Spanish translation, cultural adaptation and validation of the SarQoL®: a specific health-related quality of life questionnaire for sarcopenia.

BACKGROUND: In 2015, a specific health-related quality of life questionnaire for sarcopenia, SarQoL®, was developed and validated in French. Since then, SarQoL® has been adapted and validated in different languages. We prepared a translation, cultural adaptation and validation of the psychometric properties of the SarQoL® into Spanish. METHODS: A cross-sectional study with 86 participants. The translation and adaptation followed international guidelines with two direct translations, a synthesized version of the direct translations, two reverse translations, consensus by an expert committee of a pre-final version, pre-test by end users and final version. The discriminative power (logistic regression analyses), construct validity (Pearson and Spearman´s correlation), internal consistency (Cronbach´s alpha coefficient), test-retest reliability (intraclass correlation coefficient) and ceiling and floor effects were analyzed. RESULTS: The Spanish version showed good construct validity (high correlation with comparable domains of the SF-36), high internal consistency (Cronbach's alpha coefficient: 0.84) and excellent test-retest reliability (ICC: 0.967, 95%, CI 0.917 - 0.989). However, it had no discriminative power between sarcopenic and non-sarcopenic participants defined with the EWGSOP and FNIH diagnostic criteria of sarcopenia. It did show discriminative power between patients with decreased vs normal muscle strength (54.9 vs. 62.6, p 0.009) and low vs. normal physical performance (57.3 vs. 70.2; p 0.005). No ceiling or floor effect was found. CONCLUSIONS: The Spanish version of SarQoL® has similar psychometric properties to those of the original version of the instrument. It did not discriminate between sarcopenic and non-sarcopenic patients diagnosed according to the EWGSOP or FNIH criteria, but it did with those with low muscle strength and low physical performance.

Development and validation of a paternalism and autonomist care assessment.

AIM: There is a need for a validated instrument to measure the type of care (paternalism or person-centred) provided for older adults. Since paternalism and person-centred care are the most important caregiving styles in the field of care and as they are usually opposed, the study aims to develop and establish psychometrics data of an instrument to identify paternalistic and autonomist behaviours in older adults care contexts, which can help to enhance care practice. DESIGN: Instrument development. METHODS: After observing and standardizing behaviours in formal care contexts in 2016, an instrument was developed and proceeding to a first validation using standard validation techniques among caregivers in two care settings during 2016-2017: senior citizen centres and older adult day care centres. RESULTS: The Paternalist/Autonomist Care Assessment (PACA) is a 30-item, behaviour-based instrument which measures both the appraisal of caregivers on elements of care (Care Appraisal Scale- PACA-Appraisal) and the occurrence of behaviours (Occurrence of Care in Context- PACA-Occurrence). The Paternalist/Autonomist Care Assessment (PACA) was validated in 160 professional caregivers and was able to discriminate two factors: paternalistic or overprotective behaviours and autonomist behaviours. However, these factors were not fully dichotomous and were shown to coexist to some degree. CONCLUSION: The instrument displayed good psychometric properties to measure paternalism and autonomy in older adult care. Moreover, it showed that the two types of care are not antagonistic and can coexist, with overprotective behaviours being more frequent in contexts of care for more dependent persons. IMPACT: There are no validated instruments to measure paternalism and person-centred behaviour in care contexts. The two measures yielded by the PACA show good construct and concurrent empirical validity, internal consistency, and convergent and discriminant validity. Family caregiver, professional caregivers, nurses, older adults.

[ANTIAGING TREATMENTS: WHAT ARE WE TALKING ABOUT?]. / DE QUÉ HABLAMOS CUANDO HABLAMOS DE TERAPIAS ANTIENVEJECIMIENTO?

Antiaging medicine is nowadays an equivocal topic frequently used in geriatric medicine. It is, also, one of the most important sources of medical costs. With the words "antiaging medicine" we may express several different desires: a) to arrive at advanced age in the best possible physical and mental conditions, b) to act in order to slowing the aging process associated changes, c) to revert some of these negative changes. Prevention is the only positive successful way to achieve any of these possibilities. It means to emphasize any sort on interventions acting over health habits as physical activity, nutrition, to avoid toxic habits (tobacco) and to take primary and secondary diseases preventive measures. There is not medical evidence of effectiveness with any other measures, as hormonal therapies or reconstructive surgery.

