[Impact of a Person Centred Care Model on the quality of life, well-being, and thriving in nursing homes. A cross-sectional study]. / Impacto en residencias de la atención centrada en las personas (ACP) sobre la calidad de vida, el bienestar y la capacidad de salir adelante. Estudio transversal.

INTRODUCTION: The aging of the population has led to the introduction of qualitative and quantitative changes in healthcare resources, among which are the introduction of models of person-centred care (PCC), although there is a lack of information on their impact. The objective of this study is to assess the impact of a PCC model on the quality of life, well-being and thriving, in people living in nursing homes METHODS: Cross-sectional study. POPULATION: all persons who lived indefinitely in the two participating centres that gave their consent. Impact of PCC vs. traditional model was assessed in terms of quality of life, well-being and thriving. Effect size was estimated with Cohen d adjusted for health problems, Charlson index, and presence of depression. RESULTS: Overall participation was 78% (59/77 persons from the conventional centre and 66/88 from the PCC). The people of the PCC centre had better well-being (d = 0.378) and thriving (d = 0.566). No differences were found in quality of life. CONCLUSION: The PCC model can have a positive impact on well-being and thriving in persons living in nursing homes.

Valor económico anual de la asistencia informal en la enfermedad de Alzheimer / Annual economic cost of informal care in Alzheimer’s disease

Introducción. El coste indirecto asociado a la atención de los pacientes con enfermedad de Alzheimer (EA) lo asume principalmente la familia. Objetivo. Describir el coste asociado al tiempo de dedicación, su evolución anual, las características y la carga del cuidador asociada. Sujetos y métodos. Pacientes diagnosticados de EA no institucionalizados, seguidos ambulatoriamente en una unidad de diagnóstico y sus cuidadores principales. Estudio prospectivo y observacional de 12 meses de evolución. Se evaluaron las características clínicas del paciente a través del Cambrigde Cognitive Examination Revised, para la capacidad cognitiva; el Disability Assessment in Dementia, para la capacidad funcional, y el inventario neuropsiquiátrico, para los trastornos no cognitivos. Se recogieron los datos sociodemográficos a través del Cambridge Examination for Mental Disorders of the Elderly Revised. Se registró la dedicación del cuidador, sus características sociodemográficas y la carga (a través de la escala de Zarit). Resultados. La muestra estuvo formada por 169 pacientes y 169 cuidadores. El coste en el momento basal fue de 6.364,8 €/año, asociado principalmente al apoyo en actividades instrumentales. A los 12 meses se observó un incremento global del 29% (1.846,8 €/año). El incremento del coste se asoció a la discapacidad física (F = 25,2; gl = 1; p < 0,001), el deterioro cognitivo (F = 8,5; gl = 1; p = 0,004), la edad del paciente (F = 9,2; gl = 1; p = 0,003) y si el cuidador era o no el único (F = 20,4; gl = 1; p < 0,001). El coste de la asistencia explicó el 6,7% de la varianza total de la carga percibida por los cuidadores. Conclusiones. El coste indirecto medio de la atención fue de 6.364,8 €/año, con un incremento del 29% anual que se asoció a la discapacidad física y cognitiva, a la edad del paciente y a tener un solo cuidador (AU)

