[Psychological interventions for patients with type 2 diabetes mellitus. A systematic review and meta-analysis]. / ¿Son efectivas las intervenciones psicológicas para mejorar el control de la Diabetes Mellitus tipo 2 en adultos?: una revisión sistemática y metaanálisis.

Background Affordable interventions to improve metabolic control of Type 2-Diabetes Mellitus are increasingly necessary. Aim To review systematically the existing literature on the effects of psychological interventions on Type-2 Diabetes Mellitus compensation. Material and Methods We performed a systematic literature review and meta-analysis on the effectiveness of psychological interventions implemented for Type-2 Diabetes Mellitus patients. Research included the following electronic databases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Results Most studies showed a decrease in the level of glycated hemoglobin after interventions, which applied different initiatives complementary to standard medical treatment. Mainly, these interventions encompassed training for self-monitoring and control of diabetes based on cognitive behavioral psychology, counseling, self-assessment and physical-spiritual work based on transpersonal psychology. Conclusions Psychological tools could be an adjunct to the standard medical treatment for patients with Type-2 Diabetes Mellitus, reducing glycated hemoglobin levels and improving self-regulation, disease awareness and adherence from the self-efficacy perception perspective.

[Detection of the largest population susceptible to prescription of a program of exercises in Primary Care to prevent frailty]. / Detección de la población mayor susceptible de prescripción de un programa de ejercicios en Atención Primaria para prevenir la fragilidad.

AIM: Identify the population over 70 year's old treated in primary care who should participate in a physical exercise program to prevent frailty. Analyze the concordance among 2criteria to select the beneficiary population of the program. DESIGN: Population-based cross-sectional study. SETTINGS: Primary Care. PARTICIPANTS: Elderly over 70 years old, living in the Peñagrande neighborhood (Fuencarral district of Madrid) from the Peñagrande cohort, who accepted to participate in 2015 (n = 332). MAIN MEASUREMENTS: The main variable of the study is the need for exercise prescription in people over 70 years old at the Primary Care setting. It was identified through 2different definitions: Prefrail (1-2 of 5 Fried criteria) and Independent individuals with physical performance limited, defined by Consensus on frailty and falls prevention among the elderly (independent and with a total SPPB score <10). RESULTS: The 63,8% of participants (n = 196) need exercise prescription based on criteria defined by Fried and/or the consensus for prevention of frailty and falls in the elderly. In 82 cases the 2criteria were met, 80 were prefrail with normal physical performance and 34 were robust with a limited physical performance. The concordance among both criteria is weak (kappa index 0, 27). CONCLUSION: Almost 2thirds of the elderly have some kind of functional limitation. The criteria of the consensus document to prevent frailty detect half of the pre-frail individuals in the community.

Comprehensive geriatric assessment for identifying older people at risk of hip fracture: cross-sectional study with comparative group.

Background: Hip fracture (HF) is by far the most common serious fragility fracture. Its care is a major challenge to all healthcare systems. Aim: To determine whether there are characteristics of older people identified via comprehensive geriatric assessment (CGA) that help identify those with an increased risk of HF. Methods: The demographic, functional, cognitive and nutritional data of a cohort of patients admitted for acute HF were compared with those of a population cohort representing community-dwelling older people in the same urban district without HF. Bivariate analysis was performed on the variables in both the complete samples and in a subsample of age and sex paired subjects, followed by logistic regression analysis. Results: A total of 509 HF patients and 1315 community-dwelling older people were included. The HF patients were older and more frequently women and had more frequent disability and cognitive impairment, lower handgrip strength, lower body mass index (BMI) and a higher frequency of vitamin D deficiency compared with the community controls (P < 0.001). The variables most strongly associated with the presence of HF in the multivariate analysis, aside from age and female sex, were BMI<22 kg/m2 [odds ratio (OR) = 5.11], disability (OR = 4.32), muscle weakness (OR = 3.01), and vitamin D deficiency (OR = 2.13). Conclusions: There are easily obtained CGA determinants that are strongly associated with fragility HF. The detection of low weight, disability, malnutrition, muscle weakness, and vitamin D deficiency can help identify at-risk older people to implement prevention strategies.

[Quality of registration of dementia diagnosis in primary care: The situation in Spain in 2002-2011]. / Calidad del registro del diagnóstico de demencia en atención primaria. La situación en España en el periodo 2002-2011.

