[Nurses in the approach to frailty. Reflective analysis on the importance of nursing care in frail elderly.] / Profesionales de enfermería en el abordaje de la fragilidad. Análisis reflexivo sobre la importancia de los cuidados en la atención a la persona mayor frágil.

At present, the definition of frailty provided by the World Health Organization (WHO), which incorporates the concepts of intrinsic capacity and functional capacity, as well as the increasing prevalence of these situations in elderly people, reflect the need to develop intervention strategies in the different health systems to prevent and address frailty. This article analyzes the implication of the nursing role, as well as its framework of action and specific competencies for the prevention and addressing of the health needs related to the frail elderly person.This role is developed through the systematic use of comprehensive assessment, existence of nursing diagnoses related to frailty and its risks and the interventions and outcome criteria related to the care of the frail elderly person. Specifically, this article expose the actions and competences of nurses who carry out their activity in primary care and in the community context, in care programs for the elderly and home care, which involve both the frail elderly person and the people who care for them.

En la actualidad, una mayor unanimidad con la definición de la fragilidad, aportada por la Organización Mundial de la Salud (OMS), que incorporan los conceptos de capacidad intrínseca (CI) y capacidad funcional (CF), así como la cada vez mayor prevalencia de estas situaciones en la población mayor, reflejan la necesidad de desarrollar estrategias de intervención en los diferentes sistemas sanitarios para prevenir y abordar la fragilidad. En este artículo se analiza la implicación del rol del enfermero, así como su marco de actuación y competencias específicas para la prevención y abordaje de las necesidades y problemas de salud relacionados con la persona mayor frágil, a través del uso sistemático de la valoración integral, la existencia de diagnósticos enfermeros relativos a la fragilidad y sus riesgos y de las intervenciones y criterios de resultados vinculados a los cuidados de la persona mayor frágil. Especialmente, se exponen las actuaciones y competencias de los enfermeros que desarrollan su actividad en atención primaria y el contexto comunitario, en los programas de atención al mayor y atención domiciliaria, que implican tanto a la persona mayor frágil como a las personas que los cuidan.

Impact of the chronic disease self-management program (CDSMP) on self-perceived frailty condition: the EU-EFFICHRONIC project.

INTRODUCTION: The Chronic Disease Self-Management Program (CDSMP) improves self-efficacy and health outcomes in people with chronic diseases. In the context of the EFFICHRONIC project, we evaluated the efficacy of CDSMP in relieving frailty, as assessed by the self-administered version of Multidimensional Prognostic Index (SELFY-MPI), identifying also potential predictors of better response over 6-month follow-up. METHODS: The SELFY-MPI explores mobility, basal and instrumental activities of daily living (Barthel mobility, ADL, IADL), cognition (Test Your Memory-TYM Test), nutrition (Mini Nutritional Assessment-Short Form-MNA-SF), comorbidities, medications, and socio-economic conditions (social-familiar evaluation scale-SFES). Participants were stratified in three groups according to the 6-month change of SELFY-MPI: those who improved after CDSMP (Δ SELFY-MPI < 0), those who remained unchanged (Δ SELFY-MPI = 0), and those who worsened (Δ SELFY-MPI > 0). Multivariable logistic regression was modeled to identify predictors of SELFY-MPI improvement. RESULTS: Among 270 participants (mean age = 61.45 years, range = 26-93 years; females = 78.1%) a benefit from CDSMP intervention, in terms of decrease in the SELFY-MPI score, was observed in 32.6% of subjects. SELFY-MPI improvement was found in participants with higher number of comorbidities (1-2 chronic diseases: adjusted odd ratio (aOR)=2.38, 95% confidence interval (CI) =1.01, 5.58; ⩾ 3 chronic diseases: aOR = 3.34, 95% CI = 1.25, 8.90 vs no chronic disease), poorer cognitive performance (TYM ⩽ 42: aOR = 2.41, 95% CI = 1.12, 5.19 vs TYM > 42) or higher risk of malnutrition (MNA-SF ⩽ 11: aOR = 6.11, 95% CI = 3.15, 11.83 vs MNA-SF > 11). CONCLUSION: These findings suggest that the CDSMP intervention contributes to decreasing the self-perceived severity of frailty (SELFY-MPI score) in more vulnerable participants with several chronic diseases and lower cognitive performance and nutritional status.

EFFICHRONIC study protocol: a non-controlled, multicentre European prospective study to measure the efficiency of a chronic disease self-management programme in socioeconomically vulnerable populations.

INTRODUCTION: More than 70% of world mortality is due to chronic conditions. Furthermore, it has been proven that social determinants have an enormous impact on both health-related behaviour and on the received attention from healthcare services. These determinants cause health inequalities. The objective of this study is to reduce the burden of chronic diseases in five European regions, hereby focusing on vulnerable populations, and to increase the sustainability of health systems by implementing a chronic disease self-management programme (CDSMP). METHODS AND ANALYSIS: 2000 people with chronic conditions or informal caregivers belonging to vulnerable populations, will be enrolled in the CDSMP in Spain, Italy, the UK, France and the Netherlands. Inclusion of patients will be based on geographical, socioeconomic and clinical stratification processes. The programme will be evaluated in terms of self-efficacy, quality of life and cost-effectiveness using a combination of validated questionnaires at baseline and 6 months from baseline. ETHICS AND DISSEMINATION: This study will follow the directives of the Helsinki Declaration and will adhere to the European Union General Data Protection Regulation. The project's activities, progress and outcomes will be disseminated via promotional materials, the use of mass media, online activities, presentations at events and scientific publications. TRIAL REGISTRATION NUMBER: ISRCTN70517103; Pre-results.