[Implementation of a best practice guideline for the prevention of falls: Perception among hospitalized patients and its caregivers]. / Implantación de una guía de buenas prácticas para la prevención de caídas: percepción de los pacientes hospitalizados y sus cuidadores.

OBJECTIVE: To analyze the influence that the implementation of a fall prevention Best Practice Guideline (BPG) could have on the perception of patients and their caregivers about the utility of the activities implemented, about the care provided during admission and the adherence (the level of follow-up) to the recommendations received at discharge. MATERIAL AND METHOD: Design. Quasi-experimental study. Patients >65 years admitted≥48h to the Medical Area of the General Hospital of Albacete. SAMPLE: 104 subjects (consecutive sampling January-March 2013). Experimental group (EG). Patients admitted to BPG implementation units. Control group (CG). Usual care units. VARIABLES: Sociodemographic characteristics; previous and during admission falls, cognitive status (Pfeiffer); independence in daily life activities (ADLs); satisfaction with care and information provided, utility perceived, adherence to recommendations at discharge. DATA SOURCES: Interview and clinical history. Statistical analysis (SPSS 15.0). Descriptive and bivariant. Relative Risk. CI95%. RESULTS: 104 patients, EG 46.2% (48) and CG 53.8% (56). Women 51.9%, average age 79.9 years (s.d.=7.8). Pfeiffer 4,3 (s.d.=3.7). Previous falls 31.1%. In process, 1 fall in each group. There were statistically significant differences between EG/CG: age, cognitive status and independence in ADLs. In the EG was higher the percentage of perception about the usefulness of the recommendations to prevent falls (P<.001), greater adherence to them (P=0.0002), and to be very or quite satisfied with the information (P<.00004) and care received (P=.002). CONCLUSION: To implement recommendations according to an Evidence-based BPG to prevent falls in older people has shown, in users and caregivers, greater satisfaction, better perception of its usefulness and greater adherence to the recommendations.

Intervención educativa para prevenir incontinenciaen ancianos con fractura de cadera ECA: resultados preliminares / No disponible

Evaluar la efectividad de una intervención educativa para reducir la incidencia de incontinencia en pacientes >65 años confractura de cadera. Diseño: Ensayo clínico aleatorio. Muestreo consecutivo con asignación aleatoria a los grupos experimental y control(enmascaramiento de la secuencia de aleatorización). En el grupo experimental se realiza la intervención educativa «Entrenamiento delhábito urinario» (taxonomía NIC) en el posoperatorio, reforzando la enseñanza al paciente y cuidador con un folleto de diseño propio.Se evalúa el desarrollo de incontinencia urinaria a los tres y seis meses tras el alta. En los 45 sujetos incluidos hasta junio, la incidencia deincontinencia urinaria a los 6 meses en el grupo control ha sido del 46,7%, y en el grupo experimental del 28,6%; RR=0,61 [IC 95% 0,23-1,65]. Prevenir la incontinencia evita sufrimiento al paciente, disminuye la carga del cuidador y el gasto (AU)

To evaluate the effectiveness of an educational intervention to reduce the incidence of incontinence in pacientes >65 years withhip fracture. Design: Random clinical test. Consecutive sampling with experimental random assignment for the groups and control (maskingof the sequence of randomization). In the experimental group the educational intervention «Urinary habit Training» (taxonomy NIC) inthe postoperative is carried out, reinforcing the teaching to the patient and carer with a leaflet of own design. The development of urinaryincontinence in the three and six months after the discharge is evaluated. In the 45 individuals included until June, the incidence of urinaryincontinence at the 6 months in the control group has been of 46.7%, and in the experimental group of 28.6%; RR=0,61 [IC 95% 0.23-1.65]. To prevent the incontinence saves suffering to the patient, decreases the burden of the carer and the expense (AU)

Independencia para actividades de la vida diaria en ancianos previamente autónomos intervenidos por fractura de cadera secundaria a una caída tras 6 meses de evolución / Independence in activities of daily living 6 months after surgery in previously independent elderly patients with hip fracture caused by a fall

Objetivo. Medir la recuperación de la independencia para actividades de la vida diaria (AVD) en ancianos independientes y sin deterioro cognitivo que han tenido fractura de cadera secundaria a caída a los 6 meses tras intervención quirúrgica. Método. Estudio analítico, longitudinal, prospectivo, de seguimiento de una cohorte. Inclusión: sujetos previamente independientes para las AVD o con dependencia leve, sin deterioro del estado mental. Muestreo consecutivo. Variables: edad, sexo, lugar de residencia, tipo de fractura, estado mental (SPMSQ de Pfeiffer), independencia para AVD (según índice de Barthel [IB]) previa y a los 6 meses de la caída. Resultados. Se han incluido 207 pacientes, siendo más frecuente fue el sexo femenino (74,4%) y la fractura pertrocantérea (45,9%). La media de edad fue 80,17 años (desviación estándar [DE] = 6,95), el 7,7% estaba institucionalizado. A los 6 meses de la intervención quirúrgica, la media del IB fue de 73,37 (DE = 26,76) (antes de la caída era de 90,05); un 16,8% presentó incontinencia urinaria (previa 5,9%); un 59,2% caminó sin ayuda (previo 82,4%) y un 24,6% subía escaleras sin ayuda (previo 50,7%). Un 64,6% (previamente, un 82,1%) recuperó la capacidad de caminar por la calle. Hubo peor recuperación de la independencia en las personas institucionalizadas, en los que no eran capaces de caminar por la calle previamente a la fractura y en los que tenían leve deterioro intelectual, de forma estadísticamente significativa. Conclusiones. Sólo un 33,6% recuperó o superó su nivel de independencia previo en los 6 meses transcurridos

Objective. To measure recovery of independence in activities of daily living (ADL) 6 months after surgery in elderly patients (previously independent and without cognitive impairment) with hip fracture caused by a fall. Method. We performed a longitudinal, prospective cohort study of patients who were previously independent for ADL, or had mild dependence, and who showed no cognitive impairment. Consecutive sampling was performed. The variables studied were age, sex, habitual residence, type of hip fracture, mental status (SPMSQ Pfeiffer), and independence in ADL (according to Barthel Index [BI]) prior to the fall and 6 months after the fall. Results. The study included 207 patients. There was a predominance of female sex (74.4%) and pertrochanteric fractures (45.9%). The mean age was 80.17 years old (SD = 6.95), and 7.7% were institutionalized. Six months after surgery, the mean BI score was 73.37 (SD = 26.76) (versus 90.05 before the fall), 16.8% showed urinary incontinence (versus 5.9%), 59.2% walked without assistance (versus 82.4%) and 24.6% climbed stairs unaided (versus 50.7%). The ability to walk down the street was regained in 64.6% (versus 82.1% before the fall). Recovery of autonomy for ADL was statistically significantly lower in patients unable to walk outdoors, who were institutionalized or who had mild cognitive impairment before the fall. Conclusions. Only 33.6% of patients regained prior levels of autonomy 6 months after surgery