[Making balances between the risks and benefits of pharmacological treatment in dementia, chronic pain and anticoagulation in elderly persons]. / Haciendo equilibrios entre los riesgos y beneficios del tratamiento farmacológico en demencia, dolor crónico y anticoagulación en personas mayores.

In dementia, specific drugs and psychotropic drugs used for psychotic and behavioral symptoms have limited efficacy. Adverse effects may be important given the age and comorbidity of the patients. It is necessary, frequently, its withdrawal, planned together with the family, monitoring the response and offering non-pharmacological treatment alternatives. Chronic pain is suffered by 25-76% of the elderly who live in a community and is more frequent in women. The treatment is multidisciplinary, establishing realistic objectives, individualizing it, starting with lower doses of drugs and continuously reevaluating to control side effects and to get the correct level of analgesia. The prevalence of atrial fibrillation increases with age and is underdiagnosed. ACO is recommended with dicoumarin or direct oral anticoagulants not antagonists of vitamin K, in patients with AF older than 65 years unless contraindicated, to reduce embolic risk, confirming subgroup analyzes similar efficacy in prevention of stroke.

[Internet as an information source for health in primary care patients and its influence on the physician-patient relationship]. / Internet como fuente de información sobre salud en pacientes de atención primaria y su influencia en la relación médico-paciente.

OBJECTIVE: To describe the use of the Internet by primary care patients to seek health related information, understand how they are influenced by this information, and evaluate its impact on the doctor-patient relationship. DESIGN: Cross sectional study, through self-administered survey. SETTING: One urban health center in Madrid. PARTICIPANTS: A total of 323 questionnaires were collected from patients between 14 and 75 years old who attended a physician's office for any reason, excluding illiterate patients and those with neurological or psychiatric problems preventing them from completing the survey. MEASUREMENTS: Internet usage, ability of the internet to clarify doubts regarding health issues, patient lifestyle changes, socio-demographic variables, and physician's receptivity to the use of internet by patients. RESULTS: 61% (CI95%: 56%-67%) of patients used the Internet as a source of health information: Internet queries were able to address health doubts in 92.4% of users, 53.5% reported that the Internet changed their thinking about their health in at least one instance, 30% made behavioral changes (of which 60.1% discussed these changes with their physician), 44.3% had more questions at the physician's office, and 80.8% believe that the doctor would be willing to talk about the information found on the internet. CONCLUSIONS: Using the Internet to find information about health is very common, with positive influence on physician-patient relationship. This may be useful for achieving behavioral changes in patients and can be used as a tool in medical practice.

Improvement in Quality of Life With the Use of a Technological System Among Patients With Chronic Disease Followed Up in Primary Care (TeNDER Project): Protocol for a Randomized Controlled Trial.

BACKGROUND: Among chronic diseases, cognitive, neurological, and cardiovascular impairments are becoming increasingly prevalent, generating a shift in health and social needs. Technology can create an ecosystem of care integrated with microtools based on biosensors for motion, location, voice, and expression detection that can help people with chronic diseases. A technological system capable of identifying symptoms, signs, or behavioral patterns could provide notification of the development of complications of disease. This would help the self-care of patients with chronic disease and save health care costs, promoting the autonomy and empowerment of patients and their caregivers, improving their quality of life (QoL), and providing health professionals with monitoring tools. OBJECTIVE: The main objective of this study is to evaluate the effectiveness of a technological system (the TeNDER system) to improve quality of life in patients with chronic diseases: Alzheimer disease, Parkinson disease, and cardiovascular disease. METHODS: A multicenter, randomized, parallel-group clinical trial will be conducted with a follow-up of 2 months. The scope of the study will be the primary care health centers of the Community of Madrid belonging to the Spanish public health system. The study population will be patients diagnosed with Parkinson disease, Alzheimer disease, and cardiovascular disease; their caregivers; and health professionals. The sample size will be 534 patients (380 in the intervention group). The intervention will consist of the use of the TeNDER system. The system will monitor the patients by means of biosensors, and their data will be integrated into the TeNDER app. With the information provided, the TeNDER system will generate health reports that can be consulted by patients, caregivers, and health professionals. Sociodemographic variables and technological affinity will be measured, as will views on the usability of and satisfaction with the TeNDER system. The dependent variable will be the mean difference in QoL score between the intervention and control groups at 2 months. To study the effectiveness of the TeNDER system in improving QoL in patients, an explanatory linear regression model will be constructed. All analyses will be performed with the 95% CI and robust estimators. RESULTS: Ethics approval for this project was received on September 11, 2019. The trial was registered on August 14, 2020. Recruitment commenced in April 2021, and the expected results will be available during 2023 or 2024. CONCLUSIONS: This clinical trial among patients with highly prevalent chronic illnesses and the people most involved in their care will provide a more realistic view of the situation experienced by people with long-term illness and their support networks. The TeNDER system is in continuous development based on a study of the needs of the target population and on feedback during its use from the users: patients, caregivers, and primary care health professionals. TRIAL REGISTRATION: ClinicalTrials.gov NCT05681065; https://clinicaltrials.gov/ct2/show/NCT05681065. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/47331.

