Depression as a Risk Factor for Dementia and Alzheimer’s Disease

Preventing the onset of dementia and Alzheimer’s disease (AD), improving the diagnosis, and slowing the progression of these diseases remain a challenge. The aim of this study was to elucidate the association between depression and dementia/AD and to identify possible relationships between these diseases and different sociodemographic and clinical features. In this regard, a case-control study was conducted in Spain in 2018–2019. The definition of a case was: A person ≥ 65 years old with dementia and/or AD and a score of 5–7 on the Global Deterioration Scale (GDS). The sample consisted of 125 controls; among the cases, 96 had dementia and 74 had AD. The predictor variables were depression, dyslipidemia, type 2 diabetes mellitus, and hypertension. The results showed that depression, diabetes mellitus, and older age were associated with an increased likelihood of developing AD, with an Odds Ratio (OR) of 12.9 (95% confidence interval (CI): 4.3–39.9), 2.8 (95% CI: 1.1–7.1) and 1.15 (95% CI: 1.1–1.2), respectively. Those subjects with treated dyslipidemia were less likely to develop AD (OR 0.47, 95% CI: 0.22–1.1). Therefore, depression and diabetes mellitus increase the risk of dementia, whereas treated dyslipidemia has been shown to reduce this risk

Nurses’ Health Risk Perception on the Influence of Professional and Personal Time Management: A Cross-Sectional Descriptive Study

Occupational health risk selfperception among nurses is linked to professional time management and well-being. In contrast, most of the activities done during personal time seem to have a visibly low effect on the subjects. The importance of time management in nurses’ regular work shifts and the relevance of harmonizing personal and family life with each professional’s particular circumstances are highlighted

"With your age, what do you expect?": Ageism and healthcare of older adults in Spain

Introduction: Ageism could influence the relationship between older patients' meeting needs and healthcare professionals' answers. Aims: To highlight the experience of older adults with healthcare systems, how they perceive ageism from their healthcare providers, and to explore the relationship between perceived ageism and self-perception of aging (SPA). Methods: We conducted an exploratory qualitative study. The participants were 14 women over 65 who lived alone in their homes. Results: Professional responses ignored the expression of preferences of the older patients and excluded them from decision-making processes. These answers influenced older patients' use of health services. Moreover, the negative aspects predominated in a SPA influenced by the internalization of stereotypes and a relationship weighed down by ageist behaviors on the part of health professionals. Conclusion: Explicit situations of ageism influence an imbalance in power relations between older patients and healthcare professionals, a misuse of health services, and a negative SPA.S

Emotional Universe of Nurse Case Managers Regarding Care for Elderly at Risk in Spain: A Hermeneutical Study

The role of nurse case managers (NCM) involves a rarely visible emotional labor, even more when their role focuses on the care of elders at risk (EAR). Motivated by the lack of qualitative research on the emotional universe of NCM, this study explores the emotional universe (EU) of NCM regarding the care they provide to EAR in primary health care as well as the reasons that generate these emotions. An interpretative–phenomenological approach was implemented in southern Spain, with a purposive sampling that included nurses playing the NCM role for at least three years. Data collection was conducted in two periods (between September 2019 and July 2022). The primary collection tool was the semi-structured individual interview, with starting categories based on Bisquerra’s EU taxonomy. The analysis followed Ricoeur’s considerations, using the Nvivo software. In the NCM’s EU, the recognition of the social phenomena stands out, with an open feeling of empathy regarding the desire of the EAR to continue living at home. However, there was also helplessness, resignation, disappointment, and frustration when EAR rejected their proposals. Furthermore, the system’s limitations aroused compassion in the NCM and made them go beyond the limits of their role. This EU requires that their role be valued more, and higher responsiveness must be enforced to improve EAR care

Conditions for Feasibility of a Multicomponent Intervention to Reduce Social Isolation and Loneliness in Noninstitutionalized Older Adults

