Profile of the patient with dementia of the geriatric home care program of the National Hospital of Geriatrics and Gerontology Doctor Raúl Blanco Cervantes – San José, Costa Rica

La unidad de atención comunitaria geriátrica del Hospital Nacional de Geriatría y Gerontología Doctor Raúl Blanco Cervantes realiza visitas por un equipo interdisciplinario a adultos mayores con demencia avanzada. Cada paciente es valorado por un equipo multidisciplinario por medio de la “Sesión de Ingresos”. El presente es un estudio descriptivo que define el perfil de los usuarios con demencia que han ingresado al programa de ACG, desde enero del 2012 al junio del 2020. Se realiza un análisis exploratorio de 2079 pacientes valorados por la “Sesión de ingresos”.  La mayoría de los pacientes provienen del cantón de Desamparados.   El rango de edad va desde los 60 hasta los 105 años, con un promedio de  84,3 años El Barthel promedio es de 11,77. La mayoría son mujeres y viudas. La demencia vascular representa la causa de demencia más prevalente al ingreso, seguido de la demencia mixta. La mayoría de los pacientes presentaban polifarmacia, trastornos neuroconductuales, disfagia y alteraciones nutricionales, predominando el riesgo nutricional. Además,  un grupo minoritario de los pacientes ingresan con sonda vesical, sonda enteral, y úlceras por presión grado 3 y 4. Se documenta una red comprometida en la mayoría de los casos, principalmente liderada por los hijos, con edades desde los 19 a los 88 años con un promedio de 53,4 años. Los pacientes del presente estudio son principalmente del género femenino, viudos, mayores de 80 años, con dependencia severa, riesgo nutricional, polifarmacia, trastornos neuroconductuales y disfagia. Además, presentan alteraciones nutricionales y polifarmacia y son cuidados principalmente por sus hijos de forma comprometida.The geriatric community care unit of the Hospital Nacional de Geriatría y Gerontología visits older adults with dementia by an interdisciplinary team. Each patient is assessed by a multidisciplinary team. This is a descriptive study that describe the profile of the patients with dementia who have entered the ACG program, from January 2012 to June 2020. An exploratory analysis is performed of 2079 patients evaluated by the Unit. Most patients come from the city of Desamparados. The age ranges from 60 to 105 years, with an average of 84,3 years. The average Barthel is 11,77; Most are women widows. Vascular dementia syndromes represent the most prevalent cause of admission, followed by mixed dementia. Most patients have polypharmacy, neurobehavioral disorders, dysphagia and nutritional disturbances predominating “nutritional risk” category. A minority group have bladder catheter and nasogastric tube and had grade 3 and 4 pressure ulcers. A compromised network is identified in most cases. Most of the caregivers are their children, with ages ranging from 19 to 88 years old with an average of 53,4 years. The patients in this study are mainly female, widowers, over 80 years of age, with severe dependence, nutritional disturbances polypharmacy, neurobehavioral disorders and dysphagia. In addition, they have nutritional alterations and polypharmacy and are mainly cared for by their children in a committed way

Comparison of a palliative model and geriatric model in the quality of death in a population of a home visitation program with advanced dementia

