Safety, Effectiveness, and Immunogenicity 6 Months After BNT162B2 mRNA Vaccine in Frail Nursing Home Residents.

BACKGROUND: Elderly people who reside in long-term care facilities form a frail and vulnerable population, with multiple pathologies and high percentages of cognitive and functional disability. OBJECTIVES: The aims of this study were to assess the safety of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in frail nursing home residents and to evaluate its effectiveness 6 months after full vaccination. DESIGN: This was an ambispective observational study. SETTING: Residents of a long-term care facility in Madrid, Spain. PARTICIPANTS: One hundred and thirty-seven nursing home residents (81.8% female, mean age 87.77 ± 8.31 years) with high comorbidity (61.3% Charlson Index ≥ 3) and frailty (75% Clinical Frail Scale ≥ 7) who received the BNT162B2 mRNA vaccine. MEASUREMENTS: Safety data were collected to evaluate the type of adverse drug reactions and their duration, severity, and causality. Immunogenicity was tested 6 months after the primary vaccination and effectiveness was evaluated by the incidence of SARS-CoV-2 infection, the number of hospital admissions, and mortality due to coronavirus disease 2019 (COVID-19). RESULTS: Safety: Of the residents, 21.9% had some adverse reaction and 5.8% had a severe or more serious adverse reaction. The most frequent adverse reactions were fatigue (13.1%), pyrexia (12.4%), and headache (7.3%). No association was observed between frailty (including a need for palliative care) and clinical, functional or cognitive status of the participants and the occurrence of adverse events. Immunogenicity and Effectiveness: After 6 months of vaccination, only one case of SARS-CoV-2 infection was confirmed in the vaccinated residents. Most of the nursing home residents presented positive serology (95.2%). Loss of immunogenicity was associated with older age (95.12 ± 3.97 vs. 87.24 ± 8.25 years; p = 0.03) and no previous COVID-19 infection (16.6% vs. 70%; p < 0.001). Binary logistic regression models did not reveal this association. CONCLUSION: The BNT162B2 vaccine is well tolerated and effective in nursing home residents, independently of their clinical, functional, cognitive, or frailty characteristics. For the most part, immunogenicity has been maintained over time, regardless of comorbidity, functional status or frailty.

The situation of infection in the elderly in Spain: a multidisciplinary opinion document / Situación de la infección en el anciano: un documento multidisciplinar de opinión

Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed

La infección en los ancianos es un tema enorme que suele recibir enfoques muy específicos pero parciales. Además, es una de las áreas en las que la intervención podría tener más éxito para mejorar la calidad de vida de los pacientes mayores. En un intento de dar el mayor enfoque posible a este tema, la Fundación de Ciencias de la Salud ha convocado a expertos de diferentes áreas para elaborar este documento de opinión sobre la situación de la infección en los ancianos, tratando de comparar las opiniones de médicos expertos, enfermeras, farmacéuticos, periodistas, representantes de asociaciones de ancianos y terminando con los aspectos éticos que plantea el problema. El formato es el de la discusión de una serie de preguntas preformuladas que fueron discutidas entre todos los presentes. Empezamos discutiendo el concepto de "anciano", las razones de la predisposición a la infección, las infecciones más frecuentes y sus causas, y la carga laboral y económica que suponen para la sociedad. También preguntamos si teníamos datos para estimar la proporción de estas infecciones que podrían ser reducidas por programas específicos, incluyendo programas de vacunación. En este contexto, se discutió la baja presencia de este problema en los medios de comunicación, la posición de las asociaciones científicas y de pacientes sobre el problema y los aspectos éticos que todo esto plantea

Vacunación frente a la gripe estacional en las personas mayores. Evaluación de la vacuna tetravalente. Informe de posicionamie / Seasonal flu vaccination for older people: Evaluation of the quadrivalent vaccine. Positioning repor