OBJECTIVE: To ascertain the diagnosis associated with specific treatment for dementia in the Primary Care Electronic Clinical Record (PC-ECR) and to analyse the factors associated with the quality of registration. METHODS: Descriptive study of patients taking cholinesterase inhibitors or memantine registered in Database for pharmacoepidemiological research in PC (BIFAP) 2011: 24,575 patients between 2002 and 2011. Diagnoses associated with first prescription of these drugs were grouped into 5 categories: "dementia", "memory impairment", "dementia-related diseases", "intercurrent processes" and "convenience codes". We calculated the prevalence of each category by age and sex for each study year (95%CI) and analysed the associations and trend for 2002-2011 using difference in proportions in independent samples and binary logistic regression. RESULTS: A code of "dementia" was associated with first prescription in 56.5% (95%CI: 55.8-57.1) of patients. It was higher in women [OR1.09 (95%CI: 1.03-1.15)] and with increasing follow-up time [OR1.07 (95%CI: 1.06-1.08) for each year of follow-up]. "Convenience codes" [16.3% (95%CI: 15.8-16.7)] were coded more frequently in women and in those ≥80 years; "Memory impairment" [12.4% (95%CI: 12.0-12.8)], "related diseases" [4.6% (95%CI: 4.4-4.8)] and "intercurrent processes" [10.3% (95%CI: 9.9-10.6)] were used more in men and in persons <80 years. Between 2002 and 2011 improved the use of "convenience codes". CONCLUSIONS: Almost half of the patients taking cholinesterase inhibitors or memantine do not have a diagnosis of dementia registered in their PC-ECR. Registration improves with increasing time of follow-up. Improvements are needed in the PC-ECR, adequate care coordination, and proactive approach to increase the quality of dementia registration.

Heart failure in primary care: co-morbidity and utilization of health care resources.

BACKGROUND: In order to ensure proper management of primary care (PC) services, the efficiency of the health professionals tasked with such services must be known. Patients with heart failure (HF) are characterized by advanced age, high co-morbidity and high resource utilization. OBJECTIVE: To ascertain PC resource utilization by HF patients and variability in the management of such patients by GPs. METHODS: Descriptive, cross-sectional study targeting a population attended by 129 GPs over the course of 1 year. All patients with diagnosis of HF in their clinical histories were included, classified using the Adjusted Clinical Group system and then grouped into six resource utilization bands (RUBs). Resource utilization and Efficiency Index were both calculated. RESULTS: One hundred per cent of patients with HF were ranked in RUBs 3, 4 and 5. The highest GP visit rate was 20 and the lowest in excess of 10 visits per year. Prescription drug costs for these patients ranged from €885 to €1422 per patient per year. Health professional efficiency varied notably, even after adjustment for co-morbidity (Efficiency Index Variation Ratio of 28.27 for visits and 404.29 for prescription drug cost). CONCLUSIONS: Patients with HF register a high utilization of resources, and there is great variability in the management of such patients by health professionals, which cannot be accounted for by the degree of case complexity.

[Spanish medical students and Family Medicine. Data from the two phases of a national questionnaire]. / Los estudiantes de medicina españoles y la medicina de familia. Datos de las 2 fases de una encuesta estatal.

OBJECTIVE: To examine the perceptions and expectations about Family Practice (FP) and Primary Care (PC) in 1st, 3rd and 5th year students in medical schools. DESIGN: An observational study in two cross sections with intervals of two years. LOCATION: Spanish Medical Schools. PARTICIPANTS: 1st, 3rd and 5th year students of 22 schools (1st phase) and 15 (second phase). PRIMARY MEASUREMENTS: Self-report questionnaires completed during the first quarter of the 2009-2010 and 2011-2012 academic years. It had 70 items in three blocks: perceptions of FP (19 items), training in FP (26 items), expectations and preferences (25 items), plus 13 specific items for 3rd and 5th year students. Most of the items were answered in a 6 point Likert scale. RESULTS: A total of 5299 responses in phase I, and 3869 in phase II were received. Students perceive FP and PC as essential areas of the health system and professional practice, but with little scientific and technical appeal. The large majortiy, 87%, consider training in FP necessary and compulsory, and it should start in third year. They prefer hospital medical specialities (88-89%), followed by surgical and paediatrics. FP is preferred by the 37-39%. Only between 24% and 28% of students have a clear preference for a specialty when they start medical studies. CONCLUSIONS: FP and PC are key areas and should be part of the curriculum, but are perceived to be of low scientific appeal.

