Older People Living Alone: A Predictive Model of Fall Risk.

Falls in older people are a result of a combination of multiple risk factors. There are few studies involving predictive models in a community context. The aim of this study was to determine the validation of a new model for predicting fall risk in older adults (65+) living alone in community dwellings (n = 186; n = 117) with a test-retest reliability study. We consider in the predictive model the significant factors emerged from the bivariate analysis: age, zone, social community resources, physical exercise, self-perception of health, difficulty to keep standing, difficulty to sit and get up from a chair, strain to see, use of technical devices, hypertension and number of medications. The final model explained 28.5% of the risk of falling in older adults living alone in community dwellings. The AUC = 0.660 (se = 0.065, IC 95% 0.533-0.787, p = 0.017). The predictive model developed revealed a satisfactory discriminatory performance of the model and can contribute to clinical practice, with respect to the evaluation of risk of falling in this frailty group and preventing falls.

Caídas en personas mayores que viven solas: el papel de los factores individuales, sociales y medioambientales / Falls in older persons living alone: The role of individual, social and environmental factors

Objetivo: Identificar la prevalencia y los factores de riesgo de las caídas de las personas mayores (+ 65 años) que viven solas. Método: Se trata de un estudio descriptivo y transversal que incluyó a 186 participantes, de 65 años o más, que vivían solos en una vivienda comunitaria. Resultados: La prevalencia de caídas fue del 80,1% (IC del 95%: 74,1-85,8). Considerando los últimos 3 meses, la prevalencia de caídas se redujo al 22,2% (IC del 95%: 17,5-29,9) y el número de caídas reportadas fue de 2,4 (desviación estándar = 2,1). La mayoría de las caídas fueron accidentales (n = 74, 59,7%), seguidas de los mareos (n = 15, 12,1%), y casi el 50% se produjo por la mañana (n = 53, 45,3%). Considerando el lugar donde se produjeron las caídas, 70 (57,4%) se produjeron en casa (36,1% en el interior y 21,3% en el exterior), 41 en la calle (33,6%) y solo 11 (9,0%) en un lugar público (4,1% en el interior y 4,9% en el exterior). Tras la caída, el 30,9% de los participantes modificó su vida cotidiana como resultado de la misma. Conclusiones: Las caídas entre los adultos mayores son un problema multifactorial que requiere intervenciones integradas y multiprofesionales. La edad avanzada, el hecho de vivir solo en una zona urbana con recursos insuficientes, la reducción de la actividad física y la mala percepción de uno mismo son factores asociados a un mayor riesgo de caídas. Del mismo modo, las personas mayores que tienen dificultades para permanecer de pie, sentarse y levantarse de una silla, además de ser hipertensas y tomar un elevado número de medicamentos, están asociadas a un alto riesgo de caídas. Las investigaciones futuras deberán desarrollar y enfatizar más estudios nacionales para confirmar estos resultados.(AU)

Objective: To identify the prevalence and the risk factors of falling in older people (65+) living alone. Method: This is a descriptive and transversal study which included 186 participants, aged 65 + living alone in community-dwelling. Results: The prevalence of falls was 80.1% (95% CI 74.1-85.8). Considering the last 3 months, the prevalence of falls reduced to 22.2% (95% CI 17.5-29.9) and the number of falls reported was 2.4 (SD=2.1). Most falls were accidental (n=74, 59.7%), followed by dizziness (n=15, 12.1%) and almost 50% occurred in the morning (n=53, 45.3%). Considering the local where the falls occurred, 70 (57.4%) were at home (36.1% inside and 21.3% outside), 41 on the street (33.6%) and only 11 (9.0%) in a public place (4.1% inside and 4.9% outside). After the fall, 30.9% of the participants changed daily life after an event. Conclusions: Falls among older adults is a multifactorial problem that requires integrated and multiprofessional interventions. Older age, living alone in an urban area, with insufficient resources, reduced physical activity and a poor self-perception are factors associated with a higher risk of falling. Similarly, older people who have difficulty standing, sitting and rising from a chair, as well as being hypertensive and taking a high number of medications are associated with a high risk of falling. Future research should develop and emphasize more national studies to confirm these results.(AU)

Falls in older persons living alone: the role of individual, social and environmental factors.