Aims: To identify the factors conditioning the feasibility of an intervention to reduce social isolation and loneliness in noninstitutionalized older adults from the perspective of the intervention agents. Design: A Dimensional Grounded Theory study conducted from December 2019 to January 2020. Methods: Twelve participants were recruited from an experimental study developed in a health district of a southern Spanish city. Data were collected through focus group meetings, individual interviews, biograms, anecdote notebooks, and the field diaries of two participants not included in the other techniques. Transcripts were analyzed using thematic analysis. Findings: Findings were divided into three themes: (a) the elderly between the walls of loneliness, economic difficulties, losses, and the past; (b) intervention agents/volunteers between the walls of inexperience in the management of psychological/emotional processes, lack of moral authority, and difficulty in planning results adapted to the (elderly) person; and (c) intervention between the walls of (interest in) company and assistance at home, lack of involvement (“waiting for you to save them”), and withdrawal/“abandonment”. Conclusion: A profile of the specialized intervention agent, professionalized (or at least a mentored agent), with both technical and relational competencies; a clear understanding of the purposes of the intervention (empowerment, as opposed to having company or being helped with household chores) and the commitment to active participation by the elder; or adequate management of the completion of the intervention (flexibility, attachment management) are some of the main factors contributing to the feasibility of these approaches. Impact: The findings have potential implications in the field of primary healthcare because primary and community healthcare services can implement corrections to the proposed intervention and ensure its effectiveness under feasible conditions. The nurse is shown as the most appropriate profile to conduct this intervention, although more research is needed to analyze the feasibility of this type of intervention in the daily practice of community nurses

Cost-Effectiveness of an Exercise Programme That Provided Group or Individual Training to Reduce the Fall Risk in Healthy Community-Dwelling People Aged 65–80: A Secondary Data Analysis

: Research has demonstrated that some exercise programs are effective for reducing fall rates in community-dwelling older people; however, the literature is limited in providing clear recommendations of individual or group training as a result of economic evaluation. The objective of this study was to assess the cost-effectiveness of the Otago Exercise Program (OEP) for reducing the fall risk in healthy, non-institutionalized older people. An economic evaluation of a multicenter, blinded, randomized, non-inferiority clinical trial was performed on 498 patients aged over 65 in primary care. Participants were randomly allocated to the treatment or control arms, and group or individual training. The program was delivered in primary healthcare settings and comprised five initial sessions, ongoing encouragement and support to exercise at home, and a reinforcement session after six months. Our hypothesis was that the patients who received the intervention would achieve better health outcomes and therefore need lower healthcare resources during the follow-up, thus, lower healthcare costs. The primary outcome was the incremental cost-effectiveness ratio, which used the timed up and go test results as an effective measure for preventing falls. The secondary outcomes included differently validated tools that assessed the fall risk. The cost per patient was USD 51.28 lower for the group than the individual sessions in the control group, and the fall risk was 10% lower when exercises had a group delivery. The OEP program delivered in a group manner was superior to the individual method. We observed slight differences in the incremental cost estimations when using different tools to assess the risk of fall, but all of them indicated the dominance of the intervention group. The OEP group sessions were more cost-effective than the individual sessions, and the fall risk was 10% lower

Cost-Effectiveness of an Exercise Programme that Provided Group or Individual Training to Reduce the Fall Risk in Healthy Community-Dwelling People Aged 65–80: A Secondary Data Analysis

