Exploring the interplay of frailty, physical function, physical activity, nutritional status, and their association with quality of life and depressive symptoms in older adults with the frailty phenotype.

OBJECTIVE: This study aimed to explore the interplay between frailty, physical function, physical activity, nutritional status, and their impact on the quality of life and depressive status in older adults with frailty. METHODS: A cross-sectional study involving 235 pre-frail/frail older adults residing in Spanish communities was conducted. Frailty was assessed using Fried's criteria, physical function was evaluated using the Short Physical Performance Battery, and physical activity levels were measured via wrist-worn accelerometers. Nutritional status was determined using the Mini-Nutritional Assessment alongside anthropometric measurements. Quality of life was gauged using the EuroQoL 5-Dimension 5-Level, while depressive status was assessed using the Yesavage 15-item Geriatric Depression Scale. Multivariate linear regression and logistic regression analyses were employed to elucidate the associations of these factors with quality of life and depression. RESULTS: Our findings revealed significant correlations between various factors and quality of life. Notably, reported fatigue (ß = -0.276, p = 0.002), performance in the 4-m gait test (ß = -0.242, p = 0.001), the score on the short version of the Mini-Nutritional Assessment (ß = 0.312, p = 0.002), and engagement in light physical activity (ß = 0.180, p = 0.023) were all found to be associated with quality of life. In terms of depressive symptoms, the Mini-Nutritional Assessment score emerged as a protective factor (Odds ratio, OR: 0.812, p < 0.001), as did participation in moderate physical activity (OR: 0.988, p = 0.028). Conversely, fatigue (OR: 3.277, p = 0.003) and a slow gait speed (OR: 1.136, p = 0.045) were identified as risk factors for depressive symptoms. CONCLUSIONS: This study underscores the detrimental association of fatigue and slow gait speed on both quality of life and depressive status among older adults with frailty. In contrast, engaging in physical activity and addressing malnutrition risk emerge as critical protective factors for enhancing quality of life and ameliorating depressive symptoms in this population. CLINICAL TRIAL REGISTRATION: This is a study that uses cross-sectional data from a trial registered at ClinicalTrials.gov (Identifier: NCT05610605).

The influence of symptom severity of palliative care patients on their family caregivers.

BACKGROUND: This study anlyzed whether family caregivers of patients with advanced cancer suffer impaired sleep quality, increased strain, reduced quality of life or increased care burden due to the presence and heightened intensity of symptoms in the person being cared for. METHOD: A total of 41 patient-caregiver dyads (41 caregivers and 41 patients with advanced cancer) were recruited at six primary care centres in this cross-sectional study. Data were obtained over a seven-month period. Caregiver's quality of sleep (Pittsburgh Sleep Quality Index), caregiver's quality of life (Quality of Life Family Version), caregiver strain (Caregiver Strain Index), patients' symptoms and their intensity (Edmonton Symptom Assessment System), and sociodemographic, clinical and care-related data variables were assessed. The associations were determined using non-parametric Spearman correlation. RESULTS: Total Edmonton Symptom Assessment System was significantly related to overall score of the Pittsburgh Sleep Quality Index (r = 0.365, p = 0.028), the Caregiver Strain Index (r = 0.45, p = 0.005) and total Quality of Life Family Version (r = 0.432, p = 0.009), but not to the duration of daily care (r = -0.152, p = 0.377). CONCLUSIONS: Family caregivers for patients with advanced cancer suffer negative consequences from the presence and intensity of these patients' symptoms. Therefore, optimising the control of symptoms would benefit not only the patients but also their caregivers. Thus, interventions should be designed to improve the outcomes of patient-caregiver dyads in such cases.

Intervention to improve quality of sleep of palliative patient carers in the community: protocol for a multicentre randomised controlled trial.

BACKGROUND: Sleep disorders are commonly experienced by community caregivers for persons with cancer, with at least 72% reporting moderate to severe disorders. A consequence of this condition, which is associated with the presence of overload in the caregiver, is the increased risk of clinical depression. The aim of this study is to evaluate the effects of music on the sleep quality achieved by informal caregivers for cancer patients receiving home palliative care. In addition, we will assess the influence of specific variables that could modify these effects, analyse the correlates related to nocturnal wakefulness and consider the diurnal consequences according to the sleep characteristics identified. METHODS: This single-blind, multicentre, randomised clinical trial will focus on informal providers of care for cancer patients. Two samples of 40 caregivers will be recruited. The first, intervention, group will receive seven music-based sessions. The control group will be masked with seven sessions of therapeutic education (reinforcing previous sessions). Outcomes will be evaluated using the Pittsburgh Sleep Quality Index, a triaxial accelerometer, EuroQol-5D-5L, the Caregiver Strain Index, the Epworth Sleepiness Scale and the Client Satisfaction Questionnaire. The caregivers' satisfaction with the intervention performed will also be examined. DISCUSSION: This study is expected to extend our understanding of the efficacy of music therapy in enhancing the sleep quality of caregivers for patients receiving home palliative care. To our knowledge, no reliable scientific investigations of this subject have previously been undertaken. Music is believed to benefit certain aspects of sleep, but this has yet to be proven and, according to a Cochrane review, high-quality research in this field is necessary. One of the main strengths of our study, which heightens the quality of the randomised clinical trial design, is the objective assessment of physical activity by accelerometry and the use of both objective and subjective measures of sleep in caregivers. Music therapy for the caregivers addressed in this study is complementary, readily applicable, provokes no harmful side effects and may produce significant benefits. TRIAL REGISTRATION: The IMECA study is registered at Clinical Trials.gov, ClinicalTrials.gov Identifier: NCT04491110 . Registered 29 July, 2020.

