Health and sociodemographic determinants of excess mortality in Spanish nursing homes during the COVID-19 pandemic: a 2-year prospective longitudinal study.

BACKGROUND: Age, multimorbidity, immunodeficiency and frailty of older people living in nursing homes make them vulnerable to COVID-19 and overall mortality. OBJECTIVE: To estimate overall and COVID-19 mortality parameters and analyse their predictive factors in older people living in nursing homes over a 2-year period. METHOD: Design: A 2-year prospective longitudinal multicentre study was conducted between 2020 and 2022. SETTING: This study involved five nursing homes in Central Catalonia (Spain). PARTICIPANTS: Residents aged 65 years or older who lived in the nursing homes on a permanent basis. MEASUREMENTS: Date and causes of deaths were recorded. In addition, sociodemographic and health data were collected. For the effect on mortality, survival curves were performed using the Kaplan-Meier method and multivariate analysis using Cox regression. RESULTS: The total sample of 125 subjects had a mean age of 85.10 years (standard deviation = 7.3 years). There were 59 (47.2%) deaths at 24 months (95% confidence interval, CI, 38.6-55.9) and 25 (20.0%) were due to COVID-19, mostly in the first 3 months. In multivariate analysis, functional impairment (hazard ratio, HR 2.40; 95% CI 1.33-4.32) was a significant risk factor for mortality independent of age (HR 1.17; 95% CI 0.69-2.00) and risk of sarcopenia (HR 1.40; 95% CI 0.63-3.12). CONCLUSION: Almost half of this sample of nursing home residents died in the 2­year period, and one fifth were attributed to COVID-19. Functional impairment was a risk factor for overall mortality and COVID-19 mortality, independent of age and risk of sarcopenia.

First steps towards the deinstitutionalization of older adults: A protocol for the implementation of a complex intervention / Primeros pasos en la desinstitucionalización de adultos mayores: protocolo para la implementación de una intervención compleja

Background: Nursing homes are becoming increasingly important as end-of-life care facilities. However, many older adults want to stay in their homes as they age. Objective: To assess the feasibility of a deinstitutionalization process on selected institutionalized older adults who are willing to initiate the process. Methods: This study, divided into two phases, will be carried out over 15 months on 241 residents living in two nursing homes in Navarra (Spain). The first phase has a cross-sectional design. We will identify the factors and covariates associated with feasibility and willingness to participate in a deinstitutionalization process by bivariate analysis, essential resources for the process and residents to participate in the process. The second phase has a complex interventional design to implement a deinstitutionalization process. An exploratory descriptive and comparative analysis will be carried out to characterize the participants, prescribed services and the impact deinstitutionalization intervention will have over time (quality of life will be the main outcome; secondary variables will be health, psychosocial, and resource use variables). This study will be accompanied by a pseudo-qualitative and emergent sub-study to identify barriers and facilitators concerning the implementation of this process and understand how intervention components and context influence the outcomes of the main study. Intervention components and the way the intervention is implemented will be of great relevance in the analysis. Discussion: Alternatives to institutionalization with adapted accommodation and community support can allow people who wish to return to the community.(AU)

Introducción: Las residencias de personas mayores cobran cada vez más importancia como centros de atención al final de la vida. Sin embargo, muchos adultos mayores desean permanecer en sus casas mientras envejecen. Objetivo: Se pretende evaluar la viabilidad de un proceso de desinstitucionalización en adultos mayores seleccionados que viven en las residencias y que expresen la voluntad para iniciar el proceso. Métodos: Este estudio, dividido en dos fases, se llevará a cabo durante 15 meses en 241 sujetos que viven en dos residencias de personas mayores en Navarra (España). La primera fase tiene un diseño transversal en donde se identificarán los factores y covariables asociadas a la viabilidad y voluntad para participar en un proceso de desinstitucionalización a través de un análisis bivariante, los recursos imprescindibles para el proceso y los residentes que quieran participar en él. La segunda fase tiene un diseño de intervención compleja en la que se implementa un proceso de desinstitucionalización. Se realizará un análisis exploratorio descriptivo y comparativo para caracterizar a los participantes, los servicios prescritos y el efecto de la intervención de desinstitucionalización a lo largo del tiempo (la calidad de vida será la variable principal; las secundarias serán las referentes a la salud, las psicosociales y de uso de recursos). Este estudio irá acompañado de un subestudio pseudocualitativo y emergente para identificar las barreras y los elementos facilitadores relativos a la implementación de este proceso y comprender cómo los componentes de la intervención y el contexto influyen en los resultados del estudio principal. Los componentes de la intervención y su ejecución serán de gran relevancia en el análisis. Discusión: Las alternativas a la institucionalización con viviendas adaptadas y apoyos comunitarios pueden permitir a las personas que así lo desean el retorno a la comunidad.(AU)

Prevalence of urinary incontinence and associated factors in nursing homes: a multicentre cross-sectional study.