[AGING, HEALTH AND SOCIETY: CHALLENGES FOR NEXT DECADE]. / ENVEJECIMIENTO, SALUD Y SOCIEDAD: RETOS PARA EL PRÓXIMO DECENIO.

Main challenges that may appear in our country along next decade related with the aging process are discussed. First of these challenges must take into account demography changes. Absolute number and. rates of elderly people increases permanently and it will be so in the next future. To assume the UN slogan "active aging" could be a positive attitude, and in this way both, each individual and social collectives, must be involved. In relation with health challenges, chronic disease and disability are the two most important problems. Prevention and permanent searching attitude of efficient political health answers are two essential pillars. Challenges on the social field must be focussed on ageism. The main objective must be to fight against any form of age discrimination (ageism). Beside that educational policies oriented over professionals and citizens. Last group of challenges concerns to managers and politicians and must be focussed on the look for resources and educational promotion.

[Vitamin D. A geriatric updated perspective]. / Vitamina D. Visión actual desde la geriatría.

The aim of this review is to offer an updated survey about the relationship between old age, vitamin D and different clinical conditions. Two third of people over 65 years has insufficient serum levels of vitamin D (<30 ng/ml). Almost half of them present deficiency (<20 ng/ml), severe in many cases (<15 ng/ml). This proportion increases when we analyze non-white populations, women, and people with obesity, diabetes mellitus or diets poor in Vitamin D. Low serum vitamin D concentration has been linked to mortality, osteoporosis, falls propensity, fractures, frailty, and cardiovascular diseases, including hypertension. Several epidemiological studies open the possibility to a relationship between low levels of the vitamin D and many other diseases. Among them with different cancer, diabetes, some types of dementia, Parkinson's disease, macular degeneration or periodontitis. Also with muscle strength, mobility and physical performance. Vitamin D supplementation has beneficial clinical effects, with a significant reduction of risks, specially in subjects living in nursing-homes and in those treated with corticoids or antireabsortive drugs. These effects are doses dependent. Risk of intoxication is minimal, even with high doses of vitamin.

Factors Associated with Non-Adherence to Drugs in Patients with Chronic Diseases Who Go to Pharmacies in Spain.

BACKGROUND: Pharmacological non-adherence in chronic diseases is 40-65%. No predictive profile of non-adherence exists in patients with multiple chronic diseases. Our study aimed to quantify the prevalence of non-adherence to pharmacological treatment and its associated factors in patients who visit pharmacies in Spain. METHODS: This observational cross-sectional study included patients with one or more chronic diseases. The variables analyzed were demographics, diseases involved, self-medication, information about disease, and lifestyle. The main variable was adherence using the Morisky-Green test. A total of 132 pharmacies collaborated, providing 6327 patients representing all Spain regions (April-December 2016). Bivariate and multivariate analyses were performed and the area under the receiver operating characteristic (ROC) curve was calculated. RESULTS: Non-adherence was 48.4% (95% confidence interval (CI): 47.2-49.7%). The variables that reached significance in the multivariate model were: difficulty in taking medication, self-medication, desire for more information, smoking, lower physical activity, younger age and number of chronic treatments. Discrimination was satisfactory (area under the ROC curve = 70%). Our study found that 50% patients was non-adherent and we obtained a profile of variables associated with therapeutic non-adherence. CONCLUSIONS: It is cause for concern that in patients with multiple diseases and taking multiple medications, there is an association between non-adherence, self-medication and worse lifestyle.

[Prognostic value of functional assessment at admission in an emergency short-stay unit]. / Valor pronóstico de la valoración funcional al ingreso en una unidad de corta estancia de Urgencias.