[Reliability of a questionnaire used in the long-term follow up of the opinion and perceptions of family medicine by medical students of the University of Zaragoza (Spain)]. / Fiabilidad de un cuestionario empleado para la aplicación en el seguimiento longitudinal de la opinión y percepciones de la medicina de familia de los estudiantes de medicina de la Universidad de Zaragoza.

AIM: Family medicine deals with certain aspects and perspectives that are often left behind in the training of other levels of care, thus the need for medical students to make contact with Primary Care is of increasing importance. The aim of this study is to evaluate the reliability of the questionnaire of the UNIMEDIFAM group (FIS PI070975) for the long-term outcome of expectations and knowledge about family medicine. DESIGN: Reliability of a questionnaire. SETTING: University of Zaragoza. PARTICIPANTS: 371 students from the 1st, 3rd, 5th, and 6th years. METHOD: The internal consistency of the questionnaire was determined using Cronbach's alpha coefficient, and the stability using the test-retest. RESULTS: On scale A of the questionnaire we found that three of 19 items were unstable, in 8 of 26 on scale B, and 3 of 38 items on scale C. The Cronbach's alpha value of scale A was 0.722, 0.861 on scale B, and 0,663 on scale C. CONCLUSIONS: The 3 scales are within the appropriate values, except scale C, which is very close. The findings of this validation process can serve as a reference that may be extrapolated to the UNIMEDIFAM national questionnaire.

Improving hip fracture care in Spain: evolution of quality indicators in the Spanish National Hip Fracture Registry.

This study was carried out to analyze the evolution of the quality indicators in the Spanish National Hip Fracture Registry, after disseminating a series of recommendations based on available clinical practice guidelines to the participating hospitals. Six of the seven proposed quality indicators showed a significant improvement. PURPOSE: The Spanish National Hip Fracture Registry (RNFC) arises from the need to know the process and improve the quality of care. Our goal was to analyze the changes in the RNFC's quality indicators after an intervention based on disseminating specific recommendations among the participating hospitals, following available clinical practice guidelines. METHODS: Study comparing before and after performing an intervention in hospitals participating in the RNFC. Data from the hospitals that registered cases in 2017, and that kept registering cases in 2019. Seven quality indicators were chosen, and a standard to be achieved for each indicator was proposed. The intervention consisted in the dissemination of 25 recommendations with practical measures to improve each quality indicator, based on available clinical practice guidelines, by drafting and publishing a scientific paper and sending it via email and printed cards. Fulfilment of each quality indicator was measured after carrying out the intervention. RESULTS: Forty-three hospitals registered 2674 cases between January and May, 2017, and 8037 during 2019. The quality indicators chosen and the degree of compliance were (all with p<0.05): (1) surgery ≤48 h increased from 38.9 to 45.8%; (2) patients mobilised on the first postoperative day increased from 58.9 to 70.3%; (3) patients with anti-osteoporotic medication at discharge increased from 34.5 to 49.8%; (4) patients with calcium supplements at discharge increased from 48.7 to 62.8%; (5) patients with vitamin D supplements at discharge increased from 71.5 to 84.7%; (6) patients developing a grade >2 pressure ulcer during admission decreased from 6.5 to 5.0%; (7) patients able to move on their own at 1 month fell from 58.8 to 56.4%. More than 48% of hospitals improved the proposed indicators. CONCLUSION: Establishing quality indicators and standards and intervening through the dissemination of specific recommendations to improve these indicators achieved an improvement in hospital performance results on a national level.

[The Spanish National Hip Fractures Registry (RNFC) and the Minimum Basic Data Set (CMBD) are useful for research on hip fractures: comparison of two registries.] / El Registro Nacional de Fracturas de Cadera (RNFC) y el Conjunto Mínimo Básico de Datos son útiles para investigar sobre fracturas de cadera: comparación de ambos registros.

