Factores asociados a la función cognitiva de los adultos mayores indonesios que viven en residencias de ancianos / Associated factors to the cognitive function among indonesian older adult living in nursing home

Objetivo: Muchos adultos mayores en Indonesia deciden vivir en residencias de ancianos. Vivir en un hogar de ancianos ha sido asociado al deterioro cognitivo en adultos mayores, afectando a la capacidad para llevar a cabo actividades de la vida diaria. Este estudio tuvo como objetivo determinar la asociación entre características demográficas y clínicas y la función cognitiva en adultos mayores que viven una residencia de ancianos en Indonesia. Método: Este estudio utilizó un diseño transversal, participando 60 adultos mayores de una residencia de ancianos. La función cognitiva se evaluó utilizando el instrumento Montreal Cognitive Assessment. Se evaluaron características demográficas y clínicas como edad, nivel educativo, tiempo de permanencia en la residencia, así como niveles séricos de factor neurotrófico derivado del cerebro y dopamina. Se utilizó la prueba de Spearman-rank para el análisis de datos. Resultados: La función cognitiva de atención se correlacionó positivamente con la edad (r=0,314, p=0,015) y el tiempo de permanencia en la residencia (r=0,268, p=0,038), y negativamente con los niveles séricos de dopamina (r=–0,425, p=0,001). La función cognitiva de denominación se relacionó positivamente con la edad (r=0,263, p=0,042). Conclusiones: Edad, tiempo de internado y niveles de dopamina se asociaron a la función cognitiva en adultos mayores que viven en una residencia de ancianos. El adulto mayor debe ser evaluado en cuanto a factores asociados a la función cognitiva, para realizar los programas de mejora cognitiva en residencias de ancianos.(UA)

Objective: Many older adults in Indonesia decide to live in nursing homes. Living in a nursing home has been associated with the incidence of cognitive decline in older adult that leads to decreasing ability to perform daily activity. This study aimed to determine the association between demographic and clinical characteristics with cognitive functions in older adults living in nursing homes in Indonesia. Methods: This study used a cross-sectional design and involved 60 older adults in a nursing home. Cognitive function was evaluated using the Montreal Cognitive Assessment instrument. Demographic and clinical characteristics such as age, education level, length of stay in the nursing home, as well as serum levels of brain-derived neurotrophic factor and dopamine were studied. Spearman-Rank test was used for data analysis. Results: Cognitive function of attention had a positive correlation with age (r=0.314, p=0.015), length of stay in the nursing home (r=0.268, p=0.038), and negative correlation with dopamine serum levels (r=-0.425, p=0.001). The cognitive function of naming has a positive correlation with age (r=0.263, p=0.042). Conclusions: Age, length of stay, and dopamine levels associated with cognitive function in older adult living in nursing homes. The older adult should be assessed in term of factors associated with cognitive function to make the cognitive improvement programs in nursing homes.(AU)

Associated factors to the cognitive function among indonesian older adult living in nursing home.

OBJECTIVE: Many older adults in Indonesia decide to live in nursing homes. Living in a nursing home has been associated with the incidence of cognitive decline in older adult that leads to decreasing ability to perform daily activity. This study aimed to determine the association between demographic and clinical characteristics with cognitive functions in older adults living in nursing homes in Indonesia. METHODS: This study used a cross-sectional design and involved 60 older adults in a nursing home. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) instrument. Demographic and clinical characteristics such as age, education level, length of stay in the nursing home, as well as serum levels of brain-derived neurotrophic factor (BDNF) and dopamine were studied. Spearman-Rank test was used for data analysis. RESULTS: Cognitive function of attention had a positive correlation with age (r=0.314, P=.015), length of stay in the nursing home (r=0.268, P=.038), and negative correlation with dopamine serum levels (r=-0.425, P=.001). The cognitive function of naming has a positive correlation with age (r=0.263, P=.042). CONCLUSIONS: Age, length of stay, and dopamine levels associated with cognitive function in older adult living in nursing homes. The older adult should be assessed in term of factors associated with cognitive function to make the cognitive improvement programs in nursing homes.

