Walking to Prevent Fear of Falling Among Community-Dwelling Older Adults: A Scoping Review.

The current review sought to identify and synthesize the evidence on available interventions that include walking and their impact on fear of falling (FOF) among community-dwelling older adults without cognitive impairment. A 10-year search was conducted (January 2012 to January 2022) in two peer-reviewed databases. A total of 116 articles were identified, and 22 articles were reviewed. Most studies included multicomponent walking interventions, such as walking and another type of intervention or exercise. Among the different questionnaires to assess FOF, the Falls Efficacy Scale-International was the most used in 77.3% (n = 17) of studies. In addition to walking, interventions to reduce FOF mainly included balance training, lower extremity strengthening, cardio or aerobic exercises, or a combination of these exercises. Further research is needed to evaluate the impact of unidimensional walking interventions, as well as those that incorporate psychological and technological elements targeted to FOF prevention and management. [Journal of Gerontological Nursing, 50(1), 15-21.].

Factors Related to the Need for Informal Care Among Community-Dwelling Older Adults in Chile.

PURPOSE: To identify factors contributing to the need for informal care among community-dwelling older adults with functional impairment in Chile. METHOD: A secondary data analysis was conducted using cross-sectional data from 540 Chilean older adults aged ≥60 years (mean age = 72.2 years, SD = 6.22 years). RESULTS: Informal care need was reported by 24.3% (n = 131) of participants. Among the variables that most influenced the need for informal care among older adults were hospitalization in the past 1 year, functionality, comorbidities, and multidimensional frailty (all p < 0.05). CONCLUSION: This study identified factors that clinicians and nurses should be aware of when caring for this population to prevent or manage the need for informal care. [Journal of Gerontological Nursing, 50(2), 43-52.].

Internet use by informal caregivers in Chile: An analysis including age and gender perspectives.

OBJECTIVES: This study explored the relationship between Internet use and informal caregivers' characteristics. METHODS: We used the Chilean Sociodemographic Characterization Survey. A total of 86,172 informal caregivers were identified. We conducted a weighted χ2 to test differences in 10 types of Internet use and weighted logistic regressions with caregivers' characteristics as predictors of Internet use. RESULTS: Younger caregivers engaged in more types of use than the older ones. Education level was positively associated with all types of use, such as searching for information (OR = 3.52, CI 95% [2.34, 5.29]). Age was negatively related to Internet use. Women used the Internet more to communicate via social networks. Being single reduced the likelihood of performing certain types of use, such as information seeking. The number of people living in households has increased entertainment. CONCLUSIONS: Older caregivers with lower education levels are at greater risk of digital exclusion. The same occurred in some types of use with single caregivers, where fewer people lived in the household. CLINICAL IMPLICATIONS: The Internet can be a tool for coping with caregiving tasks and their negative consequences. Interventions should consider these characteristics when promoting online tools and performing online interventions to reach the broadest possible audience.

Providing Care During the COVID-19 Pandemic: The Experience of Formal Caregivers in Long-Term Care Facilities in Chile.

The current study aimed to identify the main challenges to formal caregivers from different long-term care facilities (LTCFs) that care for older adults (aged ≥60 years) in Chile during the coronavirus disease 2019 pandemic. Chile's national LTCF governing body (SENAMA) sent a survey to 1,190 LTCFs, receiving 996 responses. LTCF characteristics were number of residents, certification with SENAMA, licensure, geographic zone, and poverty level. Four dimensions were assessed: (a) concerns, (b) challenges, (c) needs, and (d) opportunities for improvement. The majority of respondents replied negatively to these four dimensions. Among those who responded positively, the fear of infecting a loved one, staff shortages and overwork, the need for access to psychological support, and improving payments were among formal caregivers' primary concerns. Targeting supportive interventions for formal caregivers, clinically and psychologically, is essential to preserve caregivers' health. [Journal of Gerontological Nursing, 49(5), 39-44.].

