Alteraciones del sueño y demencia en población mayor. Revisión sistemática / Sleep disturbances and dementia in the elderly population. Systematic review

Introducción: La demencia en la persona mayor es uno de los factores que más disminuye la calidad de vida, junto a las comorbilidades que conlleva, como las alteraciones del sueño. Sin embargo, numerosos estudios apuntan a una bidireccionalidad causal entre estos 2 factores. El objetivo del trabajo consiste en elaborar una revisión sistemática de las bases de datos disponibles acerca de la relación entre alteraciones en el sueño y la demencia. Metodología: Las fuentes de búsqueda fueron PubMed, Scopus y Cochrane. Se siguió la estrategia de búsqueda “((Dementia) OR (“Alzheimer Disease”)) AND ((“Sleep Wake Disorders”) OR (circadia*) OR (“sleep disorders, intrinsic”) OR (“Sleep Disorders”) OR (“Circadian Rhythm”) OR (“Circadian Clocks”) OR (“sleep disorders, circadian rhythm”) OR (“circadian dysregulation”))”, se atendieron a los criterios de inclusión/ exclusión y se extrajeron 35 artículos. Resultados: La bibliografía revisada sustenta la relación de retroalimentación entre las alteraciones del sueño y la demencia. El beta-amiloide, característico de las placas y ovillos neurofibrilares en la enfermedad del Alzheimer, aumenta tras la privación de sueño, lo que, a su vez, suele generar acúmulo en el núcleo supraquiasmático, principal regulador del ciclo sueño-vigilia y de los ritmos circadianos. Conclusiones: Las alteraciones del sueño son posibles predictores de la enfermedad del Alzheimer y, en su mayor parte, son un factor modificable de la gravedad y tiempo de inicio de la patología. Ambos se interrelacionan en una sinergia mutua (AU)

Introduction: Dementia in the elderly is one of the factors that most reduces the quality of life, together with the comorbidities that it entails, such as sleep disturbances. However, numerous studies point to a causal bidirectionality between these two factors. The aim of the study is to elaborate a systematic review of the available data base on the relationship between sleep disturbances and dementia. Methodology: The search sources were PubMed, Scopus and Cochrane, following the search strategy “((Dementia) OR (“ Alzheimer Disease “)) AND ((“ Sleep Wake Disorders“) OR (circadia *) OR (“ sleep disorders, intrinsic “) OR (“ Sleep Disorders “) OR (“Circadian Rhythm”) OR (“Circadian Clocks”) OR (“sleep disorders, circadian rhythm”) OR (“circadian dysregulation”))”and according to the inclusion / exclusion criteria, 35 articles were extracted. Results: The literature reviewed supports the feedback relationship between sleep disturbances and dementia. Amyloid-beta, characteristic of neurofibrillary plaques and tangles in Alzheimer disease, increases after sleep deprivation. Its accumulation is usually generated in the suprachiasmatic nucleus, the main regulator of the sleep-wake cycle and circadian rhythms. Conclusions: Sleep disturbances are possible predictors of AD and, for the most part, a modifiable factor of the severity and time of onset of the pathology. Both are interrelated in a mutual synergy (AU)

Sleep analysis in emergency nurses' department.

BACKGROUND: Shift work increases the risk of suffering physiological and psychological alterations, due to the sleep disorders that it usually produces in the staff with this type of workday. OBJECTIVE: Analyze the influence of shift work on sleep quality in the nursing staff of the emergency department of the University Hospital of Leon. METHODS: A total of 70 emergency department nurses aged between 24-56 years were divided into two groups (rotating shift and fixed morning or afternoon shift). The Pittsburgh sleep quality index was used for this purpose. In order to establish differences between the two groups, a bivariate analysis was performed using the χ² test. RESULTS: The results showed that both groups had "rather poor" subjective sleep quality, with scores of 8.5 for fixed shift versus. 6.3 for a rotating shift. The group of nurses' rotating shifts slept an average of 5.39 hours compared to 7.47 hours for a fixed shift. Significant differences were found in sleep latency, sleep disturbances, and the use of sleep medication, with more negative results for the rotating shift. CONCLUSIONS: Rotating shift produces a poor quality of sleep compared to a fixed morning or afternoon shift, and it would be interesting for the center itself to establish sleep improvement and sleep hygiene programs.