OBJECTIVE: National hip fracture registries have been established in several countries and recent publications show that the care process has been audited inspecting the representativeness according to quality standards. The aim of this study was to analyse if the Spanish National Hip Fracture Registry (RNFC) represents the Spanish population aged 75 and older admitted for hip fractures, and to compare its results regarding the care process with the national average, according to the National Inpatient register (Minimum Basic Dataset, CMBD). METHODS: The 2017-2018 National Minimum Basic Dataset (Conjunto Mínimo Básico de Datos, CMBD) was used as reference. For analysis, we included 83,110 cases from the CMBD and 21,130 from the RNFC. Eight common variables of both registries were selected for comparison. RESULTS: No significant differences were observed in the patient-related common variables (age, sex, type of fracture and fracture side), but statistically significant differences were found in the variables describing the care process (proportion of patients operated, deceased, surgical procedures and postoperative length of stay). CONCLUSIONS: The RNFC, designed as a convenience sample, is also representative of the population of patients aged 75 and older treated for hip fractures in Spain. However, there is a participation bias related to the professionals and the hospitals interested in voluntarily participating in a quality improvement program, which would explain the better results observed in the care process, compared to the national average as collected by the CMBD.

OBJETIVO: Los registros nacionales de fracturas de cadera se han establecido en varios países y publicaciones recientes muestran que el proceso de atención ha sido auditado para explorar su representatividad de acuerdo a estándares de calidad. El objetivo de este trabajo fue analizar si el Registro Nacional de Fracturas de Cadera (RNFC) es representativo de la población española de 75 o más años de edad ingresada por fractura de cadera, y comparar los resultados acerca del proceso asistencial con la media nacional según el Conjunto Mínimo Básico de Datos (CMBD). METODOS: Se empleó el CMBD de los años 2017-2018 como referencia. Para el análisis se incluyeron 83.110 casos del CMBD y 21.130 del RNFC. Se seleccionaron ocho variables comunes a ambos registros para ser comparadas. RESULTADOS: No se observaron diferencias significativas en las variables comunes paciente-dependientes (edad, sexo, tipo y lado de fractura), pero se hallaron diferencias significativas en las variables que describían el proceso asistencial (proporción de pacientes intervenidos, fallecidos, tipos de procedimiento quirúrgico y estancia postoperatoria). CONCLUSIONES: El RNFC, diseñado como muestra de conveniencia, es también representativa de la población de pacientes de 75 y más años, atendida por fractura de cadera en España. Sin embargo, existe un sesgo de participación relacionado con los profesionales y los hospitales interesados en participar voluntariamente en un programa voluntario de mejora de calidad que podría explicar los mejores resultados observados en el proceso asistencial, comparado con la media nacional según se recoge por el CMBD.

Handgrip strength predicts 1-year functional recovery and mortality in hip fracture patients.

OBJECTIVES: Muscle strength is a possible predictor of adverse events. It could have prognostic value in patients with hip fracture (HF). The aim of this study was to determine if handgrip strength is associated with functional impairment, readmissions, and mortality at one year in elderly patients with HF. DESIGN: A prospective observational study was carried out. It included a cohort of patients aged 65 years or older with a diagnosis of fragility HF, consecutively from January 2013 to February 2014 and seen in follow-up at one year. Statistical analysis was performed using SPSS v21 software. MAIN OUTCOME MEASURES: Five hundred and nine patients with a mean age of 85.4 ± 0.3 years were included, of whom 403 (79.2 %) were women. Clinical and functional outcomes, laboratory parameters and anthropometric measurements were collected. RESULTS: Of the total sample, 339 (66.6 %) had reduced handgrip strength, and these patients were older, more frequently institutionalized, had poorer functional and cognitive status, higher comorbidity, higher surgical risk, lower body mass index and a greater intra-hospital mortality (all p < 0.01). At one year, patients with lower handgrip strength had a major change in their ability to walk (32.7 % vs. 10.9 %, p < 0.001) and a higher mortality rate (30.4 % vs. 8.8 %, p < 0.001). However, in patients over 91 years of age, there was no association between lower handgrip strength and change in ability to walk. There were no differences in the number of readmissions. CONCLUSION: Low handgrip strength in elderly patients with HF predicts greater functional disability and higher long-term mortality.

Factors affecting exercise program adherence in patients with acute hip fracture and impact on one-year survival.

