Humanised care in acute psychiatric hospitalisation units: Definition, values and strategic initiatives from the perspective of persons with mental health problems, primary carers and professionals.

INTRODUCTION: Humanised care refers to the holistic approach to the person, considering their bio-psycho-social and behavioural dimensions. It becomes more complex when the person has mental health problems that may affect his or her will, cognition and relationship to the world. The literature on the humanisation of mental health is scarce and only offers the view of professionals. AIM: To analyse the concept, values and strategic initiatives of humanised care in acute psychiatric units from the perspective of persons with mental health problems, carers and professionals. METHOD: Qualitative grounded-theory approach. Data were collected through focus groups and in-depth interviews among persons with mental health problems, carers and professionals. RESULTS: Thirteen focus groups and three in-depth staff interviews were performed, with a total of 61 participants. Humanised care is defined as quality care of an individualised, ethical and safe nature, empowering persons/carers to involve them in their health process, helping them resist the stigma of mental illness through a therapeutic relationship, bond and communication. Formal training, teamwork and effective communication are required. Six values and strategic initiatives were identified. DISCUSSION: Each value and strategic initiatives acquires full meaning when connected with the rest. Without this interconnection, humanised care would be impossible.

Satisfacción con los cuidados de Enfermería proporcionados en una unidad de hospitalización de agudos de salud mental / Satisfaction with Nursing care provided at a hospitalization unit for acute Mental Health patients

Objetivo: analizar la satisfacción del paciente sobre los cuidados recibidos por el personal de Enfermería durante su ingreso en una unidad de hospitalización de agudos de salud mental.Métodos: estudio trasversal analítico realizado en 2021 en la unidad de hospitalización de agudos de Psiquiatría de un hospital del Vallés Occidental en Cataluña (España). La población de estudio fueron las personas con un ingreso superior a una semana que cumplimentaron la escala de Evaluación del Cuidado CAT-V (rango 27-135), en su versión validada al español. Además, se recogieron las variables clínicas de los participantes: a) tipo de ingreso: voluntario/involuntario, b) diagnóstico del ingreso, c) utilización de contención mecánica, d) consumo de tóxicos. Se realizó análisis univariado y comparativo de las variables recogidas.Resultados: se incluyeron 100 pacientes, con una media de edad de 42,5 años (19-72). El 55% (p= 55) fue mujer. La satisfacción obtuvo una puntuación mediana (P25-P75) de 114 (103-125), situándose en el cuarto cuartil de satisfacción. Los valores de satisfacción se mantuvieron en el cuarto cuartil, sin mostrar diferencias estadísticamente significativas en ninguno de los factores considerados, excepto en los valores relacionados con el uso de contención mecánica, que mostró diferencias estadísticas (p= 0,023), con peor percepción de satisfacción del cuidado para aquellos en los que se usaron, mediana (P25-P75) 96,5 (87-114), frente a los que no, 116 (108-125). Aunque no se observaron diferencias significativas para el resto de variables estudiadas se destaca que aumenta la satisfacción en los ingresos voluntarios y en las personas de mayor edad.Conclusiones: los pacientes presentaron alta satisfacción del cuidado recibido por el personal de Enfermería durante su ingreso en una unidad de hospitalización de agudos de salud mental. La prevalencia del uso de contenciones mecánicas tiene un impacto negativo sobre la satisfacción del cuidado recibido. (AU)

Objective: to analyse patient satisfaction regarding care received from the Nursing staff during their admission at a hospitalization unit for acute mental health patients.Methods: an analytical cross-sectional study conducted in 2021 at the hospitalization unit for acute Psychiatry patients at a Vallés Occidental hospital in Catalonia (Spain). The study population were those persons hospitalized for over a week who completed the Caring Assessment Tool CAT-V (range 27-135), in its version translated into Spanish. Besides, the clinical variables of participants were collected: a) type of admission: voluntary / involuntary, b) diagnosis at admission, c) use of mechanical restraint, d) use of toxic substances. There was univariate and comparative analysis of the variables collected.Results: the study included 100 patients, with 42.5 years as mean age (19-72); of these, 55% (p= 55) was female. Satisfaction obtained a median score (P25-P75) of 114 (103-125), and was placed in the fourth quartile. Satisfaction values stayed in the fourth quartile, without showing any statistically significant differences in any of the factors considered, except for those values associated with the use of mechanical restraint, which showed statistical differences (p= 0,023), with a worse perception of satisfaction with care in those for whom it was used, median (P25-P75) 96.5 (87-114), vs. those for whom it was not, 116 (108-125). Even though no significant differences were observed for the rest of variables studied, an increase in satisfaction stood out among voluntary admissions and older persons.Conclusions: patients presented high satisfaction with care received from Nursing staff during their admission at a hospitalization unit for acute mental health patients. The prevalence of the use of mechanical restraints had a negative impact on satisfaction with care received. (AU)

Beneficios de la sutura continua de la lesión perineal en la adaptación a la maternidad / Benefits of continuous suture of perineal injury in adaptation to motherhood

