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Burgos-Alonso N, Torrecilla M, Mendiguren A, Pérez-Gómez Moreta M, Bruzos-Cidón C. Strategies to Improve Therapeutic Adherence in Polymedicated Patients over 65 Years: A Systematic Review and Meta-Analysis. PHARMACY 2024; 12:35. [PMID: 38392942 PMCID: PMC10892390 DOI: 10.3390/pharmacy12010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/02/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Part of the population over 65 years of age suffer from several pathologies and are therefore polymedicated. In this systematic review and metanalysis, we aimed to determine the efficacy of several strategies developed to improve adherence to pharmacological treatment in polymedicated elderly people. DESIGN Web Of Science, PubMed and the Cochrane Library were searched until 2 January 2024. In total, 17 of the 1508 articles found evaluated the efficacy of interventions to improve adherence to medication in polymedicated elderly patients. Methodological quality and the risk of bias were rated using the Cochrane risk of bias tool. Open Meta Analyst® software was used to create forest plots of the meta-analysis. RESULTS In 11 of the 17 studies, an improvement in adherence was observed through the use of different measurement tools and sometimes in combination. The most frequently used strategy was using instructions and counselling, always in combination, in a single strategy used to improve adherence; one involved the use of medication packs and the other patient follow-up. In both cases, the results in improving adherence were positive. Five studies using follow-up interventions via visits and phone calls showed improved adherence on the Morisky Green scale compared to those where usual care was received [OR = 1.900; 95% CI = 1.104-3.270] (p = 0.021). DISCUSSION There is a high degree of heterogeneity in the studies analyzed, both in the interventions used and in the measurement tools for improving adherence to treatment. Therefore, we cannot make conclusions about the most efficacious strategy to improve medication adherence in polymedicated elderly patients until more evidence of single-intervention strategies is available.
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Affiliation(s)
- Natalia Burgos-Alonso
- Public Health Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - María Torrecilla
- Pharmacology Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - Aitziber Mendiguren
- Pharmacology Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - Marta Pérez-Gómez Moreta
- Public Health Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
| | - Cristina Bruzos-Cidón
- Nursing I Department, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, 48940 Leioa, Spain
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Gómez-Salgado J, Bernabeu-Wittel M, Aguilera-González C, Goicoechea-Salazar JA, Larrocha D, Nieto-Martín MD, Moreno-Gaviño L, Ollero-Baturone M. Concordance between the Clinical Definition of Polypathological Patient versus Automated Detection by Means of Combined Identification through ICD-9-CM Codes. J Clin Med 2019; 8:jcm8050613. [PMID: 31064157 PMCID: PMC6572229 DOI: 10.3390/jcm8050613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 11/26/2022] Open
Abstract
It is unknown whether the digital application of automated ICD-9-CM codes recorded in the medical history are useful for a first screening in the detection of polypathological patients. In this study, the objective was to identify the degree of intra- and inter-observer concordance in the identification of in-patient polypathological patients between the standard clinical identification method and a new automatic method, using the basic minimum data set of ICD-9-CM codes in the digital medical history. For this, a cross-sectional multicenter study with 1518 administratively discharged patients from Andalusian hospitals during the period of 2013–2014 has been carried out. For the concordance between the clinical definition of a polypathological patient and the polypathological patient classification according to ICD-9-CM coding, a 0.661 kappa was obtained (95% confidence interval (CI); 0.622–0.701) with p < 0.0001. The intraclass correlation coefficient between both methods for the number of polypathological patient categories was 0.745 (95% CI; 0.721–0.768; p < 0.0001). The values of sensitivity, specificity, positive-, and negative predictive values of the automated detection using ICD-9-CM coding were 78%, 88%, 78%, and 88%, respectively. As conclusion, the automatic identification of polypathological patients by detecting ICD-9-CM codes is useful as a screening method for in-hospital patients.
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Affiliation(s)
- Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Universidad de Huelva, 21007 Huelva, Spain.