[The significance of menopause for Chilean women attending primary health care centers]. / El significado de la menopausia para un grupo de mujeres chilenas atendidas en el sistema público de salud.

BACKGROUND: Menopause connects a biological event with social representations related to aging Aim: To assess the meaning of menopause in a group of Chilean women attending primary health care. MATERIAL AND METHODS: Secondary analysis of a descriptive qualitative study of in-depth interviews to explore the meaning of menopause in fifteen women aged 55 to 71 years who experienced menopause between 2 and 29 years before. Data were collected using the method proposed by the Grounded Theory. Guba's criteria of scientific rigor were used. RESULTS: Relational analysis shows that menopause divides the life cycle of women into two stages related with the possibility of having children, which is heavily influenced by the cultural significance of menopause. CONCLUSIONS: Women perceive that menopause is a natural stage and that it is the end of a period focused on tasks related to reproduction and motherhood. However, that "normality" includes a suffering process, loaded with negative cultural beliefs about menopause passed down for generations.

[Quality of life among frail older people]. / Fragilidad y su correlación con calidad de vida y utilización de los servicios de salud en personas mayores que viven en la comunidad.

BACKGROUND: Frailty has a great impact in the wellbeing of older people. AIM: To evaluate the quality of life of older people with and without frailty. MATERIAL AND METHODS: We assessed sociodemographic variables, health, integral geriatric assessment, quality of life using the WHOQoL-BREF questionnaire and the level of fragility using the Tilburg Frailty Indicator (TFI) in 538 participants. RESULTS: Three hundred and five participants aged 73 ± 7 years (229 women) were classified as fragile and 233 aged 72 ± 6 years (125 women) as not having frailty. Compared with their non-fragile counterparts, frail participants had a lower number of years attending school (5.9 and 7.4 respectively), a lower Barther index (93.6 and 98.3 respectively), a lower mini mental score (21.9 and 22.8 respectively) and a higher Yessavage depression score (2.0 and 0.8 respectively). Also, frail participants had a significantly lower total quality of life score and significantly lower scores in the physical and psychological domains. No differences were observed for the social and environmental domains. Older frail participants used health services more frequently than their non-fragile counterparts. CONCLUSIONS: In this sample, frailty was associated with a lower quality of life and worse scores in several geriatric assessment tools.

[Changes in social psychological and functional variables among older people attending a day care center]. / Evaluación de la funcionalidad y fragilidad de las personas mayores asistentes a centros de día.

BACKGROUND: Older people attending day care centers improve their social activities, perception of quality of life and reduce their institutionalization rate and risk of mortality in the medium term. AIM: To evaluate the changes in the integral geriatric assessment and frailty of a group of older people attending a day care center in Santiago. MATERIAL AND METHODS: Health self-perception, integral geriatric assessment, Barthel scale, frailty indicators, mini-mental state scale, Yesavage depression score and a scale about solitude perception were evaluated in 35 participants aged 73 ± 6 years on admission and at discharge from a day care center for older people. RESULTS: At discharge, significant improvements were observed for depression, perception of social support and physical frailty. However, no changes in functional status, cognitive function and perception of solitude were observed. CONCLUSIONS: Older people attending improve their perception of social support and decrease their frailty and depression scores.

[Frailty criteria among older people living in the community: An update]. / Criterios de fragilidad en personas mayores que viven en la comunidad: una actualización de la literatura.

Frailty is an important concept in aging research and care. Awareness of frailty signs allows healthcare workers to identify older adults at risk and design interventions to prevent their functional decline, therefore preventing adverse health outcomes. This literature review allows to identify predictors of frailty considering its physical, psychological and social domains. From the evidence found, it is possible to formulate a profile of fragile older people. Finally, future research should focus on the description of psychological and social fragility profiles, on the detection of persons likely to be fragile and finally to define precise instruments to detect fragile people, which should become the gold standards in future research.