Objetivo: Evaluar el efecto de la sutura continua de la herida perineal sobre la capacidad y la recuperación funcional de la mujer para realizar su autocuidado, el cuidado del recién nacido, lactancia materna y las actividades de la vida diaria: básicas e instrumentales, en el periodo posparto. Método: Ensayo clínico no aleatorizado con enmascaramiento de la asignación a los grupos de estudio, realizado en el Hospital Universitario Arnau de Vilanova de Lérida, hospital de tercer nivel. El grupo intervención recibió sutura continua para la reparación perineal y el grupo control sutura discontinua. La población de estudio fueron mujeres con parto eutócico y lesión perineal de segundo grado o episiotomía. Se realizaron 3 valoraciones posparto (48h, 7-10 días y al mes). Resultados: Ciento veintiséis mujeres con parto eutócico y lesión perineal de segundo grado o episiotomía participaron (n=126); 64 suturadas con técnica continua (grupo intervención) y 62 con técnica discontinua (grupo control). A las 48h posparto, el 85% de las mujeres con sutura continua fueron capaces de realizar su autocuidado y el 46,7% se recuperaron funcionalmente. A los 7-10 días, el 96,7% de las mujeres con sutura continua habían adquirido la capacidad para realizar las actividades instrumentales de la vida diaria, y el 60% se habían recuperado funcionalmente frente al 68,3% y 15%, respectivamente de las mujeres con sutura discontinua (p<0,001). A los 7-10 días, el 100% de las mujeres con sutura continua alcanzaron la recuperación funcional para el cuidado del recién nacido y el 80% para la lactancia materna, y en el grupo control el 81,7% y 30%, respectivamente (p<0,001 y p<0,001). Conclusión: Las mujeres con sutura continua restablecen su capacidad y la recuperación funcional para la realización de las AVD más precozmente y con menos dolor, que las mujeres con sutura discontinua, adaptándose más rápida y satisfactoriamente a la maternidad.(AU)

Objective: To assess the effect of the continuous suture technique of the perineal wound on the capacity and functional recovery of women when carrying out their self-care routine, the care of the newborn (NB), breastfeeding (BF) and Activities of Daily Living (ADLs), both basic (ABVD) and instrumental (IADL), during the postpartum period. Methods: Non-randomised clinical trial with blinding allocation to study groups, carried out at the Arnau de Vilanova tertiary hospital in Lérida. The intervention group received continuous suture for perineal repair and the control group discontinuous suture. The study population was women with eutocic delivery and second-degree perineal tears or episiotomy. Three postpartum assessment were performed (48hours, 7-10 days and one month). Results: 126 women with eutocic delivery and second degree perineal tears or episiotomy participated (n=126); 64 sutured with continuous technique (intervention group) and 62 with discontinuous technique (control group). At 48hours postpartum, 85% of women from the continuous suture technique group were able to perform their self-care and 46,7% of them had recovered functionally. At 7-10 days, 96,7% of women with continuous suturing had acquired the ability to perform instrumental activities of daily living and 60% had recovered functionally compared to 68,3% and 15% respectively of women with discontinuous suturing (P<.001). At 7-10 days, 100% of women with continuous suturing achieved functional recovery for newborn care and 80% for breastfeeding and in the control group 81,7% and 30% respectively (P<.001 and P<.001). Conclusions: Women who undergo the continuous suture technique restore their ability and functional recovery to perform activities of daily living earlier and with less pain than women with discontinuous suturing, adapting more quickly and satisfactorily way to motherhood.(AU)

Benefits of continuous suture of perineal injury in adaptation to motherhood.

OBJECTIVE: To assess the effect of the continuous suture technique of the perineal wound on the capacity and functional recovery of women when carrying out their self-care routine, the care of the newborn (NB), breastfeeding (BF) and Activities of Daily Living (ADLs), both basic activities of daily living (BADL) and instrumental (IADL), during the postpartum period. METHODS: Non-randomised clinical trial with blinding allocation to study groups, carried out at the Arnau de Vilanova tertiary hospital in Lérida. The intervention group received continuous suture for perineal repair and the control group discontinuous suture. The study population was women with eutocic delivery and second-degree perineal tears or episiotomy. Three postpartum assessment were performed (48 h, 7-10 days and one month). RESULTS: 126 women with eutocic delivery and second degree perineal tears or episiotomy participated (n = 126); 64 sutured with continuous technique (intervention group) and 62 with discontinuous technique (control group). At 48 h postpartum, 85% of women from the continuous suture technique group were able to perform their self-care and 46,7% of them had recovered functionally. At 7-10 days, 96,7% of women with continuous suturing had acquired the ability to perform instrumental activities of daily living and 60% had recovered functionally compared to 68,3% and 15% respectively of women with discontinuous suturing (p < 0.001). At 7-10 days, 100% of women with continuous suturing achieved functional recovery for newborn care and 80% for breastfeeding and in the control group 81,7% and 30% respectively (p < 0.001 and p < 0.001). CONCLUSIONS: Women who undergo the continuous suture technique restore their ability and functional recovery to perform activities of daily living earlier and with less pain than women with discontinuous suturing, adapting more quickly and satisfactorily way to motherhood.