- Safety and Health Posgrade Programme, Universidad Espíritu Santo, Guayaquil 092301, Ecuador.
| | - Máximo Bernabeu-Wittel
- Department of Internal Medicine, Virgen del Rocío University Hospital, University of Seville, 41013 Seville, Spain.
| | - Carmen Aguilera-González
- Department of Internal Medicine, Virgen del Rocío University Hospital, University of Seville, 41013 Seville, Spain.
| | | | - Daniel Larrocha
- Healthcare Product Service, Andalusian Health Service, 41071 Seville, Spain.
| | - María Dolores Nieto-Martín
- Department of Internal Medicine, Virgen del Rocío University Hospital, University of Seville, 41013 Seville, Spain.
| | - Lourdes Moreno-Gaviño
- Department of Internal Medicine, Virgen del Rocío University Hospital, University of Seville, 41013 Seville, Spain.
| | - Manuel Ollero-Baturone
- Department of Internal Medicine, Virgen del Rocío University Hospital, University of Seville, 41013 Seville, Spain.
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3
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Impact of Sarcopenia and Frailty in a Multicenter Cohort of Polypathological Patients. J Clin Med 2019; 8:jcm8040535. [PMID: 31003486 PMCID: PMC6517963 DOI: 10.3390/jcm8040535] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 12/29/2022] Open
Abstract
The prevalence, relationships and outcomes of sarcopenia and frailty in polypathological patients remain unknown. We performed a multicenter prospective observational study in six hospitals in order to assess prevalence, clinical features, outcome and associated risk factors of sarcopenia and frailty in a hospital-based population of polypathological patients. The cohort was recruited by performing prevalence surveys every 14 days during the inclusion period (March 2012–June 2016). Sarcopenia was assessed by means of EWGSOP criteria and frailty by means of Fried’s criteria. Skeletal muscle mass was measured by tetrapolar bioimpedanciometry. All patients were followed for 12 months. Factors associated with sarcopenia, frailty and mortality were analyzed by multivariate logistic regression, and Kaplan–Meier curves. A total of 444 patients (77.3 ± 8.4 years, 55% males) were included. Sarcopenia was present in 97 patients (21.8%), this being moderate in 54 (12.2%), and severe in 43 (9.6%); frailty was present in 278 patients (62.6%), and 140 (31.6%) were pre-frail; combined sarcopenia and frailty were present in the same patient in 80 (18%) patients. Factors independently associated to the presence of both, sarcopenia and frailty were female gender, older age, different chronic conditions, poor functional status, low body mass index, asthenia and depressive disorders, and low leucocytes and lymphocytes count. Mortality in the 12-months follow-up period was 40%. Patients with sarcopenia, frailty or both survived significantly less than those without these conditions. Sarcopenia and frailty are frequent and interrelated conditions in polypathological patients, shadowing their survival. Their early recognition and management could improve health-related outcomes in this population.
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4
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Núñez-Montenegro AJ, Martín-Yañez V, Roldan-Liébana MÁ, González-Ruiz FD, Fernández-Romero R, Narbona-Ríos C. [Design and validation of the scale to assess the fragility of chronic patients]. Aten Primaria 2018; 51:486-493. [PMID: 30352702 PMCID: PMC6837145 DOI: 10.1016/j.aprim.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 05/14/2018] [Accepted: 06/04/2018] [Indexed: 11/25/2022] Open
Abstract
Objetivo Crear una escala y herramienta que nos permita medir la fragilidad del paciente crónico. Diseño Estudio observacional sobre crónicos del área. Emplazamiento Se ha realizado entre enero de 2011 a diciembre 2015, una población de 2.108 individuos. Los datos se recogieron de la historia clínica y aplicación expresa para el registro de los pacientes frágiles, sobre hoja estructurada de recogida de datos. Participantes Sujetos frágiles del área Sanitaria Norte de Málaga. Intervención Diseño y validación de una escala. Mediciones principales Variable principal de resultado: escala de fragilidad Antequera (EPADI) constituida por seis criterios/factores valorables: edad, Pfeiffer, Barthell, Charlson, sociofamiliar y pluripatológico. Las variables de resultados en accesibilidad se utilizaron como variables de predicción. Las variables cuantitativas se describen mediante la media y desviación estándar. Las variables cualitativas las presentamos en frecuencias junto con sus porcentajes. Para obtener un modelo de predicción de la utilización de recursos la muestra se dividió en dos sub-muestras de igual tamaño. Resultados A partir de las variables de interés por expertos, se identificaron predictores univariantes en la utilización de recursos en la muestra M_EPADI1, para construir un modelo de regresión logística multivariante que permita predecir la utilización de recursos. Para la validación de la escala se utilizó la muestra M_EPADI2. Conclusiones Se ha podido comprobar que los criterios utilizados en nuestra escala son adecuados para definir la fragilidad, por lo tanto la escala EPADI valora perfectamente el grado de fragilidad de los usuarios crónicos en base a los recursos consumidos.