Sleep analysis in emergency nurses' department

SUMMARY Shift work increases the risk of suffering physiological and psychological alterations, due to the sleep disorders that it usually produces in the staff with this type of workday. OBJECTIVE: Analyze the influence of shift work on sleep quality in the nursing staff of the emergency department of the University Hospital of Leon. METHODS: A total of 70 emergency department nurses aged between 24-56 years were divided into two groups (rotating shift and fixed morning or afternoon shift). The Pittsburgh sleep quality index was used for this purpose. In order to establish differences between the two groups, a bivariate analysis was performed using the χ² test. RESULTS: The results showed that both groups had "rather poor" subjective sleep quality, with scores of 8.5 for fixed shift versus. 6.3 for a rotating shift. The group of nurses' rotating shifts slept an average of 5.39 hours compared to 7.47 hours for a fixed shift. Significant differences were found in sleep latency, sleep disturbances, and the use of sleep medication, with more negative results for the rotating shift. CONCLUSIONS: Rotating shift produces a poor quality of sleep compared to a fixed morning or afternoon shift, and it would be interesting for the center itself to establish sleep improvement and sleep hygiene programs.

Factores predictores del delirium en pacientes octogenarios hospitalizados por fractura de cadera / Predictors of delirium in octogenarian patients hospitalized for hip fracture

Introducción: El delirium es considerado como uno de los grandes síndromes geriátricos por el impacto sobre el comportamiento de los pacientes y el desconcierto y frustración que origina en los profesionales y familiares. Objetivo: identificar y describir los factores predictores del riesgo de desarrollar delirium en pacientes octogenarios hospitalizados con fractura de cadera. Método: estudio de cohorte, prospectivo realizado con una muestra de 287 pacientes (87.2 ± 3.2 años) ortogeriátricos reclutados de la Unidad de Traumatología del Hospital Universitario de León (España). Se incluyeron factores predisponentes, precipitantes y de riesgo que incluyen variables sociodemográficas, basales, quirúrgicas, farmacológicas, comorbilidades y complicaciones. Resultados: la presencia de anemia, ASA (en categoría 3-4) deterioro cognitivo, ITU, alteraciones visuales y RAO, por este orden, pueden ser consideradas como variables predictivas del delirium en pacientes octogenarios hospitalizados con fractura de cadera. Conclusión: el tipo de factores predictivos que más impactan en el desarrollo del delirium podrían ser controlados desde el mismo momento de la hospitalización del paciente. Por consiguiente, es posible minimizar el efecto de desconcierto que ocasiona habitualmente el cuadro en pacientes, familiares y sanitarios. (AU)

Introduction: Delirium is considered one of the great geriatric syndromes due to the impact on the behavior of patients and the confusion and frustration that it causes in professionals and family members. Objective: identify and describe the predictors of the risk of developing delirium in hospitalized octogenarian patients with hip fracture. Methodology: prospective cohort study carried out with a sample of 287 ortho-geriatric patients (87.2 ± 3.2 years), recruited from the Traumatology Unit of the University Hospital of León (Spain). Predisposing, precipitating and risk factors were included, including sociodemographic, baseline, surgical, pharmacological comorbidities and complications variables. Results: the results of the study show that the presence of anemia, ASA (in category 3-4), cognitive impairment, UTI, visual disturbances and RAO, variables, in this order, can be considered as predictive variables of delirium in hospitalized octogenarian patients with fracture of hip. Conclusion: this study shows that the type of predictive factors that most impact the development of delirium could be controlled from the moment the patient is hospitalized. Therefore, it is possible to minimize the effect of confusion that usually causes this syndrome in patients, family members, and health professionals. (AU)

Good practices in the recovery of ambulation in octogenarian women with hip fractures.