Análisis de la deshidratación de adultos mayores en una residencia geriátrica de España: prevalencia y factores asociados / Analysis of dehydration in older people in a nursing home in Spain: prevalence and associated factors

INTRODUCCIÓN: la deshidratación en las personas mayores institucionalizadas es un problema poco explorado, no habiéndose encontrado evidencia al respecto en relación con las personas mayores del contexto residencial español. OBJETIVOS: estimar la prevalencia de la deshidratación e identificar los factores asociados a la misma en las personas mayores institucionalizadas en una residencia geriátrica. MÉTODOS: estudio descriptivo y transversal. La deshidratación se midió a través del color de la orina. Para la identificación de los factores se seleccionaron variables sociodemográficas, clínicas, funcionales y mentales. RESULTADOS: la muestra total estudiada fue de 96 individuos con una media de edad de 86,6 años (± 7,1), de los cuales el 80,2 % eran mujeres. La prevalencia de la deshidratación fue del 31,3 % (IC 95 %: 22,0 a 40,6). Los factores que se asociaron independientemente a la deshidratación fueron la presencia de ojos hundidos (OR = 8,67; p = 0,004), la baja ingesta hídrica (OR = 3,96; p = 0,041) y el deterioro funcional (OR = 0,97; p = 0,012) y cognitivo (OR = 1,10; p = 0,009). CONCLUSIONES: este estudio permite visibilizar el problema de la deshidratación en las personas mayores institucionalizadas en España. La tabla de colores de la orina puede emplearse de forma rutinaria, no invasiva y con bajo coste, por lo que podría ser el método de elección para la detección de la deshidratación en esta población. Teniendo en cuenta que la deshidratación crónica es la más prevalente en las personas mayores, la identificación de los factores asociados es clave para mejorar su hidratación

BACKGROUND: dehydration in institutionalized elderly people has not been extensively studied. There are not clear data on the Spanish context. AIM: to estimate the prevalence of dehydration and to identify the associated factors in institutionalized older people in a nursing home. METHODS: a cross-sectional study was carried out. Dehydration was measured through the colour of urine. For the identification of the associated factors, sociodemographic, clinical, functional, and mental variables were selected. RESULTS: the total sample studied was comprised of 96 individuals with a mean age of 86.6 years (± 7.1), of whom 80.2 % were women. The prevalence of dehydration was 31.3% (95 % CI, 22.0 to 40.6). The factors that were independently associated with dehydration were the presence of sunken eyes (OR = 8.67; p = 0.004), low fluid intake (OR = 3.96; p = 0.041), and both functional (OR = 0.97; p = 0.012) and cognitive (OR = 1.10; p = 0.009) impairment. CONCLUSIONS: this study highlights the problem of dehydration in institutionalized older people in Spain. An urine colour table may be used routinely, non-invasively, and cheaply. So, it may well be the best simple method for detecting dehydration in this population. Taking into account that chronic dehydration is most prevalent in elderly people, the identification of associated factors is a key factor for a successful approach

Nursing interventions for perinatal bereavement care in neonatal intensive care units: A scoping review.

BACKGROUND: Despite technological advances and specialist training of neonatal teams, perinatal deaths still occur. Such events are traumatic experiences for the parents and increase the risk of pathological grieving. Nursing is one of the main sources of support. However, the important work of nurses in these situations is made more difficult by the lack of recognized strategies that can be implemented to assist parents and family members in the bereavement process. AIM: Identify nursing interventions to help parents of neonates admitted to neonatal intensive care units cope with perinatal loss. METHODS: A scoping review based on the methodological framework established by Arksey and O'Malley was used. A total of 327 relevant studies were identified through a bibliographic search in Pubmed, CINAHL Plus, APA PsycNET and Scopus between 2000 and 2019. The screening process included an initial analysis of the relevance of the abstract and, when required, an extensive review of the full paper. RESULTS: A total of 9 papers were finally selected which responded to the research question. All nine papers are from the USA and have different methodological characteristics. A number of effective interventions were identified, including legacy creation, support groups, family-centred accompaniment and follow-up, parental involvement in pre-mortem care, intergenerational bereavement programmes, and the use of technological and spiritual resources. CONCLUSION: In general, the scant evidence that is available about nursing interventions around perinatal bereavement care underlines the requirement to thoroughly assess the effectiveness of those that have already been designed and implemented. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: This scoping review contributes to the potential implementation of effective interventions to deal with and help parents and family members cope with perinatal bereavement, with nursing staff as the main source of support and leading interventions which have family members in the care team. This review also makes a substantial contribution to the development of a practical and evidence-based clinical guide for nursing, with recommendations that can be adapted to effective quality care criteria. It is additionally intended to encourage visibility in health policies of care and attention to perinatal grief in neonatal intensive care units.