OBJECTIVE: To identify the prevalence and the risk factors of falling in older people (65+) living alone. METHOD: This is a descriptive and transversal study which included 186 participants, aged 65+ living alone in community-dwelling. RESULTS: The prevalence of falls was 80.1% (95% CI 74.1-85.8). Considering the last 3 months, the prevalence of falls reduced to 22.2% (95% CI 17.5-29.9) and the number of falls reported was 2.4 (sd = 2.1). Most falls were accidental (n = 74, 59.7%), followed by dizziness (n = 15, 12.1%) and almost 50% occurred in the morning (n = 53, 45.3%). Considering the local where the falls occurred, 70 (57.4%) were at home (36.1% inside and 21.3% outside), 41 on the street (33.6%) and only 11 (9.0%) in a public place (4.1% inside and 4.9% outside). After the fall, 30.9% of the participants changed daily life after an event. CONCLUSIONS: Falls among older adults is a multifactorial problem that requires integrated and multiprofessional interventions. Older age, living alone in an urban area, with insufficient resources, reduced physical activity and a poor self-perception are factors associated with a higher risk of falling. Similarly, older people who have difficulty standing, sitting and rising from a chair, as well as being hypertensive and taking a high number of medications are associated with a high risk of falling. Future research should develop and emphasize more national studies to confirm these results.

Sustainability evaluation of concretes with mixed recycled aggregate based on holistic approach: Technical, economic and environmental analysis.

This research combines technical, economic and environmental analysis of the use of recycled aggregates from construction and demolition wastes in concrete production. Firstly, an experimental campaign to evaluate the effect of recycled aggregate on mechanical properties was developed. The mixture designs studied were: a reference concrete (without recycled aggregate), two concretes with 20% and 100% replacement of coarse natural aggregate by recycled concrete aggregate; and three concretes with 20, 50 and 100% replacement of coarse natural aggregate by mixed recycled aggregate. To analyze their technical feasibility, these concretes were made in the laboratory and in a concrete plant. The economic viability was also studied indicating the additional costs incurred due to the utilization of recycled aggregate in different economic scenarios. Finally, the differences in environmental impacts were analyzed for each concrete. For this purpose, energy consumption, global warming, eutrophication, acidification, photochemical ozone creation, waste generation, and abiotic depletion were accounted. 20% replacement of recycled concrete aggregates does not cause practically variations in the cost or the environmental loads, only a reduction of waste generation and abiotic depletion of 8% and 10.6% respectively. In contrast, the use of 100% replacement by mixed aggregates may increase the global warming indicator an 11% when double transport distance is assumed. But in exchange, the waste generation decreases 35% and the abiotic depletion 50%. Aggregate transport distance is a key factor that will determine the cost, energy consumption, and global warming of the mixed recycled aggregate.

Vivências dos enfermeiros sobre morte e morrer em cuidados intensivos: Uma reflexão fenomenológica / Nurses' experiences about death and dying in intensive care: A phenomenological reflection / Vivencias de los enfermeros sobre muerte y morir en cuidados críticos: Una reflexión fenomenológica

CONTEXTO: Na atualidade a morte tem vindo a ser remetida para o hospital em detrimento do espaço íntimo do lar. As unidades de cuidados intensivos são altamente tecnológicas, abertas e destituídas de privacidade, onde a morte é um fenómeno frequente, algumas vezes inesperado, mas quase sempre traumático. Neste contexto, o enfermeiro é confrontado com diversos dilemas e emoções que podem comprometer a sua saúde mental e condicionar os cuidados que presta a alguém em final de vida. OBJETIVOS: Explorar e descrever a experiência da morte e do morrer vivida pelos enfermeiros numa unidade de cuidados intensivos e de compreender o significado que lhe atribuem. MÉTODOS: Optámos pela realização de um estudo qualitativo, exploratório e descritivo, de base fenomenológica. Os participantes (N=25) foram selecionados por conveniência tendo a amostra sido atingida por saturação teórica. Os dados foram recolhidos com recurso à entrevista não estruturada e analisados segundo a reflexão fenomenológica das narrativas, segundo a perspetiva de van Manen (2016). RESULTADOS: Da análise das narrativas emergiram cinco temas: condicionantes da perceção dos enfermeiros sobre a morte e o morrer; práticas e contextos de cuidados ao doente em morte iminente; práticas e contextos de cuidados à família; mecanismos de adaptação; e conflitos internos na gestão dos cuidados. CONCLUSÕES: Estes resultados permitem uma compreensão mais abrangente do objeto em estudo e orientam as intervenções dos enfermeiros para um cuidado centrado na pessoa, digno e confortador para a família e doentes que se confrontam com a morte neste e noutros contextos.

