A 6-month educational program improves sleep behaviour in community-dwelling frail older adults: A randomised controlled trial.

BACKGROUND: The prevalence of sleep-related issues among older adults is a significant concern, with half of the older population reporting these problems. Consequently, strategies to improve sleep are needed for this population. This study aims to assess the effects of a health educational program on sleep behaviour among pre-frail or frail older adults residing in the community and to explore possible associations with frailty. METHODS: This randomised controlled trial (NCT05610605) included a total of 197 community-dwelling older adults with frailty/pre-frailty, divided into control (n = 88) and educational (n = 109) groups, were assessed at baseline, after the 6-month educational program (6 months), and 6 months after the intervention (12 months). The intervention comprised four group sessions and six follow-up phone calls, focusing on frailty, physical activity, dietary habits, and cognitive training. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and wrist-worn accelerometry. RESULTS: At 6 months, a significant time-by-group interaction was found for self-reported [ß = -0.449, 95%CI (-0.844, -0.053), p = 0.026] and accelerometer-measured [ß = 0.505, 95%CI (0.085, 0.926), p = 0.019] sleep efficiency, showing improved sleep efficiency in the intervention group vs. controls. A significant time-by-group interaction at 6 months was noted for sleep awakenings [ß = -0.402, 95%CI (-0.825, -0.020), p = 0.047]. The educational program led to a significant decrease in awakenings, while the control group experienced an increase. The change in the number of awakenings (Rs = 0.183, p = 0.020) at 6 months was significantly associated with changes in frailty. Moreover, a significant time-by-group interaction was reported at the 12-month assessment [ß = -0.449, 95%CI (-0.844, -0.053), p = 0.026] for self-reported sleep quality, indicating better results in the intervention group compared to controls. CONCLUSION: The educational program improved sleep quality and sleep efficiency while reducing the number of awakenings per night among community-dwelling frail older adults, offering a practical approach to addressing sleep-related challenges in this demographic.

[Frailty in older adults with type 2 diabetes mellitus and its relation with glucemic control, lipid profile, blood pressure, balance, disability grade and nutritional status]. / Fragilidad en el adulto mayor con diabetes mellitus tipo 2 y su relación con el control glucémico, perfil lipídico, tensión arterial, equilibrio, grado de discapacidad y estado nutricional.

INTRODUCTION: frailty identifies a subgroup of people with higher risk of morbidity and mortality. AIMS: our first aim was to determine the prevalence of frailty in older adults with type 2 diabetes mellitus; our second aim was to establish which factors are associated with frailty in these patients. MATERIAL AND METHODS: cross-sectional study in non-institutionalized people (288 patients), over 65 years of age, and diagnosed with diabetes mellitus type 2. Frailty was defined according to Freid's criteria. The following variables were assessed: blood pressure, glycosylated hemoglobin, total cholesterol, HDL and LDL cholesterol, triglycerides, Lawton and Brody index, balance through unipodal support, and nutritional status by using the Mini Nutritional Assessment questionnaire. RESULTS: the prevalence of frailty syndrome was 14.6%. The frailty group showed lower systolic blood pressure (p < 0.001), higher triglycerides levels (p = 0.007), and lower Lawton and Brody values (p < 0.001) than the non-frailty one; moreover, lower monopodal balance was observed with higher frailty levels (r = -0.306, p < 0.001). None frailty-subject was able to perform five seconds or more in balance (r = -0.343, p < 0.001). Moreover, higher frailty was related with poorer Mini Nutritional Assessment results (p = 0.013). CONCLUSION: the prevalence of frailty syndrome in patients with diabetes was higher compared with those in general population over 65 years of age. Frailty was related to lower systolic blood pressure, higher triglycerides concentrations, poorer nutritional status, and lower independency to perform instrumental activities of daily living and poorer balance.