[Analysis of dehydration in older people in a nursing home in Spain: prevalence and associated factors]. / Análisis de la deshidratación de adultos mayores en una residencia geriátrica de España: prevalencia y factores asociados.

INTRODUCTION: Background: dehydration in institutionalized elderly people has not been extensively studied. There are not clear data on the Spanish context. Aim: to estimate the prevalence of dehydration and to identify the associated factors in institutionalized older people in a nursing home. Methods: a cross-sectional study was carried out. Dehydration was measured through the colour of urine. For the identification of the associated factors, sociodemographic, clinical, functional, and mental variables were selected. Results: the total sample studied was comprised of 96 individuals with a mean age of 86.6 years (± 7.1), of whom 80.2 % were women. The prevalence of dehydration was 31.3% (95 % CI, 22.0 to 40.6). The factors that were independently associated with dehydration were the presence of sunken eyes (OR = 8.67; p = 0.004), low fluid intake (OR = 3.96; p = 0.041), and both functional (OR = 0.97; p = 0.012) and cognitive (OR = 1.10; p = 0.009) impairment. Conclusions: this study highlights the problem of dehydration in institutionalized older people in Spain. An urine colour table may be used routinely, non-invasively, and cheaply. So, it may well be the best simple method for detecting dehydration in this population. Taking into account that chronic dehydration is most prevalent in elderly people, the identification of associated factors is a key factor for a successful approach.

INTRODUCCIÓN: Introducción: la deshidratación en las personas mayores institucionalizadas es un problema poco explorado, no habiéndose encontrado evidencia al respecto en relación con las personas mayores del contexto residencial español. Objetivos: estimar la prevalencia de la deshidratación e identificar los factores asociados a la misma en las personas mayores institucionalizadas en una residencia geriátrica. Métodos: estudio descriptivo y transversal. La deshidratación se midió a través del color de la orina. Para la identificación de los factores se seleccionaron variables sociodemográficas, clínicas, funcionales y mentales. Resultados: la muestra total estudiada fue de 96 individuos con una media de edad de 86,6 años (± 7,1), de los cuales el 80,2 % eran mujeres. La prevalencia de la deshidratación fue del 31,3 % (IC 95 %: 22,0 a 40,6). Los factores que se asociaron independientemente a la deshidratación fueron la presencia de ojos hundidos (OR = 8,67; p = 0,004), la baja ingesta hídrica (OR = 3,96; p = 0,041) y el deterioro funcional (OR = 0,97; p = 0,012) y cognitivo (OR = 1,10; p = 0,009). Conclusiones: este estudio permite visibilizar el problema de la deshidratación en las personas mayores institucionalizadas en España. La tabla de colores de la orina puede emplearse de forma rutinaria, no invasiva y con bajo coste, por lo que podría ser el método de elección para la detección de la deshidratación en esta población. Teniendo en cuenta que la deshidratación crónica es la más prevalente en las personas mayores, la identificación de los factores asociados es clave para mejorar su hidratación.

Capacidad funcional en personas mayores de 65 años de la Región Sanitaria de Lleida atendidas en domicilio / Functional capacity in home care patients over 65 years attended at Lleida's Health Region

Objetivo: Valorar la relación entre los problemas de salud del paciente y la sobrecarga de la persona que lo cuida con el deterioro de la capacidad funcional de las personas mayores de 65 años incluidas en el programa de atención domiciliaria (ATDOM). Metodología: La muestra incluye todos los procesos de 6 meses o más de los pacientes de la Región Sanitaria de Lleida ocurridos durante 6 años, teniendo en cuenta que un paciente puede presentar más de un proceso. El estudio recoge los datos de la valoración al ingreso. Las variables utilizadas fueron características sociodemográficas, capacidad funcional, estado cognitivo, riesgo de úlceras por presión (UPP), sobrecarga del cuidador y riesgo social. Resultados: El total de procesos fue de 8.433, cuya duración osciló entre 6 y 92,7 meses. La media de edad fue de 86 años y el 64,2% eran mujeres. La prevalencia de algún grado de dependencia fue del 92,4%. De esta, presentaban dependencia leve/ moderada el 72,1% y grave/total, el 20,3%. Los factores asociados independientemente al deterioro funcional fueron tener 86 años o más, deterioro cognitivo, riesgo de UPP y sobrecarga del cuidador. Conclusiones: La prevalencia de algún grado de dependencia es alta en pacientes de 65 años o más ingresados en el programa ATDOM; y la más frecuente es la dependencia leve/moderada. La enfermera que cuida a estos pacientes ha de tener en cuenta que la mayor edad, ciertos problemas de salud del paciente y la sobrecarga del cuidador son factores que pueden influir en el deterioro funcional de esta población

