Anxiety and fear of death in Health Professionals in Hospital Emergency services in Aragón.

OBJECTIVES: To describe the levels of anxiety in the face of death in professionals from hospital emergency services in Aragon. To analyse its association with sociodemographic, perception and work-related variables. METHODOLOGY: Observational, descriptive and cross-sectional study. The population and context of the study were health professionals in the hospital emergency services of Aragon. A non-probabilistic sampling selection was applied (n = 230 participants). The "Collet-Lester-Fear-of-Death-Scale" instrument was introduced to measure anxiety about death. The data was collected with a self-applied telematic questionnaire. Descriptive and inferential statistics were performed to analyse the association between the study variables. RESULTS: Mean values obtained for anxiety in the face of death were 94.58 ±â€¯21.66 with a CI of 95%: (91.76-97.39) (range of scale: 28-140 points). A significant association was identified with the professional category variables (physicians, medical residents, nurses, and auxiliary nurses) (p: 0,006), gender (p: 0.001), level of training in emotional self-management (p: 0.03), self-perceived level of mental health (p: 0.07) and perception of lack of support from palliative care/mental health professionals (p: 0.006). This association was not obtained with the variables age (Sig: 0.558), total professional experience (p: 0.762) and in emergencies (p: 0.191). CONCLUSION: The levels of anxiety in the face of death in the emergency hospital services are lower than those presented in other hospital units. Variables such as professional category, degree of training in emotional self-management and self-perceived level of mental health are related to levels of anxiety in the face of death and their study requires further work.

Influence of Palliative Care Training on Nurses' Attitudes towards End-of-Life Care during the COVID-19 Pandemic in Spain.

AIM: This study aims to assess the influence of training on nurses' attitudes toward end-of-life care during the COVID-19 pandemic alarm state in Spain. DESIGN: Cross-sectional descriptive study. Data collection was carried out by means of an ad hoc questionnaire using Google Forms in April and May 2020. The score of attitudes toward end-of-life care was used, to which sociodemographic variables and training in palliative care were added. METHODS: Data were collected from 238 nursing professionals who had cared for COVID-19 and non-COVID-19 adult patients at the end-of-life stage in a hospital or nursing home. RESULTS: Results showed that 51% of the nurses in the sample had training in palliative care. However, the percentage decreased to 38.5% among those who cared for COVID-19 patients and to 44.5% in those who cared for non-COVID-19 patients. In relation to attitudes about end-of-life care, more positive attitudes and a higher mean score were found in the trained group. CONCLUSIONS: Palliative care training is a key element in end-of-life care and is even more important in times of COVID-19. IMPACT: Although end-of-life accompaniment has been studied, few studies have included the influence of training on this during the pandemic. This study identifies key elements of accompaniment and training in a comparison of COVID-19 and non-COVID-19 patients during the pandemic. In relation to attitudes toward end-of-life care, the results showed a more positive attitude and a higher mean score in the trained group (3.43 ± 0.37 versus 3.21 ± 0.32), the difference being statistically significant (p < 0.001).

Características epidemiológicas de los pacientes fallecidos en los servicios de urgencias hospitalarios del sistema aragonés de salud y su relación con el índice de comorbilidad / Deaths in hospital emergency departments in Aragon: patient characteristics and association with comorbidity

OBJETIVO: Conocer las características clínico/epidemiológicas de los pacientes fallecidos en los servicios de urgencias (SU) de Aragón (España) y su relación con el índice de comorbilidad de Charlson. MÉTODO: Estudio observacional descriptivo y transversal realizado con datos recogidos entre los años 2013-2017. Las variables se obtuvieron de la base de datos "Puesto clínico hospitalario" (PCH) y estas se relacionaron con el índice de comorbilidad de Charlson mediante el estadístico ji cuadrado (ajustado a un nivel de significación de p < 0,05). RESULTADOS: Se obtuvo un valor medio de 6,58 en el índice de Charlson, con un total de 1.177 pacientes con valores mayores o igual a 7 puntos. La edad media fue de 81,1 años (DE: 12,1), con un 52,1% de hombres. El tiempo medio de fallecimiento en el servicio fue de 639 (DE: 777) minutos. Se encontró una relación estadísticamente significativa entre la variable Índice de Charlson con la mayoría de variables de estudio, exceptuando el sexo y año de fallecimiento. CONCLUSIONES: Los pacientes fallecidos en los SU de Aragón poseen elevados índices de comorbilidad. Entre estos se observa un grupo importante de pacientes con una elevada edad, alta frecuencia de patología crónica avanzada y polifarmacia. Se resalta la necesidad de incorporar estrategias de atención crónica y paliativa en los SU para este gru¬po cada vez más numeroso de pacientes por el progresivo envejecimiento poblacional