Recommendations for the prevention of healthcare-associated infections in nursing homes / Recomendaciones para la prevención de infecciones en residencias para mayores

Nursing homes (NH) conceptually should look as much like a home as possible. However NH have unquestionable similar ities with a nosocomium as they are places where many pa tients with underlying diseases and comorbidities accumulate. There is evidence of transmission of microorganisms between residents and between residents and caregivers. We have not found any recommendations specifically aimed at the prevention of nosocomial infections in NH by the major Public Health Agencies and, therefore, the Health Sciences Foundation (Fundación de Ciencias de la Salud) has convened a series of experts and 14 Spanish scientific societies to discuss recommendations that could guide NH personnel in establishing written programs for the control and reduction of these infections. The present document is the result of these deliberations and contains suggestions for establishing such control programs on a voluntary and flexible basis in NH. We also hope that the document can help the health authorities to encourage this control activity in the different territorial areas of Spain. In our opinion, it is necessary to draw up a written plan and establish the figure of a coordinator or person respon sible for implementing these projects. The document includes measures to be implemented and ways of quantifying the real ity of different problems and of monitoring the impact of the measures established (AU)

Las residencias de ancianos (NH) aunque conceptualmente deberían parecerse lo más posible a un hogar, tienen induda bles similitudes con un nosocomio ya que son lugares donde se acumulan muchos pacientes con enfermedades de base y comorbilidades y donde la transmisión de microorganismos en tre residentes y entre residentes y cuidadores es frecuente. No hemos encontrado recomendaciones específicamente dirigidas a la prevención de las infecciones nosocomiales en NH por parte de las principales Agencias de Salud Pública y, por ello, la Fundación de Ciencias de la Salud ha convocado a una serie de expertos y a 14 sociedades científicas españolas para de batir recomendaciones que puedan orientar al personal de las NH en el establecimiento de programas escritos para el control y reducción de estas infecciones. El presente documento es el resultado de estas deliberaciones y contiene sugerencias para establecer dichos programas de control de forma voluntaria y flexible. También esperamos que el documento pueda ayudar a las autoridades sanitarias a fomentar esta actividad de control en los distintos ámbitos territoriales de España. En nuestra opi nión, es necesario elaborar un plan por escrito y establecer la figura de un coordinador o responsable de la ejecución de estos proyectos. El documento incluye las medidas a implantar y las formas de cuantificar la realidad de los diferentes problemas y de monitorizar el impacto de las medidas establecidas (AU)

Delirium en ancianos institucionalizados: una epidemia silenciosa / Delirium in institutionalized elderly: a silent epidemic

Introducción: El aumento del envejecimiento, así como de los cuidados sociales y sanitarios que requieren las personas mayores, ha condicionado que se haya incrementado exponencialmente el número de ancianos institucionalizados. En este contexto, el deliriumes una condicion común y muy angustiante, con un gran impacto biopsicosocioeconómico para el residente y su entorno. Pese a ser una entidad potencialmente prevenible, sigue siendo infratratada e infradiagnosticada. Objetivo: Analizar la evidencia científica existente sobre el manejo del delirium en ancianos que se encuentran en centros residenciales de atención a largo plazo. Metodología: Revisión narrativa mediante búsquedas bibliográficas en bases de datos relacionadas con las ciencias de la salud: CINAHL, PubMed, Biblioteca Cochrane, CUIDEN y LILACS, así como en los metabuscadores Dialnet Plus y Google Académico. Resultados: En función de los criterios de inclusión y exclusión se seleccionaron 19 artículos. El análisis de los documentos generó 2 categorías: medidas de control fisiológico y ambiental para la prevención del delirium y estrategias de intervención terapéutica. Como hallazgos, las estrategias multidisciplinares no farmacológicas podrían ser eficaces en la prevención del delirium, así como la identificación temprana de los factores de riesgo y programas educativos dirigidos a las enfermeras que atienden a esta población. De este modo, se estará ejerciendo la medida más eficaz y económica para abordar esta entidad en su fase inicial, la prevención. Conclusión: Se encontraron escasoshallazgos estadísticamente significativos sobre las asociaciones entre las intervenciones y la prevención del delirium en instituciones. Si se quiere optimizar la salud y el bienestar de los residentes deben realizarse investigaciones futuras, específicas y sólidas, y evitar los desafíos que suponen estos entornos (AU)

Introduction: The increase in ageing, as well as the social and health care it requires, has led to an exponential increase in the number of institutionalised residents. In this context, delirium is a common and very distressing condition, with a great bio psycho-social-economic impact on both the patient and his or her environment. Despite being a potentially preventable entity, it continues to be under-treated and under-diagnosed. Objective: To analyze the existing scientific evidence on the management of delirium in elderly people in long-term care residential facilities. Methodology: Narrative review by means of bibliographic searches in databases related to the Health Sciences CINAHL, PubMed, Cochrane Library, CUIDEN and LILACS, as well as in the meta-searches Dialnet Plus and Google Academic. Results: 19 articles were selected according to the inclusion and exclusion criteria. The analysis of the documents generated two categories: physiological and environmental control measures for the prevention of delirium and therapeutic intervention strategies. As findings, non pharmacological multidisciplinary strategies may be effective in preventing delirium, as well as early identification of risk factors and educational programs directed at nurses serving this population. In this way, the most effective and economical measure to address this entity in its initial phase, prevention, will be exercised. Conclusion: There were few statistically significant findings on associations between interventions and delirium prevention in institutions. If the health and well-being of residents is to be optimized, future research must be specific and robust, avoiding the challenges of these environments (AU)