BACKGROUND: Urinary incontinence (UI) is a common geriatric syndrome with high health and socio-economic impacts in nursing home (NH) residents. OBJECTIVES: To estimate the prevalence and types of UI and its associated factors in older people living in NHs in Central Catalonia (Spain). We also determined the proportion of residents who were receiving behavioural strategies to prevent/manage UI. DESIGN AND SETTING: Cross-sectional study in 5 NHs conducted from January to March 2020. METHODS: We included consenting residents aged 65 + permanently living in the NHs. Residents who were hospitalized, in a coma or palliative care were excluded. UI was assessed using Section H of the Minimum Data Set. Sociodemographic and health-related variables were examined. Descriptive, bivariate, and multivariate (logistic regression) analyses were performed. RESULTS: We included 132 subjects (82.6% women), mean age of 85.2 (SD = 7.4) years. The prevalence of UI was 76.5% (95% CI: 68.60-82.93). The most common type was functional UI (45.5%), followed by urgency UI (11.4%). Only 46.2% of residents received at least one behavioural strategy to manage UI. Most sedentary behaviour (SB) variables presented a p-value lower than 0.001 in the bivariate analyses, but none remained in the final model. Moderate-severe cognitive impairment (OR = 4.44, p =.003), anticholinergic activity (OR = 3.50, p =.004) and risk of sarcopenia using SARC-F (OR = 2.75, p =.041) were associated with UI. CONCLUSIONS: The prevalence of UI was high in this sample of NH residents compared to the literature, yet less than half received prompted voiding as a strategy to prevent/reduce UI.UI was associated with cognitive impairment, anticholinergic activity, and risk of sarcopenia.

First steps towards the deinstitutionalization of older adults: A protocol for the implementation of a complex intervention.

BACKGROUND: Nursing homes are becoming increasingly important as end-of-life care facilities. However, many older adults want to stay in their homes as they age. OBJECTIVE: To assess the feasibility of a deinstitutionalization process on selected institutionalized older adults who are willing to initiate the process. METHODS: This study, divided into two phases, will be carried out over 15 months on 241 residents living in two nursing homes in Navarra (Spain). The first phase has a cross-sectional design. We will identify the factors and covariates associated with feasibility and willingness to participate in a deinstitutionalization process by bivariate analysis, essential resources for the process and residents to participate in the process. The second phase has a complex interventional design to implement a deinstitutionalization process. An exploratory descriptive and comparative analysis will be carried out to characterize the participants, prescribed services and the impact deinstitutionalization intervention will have over time (quality of life will be the main outcome; secondary variables will be health, psychosocial, and resource use variables). This study will be accompanied by a pseudo-qualitative and emergent sub-study to identify barriers and facilitators concerning the implementation of this process and understand how intervention components and context influence the outcomes of the main study. Intervention components and the way the intervention is implemented will be of great relevance in the analysis. DISCUSSION: Alternatives to institutionalization with adapted accommodation and community support can allow people who wish to return to the community. TRIAL REGISTRATION: NCT05605392.

The effectiveness of graded motor imagery and its components on phantom limb pain in amputated patients: A systematic review.

BACKGROUND: Phantom limb pain (PLP) can be defined as pain in a missing part of the limb. It is reported in 50%-80% of people with amputation. OBJECTIVES: To provide an overview of the effectiveness of graded motor imagery (GMI) and the techniques which form it on PLP in amputees. STUDY DESIGN: Systematic review. METHODS: Two authors independently selected relevant studies, screened the articles for methodological validity and risk of bias, and extracted the data. Inclusion criteria used were clinical studies, written in English or Spanish, using GMI, laterality recognition, motor imagery, mirror therapy, or a combination of some of them as an intervention in amputated patients, and one of the outcomes was PLP, and it was assessed using a validated scale. The databases used were PubMed, Scopus, Web of Science, CINAHL, and PEDro. RESULTS: Fifteen studies were included in the review. After the intervention, all the groups in which the GMI or one of the techniques that comprise it was used showed decrease in PLP. CONCLUSION: The 3 GMI techniques showed effectiveness in decreasing PLP in amputees, although it should be noted that the application of the GMI showed better results.