Objective: To evaluate the relationship between patient's health problems and caregiver's overburden with the deterioration of the functional capacity in people older than 65 years included, on home health care program. Methodology: The sample includes every process ≥6 months of Lleida's Health Region patients during 6 years, keeping in mind that a patient can present more tan one process. The study compiles the patient's evaluation data at the admission. The variables utilized were: socio-demographic characteristics, functional capacity, cognitive status, risk of pressure ulcer, overburden of the caregiver and social risk. Results: The total of the processes was 8.433, whose duration were between 6 and 92.7 months. The age average resulted as 86 years, and the 64.2% were women. The prevalence of whatever dependency degree resulted as 92.4%, and of whole 72.1% presented a degree of dependency from low to moderate and 20.3% presented severe or total dependency. Independent factors associated to functional loss resulted as: having 86 years or more, cognitive impairment, risk of pressure ulcer and caregiver's overburden. Conclusions: The prevalence of whatever degree of dependence is higher in patients of 65 years or more included in home health care, being the most common the low to moderate dependence. The nurse that provides the cares of these patients has to keep in mind factors such as being older, certain health problems and the overburden of the caregiver, that can influence functional loss of this population

Are the classic signs of infection in concordance with results from percutaneous aspiration to diagnose infection in pressure injuries?

AIM: To explore the concordance between the presence of classic signs of infection and the positive diagnosis identified by the microbiological culture of fluid collected by percutaneous aspiration. BACKGROUND: The classic signs of infection are commonly applied in some contexts to confirm infection in pressure injuries, but its accuracy has been questioned in chronic wounds. Little is known about the concordance of this method with others, such as the deep fluid culture from pressure injuries collected by percutaneous aspiration. DESIGN: Multicentre, cross-sectional observational study. METHODS: Pressure injuries of patients from four health centres were analysed. Three types of data were recorded between February 2011 and March 2012: i) socio-demographic and clinical data, ii) number and type of infection signs and iii) microbiological results of deep fluid culture from injuries. The concordance was calculated with the kappa index to find a possible concordance between both methods. RESULTS: On 40·2% (n = 47) of injuries, two or more classic signs of infection or purulent exudate as unique sign were present, while the total positive results in the microbiological cultures were 50·4% (n = 59). The disparity of positive results, depending on the location and the stage of the pressure injury and the method applied, suggested a poor concordance between methods. The -0·092 kappa index confirmed the non-concordance of the analysed methods. CONCLUSIONS: The tandem strategy is not useful to indicate an infection in pressure injuries. We advocate exploring other signs of infection and the adoption of other more reliable signs together with the classic signs of infection.

La fragilidad como predictora de mortalidad en una cohorte de edad avanzada / Frailty as a predictor of mortality in a cohort of people aged 75 years and older

Objetivo. Determinar la asociación entre los estados de fragilidad de las personas mayores y la mortalidad en la ciudad de Lleida durante el período 2009-2012. Método. Estudio longitudinal prospectivo realizado con sujetos que viven en la ciudad de Lleida de 75 años o más de edad con tarjeta sanitaria y residentes en viviendas familiares. La fase transversal se realizó entre los años 2009 y 2010, y la fase longitudinal a los 2 años (mediana 25 meses). Resultados. La supervivencia fue peor para los frágiles frente a los prefrágiles y los no frágiles (log rank = 10,56; p = 0,005). Además de la fragilidad (hazard ratio [HR] = 4,95; intervalo de confianza del 95% [IC95%]: 1,71-14,31), la edad también fue significativa (HR = 2,87; IC95%: 1,02-8,26). Conclusión. En una cohorte prospectiva de mayores de 75 años que viven en su propio domicilio en la ciudad de Lleida, el mayor nivel de fragilidad está asociado con un mayor riesgo de muerte a los 2 años (AU)

Objective. To determine the association between frailty in older persons and mortality in the city of Lleida (Spain) between 2009 and 2012. Methods. We conducted a prospective longitudinal study based on persons living in the city of Lleida aged 75 years and older, covered by the public health system and living in single-family households. The cross-sectional study was performed between 2009 and 2010 and longitudinal study was carried out 3 years later (median 25 months). Results. Survival was lower in frail individuals than in pre-frail and non-frail individuals (log rank = 10.56; p = 0.005). In addition to frailty (HR = 4.95; 95%CI: 1.71-14.31). Age was also a significant predictor (HR = 2.87; 95%CI: 1.02-8.26). Conclusion. A higher level of frailty was associated with an increased risk of death at 2 years in a prospective cohort of elderly persons older than 75 years living in their own homes in the city of Lleida (AU)

[Frailty as a predictor of mortality in a cohort of people aged 75 years and older]. / La fragilidad como predictora de mortalidad en una cohorte de edad avanzada.

OBJECTIVE: To determine the association between frailty in older persons and mortality in the city of Lleida (Spain) between 2009 and 2012. METHODS: We conducted a prospective longitudinal study based on persons living in the city of Lleida aged 75 years and older, covered by the public health system and living in single-family households. The cross-sectional study was performed between 2009 and 2010 and longitudinal study was carried out 3 years later (median 25 months). RESULTS: Survival was lower in frail individuals than in pre-frail and non-frail individuals (log rank=10.56; p=0.005). In addition to frailty (HR=4.95; 95%CI: 1.71-14.31). Age was also a significant predictor (HR=2.87; 95%CI: 1.02-8.26). CONCLUSION: A higher level of frailty was associated with an increased risk of death at 2 years in a prospective cohort of elderly persons older than 75 years living in their own homes in the city of Lleida.

