Prevalence of urinary incontinence and associated factors in nursing homes: a multicentre cross-sectional study.

BACKGROUND: Urinary incontinence (UI) is a common geriatric syndrome with high health and socio-economic impacts in nursing home (NH) residents. OBJECTIVES: To estimate the prevalence and types of UI and its associated factors in older people living in NHs in Central Catalonia (Spain). We also determined the proportion of residents who were receiving behavioural strategies to prevent/manage UI. DESIGN AND SETTING: Cross-sectional study in 5 NHs conducted from January to March 2020. METHODS: We included consenting residents aged 65 + permanently living in the NHs. Residents who were hospitalized, in a coma or palliative care were excluded. UI was assessed using Section H of the Minimum Data Set. Sociodemographic and health-related variables were examined. Descriptive, bivariate, and multivariate (logistic regression) analyses were performed. RESULTS: We included 132 subjects (82.6% women), mean age of 85.2 (SD = 7.4) years. The prevalence of UI was 76.5% (95% CI: 68.60-82.93). The most common type was functional UI (45.5%), followed by urgency UI (11.4%). Only 46.2% of residents received at least one behavioural strategy to manage UI. Most sedentary behaviour (SB) variables presented a p-value lower than 0.001 in the bivariate analyses, but none remained in the final model. Moderate-severe cognitive impairment (OR = 4.44, p =.003), anticholinergic activity (OR = 3.50, p =.004) and risk of sarcopenia using SARC-F (OR = 2.75, p =.041) were associated with UI. CONCLUSIONS: The prevalence of UI was high in this sample of NH residents compared to the literature, yet less than half received prompted voiding as a strategy to prevent/reduce UI.UI was associated with cognitive impairment, anticholinergic activity, and risk of sarcopenia.

Risk factors for developing symptomatic COVID-19 in older residents of nursing homes: A hypothesis-generating observational study.

Objectives: To identify which risk factors were associated with developing Coronavirus Disease-19 (COVID-19) infection, with symptoms, in institutionalized older people. Methods: A 1-year longitudinal multi-center study was conducted in 5 nursing homes (NHs) over the period December 2019 to March 2021. Inclusion criteria included being a permanent resident in the NH, aged 65 years or older, and a positive diagnosis of COVID-19 objectively confirmed by a diagnostic test. A descriptive and bivariate analysis was performed, calculating relative risk (RR) with 95% confidence intervals and statistical significance at p<0.05. Results: Of the total sample of 78 individuals who tested positive for COVID-19, the mean age was 84.6 years (SD=±7.8), 62 (79.5%) were female; 40 (51.3%) participants presented with COVID-19 symptoms. Living in a private NH (RR=3.6, 95% CI [1.2-11.0], p=0.023) and having suffered a stroke (RR=4.1, 95% CI [1.1-14.7], p=0.033) were positively associated with developing COVID-19 infection with symptoms. Conclusions: Having suffered a stroke and living permanently in a private NH were positively associated with symptomatic COVID-19 in this sample of institutionalized older people.Clinical Trials ID: NCT04297904.

Efecto del confinamiento por COVID-19 sobre la incidencia y gravedad de las caídas en personas mayores institucionalizadas: estudio longitudinal / Effect of COVID-19 lockdown on the incidence and severity of falls in institutionalized older people: A longitudinal study