OBJECTIVE: To describe the clinical and personal characteristics of patients who died in hospital emergency departments in Aragon, Spain, and explore associations with the Charlson Comorbidity Index (CCI). METHODS: Descriptive, observational, cross-sectional study of deaths between 2013 and 2017. Data was extracted from the clinical database for hospital emergencies (official name, Puesto Clínico Hospitalario). Associations between variables and the CCI were explored with the χ2 test (significance level P<.05). RESULTS: The mean CCI was 6.58. A total of 1177 patients had CCIs of 7 or higher. The mean age was 81.1 years, and 52.1% were men. The mean (SD) time until death in the emergency department was 639 (777) minutes. The CCI was significantly associated with most clinical and personal variables studied, with the exception of sex and year. CONCLUSIONS: Patients who die in Aragon's emergency departments have high levels of comorbidity. A large proportion of patients are of advanced age. Polypharmacy and advanced chronic conditions are common. We stress the need to implement emergency department approaches to ongoing and palliative care for this group, which is growing as the population ages

Deaths in hospital emergency departments in Aragon: patient characteristics and association with comorbidity. / Características epidemiológicas de los pacientes fallecidos en los servicios de urgencias hospitalarios del sistema aragonés de salud y su relación con el índice de comorbilidad.

OBJECTIVES: To describe the clinical and personal characteristics of patients who died in hospital emergency departments in Aragon, Spain, and explore associations with the Charlson Comorbidity Index (CCI). MATERIAL AND METHODS: Descriptive, observational, cross-sectional study of deaths between 2013 and 2017. Data was extracted from the clinical database for hospital emergencies (official name, Puesto Clínico Hospitalario). Associations between variables and the CCI were explored with the χ2 test (significance level P<.05). RESULTS: The mean CCI was 6.58. A total of 1177 patients had CCIs of 7 or higher. The mean age was 81.1 years, and 52.1% were men. The mean (SD) time until death in the emergency department was 639 (777) minutes. The CCI was significantly associated with most clinical and personal variables studied, with the exception of sex and year. CONCLUSION: Patients who die in Aragon's emergency departments have high levels of comorbidity. A large proportion of patients are of advanced age. Polypharmacy and advanced chronic conditions are common. We stress the need to implement emergency department approaches to ongoing and palliative care for this group, which is growing as the population ages.

OBJETIVO: Conocer las características clínico/epidemiológicas de los pacientes fallecidos en los servicios de urgencias (SU) de Aragón (España) y su relación con el índice de comorbilidad de Charlson. METODO: Estudio observacional descriptivo y transversal realizado con datos recogidos entre los años 2013-2017. Las variables se obtuvieron de la base de datos "Puesto clínico hospitalario" (PCH) y estas se relacionaron con el índice de comorbilidad de Charlson mediante el estadístico ji cuadrado (ajustado a un nivel de significación de p < 0,05). RESULTADOS: Se obtuvo un valor medio de 6,58 en el índice de Charlson, con un total de 1.177 pacientes con valores mayores o igual a 7 puntos. La edad media fue de 81,1 años (DE: 12,1), con un 52,1% de hombres. El tiempo medio de fallecimiento en el servicio fue de 639 (DE: 777) minutos. Se encontró una relación estadísticamente significativa entre la variable Índice de Charlson con la mayoría de variables de estudio, exceptuando el sexo y año de fallecimiento. CONCLUSIONES: Los pacientes fallecidos en los SU de Aragón poseen elevados índices de comorbilidad. Entre estos se observa un grupo importante de pacientes con una elevada edad, alta frecuencia de patología crónica avanzada y polifarmacia. Se resalta la necesidad de incorporar estrategias de atención crónica y paliativa en los SU para este grupo cada vez más numeroso de pacientes por el progresivo envejecimiento poblacional.

[Healthcare professionals' perceptions and confrontation at patients' end-of-life in emergency departments: A qualitative systematic review]. / Afrontamiento y percepción profesional en la atención al final de la vida en los servicios hospitalarios de emergencias. Una revisión sistemática cualitativa.