Introducción: los adultos mayores con demencia avanzada son un grupo de población en crecimiento y que tienen necesidades particulares. No está claro cuál modelo de atención pueda generar una mejor calidad de muerte. Objetivo: comparar el impacto del modelo de tratamiento paliativo contra el geriátrico en la calidad de muerte en los pacientes con demencia avanzada. Metodología: se aplicó el Quality of Dying and Death Questionnaire a los cuidadores de los pacientes que habían fallecido en los años del 2016 al 2018 y que el diagnóstico de ingreso al programa fuera el de demencia avanzada. Se generaron dos grupos dependiendo del programa que realizó la atención en el domicilio, ya sea el programa de cuidados paliativos o el de geriatría. Se realiza un análsis descriptivo de ambos grupos. Se evalúa el total general dentro de las secciones del cuestionario, así como, cada uno de los apartados que las conforman. Resultados: se  registraron 162 entrevistas, 125 del cuidadores del programa geriátrico y 37 del de paliativos. Los pacientes murieron generalmente con dolor controlado, con poca conciencia de lo que pasaba alrededor, respirando cómodamente, tranquilos, sin miedo a morir, sin preocupaciones por ser una carga para la familia, pasando tiempo con sus amigos y recibiendo afecto de sus seres queridos. Los gastos, arreglos funerarios y la visita de un concejero espiritual se dieron de forma adecuada en ambos grupos.  El índice de calidad de muerte y la satisfacción en la atención fue bastante alto. No hubo diferencias significativas entre ambos grupos. Conclusión: el grado de satisfacción en la atención por parte de ambos grupos fue muy bueno sin encontrarse diferencias significativas. Se debe realizar mayores investigaciones en esta población para ofrecer un modelo óptimo apropiado para sus necesidades.Introduction: older adults with advanced dementia are a growing population group with particular needs. It is unclear which model of care can generate a better quality of death. Objective : to Compare the impact of the palliative treatment model against geriatrics on the quality of death in patients with advanced dementia. Methodology: the Quality of Dying and Death Questionnaire was applied to caregivers of patients who had died in the years 2016 to 2018 and that the diagnosis of entry into the program was that of advanced dementia. Two groups were generated depending on the program that performed the homecare, either the palliative care program or the geriatrics program. A descriptive analysis of both groups is performed. The overall total of the questionnaire is evaluated, as well as each of the constituent parts. Results: there were 162 interviews, 125 from the caregivers of the geriatric program and 37 from the palliative program. Patients died usually with controlled pain, with little awareness of what was going on around, breathing comfortably, calmly, without fear of dying, without worries about being a burden to the family, spending time with their friends and receiving affection from their loved ones. Expenses, funeral arrangements, and the visit of a spiritual advisor were given appropriately in both groups. The death quality rate and attention satisfaction were quite high. There were no significant differences between the two groups. Conclusion: the degree of satisfaction in attention on the part of both groups was very good without significant differences. Further research should be done in this population to provide an optimal model appropriate for your needs

Perfil del paciente con demencia del programa de atención domiciliaria geriátrica del Hospital Nacional de Geriatría y Gerontología Doctor Raúl Blanco Cervantes – San José, Costa Rica

The geriatric community care unit of the Hospital Nacional de Geriatría y Gerontología visits older adults with dementia by an interdisciplinary team. Each patient is assessed by a multidisciplinary team. This is a descriptive study that describe the profile of the patients with dementia who have entered the ACG program, from January 2012 to June 2020. An exploratory analysis is performed of 2079 patients evaluated by the Unit. Most patients come from the city of Desamparados. The age ranges from 60 to 105 years, with an average of 84,3 years. The average Barthel is 11,77; Most are women widows. Vascular dementia syndromes represent the most prevalent cause of admission, followed by mixed dementia. Most patients have polypharmacy, neurobehavioral disorders, dysphagia and nutritional disturbances predominating “nutritional risk” category. A minority group have bladder catheter and nasogastric tube and had grade 3 and 4 pressure ulcers. A compromised network is identified in most cases. Most of the caregivers are their children, with ages ranging from 19 to 88 years old with an average of 53,4 years. The patients in this study are mainly female, widowers, over 80 years of age, with severe dependence, nutritional disturbances polypharmacy, neurobehavioral disorders and dysphagia. In addition, they have nutritional alterations and polypharmacy and are mainly cared for by their children in a committed way.La unidad de atención comunitaria geriátrica del Hospital Nacional de Geriatría y Gerontología Doctor Raúl Blanco Cervantes realiza visitas por un equipo interdisciplinario a adultos mayores con demencia avanzada. Cada paciente es valorado por un equipo multidisciplinario por medio de la “Sesión de Ingresos”. El presente es un estudio descriptivo que define el perfil de los usuarios con demencia que han ingresado al programa de ACG, desde enero del 2012 al junio del 2020. Se realiza un análisis exploratorio de 2079 pacientes valorados por la “Sesión de ingresos”.  La mayoría de los pacientes provienen del cantón de Desamparados.   El rango de edad va desde los 60 hasta los 105 años, con un promedio de  84,3 años El Barthel promedio es de 11,77. La mayoría son mujeres y viudas. La demencia vascular representa la causa de demencia más prevalente al ingreso, seguido de la demencia mixta. La mayoría de los pacientes presentaban polifarmacia, trastornos neuroconductuales, disfagia y alteraciones nutricionales, predominando el riesgo nutricional. Además,  un grupo minoritario de los pacientes ingresan con sonda vesical, sonda enteral, y úlceras por presión grado 3 y 4. Se documenta una red comprometida en la mayoría de los casos, principalmente liderada por los hijos, con edades desde los 19 a los 88 años con un promedio de 53,4 años. Los pacientes del presente estudio son principalmente del género femenino, viudos, mayores de 80 años, con dependencia severa, riesgo nutricional, polifarmacia, trastornos neuroconductuales y disfagia. Además, presentan alteraciones nutricionales y polifarmacia y son cuidados principalmente por sus hijos de forma comprometida