INTRODUCTION: To determine the prognostic value of functional impairment on the final destination of elders admitted for acute medical illness to an emergency short-stay unit (ESSU). MATERIAL AND METHODS: We performed a prospective analysis of patients aged more than 65 years old admitted to the ESSU of Hospital Clínico San Carlos in Madrid in April 2008. A protocol was designed that included epidemiologic variables (age and gender), clinical variables (reason for admission, comorbidity measured by the Charlson Index [CI]) and functional variables (previous, admission and functional decline [FD] measured with the Barthel [BI] and Lawton Indexes [LI]). The prognostic value of FD on the decision to admit patients was analyzed through ROC curves and the cut points that maximized sensitivity and specificity were determined. RESULTS: Sixty patients were included with a mean age of 80.7 (SD 8.2) years and 71.7% were women. The reasons for admission were acute infections in 31.7%, heart failure in 23.3%, syncope in 15.0%, intestinal obstruction in 11.7%, gastrointestinal bleeding in 10.0%, and arrhythmias in 8.3%. The mean CI was 2.27 (1.45). Functional assessment was as follows: mean previous BI score: 79.25 (SD 25) and at admission: 62.92 (SD 28.19). Mean previous LI score: 4.85 (SD 2.45) and at admission: 2.98 (SD 2.42).): BI-FD: 20% (1.25-38.23), LI-FD 37.5% (16.7-70.2%). FD was found in 100% of the patients. The mean length of stay was 1.70 (SD 0.62) days. Discharge destination was home discharge in 46.7% and hospitalization unit in 53.3%. Multivariate analysis according to discharge destination (home vs hospitalization) provided the following results : BI-FI > or = 16% (OR=7.99 [1.1-60.5], p=0.037), LI-FI > or =35% (OR=19.6 [0.04-0.52], p <0.0001). CONCLUSIONS: Patients with significant FD in the emergency room should not be admitted to an ESSU since significant FD is a prognostic factor for transfer to a conventional ward.

[Analysis of placement in public nursing homes after hospital admission in the fragile elderly]. / Análisis del índice de consecución de residencia pública asistida tras ingreso hospitalario en ancianos frágiles.

INTRODUCTION: To analyze placement in public nursing homes in elderly inpatients referred by the social work unit. MATERIAL AND METHODS: We performed a cohort study in an acute geriatric unit of a tertiary hospital. The sociodemographic, clinical, functional and socioeconomic data registered on admission (inclusion period: 4 years) were analyzed. The patients were followed-up for 6 months after discharge. The percentage gaining places in public nursing homes, the waiting time (monthly incidence rate) and the reasons for not gaining a place were evaluated. The variables associated with gaining a place were introduced into a multivariate logistic regression model. RESULTS: A total of 415 elders were referred to public nursing homes. The mean age was 85.1 years (SD=6.7), and 61.9% were women. During the follow-up period, 72 elders were granted a place (17.3%; monthly incidence rate 3.14%). In the multivariate analysis, the factors independently associated with gaining a place at a public nursing home were living alone (OR 2.788; p=0.005), having a lower income (OR 0.807; p=0.018), having a social work report from the hospital (OR 2.132; p=0.037), having previously requested a place at a public nursing home (OR 3.298; p=0.002) and discharge destination other than the home (OR 5.792; p<0.001). The main causes associated with not gaining a place were death while on the waiting list (41.4%) and not completing the paperwork (32.9%). CONCLUSIONS: Hospitalization in the frail elderly frequently leads to requests for public nursing home admission, although few places are granted in the short term to patients in the acute unit. Certain socioeconomic factors and referral by social workers were positively associated with gaining a place. However, the waiting time leads to a substantial proportion of deaths and incomplete paperwork, largely due to the complexity of the process.

[Ten recommendations to improve undergraduate training in Geriatric Medicine]. / Diez recomendaciones para mejorar la enseñanza de la Geriatría en el pregrado.

