Infection control in long term care institutions for the elderly: A reflection document on the situation in Spain

A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a “nosocomiun”, i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below (AU)

Un porcentaje progresivamente creciente de las personas mayores viven durante los últimos años de su vida en residencias de ancianos. Dichas instituciones, aunque pretenden remedar lo más posible la vida en el hogar, tienen características que las hace bastante parecidas a un nosocomio, es decir a un establecimiento destinado al tratamiento de enfermos. La propia convivencia entre los ancianos, el hecho de compartir cuidadores y la exposición muy importante a terceras personas, junto con las frecuentes enfermedades predisponentes a la infección de esta población, hacen que la infección sea frecuente entre los residentes y que además sea fácilmente transmisible. Esto nos lleva a preguntarnos qué puede hacerse para prevenir la infección en este medio y más concretamente cuál es el estado del arte de la cuestión en una nación de Europa Occidental como la nuestra. El patronato de la Fundación de Ciencias de la Salud se ha formulado una serie de preguntas sobre el tema de la prevención de la infección en las Residencias de Mayores, la estructura de la misma, la legislación vigente, el cumplimiento de las medidas indicadas, los indicadores de los procesos y por ende, la necesidad de fomentar en España un documento de recomendaciones para evitar infecciones en esta población cuya morbilidad y mortalidad no necesitan ser resaltadas. Para ello, se ha convocado a un grupo multidisciplinar de expertos en distintos aspectos de este problema a los que se les han formulado las preguntas propuestas. Las preguntas han sido discutidas por el grupo en su conjunto y han conducido a una serie de conclusiones consensuadas entre los participantes. Pasamos, a continuación a relatar los resultados de la reunión (AU)

Prevalencia de diabetes mellitus en pacientes geriátricos institucionalizados en la provincia de Cádiz. Estudio Diagerca / Prevalence of diabetes mellitus in geriatric patients in nursing homes of Cádiz. Diagerca study

Objetivo. Conocer la prevalencia y las características clínicas de los ancianos diabéticos en residencias asistidas. Material y método. Estudio observacional, multicéntrico, realizado en 14 residencias geriátricas asistidas de la provincia de Cádiz. Variables del estudio: edad, sexo, prevalencia de la diabetes, tiempo de evolución de la diabetes, presencia de complicaciones (macrovasculares, retinopatía, nefropatía y neuropatía). Control metabólico: frecuencia de determinación de glucemias basales y de HbA1c. Complicaciones metabólicas sufridas; tratamiento utilizado: antidiabéticos orales y tipos, e insulinización; educación diabetológica; valoración funcional y mental. Los datos obtenidos se analizaron mediante programa estadístico SPSS v17.0. Resultados. Sobre 1.952 ancianos institucionalizados, la prevalencia de diabetes fue del 26,44%. Se incluyen en el estudio 312 pacientes, edad media: 79,7 años y el 57,4% eran mujeres. El 66,9% eran diabéticos desde hace más de 10 años. El 55,1% han sufrido algún evento vascular: ictus isquémico 55,2%; infarto de miocardio 18%, y arteriopatía periférica el 14,5%. El 29,6% padece retinopatía, el 21,3% padece nefropatía diabética y el 25,6% neuropatía diabética. El 90,1% de los pacientes dispone de determinación de HbA1c, presentando el 50% niveles entre 7 y 9%, con frecuencia de determinación semestral en el 63,4%. Como complicaciones metabólicas, el 7,1% presentó algún episodio de cetoacidosis diabética, el 2,9% síndrome hiperosmolar, y el 15,7% hipoglucemias sintomáticas. El 66% de los pacientes tomaban antidiabéticos orales, metformina el 55,3% seguido de glicazida el 10,2% y repaglinida el 3,4%. El 50,2% estaba insulinizado. El 45,6% sufría dependencia funcional con media en Barthel de 48,4 puntos. Y el 46,1% está diagnosticado de demencia, encontrándose en fase moderada el 36,7%. Conclusiones. La prevalencia de la diabetes en residencias es alta. Los ancianos diabéticos institucionalizados son de edad avanzada, con diabetes de larga evolución que han sufrido complicaciones tanto macro como microvasculares, más de la mitad ya insulinizados, y presentan un grado de discapacidad mental y funcional importante(AU)

Objective. To determine prevalence and clinical characteristics of elderly diabetic patients in nursing homes. Material and method. Observational and multicentre study in 14 nursing homes in Cádiz (Spain). Study variables: age, sex, prevalence of diabetes, duration of diabetes, complications, macrovascular complications, retinopathy, nephropathy, and neuropathy. Metabolic control: frequency of baseline blood glucose and HbA1c determinations. Metabolic complications suffered. Treatment: oral and type of antidiabetics, insulinisation. Diabetes education. Functional and mental assessment using Barthel index and MMT. Data was analysed using SPSS v17.0. Results. A total of 1952 elderly institutionalised patients were studied, with a diabetes prevalence of 26.44%. The study included 312 patients with a mean age of 79.7 years, of whom 57.4% were women, and 66.9% knew of their diagnosis of diabetes for over 10 years. Vascular events were suffered by 55.1%, with the most common being ischaemic stroke (55.2%), followed by myocardial infarction (18%) and 14.5% with peripheral arterial disease. There were 29.6% with retinopathy, 21.3% diabetic nephropathy, and 25.6% suffering from distal symmetric polyneuropathy. HbA1c analysis was performed in 90.1% of patients, with 50% levels between 7 and 9%, with a six-monthly assessment rate of 63.4%. Metabolic complications: diabetic ketoacidosis 7.1%, hyperosmolar syndrome 2.9%, and 15.7% symptomatic hypoglycaemia. Oral hypoglycaemic agents were being taken by 66% of patients, with the most frequently used being metformin (55.3%) followed by gliclazide and repaglinide (10.2%, 3.4%, respectively). 50.2% were insulinised. 45.6% functional dependence. Barthel Index average of 48.4 points, with 46.1% diagnosed with dementia, moderate state, 36.7%. Conclusions. Diabetic prevalence in nursing homes is high, and institutionalised patients are elderly, long-standing diabetics, with both macro- and microvascular complications, and have a significant level of mental and functional disabilities(AU)

[Prevalence of diabetes mellitus in geriatric patients in nursing homes of Cádiz. Diagerca study]. / Prevalencia de diabetes mellitus en pacientes geriátricos institucionalizados en la provincia de Cádiz. Estudio Diagerca.