La gripe es un importante problema de salud pública, particularmente en las personas susceptibles de presentar complicaciones asociadas, personas mayores, niños menores de 2 años, enfermos crónicos, inmunocomprometidos y embarazadas. Pero, además, la gripe tiene un gran impacto sanitario con un aumento de la demanda asistencial y un espectacular aumento de las visitas ambulatorias, sobrecargando los servicios de urgencias y hospitalarios. Durante los brotes epidémicos, las tasas de hospitalización de las personas mayores de 65 años son máximas y la mortalidad notificada por gripe en la temporada 2017/2018 ha sido de 960 defunciones. La vacunación antigripal estacional es el método con una mayor relación coste-efectividad de prevención primaria de la gripe, reduciendo las enfermedades respiratorias relacionadas, el número de visitas a las consultas médicas, el número de hospitalizaciones y muertes en personas de alto riesgo y el absentismo laboral en adultos. En los últimos años la gripe B ha recibido escasa atención en la literatura científica y, sin embargo, en períodos interepidémicos, la gripe B puede ser una de las principales causas de epidemias de gripe estacional, causando una considerable morbimortalidad y un aumento de costes. La vacuna tetravalente, a diferencia de la trivalente, obtiene una protección inmunológica frente al segundo linaje de la gripe B y, de acuerdo con una revisión crítica de la literatura científica, proporciona una protección más amplia sin afectar a la inmunogenicidad de las otras 3 cepas vacunales comunes a las vacunas trivalente y tetravalente. La vacuna tetravalente es coste-efectiva al disminuir el número de casos de gripe y siempre es una intervención rentable, con un importante ahorro de coste para el sistema de salud y para la sociedad, disminuyendo las tasas de hospitalización y de mortalidad asociadas a las complicaciones de la gripe

Influenza is a significant health problem, particularly in those persons susceptible to having associated complications, older people, children less than 2 years, patients with chronic diseases, immunocompromised patients, and pregnant women. But influenza also has a large impact on the health system, with an increase in the healthcare demand and a spectacular increase in outpatient visits, overloading the emergency and hospital services. During epidemic outbreaks, the hospital admission rates of people over 65 years are at a maximum, and the mortality notified for the 2017/2018 influenza season was 960 deaths. The seasonal anti-influenza vaccine is the method with a better cost-effective ratio of primary prevention of influenza, reducing associated respiratory diseases, the number of hospital admissions, and deaths in high risk individuals, as well as work absenteeism in adults. In the last few years, influenza B has received little attention in the scientific literature, although in the periods between epidemics influenza B can be one of the main causes of seasonal epidemics, causing considerable morbidity and mortality and an increase in costs. The quadrivalent vaccine has a second-line immunological protection against influenza B, and according to a critical review of the scientific literature, it provides wider protection without affecting immunogenicity of the other three vaccine strains common to the trivalent and tetravalent vaccine. The quadrivalent vaccine is cost-effective in reducing the number of influenza cases, and is always a worthwhile intervention, with a significant cost saving for the health system and for society, by reducing the hospital admission rates and mortality associated with the complications of influenza

[Seasonal flu vaccination for older people: Evaluation of the quadrivalent vaccine. Positioning report]. / Vacunación frente a la gripe estacional en las personas mayores. Evaluación de la vacuna tetravalente. Informe de posicionamiento.

Influenza is a significant health problem, particularly in those persons susceptible to having associated complications, older people, children less than 2 years, patients with chronic diseases, immunocompromised patients, and pregnant women. But influenza also has a large impact on the health system, with an increase in the healthcare demand and a spectacular increase in outpatient visits, overloading the emergency and hospital services. During epidemic outbreaks, the hospital admission rates of people over 65 years are at a maximum, and the mortality notified for the 2017/2018 influenza season was 960 deaths. The seasonal anti-influenza vaccine is the method with a better cost-effective ratio of primary prevention of influenza, reducing associated respiratory diseases, the number of hospital admissions, and deaths in high risk individuals, as well as work absenteeism in adults. In the last few years, influenza B has received little attention in the scientific literature, although in the periods between epidemics influenza B can be one of the main causes of seasonal epidemics, causing considerable morbidity and mortality and an increase in costs. The quadrivalent vaccine has a second-line immunological protection against influenza B, and according to a critical review of the scientific literature, it provides wider protection without affecting immunogenicity of the other three vaccine strains common to the trivalent and tetravalent vaccine. The quadrivalent vaccine is cost-effective in reducing the number of influenza cases, and is always a worthwhile intervention, with a significant cost saving for the health system and for society, by reducing the hospital admission rates and mortality associated with the complications of influenza. Supplement information: This article is part of a supplement entitled 'Seasonal flu vaccination for older people: Evaluation of the quadrivalent vaccine' which is sponsored by Sanofi-Aventis, S.A.