OBJECTIVE: To study the adherence of an Early Inpatient Exercise Program in patients with acute hip fracture, identify variables associated with its performance, and its association to one-year survival. METHODS: Observational longitudinal study of a cohort of 509 patients, admitted consecutively with a hip fracture in La Paz University Hospital (Madrid, Spain). Data included sociodemographic variables, pre-fracture physical functioning, cognitive impairment, comorbidities, measure of exercise adherence (pre-surgery exercise, post-surgery exercise, and rehabilitation sessions) and vital status at follow-up. One year after the fracture, either patients or relatives were contacted by telephone to ascertain their vital status. Data were analyzed using logistic regressions and multivariate Cox proportional hazards regression. RESULTS: Three quarters of patients (76.0%) were able to comply with the Early Inpatient Exercise Program. Factors associated with adherence were: living at home (Odds Ratio (OR)=3.39; 95% Confidence Interval (CI): 2.03, 5.64), absence of pre-fracture disability (OR=3.78; 95% CI: 2.21, 6.47), absence of pre-fracture cognitive impairment (OR=2.36; 95% CI: 1.36, 4.07) and comorbidities (OR=1.66; 95% CI: 1.03, 2.67). Early Inpatient Exercise Program adherence was associated with one-year survival (HR=1.62; 95% CI: 1.06, 2.49). CONCLUSIONS: The adherence with an Early Inpatient Exercise Program is high and is associated with 1-year survival. It is important to make a stronger effort to encourage participation in Early Inpatient Exercise Program in the 24% currently non-compliant, and in those with cognitive and physical impairments.

First proposal of quality indicators and standards and recommendations to improve the healthcare in the Spanish National Registry of Hip Fracture.

BACKGROUND: The Spanish National Hip Fracture Registry (or Registro Nacional de Fractura de Cadera, RNFC) is a database of hip fracture patients admitted to Spanish hospitals. Its goals include assessment and continuous improvement of the care process. OBJECTIVES: To (1) establish a series of indicators, (2) evaluate their initial fulfillment, (3) propose quality standards, (4) suggest recommendations to facilitate standards compliance, and (5) monitor the indicators. METHOD: The indicators fulfilled the criteria of (1) evaluating the process or outcome, (2) being clinically relevant for patients, (3) being modifiable through changes in healthcare practice, and (4) being considered important by the RNFC participants. The first quartile obtained by the group of hospitals in each of the respective variables was proposed as the standard. The Indicators Advisory Committee (IAC) elaborated a list of recommendations for each indicator, based on the available evidence. RESULTS: Seven indicators were chosen. These indicators (its baseline compliance vs. the standard to be reached, respectively) were: the proportion of patients receiving surgery within 48h (44% vs. 63%), mobilized the first postoperative day (56% vs. 86%), with antiosteoporotic medication at discharge (32% vs. 61%), with calcium supplements at discharge (46% vs. 77%), with vitamin D supplements at discharge (67% vs. 92%), who developed pressure ulcers during hospitalization (7.2% vs. 2.1%) and with independent mobility at 30 days (58% vs. 70%). The IAC has established 25 recommendations for improving care. CONCLUSION: The indicators and standards chosen are presented, as well as the list of recommendations. This process completes the first step to improve quality of care. The results will be evaluated 6 months after implementing the recommendations.

[Spanish National Hip Fracture Registry (RNFC): First-year results and comparison with other registries and prospective multi-centric studies from Spain]. / Registro Nacional de Fracturas de Cadera (RNFC): resultados del primer año y comparación con otros registros y estudios multicéntricos españoles.

OBJECTIVE: The Spanish National Hip Fracture Registry (Registro Nacional de Fracturas de Cadera or RNFC) is a Spanish, prospective, multi- centric registry, commenced in 2017. The goal of this paper is to present the data from the first annual report and to compare them with autonomic registries and recent prospective multi-centric studies performed in Spain. METHODS: We included persons 75 years or older treated for fragility hip fractures in any of the centers participating in the RNFC between January and October 2017. The descriptive statistics of each variable used the mean (and standard deviation) or the median (and interquartile ranges) for the ordinal variables and the percentage for the categoric variables. A descriptive analysis of the casemix was performed and compared with available data from the aforementioned studies. RESULTS: The RNFC included 7.208 patients from 54 hospitals, with a mean age of 86.7 (SD 5.6) years; 75.4% were women, and 36.4% showed cognitive decline. Mean surgical delay was 75.7 (SD 63.6) hours, and length of stay averaged 10.9 (SD 6.7) days. Of the patients who lived at home (75.4%), less than half (37.0%) returned home at discharge. One-month mortality was 7.1%. Comparison with other studies showed important differences, especially regarding patients newly sent to nursing homes (7.7-29.4%) and with antiosteoporotic treatment at discharge (14.5-36.7%). CONCLUSIONS: The RNFC is the largest prospective database to date that offers data regarding the characteristics of patients hospitalized for hip fractures in Spain. Comparison with recent studies showed some important differences.