Introducción: la fragilidad identifica a un subgrupo de personas con mayor riesgo de morbimortalidad.Objetivos: determinar la prevalencia de fragilidad y qué factores se asocian a esta en los pacientes adultos mayores con diabetes mellitus tipo 2.Material y métodos: estudio transversal en población residente no institucionalizada (288 pacientes), mayores de 65 años, diagnosticados de diabetes mellitus tipo 2. La fragilidad se define mediante los criterios de Freid. Se valoraron tensión arterial, hemoglobina glicosilada, colesterol total, HDL y LDL, triglicéridos, índice de Lawton y Brody, equilibrio mediante el apoyo unipodal y estado nutricional mediante el Mini Nutritional Assessment.Resultados: la prevalencia encontrada del síndrome de fragilidad fue del 14,6%. El grupo frágil tuvo niveles de tensión arterial sistólica más bajos (p < 0,001), los triglicéridos estaban más elevados (p = 0,007) y obtuvieron valores inferiores en Lawton y Brody (p < 0,001) respecto al grupo no frágil; además, el test de equilibrio monopodal ofreció tiempos menores con la fragilidad (r = -0,306, p < 0,001). Ninguno de los sujetos frágiles aguantó en equilibrio cinco segundos o más (r = -0,343, p < 0,001). Los valores del Mini Nutritional Assessment empeoraron con la fragilidad (p = 0,013).Conclusión: la prevalencia del síndrome de fragilidad en pacientes diabéticos fue mayor a la encontrada en población general mayor de 65 años. La fragilidad se asocia a una disminución de la tensión arterial sistólica, cifras de triglicéridos mayores, peor estado nutricional y disminución de la independencia para la realización de las actividades instrumentales de la vida diaria y peor equilibrio.

Nutritional differences in malnourished patients according to their liquid-intake habits after hospital discharge.

INTRODUCTION: Malnutrition is a serious and relatively common problem among hospitalized patients; moreover, it is known that a good hydration state contributes to health and wellbeing. OBJECTIVE: The aim of this study was to determine the relationship between nutritional status, functional dependency, quality of life and liquid-intake habits in malnourished patients after hospital discharge. METHODS: Cross-sectional descriptive study in 91 patients (45 males) who presented malnutrition at hospital discharge. The patients were grouped according to their liquid intake estimated through the Mini Nutritional Assessment questionnaire: 3-5 glasses (n = 42), and > 5 glasses (n = 46); removing from analysis < 3 glasses of liquid intake (n = 3). The body mass index, weight, Malnutrition Universal Screening Tool (MUST), functional dependency (Barthel questionnaire), and quality of life (Short Form 12 Health Survey [SF-12]) were assessed 2-months after discharge.  RESULTS: The > 5 glasses liquid intake group showed better nutritional status than the 3-5 glasses intake group, for weight (p < 0.001), body mass index (p = 0.001), and MUST scale (p = 0.020). Additionally, the > 5 glasses liquid intake group signifi cantly scored higher values in the total SF-12 questionnaire (p = 0.013), presenting better self-reported quality of life, and higher functional independency in the Barthel index (p = 0.037) than the 3-5 glasses liquid intake group (p = 0.013). CONCLUSIONS: Although further research is needed to elucidate the characteristics of this relationship, descriptive comparisons between groups showed favorable nutritional status, functional independency and quality of life for the > 5 glasses of liquid intake compared with the 3-5 glasses of liquid intake group during a 2-months follow-up.

[Effect of tumour necrosis factor α blockade on bone metabolism in chronic inflammatory joint diseases]. / Efecto del bloqueo del factor de necrosis tumoral α sobre el metabolismo óseo en las enfermedades inflamatorias articulares crónicas.

BACKGROUND AND OBJECTIVE: To evaluate the effect of anti-TNF treatments on bone mineral density (BMD), bone remodelling markers (BRM) and receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG) in patients with chronic inflammatory joint diseases. METHODS: A longitudinal prospective study was performed under clinical practice conditions on 31 patients diagnosed of rheumatoid arthritis, psoriatic arthropathy and ankylosing spondylitis who had received treatment with anti-TNF alpha drugs for one year. BMD, OPG and RANKL soluble form (sRANKL) were studied at the onset and end of the study. During the study (0, 3, 6, 9 and 12 month), disease activity (SDAI, BASDAI and CRP), functional capacity (HAQ, BASFI), BRM and vitamin D were studied. RESULTS: BMD was not modified after one year of treatment. The patients who took corticosteroids had a mean bone mass loss of 3% in the lumbar spine (±1.6, P=.02). In regards to the BRM, did not experience significant changes over the course of the study. Disease activity, both SDAI (P=.002) and BASDAI (P=.002), decreased. OPG was maintained without changes during the year of treatment while both the sRANKL (0.28±0.22, P=.013) and sRANKL/OPG ratio significantly decreased (0.04±0.03, P=.031). CONCLUSION: The patients being treated with anti-TNF did not present with a significant loss of DMO during the study (one year), at the same time experiencing an improvement in disease activity. This protection has been clearer in the responding patients.

