Exploring older people's experiences of the interpersonal care relationship between nurses and patients during hospitalization in the pandemic period: A qualitative study.

AIM: This article presents the findings of a qualitative study focusing on the experiences of people aged over 70 years in the interpersonal nurse-patient care relationship in hospital settings during and after the COVID-19 pandemic. The aim was to analyse different aspects of this relationship, including nurses' behaviour and caring attitudes, the person-centred model of care, patients' involvement in their own care and communication in the hospital context. DESIGN: An exploratory qualitative study was conducted on the basis of an interpretative framework. METHODS: Six focus groups were conducted. A total of 34 participants were purposively recruited from three nursing homes in Spain, Italy and Portugal. Specific inclusion criteria were used to select participants. RESULTS: Five main categories were identified. Analysis revealed the importance of empathy and sensitivity in caring relationships, as well as the need for personalized and patient-centred care. The importance of effective communication and recognition of ageist behaviour by professionals was highlighted. In addition, independent of the pandemic, situational factors in the hospital environment were identified that influence the interpersonal care relationship. CONCLUSIONS: The study highlights the need to promote a person-centred model of care that takes into account the specific preferences and needs of older people. This is achieved by identifying elements of the interpersonal nurse-patient relationship. In addition to highlighting the disparity of opinion regarding an active or passive role in self-care and decision making, the importance of addressing ageism and improving communication is emphasized. WHAT PROBLEM DID THE STUDY ADDRESS?: The importance of the patient-nurse relationship in hospital care has been highlighted in previous studies. Critical elements of the patient care experience have been identified as empathy and effective communication. Ageism in healthcare has been recognized as a potential barrier to patient-centred care. WHAT WERE THE KEY FINDINGS?: The main findings highlight the importance of empathy and personalized care, emphasize the importance of effective communication and address ageist behaviours in the nurse-patient relationship. WHERE AND WHO WILL THE RESEARCH IMPACT?: By highlighting the need for person-centred care and improved communication strategies, particularly in the context of caring for older patients during and after the COVID-19 pandemic, this research will have an impact on healthcare professionals, policy makers and carers. REPORTING METHOD: The COREQ guideline was used. PATIENT OR PUBLIC CONTRIBUTION: This study adopted a collaborative approach to ensure that patient perspectives were integrated into the research process. We organized regular focus groups. Patients were actively involved in shaping the research questions, refining the study design and interpreting the emerging findings. Their valuable input helped us to understand the nuances of their experience and to prioritize the aspects that were critical to their well-being. In addition, their insights guided the development of practical recommendations aimed at improving the interpersonal care relationship between nurses and patients in hospital settings, ensuring that their voices were heard and reflected in the proposed interventions. This patient-centred approach fostered a sense of empowerment among the participants. It reinforced the notion that their experiences and opinions are integral to shaping healthcare practice.

El cuidado centrado en la persona con demencia en la prevención de la agitación y otros síntomas neuropsiquiátricos en ancianos institucionalizados / Person-centred dementia care for prevention of agitation and other neuropsychiatric symptoms in institutionalized elderly people

OBJETIVO: examinar si el cuidado centrado en la persona con demencia (CCPD) es más eficaz que la educación brindada por el equipo de Enfermería sobre la demencia en la reducción de la agitación y otros síntomas neuropsiquiátricos, así como en la mejora de la calidad de la vida de ancianos con demencia institucionalizados. MÉTODO: ensayo controlado aleatorizado realizado en seis residencias de cuatro ciudades españolas. Muestra: 150 personas en el grupo experimental (GE) y 150 en el grupo control (GC). Intervención en GE: CCPD con modelo de práctica VIPS. Variables de resultado: cambio en la escala de agitación de Cohen, en el cuestionario neuropsiquiátrico (NPI), en la escala de Cornell para la depresión en la demencia (CSDD) y en la escala de calidad de vida QUALID. Se realizaron modelos de regresión lineal múltiple de efectos mixtos. RESULTADOS: se realizó el seguimiento a 109 sujetos en el GE y 122en el GC. En lo que respecta a la diferencia de puntuaciones entre la situación basal y la final, en el GE se produjeron cambios estadísticamente significativos en el NPI agitación (-0,5; p= 0,05) y en la calidad de vida (1,6; p= 0,02). Relativo a los cambios entre la situación basal y final, ajustados por edad, sexo, estado de salud y grado de demencia, se produjo una reducción estadísticamente significativa (p< 0,05) en NPI (-2,4) y escala de depresión de Cornell (-2,6).CONCLUSIONES: la intervención CCPD ha mostrado eficacia en la reducción y prevención de la agitación y otros síntomas neuropsiquiátricos en los pacientes con demencia institucionalizados. Aún así, es preciso seguir investigando sobre el tema, especialmente en el impacto en la calidad de vida de los pacientes y en la depresión

