Controlled trial of balance training using a video game console in community-dwelling older adults.

BACKGROUND: gamification is a potentially attractive option for improving balance and reducing falls. OBJECTIVES: to assess the effect of balance training using the NintendoTM Wii game console on balance (primary outcome), falls and fear of falling. DESIGN: quasi-randomised, open-label, controlled clinical trial in parallel groups, carried out on community-dwelling patients over 70 years, able to walk independently. Participants were assigned 1:1 to the intervention or control group. Balance training was conducted using the Nintendo WiiFitTM twice a week for 3 months. Balance was assessed using the Tinetti balance test (primary outcome), the unipedal stance and the Wii balance tests at baseline, 3 months and 1 year. Falls were recorded and Fear of falling was assessed by the Falls Efficacy Scale (Short-FES-I). RESULTS: 1,016 subjects were recruited (508 in both the intervention and the control group; of whom 274 and 356 respectively completed the 3-month assessment). There was no between-group difference in the Tinetti balance test score, with a baseline mean of 14.7 (SD 1.8) in both groups, and 15.2 (1.3) at 3 months in the intervention group compared to 15.3 (1.7) in controls; the between-group difference was 0.06 (95% CI 0.30-0.41). No differences were seen in any of the other balance tests, or in incident falls. There was a reduction in the fear of falling at 3 months, but no effect at 1 year. CONCLUSIONS: the study found no effect of balance training using the NintendoTM Wii on balance or falls in older community-dwelling patients.The study protocol is available at clinicaltrials.gov under the code NCT02570178.

[Orthostatic and postprandial hypotension in elderly patients with chronic diseases and disability: prevalence and related factors]. / Hipotensión ortostática e hipotensión posprandial en pacientes ancianos con discapacidad y enfermedades crónicas: prevalencia y factores relacionados.

INTRODUCTION: To assess the prevalence of orthostatic hypotension (OH) and postprandial hypotension (PPH) in patients admitted to an intermediate care unit, as well as to analyze the characteristics of these patients. PATIENTS AND METHODS: Sixty patients were analyzed according to the following criteria: age >65 years, able to take food orally, stand up and/or sit down, and clinically stable. A comprehensive geriatric assessment was carried out and the main diagnosis and the presence of autonomic neuropathy symptoms (ANS) were registered. Blood pressure (BP) was registered in the morning in supine position during the first 3min of postural change (standing or sitting). OH was defined as a decrease in systolic blood pressure (SBP) of 20mm Hg or a decrease in diastolic blood pressure (DBP) of 10mmHg. BP was registered after 15min of sitting and 60min after breakfast. PPH was defined as a decrease in SBP of 20mmHg. RESULTS: The mean age was 79.1+/-7.8 years. Nine patients (15%) had OH and 29 (48.3%) had PPH. The mean Lawton index (LI) score in patients with OH was 3.1+/-2.1 and was 5.2+/-2.6 in the remaining patients (P<.02). The mean body mass index (BMI) was 23.3+/-3.1 vs. 26.2+/-5.1 (P<.04). ANS was present in all nine patients (100%) with OH but in only 30 (58.8%) of the remaining 51 patients (chi-square=5.71; P<.03). CONCLUSIONS: PPH was more frequent than OH. Patients with OH had a significantly lower LI score and BMI. The presence of ANS was significantly more frequent in patients with OH. There was no significant relationship between HO and PPH or among the remaining variables studied.

[Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia]. / Evaluación del ambiente de trabajo de las enfermeras en las unidades sociosanitarias de atención intermedia de Cataluña.

INTRODUCTION: A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. METHODS: An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. RESULTS: From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a "favourable" working environment and five "mixed". The best valued factor was "work relations" and the worst was "resource provision/adaptation". Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. CONCLUSIONS: In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment.

Evaluación del ambiente de trabajo de las enfermeras en las unidades sociosanitarias de atención intermedia de Cataluña / Evaluation of the nurse working environment in health and social care intermediate care units in Catalonia