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Affiliation(s)
- Antonio Jesús Núñez-Montenegro
- Unidad de Gestión Clínica de Archidona, Área Sanitaria Norte de Málaga, Archidona, Málaga, España; Miembro del grupo de investigación en Cuidados de Málaga IBIMA AE-20 INVESCUIDA; Miembro de la Red de Investigación al Final de la Vida (Red-Eol).
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5
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Ramón-Arbués E, Martínez-Abadía B, Martín-Gómez S. [Determinants of caregiver burden. Study of gender differences]. Aten Primaria 2017; 49:308-309. [PMID: 28427914 PMCID: PMC6876004 DOI: 10.1016/j.aprim.2016.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 07/23/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Enrique Ramón-Arbués
- Centro de Salud Campo de Belchite, Sector Zaragoza II, Servicio Aragonés de Salud, Belchite, Zaragoza, España.
| | - Blanca Martínez-Abadía
- Centro de Salud Actur Norte, Sector Zaragoza I, Servicio Aragonés de Salud, Zaragoza, España
| | - Susana Martín-Gómez
- Centro de Salud Huesca Perpetuo Socorro, Sector Huesca, Servicio Aragonés de Salud, Huesca, España
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Bernabeu-Wittel M, Moreno-Gaviño L, Ollero-Baturone M, Barón-Franco B, Díez-Manglano J, Rivas-Cobas C, Murcia-Zaragoza J, Ramos-Cantos C, Fernández-Moyano A. Validation of PROFUND prognostic index over a four-year follow-up period. Eur J Intern Med 2016; 36:20-24. [PMID: 27491587 DOI: 10.1016/j.ejim.2016.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/16/2016] [Accepted: 07/22/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND/OBJECTIVES The PROFUND index stratifies accurately the 12-month mortality risk of polypathological patients (PPs), but its fitness over a longer follow-up period remains unknown. We aimed to explore the calibration and discrimination power of PROFUND index over 4-years, in order to assess its follow-up interval generalizability. DESIGN Multicenter prospective cohort-study. SETTING 33 Spanish hospitals. PARTICIPANTS PPs included after hospital discharge, outpatient clinics, or home hospitalization. MEASUREMENTS Mortality over a 4-year follow-up period. METHODS PROFUND index calibration was assessed by risk-quartiles predicted/observed mortality (Hosmer-Lemeshow goodness-of-fit test), and its discrimination power by ROC curves. RESULTS A total of 768 patients were included (630 [82%] of them completed the 4-year follow-up). Global mortality rate was 63.5%. When assessing individual patient scores, mortality was 52% in the lowest risk group (0-2 points in PROFUND score); 73.5% in the low-intermediate risk group (3-6 points), 85% in the intermediate-high group (7-10 points); and 92% in the highest risk group (≥11 points). Accuracy testing of the PROFUND index showed good calibration (P=.8 in the Hosmer-Lemeshow goodness-of-fit test), and also a good discrimination power (AUC=0.71 [0.67-0.77] in ROC curve). CONCLUSIONS The PROFUND index maintained its accuracy in predicting mortality of polypathological patients over a 4-year follow-up period. This index may be of potential usefulness in deciding the most appropriate health-care interventions in populations with multimorbidity.
