OBJETIVO: Desarrollar un plan de atención específi co en pacientes con demencia avanzada institucionalizados, planificando los cuidados mediante el control sintomático, tomando decisiones con el cuidador principal, realizando un apoyo psicológico y espiritual. MÉTODO: Estudio descriptivo de periodo en el Centro Txara 1, desde el 1 de julio de 2014 hasta el 31 de diciembre de 2016, identifi cando a aquellos residentes con demencia avanzada y síndrome de declive. Se recoge trimestralmente el grado de control de síntomas (Symptom Management at the End-of-Life in Dementia) (SM-EOLD), utilizando la escala PAINAD para la valoración del dolor; el confort en el momento de la agonía se determina diariamente (The Comfort Assessment in Dying with Dementia) (CAD-EOLD), estableciendo con el cuidador principal la toma de decisiones basadas en los objetivos asistenciales paliativos. Tras el fallecimiento se realiza una encuesta de satisfacción al cuidador (Satisfaction with Care at the End-of-Life in Dementia) (SWC-EOLD) y contacto periódico con la pastoral para el apoyo espiritual. RESULTADOS: Se han analizado 74 residentes, con una edad media de 87 años, un 79 % mujeres, con 4,6 medicamentos de media, con enfermedad de Alzheimer como principal causa de demencia. En el control de síntomas en fase estable no se detecta inestabilidad física o conductual relevante, detectándose en un 5 % la presencia de dolor. De 50 residentes fallecidos, el 94 % sucede en el propio centro, en un 67 % se puede registrar el grado de confort destacando la presencia de disnea y disfagia, al ser la infección respiratoria aspirativa la principal causa de fallecimiento. En un 66 % de la población seleccionada se realiza atención espiritual. Un 30 % de los cuidadores principales responden a la encuesta de satisfacción, con un alto porcentaje de aceptación en el nivel de cuidados. CONCLUSIONES: La identificación de los pacientes con demencia avanzada en situación de final de vida permite estructurar un plan de atención en el centro gerontológico, conociendo las necesidades sintomáticas, el grado de confort o bienestar y consensuando las decisiones en cuanto a la proporcionalidad de cuidados con la familia. Ante situaciones de descompensación aguda, la coordinación con los recursos sociosanitarios disponibles es fundamental para poder llevar a cabo las decisiones adoptadas del equipo sanitario con el cuidador principal
OBJECTIVE: To develop a specific care plan for institutionalized patients with advanced dementia based on symptom control and including joint decision making with the primary caregiver as well as psychological and spiritual support. METHOD: A descriptive 1-period study at Centro Txara 1, from July 1 2014 to December 31 2016, which identified residents with advanced dementia and geriatric failure-to-thrive syndrome. Symtom control extent was quarterly assessed using the Symptom Management at the End-of-Life in Dementia (SM-EOLD) scale, and the PAINAD scale for pain; comfort at the end of life was assessed daily with the Comfort Assessment in Dying with Dementia (CAD-EOLD) instrument, and decisions were made jointly with the primary caregiver based on the goals of palliative care. After the death of the patient a satisfaction survey was administered to the caregiver (Satisfaction with Care at the End-of-Life in Dementia, SWC-EOLD), who was also provided with regular contact with the pastoral care team for spiritual support. RESULTS: A total of 74 residents were assessed with a mean age of 87 years; 79% were females, mean number of drugs was 4.6, and Alzheimer's disease was the primary cause of dementia. Stable-phase symptom control identified no relevant phisical or behavioral instability, but pain was found in 5% of the sample. Of 50 residents who passed away, 94% died in the hospice; in 67% comfort degree could be collected, and the presence of shortness of breath and dysphagia stood out, as aspiration-induced respiratory infection was the primary cause of death. Spiritual care was provided for 66% of the study population. In all, 30% of primary caregivers responded to the satisfaction survey showing a high percentage of acceptance of level of care. CONCLUSIONS: Identifying patients with advanced dementia at the end of life allows the development of a hospice care plan considering symptom needs, comfort degree and wellbeing, and involving consensus decisions about care proportionality with the family. Should an acute decompensation occur, coordination with the available social and healthcare resources is key for implementing the decisions agreed between the healthcare team and the primary caregiver