Haciendo equilibrios entre los riesgos y beneficios del tratamiento farmacológico en demencia, dolor crónico y anticoagulación en personas mayores / Making balances between the risks and benefits of pharmacological treatment in dementia, chronic pain and anticoagulation in elderly persons

En la demencia los fármacos específicos y psicofármacos utilizados para síntomas psicóticos y de conducta tienen eficacia limitada. Los efectos adversos pueden ser importantes dada edad y comorbilidad de los pacientes. Es necesario, frecuentemente, su retirada, planificada conjuntamente con familiares, monitorizando la respuesta y ofreciendo alternativas de tratamiento no farmacológicas. El dolor crónico lo sufren el 25-76% de los ancianos que viven en comunidad y es más frecuente en mujeres. El tratamiento es multidisciplinar, estableciendo objetivos realistas, individualizándolo, iniciando con dosis menores los fármacos y reevaluando continuamente para controlar efectos secundarios y lograr el nivel de analgesia correcto. La prevalencia de fibrilación auricular (FA) aumenta con la edad y está infradiagnosticada. Se recomienda anticoagulación oral con dicumarínicos o anticoagulantes orales directos no antagonistas de la vitamina K, en pacientes con FA mayores de 65 años salvo contraindicación, para reducir el riesgo embólico, confirmando los análisis de subgrupos eficacia similar en prevención de ACV

In dementia, specific drugs and psychotropic drugs used for psychotic and behavioral symptoms have limited efficacy. Adverse effects may be important given the age and comorbidity of the patients. It is necessary, frequently, its withdrawal, planned together with the family, monitoring the response and offering non-pharmacological treatment alternatives. Chronic pain is suffered by 25-76% of the elderly who live in a community and is more frequent in women. The treatment is multidisciplinary, establishing realistic objectives, individualizing it, starting with lower doses of drugs and continuously reevaluating to control side effects and to get the correct level of analgesia. The prevalence of atrial fibrillation increases with age and is underdiagnosed. ACO is recommended with dicoumarin or direct oral anticoagulants not antagonists of vitamin K, in patients with AF older than 65 years unless contraindicated, to reduce embolic risk, confirming subgroup analyzes similar efficacy in prevention of stroke

Internet como fuente de información sobre salud en pacientes de atención primaria y su influencia en la relación médico-paciente / Internet as an information source for health in primary care patients and its influence on the physician-patient relationship

Objetivo: Describir el uso que hacen los pacientes de atención primaria para buscar información sobre salud en internet, conocer cómo les influye esta información y su impacto en la relación médico-paciente. Diseño: Estudio descriptivo transversal mediante encuesta autoadministrada. Emplazamiento: Un centro de salud urbano de Madrid. Participantes: Se recogieron 323 cuestionarios de pacientes entre 14 y 75 años que acudieran a la consulta por cualquier motivo, excepto pacientes analfabetos o con problemas neurológicos o psiquiátricos que les impidieran contestar la encuesta. Mediciones principales: Uso de internet, utilidad, respuesta a dudas de salud, cambios de estilo de vida, variables sociodemográficas, receptividad del médico al uso de internet. Resultados: El 61% (IC95%: 56-67%) han usado internet como fuente de información sobre salud. Internet respondió a las dudas de salud en el 92,4% de los usuarios de internet; el 53,5% refirieron que alguna vez internet cambió su forma de pensar sobre su salud y el 30% realizaron algún cambio de comportamiento, comentándolos con su médico el 60,1%; el 44,3% refirieron hacer más preguntas en consulta y el 80,8% creen que su médico estaría dispuesto a conversar acerca de la información encontrada en internet. Conclusiones: El uso de internet para consultar información sobre salud es muy frecuente, con influencia positiva en la relación médico-paciente. Puede ser útil para lograr cambios de comportamiento y usarlo como un aliado en nuestra consulta(AU)

