VIG-Express: Consensus on an express multidimensional/geriatric assessment system in Catalonia

[spa] Objetivo: Consensuar una herramienta de valoración multidimensional/geriátrica rápida (VMGR), como sistema compartido y universal de valoración multidimensional de personas con multimorbilidad, fragilidad, complejidad o situación avanzada, para todos los profesionales del sistema de salud y social de Catalun ̃a. Disen ̃o: Consenso de profesionales en tres fases, combinando sesiones presenciales con trabajo telemático. Emplazamiento: Catalun ̃a. Participantes: Se constituyó un grupo de 27 profesionales de carácter interdisciplinario repre- sentativo de los distintos ámbitos de atención. Método: Se han combinado las metodologías de Design thinking para el consenso inicial de características de la herramienta de VMGR (fase 1), con la metodología Lean Start-Up para el disen ̃o de la nueva herramienta de VMGR (fase 2), que finalmente se testeó en un grupo de pacientes (fase 3). Resultados: En la fase 1 se consensuó que la herramienta de VMGR ideal debía permitir una valoración ad hoc de las personas, ser rápida y ágil (tiempo < 10 minutos), identificar las dimen- siones alteradas mediante preguntas trigger y facilitar el diagnóstico de situación (idealmente cuantificado). En la fase 2 se elaboró el prototipo de una nueva herramienta de VMGR de 15 + dos preguntas (VIG-Express), finalmente testeada en 35 personas en la fase 3. Conclusiones: En los resultados preliminares, la herramienta VIG-Express parece facilitar una valoración multidimensional sencilla y rápida y la personalización de las intervenciones, así como una mirada única y un relato compartido entre los profesionales de los distintos ámbitos de atención. Serán necesarios más estudios para corroborar estos hallazgos. [spa] Objective: To reach a consensus on an rapid multidimensional/geriatric assessment (RMGA) tool for all health and social professionals of Catalonia as a shared and universal system to assess patients with multimorbidities, frailty, complexity or advanced conditions. Design: Three-phase consensus of professionals, combining in-person sessions with telematics. Location: Catalonia. Participants: A group of 27 interdisciplinary professionals from different care settings. Method: The Design Thinking methodology for an initial consensus on the characteristics of the RMGA tool (Phase 1) has been combined with the Lean Startup methodology to create a new RMGA tool (Phase 2), and then tested in a group of patients (Phase 3). Results: In Phase 1, a consensus was reached that the perfect RMGA tool should allow for an ad hoc assessment of patients, be fast and flexible (<10 min), identify altered dimensions using trigger questions and facilitate the diagnosis of the condition (ideally quantified). In Phase 2, a prototype of a new RMGA tool containing 15 + 2 questions (VIG-Express) was developed, which was then tested in 35 patients in Phase 3. Conclusions: Based on preliminary results, the VIG-Express tool seems to facilitate a simple, rapid multidimensional assessment and the customization of interventions, as well as provide a unique look and shared narrative between professionals from different care settings. More studies will be required to corroborate these findings

Effectiveness of an integrated care program for intensive home care services after discharge of stroke patients

The continuity of care in hospital discharge is a cornerstone of patient-centred care, particularly after an acute episode with a high impact on patients’ autonomy. In the setting of stroke, a highly disabling disease, early delivery of post-discharge support services has been associated with better health outcomes. However, the lack of integration between social and health care services often delays the start of home care services in these patients, likely worsening health outcomes. In our area, a post-stroke intensive home care program (RHP) was launched to integrate social and health care services for improving the domiciliary care of stroke patients after hospital discharge

Frailty degree and illness trajectories in older people towards the end-of-life:a prospective observational study