OBJETIVO: El Registro Nacional de Fracturas de Cadera (RNFC) es un registro español multicéntrico, prospectivo y continuo, que comenzó en 2017. El objetivo de este artículo fue presentar los datos del primer informe anual y compararlos con los registros autonómicos y los estudios multicéntricos realizados recientemente en España. METODOS: Se incluyeron las personas de 75 años o más atendidas con el diagnóstico de fractura de cadera por fragilidad en alguno de los hospitales participantes en el RNFC, entre enero y octubre de 2017. En el análisis estadístico se utilizó la media y desviación estándar o mediana y rangos intercuartílicos para las variables numéricas y los porcentajes para las variables categóricas. Se realizó un análisis descriptivo global de la casuística y se comparó con los datos disponibles de los estudios previos mencionados. RESULTADOS: Se registraron 7.208 personas de 54 hospitales, con una edad media de 86,7 años (DE 5,6). El 75,4% fueron mujeres y el 36,4% presentaron deterioro cognitivo previo. La demora quirúrgica media fue de 75,7 horas (DE 63,6) y la estancia media fue de 10,9 días (DE 6,7). De las personas que vivían en un domicilio antes de la fractura (75,4%), menos de la mitad (37,0%) volvieron a él tras el alta hospitalaria. Al mes, había fallecido el 7,1%. La comparación con los otros estudios mostró algunas diferencias importantes, sobre todo en la ubicación previa, en el porcentaje de pacientes institucionalizados de novo (7,7-29,4%) y en el porcentaje con tratamiento antiosteoporótico al alta (14,5-36,7%). CONCLUSIONES: El RNFC es la mayor base de datos prospectiva que aporta datos sobre el perfil de los pacientes hospitalizados por fractura de cadera en España. La comparación con otros estudios recientes muestra algunas diferencias importantes.

Validación del test Nuevo Signo Vital para la medición de la alfabetización en salud

Background: Health literacy is a determinant, powerful predictor of health. The Newest Vital Sign test (NVS) evaluates health literacy assessing the capacity of participants to understand the nutrition information label of an ice cream. Aim: To validate The NVS test for its application in the sociocultural context on primary care patients in Chile. Material and Methods: In a descriptive cross-sectional study, 1,117 people aged 58 ± 14 years (70% women) registered in the Cardiovascular Health Program of different Family Health Centers, answered the NVS test. They also answered the Test of Functional Health Literacy for Adults (TOFHLA) and the Health Literacy Survey, European Union (HLS-EU-32). An exploratory analysis was carried out. In addition, the Kuder-Richarson-20 reliability coefficient and Item-Test Point Biserial Correlations were calculated. The construct validity of the NVS was obtained using the Item Response Theory. The sensitivity and specificity of NVS were estimated using receiver operating characteristic curves using the TOFHLA score as gold standard. To establish the cutoff points, the Stratum-Specific Likelihood Ratio analysis was used. Results: The reliability of the test was adequate (KR-20 = 0.7478) and the values of the two logistic parameters model confirmed that the NVS items account for the health literacy construct. Conclusions: The NVS test turned out to be a valid and reliable instrument, and its application is recommended to measure the level of health literacy.

Use of Primary Care Services, Care Specialized and Drug Use by Population 65 Years and More in the Community of Madrid, Spain. / Utilización de servicios de atención primaria, atención especializada y consumo de medicamentos por la población de 65 años y más en la Comunidad de Madrid.