OBJECTIVE: Determine good recovery practices for ambulation of octogenarian women after hospital discharge after being operated on for hip fracture. METHODS: Prospective study during the second half of 2019, with 192 women (85.95 ± 5.1 years) with hip fracture. A medical history, fracture types, complications, surgical treatment, and assessment of the level of ambulation were recorded before and after six months of hospital discharge. RESULTS: 100 patients lived in the family home and 92 in an institutional center, 68.2% provided pertrochanteric fracture and a total of 3.7 comorbidities, all of them received spinal anesthesia and were admitted an average of 11.4 days. After six months, the patients showed a significant loss of functional independence with respect to the situation prior to the fracture, both for the ability to wander and for activities of daily living. It is noteworthy that the worst prognosis in the recovery of ambulation has to do with intermediate levels of ambulation and that the functional level of departure influences to a lesser extent than the place where they perform the recovery. CONCLUSIONS: Age is a factor that influences the recovery of hip fracture, but there are other influential factors since patients who remain in the family home have a better functional prognosis than those who recover in institutionalized centers, after six months of hospital discharge.

Predictors of Delirium in Octogenarian Patients Hospitalized for a Hip Fracture.

INTRODUCTION: Since delirium is a major complication that can arise after a patient with a hip fracture has been hospitalized, it is considered to be one of the most common geriatric conditions. Therefore, its prevention and early detection are essential for reducing both the length of the patient's stay in the hospital and complications during the hospitalization process. OBJECTIVE: To identify and analyze the predictors for developing delirium in octogenarians who were admitted to hospital for a hip fracture. METHODOLOGY: A prospective study conducted with a sample of 287 patients aged 80 years and older (mean age 87.2 ± 3.2 years; 215 women, 72 men), recruited from the Trauma Unit of the University Hospital of León (Spain). Further, 71.1% of the patients lived in a family member's home, while the other 28.9% lived in a nursing home. After observing each patient's interactions with their doctor in a clinical setting, the data for this study were obtained by reviewing the selected patients' charts. The variables analyzed were sociodemographic information (age, sex, and place of residence), medical information (type of hip break and surgical intervention), cognitive impairment (MMSE score), functional level (Barthel Index score), and clinical information (pharmacological, comorbidities, complications, and the diagnosis and assessment of the severity of delirium in a patient). The univariate and multivariate logistic regression analysis showed a significant relationship between acute confusional state and the following variables: anemia, American Society of Anesthesiologists (ASA) III and IV patients, state of cognitive frailty and functional level, a urinary tract infection, changes in the visual field, renal arterial occlusion, and the type and dosage of drugs administered (this variable was identified in the multivariate model). The inverse relationship between anemia and acute confusional state is surprising. CONCLUSION: This research shows that clinical observation of acute confusional state is necessary but not sufficient for addressing this condition early and adequately in older adults who have been hospitalized for a hip fracture.

Good practices in the recovery of ambulation in octogenarian women with hip fractures

SUMMARY OBJECTIVE: Determine good recovery practices for ambulation of octogenarian women after hospital discharge after being operated on for hip fracture. METHODS: Prospective study during the second half of 2019, with 192 women (85.95 ± 5.1 years) with hip fracture. A medical history, fracture types, complications, surgical treatment, and assessment of the level of ambulation were recorded before and after six months of hospital discharge. RESULTS: 100 patients lived in the family home and 92 in an institutional center, 68.2% provided pertrochanteric fracture and a total of 3.7 comorbidities, all of them received spinal anesthesia and were admitted an average of 11.4 days. After six months, the patients showed a significant loss of functional independence with respect to the situation prior to the fracture, both for the ability to wander and for activities of daily living. It is noteworthy that the worst prognosis in the recovery of ambulation has to do with intermediate levels of ambulation and that the functional level of departure influences to a lesser extent than the place where they perform the recovery. CONCLUSIONS: Age is a factor that influences the recovery of hip fracture, but there are other influential factors since patients who remain in the family home have a better functional prognosis than those who recover in institutionalized centers, after six months of hospital discharge.

RESUMO OBJETIVO: Determinar boas práticas para a recuperação da ambulação de octogenárias posterior à alta hospitalar após cirurgia por fratura da pelve. METODOLOGIA: Um estudo prospectivo realizado no segundo semestre de 2019 com 192 mulheres (85,95 ± 5,1 anos) com fratura da pelve. O histórico médico, tipo de fratura, complicações, tratamento cirúrgico, e avaliação do nível de ambulação foram registrados antes da alta hospitalar e após seis meses. RESULTADOS: De todas as pacientes, 100 viviam com a família e 92 em alguma instituição, 68.2% tinham fratura peritrocantérica e uma média de 3,7 comorbidades; todas receberam anastesia espinhal e ficaram internadas por 11,4 dias em média. Após seis meses, as pacientes apresentaram uma perda significativa da independência funcional em relação à situação anterior à fratura, tanto em relação à capacidade de ambulação e atividades cotidianas. É importante ressaltar que o prognóstico negativo em relação à recuperação da ambulação está relacionado a níveis intermediários de ambulação e que o nível funcional de saída tem menor influência do que o local onde a recuperação é feita. CONCLUSÃO: A idade é um fator que influencia a recuperação de fraturas da pelve. Porém, há outros fatores com influência, já que as pacientes que ficam com familiares têm um prognostico funcional melhor do que aquelas que se recuperam em instituições, após seis meses da alta hospitalar.