Protocol for a systematic review and meta-analysis assessing the effectiveness of deprescribing in falls prevention in older people

Introduction One of the known risk factors for fall incidents is the use of specific medications, fall-risk-increasing drugs (FRIDs). However, to date, there is uncertainty related to the effectiveness of deprescribing as a single intervention in falls prevention. Thus, a comprehensive update of the literature focusing on all settings in which older people receive healthcare and all deprescribing interventions is warranted to enhance the current knowledge.Methods and analysis This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was performed in Cochrane Central Register of Controlled Trials, MEDLINE, Embase and PsycINFO (2 November 2020). We will also search in trial registers. We will include randomised controlled trials, in which any deprescribing intervention is compared with usual care and reports falls as an outcome. Both title and abstract screening and full-text screening will be done by two reviewers. The Cochrane Collaboration revised tool of Risk of Bias will be applied to perform risk of bias assessment. We will categorise the results separately for every setting. If a group of sufficiently comparable studies will be identified, we will perform a meta-analysis applying random effects model. We will investigate heterogeneity using a combination of visual inspection of the forest plot along with consideration of the χ2 test and the I2 statistic results. We have prespecified several subgroup and sensitivity analyses.Ethics and dissemination Ethics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations. Furthermore, this systematic review will inform the recommendations of working group of polypharmacy and FRIDs of the anticipated World’s Falls Guidelines.PROSPERO registration number CRD42020218231

Evaluation of clinical practice guidelines on fall prevention and management for older adults : a systematic review

IMPORTANCE With the global population aging, falls and fall-related injuries are ubiquitous, and several clinical practice guidelines for falls prevention and management for individuals 60 years or older have been developed. A systematic evaluation of the recommendations and agreement level is lacking. OBJECTIVES To perform a systematic review of clinical practice guidelines for falls prevention and management for adults 60 years or older in all settings (eg, community, acute care, and nursing homes), evaluate agreement in recommendations, and identify potential gaps. EVIDENCE REVIEW A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses statement methods for clinical practice guidelines on fall prevention and management for older adults was conducted (updated July 1, 2021) using MEDLINE, PubMed, PsycINFO, Embase, CINAHL, the Cochrane Library, PEDro, and Epistemonikos databases. Medical Subject Headings search terms were related to falls, clinical practice guidelines, management and prevention, and older adults, with no restrictions on date, language, or setting for inclusion. Three independent reviewers selected records for full-text examination if they followed evidence- and consensus-based processes and assessed the quality of the guidelines using Appraisal of Guidelines for Research & Evaluation II (AGREE-II) criteria. The strength of the recommendations was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation scores, and agreement across topic areas was assessed using the Fleiss κ statistic. FINDINGS Of 11 414 records identified, 159 were fully reviewed and assessed for eligibility, and 15 were included. All 15 selected guidelines had high-quality AGREE-II total scores (mean [SD], 80.1% [5.6%]), although individual quality domain scores for clinical applicability (mean [SD], 63.4% [11.4%]) and stakeholder (clinicians, patients, or caregivers) involvement (mean [SD], 76.3% [9.0%]) were lower. A total of 198 recommendations covering 16 topic areas in 15 guidelines were identified after screening 4767 abstracts that proceeded to 159 full texts. Most (11) guidelines strongly recommended performing risk stratification, assessment tests for gait and balance, fracture and osteoporosis management, multifactorial interventions, medication review, exercise promotion, environment modification, vision and footwear correction, referral to physiotherapy, and cardiovascular interventions. The strengths of the recommendations were inconsistent for vitamin D supplementation, addressing cognitive factors, and falls prevention education. Recommendations on use of hip protectors and digital technology or wearables were often missing. None of the examined guidelines included a patient or caregiver panel in their deliberations. CONCLUSIONS AND RELEVANCE This systematic review found that current clinical practice guidelines on fall prevention and management for older adults showed a high degree of agreement in several areas in which strong recommendations were made, whereas other topic areas did not achieve this level of consensus or coverage. Future guidelines should address clinical applicability of their recommendations and include perspectives of patients and other stakeholders