Research has demonstrated that some exercise programs are effective for reducing fall rates in community-dwelling older people; however, the literature is limited in providing clear recommendations of individual or group training as a result of economic evaluation. The objective of this study was to assess the cost-effectiveness of the Otago Exercise Program (OEP) for reducing the fall risk in healthy, non-institutionalized older people. An economic evaluation of a multicenter, blinded, randomized, non-inferiority clinical trial was performed on 498 patients aged over 65 in primary care. Participants were randomly allocated to the treatment or control arms, and group or individual training. The program was delivered in primary healthcare settings and comprised five initial sessions, ongoing encouragement and support to exercise at home, and a reinforcement session after six months. Our hypothesis was that the patients who received the intervention would achieve better health outcomes and therefore need lower healthcare resources during the follow-up, thus, lower healthcare costs. The primary outcome was the incremental cost-effectiveness ratio, which used the timed up and go test results as an effective measure for preventing falls. The secondary outcomes included differently validated tools that assessed the fall risk. The cost per patient was USD 51.28 lower for the group than the individual sessions in the control group, and the fall risk was 10% lower when exercises had a group delivery. The OEP program delivered in a group manner was superior to the individual method. We observed slight differences in the incremental cost estimations when using different tools to assess the risk of fall, but all of them indicated the dominance of the intervention group. The OEP group sessions were more cost-effective than the individual sessions, and the fall risk was 10% lower

The relation between functional performance, falls and previous falls among participants in the Otago programme: a secondary data analysis

Ana Beatriz Bays Moneo pertenece al Otago Project Working GroupFall prevention is a key priority in healthcare policies. Multicomponent exercises reduce the risk of falls. The purpose of this study is to describe the relationship between functional performance and falls after following the Otago multicomponent exercise programme and previous falls. A prospective multi-centre intervention study was performed on 498 patients aged over 65 in primary care, with or without a history of previous falls. Sociodemographic, anthropometric and functionality data were collected. The primary outcome was the occurrence of falls; functional performance was measured using the Tinetti, Short Physical Performance Battery and Timed Up and Go tests. Among the patients, 29.7% referred to previous falls. There was a statistically significant (p < 0.001) increase in falls at 6 months (10.1%) and at 12 months (7.6%) among participants with previous falls in the baseline assessment compared to those without. In addition, the existence of previous falls could be considered a risk factor at 6 and 12 months (OR =2.37, p = 0.002, and OR = 1.76, p = 0.046, respectively). With regard to balance and gait, differences between the groups were observed at 6 months in the Tinetti score (p < 0.001) and in the baseline assessment Timed Up and Go score (p < 0.044). Multicomponent exercises improve the fall rate, balance and gait in older people, although this improvement is less in people with previous falls. Earlier intervention and tailoring of exercises in patients with previous falls could help improve outcomes.The Project coordinated with file codes PI16/01520, PI16/00821, PI16/01316, PI16/01649, PI16/01042, PI16/01159 and PI16/01312 was funded by the Carlos III Health Institute through the Strategic Action in Health 2016 and co-funded by the European Regional Development Fund "A way to make Europe"; PI16CIII/00031 was funded by the Carlos III Health Institute through the 2016 Intramural Strategic Action in Health; 2016111005 was funded by the Government of the Basque Country Department of Health through the 2016 subsidies for research projects; FFIS17/AP/02/was funded by the Autonomous Community of the Region of Murcia through the Region of Murcia Foundation for Health Training and Research

Determinants for addressing social isolation and loneliness of non-institutionalized older adults from Primary Health Care