Predictors of sleep disturbances in caregivers of patients with advanced cancer receiving home palliative care: A descriptive cross-sectional study.

PURPOSE: To evaluate the quality of sleep in caregivers of patients with advanced cancer receiving home palliative care, basing the analysis on subjective and objective measures, and to develop a predictive model of sleep disturbances among this population. METHOD: A descriptive cross-sectional study was conducted in six clinical management units within primary healthcare centres. Data were obtained during a period of six months, from a sample population of 41 caregivers. The Pittsburgh Sleep Quality Index (PSQI) and a 7-day accelerometry evaluation were performed to assess sleep quality. Daytime sleepiness, caregiver strain and quality of life were also evaluated. RESULTS: According to the PSQI, 90.2% of participants had poor sleep quality. The average duration of night-time sleep, measured by accelerometry and the PSQI, was 6 h. Taking PSQI as the dependent variable, the study model predicted 40.7% of the variability (p < 0.01). The variables "Caregiver strain" and "Daily hours dedicated to care" produced the following results: B coefficient 0.645; p = 0.001; and B coefficient 0.230; p = 0.010, respectively. CONCLUSIONS: The caregivers presented significant health-related alterations, including sleep disturbances, which were directly related to two variables: the index of caregiver strain and the number of hours per day dedicated to providing care.

Applicability and Clinical Validity of Nursing Outcomes Classification in a Nursing Intervention of Nutritional Counseling for Patients With Malnutrition.

PURPOSE: To determine the applicability of the Nursing Outcomes Classification (NOC) after nutritional counseling intervention in malnourished patients. METHODS: Prospective, randomized, open-label study in 106 hospital patients with malnutrition. The NOC indicators evaluated were 162202 and 180201. FINDINGS: The intervention group significantly increased both NOC indicator scores compared with the control group, these indicators significantly correlated with body mass index, Malnutrition Universal Screening Tool, and Barthel's Index. CONCLUSION: The NOC indicators are sensitive to patients' changes in clinical practice, and correlate well with other indicators in this context. IMPLICATIONS FOR NURSING PRACTICE: The NOC can be used to assess malnourished patients in the clinical setting.

Rol de cuidadores migrantes de mayores dependientes y opinión de la asistencia sanitaria en atención primaria / Role of migrant caregivers of dependent elderly and opinion of health care in Primary Care

Objetivo: Describir el proceso de experiencias de vida de las personas migrantes que se convierten en cuidadores de mayores en situación de dependencia y conocer su opinión de la asistencia sanitaria. Diseño: Investigación cualitativa fenomenológica basada en la metodología de la teoría fundamentada. Realizado en el distrito sanitario Málaga-Guadalhorce durante 2017 y 2018. La captación se realizó mediante las enfermeras de familia de los centros de salud y a través de la base de datos de programas de atención domiciliaria de siete centros de salud. Se realizaron 17 entrevistas en profundidad a cuidadores migrantes que llevan cuidando un año o más a personas dependientes, hasta la saturación de la información. Resultados: En este estudio se han descrito tres fases: fase inicial, la persona siente la necesidad de cambio y motivación para venir; segunda fase, búsqueda de trabajo en nuestro país y asunción de nuevas actividades; tercera fase, estrategia de afrontamiento e incertidumbre por expectativas de futuro. Manifiestan mejoras en salud en relación con: tiempos reducidos de consulta, dificultad para ver especialistas, falta de regularidad en las visitas médicas en domicilio y discriminación sufrida por ser migrante. Conclusión: Los migrantes traen experiencia en el cuidado de sus diferentes culturas que deben ser exploradas. El refuerzo positivo de los empleadores, salarios y tiempo libre han sido condicionantes de mejora de satisfacción laboral y apoyo social. Lo mejor valorado del servicio sanitario son las visitas domiciliarias por el refuerzo positivo. Al mismo tiempo se quejan de que no reciben todas las que necesitan. Los profesionales deben realizar intervenciones en cada fase para facilitar la adopción de este rol, tratar de solucionar los problemas que surjan e informar a los organismos de salud de nuestra comunidad autónoma sobre dónde están los puntos débiles que deben mejorarse y de qué puntos fuertes partimos (AU)

Objective: To describe the process of life experiences of migrants who become caregivers of elderly people in situations of dependency and to know their opinion about health care. Design: Phenomenological qualitative research based on the methodology of grounded theory. Carried out in the Málaga-Guadalhorce health district, during 2017 and 2018. Recruitment was carried out by nurses from families in the Health Centers and through a database of home care programs, from seven health centers. 17 in-depth interviews were carried out with migrant caregivers, who have been caring for a year or more, dependent people, until the saturation of the information. Results: Three phases have been described in this study. In the initial stage the person feels the need for change and motivation to come; second stage of job search in our country and assume new activities; third stage of coping strategy and uncertainty for future expectations. They show improvements in health in relation to: reduced medical consultation time, it is difficult to consult with specialists, lack of regularity in home doctor visits and discrimination suffered by being a migrant. Conclusion: Migrants bring experience in caring for their different cultures that must be explored. The positive reinforcement of employers, salaries and free time have been conditions for improving job satisfaction and social support. What they value most in the health service are home visits for positive reinforcement, at the same time they complain that they do not receive all they need. Professionals should make interventions at each stage to facilitate the adoption of this role (AU)