BACKGROUND: Death is now being sent to the hospital at the expense of the intimate space of the home. Intensive care units are a highly technological space, open and deprived of privacy, where death is a frequent phenomenon, sometimes unexpected, but almost always traumatic. In this context, the nurse is confronted with diverse dilemmas and emotions that can compromise her mental health and consequently, condition the health care that gives to someone who experiences the end-of-life. AIM: To explore and describe the experience of death and dying experienced by nurses in an intensive care unit, and understands the meaning attributed to it. METHODS: We opted for a qualitative study, exploratory and descriptive, of phenomenological basis. The participants (N=25) were selected by convenience, and the sample being reached by theoretical saturation. The results were collected with the unstructured interview and analysed according to phenomenological reflection of the narratives in light of the prospect of van Manen (2016). RESULTS: From the analysis of the narratives emerged five (5) themes: conditioners of nurses' perception of death and dying; practices and contexts of patient care in imminent death; practices and contexts of care to the family; mechanisms of adaptation; and internal conflicts in the management of care. CONCLUSIONS: These results allow a broader understanding of the object under study and can guide the nurses´ interventions towards more person-centered, more dignified and more comforting care for the family and patients facing death in this and other contexts.

CONTEXTO: En la actualidad la muerte ha sido remitidas al hospital en detrimento del espacio íntimo del hogar. Las unidades de cuidados críticos son altamente tecnológicas, abiertas y carentes de privacidad, donde la muerte es un fenómeno frecuente, inesperado e traumático. En este contexto, el enfermero se enfrenta a diversos dilemas y emociones, que pueden comprometer su salud mental y, consecuentemente, condicionar los cuidados que presta a alguien en final de la vida. OBJETIVOS: Explorar y describir la experiencia de la muerte y del morir vivida por los enfermeros en cuidados críticos, y comprender el significado que le atribuyen. METODOLOGÍA: Optamos por la realización de un estudio cualitativo, exploratorio y descriptivo, de base fenomenológica. Los participantes (N=25) fueron seleccionados por conveniencia teniendo la muestra se ha alcanzada por saturación teórica. Los datos fueron recogidos con recurso a la entrevista no estructurada y analizados según la reflexión fenomenológica de las narrativas, según la perspectiva de van Manen (2016). RESULTADOS: Del análisis de las narrativas surgieron cinco temas: condicionantes de la percepción de los enfermeros sobre la muerte y el morir; prácticas y contextos de atención al enfermo en muerte inminente; prácticas y contextos de cuidado de la familia; mecanismos de adaptación; y conflictos internos en la gestión del cuidado. CONCLUSIONES: Estos resultados permiten una comprensión más amplia del objeto en estudio y pueden orientar las intervenciones de los enfermeros, para un cuidado más centrado en la persona, y más digno para la familia y enfermos, que enfrentan la muerte.

Training informal caregivers to care for older people after stroke: A quasi-experimental study.

AIMS: This study aimed at evaluating whether training on practical skills involved in providing care reduces the burden experienced by informal caregivers and improves their general health condition. BACKGROUND: A substantial number of informal caregivers lack skills to deliver poststroke assistance to older people after hospital discharge, which leads to burden situations as well as mental and physical health deterioration of the former. DESIGN: A quasi-experimental design. METHODS: This study involved 174 informal caregivers of older people who overcame a stroke. The control group (N = 89) received the usual type of care delivered in healthcare units. The experimental group (N = 85) adopted the InCARE programme for 1 week (T0), 1 month (T1) and 3 (T2) months and received telephone support by counselling caregivers on the subsequent 3rd, 6th, 8th and 10th weeks to hospital discharge. It aimed at facilitating the caregiver's adjustment to the demands of a poststroke stage and at increasing knowledge and practical skills to support the decision-making. Data collection occurred between February-December 2014 at the Community Home Care Services in northern Portugal. RESULTS: The experimental group obtained significantly better results regarding practical skills as well as lower burden levels and a better general mental health condition when compared with the control group 1 (T1) and 3 (T2) months after intervention. CONCLUSION: Findings suggest that our programme improved practical skills, helped reduce burden levels with better scores and improvement regarding general mental health condition of informal caregivers.

Concretes and mortars with waste paper industry: Biomass ash and dregs.