Validation of the Spanish-language version of the Prolapse Quality of Life questionnaire in Chilean women.

INTRODUCTION AND HYPOTHESIS: The Prolapse Quality of Life (P-QOL) questionnaire is a specific health-related quality of life (HRQL) instrument to assess the impact of POP on women. It has been validated in English-speaking women and to date has been translated into several other languages. However, currently there is no Spanish translation of the P-QOL questionnaire. The aim of this study was to translate the P-QOL questionnaire into Spanish and to assess its feasibility, validity, and reliability. METHODS: Following a forward- and back-translation of the original English P-QOL questionnaire into Spanish language, the translated questionnaire was reviewed by a group of patients as well as an expert panel to assess its comprehensibility. In this cross-sectional study women with POP symptoms were recruited from a tertiary referral teaching hospital. Women were defined as symptomatic if they report feeling a lump/bulge/pressure in the vagina. The Spanish translated P-QOL questionnaire was self-administered to all women. Reliability, content, and construct validity were evaluated using the Cronbach's alpha coefficient, ANOVA, and Spearman's correlation tests. RESULTS: One hundred and twenty-eight women were studied. There were no missing items. The Cronbach's alpha ranged from 0.626 to 0.866 across domains, demonstrating the good reliability of the Spanish P-QOL. The severity of symptoms was related to the worst quality of life, but the severity of POP was not related to poorer QoL. CONCLUSIONS: The Spanish translated version of the P-QOL is a reliable, consistent and valid instrument to assess symptom severity and QoL impact in Chilean women with POP.

[Recommendations of health care users and professionals to achieve a timely access to HIV diagnosis]. / Optimizando el acceso oportuno al test de ELISA para el diagnóstico del VIH: Recomendaciones desde los usuarios y profesionales de la Atención Primaria de Salud.

BACKGROUND: Early HIV (human immunodeficiency virus) diagnosis optimizes therapies aimed at reducing viral load, increasing survival, lowering health costs and reducing the number of people infected with the virus. In Chile, despite widespread and readily available HIV testing, infected people continue to get tested in a late fashion and are usually diagnosed in advanced stages of the disease. AIM: To determine the elements that facilitate or impede a timely HIV testing and to evaluate how to improve the access to HIV testing. MATERIAL AND METHODS: Descriptive, in-depth interviews to 30 participants with unknown serology, 15 participants diagnosed at AIDS stage and 15 health care professionals working at a primary healthcare settings. RESULTS: Users and professionals formulated three suggestions to improve timely access to ELISA test for HIV diagnosis. Namely, to inform users and professionals about the characteristics of the disease and diagnostic test, to offer fast and easy access to HIV testing, and to train the whole healthcare team about obtaining informed consent for testing. CONCLUSIONS: These recommendations should be implemented at healthcare centers to attain a timely HIV diagnosis.

Predictive ability of both the healthy aging index and the frailty index for all-cause mortality.

AIM: We aimed to develop and assess a modified healthy aging index (HAI) among Chileans aged 60 years and older and compare its predictive ability for all-cause mortality risk with the frailty index (FI). METHODS: This prospective study analyzed data from the Chilean National Health Survey (CNHS) conducted in 2009-2010. We included 847 adults with complete data to construct the HAI and FI. The HAI comprised five indicators (lung function, systolic blood pressure, fasting glucose, cognitive status, and glomerular filtration rate), while the FI assessed frailty using a 36-item scale. HAI scores were calculated by summing the indicator scores, ranging from 0 to 10, with higher scores indicating poorer health. Receiver operating curves (ROC) and area under the curve (AUC) were used to assess predictive validity. Associations with all-cause mortality were assessed using Cox proportional hazard models adjusted by confounders. RESULTS: The mean HAI score was 4.06, while the FI score was 0.24. The AUC for mortality was higher for the HAI than the FI (0.640, 95% confidence interval (CI) 0.601 to 0.679 vs. 0.586, 95% CI 0.545 to 0.627). After adjusting for confounders, the FI showed a higher mortality risk compared to the HAI (2.63, 95% CI 1.76 to 3.51 vs. 1.16, 95% CI 1.08 to 1.26). CONCLUSION: The FI and HAI were valid predictors for all-cause mortality in the Chilean population. Integrating these indices into research and clinical practice can significantly enhance our capacity to identify at-risk individuals.