The Quality Index for Nutrition in Nursing Homes (QUINN). A new tool for evaluating diet quality in long-term care homes.

Introduction: Background: the assessment of diet quality (DQ) is fundamental to the study of disease-diet associations, and it is necesary to implement an easy to-apply tool in nursing homes (NHs). Our objective was to propose and apply a novel diet quality indicator (DQIn) using an a priori approach for NHs. Methods: the QUality Index for Nutrition in Nursing homes (QUINN) was implemented in a public NH located in Valladolid, Spain, during a 5-week period (n = 137 subjects). The choice of the QUINN components was based on a rapid review. The QUINN was based on 15 dietary components - 12 were basic (vegetables, fruits, legumes, olive oil, cereals, dairy, white fish and seafood, white-meat, eggs/positive; other fats, red and processed meat, and sweets/negative), and 3 were supplementary (fruits and vegetables variety, oily-fish, and whole-grains/positive). Each component was classified into 4-categories (0, 1, 2 o 3 points; range: 0-45 points). Results: the QUINN was tested on a menu offered by a NH giving a result of 34 points (good diet). The components with the highest scores were related to the Mediterranean diet (high consumption of legumes, olive oil, white fish and shellfish; low intake of other fats; and a wide variety of fruits and vegetables), together with cereals, white meat, dairy, and eggs. The components that required a major change were red- and processed-meats, sweets, and whole grains. Conclusion: the menu of this Spanish NH showed a good DQ according to the QUINN. The assessment of the DQ in NHs using QUINN will allow the proposal of interventions aimed at improving their diet.

Introducción: Antecedentes: la valoración de la calidad de la dieta es fundamental para el estudio de las asociaciones enfermedad-dieta, y es necesario implantar una herramienta de fácil aplicación en las residencias de ancianos. Nuestro objetivo fue proponer y aplicar un nuevo indicador de calidad de la dieta (diet quality indicator, DQIn) utilizando un enfoque a priori para su utilización en residencias de ancianos. Métodos: el Índice de Calidad Nutricional en Residencias de Ancianos (QUality Index for Nutrition in Nursing homes, QUINN) se aplicó en una residencia pública de Valladolid durante un periodo de 5 semanas (n = 137 sujetos). La elección de los componentes del QUINN se basó en una revisión rápida. En el QUINN se consideraron 15 componentes dietéticos, 12 básicos (verduras, frutas, legumbres, aceite de oliva, cereales, lácteos, pescado blanco y marisco, carnes blancas, huevos/positivos; otras grasas, carnes rojas y procesadas, y dulces/negativos) y 3 adicionales (variedad de frutas y verduras, pescado azul, y cereales integrales/positivos). Cada componente se clasificó en 4 categorías (0, 1, 2 o 3 puntos; rango: 0-45 puntos). Resultados: el QUINN se aplicó en el menú ofertado por una residencia de ancianos dando un resultado de 34 puntos (dieta de buena calidad). Los componentes con mayor puntuación estaban relacionados con la dieta mediterránea (alto consumo de legumbres, aceite de oliva, pescado blanco y marisco, bajo consumo de otras grasas y variedad de frutas y verduras), junto con los cereales, las carnes blancas, los lácteos y los huevos. Los componentes que requerían un cambio importante fueron las carnes rojas y procesadas, los dulces y los cereales integrales. Conclusión: el menú de esta residencia de ancianos situada en España mostró una calidad de la dieta buena según el QUINN. La evaluación de la calidad de la dieta en las residencias de ancianos mediante el QUINN permitirá proponer intervenciones para mejorar la dieta.