[ES] Objetivo: Identificar los principales condicionantes que los profesionales de atención primaria indican a la hora de implementar y desarrollar intervenciones sobre el aislamiento y la soledad. Diseño: Investigación cualitativa con análisis Sistemático de Teoría Fundamentada y Diseño narrativo de tópicos. Emplazamiento: Desarrollada en 13 centros de atención primaria del Distrito Sanitario Córdoba y Guadalquivir, abarcando zonas urbanas y rurales. Participantes: Se identificaron 3 perfiles: medicina de familia/atención comunitaria, enfermería comunitaria y enfermería de gestión de casos. La selección se llevó a cabo entre aquellos que mostraron mayor motivación y compromiso con una intervención sobre aislamiento/soledad. Método: Muestreo intencional. El trabajo se fundamentó en entrevistas en profundidad individuales, en grupos focales y entrevistas dialógicas. Resultados: a) Persisten imágenes deformadas sobre la soledad/aislamiento social y el vivir solo que dificultan su identificación; b) Los principales determinantes disruptivos en la estructura y organización del sistema de atención tienen que ver con la ausencia de programas de detección, la hegemonía del modelo biomédico y el déficit de recursos (a la luz de este modelo); c) Los principales facilitadores se vinculan con el rol enfermero, privilegiado para estas intervenciones según los participantes; y, finalmente, d) Es necesario contar con componentes personales, tanto de la persona mayor como de los profesionales. Conclusiones: La intervención sobre el aislamiento social y la soledad en atención primaria está condicionada por factores, organizacionales y estructurales, profesionales y personales. Contar con ellos es fundamental a la hora de garantizar su factibilidad. [EN] Objective: To identify the main conditioning factors that Primary Care professionals indicate when implementing and developing interventions on isolation and loneliness. Design: Qualitative research with grounded theory, systematic analysis and narrative design of topics. Location: Developed in 12 Primary Care centres of the Health District of Córdoba and Guadalquivir, covering urban and rural areas. Participants: Three profiles were identified: family medicine/community care, community nursing and case management nursing. The selection was carried out among those who showed greater motivation and commitment to an intervention on isolation/loneliness. Method: Purposive sampling. The work was based on individual in-depth interviews, focus groups and dialogic interviews. Results: (a) Distorted images persist about loneliness/social isolation and living alone that make it challenging to identify; (b) the main disruptive determinants in the structure and organization of the care system have to do with the absence of screening programs, the hegemony of the biomedical model and the deficit of resources (in light of this model); (c) the main facilitators are linked to the nursing role, privileged for these interventions according to the participants; and, finally, (d) personal components are necessary, both from the older adult and from the professionals. Conclusions: Intervention on social isolation and loneliness in Primary Care is conditioned by organizational and structural, professional and personal factors. It is essential to take them into account in order to guarantee their feasibility.El presente trabajo ha sido financiado por la Consejería de Salud y Familias de la Junta de Andalucía (AP-0079-2016) y por la Sociedad Española de Medicina Familiar y Comunitaria (semFYC), gracias a la beca «Francesc Borrell», 2018.S

Monitoring and evaluation of nursing practices through the sisep application

El avance tecnológico y la consecuente incorporación de las TICs en el ámbito docente ha conllevado la aparición de nuevas herramientas para facilitar a los docentes el proceso de seguimiento y evaluación del alumnado. De igual forma, dicho avance ha contribuido a la adquisición de un modelo de aprendizaje más proactivo e individualizado por parte del alumnado. El presente proyecto pretende implementar una herramienta informática denominada “Seguimiento y Evaluación de Practicas” (SISEP) en las asignaturas de prácticas clínicas de la titulación de Grado en Enfermería para optimizar el seguimiento y la evaluación de los alumnos durante el desarrollo de sus prácticas externas, así como mejorar el proceso de adquisición de competencias y habilidades. La metodología ha consistido en la elaboración de material didáctico para dicha aplicación y la posterior evaluación del grado de satisfacción de los distintos roles implicados en su uso mediante un cuestionario autoadministrado de elaboración propia. El grado de satisfacción con respecto a la aplicación fue alto, señalando que contribuye de forma decisiva en la adquisición de competencias, aunque no en todos los casos los usuarios han considerado su interfaz como completamente sencilla o intuitiva.The technological advance and consequent incorporation of IT in the teaching field has entailed the appearance of new tools to facilitate teachers the process of monitoring and evaluating students. In the same way, this advance has contributed to the acquisition of a more proactive and individualized learning model on the students' side. The present project intends to implement a computer tool called “Monitoring and Evaluation of Practices” (SISEP) in the subjects of clinical practices of the degree in Nursing in order to optimize the monitoring and evaluation of students during the development of their external practices, as well as improving the process of acquiring skills and abilities. The methodology used consisted in the elaboration of the teaching material and the later evaluation of the degree of satisfaction from the different roles involved through the use of a self-administered, self-produed questionnaire. The degree of satisfaction regarding the application was high, pointing out its decisive contribution to the acquisition of skills, even if not all users have found its interface clear or intuitive enough