Determining minimum number of valid days for accurate estimation of sedentary behaviour and awake-time movement behaviours using the ActivPAL3 in nursing home residents.

INTRODUCTION: Scarce evidence is available about the minimum number of valid days wearing the activPAL3 to obtain a precise estimate of sedentary behaviour (SB) and awake-time movement behaviours (ATMB) in nursing home (NH) residents. The study aimed to determine the minimum number of valid days required for accurately estimate SB and ATMB using the activPAL3 device in NH residents. It also investigated how the starting point of a day (the 24-h period) impacted reliability. METHODS: Participants wore an activPAL3 for 7 consecutive days. The data was classified in two-time blocks (00:00 Ante Meridiem (AM)-00:00 AM midnight vs 12:00 Post Meridiam (PM) -12:00 PM midday) and the sample was stratified into two groups according to their capacity to stand and walk, to examine if timing of sampling or physical functioning affected minimum wear time. SB, ATMB, sociodemographic, and health-related variables were collected. Sensitivity of the time-blocks were tested through the dispersion frequencies and differences between blocks through Kolmogorov-Smirnov test for normality; parametric variables through two-related means T-test and Wilcoxon test for non-parametric data. Reliability was assessed with the Cronbach's Alpha and the intra-class correlation coefficient (ICC), using a one-factor model estimating the reliability for each measurement day loading in the same latent factor. RESULTS: Ninety-five NH residents (81.1% women; age = 85.8 ± 7.2 years) were included. The midnight block had higher reliability, sensitivity and no statistically significant differences between days were found. At least three consecutive days of monitoring were necessary to achieve a reliability of ICC ≥ 0.8 for those NH residents able to stand and walk and six days for those unable. CONCLUSIONS: NH residents who are able to stand and walk require a minimum of three consecutive days wearing the device, while those who are unable require at least six days due to their highly homogenous daily routines and sensitivity to PA events. Regardless of the activPAL3 recording start time, data processing should reference the midnight time block.

Multimodal home care intervention for dependent older people “Live better at home”: Protocol of a randomized clinical trial / Intervención multimodal en domicilios para gente mayor dependiente «Vivir mejor en casa»: Protocolo de un ensayo clínico aleatorizado

Background The intensity of the home care interventions for dependent older people offered in Spain may not be sufficient to help keep older people living at home, being the institutionalization in a nursing home (NH) an unavoidable consequence. Objective To evaluate the effect of intensification in home care interventions on users with grade II or III dependency, as well as training for their informal caregivers in order to delay or avoid their institutionalization in a NH. Methods A randomized clinical trial with two parallel arms and blinded assessment will be conducted at the community level in two municipalities in Catalonia (Spain). The study will include those older people (aged 65 and over) living in the community, with degree II or III of dependency, users of the public home care unwilling to be institutionalized and with a main informal caregiver in charge, who will also participate in the study. The assessments will be performed monthly up to 15 months, when the intervention will be finished. The main outcome will be the time until the willingness for admission to a NH. Secondary variables will be composed of sociodemographic, health, psychosocial, resource use, and follow-up variables. A multivariate Cox regression model will be carried out to estimate the effectiveness of the intervention. Discussion A multimodal home care intervention could improve the health and psychosocial status of dependent people and their informal caregivers and facilitate their permanence at home (AU)

Introducción La intensidad de las intervenciones del servicio de atención domiciliaria (SAD) para personas mayores en situación de dependencia que se ofrece en España puede no ser suficiente para ayudarles a permanecer viviendo en su domicilio, siendo la institucionalización en una residencia geriátrica una consecuencia inevitable. Objetivo Evaluar el efecto de una intensificación en las intervenciones del SAD en personas con grado de dependencia II o III, así como una formación de sus personas cuidadoras no profesionales para retrasar o evitar su institucionalización en una residencia geriátrica. Métodos Se realizará un ensayo clínico aleatorizado con dos brazos paralelos y evaluación ciega a nivel comunitario en dos municipios de Cataluña (España). El estudio incluirá a aquellas personas mayores (de 65 años o más) que vivan en la comunidad, con grado II o III de dependencia, usuarias del SAD público, sin voluntad de institucionalización y con una persona cuidadora no profesional principal a cargo, quien participará en el estudio. Las valoraciones se realizarán mensualmente hasta los 15 meses, cuando finalizará la intervención. La variable principal será el tiempo transcurrido hasta la voluntad de ingreso en una residencia geriátrica. Las variables secundarias se diferenciarán entre sociodemográficas, de salud, psicosociales, de uso de recursos y de seguimiento. Para estimar la eficacia de la intervención se realizará un modelo de regresión de Cox multivariante. Discusión Una intervención multimodal podría mejorar el estado de salud y psicosocial de las personas dependientes y sus personas cuidadoras no profesionales y facilitar su permanencia en el hogar (AU)

Multimodal home care intervention for dependent older people "Live better at home": Protocol of a randomized clinical trial.