Antecedentes: En la pandemia de COVID-19 se declararon medidas en residencias geriátricas, como el confinamiento estricto. Objetivo: Evaluar el impacto del confinamiento sobre la incidencia de caídas y sus factores asociados en personas mayores institucionalizadas durante el primer año de pandemia en comparación con el año previo. Métodos: Se realizó un estudio multicéntrico, comparativo entre el año prepandemia (marzo 2019- febrero 2020) y el primer año (marzo 2020- febrero 2021) en cinco residencias de Cataluña, España. Se registró el número de caídas, fecha, lugar y consecuencias, así como información sociodemográfica y de salud. Se realizó un análisis descriptivo, bivariante y multivariado, calculando Odds Ratio (OR) con intervalos de confianza del 95% y significación estadística de p < 0,05. Resultados: La muestra fue de 80 individuos, con una edad media de 84,4 años, siendo 83,7% mujeres. El primer año de pandemia, aumentaron las caídas por persona 0,21% (en habitaciones 32,0%). En el análisis multivariado del periodo prepandemia, el riesgo de sarcopenia (OR = 4,02; IC 95% [1,09-14,82] p = 0,036) resultó un factor de riesgo de caídas independientemente de la edad y la hipertensión. En el primer año de pandemia no se encontraron factores asociados estadísticamente significativos. Conclusiones: En el primer año de pandemia por COVID-19, aumentaron 15,6% las caídas y 8,7% las personas que cayeron en comparación con el año anterior. Cambió el lugar de las zonas comunes a las habitaciones y la severidad, aumentando 10,1% las fracturas. La edad avanzada, el riesgo de sarcopenia y la hipertensión arterial se asociaron a las caídas en el periodo prepandemia. (AU)

Background: During the COVID-19 pandemic, virus contention measures such as strict confinement were declared in nursing homes. Objective: To assess the impact of confinement on the incidence of falls and their associated factors in institutionalized older persons during the first year of the pandemic compared to the previous year. Methods: A multicenter, comparative study was conducted between the pre-pandemic year (March 2019 to February 2020) and the first year (March 2020 to February 2021) in five nursing homes in Catalonia (Spain). The number of falls, date, placement and consequences were recorded, as well as sociodemographic and health information. A descriptive, bivariate and multivariate analysis was performed, calculating odds ratio (OR) with 95% confidence intervals and statistical significance of p<0.05. Results: The sample consisted of 80 individuals, with a mean age of 84.4 years, 83.7% being women. In the first year of the pandemic, the number of falls per person increased by 0.21% (32.0% in rooms). In multivariate analysis of the pre-pandemic period, the risk of sarcopenia (OR = 4.02; 95% CI [1.09–14.82], p = 0.036) was a risk factor for falls independently of age and hypertension. In the first year of pandemic no statistically significant associated factors were found. Conclusions: In the first year of the COVID-19 pandemic, there was a 15.6% increase in falls and an 8.7% increase in the number of people who fell compared to the previous year. The falls’ location changed from common areas to bedrooms and increased in severity, with a 10.1% increase in fractures. Older age, risk of sarcopenia and arterial hypertension were associated with falls during the pre-pandemic period. (AU)

[Effect of COVID-19 lockdown on the incidence and severity of falls in institutionalized older people: A longitudinal study]. / Efecto del confinamiento por COVID-19 sobre la incidencia y gravedad de las caídas en personas mayores institucionalizadas: estudio longitudinal.

BACKGROUND: During the COVID-19 pandemic, virus contention measures such as strict confinement were declared in nursing homes. OBJECTIVE: To assess the impact of confinement on the incidence of falls and their associated factors in institutionalized older persons during the first year of the pandemic compared to the previous year. METHODS: A multicenter, comparative study was conducted between the pre-pandemic year (March 2019 to February 2020) and the first year (March 2020 to February 2021) in five nursing homes in Catalonia (Spain). The number of falls, date, placement and consequences were recorded, as well as sociodemographic and health information. A descriptive, bivariate and multivariate analysis was performed, calculating odds ratio (OR) with 95% confidence intervals and statistical significance of p<0.05. RESULTS: The sample consisted of 80 individuals, with a mean age of 84.4 years, 83.7% being women. In the first year of the pandemic, the number of falls per person increased by 0.21% (32.0% in rooms). In multivariate analysis of the pre-pandemic period, the risk of sarcopenia (OR = 4.02; 95% CI [1.09-14.82], p = 0.036) was a risk factor for falls independently of age and hypertension. In the first year of pandemic no statistically significant associated factors were found. CONCLUSIONS: In the first year of the COVID-19 pandemic, there was a 15.6% increase in falls and an 8.7% increase in the number of people who fell compared to the previous year. The falls' location changed from common areas to bedrooms and increased in severity, with a 10.1% increase in fractures. Older age, risk of sarcopenia and arterial hypertension were associated with falls during the pre-pandemic period.