Características funcionales de mujeres octogenarias con fractura de cadera después del alta hospitalaria / Functional characteristics of octogenarian women with hip fracture after hospital discharge

OBJETIVO: Identificar las principales características clínicas, funcionales y cognitivas de las mujeres octogenarias hospitalizadas con diagnóstico de fractura de cadera en el Hospital Universitario de León (España). Además, determinar la influencia del domicilio, al que se trasladan los pacientes al recibir el alta hospitalaria en la recuperación de la deambulación. MÉTODO: Estudio piloto prospectivo descriptivo transversal que analiza las características fisiológicas de mujeres mayores hospitalizadas con diagnóstico de fractura de cadera en el Hospital de León. RESULTADOS: Se incluyeron 96 mujeres con una edad media de 85,95 ± 5,1 años. El número total de comorbilidades presentadas por las pacientes fue de 3,7. El tipo de fractura más frecuente fue la pertrocantérica. Todos los pacientes empeoraron respecto a la capacidad de deambulación basal, encontrando las mayores diferencias en los que fueron institucionalizados frente a los que permanecieron en su residencia habitual. CONCLUSIONES: El domicilio al que se trasladan los pacientes al recibir el alta hospitalaria es un factor determinante para la recuperación de la movilidad e independencia de los mismos. En este sentido, es importante señalar que la práctica habitual de institucionalización de las personas mayores después de una fractura de cadera se asocia con una peor recuperación

OBJECTIVE: To identify the main clinical, functional and cognitive characteristics of hospitalized octogenarian women diagnosed with hip fracture at the University Hospital of León (Spain). In addition, to determine the influence home, to which patients are transferred upon discharge from the recovery from wandering. METHOD: Prospective descriptive pilot study cross-sectional analysis of the physiological characteristics of hospitalized older women with a diagnosis of hip fracture at the Hospital de León. RESULTS: It included 96 women with an average age of 85.95 ± 5.1 years. The total number of comorbidities presented by patients was 3.7. The most common type of fracture frequent was the pertrochanteric. All patients worsened with respect to the capacity of basal wandering, finding the greatest differences in those who were institutionalized as opposed to those who remained at their usual residence. CONCLUSIONS: The address to which patients are transferred when they are discharged from hospital is a determining factor in the recovery of mobility and independence of themselves. In this regard, it is important to note that the usual practice of institutionalisation of older people after a hip fracture is associated with a worse recovery

Influence of different sports on fat mass and lean mass in growing girls.

PURPOSE: The aim of this study was to analyze and compare the effects of different sports (swimming, football, basketball, and handball) on fat mass and lean mass in prepubertal and pubertal girls. METHODS: Two hundred girls (10.6 ± 1.5 years old, Tanner stages I-III) participated in the study and were divided into 5 groups: 40 swimmers, 40 football players, 40 basketball players, 40 handball players, and 40 controls. Fat and lean masses at whole body, arms, trunk, and legs were measured using dual-energy X-ray absorptiometry (DXA). Pubertal status was determined using Tanner test. Effects of different sports on fat and lean masses were assessed through analysis of covariance with height as covariates. Analyses were performed separately in 2 groups depending on the Tanner stage (prepubertal and pubertal). RESULTS: The girls of the control group had less lean mass and more fat mass compared to the girls who play sports (p < 0.05). There were differences in body fat between sports. The swimmers and football players had less body fat (p < 0.05). On the other hand, handball players showed the highest values in lean mass (p < 0.05). CONCLUSION: Impact sports (football, basketball, and handball) and low-impact sports (swimming) provide an appropriate development of lean mass in growing girls. We can conclude that people practicing sports at early ages ensure a lower fat mass and higher lean mass compared to those who do not practice. These results may be useful as a preventive method of adult obesity.