Humans , Male , Female , Aged, 80 and over , Dementia/etiology , Health of Institutionalized Elderly , Hospice Care/psychology , Caregivers/statistics & numerical data , Spiritual Therapies , Prospective Studies , Dementia/prevention & control
OBJECTIVES: To determine the effect of multicomponent exercise on frailty and related adverse outcomes in residents of long-term nursing homes (LTNHs). DESIGN: A single-blind randomized controlled trial. SETTING: Ten LTNHs in Gipuzkoa, Spain. PARTICIPANTS: The study sample comprised 112 men and women aged 70 years or older who scored 50 or higher on the Barthel Index, 20 or higher on the MEC-35 test (an adapted and validated version of the Mini-Mental State Examination in Spanish), and who were capable of standing up and walking independently for at least 10 m. INTERVENTION: Subjects in the control group (CG) participated in routine activities. The intervention group (IG) participated in a 6-month program of individualized and progressive multicomponent exercise at moderate intensity. MEASUREMENTS: Frailty was assessed by four different scales at baseline and at 6 months. The Barthel Index was measured at baseline and at 12 months. Frailty-related adverse outcomes were recorded from 12 months before to 12 months after starting the intervention. RESULTS: A lower prevalence of frailty was observed in the IG compared with the CG according to Fried's frailty phenotype, Short Physical Performance Battery, and Tilburg Frailty Indicator after 6 months (p < .05). There was a decline in the CG on the Barthel Index after 12 months (p < .05), whereas score was maintained in the IG. Both groups experienced a similar number of falls before and after the intervention (p > .05), but during the 6-month intervention period, fewer falls were observed in the IG than the CG (p < .05). Lower overall mortality was observed 12 months after starting the intervention for the IG than the CG (1 vs 6, respectively; p = .05). CONCLUSION: Individualized and progressive multicomponent exercise at moderate intensity seems to be effective to prevent falls and reduce frailty and mortality.
Exercise/physiology , Frail Elderly/statistics & numerical data , Nursing Homes , Accidental Falls/prevention & control , Aged , Female , Humans , Male , Mortality , Single-Blind Method , Spain , Surveys and Questionnaires
Introducción: La adaptación y validación al euskera de pruebas para la evaluación del deterioro cognitivo avanzado es una necesidad no cubierta para personas mayores vascoparlantes. El presente trabajo realiza el estudio de validación al euskera de la escala Severe Mini Mental State Examination (SMMSE-eus). Material y métodos: En el estudio participaron 109 sujetos con demencia avanzada (MEC<15) clasificados según la escala de Deterioro global (GDS) con GDS 5-7 y que dominaban tanto el euskera como el castellano. Resultados: Los resultados mostraron que el SMMSE-eus muestra una alta consistencia interna (α=0,92), una buena fiablidad test-restest (r=0,88; p<0,01) y una alta fiabilidad interjueces (CCI=0,99; p<0,00) tanto para la puntuación global como para cada uno de los ítems. Conclusiones: Tanto la alta consistencia interna como el alto nivel de fiabilidad interjueces y los resultados obtenidos en el test-retest hacen del SMMSE-eus un instrumento apropiado como escala breve en la valoración del deterioro cognitivo grave de personas vascoparlantes. Por ello el SMMSE-eus puede ser considerado válido, fiable y una alternativa importante para evaluar en su lengua materna, en este caso en euskera, la capacidad cognitiva en personas con demencia avanzada
