[Geriatric assessment tools in Spanish Geriatric Departments]

Fear of Falling as a Behavioral Symptom in Neurocognitive Impaired Patients: Evidence from an Underrepresented Population

BACKGROUND

Fear of falling (FoF) is a condition associated with falls, multi-morbidity, and functional impairment. To date it remains unknow which clinical, somatic, socio-demographic, behavioral, and emotional factors are associated with FoF and how these factors interact in people with Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD).

OBJECTIVE

Identify the association of FoF with clinical, socio-demographic, and neuropsychiatric factors in patients with AD and bvFTD.

METHODS

We evaluated 98 participants, 58 with AD and 40 with bvFTD at mild or moderate stages and assess FoF using the Falls Efficacy Scale-International. Additionally, we analyzed cognitive, physical performance variables, functional impairment, and affective and behavioral symptoms associated with FoF using standardized scales and a regression model analysis.

RESULTS

The prevalence of FoF in AD and bvFTD was 51% and 40%, respectively. In the AD group, physical performance [F (3, 53) = 4.318, p = 0.009], the behavioral symptoms model [F (19, 38) = 3.314, p = 0.001], and the anxiety model [F (1, 56) = 13.4, p≤0.01] showed statistically significant values. In addition, the presence of hallucinations assessed with the Neuropsychiatric Inventory and social behavior assessed with the Mild Behavioral Impairment Checklist were significant. In contrast, in the bvFTD group, a homologous group of models was evaluated but we did not find any significant results.

CONCLUSION

FoF in people with AD was related to physical performance, neuropsychiatric symptoms such as apathy and hallucinations, and affective symptoms such as anxiety. However, this pattern was not seen in the bvFTD group, and therefore further studies are required.

Non-pharmacological interventions to reduce pain in dementia: A quasi-experimental study

This study evaluated a non-pharmacological intervention nursing protocol for pain control and assessment of its evolution in a cohort of patients with moderate-to-severe dementia residing in three long-term care facilities in a metropolitan area in Spain. The study was a quasi-experimental pre- and post-exploratory intervention. The presence of pain was evaluated before and after the interventions of nursing protocol for 7 days, carried out by nurses. 157 residents of three centers participated (mean age 81.8 years, 58.1% were women, 83.2% had severe or moderately severe dementia and 65.2%) had regularly scheduled analgesic treatment. At baseline evaluation, the prevalence of pain, assessed with the PAINAD scale was 43.9% and this increased to 73.5% when pain was measured during bathing. The implementation of the nursing protocol of non-pharmacological interventions produced a decrease in pain of 11% (p = 0.0001). Multivariate Ancova analysis demonstrated that non-pharmacological interventions were effective independently of other factors as pressure sores or gender. The implementation of non-pharmacological interventions in social health care centers can produce a decrease in pain for those with dementia.

Factors of presenting an acute confusional syndrome after a hip fracture

INTRODUCTION

Acute confusional syndrome (ACS) is a geriatric syndrome that manifests itself with changes in cognition, attention, underactive or hyperactive motor response, and fluctuation in the level of consciousness after trauma, hospitalisation or surgery. The objective is to know the risk factors and prevention of acute confusional syndrome in the elderly with hip fractures (HF) .

METHODS

Prospective observational cohort study. The inclusion criteria was to be age ≥ 65 and HF operated under selective spinal anesthetic (bupivacaine ≤ 7 mg + fentanyl 10-15 .mu.g) without benzodiazepine, ketamine or propofol. The potential risk factors of ACS were recorded: demographic variables, fracture type, Charlson index, ASA risk, performance of a peripheral nerve block (PNB), and scale scores: Barthel, Fried, Pfeifer, RCMS, MNA and VAS. ACS was diagnosed by the CAM questionnaire. The risk factors were estimated by binary logistic regression.

RESULTS

Of the 133 patients included, 60 (45.11%) developed preoperative ACS, and 25 developed (18.8%) postoperative ACS. Having identified cognitive impairment with ≥ 3 points on the RCMS (OR 11.04 [ 95% ic: 1.3 - 89.1], p <0.001) or Pfeiffer (OR 6.94 [95% ic: 1.07 - 44.69], p <0.0 41) was a risk factor of ACS. Among patients with cognitive impairment or dementia, the increase of surgical delay (OR 1.95 [ 95% CI: 1.2 -2.91], p <0.001) was associated with the increased likelihood of presenting perioperative ACS, while performing a perioperative PNB decreased the likelihood of presenting perioperative ACS (without PNB: 43.8%, with PNB: 4.7%, OR 0.3 [0.2 to 0.43], p <0.001).