[Relationship between age, body mass index, dependency and quality of life in malnourished patients after hospital discharge]. / Relación entre la edad, el índice de masa corporal, el grado de dependencia y la calidad de vida en pacientes con desnutrición tras un alta hospitalaria.

INTRODUCTION: The quality of life assessment means investigating how patients perceive their disease. Malnutrition-specific characteristics make patients more vulnerable, so it is important to know how these factors impact on patients' daily life. AIM: To assess the quality of life in malnourished patients who have had hospital admission, and to determine the relationship of the quality of life with age, body mass index, diagnosis of malnutrition, and dependency. METHOD: Multicenter transversal descriptive study in 106 malnourished patients after hospital admission. The quality of life (SF-12 questionnaire), BMI, functional independency (Barthel index), morbidity, and a dietary intake evaluation were assessed. The relationship between variables was tested by using the Spearman correlation coefficient. RESULTS: The patients of the present study showed a SF-12 mean of 38.32 points. The age was significantly correlated with the SF-12 (r= -0.320, p= 0.001). The BMI was correlated with the SF-12 (r= 0.251, p= 0.011) and its mental component (r= 0.289, p= 0.03). It was also reported a significant correlation between the Barthel index and the SF-12 (r= 0.370, p< 0.001). CONCLUSIONS: The general health perception in malnourished patients who have had a hospital admission was lower than the Spanish mean. Moreover, the quality of life in these patients is significantly correlated with age, BMI and functional independency.

Introducción: La evaluación de la calidad de vida significa investigar cómo el paciente percibe la propia enfermedad. Los pacientes con desnutrición presentan unas características especiales que les hacen más vulnerables, por lo que es importante conocer cómo les afectan estos factores en el desarrollo de su vida habitual. Objetivo: Analizar la valoración de la calidad de vida en personas con desnutrición que han estado ingresadas y su asociación con la edad, el índice de masa corporal, el tipo de diagnóstico de desnutrición, y el grado de dependencia. Método: Estudio descriptivo trasversal multicéntrico en 106 pacientes desnutridos hospitalizados. Se realizó una valoración de la calidad de vida (cuestionario SF-12), el IMC, la independencia funcional (índice de Barthel), los factores de morbilidad, y de la evaluación de la ingesta. La asociación entre las distintas variables se analizó mediante correlación no paramétrica de Spearman. Resultados: Los pacientes de este estudio presentaban una media en el SF-12 de 38,32 puntos. La edad se correlaciona de forma significativa con el SF-12 (r= -0,320, p= 0,001). El IMC se correlaciona tanto con el SF-12 (r= 0,251, p= 0,011) como con el componente mental (r= 0,289, p= 0,03). El índice de Barthel también mostró correlaciones estadísticamente significativas con el SF-12 (r= 0,370, p< 0,001). Conclusiones: La autopercepción de la salud en pacientes desnutridos que han tenido un ingreso hospitalario se encuentra por debajo de la media española; además esta calidad de vida se ve afectada por la edad, el IMC y la capacidad funcional del paciente.

Characteristics of patients with spondyloarthritis followed in rheumatology units in Spain. emAR II study.