Proceso de recuperación en las personas mayores intervenidas por fractura de cadera / Recovery process in elderly patients after hip fracture surgery

OBJETIVO: identificar las principales características clínicas, funcionales y cognitivas de los pacientes mayores hospitalizados con fractura de cadera en el Hospital Universitario de León y analizar la influencia del tipo de domicilio tras el alta hospitalaria en el proceso de recuperación. MÉTODOS: estudio preliminar descriptivo transversal en el que se analizaron las características fisiológicas de personas mayores que fueron hospitalizadas por diagnóstico de fractura de cadera en el Hospital de León. Para ello se seleccionó a personas mayores de 75 años hospitalizadas por fractura de cadera. Se evaluó el estado de salud del paciente en el momento de ingreso y tras seis semanas después del alta hospitalaria. RESULTADOS: se incluyeron 38 personas mayores. Todos los pacientes intervenidos perdieron de manera significativa funcionalidad con respecto a su situación basal (domicilio propio p< 0,009; domicilio de familiares p< 0,024; residencia geriátrica p< 0,018). El número de comorbilidades presentadas por los pacientes fue de 3,7, siendo esto un agravante más que complica el proceso de recuperación. Los pacientes que peor deambulación adquirieron a las seis semanas tras el alta hospitalaria fueron aquellos que se trasladaron a una residencia, siendo estas diferencias significativas al compararlas con los que se trasladaron a casa de un familiar (p< 0,023). CONCLUSIONES: los pacientes que se trasladaron a una residencia geriátrica tras una intervención de fractura de cadera presentan peor deambulación a las seis semanas tras el alta hospitalaria

OBJECTIVE: to identify the main clinical, functional and cognitive characteristics of elderly patients admitted at the Hospital Universitario de León with hip fracture, and to analyze the influence on the recovery process of their type of living environment after discharge from hospital. METHODS: a preliminary transversal descriptive study that analyzed the physiological characteristics of elderly patients who were hospitalized due to hip fracture diagnosis in the Hospital de León. To this aim, >75-year-old patients were selected, who had been hospitalized due to hip fracture. The health status of patients was assessed at admission and six weeks after hospital discharge. RESULTS: thirty-eight (38) elderly persons were included. All patients who underwent surgery experienced a significant loss of functionality regarding their basal situation (own home p< 0.009; the home of relatives p< 0.024; geriatric institution p< 0.018). The number of comorbidities presented by patients was 3.7, and this was an additional problem that complicated further the recovery process. The patients with a worse walking ability six weeks after hospital discharge were those transferred to a geriatric institution, with a significant difference in comparison with those transferred to the home of a relative (p< 0.023). CONCLUSIONS: those patients transferred to a geriatric institution after hip fracture surgery presented worse walking abilities at six weeks after hospital discharge

Uso de la comunicación prosocial en profesionales sanitarios y sociales con personas mayores. Estudio piloto / Using the prosocial communication in health and social mediators with elderly. A pilot study

Los profesionales sociales y de la salud están desbordados ante la creciente demanda de servicios, lo que requiere crear fórmulas dirigidas a una implicación más activa de los usuarios en su propia salud. Objetivo: diseñar un cuestionario de prosociabilidad y aplicarlo a profesionales del ámbito social y sanitario en vivo. Metodología: Cuatro observadores valoraron la prosociabilidad de 20 profesionales que interaccionaban con mayores en situación de consulta y/o actividades de ocio. La herramienta de evaluación fue un Cuestionario de buenas prácticas de comunicación prosocial, elaborado por nuestro equipo. Nueve factores relacionados con la competencia prosocial fueron observados mediante 22 ítems de conductas y actitudes. Resultados: los centros y profesionales de la salud emplean más la prosociabilidad, posiblemente ya que atienden de forma personalizada, mientras que centros y profesionales sociales atienden grupalmente. Conclusiones: Se precisan más investigaciones sobre cómo incorporar conductas prosociales en atención grupal. Además, se necesita más entrenamiento de competencias prosociales para disminuir el estilo de rol de experto, dominante entre los profesionales del estudio