BACKGROUND: Emergency services are specialized in population's severe illness care. However, the increasing trend of chronic patients which in some cases require of palliative care, has lead to a higher influx of this type of patients in emergency services, thus growing the rate of deaths consequently. How is this fact perceived by the health professionals and which strategies they count on to face patients' death? The aim of this work was to deeply review the perception and the strategies to face patients' death in the end-of-life (EOL) at emergency services. METHODS: Systematic review of qualitative studies was made according to PRISMA statements. Research was performed in the following bibliographic databases: Pubmed, Web of Science, Scopus, EMBASE, CINAHL, VHL Regional portal, Cuiden, COCHRANE LIBRARY and JBI. Inclusion criteria were as follows: Physicians and Nurses with at least one year of working experience as health professionals, Pediatric care excluded. Methodological quality, data extraction and its inclusion process was made in agreement with the tools described in JBI. RESULTS: The extracted findings were structured and added in 4 thematic categories: 1) Priority of professional attention according to the causes and origin of patient's death; 2) Environmental barriers in the department hindering attention at the EOL; 3) professionals' emotions dealing with patients' death; 4) Professional strategies dealing with patient' death. CONCLUSIONS: Health care professionals (Physicians and nurses) face more efficiently patients' death when is caused by a critic disease than when is caused by chronic/palliative diseases. Environment and the lack of training have been identified as factors that difficult end-of-life attention in emergency services.

OBJETIVO: Los servicios de urgencias están especializados en la atención de afecciones agudo/críticas de la población, sin embargo, el aumento considerable de enfermedades crónicas que en algunos casos requieren cuidados paliativos ha generado una mayor afluencia de estos pacientes a los departamentos de emergencias (DE), produciéndose en ocasiones, la muerte en los mismos. ¿Cómo perciben y qué tipo de estrategias poseen los profesionales ante el fallecimiento de un paciente en éste servicio? El objetivo de este trabajo fue analizar la percepción y las estrategias de afrontamiento de los profesionales en la atención al final de la vida (FV) en los DE. METODOS: Revisión sistemática de estudios cualitativos cumpliendo los criterios de la Declaración PRISMA. La búsqueda se realizó en las bases bibliográficas: Pubmed, Web of Science, Scopus, EMBASE, CINAHL, VHL Regional Portal, Cuiden, COCHRANE LIBRARY y JBI. Los criterios de inclusión fueron: profesionales de medicina/ enfermería, con más de un año de experiencia. No se incluyó la atención pediátrica. La calidad metodológica, la extracción de los datos y el proceso de síntesis se realizó mediante las herramientas de la guía para revisiones sistemáticas cualitativas del JBI. RESULTADOS: Se estructuró los hallazgos extraídos en 4 categorías temáticas: 1) Prioridad de atención profesional según las causas/origen de la muerte; 2) Barreras ambientales en los DE que dificultan la atención al FV; 3) Emociones del profesional frente a la muerte de los pacientes; 4) Estrategias profesionales relacionadas con la muerte del paciente. CONCLUSIONES: Los profesionales sanitarios (médicos/enfermeras) afrontan de forma más eficaz los fallecimientos ocasionados por causas de origen aguda/críticas, frente las presentadas por causas crónico/paliativas. Las características del entorno y la falta de formación para el afrontamiento profesional se destacan como factores que dificultan la atención al FV en estos departamentos.

Assessment of the needs for palliative care in advanced chronic patients on discharge. / Valoración de la necesidad de atención paliativa de pacientes crónicos avanzados en el momento del alta hospitalaria.