Sintomatología depresiva en ancianos. La influencia del género / Depressive symptoms in elderly women. The influence of gender

Objetivo. Examinar las posibles diferencias de género en la presencia de sintomatología depresiva en personas mayores de 75 años de la comunidad. Métodos. Se trata de un estudio transversal descriptivo. La fuente de datos fue la encuesta realizada para el estudio de fragilidad en Lleida (encuesta FRALLE). Los síntomas depresivos se midieron con The Center for Epidemiologic Studies Depresion Scale (CES-D). Para analizar la relación del género con los síntomas depresivos se usaron técnicas de regresión logística. Resultados. La prevalencia de síntomas depresivos fue del 33,1% para el conjunto de la muestra, del 22,8% para los varones y del 40,3% para las mujeres. En toda la población, el género obtuvo resultados estadísticamente significativos en los 3 modelos construidos. Así, las mujeres tenían un mayor riesgo de depresión que los varones, incluso después de ajustar por los factores sociodemográficos y por los de estado de salud, presentando casi el doble de probabilidades de padecer depresión. Conclusiones. Los datos obtenidos sugieren que las mujeres tienen más riesgo de presentar síntomas depresivos que los varones. Así mismo, los factores protectores de sintomatología depresiva son el nivel alto de estudios en las mujeres y la presencia de pareja en los varones(AU)

Objective. To examine gender differences in depressive symptoms in people over 75 years of age in the community. Methods. This is a descriptive cross-sectional study. The data was obtained from the study of frailty in Lleida (FRALLE survey). Depressive symptoms were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D). Logistic regression were used to analyse the relationship of gender with depressive symptoms. Results. The prevalence of depressive symptoms was 33.1%; 22.8% for men and 40.3% for women. In the total population, gender was statistically significant in all three models constructed. Thus, women have nearly double the prevalence rates for depression compared to men, even after adjusting for social and demographic factors and the health status. Conclusions. The results suggest that women have a higher risk of depressive symptoms than men, and the protective factors of depressive symptoms are higher education in women, and the presence of a partner in men(AU)

[Depressive symptoms in elderly women. The influence of gender]. / Sintomatología depresiva en ancianos. La influencia del género.

OBJECTIVE: To examine gender differences in depressive symptoms in people over 75 years of age in the community. METHODS: This is a descriptive cross-sectional study. The data was obtained from the study of frailty in Lleida (FRALLE survey). Depressive symptoms were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D). Logistic regression were used to analyse the relationship of gender with depressive symptoms. RESULTS: The prevalence of depressive symptoms was 33.1%; 22.8% for men and 40.3% for women. In the total population, gender was statistically significant in all three models constructed. Thus, women have nearly double the prevalence rates for depression compared to men, even after adjusting for social and demographic factors and the health status. CONCLUSIONS: The results suggest that women have a higher risk of depressive symptoms than men, and the protective factors of depressive symptoms are higher education in women, and the presence of a partner in men.

Análisis de la esperanza de vida libre de discapacidad a lo largo de la biografía: de la madurez a la vejez / Analysis of disability-free life expectancy over the lifespan: from maturity to old age

Objective To determine the life stages in which disability-free life expectancy is shortened before the age of 70 years. Method A retrospective longitudinal analysis was carried out in a cohort of 1,286 non-institutionalized people aged from 70 to 74 years old living in metropolitan areas. Disability was measured by instrumental and basic activities of daily living. Disability-free life expectancy was calculated. The Kaplan-Meier method was used to calculate survival probabilities. Results The incidence of basic disability increased from 50 to 54 years old and progressively accelerated until the age of 65-69 years old when the probability of instrumental disability was slightly higher among men than among women (0.23 in men versus 0.19 in women). Disability-free survival was lower among women than among men both for all types of disability (LogRank = 5.80; p = 0.016) and for basic disability (LogRank = 4.315; p = 0.038).Conclusions This study reveals the importance of instrumental disability for domestic tasks among older men. Women had a lower probability of disability-free survival and were more likely to be affected by any type of disability as well as by basic disability. For both genders, there is a slight decrease in disability-free survival from the age of 40 to 60 years. From this age onwards, this decrease markedly accelerates(AU)