OBJECTIVE: to examine if person-centred dementia care (PCDC) is more effective than the education on dementia provided by the Nursing team in terms of the reduction of agitation and other neuropsychiatric symptoms, as well as in the improvement of quality of life for institutionalized elderly people with dementia. METHOD: a randomized controlled clinical trial conducted in six retirement homes in four Spanish cities. Sample: 150 persons in the Experimental Group (EG), and 150 in the control group (CG).Intervention in the EG: PCDC with the VIPS practice model. Outcome variables: change in Cohen's agitation scale, in the neuropsychiatric questionnaire (NPI), in Cornell's scale for depression in dementia (CSDD) and in the QUALID quality of life scale. Multiple linear mixed effects regression models were conducted. RESULTS: follow-up was conducted on 109 subjects in the EG and122 in the CG. Regarding the difference in scores between basal and final situation, there were statistically significant changes in the agitation NPI (-0.5; p= 0.05) and in quality of life (1.6; p= 0.02).Regarding changes between basal and final situation, adjusted by age, gender, health condition and degree of dementia, there was a statistically significant reduction (p< 0.05) in NPI (-2.4) and Cornell's Depression Scale (-2.6).CONCLUSIONS: the PCDC intervention has shown efficacy in the reduction and prevention of agitation and other neuropsychiatric symptoms in institutionalized patients with dementia. Even so, it is necessary to conduct more research on this matter, particularly in terms of its impact on the quality of life of patients and on depression

Prevalencia de sarcopenia en mayores con demencia institucionalizados / Prevalence of sarcopenia in institutionalized elderly patients with dementia

OBJETIVO: estimar la prevalencia de sarcopenia aplicando los nuevos criterios diagnósticos, en mayores con demencia institucionalizados, analizando la asociación entre la sarcopenia, el grado de demencia y el estado nutricional. MÉTODO: estudio descriptivo trasversal multicéntrico con 189 sujetos diagnosticados de demencia en fase media, institucionalizados en siete centros residenciales de distintas ciudades españolas. Se valoraron los actuales criterios de sarcopenia a través de varias pruebas (bioimpedancia, dinamometría y pruebas de rendimiento físico). También se valoró el deterioro mediante la Global Deterioration Scale (GDS) y la Functional Assessment Staging (FAS) y estado nutricional a través del Mini Nutritional Assessment (MNA). Se realizaron pruebas paramétricas (t de Student y ANOVA). RESULTADOS: el 74% era mujer y la media de edad fue de 82,3 años. El 57,1% estaba en estadio 5 y el 42,9% en estadio 6, según la GDS/FAS. El MNA indicó que el 54,6% presentaba riesgo de malnutrición, el 36,2%, malnutrición y el 9,2% estaba en normalidad. Presentó sarcopenia el 68,8% de los sujetos. Hubo diferencias significativas para sarcopenia en función de la fase de demencia, y entre sarcopenia y estado de malnutrición. CONCLUSIÓN: existe un elevado porcentaje de sarcopenia entre mayores con demencia institucionalizados y esta a su vez se relaciona con el estado de demencia y los estados de malnutrición. El profesional de Enfermería es el responsable de la valoración general, nutricional y de la planificación de los cuidados, por lo que juega un papel esencial en la detección precoz de este problema de graves repercusiones en la población mayor

OBJECTIVE: to determine the prevalence of sarcopenia, by applying new diagnostic criteria, in institutionalized elderly patients with dementia, analyzing the association between sarcopenia, stage of dementia, and nutritional status. METHOD: multicenter transversal descriptive study, with 189 patients diagnosed with dementia in intermediate stage, institutionalized in seven residential centres in different Spanish cities. Current sarcopenia criteria were assessed through different tests (bioimpedance, dynamometry, and physical performance tests). Deterioration was also assessed, with the Global Deterioration Scale (GDS) and the Functional Assessment Staging (FAS), and nutritional status was assessed through the Mini Nutritional Assessment (MNA). Parametric tests were conducted (Student's t and ANOVA). RESULTS: 74% of patients were female, and their mean age was 82.3 years. 57.1% were in Stage 5 and 42.9% in Stage 6, according to the GDS/FAS. The MNA showed that 54.6% presented risk of malnutrition, 36.2% presented malnutrition, and 9.2% were normal. 68.8% of patients presented sarcopenia. There were significant differences for sarcopenia based on the stage of dementia, and between sarcopenia and malnutrition status. CONCLUSION: there is a high rate of sarcopenia in institutionalized elderly patients with dementia, and at the same time this is associated with the status of dementia and malnutrition. The Nursing Professional is responsible for the overall and nutritional assessment, and for planning of care, therefore they will play an essential role in the early detection of this problem that has severe consequences on the elderly population