Aplicación informática de Telemedicina parala vigilancia del soporte nutricional de personas institucionalizadas en residencias de ancianos desde un servicio de farmacia hospitalaria / Telemedicine informatics application for nutritional support surveillance of instutionalized persons in nursing homes from a hospital pharmacy service

Introducción: Los pacientes institucionalizados que requieren soporte nutricional artificial acuden de forma periódica a las consultas de la Unidad deSoporte Nutricional del Servicio de Farmacia. En ellas se realiza una valoración nutricional inicial, a partir de la cual se establece la pauta nutricional y elplan de seguimiento. La Telemedicina y la Telefarmacia se han expandido enlos últimos años para la monitorización remota de personas institucionalizadas.Objetivo: Evaluar la implementación de una aplicación informática deTelemedicina para la vigilancia del soporte nutricional de personas institucionalizadas en residencias de ancianos desde un servicio de farmaciahospitalaria.Método: Se formó un equipo multidisciplinar liderado por el Servicio deFarmacia. Los datos de pacientes institucionalizados que requieren soportenutricional artificial se obtuvieron del programa SILICON y de los registrosinternos del Servicio de Farmacia. Se eligieron las primeras residenciascandidatas según la experiencia previa en el manejo de la aplicación informática de asistencia domiciliaria. Se analizaron llas variables de soportenutricional necesarias para el seguimiento nutricional: Mini NutritionalAssessment, recordatorio de ingestas de las últimas 24 horas, control deúlceras por presión y parámetros analíticos. Se analizó el flujo de información existente entre las residencias sociosanitarias y la atención hospitalariay se valoraron las opciones disponibles a través de la plataforma tecnológica de asistencia domiciliaria.Resultados: El Servicio de Farmacia realizó seguimiento nutricional amás de 300 pacientes institucionalizados en 28 residencias sociosanitariasen el año 2021. (AU)

Introduction: Institutionalized patients who require nutrition supportregularly visit the Unit of Nutrition Support of the Hospital Pharmacy Service. During these visits, prior to establishing a nutrition regime and followup scheme, an initial nutritional status assessment is performed. Telemedicine and Telepharmacy have expanded in recent years for remotemonitoring of institutionalized persons.Objective: To evaluate the implementation of a Telemedicine informaticsapplication for nutritional support surveillance of instutionalized persons innursing homes from a hospital pharmacy service.Method: A multidisciplinary team led by the Hospital Pharmacy Servicewas created. Data of institutionalized persons in nursing homes needingartificial nutritional support was extracted from the SILICON prescriptionsystem and the internal ecords of the hospital pharmacy service. Nursing homes were selected on the basis of their previous experience usingthe Telemedicine informatics application TELEA. The following nutritional support variables were assessed: score on Mini-Nutritional Assessmentquestionnaire; a 24-h food record; pressure ulcer control; and laboratoryparameters. The existing information flow between nursing homes andhospital specialists was analyzed. The functionalities available on TELEAwere considered.Results: In 2021, over 300 institutionalized persons from 28 nursinghomes were incluided for nutritional support surveillance program of thehospital pharmacy service. The project was implemented in two nursinghomes serving 38 patients, although only 13 were involved in the nutrition surveillance program of the Nutrition Support Unit. Nutritional statusassessment and nutritional support surveillance reports were adapted tothe Telemedicine informatics application. (AU)

The Quality Index for Nutrition in Nursing Homes (QUINN). A new tool for evaluating diet quality in long-term care homes / El índice de calidad de la nutrición en las residencias de ancianos (QUINN). Una nueva herramienta para evaluar la calidad de la dieta en las residencias de ancianos

Antecedentes: la valoración de la calidad de la dieta es fundamental para el estudio de las asociaciones enfermedad-dieta, y es necesario implantar una herramienta de fácil aplicación en las residencias de ancianos. Nuestro objetivo fue proponer y aplicar un nuevo indicador de calidad de la dieta (diet QUALITY indicator, DQIn) utilizando un enfoque a priori para su utilización en residencias de ancianos. Métodos: el Índice de Calidad Nutricional en Residencias de Ancianos (QUALITY Index for NUTRITION in NURSING homes, QUINN) se aplicó en una residencia pública de Valladolid durante un periodo de 5 semanas (n = 137 sujetos). La elección de los componentes del QUINN se basó en una revisión rápida. En el QUINN se consideraron 15 componentes dietéticos, 12 básicos (verduras, frutas, legumbres, aceite de oliva, cereales, lácteos, pescado blanco y marisco, carnes blancas, huevos/positivos; otras grasas, carnes rojas y procesadas, y dulces/negativos) y 3 adicionales (variedad de frutas y verduras, pescado azul, y cereales integrales/positivos). Cada componente se clasificó en 4 categorías (0, 1, 2 o 3 puntos; rango: 0-45 puntos). Resultados: el QUINN se aplicó en el menú ofertado por una residencia de ancianos dando un resultado de 34 puntos (dieta de buena calidad). Los componentes con mayor puntuación estaban relacionados con la dieta mediterránea (alto consumo de legumbres, aceite de oliva, pescado blanco y marisco, bajo consumo de otras grasas y variedad de frutas y verduras), junto con los cereales, las carnes blancas, los lácteos y los huevos. Los componentes que requerían un cambio importante fueron las carnes rojas y procesadas, los dulces y los cereales integrales. Conclusión: el menú de esta residencia de ancianos situada en España mostró una calidad de la dieta buena según el QUINN. La evaluación de la calidad de la dieta en las residencias de ancianos mediante el QUINN permitirá proponer intervenciones para mejorar la dieta. (AU)