BACKGROUND: Ageing of the Spanish population results in an increase in health services required. Therefore, determine the frequency of the health services utilization in this age group and analyze their determinants has a great interest.The aim was to analyze the utilization of health services among older people living in two urban neighborhoods of northern Madrid. METHODS: A cross-sectional population-based study. It is studied a cohort of 1327 individuals ≥ 65 years, stratified by age and sex. Nine utilization indicators were defined. For each indicator frequencies and the association of each with the other variables were calculated by multivariate analysis. RESULTS: The distribution of indicators expressed as a percentage of the user population is: GP appoiments/month 64.8% (95%CI 62.3 to 67.4); nursing appoiments/month 44.6% (95% CI 41.2 to 47.2); home medical visits/month 3.1% (95%CI 2.2 to 4.1); home nursing visits/month 3% (95%CI 2.1 to 3.9); hospitalization/year 16.4% (95%CI 14.4 to 18.4); appoiments rheumatologist/orthopedic/year 25.1% (95%CI 22.7 to 27.4); physiotherapist appoiments/year 12.9% (95% CI 11.1 to 14.7); podiatrist appoiments/year 30.6% (95%CI 28.1 to 33.1) and polypharmacy (≥5 drugs) 55.7% (95% CI 53 to 58.4). Comorbidity was the best predictor of health care utilization ranging from OR 4.10 (95%CI: 3.07-5,49) to OR 1.39 (95%CI: 0.97-1.99) in polymedicated and visit the physiotherapist respectively. Cardiovascular disease (OR 1.34; 95%CI 1.03-1,76) and diabetes (OR 1.46; 95%CI: 1.05 -2.02) were independently associated with increased use of family doctor. Dependence was the main determinant for home healthcare (OR 3.38; 95%CI: 1.38-8.28) and nurses (OR 9.71; 95%CI: 4.19-22.48) Mood disorders were associated to polypharmacy (OR 2.06; 95%CI: 1,48-2.86) and to visits to family doctor (OR 1.52; 95%CI: 1,13-2.04). CONCLUSIONS: The comorbidity is the strongest predictor of health services utilization. Cardiovascular diseases and diabetes are independently associated to greater use. Dependence is the main determinant of home care. Mood disorders associated with polypharmacy and increased attendances to the General Practitioner.

OBJETIVO: El envejecimiento de la población española se traduce en un aumento de las prestaciones sanitarias requeridas por la población mayor, por ello conocer la frecuencia de la utilización de los servicios sanitarios de este grupo de edad y analizar sus factores determinantes es de especial interés. El objetivo fue analizar la utilización de servicios sanitarios de la población mayor residente en dos barrios urbanos del norte de Madrid. METODOS: Estudio transversal de base poblacional. Se estudió una cohorte de 1.327 individuos igual o mayor a 65 años, estratificada por edad y sexo. Se definieron 9 indicadores de utilización durante el mes anterio o durante el último año. Para cada indicador se calcularon las frecuencias y la asociación con el resto de variables mediante análisis multivariante. RESULTADOS: la distribución de los indicadores expresada como proporción de la población usuaria fue: consultas médico/mes 64,8% (IC95%:62,3-67,4); consultas enfermería/mes 44,6% (IC95%:41,2-47,2); domicilios médico/mes 3,1% (IC95%:2,2-4,1); domicilios enfermería/mes 3%(IC95%:2,1-3,9); hospitalización/año 16,4% (IC95%:14,4-18,4); consultas reumatólogo/traumatólogo/año 25,1% (IC95%:22,7-27,4); consultas fisioterapeuta/año 12,9% (IC95%:11,1-14,7); consultas podólogo/año 30,6% (IC95%:28,1-33,1) y polimedicados (≥5 fármacos) 55,7% (IC95%: 53-58,4). La comorbilidad fue la variable que mejor predijo la utilización de servicios sanitarios oscilando entre OR 4.10 (IC95%:3.07-5,49) y OR 1,39 (IC95%: 0.97-1.99) para estar polimedicado y visitar al fisioterapeuta respectivamente. Enfermedades cardiovasculares (OR 1,34; IC95%:1.03-1,76) y diabetes (OR 1,46; IC95%:1,05-2,02) se asociaron de forma independiente a mayor utilización del médico de familia. La dependencia fue el principal determinante de atención domiciliaria para el médico (OR 3,38; IC95%: 1,38-8,28) y para enfermería (OR 9.71; IC 95%: 4.19-22.48). Trastornos del ánimo se asociaron a mayor polimedicación (OR 2.06; IC95%: 1,48-2.86) y visitas al médico de familia (OR 1,52; IC 95%:1,13-2.04). CONCLUSIONES: La comorbilidad fue la variable que mejor predijo la utilización de servicios sanitarios. Las enfermedades cardiovasculares y la diabetes se asocian de forma independiente a mayor utilización de servicios. Los trastornos del ánimo se asocian a mayor polimedicación y más visitas al médico de familia.

[Cognitive assessment in the elderly. Normative data of a Spanish population sample older than 70 years]. / Evaluación cognitiva del anciano. Datos normativos de una muestra poblacional española de más de 70 años.