Introduction. The indirect cost associated with the care of patients with Alzheimer’s disease is taken on primarily by the family. Aim. To describe the cost associated with time dedication, its annual evolution, associated characteristics and related caregiver burden. Subjects and methods. Non-institutionalized patients diagnosed with Alzheimer’s disease who are managed on an outpatient basis in a diagnosis unit and their primary caregivers. Prospective and observational study conducted over 12 months. The patient’s clinical features were assessed using the Cambrigde Cognitive Examination Revised for cognitive capacity, the Disability Assessment in Dementia for functional capacity and the Neuropsychiatric Inventory for non-cognitive disorders. Sociodemographic data were collected by means of the Cambridge Examination for Mental Disorders of the Elderly Revised. The caregiver’s dedication, sociodemographic characteristics and burden (by means of the Zarit interview) were recorded. Results. Sample comprised of 169 patients and 169 caregivers. The cost at baseline was 6364.8 €/year, and was mainly associated with support in instrumental activities. At 12 months, an overall increase of 29% was observed (1846.8 €/year). Cost increase was associated with physical (F = 25.2; df = 1; p < 0.001) and cognitive (F = 8.5; df = 1; p = 0.004) disability, patient age (F = 9.2; df = 1; p = 0.003) and with whether the caregiver was the only caregiver or not (F = 20.4; df = 1; p < 0.001). The cost of care explained 6.7% of the total variance of the burden perceived by caregivers. Conclusions. Care has a mean indirect cost of 6364.2 €/year, with an annual increase of 29% that was associated with physical and cognitive disability, patient age and having one single caregiver (AU)

[Annual economic cost of informal care in Alzheimer's disease]. / Valor económico anual de la asistencia informal en la enfermedad de Alzheimer.

INTRODUCTION: The indirect cost associated with the care of patients with Alzheimer's disease is taken on primarily by the family. AIM: To describe the cost associated with time dedication, its annual evolution, associated characteristics and related caregiver burden. SUBJECTS AND METHODS: Non-institutionalized patients diagnosed with Alzheimer's disease who are managed on an out-patient basis in a diagnosis unit and their primary caregivers. Prospective and observational study conducted over 12 months. The patient's clinical features were assessed using the Cambrigde Cognitive Examination Revised for cognitive capacity, the Disability Assessment in Dementia for functional capacity and the Neuropsychiatric Inventory for non-cognitive disorders. Sociodemographic data were collected by means of the Cambridge Examination for Mental Disorders of the Elderly Revised. The caregiver's dedication, sociodemographic characteristics and burden (by means of the Zarit interview) were recorded. RESULTS: Sample comprised of 169 patients and 169 caregivers. The cost at baseline was 6364.8 euro/year, and was mainly associated with support in instrumental activities. At 12 months, an overall increase of 29% was observed (1846.8 euro/year). Cost increase was associated with physical (F = 25.2; df = 1; p < 0.001) and cognitive (F = 8.5; df = 1; p = 0.004) disability, patient age (F = 9.2; df = 1; p = 0.003) and with whether the caregiver was the only caregiver or not (F = 20.4; df = 1; p < 0.001). The cost of care explained 6.7% of the total variance of the burden perceived by caregivers. CONCLUSIONS: Care has a mean indirect cost of 6364.2 euro/year, with an annual increase of 29% that was associated with physical and cognitive disability, patient age and having one single caregiver.

[Adaptation and convergent validity of a telephone-based Mini-Mental State Examination]. / Adaptación y validez convergente de una versión telefónica del Mini-Mental State Examination.

BACKGROUND AND OBJECTIVE: To adapt to Spanish and to determine the convergent validity of a Telephone Mini-Mental State Examination (t-MMSE) in order to assess the cognitive functions in Alzheimer's disease (AD) patients. PATIENTS AND METHOD: Prospective and observational study of a clinical sample consisting of patients with dementia from a memory clinic. Consecutive sampling of participants was used and convergent validity of the t-MMSE and MMSE scores was determined using several statistics measures. Patients were randomly assigned depending on the administration of the in-person/telephone test (MMSE and t-MMSE) or telephone/in-person (t-MMSE and MMSE) test within a 1- to 7-day interval. The effect of the confusion variables (age, gender, years of education, dementia severity, presence or absence of hearing impairment and administration order) on the concordance between the in-person and telephone MMSE versions was analysed. RESULTS: After translating and retranslating the t-MMSE, of 141 participants, 77.47% subjects completed the protocol of the study. For the total score, the statistics for the convergent validity suggested a high consistency, independently of the order of test administration (intraclass correlation coefficient = 0.87, Spearman's rho = 0.77); for the all subscores, it suggested moderate and good correlations. The difference between subscores did not range more than 1 point in any case. Confusion variables did not affect the variability of the performance scores between t-MMSE and MMSE. CONCLUSIONS: The t-MMSE can be used as a good tool to estimate the MMSE score of patients with dementia.