Background: the assessment of diet QUALITY (DQ) is fundamental to the study of disease-diet associations, and it is necesary to implement an easy to-apply tool in NURSING homes (NHs). Our objective was to propose and apply a novel diet QUALITY indicator (DQIn) using an a priori approach for NHs. Methods: the QUALITY Index for NUTRITION in NURSING homes (QUINN) was implemented in a public NH located in Valladolid, Spain, during a 5-week period (n = 137 subjects). The choice of the QUINN components was based on a rapid review. The QUINN was based on 15 dietary components — 12 were basic (vegetables, fruits, legumes, olive oil, cereals, dairy, white fish and seafood, white-meat, eggs/positive; other fats, red and processed meat, and sweets/negative), and 3 were supplementary (fruits and vegetables variety, oily-fish, and whole-grains/positive). Each component was classified into 4-categories (0, 1, 2 o 3 points; range: 0-45 points). Results: the QUINN was tested on a menu offered by a NH giving a result of 34 points (good diet). The components with the highest scores were related to the Mediterranean diet (high consumption of legumes, olive oil, white fish and shellfish; low intake of other fats; and a wide variety of fruits and vegetables), together with cereals, white meat, dairy, and eggs. The components that required a major change were red- and processed-meats, sweets, and whole grains. Conclusion: the menu of this Spanish NH showed a good DQ according to the QUINN. The assessment of the DQ in NHs using QUINN will allow the proposal of interventions aimed at improving their diet. (AU)

High incidence of COVID-19 at nursing homes in Madrid, Spain, despite preventive measures / Elevada incidencia de COVID-19 en residenciasde ancianos en Madrid, España, a pesar de lasmedidas de prevención

Objective. To assess the impact of COVID-19 at nine nursing homes in Madrid, Spain, during the first wave of COVID-19infection and lockdown period when preventive measureswere taken to avoid transmission among residents.Methods. Nine hundred forty-two residents and 846 staffmembers from nine nursing homes participated in the study(April 18 to June 20, 2020). All participants were tested forSARS-CoV-2 in the nasopharynx by PCR and for IgG antibodiesdetection. Microbiological status at sampling was defined asactive infection (positive PCR ± presence of antibodies), pastinfection (negative PCR + presence of antibodies), or naïveparticipants (negative PCR + absence of antibodies).Results. Laboratory results helped classify the residents ashaving active infection (n=224; 23.8%), past infection (n=462;49.1%), or being naïve (n=256; 27.1%); staff members wereactively infected (n=127; 15.1%), had had a past infection(n=290; 34.2%), or were naïve (n=429; 50.7%). Overall, thepercentage of participants with COVID-19 was significantlyhigher in residents than in staff members (72.8% vs 49.2%;P=0.001). The clinical situation of residents vs staff at sampling was as follows: acute manifestations compatible withCOVID-19 (7.3% vs 3.9%; P<0.01) and no manifestations ofinfection (92.7% vs 96.0%; P<0.01). A large proportion of bothasymptomatic and symptomatic residents (69.4% vs 86.6%;P=0.015) had positive PCR results (mostly alongside positiveIgG determinations).Conclusions. COVID-19 affects 75% of the residents innursing homes in Madrid. The high impact in these settings, despite the strict restrictions adopted during the lockdown,demonstrates the ability of SARS-CoV-2 to cause outbreaks. (AU)