OBJECTIVES: To describe the advanced chronic patients admitted to an internal medicine department and to identify whether they meet the criteria for the need for palliative care at the time of hospital discharge according to the NECPAL-CCOMS.ICO® instrument. MATERIAL AND METHODS: Observational, descriptive and cross-sectional study performed on patients admitted to the internal medicine department of the Hospital Clínico Universitario Lozano Blesa (Saragossa), with a diagnosis of advanced progressive chronic diseases, from May 1, 2017 to September 1, 2017 Variables: sex, age, advanced chronic disease, reason for admission, primary caregiver, origin (residence, address, etc.), number of readmissions in the previous year, existence of advance directives, disability of the patient, existence of order not to resuscitate, Charlson Index and all the variables contained in the NECPAL Instrument CCOMS-ICO ® VERSION 3.0 2016. The data collection was done when the patient was scheduled to be discharged, having resolved the acute circumstance that led to the admission. RESULTS: the sample size was 142 patients who met the inclusion criteria: diagnosis of disease advanced evolutionary chronic ages, Charlson Index ≥3 at the time the patient was scheduled to be discharged and signed their informed consent. The average age was 85.80 years and 50.7% were men. The average age of the women was higher than that of the men. The most prevalent advanced chronic disease was chronic heart disease. None of the patients had advance care directives in place.. Nutritional, functional, cognitive and severe dependence was determined in more than 50%. In more than 90% there was the presence of geriatric syndromes and persistent symptoms. The presence of emotional distress was also evident, as was the use of resources. CONCLUSIONS: A palliative approach in the care of chronicity would have a very positive impact on the quality of life of the patient and family, would positively influence health systems and would result in cost savings. Implementing the NECPAL CCOMS-ICO® instrument in the health services that serve high proportions of chronically ill patients, accompanied by training measures for health personnel and adaptation of resources, can introduce a qualitative and quantitative change that is very relevant in our the health system.

Afrontamiento y percepción profesional en la atención al final de la vida en los servicios hospitalarios de emergencias. Una revisión sistemática cualitativa / Healthcare professionals' perceptions and confrontation at patients' end-of-life in emergency departments: a qualitative systematic review

OBJETIVO: Los servicios de urgencias están especializados en la atención de afecciones agudo/críticas de la población, sin embargo, el aumento considerable de enfermedades crónicas que en algunos casos requieren cuidados paliativos ha generado una mayor afluencia de estos pacientes a los departamentos de emergencias (DE), produciéndose en ocasiones, la muerte en los mismos. ¿Cómo perciben y qué tipo de estrategias poseen los profesionales ante el fallecimiento de un paciente en éste servicio? El objetivo de este trabajo fue analizar la percepción y las estrategias de afrontamiento de los profesionales en la atención al final de la vida (FV) en los DE. MÉTODOS: Revisión sistemática de estudios cualitativos cumpliendo los criterios de la Declaración PRISMA. La búsqueda se realizó en las bases bibliográficas: Pubmed, Web of Science, Scopus, EMBASE, CINAHL, VHL Regional Portal, Cuiden, COCHRANE LIBRARY y JBI. Los criterios de inclusión fueron: profesionales de medicina/ enfermería, con más de un año de experiencia. No se incluyó la atención pediátrica. La calidad metodológica, la extracción de los datos y el proceso de síntesis se realizó mediante las herramientas de la guía para revisiones sistemáticas cualitativas del JBI. RESULTADOS: Se estructuró los hallazgos extraídos en 4 categorías temáticas: 1) Prioridad de atención profesional según las causas/origen de la muerte; 2) Barreras ambientales en los DE que dificultan la atención al FV; 3) Emociones del profesional frente a la muerte de los pacientes; 4) Estrategias profesionales relacionadas con la muerte del paciente. CONCLUSIONES: Los profesionales sanitarios (médicos/enfermeras) afrontan de forma más eficaz los fallecimientos ocasionados por causas de origen aguda/críticas, frente las presentadas por causas crónico/paliativas. Las características del entorno y la falta de formación para el afrontamiento profesional se destacan como factores que dificultan la atención al FV en estos departamentos

BACKGROUND: Emergency services are specialized in population's severe illness care. However, the increasing trend of chronic patients which in some cases require of palliative care, has lead to a higher influx of this type of patients in emergency services, thus growing the rate of deaths consequently. How is this fact perceived by the health professionals and which strategies they count on to face patients' death? The aim of this work was to deeply review the perception and the strategies to face patients' death in the end-of-life (EOL) at emergency services. METHODS: Systematic review of qualitative studies was made according to PRISMA statements. Research was performed in the following bibliographic databases: Pubmed, Web of Science, Scopus, EMBASE, CINAHL, VHL Regional portal, Cuiden, COCHRANE LIBRARY and JBI. Inclusion criteria were as follows: Physicians and Nurses with at least one year of working experience as health professionals, Pediatric care excluded. Methodological quality, data extraction and its inclusion process was made in agreement with the tools described in JBI. RESULTS: The extracted findings were structured and added in 4 thematic categories: 1) Priority of professional attention according to the causes and origin of patient's death; 2) Environmental barriers in the department hindering attention at the EOL; 3) professionals' emotions dealing with patients' death; 4) Professional strategies dealing with patient' death. CONCLUSIONS: Health care professionals (Physicians and nurses) face more efficiently patients' death when is caused by a critic disease than when is caused by chronic/palliative diseases. Environment and the lack of training have been identified as factors that difficult end-of-life attention in emergency services

Frailty and mortality or incident disability in institutionalized older adults: the FINAL study.