Introduction: Adaptation and validation to the Basque language of tests to assess advanced cognitive impairment is a not covered need for Basque-speaking people. The present work shows the validation of the Basque version of the Severe Mini Mental State Examination (SMMSE). Material and methods: A total of 109 people with advanced dementia (MEC<15) took part in the validation study, and were classified as GDS 5-7 on the Geriatric Depression Scale (GDS). All participants were Spanish-Basque bilingual. Results: It was shown that SMMSE-eus has a high internal consistency (alpha=0.92), a good test-retest reliability (r=0.88; P<.01), and a high inter-rater reliability (CCI=0.99; P<.00) for the overall score, as well as for each item. Conclusions: Both the high internal consistency and inter-rater reliability, and to a lesser extent, test-retest reliability, made the SMMSE-eus a valid test for the brief assessment of cognitive status in people with advanced dementia in Basque-speaking people. For this reason, the SMMSE-eus is a usable and reliable alternative for assessing Basque-speaking people in their mother-tongue, or preferred language
Humans , Male , Female , Aged , Aged, 80 and over , Cognition Disorders/diagnosis , Dementia/diagnosis , Psychological Tests/statistics & numerical data , Severity of Illness Index , Psychometrics/instrumentation , Reproducibility of Results , Reproducibility of Results , Multilingualism
INTRODUCTION: Adaptation and validation to the Basque language of tests to assess advanced cognitive impairment is a not covered need for Basque-speaking people. The present work shows the validation of the Basque version of the Severe Mini Mental State Examination (SMMSE). MATERIAL AND METHODS: A total of 109 people with advanced dementia (MEC<15) took part in the validation study, and were classified as GDS 5-7 on the Geriatric Depression Scale (GDS). All participants were Spanish-Basque bilingual. RESULTS: It was shown that SMMSE-eus has a high internal consistency (alpha=0.92), a good test-retest reliability (r=0.88; P<.01), and a high inter-rater reliability (CCI=0.99; P<.00) for the overall score, as well as for each item. CONCLUSIONS: Both the high internal consistency and inter-rater reliability, and to a lesser extent, test-retest reliability, made the SMMSE-eus a valid test for the brief assessment of cognitive status in people with advanced dementia in Basque-speaking people. For this reason, the SMMSE-eus is a usable and reliable alternative for assessing Basque-speaking people in their mother-tongue, or preferred language.
Cognition Disorders/diagnosis , Mental Status and Dementia Tests , Aged , Aged, 80 and over , Cognition Disorders/etiology , Dementia/complications , Female , Humans , Language , Male , Severity of Illness Index , Spain
La enfermedad pulmonar obstructiva crónica (EPOC) se caracteriza por una obstrucción progresiva y escasamente reversible al flujo aéreo. La pérdida de peso es una complicación frecuente en estos pacientes y un factor determinante de su capacidad funcional, estado de salud y mortalidad. La intervención en los ancianos con EPOC ha de ir precedida de una valoración que identifique el estado nutricional, los factores de riesgo y los objetivos terapéuticos. Las recomendaciones dietéticas deben contener proporciones adecuadas de macro- y micronutrientes pararecuperar o mantener el estado nutricional y evitar complicaciones. Individualizar el tratamientoes muy importante para mejorar la calidad de vida de estos pacientes (AU)
Chronic obstructive pulmonary disease (COPD) is characterized by progressive and partially reversible airway obstruction. Weight loss is a frequently occurring complication in patients with COPD and is a determining factor of functional capacity, health status and mortality. For elderly patients with COPD, nutrition therapy is initiated after the evaluation of the nutritional state of the patient, which identifies nutritional risk, there by allowing the proper level of treatment to be established. The prescribed diet should contain appropriate proportions of macronutrients and micronutrients in order to regain or maintain the proper nutritional state and to avoid complications. In the treatment of elderly patients with COPD, individualized nutrition therapy is extremely important and has been shown to be fundamental to improving quality of life (AU)
Humans , Male , Female , Aged , Pulmonary Disease, Chronic Obstructive/complications , Nutrition Disorders/diet therapy , Nutrition Assessment , Nutritional Support/methods