OBJECTIVE: To describe the main demographic and clinical features of patients with spondyloarthropaties in Spain. PATIENTS AND METHODS: Review of randomized clinical charts of patients with spondyloarthropaties with at least one visit to the rheumatologist in the previous two years. Information was collected on demographic and clinical data (duration of illness, diagnostic category, disease activity, extrarticular manifestations, comorbidity and work disability). RESULTS: 1,168 patients were included in the study. Their median age was 49.2 years (39.7-60.5), 68.0% were males, and median time of disease was 105.1 month (48.4-192.5). The diagnoses and clinical data such as the BASDAI were reported only in 34,0% of the patients. The most widely used measure of metrology, the Schober test, was missing in 37.7% of the clinical charts. The patients included had the following diagnoses: Ankylosing spondylitis (n = 629, 55.2%), Psoriatic arthritis (n= 253, 22.2%), Undifferentiated spondyloarthritis (n = 184, 16.1%), Arthritis associated to Inflammatory bowel disease (n= 50, 4.4%), and Reactive arthritis (n= 16, 1.4%). The most common extraarticular manifestations were psoriasis (20.8%), anterior uveitis (19.4%), and enthesitis (16.9%). Some kind of work disability was reported in 8.3% of the patients. CONCLUSIONS: Demographic and clinical characteristics of patients with spondyloarthropaties in Spain do not differ as a whole from other published studies, except for Undifferentiated Spondyloarthritis, which was more likely in our patients than in other studies. The quality of the records of activity in the clinical charts could be improved.

[The influence of dysfunctional thoughts on the burden of the dependent person caregiver]. / Influencia de los pensamientos disfuncionales en la sobrecarga de los cuidadores de personas dependientes.

OBJECTIVE: To determine the influence of dysfunctional thoughts and their relationship on the burden of caregivers. METHOD: Descriptive study conducted in the San Andrés Torcal Health Centre, Malaga, Spain, in 2010. SUBJECTS: A random sample was selected from dependent person caregivers of the centre. Those patients who were receiving palliative care and those cases where the care was less than 6 weeks were excluded.We used the Dysfunctional Thoughts Questionnaire (DTQ) and the short Zarit questionnaire was used on the caregivers. Sociodemographic variables of the caregiver and variables related to care (presence of support, duration of care, and if applicable, the type of help received by them), were collected. Sociodemographic variables of the patients, as well as the Barthel index and presence or absence of dementia were recorded. ANALYSIS USED: descriptive analysis, Pearson correlation coefficient to assess the association between quantitative variables and Kolmogorov-Smirnov test. RESULTS: The mean DTQ score was 49.94 (95% CI; 42.0 - 49.8). The burden measured by Zarit test and dysfunctional thoughts were positively associated (Pearson correlation coefficient 0.57, P<.001). CONCLUSIONS: Dysfunctional thoughts have a high impact on our population of caregivers and may be a contributing factor to the onset of fatigue in the caregiver role.There is a positive association between stress of caregivers and dysfunctional thoughts, and is more intensive in caregivers of patients without dementia.

[Evaluation of the situation of the elderly who live alone in a health zone]. / Valoración de las necesidades de los ancianos que viven solos en una zona básica de salud.

OBJECTIVE: To determine the needs of elderly individuals living alone and with some degree of dependency for activities of daily live. METHOD: We performed a cross-sectional descriptive study in an urban health center (San Andrés-Torcal in Málaga, Spain). Persons aged more than 65 years old who lived alone and had some degree of dependency were studied. RESULTS: The sample was composed of 64 elderly individuals, 58 women and 6 men. The mean age was 83.3 years (SD 4.13). Sixteen people (25%) were independent for daily living when aided by others, while 48 (75%) had one or more needs that were not covered. The most frequent nursing diagnoses were: impaired physical mobility in 58, risk of falls in 54, diversional activity deficit in 48, impaired urinary elimination in 38, and social isolation or deterioration in social interaction in 36. Fifty-six individuals had family. Half had no contact with neighbors, 12 (18.8%), did not receive visits, and 26 (40.6%) had nobody to whom they could tell their problems. Architectonic barriers to the house were identified in 48 individuals and access barriers to the home were found in 29. The total sample received a pension of between 301 and 600 euros. CONCLUSIONS: The persons evaluated showed numerous areas of dependency and there was a high proportion whose basic needs were not suitably covered. Because of the multiple and distinct problems identified, we believe that active screening should be performed in this vulnerable population. In addition, special attention should be paid to these individuals and the required help should be offered so that they have information and access to the available health and social resources.