BACKGROUND: The intensity of the home care interventions for dependent older people offered in Spain may not be sufficient to help keep older people living at home, being the institutionalization in a nursing home (NH) an unavoidable consequence. OBJECTIVE: To evaluate the effect of intensification in home care interventions on users with grade II or III dependency, as well as training for their informal caregivers in order to delay or avoid their institutionalization in a NH. METHODS: A randomized clinical trial with two parallel arms and blinded assessment will be conducted at the community level in two municipalities in Catalonia (Spain). The study will include those older people (aged 65 and over) living in the community, with degree II or III of dependency, users of the public home care unwilling to be institutionalized and with a main informal caregiver in charge, who will also participate in the study. The assessments will be performed monthly up to 15 months, when the intervention will be finished. The main outcome will be the time until the willingness for admission to a NH. Secondary variables will be composed of sociodemographic, health, psychosocial, resource use, and follow-up variables. A multivariate Cox regression model will be carried out to estimate the effectiveness of the intervention. DISCUSSION: A multimodal home care intervention could improve the health and psychosocial status of dependent people and their informal caregivers and facilitate their permanence at home. TRIAL REGISTRATION: NCT05567965.

Risk factors for developing symptomatic COVID-19 in older residents of nursing homes: A hypothesis-generating observational study.

Objectives: To identify which risk factors were associated with developing Coronavirus Disease-19 (COVID-19) infection, with symptoms, in institutionalized older people. Methods: A 1-year longitudinal multi-center study was conducted in 5 nursing homes (NHs) over the period December 2019 to March 2021. Inclusion criteria included being a permanent resident in the NH, aged 65 years or older, and a positive diagnosis of COVID-19 objectively confirmed by a diagnostic test. A descriptive and bivariate analysis was performed, calculating relative risk (RR) with 95% confidence intervals and statistical significance at p<0.05. Results: Of the total sample of 78 individuals who tested positive for COVID-19, the mean age was 84.6 years (SD=±7.8), 62 (79.5%) were female; 40 (51.3%) participants presented with COVID-19 symptoms. Living in a private NH (RR=3.6, 95% CI [1.2-11.0], p=0.023) and having suffered a stroke (RR=4.1, 95% CI [1.1-14.7], p=0.033) were positively associated with developing COVID-19 infection with symptoms. Conclusions: Having suffered a stroke and living permanently in a private NH were positively associated with symptomatic COVID-19 in this sample of institutionalized older people.Clinical Trials ID: NCT04297904.

Efecto del confinamiento por COVID-19 sobre la incidencia y gravedad de las caídas en personas mayores institucionalizadas: estudio longitudinal / Effect of COVID-19 lockdown on the incidence and severity of falls in institutionalized older people: A longitudinal study

Antecedentes: En la pandemia de COVID-19 se declararon medidas en residencias geriátricas, como el confinamiento estricto. Objetivo: Evaluar el impacto del confinamiento sobre la incidencia de caídas y sus factores asociados en personas mayores institucionalizadas durante el primer año de pandemia en comparación con el año previo. Métodos: Se realizó un estudio multicéntrico, comparativo entre el año prepandemia (marzo 2019- febrero 2020) y el primer año (marzo 2020- febrero 2021) en cinco residencias de Cataluña, España. Se registró el número de caídas, fecha, lugar y consecuencias, así como información sociodemográfica y de salud. Se realizó un análisis descriptivo, bivariante y multivariado, calculando Odds Ratio (OR) con intervalos de confianza del 95% y significación estadística de p < 0,05. Resultados: La muestra fue de 80 individuos, con una edad media de 84,4 años, siendo 83,7% mujeres. El primer año de pandemia, aumentaron las caídas por persona 0,21% (en habitaciones 32,0%). En el análisis multivariado del periodo prepandemia, el riesgo de sarcopenia (OR = 4,02; IC 95% [1,09-14,82] p = 0,036) resultó un factor de riesgo de caídas independientemente de la edad y la hipertensión. En el primer año de pandemia no se encontraron factores asociados estadísticamente significativos. Conclusiones: En el primer año de pandemia por COVID-19, aumentaron 15,6% las caídas y 8,7% las personas que cayeron en comparación con el año anterior. Cambió el lugar de las zonas comunes a las habitaciones y la severidad, aumentando 10,1% las fracturas. La edad avanzada, el riesgo de sarcopenia y la hipertensión arterial se asociaron a las caídas en el periodo prepandemia. (AU)