Sarcopenia and associated factors according to the EWGSOP2 criteria in older people living in nursing homes: a cross-sectional study.

BACKGROUND: In 2018, the European Working Group on Sarcopenia in Older People (EWGSOP2) updated the original definition of sarcopenia, establishing new criteria to be used globally. Early diagnosis of sarcopenia in nursing home residents and the identification of contributing factors would target interventions to reduce the incidence of malnutrition, social isolation, functional decline, hospitalization and mortality. AIM: Verify the prevalence and the degree of severity of sarcopenia according to the new EWSGOP2 criteria and to analyse its associated factors in residents living in nursing homes in Central Catalonia (Spain). DESIGN: A cross-sectional multicenter study was conducted in 4 nursing homes. SARC-F test was applied as the initial screening, muscle strength was measured by a dynamometer, skeletal muscle mass by bioimpedance analysis and physical performance by Gait Speed. Four categories were used: total probable sarcopenia, probable sarcopenia, confirmed sarcopenia and severe sarcopenia. RESULTS: Among the total sample of 104 nursing home residents (mean age 84.6, ± 7.8; median 86, IQR 110), 84.6% were women and 85 (81.7%) (95% confidence interval [CI] 73.0-88.0) had total probable sarcopenia, 63 (60.5%) had probable sarcopenia, 19 (18.3%) had confirmed sarcopenia and 7 (6.7%) had severe sarcopenia. In the bivariate analysis, obesity was negatively associated and total time in sedentary behavior positively associated with all sarcopenia categories. In addition, malnutrition and urinary continence were positively associated with total and probable sarcopenia. Urinary incontinence was a positive associated factor of total and probable sarcopenia. In the multivariate analysis, obesity represented a negative associated factor: OR = 0.13 (0.03 - 0.57), p = 0.007 and OR = 0.14 (0.03 - 0.60), p = 0.008 with total and probable sarcopenia, respectively, adjusted by urinary incontinence status. For confirmed sarcopenia, obesity also represented a negative associated factor OR = 0.06 (0.01 - 0.99), p = 0.049 and the total time in sedentary behavior a positive associated factor OR = 1.10 (1.00- 1.20), p = 0.040. CONCLUSIONS: According the EWGSOP2 criteria, high prevalence of sarcopenia was found in institutionalized older people, ranging from 6.7 to 81.7% depending on the category. Malnutrition, urinary incontinence and total time in sedentary behavior were associated with sarcopenia, whilst obesity represented a protective factor in this population.

De la edad cronológica a la fragilidad: ¿un nuevo paradigma en la valoración de las personas con enfermedad oncológica atendidas en unidades de cuidados paliativos? / From chronological age to frailty: a new paradigm in the evaluation of patients with cancer admited in a palliative care units?

Introducción: Aunque es conocida la relación entre fragilidad y cáncer, se desconoce cómo su valoración mediante un índice de fragilidad (IF) puede ser útil en una unidad de cuidados paliativos (UCP). El objetivo del estudio es describir: 1) el grado de fragilidad y su evolución en personas con enfermedad oncológica ingresadas en una UCP; 2) la relación entre fragilidad y mortalidad intrahospitalaria por grupos de edad cronológica.Metodología: Se trata de un estudio de cohortes prospectivo y observacional. Se incluyeron personas con enfermedad oncológica que ingresaron en la UCP, entre julio de 2018 y junio de 2019. Se evaluaron variables demográficas, la fragilidad —mediante el índice Frágil-VIG (IF-VIG)— y la mortalidad intrahospitalaria.Resultados: Se reclutaron 91 pacientes, con una edad media de 72,2 ± 12,9 años (48,4 % mujeres), presentando una mortalidad intrahospitalaria del 63,7 %. En el momento del ingreso (IF-VIGi) se constató un incremento de fragilidad (0,43 vs. 0,28) con relación a la situación basal (IF-VIGb), que mejoró (0,31) en el momento del alta (IF-VIGa). Si bien no se constató asociación entre la edad cronológica y mortalidad, en el análisis comparativo se evidenció una estrecha relación entre mortalidad intrahospitalaria y grado de fragilidad. En las personas mayores (> 65 años) la mortalidad estaba especialmente relacionada con el IF-VIGb (p = 0,025) y sobre todo el IF-VIGi (p < 0,001), mientras que la variación del grado de fragilidad (IF-VIGi – IF-VIGb) era el factor más determinante en personas de ≤ 65 años (p = 0,025) y en aquellas de entre 66-84 años (p = 0,009).Conclusiones: La mortalidad intrahospitalaria de personas con cáncer que ingresaron en una UCP está más relacionada con el grado de fragilidad que con su edad cronológica. La valoración del grado de fragilidad en estos pacientes puede ser útil para la individualización de la atención. (AU)