Objectives To assess the degree of frailty in older people with different advanced diseases and its relationship with end-of-life illness trajectories and survival.Methods Prospective, observational study, including all patients admitted to the Acute Geriatric Unit of the University Hospital of Vic (Spain) during 12 consecutive months (2014–2015), followed for up to 2 years. Participants were identified as end-of-life people (EOLp) using the NECPAL (NECesidades PALiativas, palliative care needs) tool and were classified according to their dominant illness trajectory. The Frail-VIG index (Valoración Integral Geriátrica, Comprehensive Geriatric Assessment) was used to quantify frailty degree, to calculate the relationship between frailty and mortality (Receiver Operating Characteristic (ROC) curves), and to assess the combined effect of frailty degree and illness trajectories on survival (Cox proportional hazards model). Survival curves were plotted using the Kaplan-Meier estimator with participants classified into four groups (ie, no frailty, mild frailty, moderate frailty and advanced frailty) and were compared using the log-rank test.Results Of the 590 persons with a mean (SD) age of 86.4 (5.6) years recruited, 260 (44.1%) were identified as EOLp, distributed into cancer (n=31, 11.9%), organ failure (n=79, 30.4%), dementia (n=86, 33.1%) and multimorbidity (n=64, 24.6%) trajectories. All 260 EOLp had some degree of frailty, mostly advanced frailty (n=184, 70.8%), regardless of the illness trajectory, and 220 (84.6%) died within 2 years. The area under the ROC curve (95% CI) after 2 years of follow-up for EOLp was 0.87 (0.84 to 0.92) with different patterns of survival decline in the different end-of-life trajectories (p&lt;0.0001). Cox regression analyses showed that each additional deficit of the Frail-VIG index increased the risk of death by 61.5%, 30.1%, 29.6% and 12.9% in people with dementia, organ failure, multimorbidity and cancer, respectively (p&lt;0.01 for all the coefficients).Conclusions All older people towards the end-of-life in this study were frail, mostly with advanced frailty. The degree of frailty is related to survival across the different illness trajectories despite the differing survival patterns among trajectories. Frailty indexes may be useful to assess end-of-life older people, regardless of their trajectory

Clinical characteristics of COVID-19 in older adults. A retrospective study in long-term nursing homes in Catalonia

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Residències d'avis; Taxes de mortalitatCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Hogares de ancianos; Tasas de mortalidadCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Nursing homes; Death ratesThe natural history of COVID-19 and predictors of mortality in older adults need to be investigated to inform clinical operations and healthcare policy planning. A retrospective study took place in 80 long-term nursing homes in Catalonia, Spain collecting data from March 1st to May 31st, 2020. Demographic and clinical data from 2,092 RT-PCR confirmed cases of SARS-CoV-2 infection were registered, including structural characteristics of the facilities. Descriptive statistics to describe the demographic, clinical, and molecular characteristics of our sample were prepared, both overall and by their symptomatology was performed and an analysis of statistically significant bivariate differences and constructions of a logistic regression model were carried out to assess the relationship between variables. The incidence of the infection was 28%. 71% of the residents showed symptoms. Five major symptoms included: fever, dyspnea, dry cough, asthenia and diarrhea. Fever and dyspnea were by far the most frequent (50% and 28%, respectively). The presentation was predominantly acute and symptomatology persisted from days to weeks (mean 9.1 days, SD = 10,9). 16% of residents had confirmed pneumonia and 22% required hospitalization. The accumulated mortality rate was 21.75% (86% concentrated during the first 28 days at onset). A multivariate logistic regression analysis showed a positive predictive value for mortality for some variables such as age, pneumonia, fever, dyspnea, stupor refusal to oral intake and dementia (p<0.01 for all variables). Results suggest that density in the nursing homes did not account for differences in the incidence of the infection within the facilities. This study provides insights into the natural history of the disease in older adults with high dependency living in long-term nursing homes during the first pandemic wave of March-May 2020 in the region of Catalonia, and suggests that some comorbidities and symptoms have a strong predictive value for mortality.The authors(s) received to specific funding for this work

Vacunació COVID-19: guia d’actuació residències

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Vacunació; Residències; Procediment d'actuacióCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Vacunación; Residencias; Procedimiento de actuaciónCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Vaccination; Residences; Action procedureEn aquest document s'exposa el procediment a seguir durant el procés de vacunació contra la COVID-19 a les residències de Catalunya

Mesures i recomanacions per a la COVID-19 dels serveis de centre de dia per a gent gran

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Prevenció; Centres de dia; Gent granCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Prevención; Centros de día; AncianosCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Prevention; Day centers; SeniorsEl document que es presenta estableix criteris i mesures per adaptar el funcionament dels centres a aquesta nova etapa que s’obre amb la vacunació de les persones usuàries i treballadors. No obstant això, les entitats proveïdores han de poder generar un entorn de seguretat a les persones ateses i al conjunt de professionals davant els riscos del COVID-19

Data and care integration for post-acute intensive care program of stroke patients: effectiveness assessment using a disease-matched comparator cohort