Multidimensional Frailty, Quality of Life and Self-Management in Aging Hispanics Living With HIV.

An observational cross-sectional study was conducted to examine multidimensional frailty and its potential impact on quality of life (QOL) in aging Hispanic people living with HIV (PLWH) and assess the extent to which HIV self-management moderates this association. The sample included 120 Hispanic PLWH aged 50 years and older (M = 59.11; SD = 7.04). The structural equation modeling analyses demonstrated that multidimensional frailty was significantly related to QOL in its two dimensions, physical and mental (p < .001). The relationship between multidimensional frailty and mental and physical QOL remained significant even after controlling for confounders (age and gender). The moderator analyses indicated no statistically significant moderator effect of HIV self-management on multidimensional frailty and mental or physical QOL. These study results have practical implications that highlight the need for early screening for frailty with a multidimensional focus. Age-appropriate and culturally tailored interventions to prevent or mitigate multidimensional frailty may improve QOL.

[Facilitators and barriers to HIV testing: a literature review]. / Facilitadores y barreras que enfrentan las personas al tomarse el test de ELISA para el diagnóstico del VIH: revisión de la literatura.

BACKGROUND: Late diagnosis of HIV is a problem of international and national relevance. Despite the availability of HIV testing in primary health care, it is often performed too late. AIM: To identify facilitators and barriers to early HIV testing in primary health care. METHODS: Four databases of nursing, psychological, biomedical, and health related professions areas were examined with a review protocol. Results were grouped into two main subjects: facilitators and barriers occurring among the population, among health care workers, and within primary health care centers. RESULTS: Perception of risk behaviors, self-care, social support, trust, confidentiality of the examination, the offer of the examination, and the knowledge of early treatment have been recognized as facilitators for taking the exam. The lack of information about the test and the disease are recognized as the main barrier to access the test. This information is a cornerstone to design and implement strategies to increase the number of people taking voluntarily HIV testing.

Acceptability of HPV Vaccines: A Qualitative Systematic Review and Meta-Summary.

In 2006, the human papillomavirus (HPV) vaccine was approved for use as an effective intervention for reducing the risk of developing cervical cancer; however, its successful implementation is dependent on acceptability. This study aims to provide a comprehensive understanding of the reasons that favor or do not favor the acceptability of HPV vaccines. METHODS: We conducted a systematic review and meta-summary of qualitative research on 16 databases. A total of 32 articles that considered the perspectives of vaccine users, their parents, and the professionals who care for them were reviewed. Synthesis was conducted as described by Sandelowski and Barroso. RESULTS: We used inductive and deductive methods to obtain a total of 22 dimensions, out of which three issues stood out that should be considered to improve acceptability and are formed by three groups of study, namely, information about the vaccine, fears and side effects, and sexuality associated with the vaccine. CONCLUSIONS: Acceptability, as well as adherence to HPV vaccination, is a complex concept. This review highlights the perspectives of the three sets of actors involved in the process (i.e., users, parents, and professionals) and views these factors in relation to acceptability as a guide for new interventions.

Factors Related to Multidimensional Frailty Among Hispanic People Living With HIV Aged 50 Years and Above: A Cross-sectional Study.