Background: During the COVID-19 pandemic, virus contention measures such as strict confinement were declared in nursing homes. Objective: To assess the impact of confinement on the incidence of falls and their associated factors in institutionalized older persons during the first year of the pandemic compared to the previous year. Methods: A multicenter, comparative study was conducted between the pre-pandemic year (March 2019 to February 2020) and the first year (March 2020 to February 2021) in five nursing homes in Catalonia (Spain). The number of falls, date, placement and consequences were recorded, as well as sociodemographic and health information. A descriptive, bivariate and multivariate analysis was performed, calculating odds ratio (OR) with 95% confidence intervals and statistical significance of p<0.05. Results: The sample consisted of 80 individuals, with a mean age of 84.4 years, 83.7% being women. In the first year of the pandemic, the number of falls per person increased by 0.21% (32.0% in rooms). In multivariate analysis of the pre-pandemic period, the risk of sarcopenia (OR = 4.02; 95% CI [1.09–14.82], p = 0.036) was a risk factor for falls independently of age and hypertension. In the first year of pandemic no statistically significant associated factors were found. Conclusions: In the first year of the COVID-19 pandemic, there was a 15.6% increase in falls and an 8.7% increase in the number of people who fell compared to the previous year. The falls’ location changed from common areas to bedrooms and increased in severity, with a 10.1% increase in fractures. Older age, risk of sarcopenia and arterial hypertension were associated with falls during the pre-pandemic period. (AU)

Co-created Technological Solutions for Caregivers in Health Care: Systematic Review.

BACKGROUND: Support interventions for caregivers can reduce their stress, possibly improving the quality of patients' care while reducing care costs. Technological solutions have been designed to cover their needs, but there are some challenges in making them truly functional for end users. Co-design approaches present important opportunities for engaging diverse populations to help ensure that technological solutions are inclusive and accessible. OBJECTIVE: This study aimed to identify co-created technological solutions, as well as the process followed for their co-creation, in the field of health for caregivers. METHODS: The literature review was conducted in the Medline, Web of Science, Scopus, Science Direct, Scielo, and IEEE Xplore databases. The inclusion criteria were studies written in English or Spanish and with a publication date until May 2021. The content had to specify that the caregivers actively participated in the co-creation process, which covered until the development phase of the technological solution (prototype). The level of evidence and the methodological quality were analyzed when possible, using the Scottish Intercollegiate Guidelines Network criteria and the Mixed Methods Appraisal Tool, version 2018, respectively. RESULTS: In total, 410 papers were identified, and 11 met the eligibility criteria. The most predominant articles were mixed methods studies and qualitative studies. The technology used in the analyzed articles were mobile or web applications (9 studies) and specific devices such as sensors, cameras, or alarm systems (2 studies) to support the health and social aspects of caregivers and improve their education in care. The most common patient profile was older people (7 studies); 6 studies used co-creation in the requirements phase, 6 studies detailed the design phase. In 9 studies, the prototype was iteratively refined in the development phase, and the validation phase was performed in 5 of the reviewed studies. CONCLUSIONS: This systematic review suggests that existing co-created technological solutions in the field of health for caregivers are mostly mobile or web applications to support caregivers' social health and well-being and improve their health knowledge when delivering care to patients, especially older people. As for the co-creation process, caregivers are particularly involved during development and in the design. The scarce literature found indicates that further research with higher methodological quality is needed.

[Effect of COVID-19 lockdown on the incidence and severity of falls in institutionalized older people: A longitudinal study]. / Efecto del confinamiento por COVID-19 sobre la incidencia y gravedad de las caídas en personas mayores institucionalizadas: estudio longitudinal.