Sistemes d'informació, Atenció integrada; Ictus; Atenció domiciliàriaSistemas de información; Atención integrada; Ictus; Atención domiciliariaInformation systems; Integrated care; Stroke; Domiciliary carePurpose: to assess the effectiveness of an integrated care program for post-acute care of stroke patients, the return home program (RHP program), deployed in Barcelona (North-East Spain) between 2016 and 2017 in a context of health and social care information systems integration. Design/methodology/approach: the RHP program was built around an electronic record that integrated health and social care information (with an agreement for coordinated access by all stakeholders) and an operational re-design of the care pathways, which started upon hospital admission instead of discharge. The health outcomes and resource use of the RHP program participants were compared with a population-based matched control group built from central healthcare records of routine care data. Findings: the study included 92 stroke patients attended within the RHP program and the patients’ matched controls. Patients in the intervention group received domiciliary care service, home rehabilitation, and telecare significantly earlier than the matched controls. Within the first two years after the stroke episode, recipients of the RHP program were less frequently institutionalized in a long-term care facility (5 vs 15%). The use of primary care services, non-emergency transport, and telecare services were more frequent in the RHP group

Excess mortality among older adults institutionalized in long-term care facilities during the COVID-19 pandemic: a population-based analysis in Catalonia

Objectives: To assess excess mortality among older adults institutionalized in nursing homes within the successive waves of the COVID-19 pandemic in Catalonia (north-east Spain).Design: Observational, retrospective analysis of population-based central healthcare registries.Setting and participants: Individuals aged >65 years admitted in any nursing home in Catalonia between January 1, 2015, and April 1, 2022.Methods Deaths reported during the pre-pandemic period (2015-2019) were used to build a reference model for mortality trends (a Poisson model, due to the event counting nature of the variable mortality), adjusted by age, sex, and clinical complexity, defined according to the adjusted morbidity groups. Excess mortality was estimated by comparing the observed and model-based expected mortality during the pandemic period (2020-2022). Besides the crude excess mortality, we estimated the standardized mortality rate (SMR) as the ratio of weekly deaths' number observed to the expected deaths' number over the same period.Results: The analysis included 175,497 older adults institutionalized (mean 262 days, SD 132), yielding a total of 394,134 person-years: 288,948 person-years within the reference period (2015-2019) and 105,186 within the COVID-19 period (2020-2022). Excess number of deaths in this population was 5,403 in the first wave and 1,313, 111, -182, 498, and 329 in the successive waves. The first wave on March 2020 showed the highest SMR (2.50; 95% CI 2.45-2.56). The corresponding SMR for the 2nd to 6th waves were 1.31 (1.27-1.34), 1.03 (1.00-1.07), 0.93 (0.89-0.97), 1.13 (1.10-1.17), and 1.07 (1.04-1.09). The number of excess deaths following the first wave ranged from 1,313 (2nd wave) to -182 (4th wave). Excess mortality showed similar trends for men and women. Older adults and those with higher comorbidity burden account for higher number of deaths, albeit lower SMRs.Conclusion: Excess mortality analysis suggest a higher death toll of the COVID-19 crisis in nursing homes than in other settings. Although crude mortality rates were far higher among older adults and those at higher health risk, younger individuals showed persistently higher SMR, indicating an important death toll of the COVID-19 in these groups of people

Central de resultats: impacte en la supervivència i despesa associada a la fractura de fèmur en les persones grans a Catalunya

Fractura; Fèmur; AnciansFracture; Femur; ElderAncianosLa fractura de fèmur a l’ancià representa, actualment, un greu problema sanitari. Comporta un increment de la morbiditat, la mortalitat, el deteriorament funcional, la despesa sanitària i augmenta el grau de dependència i d’institucionalització d’aquests pacients a l’any següent a la fractura

Mesures i recomanacions per al maneig de la COVID-19 dels centres i serveis socials d’atenció diürna per a persones amb discapacitat

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Centros de atención diurna; Personas discapacitadasCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Centres d'atenció diürna; Persones discapacitadesCoronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Day care centers; Disabled peopleEl document que es presenta estableix criteris i mesures per adaptar el funcionament dels centres a aquesta nova etapa que s’obre amb la vacunació de les persones usuàries i treballadors. No obstant això, les entitats proveïdores han de poder generar un entorn de seguretat a les persones ateses i al conjunt de professionals davant els riscos del COVID-19. L’Administració ha de proporcionar instruccions, pautes, criteris i el suport necessari per a la protecció i l’adaptació dels serveis ocupacionals i d’atenció diürna especialitzada