OBJECTIVE: To determine prevalence and clinical characteristics of elderly diabetic patients in nursing homes. MATERIAL AND METHOD: Observational and multicentre study in 14 nursing homes in Cádiz (Spain). STUDY VARIABLES: age, sex, prevalence of diabetes, duration of diabetes, complications, macrovascular complications, retinopathy, nephropathy, and neuropathy. Metabolic control: frequency of baseline blood glucose and HbA1c determinations. Metabolic complications suffered. TREATMENT: oral and type of antidiabetics, insulinisation. Diabetes education. Functional and mental assessment using Barthel index and MMT. Data was analysed using SPSS v17.0. RESULTS: A total of 1952 elderly institutionalised patients were studied, with a diabetes prevalence of 26.44%. The study included 312 patients with a mean age of 79.7 years, of whom 57.4% were women, and 66.9% knew of their diagnosis of diabetes for over 10 years. Vascular events were suffered by 55.1%, with the most common being ischaemic stroke (55.2%), followed by myocardial infarction (18%) and 14.5% with peripheral arterial disease. There were 29.6% with retinopathy, 21.3% diabetic nephropathy, and 25.6% suffering from distal symmetric polyneuropathy. HbA1c analysis was performed in 90.1% of patients, with 50% levels between 7 and 9%, with a six-monthly assessment rate of 63.4%. Metabolic complications: diabetic ketoacidosis 7.1%, hyperosmolar syndrome 2.9%, and 15.7% symptomatic hypoglycaemia. Oral hypoglycaemic agents were being taken by 66% of patients, with the most frequently used being metformin (55.3%) followed by gliclazide and repaglinide (10.2%, 3.4%, respectively). 50.2% were insulinised. 45.6% functional dependence. Barthel Index average of 48.4 points, with 46.1% diagnosed with dementia, moderate state, 36.7%. CONCLUSIONS: Diabetic prevalence in nursing homes is high, and institutionalised patients are elderly, long-standing diabetics, with both macro- and microvascular complications, and have a significant level of mental and functional disabilities.

Tratamiento no farmacológico del delirium / Non-pharmacological treatment of delirium

El delirium es un síndrome geriátrico de elevada prevalencia, cuyo manejo terapéutico es complejo debido a la interacción de una amplia serie de posibles causas en sujetos con predisposición a presentarlo. Su tratamiento debe ser etiológico, tratando la causa de éste, pero se debe acompañar de una serie de medidas terapéuticas que faciliten un correcto cuidado al paciente que lo padece y en ocasiones especiales usar fármacos que controlen los síntomas. El objetivo del presente trabajo es revisar los trabajos publicados sobre los tratamientos no farmacológicos, comentándolos, con un apartado especial sobre el uso de medidas de restricción en ancianos con delirium. Presentamos las diferentes opciones que se deben plantear en un plan de cuidados individualizado y multidisciplinar, donde médicos, enfermeros, terapeutas, fisioterapeutas y trabajadores sociales colaboren para mejorar la calidad de vida del anciano afectado de delirium. Revisamos las modificaciones del entorno precisas, la elaboración de una rutina diaria, higiene del sueño, práctica de ejercicio físico y actividades de ocio durante el día, aplicadas para los pacientes afectados de delirium (AU)

Delirium is a highly prevalent geriatric syndrome, whose therapeutic management is complex due to the interaction of multiple possible causes in predisposed individuals. Treatment should be etiologic, aiming to treat the cause of the delirium. However, a series of therapeutic measures that facilitate the appropriate care of affected patients should also be provided and sometimes drugs should be used to control symptoms. The present article aims to review studies published on non-pharmacological treatment of delirium, with a special section on the use of restraints in elderly people with this syndrome. We present the distinct options that should be considered in an individually-tailored, multidisciplinary care plan, in which physicians, nurses, therapists, physiotherapists and social workers collaborate to improve quality of life in the elderly patient with delirium. We review the modifications to the environment (design of a daily routine, sleep hygiene, physical exercise and leisure activity during the day) required in patients with delirium (AU)

[Non-pharmacological treatment of delirium]. / Tratamiento no farmacológico del delirium.

Delirium is a highly prevalent geriatric syndrome, whose therapeutic management is complex due to the interaction of multiple possible causes in predisposed individuals. Treatment should be etiologic, aiming to treat the cause of the delirium. However, a series of therapeutic measures that facilitate the appropriate care of affected patients should also be provided and sometimes drugs should be used to control symptoms. The present article aims to review studies published on non-pharmacological treatment of delirium, with a special section on the use of restraints in elderly people with this syndrome. We present the distinct options that should be considered in an individually-tailored, multidisciplinary care plan, in which physicians, nurses, therapists, physiotherapists and social workers collaborate to improve quality of life in the elderly patient with delirium. We review the modifications to the environment (design of a daily routine, sleep hygiene, physical exercise and leisure activity during the day) required in patients with delirium.