BACKGROUND: Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic. OBJECTIVES: To determine the association between frailty and mortality or incident disability in basic activities of daily living (BADL) in institutionalized Spanish older adults. DESIGN: Concurrent cohort study. SETTING: Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain. PARTICIPANTS: Of the 324 institutionalized adults older than 65 years enrolled at baseline, 21 (5.5%) were lost during the one-year follow-up. Of the 303 remaining, 63 (20.8%) died, 91 (30.0%) developed incident disability, and 140 (49.2%) were free of both events. 16 participants were not suitable for analysis due to incomplete data. MEASUREMENTS: Frailty was defined by the presence of three or more Fried criteria: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Incident disability in BADL was considered when new onset disability in bathing, grooming, toileting, dressing, eating or transferring was detected with the Barthel index. Logistic regression models were constructed adjusted for age, sex, body mass index (BMI), previous Barthel index and Minimental State Examination (MMSE), and high comorbidity (Charlson index ≥3). RESULTS: 287 participants with valid data. Mean age 84.2 (SD 6.8), with 187 (65.2%) women. 199 (69.3%) were frail, and 72 (25.1%) had high comorbidity. Mean BMI 27.6 (SD 5.2), Barthel index 53.4 (SD 37.1), and MMSE 14.2 (SD 9.7). At follow-up, 43 (21.6%) frail participants and 15 (17.0%) non-frail ones died. 73 (46.8%) frail participants and 16 (21.9%) non-frail ones developed incident disability in BADL (p<0.001). Frailty was associated with incident disability or mortality (OR 3.3; 95% CI 1.7-6.6) adjusted for all study covariables. CONCLUSION: In a cohort of institutionalized older adults, frailty was associated with mortality or incident disability in BADL.

Frailty in INstitutionalized older adults from ALbacete. The FINAL Study: rationale, design, methodology, prevalence and attributes.

BACKGROUND: Little is known about frailty in institutionalized older adults, and there are few longitudinal studies on this topic. OBJECTIVES: To determine the prevalence and attributes of frailty in institutionalized Spanish older adults. DESIGN: Cross-sectional analysis of basal data of a concurrent cohort study. SETTING: Two nursing homes, Vasco Núñez de Balboa and Paseo de la Cuba, in Albacete, Spain. PARTICIPANTS: 331 institutionalized adults older than 65 years. MEASUREMENTS: Frailty was defined by the presence of 3 or more Fried criteria and prefrailty by the presence of 1 or 2: unintentional weight loss, low energy, exhaustion, slowness, and low physical activity. Covariables were sociodemographic, anthropometric, functional, cognitive, affective and of comorbidity. Hospitalization, emergency visits and falls in the 6 previous months was recorded. Differences between non-frail and prefrail as one group and frail participants were analyzed using χ(2) tests, t-Student and logistic regression. RESULTS: Mean age 84.1 (SD 6.7), with 209 (65.1%) women. 68.8% were frail, 28.4% pre-frail, 2.8% non-frail, and in 2.2% three criteria were not available to determine frailty status. Women were more frequently frail than men (77.1% vs. 22.9%; p<0.001), and frail participants were older (85.1 vs. 82.3; p<0.001) than non-frail ones. Female sex (OR 2.7 95%CI 1.2-6.2), Barthel index (OR 2.2 95%CI 1.2-4.4), depression risk (OR 2.2 95%CI 1.0-4.9) and Short Physical Performance Battery scores (0.7 95%CI 0.6-0.8) were independently associated with frailty status. Frailty had a non-significant association with hospitalization (OR 1.9 95%CI 0.8-4.5) and emergency visits (OR 1.5 95%CI 0.7-3.2) in the previous 6 months. CONCLUSION: In a cohort of institutionalized older adults the prevalence of frailty was 68.8% and was associated with adverse health geriatric outcomes.