CONCLUSION

Identifying patients with HF and cognitive impairment using RCMS or the Pfeiffer test and performing HF surgery within 36 h administering perioperative PNB could reduce the incidence of ACS.

Benefits of Dog-Assisted Therapy in Patients with Dementia Residing in Aged Care Centers in Spain

(1) Background: Currently, the scientific evidence on the benefits of assisted therapy with dogs in dementia is not clear. In this study, we want to evaluate such benefits through a randomized controlled clinical trial in multiple centers across the country. (2) Methods: The participants were people over 65 years old with dementia, residing in senior centers in Spain (n = 334). The experimental group underwent assisted therapy with dogs based on the Comprehensive Cognitive Activation Program in Dementia, for 8 months, with weekly sessions of 45 min. Data were collected at the commencement, middle, and end of the program, to evaluate the aspects using the Mini-Examination Cognitive, the modified Bartell Index, the Cornell Scale for Depression in Dementia and the Neuropsychiatric Inventory. (3) Results: The results show significant improvements in the experimental group versus the control group in the affective (T1 = p 0.000; T2 = p 0.000) and behavioral (T1 = p 0.005; T2 = p 0.000) aspects, with the affective aspect displaying greater progress in participants with additional depressive (p = 0.022) or anxiety (p = 0.000) disorders, shorter institutionalization periods (r = −0.222, p = 0.004), and those undergoing complementary psychotherapy (p = 0.033) or alternative therapy (p = 0.011). (4) Conclusions: Dog therapy is effective in improving the affective and behavioral aspects of institutionalized patients with dementia.

Baseline and 1-year follow-up differences between hip-fracture patients admitted from nursing homes and the community. A cohort study on 509 consecutive patients (FONDA Cohort)

OBJECTIVE

To determine the clinical and functional differences at hospital admission and at 1 year after a hip fracture (HF) in nursing homes (NH) and community-dwelling (CD) patients.

METHODS

All patients with HF admitted to the orthogeriatric unit at a university hospital between January 2013 and February 2014 were prospectively included. Clinical and functional variables, and mortality were recorded during the hospital admission. The patients were contacted by telephone at 1 year to determine their vital condition and functional status.

RESULTS

A total of 509 patients were included, 116 (22.8%) of whom came from NH. Compared with the CD patients, the NH patients had higher surgical risk (ASA ≥3: 83.6% vs. 66.4%, P<.001), poorer theoretical vital prognosis (Nottingham Profile ≥5: 98.3% vs. 56.6%, P<.001), higher rate of previous functional status (median Barthel index: 55 [IQR, 36-80] vs. 90 [IQR, 75-100], P<.001), poorer mental status (Pfeiffer's SPMSQ>2: 74.1% vs. 40.2%, P<.001), and a higher rate of sarcopenia (24.3% vs. 15.2%, P<.05). There were no differences in in-hospital or at 1-year mortality. At 1 year, NH patients recovered their previous walking capacity at a lower rate (38.5% vs. 56.2%, P<.001).

CONCLUSIONS

Among the patients with HF treated in an orthogeriatric unit, NH patients had higher, surgical risk, functional and mental impairment, and a higher rate of sarcopenia than CD patients. At 1 year of follow-up, NH patients did not have higher mortality, but they recovered their previous capacity for walking less frequently.

Individual and institutional factors associated with functional disability in nursing home residents: An observational study with multilevel analysis

Background

High prevalence of functional limitations has been previously observed in nursing homes. Disability may depend not only on the characteristics of the residents but also on the facility characteristics. The aims of this study were: 1, to describe the prevalence of functional disability in older people living in Spanish nursing homes; and 2, to analyze the relationships between individual and nursing home characteristics and residents’ functional disability.

Methods

A cross-sectional study with data collected from 895 residents in 34 nursing homes in the province of Albacete (Spain) was conducted. Functional status was assessed by the Barthel Index. Taking into account both levels of data (individual and institutional characteristics) we resorted to a multilevel analysis in order to take different sources of variability in the data.

Results

The prevalence of functional disability of the total sample was 79.8%. The best fitting multilevel model showed that female gender, older age, negative self-perception of health, and living in private nursing homes were factors significantly associated with functional disability. After separating individual and institutional effects, the institutions showed significant differences.

Conclusions

In line with previous findings, our study found high levels of functional dependence among institutionalized elders. Gender, age, self-perception of health, and institution ownership were associated with functional status. Disentangling individual and institutional effects by means of multilevel models can help evaluate the quality of the residences.