BACKGROUND: During the COVID-19 pandemic, virus contention measures such as strict confinement were declared in nursing homes. OBJECTIVE: To assess the impact of confinement on the incidence of falls and their associated factors in institutionalized older persons during the first year of the pandemic compared to the previous year. METHODS: A multicenter, comparative study was conducted between the pre-pandemic year (March 2019 to February 2020) and the first year (March 2020 to February 2021) in five nursing homes in Catalonia (Spain). The number of falls, date, placement and consequences were recorded, as well as sociodemographic and health information. A descriptive, bivariate and multivariate analysis was performed, calculating odds ratio (OR) with 95% confidence intervals and statistical significance of p<0.05. RESULTS: The sample consisted of 80 individuals, with a mean age of 84.4 years, 83.7% being women. In the first year of the pandemic, the number of falls per person increased by 0.21% (32.0% in rooms). In multivariate analysis of the pre-pandemic period, the risk of sarcopenia (OR = 4.02; 95% CI [1.09-14.82], p = 0.036) was a risk factor for falls independently of age and hypertension. In the first year of pandemic no statistically significant associated factors were found. CONCLUSIONS: In the first year of the COVID-19 pandemic, there was a 15.6% increase in falls and an 8.7% increase in the number of people who fell compared to the previous year. The falls' location changed from common areas to bedrooms and increased in severity, with a 10.1% increase in fractures. Older age, risk of sarcopenia and arterial hypertension were associated with falls during the pre-pandemic period.

How did the COVID-19 pandemic affect urinary incontinence and its management in the nursing homes? A descriptive phenomenological study.

BACKGROUND: Management of urinary incontinence (UI) in nursing homes (NHs) represents a complex process that may have become more challenging during a period in which front-line health professionals (HPs) must deal with the outbreak of a new infectious disease. We aimed to investigate how UI and its management was affected in NHs during the COVID-19 pandemic based on the perception of health professionals. METHODS: This qualitative study was conducted between January and March 2021 with 16 health professionals working in nine NHs in the Osona county (Barcelona, Spain) during the COVID-19 pandemic. The individual interviews were conducted via online videoconferencing and each session was audio recorded. RESULTS: The HPs highlighted that the COVID-19 pandemic affected the management of continence in NHs, resulting in increased UI. Two main factors were identified: workforce-related and resident-related factors. Considering the workforce, three main topics emerged: pandemic as the priority, lack of personnel and use of personal protective equipment as an obstacle to communication with residents and attending to their needs. CONCLUSION: Managing UI in NHs always has been a challenging point of care, and these challenges were worsened by the restrictions and additional difficulties that arose during the COVID-19 pandemic.

Effectiveness of graded motor imagery protocol in phantom limb pain in amputed patient: Protocol of a randomized clinical trial.

OBJECTIVE: The aim of this study is to analyse the effectiveness of the Graded Motor Imagery (GraMI) protocol in phantom limb pain in amputee patients. MATERIALS AND METHODS: A randomised clinical trial will be conducted, with two parallel groups and simple blinding, and a phenomenological study with semi-structured interviews. People over the age of 18, with amputation of one limb, with a minimum score of 3 on the visual analogue scale of pain, who are pharmacologically stable and have been discharged from hospital, will be recruited. An initial assessment, a post-intervention assessment (9 weeks) and a follow-up assessment (12 weeks post-intervention) will be performed, in which pain, quality of life, functionality and psychological aspects will be assessed. The aim of the qualitative study is to find out about the experience of living with phantom limb pain and to identify the satisfaction with the intervention. A descriptive, univariate and bivariate quantitative statistical analysis will be performed using the SPSS program, with a 95% confidence level and a statistical significance level of p < 0.05. The qualitative analysis will be carried out using the Atlas.ti 8.0 program, where the different interviews will be analysed, coded and categorised. DISCUSSION: The GraMI protocol allows the patient to work on motor learning through brain reorganisation, analytical movements, sensory stimulation, and functional activities. In addition, it can help to standardise the use of graded motor imagery in future studies and in clinical practice with this patient profile. TRIAL REGISTRATION: NCT05083611.

Incidence and Predictive Factors of Functional Decline in Older People Living in Nursing Homes: A Systematic Review.