Social and sanitary professionals are overwhelmed by the growing demand of services. This fact calls for the creation of terapeutical formulas promoting the active implication of users with their own health. Objective: Observe the level of prosocial communication among social and health professionals while interacting with seniors in either medical consultation or leisure supervision. Metodology: 4 observers have assessed the prosociability of 20 social and sanitary professionals. The evaluation tool was the Test of Best Practices for Prosocial Communication, designed and developed by our own research team. It includes 9 factors related to prosocial competence and 22 items related to specific behaviours and attitudes. Results: The sanitary centers and professionals exhibit higher prosocial scores. While sanitary centers take care of users on a personal basis, social centers handle users on a groupal basis. Conclusions: More research is required on strategies to incorporate prosocial conducts under groupal attention. The study manifests that more training is needed on prosocial competence in order to aminorate the expert role, which is dominant among professionals in this study

Sarcopenia, envejecimiento y actividad física / Sarcopenia, aging and physical activity

Los cambios que se producen en la composición corporal durante el proceso de envejecimiento pueden provocar un aumento de enfermedades como la obesidad y la sarcopenia. Se entiende por sarcopenia el descenso de la masa muscular esquelética que ocurre durante el proceso de envejecimiento, con una pérdida gradual de la fuerza y con riesgo de provocar una discapacidad física, diminución en la calidad de vida y aumento de la mortalidad. Actualmente se ha constatado cómo la inactividad o el descenso del nivel de actividad física son dos de los mecanismos subyacentes que favorecen el desarrollo de la sarcopenia y, por este motivo, la actividad física parece ser un factor determinante para prevenir o ralentizar el desarrollo de dicha patología. En este sentido, se aprecia la importancia de promover un estilo de vida activo de las personas mayores para garantizar una composición corporal saludable durante el proceso de envejecimiento

Changes in body composition during the aging process can cause an increase of conditions such as obesity and sarcopenia. The latter is understood as a reduction in total-body skeletal muscle mass which occurs during the aging process, with a gradual loss of strength, and with risk of causing physical disability, reduction in quality of life, and increase in mortality. It has been currently confirmed that lack of activity or a reduction in the level of physical activity are two of the underlying mechanisms which favour the development of sarcopenia and, for that reason, physical activity seems to be a determining factor to prevent or slowdown the development of said condition. In this sense, it is important to promote an active lifestyle in elderly persons, in order to ensure a healthy body composition during the aging process

Respiratory function and changes in lung epithelium biomarkers after a short-training intervention in chlorinated vs. ozone indoor pools.

BACKGROUND: Swimming in indoor pools treated with combined chemical treatments (e.g. ozone) may reduce direct exposure to disinfection byproducts and thus have less negative effects on respiratory function compared to chlorinated pools. The aim of this study is to analyze the effects of a short-term training intervention on respiratory function and lung epithelial damage in adults exercising in indoor swimming pool waters treated with different disinfection methods (chlorine vs. ozone with bromine). METHODS: Lung permeability biomakers [surfactant protein D (SP-D) and Clara cell secretory protein (CC16) in plasma] and forced expiratory volumes and flow (FEV1, FVC and FEF25-75) were measured in 39 healthy adults. Thirteen participants swam during 20 sessions in a chlorinated pool (CP), 13 performed and equivolumic intervention in an ozone pool (OP) and 13 were included in a control group (CG) without exposition. RESULTS: Median plasma CC16 levels increased in CP swimmers (4.27 ± 3.29 and 6.62 ± 5.51 µg/L, p=0.01, pre and post intervention respectively) while no significant changes in OP and CG participants were found. No significant changes in median plasma SP-D levels were found in any of the groups after the training period. FVC increased in OP (4.26 ± 0.86 and 4.43 ± 0.92 L, p<0.01) and CP swimmers (4.25 ± 0.86 and 4.35 ± 0.85 L, p<0.01). FEV1 only increased in OP swimmers (3.50 ± 0.65 and 3.59 ± 0.67, p=0.02) and FEF25-75 decreased in CP swimmers (3.70 ± 0.87 and 3.37 ± 0.67, p=0.02). CONCLUSION: Despite lung function being similar in both groups, a higher lung permeability in CP compared to OP swimmers was found after a short-term swimming program. Combined chemical treatments for swimming pools such as ozone seem to have less impact on lung epithelial of swimmers compared to chlorinated treated pools.