Objective: To describe the use of the Internet by primary care patients to seek health related information, understand how they are influenced by this information, and evaluate its impact on the doctor-patient relationship. Design: Cross sectional study, through self-administered survey. Setting: One urban health center in Madrid. Participants: A total of 323 questionnaires were collected from patients between 14 and 75 years old who attended a physician's office for any reason, excluding illiterate patients and those with neurological or psychiatric problems preventing them from completing the survey. Measurements: Internet usage, ability of the internet to clarify doubts regarding health issues, patient lifestyle changes, socio-demographic variables, and physician's receptivity to the use of internet by patients.Results61% (CI95%: 56%-67%) of patients used the Internet as a source of health information: Internet queries were able to address health doubts in 92.4% of users, 53.5% reported that the Internet changed their thinking about their health in at least one instance, 30% made behavioral changes (of which 60.1% discussed these changes with their physician), 44.3% had more questions at the physician's office, and 80.8% believe that the doctor would be willing to talk about the information found on the internet. Conclusions: Using the Internet to find information about health is very common, with positive influence on physician-patient relationship. This may be useful for achieving behavioral changes in patients and can be used as a tool in medical practice(AU)

Prevalencia de fragilidad en una población urbana de mayores de 65 años y su relación con comorbilidad y discapacidad / Prevalence of frailty in an elderly Spanish urban population. Relationship with comorbidity and disability

ObjetivoEstimar la prevalencia de fragilidad según los criterios de Fried en una población urbana española de 65 años o más y analizar los factores sociodemográficos y de salud asociados.PoblaciónPacientes de 65 años o más residentes en el Barrio de Peñagrande (distrito Fuencarral de Madrid).DiseñoEstudio transversal sobre la población basal del estudio «cohorte Peñagrande» formada por 814 individuos.Mediciones principalesLa fragilidad se definió por la presencia de 3 o más de los siguientes criterios: pérdida de peso no intencionada, debilidad muscular, agotamiento, lentitud al caminar y baja actividad física. Se midieron edad, sexo, estado civil, nivel educativo, ingresos del hogar, número de trastornos crónicos y capacidad funcional. Se realizó un análisis descriptivo ponderado por edad y sexo. Se estimó la asociación con odds ratio (OR) e intervalos de confianza (IC).ResultadosLa tasa de respuesta obtenida fue del 73,3%, el 48,6% eran hombres y la mediana de edad fue de 76 años (71–83). La prevalencia de fragilidad estimada en la población de estudio fue del 10,3% (IC del 95%: 8,2–12,5): el 8,1% en hombres y el 11,9% en mujeres (p=0,084).ResultadosLa fragilidad se asoció de forma independiente a edad superior a los 85 años (OR=3,61; IC del 95%: 1,26–10,29), a bajo nivel educativo (OR=1,71; IC del 95%: 1,01–2,90), a comorbilidad (OR=1,27; IC del 95%: 1,03–1,56 por cada proceso crónico) y a discapacidad (OR=15,61; IC del 95%: 8,88–27,45).ConclusionesLa prevalencia de fragilidad en una población española de mayores de 65 años es similar a estudios publicados en otros países. En nuestro medio, la población potencialmente beneficiaria del cribado de fragilidad serían los mayores de 85 años y los individuos con múltiples procesos crónicos y con bajo nivel educativo(AU)