This article describes a study on the viability of using waste from the paper industry: biomass boiler ash and green liquor dregs to fabricate mortars and concretes. Both types of ash were characterized by obtaining their chemical and mineralogical composition, their organic matter content, granulometry, adsorption and other common tests for construction materials. Seven different mortars were fabricated, one for reference made up of cement, sand, and water, three in which 10, 20, or 30% of the cement was replaced by biomass ash, and three others in which 10, 20, or 30% of the cement was replaced with dregs. Test specimens were fabricated with these mortars to conduct flexural and compression tests. Flexural strength is reduced for all the mortars studied. Compressive strength increases for the mortars fabricated with biomass ash and decreases for the mortar with dregs. Finally, 5 concretes were made, one of them as a reference (neither biomass ash nor dregs added), two of them with replacements of 10 and 20% of biomass ash instead of cement and another two with replacements of 10 and 20% of dregs instead of cement. The compressive and tensile splitting strength increase when a 10% of ash is replaced and decrease in all the other cases. The modulus of elasticity always decreases.

Development and psychometric properties of ECPICID-AVC to measure informal caregivers' skills when caring for older stroke survivors at home.

INTRODUCTION: Informal caregivers provide a significant part of the total care needed by dependent older people poststroke. Although informal care is often the preferred option of those who provide and those who receive informal care, informal caregivers often report lack of preparation to take care of older dependent people. This article outlines the development and psychometric testing of informal caregivers' skills when providing care to older people after a stroke - ECPICID-AVC. DESIGN: Prospective psychometric instrument validation study. METHODS: Eleven experts participated in a focus group in order to delineate, develop and validate the instrument. Data were gathered among adult informal caregivers (n = 186) living in the community in Northern Portugal from August 2013 to January 2014. RESULTS: The 32-item scale describes several aspects of informal caregiver's skills. The scale has eight factors: skill to feed/hydrate by nasogastric feeding, skill to assist the person in personal hygiene, skill to assist the person for transferring, skill to assist the person for positioning, skill to provide technical aids, skill to assist the person to use the toilet, skill to feed/hydrate and skill to provide technical aids for dressing/undressing. Analysis demonstrated adequate internal consistency (Cronbach's alpha = 0.83) and good temporal stability 0.988 (0.984-0.991). CONCLUSION: The psychometric properties of the measurement tool showed acceptable results allowing its implementation in clinical practice by the nursing community staff for evaluating practical skills in informal caregivers when providing care to older stroke survivors living at home.

Intervention in informal caregivers who take care of older people after a stroke (InCARE): study protocol for a randomised trial.

AIM: This study aims at describing an intervention based on informal caregivers' skills when taking care of older people after a stroke (InCARE). BACKGROUND: Most informal caregivers feel unprepared to deliver assistance in activities of daily living at home. This lack of preparedness can lead to misconceptions, burden and affect their health, which, consequently, may imply hospital readmissions or early institutionalization of the older adults. DESIGN: A single blinded randomised trial. METHODS: This study will recruit 198 dyads, comprising old stroke survivors and their caregivers, who will be divided into two groups: intervention and control (protocol approved in May 2013). INCLUSION CRITERIA: (informal caregivers) absence of cognitive impairment; resident in the Cávado Region; to return the informed consent (older people) are over 65 years of age; have had a first stroke and; be dependent on at least one of the self-care activities post hospital discharge. PRIMARY OUTCOME: informal caregivers' skills. SECONDARY OUTCOMES: include burden and Health Quality of Life in informal caregivers; functionality, hospital readmission and institutionalization of older people stroke survivors, measured 1 and 3 months after InCARE programme. DISCUSSION: The InCARE programme will highlight new ways to understand the feasibility of a large trial, which supports caregivers who take care of older people after a stroke. It will be expected that the level of burden decreases, thus helping informal caregivers enhance their quality of life. Also, it is expected that older people's functionality will be improved and that hospital readmission or institutionalization may be avoided.

Estimation of the annual production and composition of C&D Debris in Galicia (Spain).

One of the key aspects that must be taken into consideration within the framework of Sustainable Construction is the management of Construction and Demolition (C&D) Debris. As for other types of waste, specific handling procedures are required to manage C&D Debris; these include reduction, reuse, recycling, and if all other possibilities fail, recovery or disposal. For public planning strategies aimed at the management of C&D Debris to be effective, it is first necessary to have specific knowledge of the type of waste materials generated in a particular region. After verifying that the methods available to determine the production and composition of C&D Debris are limited, this paper presents a procedure to ascertain the production and composition of C&D Debris, in any region. The procedure utilizes data on the surface areas of newly constructed buildings, renovations and demolitions, which are estimated from available data for recent years, as well as information on the quantity of debris generated per surface area in any type of construction site, which is obtained from recently executed constructions or from the ground plans of older buildings. The method proposed here has been applied to Galicia, one of Spain's autonomous communities, for which the quantity and composition of C&D Debris have been estimated for the horizon year 2011.