OBJECTIVES: To review the evidence on incidence and predictive factors of functional decline (FD) in nursing home (NH) residents. DESIGN: A systematic review of the literature. SETTING AND PARTICIPANTS: Longitudinal studies involving individuals age 60 years and older living in a NH and with at least 2 functional capacity assessments were eligible. METHODS: The search was carried out up to June 2021 and was conducted in Embase, PubMed, Web of Science, Cochrane Library, CINAHL, Scopus, SciELO, and Google Scholar databases. RESULTS: A total of 27 studies met the eligibility criteria, most of which were prospective, recruiting participants in more than 1 NH, and conducted in a single country. Studies reported a high rate of functional dependency at baseline and FD at follow-up; in 1 year, 38.9% to 50.6% of residents experienced FD. Predictive factors of FD that were significant in at least 2 of the included studies were cognitive impairment, functional status at baseline, urinary incontinence, length of institutionalization, age, depression, being married, being male, and stroke disease. Protective factors were licensed nursing hours and presence of a geriatrician within the NH staff. CONCLUSIONS AND IMPLICATIONS: This review highlights the high incidence of FD in NH residents and identifies risk and protective factors of FD that may support the design of preventative strategies for this vulnerable and frail population.

Sarcopenia and associated factors according to the EWGSOP2 criteria in older people living in nursing homes: a cross-sectional study.

BACKGROUND: In 2018, the European Working Group on Sarcopenia in Older People (EWGSOP2) updated the original definition of sarcopenia, establishing new criteria to be used globally. Early diagnosis of sarcopenia in nursing home residents and the identification of contributing factors would target interventions to reduce the incidence of malnutrition, social isolation, functional decline, hospitalization and mortality. AIM: Verify the prevalence and the degree of severity of sarcopenia according to the new EWSGOP2 criteria and to analyse its associated factors in residents living in nursing homes in Central Catalonia (Spain). DESIGN: A cross-sectional multicenter study was conducted in 4 nursing homes. SARC-F test was applied as the initial screening, muscle strength was measured by a dynamometer, skeletal muscle mass by bioimpedance analysis and physical performance by Gait Speed. Four categories were used: total probable sarcopenia, probable sarcopenia, confirmed sarcopenia and severe sarcopenia. RESULTS: Among the total sample of 104 nursing home residents (mean age 84.6, ± 7.8; median 86, IQR 110), 84.6% were women and 85 (81.7%) (95% confidence interval [CI] 73.0-88.0) had total probable sarcopenia, 63 (60.5%) had probable sarcopenia, 19 (18.3%) had confirmed sarcopenia and 7 (6.7%) had severe sarcopenia. In the bivariate analysis, obesity was negatively associated and total time in sedentary behavior positively associated with all sarcopenia categories. In addition, malnutrition and urinary continence were positively associated with total and probable sarcopenia. Urinary incontinence was a positive associated factor of total and probable sarcopenia. In the multivariate analysis, obesity represented a negative associated factor: OR = 0.13 (0.03 - 0.57), p = 0.007 and OR = 0.14 (0.03 - 0.60), p = 0.008 with total and probable sarcopenia, respectively, adjusted by urinary incontinence status. For confirmed sarcopenia, obesity also represented a negative associated factor OR = 0.06 (0.01 - 0.99), p = 0.049 and the total time in sedentary behavior a positive associated factor OR = 1.10 (1.00- 1.20), p = 0.040. CONCLUSIONS: According the EWGSOP2 criteria, high prevalence of sarcopenia was found in institutionalized older people, ranging from 6.7 to 81.7% depending on the category. Malnutrition, urinary incontinence and total time in sedentary behavior were associated with sarcopenia, whilst obesity represented a protective factor in this population.

Validation of a dual-task exercise program to improve balance and gait speed in older people (DualPro): a Delphi study.

Background: Most physical exercise programs for older people work the physical component in isolation, excluding cognitive aspects. Previous studies reported that both components (physical and cognitive) are necessary for correct functioning of older people in the society. Purpose: To create and validate a dual-task exercise program (DualPro) to improve balance and gait speed in older people. Methods: Expert consensus or the Delphi Method was used for validation. A group of 17 experts in neurorehabilitation and geriatrics was recruited to assess the proposed exercise program. They were selected taking into account their experience in clinical practice as well as their knowledge of the subject through the use of the expert competence coefficient (K). Online questionnaires were sent with a total of 11 exercises, which had to be rated using a "Likert" scale from 1 to 7. Results: Two rounds were conducted to achieve 100% consensus in all exercises. The interquartile range of each exercise in both rounds was stable. During the second round, the relative interquartile range was less than 15% in all the questions, thus demonstrating consensus among the experts. Conclusion: Experts in neurorehabilitation and geriatrics have concluded the validity of the progressive and systematized program of dual-task exercises focused on improving balance and gait speed for older people. This exercise program can help in the homogenization of the use of dual-task exercises in future studies and in professional practice.