BACKGROUND AND OBJECTIVE: To define the parameters of normal cognitive performance in an easy to administer neuropsychological battery of a Spanish population sample of elderly over 70 years. SUBJECTS AND METHOD: We examined 527 home dwelling elderly from the longitudinal study Envejecer en Leganés, 71 to 99 years old (mean age [SD] 79 [6.2] years, 51.8% women, 38.7% without formal education), with an extensive clinical survey, a neurological exam and the following neuropsychological battery: Short Portable Mental Status Questionnaire, Mini Mental State Examination, Benton Orientation Test, Bell Test, Verbal Fluency, Clock Drawing Test, Trail Making Test, Free and Cued Figures Recall, Logic Memory, Naming, incidental Recall, Delayed Recall, Similarities, IQCODE Questionnaire Of Jorm and Depression Questionnaire CES-D. 111 cases who rejected the assessment or had sensomotor limitations were excluded. 368 non demented subjects (according to DSM-IV criteria; 88.5% of the de 416 remaining cases) were selected to establish the normative data of every test. RESULTS: The analyzed subsample was representative of the total sample. The normative data for every neuropsychological test were obtained in the total group of non demented subjects and in the subgroups stratified by four age levels and two cultural levels. The mean values, standard deviations, range and percentiles for every test and subgroup are presented. CONCLUSIONS: The normative data obtained in this population sample for a neuropsychological battery easy to administer to poorly educated elderly can be useful to rigourously apply the criteria of dementia and mild cognitive impairment in future clinical and population studies.

Detección de la población mayor susceptible de prescripción de un programa de ejercicios en Atención Primaria para prevenir la fragilidad / Detection of the largest population susceptible to prescription of a program of exercises in Primary Care to prevent frailty

Objetivo: Identificar a la población mayor de 70 años atendida en Atención Primaria, susceptible de participar en un programa de ejercicio físico para prevenir fragilidad. Analizar la concordancia entre 2 criterios para seleccionar la población beneficiaria del programa. Diseño: Estudio transversal de base poblacional. Emplazamiento: Atención Primaria. Participantes: Mayores de 70 años no frágiles residentes del Barrio Peñagrande (distrito Fuencarral, Madrid) pertenecientes a la cohorte de Peñagrande localizables en 2015 y que aceptaron participar (n = 307). Mediciones principales: La variable principal del estudio es la necesidad de prescripción de ejercicio en Atención Primaria en personas mayores de 70 años; se identificó a través de 2 definiciones diferentes: personas prefrágiles (1 o 2 de los 5 criterios de Fried) y personas independientes con desempeño físico limitado, definida por los criterios del documento de consenso sobre prevención de fragilidad y caídas en la persona mayor (mayor de 70 años independiente y con puntuación total del SPPB < 10). Resultados: El 63,84% de los participantes (n = 196) necesitan prescripción del ejercicio por ser prefrágiles y/o por cumplir los criterios definidos en el documento de consenso. En 82 casos cumplían los 2criterios (prefragilidad y desempeño físico disminuido), 80 eran prefrágiles con desempeño físico normal y 34 eran robustos con desempeño físico limitado. La concordancia entre ambos criterios es débil (índice kappa 0,27). Conclusión: Casi 2 tercios de los mayores presentan algún tipo de limitación funcional. Los criterios del documento de consenso para prevenir la fragilidad detectan a la mitad de los individuos prefrágiles de la comunidad

Aim: Identify the population over 70 year's old treated in primary care who should participate in a physical exercise program to prevent frailty. Analyze the concordance among 2 criteria to select the beneficiary population of the program. Design: Population-based cross-sectional study. Settings: Primary Care. Participants: Elderly over 70 years old, living in the Peñagrande neighborhood (Fuencarral district of Madrid) from the Peñagrande cohort, who accepted to participate in 2015 (n = 332). Main measurements: The main variable of the study is the need for exercise prescription in people over 70 years old at the Primary Care setting. It was identified through 2 different definitions: Prefrail (1-2 of 5 Fried criteria) and Independent individuals with physical performance limited, defined by Consensus on frailty and falls prevention among the elderly (independent and with a total SPPB score <10). Results: The 63,8% of participants (n = 196) need exercise prescription based on criteria defined by Fried and/or the consensus for prevention of frailty and falls in the elderly. In 82 cases the 2 criteria were met, 80 were prefrail with normal physical performance and 34 were robust with a limited physical performance. The concordance among both criteria is weak (kappa index 0, 27). Conclusion: Almost 2 thirds of the elderly have some kind of functional limitation. The criteria of the consensus document to prevent frailty detect half of the pre-frail individuals in the community