Objetivo: Determinar en qué etapas del curso de vida previo a los 70 años se acortan las expectativas de vida en salud. Método: Análisis longitudinal retrospectivo. La población a estudio es una cohorte de 1286 individuos de 70 a 74 años de edad que viven en áreas metropolitanas, no institucionalizados. La discapacidad se mide mediante el desarrollo de las actividades instrumentales de la vida diaria y las actividades básicas de la vida diaria. Se calcula la esperanza de vida libre de discapacidad y la probabilidad de supervivencia mediante Kaplan-Meier. Resultados: La incidencia de discapacidad básica aumenta a partir del tramo de 50 a 54 años de edad, y se acelera progresivamente hasta los 65 a 69 años, cuando la probabilidad de padecer discapacidad instrumental es ligeramente superior en los hombres que en las mujeres (0,23 en hombres y 0,19 en mujeres). La supervivencia sin discapacidad de las mujeres fue peor que la de los hombres, tanto para cualquier tipo de discapacidad (LogRank = 5,80; p = 0,016) como para la discapacidad básica (LogRank =4,315; p = 0,038).Conclusiones: Se pone de manifiesto el importante peso que para la autonomía de la población masculina de estas edades tiene la falta de habilidad instrumental para cuestiones domésticas. Además, las mujeres ostentan un peor pronóstico de supervivencia sin discapacidad, tanto para cualquier tipo de discapacidad como para la discapacidad básica. Para ambos sexos, desde los 40 hasta los 60 años de edad, hay un ligero descenso de la supervivencia sin discapacidad, y a partir de esa edad el descenso se acelera notablemente (AU)

[Analysis of disability-free life expectancy over the lifespan: from maturity to old age]. / Análisis de la esperanza de vida libre de discapacidad a lo largo de la biografía: de la madurez a la vejez.

OBJECTIVE: To determine the life stages in which disability-free life expectancy is shortened before the age of 70 years. METHOD: A retrospective longitudinal analysis was carried out in a cohort of 1,286 non-institutionalized people aged from 70 to 74 years old living in metropolitan areas. Disability was measured by instrumental and basic activities of daily living. Disability-free life expectancy was calculated. The Kaplan-Meier method was used to calculate survival probabilities. RESULTS: The incidence of basic disability increased from 50 to 54 years old and progressively accelerated until the age of 65-69 years old when the probability of instrumental disability was slightly higher among men than among women (0.23 in men versus 0.19 in women). Disability-free survival was lower among women than among men both for all types of disability (LogRank = 5.80; p = 0.016) and for basic disability (LogRank = 4.315; p = 0.038). CONCLUSIONS: This study reveals the importance of instrumental disability for domestic tasks among older men. Women had a lower probability of disability-free survival and were more likely to be affected by any type of disability as well as by basic disability. For both genders, there is a slight decrease in disability-free survival from the age of 40 to 60 years. From this age onwards, this decrease markedly accelerates.

Protective effects of social networks on disability among older adults in Spain.

The loss of autonomy at advanced ages is not only associated with ageing, but also with the characteristics of the physical and social environment. Recent investigations have shown that social networks, social engagement and participation act like predictors of disability among the elderly. The aim of this study is to determine whether social networks are related to the development and progression of disability in the early years of old age. The source of data is the first wave of the survey "Processes of Vulnerability among Spanish Elderly", carried out in 2005 to a sample of 1244 individuals. The population object of study is the cohort aged 70-74 years in metropolitan areas (Madrid and Barcelona) and not institutionalized. Disability is measured by the development of basic activities of daily life (ADL), and instrumental activities of daily life (IADL). The structural aspects of the social relationships are measured through the diversity of social networks and participation. We used the social network index (SNI). For each point over the SNI, the risk of developing any type of disability decreased by 49% (HR=0.51, 95%CI=0.31-0.82). The SNI was a decisive factor in all forecasting models constructed with some hazard ratios (HR) that ranged from 0.29 (95%CI=0.14-0.59) in the first model to 0.43 (95%CI 0.20-0.90) in the full model. The results of the present study showed a strong association between an active social life, emotional support provided by friends and confidents and disability. These findings suggest a protective effect of social networks on disability. Also, these results indicate that some family and emotional ties have a significant effect on both the prevalence and the incidence of disability.

Criterios de fragilidad del adulto mayor. Estudio piloto / Frailty criteria in the elderly: a pilot study

Objetivo: Testar la medición de fragilidad mediante los criterios de Fried modificados por Ávila-Funes en personas de 75 años o más que viven en sus domicilios.Diseño: Estudio piloto de diseño transversal.Emplazamiento: Todas las áreas básicas de salud (7) de la ciudad de Lleida.Participantes: Se seleccionó una muestra probabilística de cada estrato, siendo la muestratotal de 323 individuos.Mediciones principales: Características sociodemográficas, medidas de los 5 criterios de fragilidad(pérdida involuntaria de peso, baja energía o «agotamiento», lentitud en la movilidad,debilidad muscular y baja actividad física) y escalas de valoración geriátrica (índice de Charlson,test Pfeiffer, índice de Katz y de Lawton y Brody, test MNA escala CES-D).Resultados: La prevalencia de fragilidad fue del 8,5%. Los factores asociados a fragilidad fueronel sexo femenino y tener pocos ingresos mensuales. A medida que la fragilidad aumenta, elestado cognitivo, las actividades de la vida diaria y el estado nutricional se deterioran y existemayor comorbilidad. Las puntuaciones de los criterios de fragilidad empleados presentaron unacorrelación significativa con las puntuaciones de las escalas de valoración geriátrica estudiadas.Conclusiones: La prevalencia de fragilidad es similar a otros estudios consultados que hanempleado los mismos criterios para definirla. Las medidas de los criterios de fragilidad hanresultado ágiles para la trascripción de los resultados. El estudio de la fragilidad mediantemarcadores específicos permite la prevención y el perfeccionamiento de nuevos programas deintervención(AU)