Objetivo. Evaluar el impacto de la COVID-19 en nueve residencias de ancianos en Madrid (España) durante la primeraola de infección y el período de confinamiento, cuando se tomaron medidas preventivas para evitar la transmisión en estoscentros.Métodos. Se tomaron muestras de 942 residentes y 846miembros del personal de nueve residencias de ancianos (del18 de abril al 20 de junio de 2020). A todos los participantesse les realizó una prueba PCR en muestra nasofaríngea, y detección de anticuerpos IgG en sangre. El estado microbiológicoen el momento del muestreo se definió como infección activa(PCR positiva ± presencia de anticuerpos), infección pasada(PCR negativa + presencia de anticuerpos) o sin infección (PCRnegativa + ausencia de anticuerpos).Resultados. Los residentes tuvieron infección activa(n=224; 23,8%), infección pasada (n=462; 49,1%) o no infección (n=256; 27,1%); el personal presentó infección activa(n=127; 15,1%), infección pasada (n=290; 34,2%) o no tuvieron infección (n=429; 50,7%). En general, el porcentaje departicipantes con COVID-19 fue significativamente mayor entre los residentes que entre los miembros del personal (72,8%vs 49,2%; P=0,001). La situación clínica de los residentes vsel personal en el momento del muestreo fue: manifestacionesagudas compatibles con COVID-19 (7,3% vs 3,9%; P<0,01) ysin manifestaciones de infección (92,7% vs 96,0%; P<0,01).Una elevada proporción de residentes tanto asintomáticos como sintomáticos (69,4% vs 86,6%; P=0,015) tuvieron resultados positivos de PCR (principalmente junto con determinaciones positivas de IgG).Conclusiones. La COVID-19 afectó al 75% de los ancianos de las residencias de mayores de Madrid. El alto impactoen este entorno, a pesar de las estrictas restricciones adoptadas durante el confinamiento, demuestra la capacidad delSARS-CoV-2 para provocar brotes. (AU)

[Nursing homes in Portugal during the COVID-19 outbreak: Challenges for the future]. / Residencias de ancianos en Portugal durante la COVID-19: desafíos para el futuro.

OBJECTIVE: This study sought to explore the perceptions of experts about the performance of nursing homes during the COVID-19 outbreak. METHOD: A qualitative study was developed in two stages: (1) a focus group, conducted in May 2020, with 5 experts; (2) a modified e-Delphi, implemented in September 2020 with 22 experts, both in the area of assistance in nursing homes from Northern and Center of Portugal. RESULTS: The results allowed identifying three main areas that influenced the performance of nursing homes during the COVID-19 outbreak: organization models and resources; physical and mental health of residents and; family as a support. CONCLUSIONS: Older adults residing in nursing homes are particularly vulnerable to severe disease or death from COVID-19. It is emergent that nursing homes prevent physical and mental frailty in older residents and the loneliness aggravated by the pandemic circumstances. Decision-makers need to recognize that older people living in nursing homes have several health needs, which should determine the implementation of new strategies namely the increase in the number of professionals with appropriate skills.

Residencias de ancianos en Portugal durante la COVID-19: desafíos para el futuro / Nursing homes in Portugal during the COVID-19 outbreak: Challenges for the future

Objetivo:Este estudio pretende explorar la percepción de los especialistas sobre el desempeño de las residencias de ancianos durante la COVID-19.Método:Este es un estudio desarrollado en 2 fases: 1) un grupo focal, con el que se trabajó en mayo 2020, con 5 especialistas y 2) un Delphi modificado, implementado en septiembre 2020 con 22 especialistas, ambos en el área de asistencia en residencias de ancianos del norte y centro de Portugal.Resultados:Los resultados permitieron identificar 3 áreas principales que influenciaron el desempeño de las residencias de ancianos desde el inicio del brote de la COVID-19: modelos de organización y recursos; salud física y mental de los residentes y; la familia como apoyo.Conclusiones:Las personas mayores que residen en residencias para ancianos quedan particularmente vulnerables a la COVID-19, pues esta enfermedad puede tener para ellos consecuencias muy graves o incluso conducirle a la muerte. Es importante que las residencias prevengan la fragilidad física y mental de los ancianos, así como la soledad que muy probablemente les asola debido a las circunstancias pandémicas. Los responsables por las residencias de ancianos deben percibir que las personas mayores que viven en ellas tienen. por lo general. problemas de salud, lo que debería determinar la implementación de nuevas estrategias, entre ellas el aumento del número de profesionales debidamente capacitados.