Urinary Incontinence and Its Association with Physical and Psycho-Cognitive Factors: A Cross-Sectional Study in Older People Living in Nursing Homes.

Urinary incontinence (UI) is a common geriatric syndrome affecting bladder health and is especially prevalent in nursing homes (NHs). The aim of the study was to determine the prevalence of UI and its associated factors in five Spanish NHs. UI (measured with Minimum Data Set 3.0), sociodemographic, and health-related variables were collected. Chi-square (or Fisher's) or Student's t-test (or Mann Whitney U) for bivariate analysis were used, with Prevalence Ratio (PR) as an association measure. The prevalence of UI was 66.1% (CI:95%, 53.6-77.2) in incontinent (n = 45, mean age 84.04, SD = 7.7) and continent (n = 23, mean age 83.00, SD = 7.7) groups. UI was significantly associated with frailty (PR = 1.84; 95%CI 0.96-3.53), faecal incontinence (PR = 1.65; 95%CI 1.02-2.65), anxiety (PR = 1.64; 95%CI 1.01-2.66), physical performance (PR = 1.77; 95%CI 1.00-3.11), and cognitive state (PR = 1.95; 95%CI 1.05-3.60). Statistically significant differences were found between incontinent and continent NH residents for limitations in activities of daily living (ADL), mobility, quality of life, sedentary behaviour, and handgrip strength. It can be concluded that two out of three of the residents experienced UI, and significant associated factors were mainly physical (sedentary behaviour, frailty, physical performance, ADL limitations, mobility, faecal incontinence, and handgrip strength) followed by psycho-cognitive factors (cognition, anxiety, and quality of life).

Development and Validation of a Graded Motor Imagery Intervention for Phantom Limb Pain in Patients with Amputations (GraMI Protocol): A Delphi Study.

BACKGROUND: Phantom limb pain can be defined as discomfort or pain in a missing part of the limb. The aims of this study were to develop and validate, through a Delphi methodology, a graded motor imagery protocol in order to reduce phantom limb pain. METHOD: Physiotherapists and/or occupational therapists with experience in research and a minimum clinical experience of five years in the field of neurorehabilitation and/or pain were recruited by part of a group of experts to assess the intervention. The study was conducted through an online questionnaire, where experts assessed each aspect of the intervention through a Likert scale. As many rounds as necessary were carried out until consensus was reached among experts. RESULTS: A total of two rounds were required to fully validate the intervention. During the second round, the relative interquartile range of all aspects to be assessed was less than 15%, thus showing a consensus among experts and with good concordance (Kappa index of 0.76). CONCLUSION: Experts validated a graded motor imagery intervention of phantom limb pain in patients with amputations (GraMi protocol). This intervention can help to homogenize the use of graded motor imagery in future studies and in clinical practice.

Urinary incontinence and sedentary behaviour in nursing home residents in Osona, Catalonia: protocol for the OsoNaH project, a multicentre observational study.

INTRODUCTION: Several studies have shown that physical activity (PA) levels and sedentary behaviour (SB) are independent risk factors for many health-related issues. However, there is scarce evidence supporting the relationship between SB and urinary incontinence (UI) in community-dwelling older adults, and no information on any possible association in institutionalised older adults. Stage I of this project has the main objective of determining the prevalence of UI and its associated factors in nursing home (NH) residents, as well as analysing the association between UI (and its types) and SB. Stage II aims to investigate the incidence and predictive factors of functional and continence decline, falls, hospitalisations, mortality and the impact of the COVID-19 pandemic among NH residents. METHODS AND ANALYSIS: Stage I is an observational, multicentre, cross-sectional study with mixed methodology that aims to explore the current status of several health-related outcomes in NH residents of Osona (Barcelona, Spain). The prevalence ratio will be used as an association measure and multivariate analysis will be undertaken using Poisson regression with robust variance. Stage II is a 2-year longitudinal study that aims to analyse functional and continence decline, incidence of falls, hospitalisations, mortality and the impact of the COVID-19 pandemic on these outcomes. A survival analysis using the actuarial method for functional decline and continence, evaluated every 6 months, and the Kaplan-Meier method for falls, hospitalisations and deaths, and Cox regression for multivariate analysis will be undertaken. ETHICS AND DISSEMINATION: The study received the following approvals: University of Vic - Central University of Catalonia Ethics and Research Committee (92/2019 and 109/2020), Clinical Research Ethics Committee of the Osona Foundation for Health Research and Education (FORES) (code 2020118/PR249). Study results will be disseminated at conferences, meetings and through peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04297904.