Objective: To measure the frailty of people 75 years or over and who live in their own homesbased on Fried’s criteria and modified by Ávila-Funes.Design: Pilot study of cross-sectional design.Site: Primary Health Care Centres (7) in the city of Lleida.Participants: A probabilistic sample was selected for every stratum. The total sample was 323individuals.Primary measurements: Socio-demographic characteristics, measurement of the five frailtycriteria (involuntary lose of weight, low energy or exhaustion, slow mobility, muscle weakness,low physical activity), and geriatric assessment scales (Charlson Index, Pfeiffer’s Test,Katz Index, Lawton and Brody Index, MNA Test and CES-D scale).Results: The prevalence of frailty was 8.5%. Factors associated with frailty were, female sexand low monthly income. It was observed that if the frailty increases, there is deterioration ofcognitive status, activities of daily living and nutritional status. There is also higher morbidity.Frailty criteria scores showed a significant correlation with geriatric assessment scales scores.Conclusions: The prevalence of frailty in elderly people is similar to those in other studies thathave used the same criteria. The measurement of frailty criteria in this study demonstratesa better ability for transcription of results. A frailty study using specific markers enhancesprevention and improvement of new intervention programs(AU)

[Frailty criteria in the elderly: a pilot study]. / Criterios de fragilidad del adulto mayor. Estudio piloto.

OBJECTIVE: To measure the frailty of people 75 years or over and who live in their own homes based on Fried's criteria and modified by Ávila-Funes. DESIGN: Pilot study of cross-sectional design. SITE: Primary Health Care Centres (7) in the city of Lleida. PARTICIPANTS: A probabilistic sample was selected for every stratum. The total sample was 323 individuals. PRIMARY MEASUREMENTS: Socio-demographic characteristics, measurement of the five frailty criteria (involuntary lose of weight, low energy or exhaustion, slow mobility, muscle weakness, low physical activity), and geriatric assessment scales (Charlson Index, Pfeiffer's Test, Katz Index, Lawton and Brody Index, MNA Test and CES-D scale). RESULTS: The prevalence of frailty was 8.5%. Factors associated with frailty were, female sex and low monthly income. It was observed that if the frailty increases, there is deterioration of cognitive status, activities of daily living and nutritional status. There is also higher morbidity. Frailty criteria scores showed a significant correlation with geriatric assessment scales scores. CONCLUSIONS: The prevalence of frailty in elderly people is similar to those in other studies that have used the same criteria. The measurement of frailty criteria in this study demonstrates a better ability for transcription of results. A frailty study using specific markers enhances prevention and improvement of new intervention programs.

Influencia de las relaciones sociales en la aparición y progresión de la discapacidad en personas mayores en Europa / Influence of social ties on the onset and progression of disability among the elderly in Europe

Objetivo. Se examina la asociación entre prevalencia, incidencia y recuperación de discapacidad para las actividades de la vida diaria (AVD) y los vínculos sociales de las personas de más de 65 años no institucionalizadas en Finlandia, Países Bajos y España. Método. Los datos proceden del estudio CLESA. La muestra de referencia estaba compuesta por 3.648 sujetos de entre 65 y 85 años de edad, no institucionalizados, que vivían en Finlandia, Países Bajos y España. Se determinó la discapacidad en 4 AVD, tanto en el estudio transversal como en el seguimiento. Se construyó un indicador de vínculos sociales teniendo en cuenta la participación social, el número de vínculos familiares y la presencia de amigos. Se utilizó la regresión logística con los datos de prevalencias, incidencias y recuperación, para estimar la asociación entre discapacidad y vínculos sociales ajustando por nivel de educación, comorbilidad y salud percibida. Resultados. El efecto modificador del país, edad y sexo se testó en todos los modelos. En todos los países, el indicador de vínculos sociales, presencia de amigos y la participación social está asociado con la prevalencia de discapacidad en las AVD. La incidencia de discapacidad en las AVD está asociada con el número de vínculos familiares, y hay una relación más acusada en España que en Finlandia y Países Bajos. La recuperación de las AVD está asociada con el indicador completo de vínculos sociales. No se encontraron diferencias en cuanto a sexo o edad en estas asociaciones. Discusión. Los vínculos sociales parecen generar un efecto beneficioso en el mantenimiento y la restauración de las AVD. Mientras los vínculos sociales juegan un importante papel en el mantenimiento y la restauración de la función en los 3 países estudiados, los vínculos familiares parecen generar un efecto más fuerte, en la protección contra la incidencia de discapacidad, que la participación social y la fuerza de este efecto varía según la cultura (AU)

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