Delphi consensus of an expert committee in oncogeriatrics regarding comprehensive geriatric assessment in seniors with cancer in Spain.

OBJECTIVES: The aim of this work was to reach a national consensus in Spain regarding the Comprehensive Geriatric Assessment (CGA) domains in older oncological patients and the CGA scales to be used as a foundation for widespread use. MATERIAL AND METHODS: The Delphi method was implemented to attain consensus. Representatives of the panel were chosen from among the members of the Oncogeriatric Working Group of the Spanish Society of Medical Oncology (SEOM). Consensus was defined as ≥66.7% coincidence in responses and by the stability of said coincidence (changes ≤15% between rounds). The study was conducted between July and December 2016. RESULTS: Of the 17 people invited to participate, 16 agreed. The panel concluded by consensus that the following domains should be included in the CGA:(and the scales to evaluate them): functional (Barthel Index, Lawton-Brody scale, gait speed), cognitive (Pfeiffer questionnaire), nutritional (Mini Nutritional Assessment - MNA), psychological/mood (Yesavage scale), social-familial (Gijon scale), comorbidity (Charlson index), medications, and geriatric syndromes (urinary and/or fecal incontinence, low auditory and/or visual acuity, presence of falls, pressure sores, insomnia, and abuse). Also by consensus, the CGA should be administered to older patients with cancer for whom there is a subsequent therapeutic intent and who scored positive on a previous frailty-screening questionnaire. CONCLUSION: After 3 rounds, consensus was reached regarding CGA domains to be used in older patients with cancer, the scales to be administered for each of these domains, as well as the timeline to be followed during consultation.

BAHNG score: predictive model for detection of subjects with the oropharynx colonized by uncommon microorganisms / Escala BAHNG: modelo predictivo para la detección de sujetos colonizados en la orofaringe por microorganismos menos habituales

Objective. Pneumonia is most frequently produced by the microaspiration of flora that colonizes the oropharynx. Etiological diagnosis of pneumonia is infrequent in clinical practise and empirical treatment should be prescribed. The aims of the present study were to determine the factors associated with oropharynx colonization by uncommon microorganisms (UM) and to develop a predictive model. Methods. A cross-sectional study that included all patients living in one long-term care facilities was developed. Demographic, comorbidities, basal functional status and clinical data were collected. To determinate the oropharyngeal colonization, a single sample of pharynx was obtained for each subject using a cotton swab. Results. A total of 221 subjects were included, mean age 86.27 (SD 8.05) years and 157 (71%) were female. In 32 (14.5%) subjects UM flora was isolated, Gram-negative bacilli in 16 (7.2%) residents, and Staphylococcus aureus in 16 (7.2%). The predictive model included the presence of hypertension, neuromuscular disease, Barthel < 90 and use of PEG. The BAHNG score (BArthel, Hypertension, Neuromuscular, Gastrostomy), showed an area under the curve of 0.731 (CI 95% 0.643-0.820; p<0.001). We have classified patients according to this score in low (0-2 points), intermediate (3-5 points) and high risk (≥ 6). The probability of UM colonization in the oropharyngeal based on this classification is 4.1%, 15.8% and 57.1% for low, intermediate and high risk, respectively. Conclusion. The BAHNG score could help in the identifications of elderly patients with high risk of colonization by UM. In case of pneumonia the evaluation of the subject through this score could help in the initial decisions concerning antibiotic treatment (AU)

Objetivo. La neumonía se produce, con mayor frecuencia, por la microaspiración de la flora que coloniza la orofaringe. Su diagnóstico etiológico es infrecuente en la práctica clínica, prescribiéndose el tratamiento empíricamente. El objetivo del presente estudio fue determinar los factores asociados con la colonización de la orofaringe por microorganismos menos habituales y desarrollar un modelo predictivo. Métodos. Se realizó un estudio transversal que incluyó a todos los pacientes ingresados en una residencia de larga estancia. Se recogieron datos demográficos, comorbilidades, estado funcional basal y datos clínicos. Para determinar la colonización orofaríngea, se obtuvo una muestra única de la faringe para cada sujeto con un hisopo de algodón. Resultados. Se incluyeron un total de 221 sujetos, con una edad media de 86,27 (DE 8,05) años y 157 (71%) fueron mujeres. En 32 (14,5%) sujetos se aisló flora menos habitual: bacilos gramnegativos en 16 (7,2%) residentes y Staphylococcus aureus en 16 (7,2%). El modelo predictivo incluyó la presencia de hipertensión, enfermedad neuromuscular, Barthel <90 y tener gastrostomía endoscópica percutánea. La escala BAHNG (BArthel, Hipertensión, Neuromuscular, Gastrostomía) mostró un área bajo la curva de 0,731 (IC 95% 0,643-0,820; p <0,001). Se clasificó a los pacientes según la puntuación en bajo (0-2 puntos), intermedio (3-5 puntos) y alto riesgo (≥ 6). La probabilidad de colonización de la orofaringe por microorganismos menos habituales según esta clasificación fue del 4,1%, 15,8% y 57,1% para el riesgo bajo, intermedio y alto, respectivamente. Conclusión. La escala BAHNG podría ayudar en la identificación de pacientes ancianos con alto riesgo de colonización de la orofaringe por microorganismos menos habituales. En caso de neumonía, la evaluación del sujeto a través de esta escala podría ayudar en las decisiones iniciales sobre el tratamiento antibiótico a instaurar (AU)

Vacunación frente a la gripe estacional en las personas mayores. Evaluación de la vacuna adyuvada. Informe de posicionamiento / Seasonal flu vaccination for older people: evaluation of the adjuvanted vaccine. Positioning report

La gripe es un importante problema de salud pública, particularmente en las personas mayores, con una significativa carga clínica y económica y con una alta mortalidad. En España, durante la temporada 2015- 2016, se han notificado 3.101 casos graves hospitalizados confirmados por gripe, de los que han fallecido el 11% (352 casos). Además, hay un gran aumento de costes económicos y sanitarios por sus complicaciones y los mayores de 65 años representan aproximadamente el 64% del total de costes de la gripe. La vacuna antigripal estacional es la estrategia fundamental, y los estudios de coste-beneficio y coste-efectividad así lo demuestran. Uno de los objetivos prioritarios es mejorar la respuesta inmune de las vacunas, y una línea importante de investigación es la búsqueda e inclusión en las vacunas de adyuvantes o inmunoestimuladores. En este informe de posicionamiento se evalúa la vacunación en las personas mayores y la importancia de la vacuna adyuvada en los mayores, que refuerza la inmunogenicidad mediante una revisión crítica de la bibliografía relacionada con la mayor evidencia disponible sobre su inmunogenicidad, efectividad y evaluación económica (AU)

Flu is a major public health problem, particularly for older people, and creates an important clinical and economic burden. A high mortality rate was reported in Spain during the period 2015 to 2016; 3,101 serious cases were hospitalised with a confirmed diagnosis of flu, of which 11% died (352 cases). Furthermore, financial and health costs are greatly increased by the complications of flu; people aged over 65 years represent approximately 64% of the total costs. Seasonal flu vaccination is the fundamental strategy, as demonstrated by cost-benefit and cost-effectiveness studies. A priority objective is to improve the vaccine’s immune response and the search for and inclusion of adjuvants and immunostimulants in vaccines is a major line of research. This positioning report evaluates vaccination for older people and the importance of the adjuvanted vaccine in the elderly in strengthening immunogenicity, by means of a critical review of the literature based on the best evidence available on its immunogenicity and effectiveness, and an economic assessment (AU)

[Seasonal flu vaccination for older people: Evaluation of the adjuvanted vaccine. Positioning report]. / Vacunación frente a la gripe estacional en las personas mayores. Evaluación de la vacuna adyuvada: Informe de posicionamiento.

Flu is a major public health problem, particularly for older people, and creates an important clinical and economic burden. A high mortality rate was reported in Spain during the period 2015 to 2016; 3,101 serious cases were hospitalised with a confirmed diagnosis of flu, of which 11% died (352 cases). Furthermore, financial and health costs are greatly increased by the complications of flu; people aged over 65 years represent approximately 64% of the total costs. Seasonal flu vaccination is the fundamental strategy, as demonstrated by cost-benefit and cost-effectiveness studies. A priority objective is to improve the vaccine's immune response and the search for and inclusion of adjuvants and immunostimulants in vaccines is a major line of research. This positioning report evaluates vaccination for older people and the importance of the adjuvanted vaccine in the elderly in strengthening immunogenicity, by means of a critical review of the literature based on the best evidence available on its immunogenicity and effectiveness, and an economic assessment.

[Non-pharmacological treatment of cognitive impairment]. / Tratamiento no farmacológico del deterioro cognitivo.

This article reviews the effect of non-pharmacological therapies in persons with cognitive impairment, especially treatments aimed at brain stimulation and functional maintenance, since both pharmacological and non-pharmacological therapies affecting the cognitive and psychoaffective domains are reviewed in another article in this supplement. The article also discusses the close and reciprocal relationship between cognitive impairment, diet and nutritional status and describes the main nutritional risk factors and protective factors in cognitive decline.

Tratamiento no farmacológico del deterioro cognitivo / Non-pharmacological treatment of cognitive impairment

A lo largo de este artículo se revisa el efecto de las terapias no farmacológicas en las personas que desarrollan un cuadro de deterioro cognitivo, especialmente aquellas encaminadas a la estimulación y mantenimiento funcional, ya que tanto las terapias farmacológicas como las no farmacológicas que inciden a nivel de la esfera cognitiva y psicoafectiva son objeto de otra sección de esta monografía. Del mismo modo se aborda la estrecha y recíproca relación que existe entre el deterioro cognitivo, la alimentación y el estado nutricional de las personas, describiendo los principales factores de riesgo nutricional y los factores protectores para el desarrollo del deterioro cognitivo (AU)

This article reviews the effect of non-pharmacological therapies in persons with cognitive impairment, especially treatments aimed at brain stimulation and functional maintenance, since both pharmacological and non-pharmacological therapies affecting the cognitive and psychoaffective domains are reviewed in another article in this supplement. The article also discusses the close and reciprocal relationship between cognitive impairment, diet and nutritional status and describes the main nutritional risk factors and protective factors in cognitive decline (AU)

Sujeciones mecánicas y farmacológicas en servicios y centros geriátricos y gerontológicos / Physical and pharmacological restraints in geriatric and gerontology services and centers

Las sujeciones mecánicas y las farmacológicas constituyen un tema controvertido en la asistencia geriátrica por sus repercusiones morales, éticas, sociales y jurídicas y, pese a ello, no existe legislación específica a nivel estatal. El uso de las sujeciones se cuestiona cada vez más, ya que existen estudios que demuestran que no disminuyen las caídas ni sus consecuencias, sino que pueden aumentarlas, producir complicaciones, lesiones y accidentes potencialmente mortales. No siempre se utilizan racionalmente pese a comprometer un derecho fundamental de las personas, como la libertad, constitucionalmente protegido, además de afectar a valores y principios como la dignidad y la autoestima personal: hay centros en los se utilizan en más del 50 % de sus usuarios, y para las que en algunos casos, no cuentan con el consentimiento de sus representantes. En ocasiones, se utilizan para conseguir objetivos organizativos o ambientales, como el cumplimiento de horarios ajustados, y para disminuir o evitar la supervisión de personas que deambulan erráticamente; y a veces se usan indefinidamente. Mayor confusión aún existe con respecto al emergente concepto de las sujeciones químicas o farmacológicas, ya que no existe un marco conceptual basado en evidencia científica, suficientemente consensuado para los profesionales. En este contexto la Sociedad Española de Geriatría y Gerontología (SEGG), consciente de la importancia y trascendencia del tema e intentando, por un lado, preservar y garantizar las máximas libertad, dignidad y autoestima y, por otro, velar por las máximas integridad, seguridad legal y jurídica de las personas atendidas en servicios y centros geriátricos y gerontológicos, decidió crear un Comité Interdisciplinar de Sujeciones constituido por socios de diferentes disciplinas y miembros de algunos grupos de trabajo o comités de la SEGG, por profesionales externos de grupos, de entidades y asociaciones expertos en sujeciones e integrar en él a los principales movimientos «antisujeciones». Fruto de ello es el Documento de consenso sobre sujeciones mecánicas y farmacológicas, así como el Consenso sobre sujeciones mecánicas y farmacológicas, publicado por la SEGG, que debe suponer un salto cualitativo en la atención de los mayores, y servir como guía de buena práctica para los profesionales (AU)

Physical and pharmacological restraints are a controversial issue in the context of geriatric care due to their moral, ethical, social and legal repercussions and, despite this fact, no specific legislation exists at a national level. The use of restraints is being questioned with growing frequency, as there are studies that demonstrate that restraints do not reduce the number of falls or their consequences, but rather can increase them, cause complications, injuries and potentially fatal accidents. Restraints are not always used rationally, despite compromising a fundamental human right, that is, freedom, protected in the Constitution, as well as values and principles, such as dignity and personal self-esteem. There are centers where restraints are applied to more than 50 % of patients, and in some cases without the consent of their legal representatives. On some occasions, restraints are used for attaining organizational or environmental objectives, such as complying with tight schedules, and for reducing or avoiding the supervision of patients who walk erratically and, at times, are used indefinitely. Even greater confusion exists with respect to the emerging concept of chemical or pharmacological restraints, since no conceptual framework exists based on scientific evidence, and with sufficient consensus for guiding healthcare workers. In this context, the Sociedad Española de Geriatría y Gerontología (SEGG - Spanish Geriatrics and Gerontology Society), aware of the significance and transcendence of the issue, and in an attempt to preserve and guarantee maximum freedom, dignity and self-esteem, on the one hand, and to ensure the maximum integrity and legal certainty of the persons cared for in geriatric and gerontology services and centers, on the other, decided to create an «Interdisciplinary Committee on Restraints» made up by members from different disciplines and members of SEGG Working Groups or Committees, external health care workers, groups, organizations, and associations, who are experts in restraints, as well as the main «anti-restraint» movements. An outcome of this decision is the Consensus document on physical and pharmacological restraints, together with the Consensus on physical and pharmacological restraints, published by the SEGG, which should signify a qualitative leap forward in care for the elderly, and serving as a best practice guide for healthcare workers (AU)

[Physical and pharmacological restraints in geriatric and gerontology services and centers]. / Sujeciones mecánicas y farmacológicas en servicios y centros geriátricos y gerontológicos.

Physical and pharmacological restraints are a controversial issue in the context of geriatric care due to their moral, ethical, social and legal repercussions and, despite this fact, no specific legislation exists at a national level. The use of restraints is being questioned with growing frequency, as there are studies that demonstrate that restraints do not reduce the number of falls or their consequences, but rather can increase them, cause complications, injuries and potentially fatal accidents. Restraints are not always used rationally, despite compromising a fundamental human right, that is, freedom, protected in the Constitution, as well as values and principles, such as dignity and personal self-esteem. There are centers where restraints are applied to more than 50% of patients, and in some cases without the consent of their legal representatives. On some occasions, restraints are used for attaining organizational or environmental objectives, such as complying with tight schedules, and for reducing or avoiding the supervision of patients who walk erratically and, at times, are used indefinitely. Even greater confusion exists with respect to the emerging concept of chemical or pharmacological restraints, since no conceptual framework exists based on scientific evidence, and with sufficient consensus for guiding healthcare workers. In this context, the Sociedad Española de Geriatría y Gerontología (SEGG--Spanish Geriatrics and Gerontology Society), aware of the significance and transcendence of the issue, and in an attempt to preserve and guarantee maximum freedom, dignity and self-esteem, on the one hand, and to ensure the maximum integrity and legal certainty of the persons cared for in geriatric and gerontology services and centers, on the other, decided to create an "Interdisciplinary Committee on Restraints" made up by members from different disciplines and members of SEGG Working Groups or Committees, external health care workers, groups, organizations, and associations, who are experts in restraints, as well as the main "anti-restraint" movements. An outcome of this decision is the Consensus document on physical and pharmacological restraints, together with the Consensus on physical and pharmacological restraints, published by the SEGG, which should signify a qualitative leap forward in care for the elderly, and serving as a best practice guide for healthcare workers.

[Use of physical restraints in an elderly population living in public nursing homes]. / Uso de sujeciones físicas en una población anciana ingresada en residencias públicas.

OBJECTIVE: To determine the prevalence of the use of physical restraints in public nursing homes through the Residents' Functional Classification Information System in order to assess the introduction of a protocol designed to reduce and rationalize the use of these devices. MATERIAL AND METHODS: Twenty-five public nursing homes in the autonomous region of Madrid were included in this study. The following data on the use of physical restraints were analysed: frequency of use (daily or less than daily), type of device, level of functional dependence for activities of daily living, and severity of cognitive impairment. RESULTS: A total of 5346 residents were included. The prevalence of the use of restraints was 8.4%. When the use of bedrails was added, this percentage rose to 20.8%. Bedrails accounted for 63.4% of all restraints used, trunk restraints for 17.7%, limb restraints for 3%, and chairs preventing voluntary rising for 15.9%. A single device was used in 62.6%. Of the restraints, 71.4% were used daily and 28.6% were used temporarily. CONCLUSIONS: The results of this study represent an approximation to the current use of physical restraints in nursing homes. The prevalence found was similar to, or less than, that observed in previous studies. The most commonly used form of restraint was bedrails. The use of these devices is probably excessive, affecting even residents without cognitive impairment or physical dependence. To reduce the use of restraints and guarantee optimal care when their application is indicated, the Regional Social Welfare Service systematically applies a protocol for the prevention and use of physical restraints.

Uso de sujeciones físicas en una población anciana ingresada en residencias públicas / Use of physical restraints in an elderly population living in public nursing homes

Objetivo: conocer la prevalencia de uso de dispositivos de sujeción física en residencias públicas de mayores utilizando el Sistema de Información Clasificación Funcional de Residentes, para evaluar la implantación del protocolo dirigido a reducir su uso y asu manejo racional.Material y métodos: se han incluido en este estudio las 25 residencias públicas de la Comunidad de Madrid. Se analizan datos sobre el uso de sujeciones físicas: frecuencia de su uso (diario o no), tipo de dispositivo, grado de dependencia funcional para las actividades de la vida diaria (AVD) y el grado de deterioro cognitivo. Resultados: residentes incluidos: 5.346. La prevalencia fue del 8,4%. Añadiendo el uso de barandillas en la cama, el porcentaje se eleva al 20,8%. El 63,4% de las sujeciones eran barandillas; había restricción de tronco en el 17,7%, restricción de miembros en el 3% y sillas de sujeción en el 15,9%. Sólo se utilizó un dispositivoen el 62,6%. De las sujeciones, el 71,4% se utilizó a diario y 28,6% de forma no permanente.Conclusiones: los resultados permiten obtener una aproximación a la situación actual del uso de sujeciones físicas en residencias. La prevalencia es similar a la obtenida en otros estudios e incluso inferior a otras publicadas. Las barandillas son el dispositivo de sujeción más empleado. Probablemente exista un uso excesivo de barandillas que afecta incluso a residentes sin deterioro cognitivo ni dependencia física.Para reducir su utilización y garantizar los mejores cuidados en aquellos casos en los que estén indicadas, el Servicio Regional de Bienestar Social está aplicando de forma sistemática un protocolo de prevención y uso de sujeciones mecánicas

Objective: to determine the prevalence of the use of physical restraints in public nursing homes through the Residents’ Functional Classification Information System in order to assess the introduction of a protocol designed to reduce and rationalize the use of these devices.Material and methods: twenty-five public nursing homes in the autonomous region of Madrid were included in this study. The following data on the use of physical restraints were analysed: frequency of use (daily or less than daily), type of device, level offunctional dependence for activities of daily living, and severity of cognitive impairment.Results: a total of 5346 residents were included. The prevalence of the use of restraints was 8.4%. When the use of bedrails was added, this percentage rose to 20.8%. Bedrails accounted for 63.4% of all restraints used, trunk restraints for 17.7%, limb restraints for 3%, and chairs preventing voluntary rising for15.9%. A single device was used in 62.6%. Of the restraints, 71.4% were used daily and 28.6% were used temporarily.Conclusions: the results of this study represent an approximation to the current use of physical restraints in nursing homes. The prevalence found was similar to, or less than, that observed in previous studies.The most commonly used form of restraint was bedrails. The use of these devices is probably excessive, affecting even residents without cognitive impairment or physical dependence. To reduce the use of restraints and guarantee optimal care when their applicationis indicated, the Regional Social Welfare Service systematically applies a protocol for the prevention and use of physical restraints

Prevención y promoción de la salud en el anciano institucionalizado : la residencia como espacio de convivencia y de salud

Manual práctico para la intervención en colectivos de personas mayores. Aporta recursos metodológicos de apoyo para profesionales socio-sanitarios, en el ámbito residencial y asistencial, tanto en lo que se refiere a los procesos de adaptación, como a la optimización de las estrategias de atención.

Derecho a una buena visión en los mayores : evitar la ceguera evitable

Documento que contiene los principales problemas que pueden darse en la capacidad de visión en las personas de edad, así como una propuesta de soluciones y estrategias preventivas que, en su conjunto, se dirigen a "evitar la ceguera evitable".