Objective:This study sought to explore the perceptions of experts about the performance of nursing homes during the COVID-19 outbreak.Method:A qualitative study was developed in two stages: (1) a focus group, conducted in May 2020, with 5 experts; (2) a modified e-Delphi, implemented in September 2020 with 22 experts, both in the area of assistance in nursing homes from Northern and Center of Portugal.Results:The results allowed identifying three main areas that influenced the performance of nursing homes during the COVID-19 outbreak: organization models and resources; physical and mental health of residents and; family as a support.Conclusions:Older adults residing in nursing homes are particularly vulnerable to severe disease or death from COVID-19. It is emergent that nursing homes prevent physical and mental frailty in older residents and the loneliness aggravated by the pandemic circumstances. Decision-makers need to recognize that older people living in nursing homes have several health needs, which should determine the implementation of new strategies namely the increase in the number of professionals with appropriate skills.

[Patient safety in nursing homes. The experience of the Autonomous Community of the Region of Murcia]. / La seguridad del paciente en las residencias sociosanitarias. La experiencia de la Comunidad Autónoma de la Región de Murcia.

The pandemic has exposed the vulnerability of residential centers and the fragility of the population that lives there. In the Region of Murcia, care for this population group became a priority and a regional plan was drawn up to attend the needs of residents from the ethical framework of procedural justice. The immediacy imposed by the health crisis has meant that all this intervention is not without risks. Based on the Reason model, we have carried out a root cause analysis of the contributing factors that led the nursing homes to suffer a devastating impact, categorizing the security failures at three levels: infection control, social health environment and health-clinical environment. The pandemic has shown the urgency of strengthening the care model that we offer to our elders. A model that guarantees the coverage of the needs of extremely fragile patients that go beyond health and biomedical care and that considers their preferences and values.

Experiencia de Atención Comunitaria en residencias de ancianos durante la primera ola de la pandemia COVID-19 / Experience in Community Care in nursing homes during the first wave of the COVID-19 pandemic

La COVID-19 ha producido muchas muertes en las residencias geriátricas. El compromiso de las enfermeras/os y médicos de Atención Primaria (AP) con la población que atienden hacía indispensable realizar acciones comunitarias para mejorar la atención de estas personas.El objetivo general fue implementar el “Plan de Acción para la Gestión de Personas en el Ámbito Residencial y la Asistencia Sanitaria en Situación de Pandemia por COVID-19” de la Generalitat de Cataluña y adecuarlo a las necesidades concretas en los centros atendidos. La intervención fue realizada por enfermeras y médicas de AP en dos residencias de ancianos de un núcleo urbano de Barcelona entre marzo y mayo de 2020. Constó de tres etapas: 1) Valoración: las dos residencias atendían 41 residentes (78,6% mujeres; edad media 84,5 años). El 100% tenía patología crónica, el 41,5% presentaba dependencia total, un 21,9% dependencia grave y el 26,8% tenía deterioro cognitivo. Un 63,4% estaba asintomático. Se identificaron carencias de material, infraestructuras y conocimientos. 2) Acciones de coordinación: desinfección de residencias por el servicio de bomberos y toma de muestras PCR que fueron negativas en el 100% de residentes y positivas en cuatro cuidadoras. 3) Taller de educación sanitaria para personal con trato directo a las personas residentes.Las residencias se mantuvieron libres de COVID-19 hasta el momento del inicio de la desescalada a finales de mayo de 2020. Se mantuvo la relación posterior con las residencias. La intervención comunitaria puede haber contribuido a la falta de casos de contagio de trabajadoras y personas residentes.(AU)

COVID-19 has caused many deaths in geriatric homes. The commitment by female Primary Care doctors and nurses with the population they manage made it essential to conduct community actions in order to improve the care for these persons.The general objective was to implement the “Plan of Action for Managing Persons in the Nursing Home Setting and Healthcare during the COVID-19 Pandemic” of the Government of Catalonia, and to adapt it to the specific needs in the centres managed. The intervention was conducted by female Primary Care nurses and doctors, in two nursing homes from an urban area of Barcelona between March and May, 2020. It consisted of three stages: 1) Assessment: Both nursing homes cared for 41 persons (78.6% were female; mean age: 84.5 years). Of these, 100% had a chronic condition, 41.5% presented total dependence, 21.9% presented severe dependence, and 26.8% suffered cognitive deterioration; 63.4% of them were asymptomatic. Lack of materials, infrastructures, and knowledge were detected. 2) Coordination actions: Disinfection of nursing homes by the Fire Department, and extraction of PCR samples, which tested negative in 100% of patients and positive in four caregivers. 3) Health Education Workshop for staff in direct contact with the persons living in the nursing home.Nursing homes stayed free of COVID-19 until the start of de-escalation by the end of May, 2020. Subsequent contact was maintained with nursing homes. Community intervention might have contributed to the lack of infection cases among workers and persons living in the nursing homes.(AU)

Prevalence of SARS-CoV-2 infection in general practitioners and nurses in primary care and nursing homes in the Healthcare Area of León and associated factors.

