old.El presente estudio ha sido financiado por el Fondo de Investigaciones Sanitarias ISCIII (PI17/01887) y el Fondo Europeo de Desarrollo Regional (“Una forma de construir Europa”). Los financiadores no tuvieron ningún papel en el diseño del estudio o en la decisión de publicar el estudioS

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe