Fear of Falling in Older Adults Treated at a Geriatric Day Hospital: Results from a Cross-Sectional Study.

(1) Background: The fear of falling (FOF) is a geriatric syndrome that causes a decrease in daily activities and personal autonomy. Its prevalence is highly variable as are the methodologies used to assess it. This study aimed at estimating the prevalence and describing the main determinants of FOF in older adults attending a geriatric day hospital. (2) Methods: Descriptive, cross-sectional study of individuals aged ≥70 years, who attended an ambulatory functional rehabilitation group in the metropolitan area of Barcelona. FOF was assessed using the Activities-Specific Balance Confidence (ABC) scale. Other recorded outcomes were: sex, age, marital status, living alone, level of education, degree of autonomy, pain, previous falls, visual acuity, and signs of depression. Prevalence was estimated overall and according to the possible determinants. (3) Results: The study included 62 individuals (66.1% women), with a prevalence of fear of falling of 38.7% (95% CI 26.2-51.2%). The identified determinants were pain (OR = 7.4, 95% CI 1.4-39.7), a history of falls (OR = 25.3, 95% CI 2.1-303.4), poor visual acuity (OR = 5.6, 95% CI 1.0-29.8), and signs of depression (OR = 19.3, 95% CI 1.4-264.3). (4) Conclusions: The prevalence and determinants of fear of falling in older adults attending geriatric day hospitals were similar to those described in those dwelling in the community.

Central de Resultados del ámbito sociosanitario en Cataluña. Evolución 2013-2018 / Results Centre of Social and Health Care Network in Catalonia. Evolution 2013–2018

Objetivo : La Central de Resultados (CdR) nace con la misión de medir, evaluar y difundir los resultados alcanzados por los diferentes agentes del sistema sanitario, en base a medidas relevantes. El objetivo de este trabajo es describir la evolución de los indicadores utilizados en la CdR del ámbito sociosanitario (CdR-SS), incluyendo algunos indicadores sensibles a la práctica enfermera.Método: Estudio observacional, descriptivo y transversal de los 6 informes de CdR-SS (2013-2018). Se analizan indicadores que incluyen actividad realizada, días de estancia, consecución de objetivos rehabilitadores, altas a domicilio, mortalidad y úlceras por presión.Resultados: Hubo un aumento de la actividad en las diferentes líneas y una disminución en los días de estancia. Los resultados mostraron heterogeneidad entre centros. La mejora funcional y las altas a domicilio mostraron una tendencia creciente, mientras que la mortalidad tendió a disminuir. Se mantuvo estabilidad en la prevalencia de úlceras por presión de grados iii-iv.Conclusiones: La CdR-SS ha incluido diferentes indicadores en los diversos informes para mejorar la capacidad de evaluación y benchmarking sociosanitario. Los informes de CdR-SS aportan transparencia y rendimiento de cuentas del ámbito e invitan a profundizar en la mejora de este sector, mostrando que evoluciona hacia la atención intermedia con la entrada de subagudos y la mayor eficiencia de convalecencia. La incorporación de indicadores sensibles a la práctica enfermera contribuye a visibilizar los cuidados y al colectivo enfermero. (AU)

Objective: The Results Centre's (RC) mission is to measure, evaluate and disseminate the results achieved by the different agents of the health system, based on relevant measures. The purpose of this research is to describe the evolution of indicators used in the social and health care network RC (RC-SH), including some indicators sensitive to nursing practice.Method: Observational, descriptive cross-sectional study based on data from 6 RC-SH reports (2013–2018). Indicators including activity carried out, days of stay, achievement of rehabilitation goals, discharge to home, mortality and pressure ulcers are analysed.Results: There was an increase in activity on the different social and health resources and days of stay decrease. Results were heterogeneous between centres. Functional improvement and home discharge showed an increasing trend, while mortality tended to decrease. The prevalence of grade III–IV pressure ulcers was maintained.Conclusions: RC-SH reports have included different indicators to improve the capacity of evaluation and benchmarking for social and health network. These reports provide transparency and accountability in the field and invite further improvement in this sector. Also RC-SH results show that social and health network evolves towards intermediate care with the entry of subacute resources and the greater efficiency of convalescence. The incorporation of indicators sensitive to nursing practice contributes to making nurses and nursing care visible. (AU)

[Results Centre of Social and Health Care Network in Catalonia. Evolution 2013-2018]. / Central de Resultados del ámbito sociosanitario en Cataluña. Evolución 2013-2018.

OBJECTIVE: The Results Centre's (RC) mission is to measure, evaluate and disseminate the results achieved by the different agents of the health system, based on relevant measures. The purpose of this research is to describe the evolution of indicators used in the social and health care network RC (RC-SH), including some indicators sensitive to nursing practice. METHOD: Observational, descriptive cross-sectional study based on data from 6 RC-SH reports (2013-2018). Indicators including activity carried out, days of stay, achievement of rehabilitation goals, discharge to home, mortality and pressure ulcers are analysed. RESULTS: There was an increase in activity on the different social and health resources and days of stay decrease. Results were heterogeneous between centres. Functional improvement and home discharge showed an increasing trend, while mortality tended to decrease. The prevalence of grade III-IV pressure ulcers was maintained. CONCLUSIONS: RC-SH reports have included different indicators to improve the capacity of evaluation and benchmarking for social and health network. These reports provide transparency and accountability in the field and invite further improvement in this sector. Also RC-SH results show that social and health network evolves towards intermediate care with the entry of subacute resources and the greater efficiency of convalescence. The incorporation of indicators sensitive to nursing practice contributes to making nurses and nursing care visible.

Non-pharmacological interventions to reduce pain in dementia: A quasi-experimental study.

This study evaluated a non-pharmacological intervention nursing protocol for pain control and assessment of its evolution in a cohort of patients with moderate-to-severe dementia residing in three long-term care facilities in a metropolitan area in Spain. The study was a quasi-experimental pre- and post-exploratory intervention. The presence of pain was evaluated before and after the interventions of nursing protocol for 7 days, carried out by nurses. 157 residents of three centers participated (mean age 81.8 years, 58.1% were women, 83.2% had severe or moderately severe dementia and 65.2%) had regularly scheduled analgesic treatment. At baseline evaluation, the prevalence of pain, assessed with the PAINAD scale was 43.9% and this increased to 73.5% when pain was measured during bathing. The implementation of the nursing protocol of non-pharmacological interventions produced a decrease in pain of 11% (p = 0.0001). Multivariate Ancova analysis demonstrated that non-pharmacological interventions were effective independently of other factors as pressure sores or gender. The implementation of non-pharmacological interventions in social health care centers can produce a decrease in pain for those with dementia.

Characteristics and Service Utilization by Complex Chronic and Advanced Chronic Patients in Catalonia: A Retrospective Seven-Year Cohort-Based Study of an Implemented Chronic Care Program.

The Chronic Care Program introduced in Catalonia in 2011 focuses on improving the identification and management of complex chronic (CCPs) and advanced chronic patients (ACPs) by implementing an individualized care model. Its first stage is their identification based on chronicity, difficult clinical management (i.e., complexity), and, in ACPs, limited life prognosis. Subsequent stages are individual evaluation and implementation of a shared personalized care plan. This retrospective study, including all CCPs and ACPs identified in Catalonia between 2013 and 2019, was aimed at describing the characteristics and healthcare service utilization among these patients. Data were obtained from an administrative database and included sociodemographic, clinical, and service utilization variables and morbidity-associated risk according to the Adjusted Morbidity Groups (GMA) stratification. During the study period, CCPs' and ACPs' prevalence increased and was higher in lower-income populations; most cases were women. CCPs and ACPs had all comorbidities at higher frequencies, higher utilization of healthcare services, and were more frequently at high risk (63% and 71%, respectively) than age-, sex-, and income level-adjusted non-CCP (23%) and non-ACP populations (30%). These results show effective identification of the program's target population and demonstrate that CCPs and ACPs have a higher burden of multimorbidity and healthcare needs.

Comparación psicométrica de las escalas PAINAD y Abbey Pain Scale en centros sociosanitarios de Barcelona / Psychometric comparison of the Painad and Abbey Pain scales in long-term care facilities in Barcelona

Introducción: Se estima que el 30-50 % de las personas con demencia experimentan dolor crónico en residencias en España. A pesar de que hay validadas muchas escalas para la valoración del dolor en personas con demencia, sigue sin existir una que pueda considerarse como el gold standard. Además, no hay estudios realizados al respecto en medio sociosanitario. Por ello nos proponemos como objetivos principales la comparación psicométrica de la escala Pain Assessment in Advanced Dementia (PAINAD) y la Abbey Pain Scale (ABBEY) en personas con demencia en centros sociosanitarios. Metodología: Se llevaron a cabo un análisis de comparación psicométrica y un diseño transversal descriptivo. Se incluyeron mayores de 65 años con demencia moderada-severa ingresados en centros sociosanitarios del área sanitaria del Baix Llobregat. Resultados: El alfa de Cronbach en reposo para la escala PAINAD fue de 0,847 y durante el aseo de 0,845. Para la escala ABBEY se obtuvo un alfa de Cronbach de 0,728 en reposo y de 0,814 durante el aseo. Ambas escalas mostraron buenas concordancias, pero en el análisis por ítems los cambios físicos y los cambios fisiológicos de la ABBEY demostraron muy poca sensibilidad. La prevalencia de dolor basal ha sido del 43,9 % y durante el aseo fue del 73,5 %. Conclusiones: Ambas escalas mantuvieron buenas propiedades psicomimétricas pero la escala PAINAD es claramente mejor valorada. La prevalencia de dolor en personas con demencias ingresadas en centros sociosanitarios es del 43,9 %. Se propone para la mejor evaluación del dolor pasar la escala durante una actividad que implique movimiento. (AU)

Introduction: It is estimated that 30-50 % of people with dementia experience chronic pain at nursing homes in Spain. Despite the fact that there are many validated scales for the assessment of pain in people with dementia, there is still no single scale that may be considered the goldstandard. Furthermore, no studies have been carried out in this regard in a social and health environment. Therefore, we propose as primary objective a psychometric comparison of the Pain Assessment in Advanced Dementia Scale (PAINAD) and the Abbey Pain Scale (ABBEY) in people with dementia in long-term care facilities. Methodology: To achieve the objective we simultaneously carried out a psychometric comparison analysis and a descriptive cross-sectional design. Those over 65 years of age with moderate-severe dementia admitted to social health centers in the Baix Llobregat health area were included. Results: Cronbach’s alpha at rest for the PAINAD scale was 0.847 and 0.845 during toilet. For the ABBEY scale, a Cronbach’s alpha of 0.728 was obtained at rest and of 0.814 during toilet. Both scales showed good agreements, but in the item analysis ABBEY showed very little sensitivity for physical changes and physiological changes. The prevalence of pain at baseline was 43.9 %, and during grooming it was 73.5 %. Conclusions: Both scales displayed good psychometric properties but the PAINAD scale was clearly better. The prevalence of pain in people with dementia admitted to health centers is 43.9 %. Pain in people with dementia may need to be measured during movement activity to reveal actual pain. (AU)