INTRODUCTION: Population ageing and scientific progress have made specific training in Geriatrics essential for any medical students. There are different international recommendations on the teaching of Geriatric Medicine at undergraduate level, but they are still far from being offered systematically. The aim of this work was to develop a National list of recommendations in order to improve training in Geriatric Medicine at the undergraduate level. MATERIAL AND METHODS: A list of 10 recommendations was produced by reflecting on the Geriatric training situation in Spain in 2016/2017 and international recommendations. Consensus was reached among the members of the Spanish Society of Geriatrics and Gerontology (SEGG) working group on «Geriatric training at undergraduate level¼ through 2meetings and online discussions. RESULTS: A list of 10 of recommendations on Geriatric training in Spanish Medical Schools is proposed, including areas such as, the status of the discipline in the curriculum, length, contents, practical training, lecturers, teaching methods, and innovation. CONCLUSIONS: These recommendations are intended to improve Geriatrics training. They can be used by different Medical Schools either to adapt their programs or to start training in Geriatric Medicine.

[Evaluation of postural control systems in elderly patients with repeated falls]. / Valoración de los sistemas de control postural en ancianos con caídas de repetición.

AIMS: a) to describe postural control disorders in elderly patients with recurrent falls; b) to analyze the influence of sensory deficits on centre of gravity control mechanisms; and c) to assess the functional consequences of balance disorders and falls in this group of patients. MATERIAL AND METHODS: patients aged more than 65 years old referred to a falls unit with two or more falls in the previous 6 months were included in this study. The protocol included posturographic studies with a Neurocom Balance Master. To evaluate motor control, Rhythmic Weight Shift (RWS test) was performed. To assess sensorial control, Modified Clinical Test of Sensory Interaction on Balance (MCT test) was used. Other tests performed were the Sit to Stand (SS test), Walk across (WA test) and Step up over (SO test). RESULTS: a total of 109 patients (85.3% women) were studied. Mean age was 78.01 years (SD: 5.38). Disorders in one or more afferent sensorial systems were found in 51.7% of the patients (27.5% visual deficiencies, 17.6% vestibular alterations, and 6.6% somatosensorial deficits). Two afferent systems were compromised in 25.3%, and all three were compromised in 11.1% of the patients. No significant differences were found in directional control (RWS) when compared with the number of altered systems. CONCLUSIONS: posturographic studies provide sensitive information on static and dynamic centre of gravity control systems, eventual sensory deficits, and patients' ability to carry out basic activities of daily living. In our sample, the most frequent deficit was visual impairment. This information is essential to establish a correct management programme.

Financial fraud and health: the case of Spain.

OBJECTIVE: To examine whether financial fraud is associated with poor health sleeping problems and poor quality of life. METHODS: Pilot study (n=188) conducted in 2015-2016 in Madrid and León (Spain) by recruiting subjects affected by two types of fraud (preferred shares and foreign currency mortgages) using venue-based sampling. Information on the monetary value of each case of fraud; the dates when subjects became aware of being swindled, lodged legal claim and received financial compensation were collected. Inter-group comparisons of the prevalence of poor physical and mental health, sleep and quality of life were carried according to type of fraud and the 2011-2012 National Health Survey. RESULTS: In this conventional sample, victims of financial fraud had poorer health, more mental health and sleeping problems, and poorer quality of life than comparable populations of a similar age. Those who had received financial compensation for preferred share losses had better health and quality of life than those who had not been compensated and those who had taken out foreign currency mortgages. CONCLUSION: The results suggest that financial fraud is detrimental to health. Further research should examine the mechanisms through which financial fraud impacts health. If our results are confirmed psychological and medical care should be provided, in addition to financial compensation.

[Intestinal microbiota and ageing: A new intervention route?]. / Microbiota intestinal y envejecimiento: ¿un nuevo camino de intervención?

Intestinal microbiota (IM) has continued to be the subject in all types of studies and publications. More is known on its different components and functions, as well as the changes that take place in IM through the life cycle, and the role of the factors involved in these changes. The aim of this review is to update the relationship between IM and aging. The presentation in 4 sections: (i)main factors of the human ageing process, underlining those related with gut changes; (ii)conceptual meaning of words like microbiota and other related terms; (iii)to comment on the most current findings as regards the changes in IM that occur in the ageing process, whether arising from the physiology or from disease situations, or other factors (environment, diet, drugs, etc.), and the health-consequences of these changes, and (iv)possibilities of different active positive interventions, with emphasis on diet measures.