ABSTRACT: Among Hispanics, frailty has been extensively studied as a physical syndrome associated with an increased risk for adverse outcomes. Because of additional barriers to accessing care, the impact of frailty may be even more significant for people living with HIV (PLWH). Multidimensional frailty among Hispanic PLWH has not been studied. This study aimed to examine the factors related to multidimensional frailty among Hispanic PLWH aged 50 years and above. A cross-sectional design with 120 participants was used. Hypothesized factors related to multidimensional frailty were sociodemographic and psychosocial variables. Multidimensional frailty was measured with the Tilburg Frailty Indicator. We found that 45.83% of the participants were frail ( n = 55), and multidimensional frailty was significantly associated with higher depressive symptoms ( b = .26, p < .001) and a higher number of comorbidities ( b = .71, p < .001). This study identified factors that clinicians should be aware of when caring for Hispanic PLWH to prevent or manage frailty-related complications.

[Effectiveness of an educational program about the Chilean AIDS law in primary care health workers]. / Eficacia de una intervención educativa sobre conocimientos de ley chilena de SIDA en trabajadores de salud primaria.

BACKGROUND: In Chile, members of the civil society and government achieved the passing of the HIV/AIDS Law (19.779). The level of knowledge of the law held by healthcare workers in Chile is not well known. AIM: To analyze the effect of an intervention on knowledge of the existence of the law and its application in clinical practice among primary healthcare workers in southeastern Santiago. MATERIAL AND METHODS: Healthcare workers of primary care centers were invited to participate in the study. One group received an educational intervention lasting a total of 16 hours, about AIDS physiopathology, sexually transmitted diseases, communication with patients and current legislation. A control group did not receive the educational intervention. Both groups answered a self-administered questionnaire about the HIV/AIDS law at baseline and three months after the intervention. RESULTS: The intervention was carried out in 262 workers and 293 participated as controls. The initial evaluation revealed that only 16.3% (n = 89) had heard of the law, without any significant difference between intervention and control groups. The knowledge about the law improved by 65% in the intervention group and did not change in controls. At the end of the education period, the intervention and control groups improved their global knowledge by 29 and 3%, respectively (p < 0.05). CONCLUSIONS: The educational intervention was effective in improving knowledge of the HIV/AIDS Law among Chilean healthcare workers.

Fear of Falling among Community-dwelling Sedentary and Active Older People.

OBJECTIVES: The study sought to compare community-dwelling older people with respect to their level of physical activity and to the fear of falls between a group of sedentary elderly and a group of active elderly. METHODS: Cross-sectional descriptive study carried out with 113 community-dwelling older people (45 sedentary and 48 active), users of an outpatient care center of the private health system with a geriatric program in Santiago, Chile. The study measured socio-demographic variables, state of health, comprehensive geriatric assessment, exercise, depression with the Yesavage scale, and fear of falling with the Short Falls Efficacy Scale - International (Short FES-I). RESULTS: Sedentary older people have significantly higher scores in the Yesavage depression scale compared with active older people (4.2 versus 0.8). No statistically significant differences were found when comparing both groups of sedentary and active participants in terms of socio-demographic variables along with health, and functional and cognitive capacity. Regarding the fear of falling, the sedentary had a slightly higher score than the active (12 versus 11), although not significant. CONCLUSIONS: This study showed that fear of falling was equal in sedentary and active older people who live in the community, although it was found that sedentary individuals had a higher risk of having a positive screening for geriatric depression in those participants who do not perform physical activity.

[Educational needs of parents of hemophiliac children: An approach to comprehensive care]. / Necesidades educativas de padres de niños hemofílicos: Una aproximación hacia el cuidado integral.