Introducción. Un ambiente laboral favorable facilita que las enfermeras realicen su trabajo con mayor satisfacción y en mejores condiciones, hecho que podría influir en la calidad de los resultados obtenidos en los centros sociosanitarios. Los objetivos del estudio fueron: 1) Identificar la tipología de centros en función del ambiente laboral percibido por las enfermeras; y 2) describir las características individuales de las enfermeras relacionadas con dicha valoración. Métodos. Estudio observacional, descriptivo, prospectivo y transversal, multicéntrico realizado el último trimestre de 2014. Se administró a las enfermeras de las unidades de atención intermedia un cuestionario con el Practice Environment Scale of the Nursing Work Index (PES-NWI), que evalúa 5 factores del entorno laboral mediante 31 ítems. Se recogieron también variables sociodemográficas, laborales/profesionales y formativas. Resultados. De 501 enfermeras en 14 centros participaron 388 (77% de respuesta). La puntuación media del PES-NWI fue 84,75. Nueve centros obtuvieron una valoración del entorno laboral «favorable» y 5 «mixto». El factor mejor valorado fue «relaciones laborales» y el peor «dotación/adecuación de recursos». El turno de trabajo rotativo, trabajar en varias unidades, tener responsabilidades de gestión y tener máster universitario fueron características de las enfermeras que se relacionaron con una mejor percepción del entorno. Conclusiones. En la mayoría de los centros el ambiente laboral fue percibido como favorable. Algunas características laborales/profesionales y formativas se relacionaron con la valoración del entorno laboral (AU)

Introduction. A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. Methods. An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. Results. From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a 'favourable' working environment and five 'mixed'. The best valued factor was 'work relations' and the worst was 'resource provision/adaptation'. Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. Conclusions. In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment (AU)

Hipotensión ortostática e hipotensión posprandial en pacientes ancianos con discapacidad y enfermedades crónicas: prevalencia y factores relacionados / Orthostatic and postprandial hypotension in elderly patients with chronic diseases and disability: prevalence and related factors

Introducciónevaluar la prevalencia de hipotensión ortostática (HO) e hipotensión posprandial (HPP) en pacientes ingresados en una unidad de convalecencia y analizar sus características.Pacientes y métodosse analizó a 60 pacientes mayores de 65 años, con capacidad de ingesta por vía oral, de sedestación y/o bipedestación, y en situación de estabilidad clínica. Se realizó una valoración geriátrica completa y se registraron el diagnóstico principal y la presencia de síntomas de neuropatía autonómica (SNA). La presión arterial (PA) se registró por la mañana en posición supina y en los 3 primeros minutos de sedestación y/o bipedestación; se definió HO como el descenso de ≥20mmHg de PA sistólica (PAS) o ≥10mmHg de PA diastólica (PAD). Se registró también la PA después de que el paciente hubiera estado sentado 15min y 60min después del desayuno; se definió la HPP como el descenso de >20mmHg de la PAS.Resultadosla edad media±desviación estándar (DE) de los pacientes fue de 79,1±7,8 años. Nueve (15%) pacientes tuvieron HO y 29 (48,3%) HPP. La media±DE del índice de Lawton (IL) en pacientes con HO fue de 3,1±2,1; mientras que en los restantes fue de 5,2±2,6 (p<0,02) y la del índice de masa corporal (IMC) fue de 23,3±3,1 y 26,1±5,1 (p<0,04). Los 9 pacientes con HO tenían SNA (100%), mientras que de los 51 restantes sólo lo tuvieron 30 (58,8%) (χ2=5,71; p<0,03).Conclusionesla HPP fue más frecuente que la HO. Los pacientes con HO presentaron de forma significativa un menor IL e IMC. La presencia de SNA fue significativamente más frecuente en los pacientes con HO. No hubo relación significativa entre la HO y HPP, ni tampoco en el resto de las variables estudiadas (AU)

IntroductionTo assess the prevalence of orthostatic hypotension (OH) and postprandial hypotension (PPH) in patients admitted to an intermediate care unit, as well as to analyze the characteristics of these patients.Patients and methodsSixty patients were analyzed according to the following criteria: age >65 years, able to take food orally, stand up and/or sit down, and clinically stable. A comprehensive geriatric assessment was carried out and the main diagnosis and the presence of autonomic neuropathy symptoms (ANS) were registered. Blood pressure (BP) was registered in the morning in supine position during the first 3min of postural change (standing or sitting). OH was defined as a decrease in systolic blood pressure (SBP) of ≥20mm Hg or a decrease in diastolic blood pressure (DBP) of ≥10mmHg. BP was registered after 15min of sitting and 60min after breakfast. PPH was defined as a decrease in SBP of ≥20mmHg.ResultsThe mean age was 79.1±7.8 years. Nine patients (15%) had OH and 29 (48.3%) had PPH. The mean Lawton index (LI) score in patients with OH was 3.1±2.1 and was 5.2±2.6 in the remaining patients (P<.02). The mean body mass index (BMI) was 23.3±3.1 vs. 26.2±5.1 (P<.04). ANS was present in all nine patients (100%) with OH but in only 30 (58.8%) of the remaining 51 patients (chi-square=5.71; P<.03).ConclusionsPPH was more frequent than OH. Patients with OH had a significantly lower LI score and BMI. The presence of ANS was significantly more frequent in patients with OH. There was no significant relationship between HO and PPH or among the remaining variables studied (AU)