[Age discrimination. Point of view of the professionals]. / ¿Se discrimina a los mayores en función de su edad? Visión del profesional.

INTRODUCTION: It is generally believed that legislation is an essential resource in the prevention of discriminatory behaviour against older people. This study first examines the Spanish legislation for potential age discrimination and then uses the C-EVE-D questionnaire to ask professionals in social work and health care settings the extent to what certain ageist behaviours described in the questionnaire are observed in practice. METHODS: The field study was carried out with professionals in geriatrics and gerontology, who are members of Spanish Society for Geriatrics and Gerontology (SEGG). The EVE discrimination questionnaire consists of 28 items which investigate the existence of age discrimination in medical and social care contexts. RESULTS: A total of 174 people (63% women; mean age: 45.6 years) took part in the study, with a mean professional experience of 17.2 years. Doctors made up 59% of the sample, psychologists 19%, with the rest coming from other professions. The first 20 discrimination items of the EVE-D questionnaire were significantly positively reported by more than 60% of the sample. CONCLUSIONS: Although Spanish legislation, from the constitution down to the rules that govern social and health care settings, clearly prohibits any kind of discrimination with regard to age, our results show that Spanish professionals most closely involved in the care of older people perceive both direct and indirect age discrimination. Furthermore, evidence was found of prejudice in the treatment of older people as a phenomenon in day-to-day health and social services care, both when analysing medical cases and, to a greater extent, cases of a more general nature and/or relating to co-existence.

[Length of stay in patients admitted for acute heart failure]. / Tiempo de estancia prolongado en los pacientes ingresados por insuficiencia cardiaca aguda.

OBJECTIVE: To identify the factors associated with prolonged length of hospital stay in patients admitted for acute heart failure. METHODS: Multipurpose observational cohort study including patients from the EAHFE registry admitted for acute heart failure in 25 Spanish hospitals. Data were collected on demographic and clinical variables and on the day and place of admission. The primary outcome was length of hospital stay longer than the median. RESULTS: We included 2,400 patients with a mean age of 79.5 (9.9) years; of these, 1,334 (55.6%) were women. Five hundred and ninety (24.6%) were admitted to the short stay unit (SSU), 606 (25.2%) to cardiology, and 1,204 (50.2%) to internal medicine or gerontology. The mean length of hospital stay was 7.0 (RIC 4-11) days. Fifty-eight (2.4%) patients died and 562 (23.9%) were readmitted within 30 days after discharge. The factors associated with prolonged length of hospital stay were chronic pulmonary disease; being a device carrier; having an unknown or uncommon triggering factor; the presence of renal insufficiency, hyponatremia and anaemia in the emergency department; not being admitted to an SSU or the lack of this facility in the hospital; and being admitted on Monday, Tuesday or Wednesday. The factors associated with length of hospital stay≤7days were hypertension, having a hypertensive episode, or a lack of treatment adherence. The area under the curve of the mixed model adjusted to the center was 0.78 (95% CI: 0.76-0.80; p<0.001). CONCLUSIONS: A series of factors is associated with prolonged length of hospital stay and should be taken into account in the management of acute heart failure.

[Dignity of the elderly]. / Dignidad de la persona mayor.

A discussion is presented on what is understood by «dignity¼ when applied to the elderly, highlighting it universal character and contrasting it with the greater risks of suffering «indignities¼ to which the elderly are exposed. The discussion is divided into 3 sections. In the first, the risk factors in this sense could lead to physiological losses and illnessess, which in in the physical, mental and social sense are associated with ageing. In the second, the question of discrimination of the elderly as a form of aggression due to age, and is so widespread and infrequently studied. Lastly, it is discussed how to interpret the advice of the United Nations on how to promote active ageing as a defence system against indignities. It concludes with the message that neither the limitations that accompany the ageing process, nor the different forms of aggression that the elderly may be subjected to, provide sufficient argument neither for a loss of individual nor collective dignity. This is something which we all must endeavour to achieve and which must be maintained and be respected by individuals and by society at all times.