INTRODUCTION: In Chile, hemophilia was incorporated into the System of Explicit Health Guarantees (GES), which ensures access to treatment and financial protection for these patients. To support patients and their families, educational programs have been proposed that focus on managing possible complications of the pathology, first aid, and prophylaxis, however, there are no educational instances focused on the needs of the patients. OBJECTIVE: To know the educational needs of parents with hemophilic chil dren and adolescents regarding contents, people, place, methodology, and stage of the illness. Sub jects and Method: Descriptive qualitative study of 15 parents with hemophilic children in outpatient care. For the data collection, we used a semi-structured interview with five open questions, aimed at the search for educational needs such as what (contents), how (methodology), when (moment), who (person), and where (place) is education needed. For data analysis, were used the Berelson's content analysis technique. To guarantee the scientific validity of the qualitative results, the methodological rigor criteria of Guba and Lincoln were used. RESULTS: The most frequent educational needs reported by parents include content such as venipuncture training, injury prevention, pathophysiological as pects of the disease, among others; with methodology developed in group workshops and guided by a peer; in a comfortable and familiar place; in three stages of the disease's development (diagnosis, blee ding events, and development of autonomous activities), and provided by professionals and peers. CONCLUSION: Knowledge of educational needs is the basis for the creation of an educational program that guides the comprehensive care of hemophilic children and their parents.

Use of Botulinum Toxin in Orofacial Clinical Practice.

INTRODUCTION: Botulinum neurotoxin (BoNT) is a potent biological toxin and powerful therapeutic tool for a growing number of clinical orofacial applications. BoNT relaxes striated muscle by inhibiting acetylcholine's release from presynaptic nerve terminals, blocking the neuromuscular junction. It also has an antinociceptive effect on sensory nerve endings, where BoNT and acetylcholine are transported axonally to the central nervous system. In dentistry, controlled clinical trials have demonstrated BoNT's efficiency in pathologies such as bruxism, facial paralysis, temporomandibular joint (TMJ) disorders, neuropathic pain, sialorrhea, dystonia and more. AIM: This study's aim was to conduct a systematic literature review to assess the most recent high-level clinical evidence for BoNT's efficacy and for various protocols (the toxin used, dilution, dosage and infiltration sites) used in several orofacial pathologies. MATERIALS AND METHODS: We systematically searched the MedLine database for research papers published from 2014 to 2019 with randomly allocated studies on humans. The search included the following pathologies: bruxism, dislocation of the TMJ, orofacial dystonia, myofascial pain, salivary gland disease, orofacial spasm, facial paralysis, sialorrhea, Frey syndrome and trigeminal neuralgia. RESULTS: We found 228 articles, of which only 20 met the inclusion criteria: bruxism (four articles), orofacial dystonia (two articles), myofascial pain (one article), salivary gland disease (one article), orofacial spasm (two articles), facial paralysis (three articles), sialorrhea (four articles) or trigeminal neuralgia (three articles). DISCUSSION: The clinical trials assessed showed variations in the dosage, application sites and musculature treated. Thus, applying BoNT can reduce symptoms related to motor muscular activity in the studied pathologies efficiently enough to satisfy patients. We did not identify the onset of any important side effects in the literature reviewed. We conclude that treatment with BoNT seems a safe and effective treatment for the reviewed pathologies.

Observed use of standard precautions in Chilean community clinics.

OBJECTIVES: In Chile, little information about the use of standard precautions (SP) among health care workers (HCWs) exists. As part of a larger study to tailor and test an HIV prevention intervention for community HCWs, this study describes the observed frequency with which appropriate SP were used by HCWs in low-income community clinics of Santiago. Also, the availability of supplies is described. SAMPLE: A total of 52 structured observations with potential contamination with body fluids were done. RESULTS: HCWs used SP inconsistently, especially neglecting hand washing, surface cleaning, and cleaning of shared materials. Lack of materials contributed in some instances of failure to use SPs, especially wiping surfaces and safe disposal of sharp instruments, as shown by a positive correlation between use of SP and availability of materials. Essential materials were usually available. Although more education should relate to a better understanding of the importance of SP, no difference was found between professionals and paraprofessionals in the use of SP. CONCLUSIONS: It is clear that the initial training, continuing education, and ongoing support for practicing SP are not adequate. Training should be offered to HCWs involved in caring for clients at community clinics to stop the spread of HIV or other infectious diseases in health care settings.