Introduction: Although the relationship between frailty and cancer is known, it is unknown how its assessment by means of a frailty index (FI) can be useful in a Palliative Care Unit (PCU). The objective of the study is to describe: 1) the degree of frailty and its evolution in patients with oncological disease admitted to a PCU; 2) the relationship between frailty and in-hospital mortality by chronological age groups.Methodology: This is a prospective and observational cohort study. Patients with oncological disease who were admitted to the PCU between July 2018 and June 2019 were included. Demographic variables, frailty —using the Frail-VIG index (IF-VIG)—, and in-hospital mortality were evaluated.Results: Ninety-one patients were recruited, with a mean age of 72.2 ± 12.9 years (48.4 % women), presenting an in-hospital mortality of 63.7 %. At the admission (IF-VIGi) an increase in frailty (0.43 vs. 0.28) in relation to the baseline situation (IF-VIGb), which improved (0.31) at the time of discharge (IF-VIGa). Although no association was found between chronological age and mortality, the comparative analysis revealed relationship between in-hospital mortality and degree of frailty. In elderly (> 65 years), mortality was especially related to the IF-VIGb (P = .025) and especially the IF-VIGi (P < .001), while the variation in the degree of frailty (IFVIGi – IF-VIGb) was the most determining factor in people aged ≤ 65 years (P = .025) and in those between 66-84 years (P = .009).Conclusions: The in-hospital mortality of patients with cancer admitted to a PCU is more related to the degree of frailty than to their chronological age. Assessing the degree of frailty in these patients can be useful for individualizing care. (AU)

Urinary incontinence and sedentary behaviour in nursing home residents in Osona, Catalonia: protocol for the OsoNaH project, a multicentre observational study.

INTRODUCTION: Several studies have shown that physical activity (PA) levels and sedentary behaviour (SB) are independent risk factors for many health-related issues. However, there is scarce evidence supporting the relationship between SB and urinary incontinence (UI) in community-dwelling older adults, and no information on any possible association in institutionalised older adults. Stage I of this project has the main objective of determining the prevalence of UI and its associated factors in nursing home (NH) residents, as well as analysing the association between UI (and its types) and SB. Stage II aims to investigate the incidence and predictive factors of functional and continence decline, falls, hospitalisations, mortality and the impact of the COVID-19 pandemic among NH residents. METHODS AND ANALYSIS: Stage I is an observational, multicentre, cross-sectional study with mixed methodology that aims to explore the current status of several health-related outcomes in NH residents of Osona (Barcelona, Spain). The prevalence ratio will be used as an association measure and multivariate analysis will be undertaken using Poisson regression with robust variance. Stage II is a 2-year longitudinal study that aims to analyse functional and continence decline, incidence of falls, hospitalisations, mortality and the impact of the COVID-19 pandemic on these outcomes. A survival analysis using the actuarial method for functional decline and continence, evaluated every 6 months, and the Kaplan-Meier method for falls, hospitalisations and deaths, and Cox regression for multivariate analysis will be undertaken. ETHICS AND DISSEMINATION: The study received the following approvals: University of Vic - Central University of Catalonia Ethics and Research Committee (92/2019 and 109/2020), Clinical Research Ethics Committee of the Osona Foundation for Health Research and Education (FORES) (code 2020118/PR249). Study results will be disseminated at conferences, meetings and through peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04297904.