OBJECTIVE: To evaluate the prevalence of and factors associated with SARS-CoV-2 infection in general practitioners and nurses from primary care centers and nursing homes in the Healthcare Area of León (Spain). MATERIALS AND METHODS: Cross-sectional study in a convenience sample of professionals from 30 health centers and 30 nursing homes from the primary care management division of the Healthcare Area of Leon. The work center, type of profession, COVID-19 infection, level of exposure, compliance with preventive measures, isolation (if required) and diagnostic tests carried out were collected. The determination of infection was made by differentiated rapid diagnostic test (dRDT), using a finger-stick whole-blood sample. The association of variables with infection was assessed by multivariable non-conditional logistic regression. The true prevalence of SARS-CoV-2 infection was calculated according to two scenarios for RDT (Sensitivity=0.6 and Specificity=0.985; Sensitivity=0.8 and Specificity=1). RESULTS: The true prevalence of SARS-CoV-2 infection was between 4.9% and 11.0%. The observed prevalence was 5.9% and was higher in nursing homes than in primary care centers (9.5% vs. 5.5%). No statistically significant differences were observed by sex, type of professional, level of exposure or compliance with preventive measures. CONCLUSIONS: The prevalence of SARS-CoV-2 infection in this group is low. A high number of professionals remain susceptible to SARS-CoV-2 infection and therefore protective measures should be taken, especially for professionals working in nursing homes.

Staphylococcus aureus carriage in older populations in community residential care homes: Prevalence and molecular characterization of MRSA isolates.

INTRODUCTION: The epidemiology of S. aureus depends on conditions in specific populations. Few studies of S. aureus colonization in the older population have been performed in Spain. The aim of this study was to determine the prevalence of methicillin-resistant S. aureus (MRSA) colonization and its molecular epidemiological characteristics in an institutionalized population in community residential care homes in Cadiz, Spain. METHODS: A cross-sectional epidemiological study was conducted in three residential care homes for older people. Axilla and nostril samples were tested. Identification of S. aureus and antimicrobial susceptibility testing were by MALDI-TOF and MicroScan panels. MRSA strains were subjected to SCCmec typing, multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). The presence of Panton-Valentine leukocidin (PVL) genes was determined by PCR in all S. aureus strains. RESULTS: A total of 293 residents were included. Fifty-one residents (17.4%) were colonized with methicillin-sensitive S. aureus (MSSA) and 11 (3.8%) with MRSA. Resistance to at least two aminoglycosides was observed in 25.4% of MSSA and 90.9% and of MRSA isolates, and resistance to levofloxacin in 80.3% of MSSA and 100% of MRSA isolates. SCCmecIV was detected in all isolates and all except one (ST-125) were ST-8. None of the S. aureus isolates were positive for PVL. CONCLUSIONS: A low rate of S. aureus carriage was detected and the prevalence of MRSA was very low. ST8-MRSA-IVc was the dominant clone, and only one strain belonged to ST125-MRSA-IVc. We found MRSA transmission within the residential care homes and a very high rate of quinolone resistance in MSSA and MRSA.

[Facilitators and barriers regarding end of life care at nursing homes: A focus group study]. / Dificultades y factores favorables para la atención al final de la vida en residencias de ancianos: un estudio con grupos focales.

AIM: To identify the facilitators and barriers experienced by professional related to end of life care in nursing homes. DESIGN: Descriptive qualitative research with phenomenological orientation, through content analysis. PLACEMENT: Nursing Homes at Primary Care District in Granada (Spain). PARTICIPANTS: Fifteen clinical professionals with, at least 6 months of experience in nursing homes, without specific background in palliative care. METHODS: Three focus groups were undertaken with professionals of different disciplines and nursing homes. Interviews were recorded and transcribed literally. An open and axial coding was performed to identify relevant categories. RESULTS: Professionals identified difficulties in the communication with families related to relatives' feelings of guilt, difficulty in understanding the deterioration of their relative, and addressing too late the issue of death. Regarding decision making, professionals recognized that they do not encourage participation of patients. Advance directives are valued as a necessary tool, but they do not contemplate implementing them systematically. Other difficulties that professionals highlighted are lack of coordination with other professionals, related to misunderstanding of patients' needs, as well as lack of training, and lack of material and human resources. Facilitators include relationships with primary care teams. CONCLUSION: It is necessary to improve communication among nursing homes professionals, families, patients and other health workers.