Effect of strength exercise with elastic bands and aerobic exercise in the treatment of frailty of the elderly patient with type 2 diabetes mellitus. / Efecto del ejercicio de fuerza muscular mediante bandas elásticas combinado con ejercicio aeróbico en el tratamiento de la fragilidad del paciente anciano con diabetes mellitus tipo 2.

AIM: To evaluate in the elderly diabetic patient the probability of improving the frailty after performing strength exercises with an elastic band and aerobic exercise. METHODS: Prospective study of diabetic patients older than 70 years, with Barthel >80 points and Global Deterioration Scale -Functional Assessment Staging <3 points. Strength exercises with an elastic band 3 days a week and walk 30min a day 5 days a week were recommended. Adherence to the exercises was assessed using the Haynes-Sacket test. Frailty was assessed by the Fried criteria and functional capacity by the Short Physical Performance Battery at baseline and at 6 months. RESULTS: 44 patients completed 6 months of follow-up. There was non-adherence to aerobic exercises in 38.6% of cases and to exercises with elastic bands in 47.7%. The prevalence of frailty decreased from an initial 34.1% to 25% at 6 months (p=0.043) and the percentage of patients with a moderate-severe functional limitation was reduced from 26.2% to 21.4% (p=0.007). Adherence to aerobic exercises (p=0.034) and absence of coronary ischemic heart disease (p=0.043) predisposed to improve frailty. CONCLUSIONS: Performing 6-month strength exercises with an elastic band and aerobic exercise reduces the prevalence of frailty in elderly diabetic patients. The probability of improving frailty decreases in case of coronary ischemic heart disease and increases with adherence to aerobic exercises.

Actitudes, conocimientos y práctica de los profesionales de enfermería en el uso de restricciones físicas con personas mayores / Use of physical restraints on the elderly: Attitudes, knowledge and practice among nursing staff

Objetivos. Explorar las actitudes, los conocimientos y la práctica relacionada con el uso de restricciones físicas en profesionales de enfermería que trabajan con ancianos, así como la relación entre estas variables. Material y métodos. Estudio transversal de tipo descriptivo y correlacional realizado en 8 residencias geriátricas, basado en 3 cuestionarios que examinaban las citadas variables. Resultados. Se incluyeron 378 encuestas (94 enfermeras y 284 auxiliares). Los profesionales tenían una actitud ligeramente en contra de las restricciones, si bien estaban dispuestos a usarlas para evitar caídas. Con relación a los conocimientos, obtuvieron un 66% de aciertos; solo un 32% creía que existen alternativas a la contención y el 69,1% ignoraba que pudiese causar la muerte de pacientes. Además, un 69,8% afirmó que su formación era escasa. La práctica podría considerarse aceptable, si bien un 61,9% opinaba que no sería necesario solicitar a la familia el consentimiento informado y solo el 47,1% de las enfermeras registraría siempre en la historia su uso. Existen diferencias en cuanto a actitudes, conocimientos y práctica entre los 2 grupos profesionales. Se observa que cuanto peores son los conocimientos y más favorable es la actitud hacia este procedimiento, peor es la práctica profesional vinculada a su aplicación. Conclusiones. La actitud del personal ante la restricción física es ambigua, y en sus conocimientos y práctica se han detectado creencias erróneas. Dada la influencia de los conocimientos sobre el resto de las variables es necesario mejorar la formación de los profesionales (AU)

Objectives: To investigate the attitudes, knowledge and practice on the use of physical restraints by nursing staff working with the elderly, as well as the relationship existing between these variables. Material and methods: A cross-sectional descriptive and correlational study was conducted among professionals from eight nursing homes. Three questionnaires asking about the mentioned variables were used. Results: A total of 378 questionnaires were finally included (94 nurses and 284 auxiliary nurses). The professionals’ attitude was generally against the use of restraints, although they were in favour of using them to avoid falls. With regard to knowledge, they obtained 66% of the correct answers; only 32% believed that there were alternatives to restraints, and 69.1% were unaware that these procedures could cause the death of patients. A total of 69.8% said that their training regarding restraint was limited. The practice could be considered acceptable, although the 61.9% thought it was not necessary to get informed consent from the family, and only 47.1% of the nurses always recorded its use in the patient’s history. Differences between attitudes, knowledge and practice were found among the two groups. A relationship between the variables was confirmed; less knowledge and more favourable attitude towards physical restraints correlate with a worst practice. Conclusions: The attitude of the staff to physical restraints is ambiguous, and erroneous concepts have been detected in their knowledge and practice. Given the influence of knowledge on the rest of the variables, the training of the professionals needs to be improved (AU)

[Use of physical restraints on the elderly: attitudes, knowledge and practice among nursing staff]. / Actitudes, conocimientos y práctica de los profesionales de enfermería en el uso de restricciones físicas con personas mayores.

OBJECTIVES: To investigate the attitudes, knowledge and practice on the use of physical restraints by nursing staff working with the elderly, as well as the relationship existing between these variables. MATERIAL AND METHODS: A cross-sectional descriptive and correlational study was conducted among professionals from eight nursing homes. Three questionnaires asking about the mentioned variables were used. RESULTS: A total of 378 questionnaires were finally included (94 nurses and 284 auxiliary nurses). The professionals' attitude was generally against the use of restraints, although they were in favour of using them to avoid falls. With regard to knowledge, they obtained 66% of the correct answers; only 32% believed that there were alternatives to restraints, and 69.1% were unaware that these procedures could cause the death of patients. A total of 69.8% said that their training regarding restraint was limited. The practice could be considered acceptable, although the 61.9% thought it was not necessary to get informed consent from the family, and only 47.1% of the nurses always recorded its use in the patient's history. Differences between attitudes, knowledge and practice were found among the two groups. A relationship between the variables was confirmed; less knowledge and more favourable attitude towards physical restraints correlate with a worst practice. CONCLUSIONS: The attitude of the staff to physical restraints is ambiguous, and erroneous concepts have been detected in their knowledge and practice. Given the influence of knowledge on the rest of the variables, the training of the professionals needs to be improved.

[Barthel and Charlson indexes for the prognosis of mortality and institutionalization in hospitalized geriatric patients]. / Indice de Charlson versus índice de Barthel como predictor de mortalidad e institucionalización en una unidad geriátrica de agudos y media estancia.

INTRODUCTION: To compare the validity of the Barthel (BI) and Charlson comorbidity index (CCI) as well as the age-adjusted CCI for the prognosis of mortality and institutionalization in hospitalized geriatric patients. MATERIAL AND METHODS: A retrospective study was conducted to evaluate patients admitted to an acute care geriatric ward and mid-term care facility in 2006 (n=343). The independent variables were the admission BI (registered in the clinical history in all patients) and the CCI and the age-adjusted CCI, which were registered "a posteriori" using the available information. The outcome variable was mortality or institutionalization when the patient was discharged. The sensitivity and specificity values for each of the cut-off points selected from the scales analyzed were recorded and ROC curves were constructed for each of these points; the area under the curve (AUC) with a confidence interval (CI) of up to 95% was calculated. RESULTS: The mean age was 82.3 years (58.6% women). The AUC was 0.736 (95% CI=0.68-0.79) for the BI, 0.61 (95% CI=0.55-0.67) for the CCI and 0.625 (95% CI=0.56-0.69) for the age-adjusted CCI. Statistically significant differences were found among the AUC of the BI compared with that of the other two indexes (p<0.01). CONCLUSIONS: As predictors of mortality and institutionalization, the BI was superior to the CCI and the age-adjusted CCI. The BI could therefore be more useful than the other two indexes when considering an adequate use of healthcare services.