AimTo estimate prevalence of frailty, by Fried criteria, in a Spanish urban old population, and to analyse relationship with comorbidity and disability.PopulationAged ≥65 living in Peñagrande area (Fuencarral district in Madrid, Spain).DesignCross-sectional study. Baseline evaluation of "Cohort of Peñagrande" established in 814 person.MeasurementsFrailty was defined by the presence of ≥3 of the following criteria: unintentional weight loss, weakness (grip strength), exhaustion, low walking speed, and low physical activity. Age, gender, marital status, educational level, global income at home, comorbidity and disability were measured. A descriptive bivariate and multivariate analysis was performed and ponderated by age and gender in study population. Association was estimated by Odds Ratio and confidence intervals (OR, IC 95%).Results73,3% participated (N=814), 48,6% were men and the median age was 76 [71–83]. The estimated prevalence of frailty in the study population was 10,3% (IC95%: 8,2–12,5): 8,1% male and 11,9% female (p=0.084).ResultsFrailty was associated with aged ≥85 (OR=3,61; IC95%: 1,26–10,29), low educational level (OR=1,71; IC95%: 1,01–2,90), comorbidity (OR=1,27; IC95%:1,03–1,56 by each process) and disability (OR=15,61; IC95%: 8,88–27,45).ConclusionsPrevalence of frailty in an elderly spanish population is similar to international studies. In our environment first beneficiary population for frailty detection is constituted by people aged ≥85, and those with comorbidity and low educational level(AU)

Evaluación de una intervención en cuidadores de pacientes con demencia (programa ALOIS) mediante una escala de calidad de vida / Evaluation of a psychoeducational intervention in the principal caregivers of patients with dementia (ALOIS program) through a quality of life questionnaire

Introducción: evaluar una intervención psicoeducativa en un grupo de cuidadores principales de pacientes con demencia mediante una encuesta de calidad de vida (SF-36). Material y métodos: Diseño: estudio de intervención no controlado. Emplazamiento: atención primaria. Participantes: cuidadores principales de pacientes con demencia. Intervenciones: sesiones educativas grupales impartidas por equipos multidisciplinarios integrados por médicos, enfermeras y trabajadores sociales. Mediciones: perfil del cuidador. Estadio de la enfermedad. Calidad de vida mediante SF-36 preintervención y postintervención. Resultados: participaron en el programa 72 cuidadores, de los que 64 completaron el estudio. Las características sociodemográficas de los cuidadores incluidos eran semejantes a las de otros estudios realizados en nuestro medio. Todas las dimensiones de calidad de vida incluidas en el cuestionario mejoraron tras la intervención, pero sólo las dimensiones referidas a dolor corporal, vitalidad, funcionamiento social, rol emocional y salud mental experimentaron un incremento significativo. La valoración subjetiva realizada por los cuidadores sobre la salud actual comparada con la de hace un año también mejoró tras la intervención. Las mujeres y el aumento de la edad se correspondían con peores puntuaciones en todas las dimensiones del SF-36. El resto de los parámetros estudiados, incluido el estadio de la enfermedad, no tenían relación con las puntuaciones obtenidas. Conclusiones: nuestros hallazgos indican que una intervención psicoeducativa grupal sobre cuidadores de pacientes con demencia puede mejorar su calidad de vida. Mientras algunas características del cuidador (edad, sexo) parecen relacionadas con su calidad de vida, ésta no parece recibir la influencia del estadio de la enfermedad del paciente (AU)

Introduction: to evaluate a psychoeducational intervention in a group of principal caregivers of patients with dementia through a quality of life questionnaire (SF-36). Material and methods: Design: non-controlled, intervention study. Setting: primary care. Participants: principal caregivers of patients with dementia. Interventions: group education sessions provided by multidisciplinary groups composed of doctors, nurses and social workers. Measures: caregiver profile. Disease stage. Quality of life measured through the SF-36 before and after the intervention. Results: seventy-two caregivers participated in the program, of which 64 completed the study. The sociodemographic characteristics of the caregivers included were similar to those found in other studies performed in our environment. All the domains of quality of life included in the questionnaire improved after the intervention but only the domains related to body pain, vitality, social functioning, emotional role and mental health showed a significant improvement. Caregivers’ subjective evaluation of their current health status compared with that 1 year previously also improved after the intervention. Women and greater age were associated with worse scores on all the domains of the SF-36. The remaining variables studied, including disease stage, showed no association with the scores obtained. Conclusions: our findings suggest that a group psychoeducational intervention in the caregivers of patients with dementia can improve quality of life. While quality of life seems to be associated with some caregiver characteristics (age, sex), it does not seem to be influenced by the stage of dementia (AU)