Adaptación y validez convergente de una versión telefónica del Mini-Mental State Examination / Adaptation and convergent validity of a telephone-based Mini-Mental State Examination

Fundamento y objetivo: Adaptar al castellano y determinar la validez convergente de una versión telefónica del Mini-Mental State Examination (t-MMSE) para valorar las funciones cognoscitivas de los pacientes con demencia. Pacientes y método: Estudio observacional y prospectivo de pacientes con demencia seleccionados mediante muestreo consecutivo de las consultas ambulatorias de una unidad hospitalaria. Se evaluó la validez convergente de las puntuaciones del t-MMSE respecto a las puntuaciones del MMSE mediante diversos indicadores. Los participantes fueron aleatorizados a la aplicación de los tests, en el intervalo de 1 semana, presencial-telefónica (MMSE y t-MMSE) y telefónica- presencial (t-MMSE y MMSE). Se analizó el efecto de variables de confusión (edad, sexo, escolaridad, gravedad de la demencia, déficit auditivo y orden de aplicación) en el grado de concordancia entre el t-MMSE y el MMSE. Resultados: Tras el proceso de traducción directa e inversa del t-MMSE, fue posible aplicar el protocolo de estudio al 77,47% de los candidatos a participar (n=141). Para la puntuación total, los indicadores de validez convergente fueron elevados independientemente del orden de aplicación (coeficiente de correlación intraclase = 0,87; rho de Spearman = 0,77). Los indicadores de validez de las subpuntuaciones presentaron valores entre moderados y buenos. Las diferencias entre las subpuntuaciones no fueron superiores a 1 punto en ningún caso. No se observó ningún efecto de las variables de confusión en la variación de las puntuaciones entre el t-MMSE y el MMSE. Conclusiones: El t-MMSE puede ser utilizado de forma válida para estimar la puntuación del MMSE en pacientes con demencia

Background and objective: To adapt to Spanish and to determine the convergent validity of a Telephone Mini-Mental State Examination (t-MMSE) in order to assess the cognitive functions in Alzheimer's disease (AD) patients. Patients and method: Prospective and observational study of a clinical sample consisting of patients with dementia from a memory clinic. Consecutive sampling of participants was used and convergent validity of the t-MMSE and MMSE scores was determined using several statistics measures. Patients were randomly assigned depending on the administration of the in-person/telephone test (MMSE and t-MMSE) or telephone/in-person (t-MMSE and MMSE) test within a 1- to 7-day interval. The effect of the confusion variables (age, gender, years of education, dementia severity, presence or absence of hearing impairment and administration order) on the concordance between the in-person and telephone MMSE versions was analysed. Results: After translating and retranslating the t-MMSE, of 141 participants, 77.47% subjects completed the protocol of the study. For the total score, the statistics for the convergent validity suggested a high consistency, independently of the order of test administration (intraclass correlation coefficient = 0.87, Spearman's rho = 0.77); for the all subscores, it suggested moderate and good correlations. The difference between subscores did not range more than 1 point in any case. Confusion variables did not affect the variability of the performance scores between t-MMSE and MMSE. Conclusions: The t-MMSE can be used as a good tool to estimate the MMSE score of patients with dementia

[Mortality-associated factors in patients with Alzheimer's disease treated with galantamine]. / Factores asociados a la mortalidad en pacientes con enfermedad de Alzheimer tratados con galantamina.

BACKGROUND AND OBJECTIVE: To study the effect of clinical and demographic variables on mortality in patients with probable Alzheimer's disease treated with the cholinesterase inhibitor galantamine. PATIENTS AND METHOD: This retrospective cohort study reviewed 172 medical records, gathering information such as demographic and clinical variables, adverse events, number of withdrawals and duration of treatment with galantamine. RESULTS: Of 172 patients, 18.6% had adverse events. Galantamine was well tolerated in 15.4% of patients but they abandoned the treatment because of several reasons after a median duration of treatment of 13.3 months and an average dose of 15.0 mg/day. The overall rate of mortality was 12.5%, being, 19.0% for those who abandoned the treatment and 11.3% for those who dit not. The univariate analysis showed that patients who died were older, had had more antipsychotic medications, had a higher total Blessed score and had suffered from more episodes of heart failure. The associated variables in the multivariate analysis using a binary logistic regression were mortality, sex, age, hypertension, heart failure, arrhythmia, antipsychotic treatment and greater cognitive impairment. CONCLUSIONS: The duration and the dose of treatment with galantamine were not associated with increased mortality. Related variables were an advanced age, male sex, cardiovascular diseases and antipsychotic treatment.

Factores asociados a la mortalidad en pacientes con enfermedad de Alzheimer tratados con galantamina / Mortality-associated factors in patients with Alzheimer's disease treated with galantamine

Fundamento y objetivo: El propósito del presente trabajo ha sido estudiar el efecto de variables clínicas y demográficas en la mortalidad en pacientes con enfermedad de Alzheimer tratados con galantamina. Pacientes y método: Se ha realizado un estudio de cohorte retrospectivo a partir de la revisión de las historias clínicas de una muestra de pacientes diagnosticados de enfermedad de Alzheimer a quienes se había prescrito tratamiento con galantamina. Se recogió información sobre diversas variables demográficas y clínicas y sobre los acontecimientos adversos, abandonos y duración del tratamiento con fármacos anticolinesterásicos. Resultados: La muestra estuvo formada por 172 pacientes, de los que el 18,6% presentó intolerancia a la galantamina. El 15,4% de los pacientes que la toleraron abandonó el tratamiento por diversos motivos tras una duración media de 13,3 meses y una dosis media de 15,0 mg/día. La tasa de mortalidad total fue del 12,5%; la tasa en los pacientes que abandonó el tratamiento fue del 19,0% y en los que no lo abandonaron del 11,3%. El análisis univariante mostró que los fallecidos tenían una mayor edad y puntuación más elevada en la escala de Blessed, y que entre ellos era mayor el número de casos con insuficiencia cardíaca y el de casos tratados con antipsicóticos. El análisis multivariante mediante regresión logística binaria identificó como variables asociadas a la mortalidad el sexo, la edad, la hipertensión arterial, la insuficiencia cardíaca, la arritmia, el tratamiento con antipsicóticos y un mayor deterioro cognitivo. Conclusiones: El tiempo y la dosis de tratamiento con galantamina no se asociaron a un incremento de la mortalidad. Las variables relacionadas con ésta fueron la edad avanzada, el sexo masculino, los trastornos cardiovasculares y el tratamiento con fármacos antipsicóticos

Background and objective: To study the effect of clinical and demographic variables on mortality in patients with probable Alzheimer's disease treated with the cholinesterase inhibitor galantamine. Patients and method: This retrospective cohort study reviewed 172 medical records, gathering information such as demographic and clinical variables, adverse events, number of withdrawals and duration of treatment with galantamine. Results: Of 172 patients, 18.6% had adverse events. Galantamine was well tolerated in 15.4% of patients but they abandoned the treatment because of several reasons after a median duration of treatment of 13.3 months and an average dose of 15.0 mg/day. The overall rate of mortality was 12.5%, being, 19.0% for those who abandoned the treatment and 11.3% for those who dit not. The univariate analysis showed that patients who died were older, had had more antipsychotic medications, had a higher total Blessed score and had suffered from more epidodes of heart failure. The associated variables in the multivariate analysis using a binary logistic regression were mortality, sex, age, hypertension, heart failure, arrhythmia, antipsychotic treatment and greater cognitive impairment. Conclusions: The duration and the dose of treatment with galantamine were not associated with increased mortality. Related variables were an advanced age, male sex, cardiovascular diseases and antipsychotic treatment