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Affiliation(s)
- M Bernabeu-Wittel
- Internal Medicine Department of, Hospital Virgen del Rocío, Sevilla, Spain.
| | - L Moreno-Gaviño
- Internal Medicine Department of, Hospital Virgen del Rocío, Sevilla, Spain
| | - M Ollero-Baturone
- Internal Medicine Department of, Hospital Virgen del Rocío, Sevilla, Spain
| | - B Barón-Franco
- Internal Medicine Department of, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - J Díez-Manglano
- Internal Medicine Department of, Hospital Royo Villanova, Zaragoza, Spain
| | - C Rivas-Cobas
- Internal Medicine Department of, Hospital Virgen del Rocío, Sevilla, Spain
| | - J Murcia-Zaragoza
- Internal Medicine Department of, Hospital General de Alicante, Spain
| | - C Ramos-Cantos
- Internal Medicine Department of, Hospital de la Axarquía, Málaga, Spain
| | - A Fernández-Moyano
- Internal Medicine Department of, Hospital San Juan de Dios del Aljarafe, Sevilla, Spain
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Casado-Mejía R, Ruiz-Arias E. Influence of Gender and Care Strategy in Family Caregivers´ Strain: A Cross-Sectional Study. J Nurs Scholarsh 2016; 48:587-597. [DOI: 10.1111/jnu.12256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Rosa Casado-Mejía
- Professor, Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry; University of Seville; Seville Spain
| | - Esperanza Ruiz-Arias
- Professor, Nursing Department, Faculty of Nursing; Physiotherapy and Podiatry, University of Seville; Seville Spain
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8
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Álvarez-Tello M, Casado-Mejía R, Praena-Fernández JM, Ortega-Calvo M. [Developing a predictive model for the caregiver strain index]. Rev Esp Geriatr Gerontol 2016; 52:15-19. [PMID: 26857085 DOI: 10.1016/j.regg.2015.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/27/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patient homecare with multiple morbidities is an increasingly common occurrence. The caregiver strain index is tool in the form of questionnaire that is designed to measure the perceived burden of those who care for their families. The aim of this study is to construct a diagnostic nomogram of informal caregiver burden using data from a predictive model. METHODS The model was drawn up using binary logistic regression and the questionnaire items as dichotomous factors. The dependent variable was the final score obtained with the questionnaire but categorised in accordance with that in the literature. Scores between 0 and 6 were labelled as "no" (no caregiver stress) and at or greater than 7 as "yes". The version 3.1.1R statistical software was used. To construct confidence intervals for the ROC curve 2000 boot strap replicates were used. RESULTS A sample of 67 caregivers was obtained. A diagnosing nomogram was made up with its calibration graph (Brier scaled = 0.686, Nagelkerke R2=0.791), and the corresponding ROC curve (area under the curve=0.962). FINDINGS The predictive model generated using binary logistic regression and the nomogram contain four items (1, 4, 5 and 9) of the questionnaire. R plotting functions allow a very good solution for validating a model like this. The area under the ROC curve (0.96; 95% CI: 0.994-0.941) achieves a high discriminative value. Calibration also shows high goodness of fit values, suggesting that it may be clinically useful in community nursing and geriatric establishments.
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Affiliation(s)
- Margarita Álvarez-Tello
- Unidad de Gestión Clínica Polígono Sur-Las Letanías, Distrito Sanitario de Atención Primaria, Sevilla, España
| | - Rosa Casado-Mejía
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, España
| | - Juan Manuel Praena-Fernández
- Unidad de Metodología y Evaluación de la Investigación, Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Manuel Ortega-Calvo
- Centro de Salud Esperanza Macarena, Unidad de Investigación Distrito Sanitario de Atención Primaria, Sevilla, España; CIBER de la Fisiopatología de la Obesidad y de la Nutrición, Instituto de Salud Carlos III, Madrid, España.
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Núñez Montenegro AJ, Montiel Luque A, Martín Aurioles E, Torres Verdú B, Lara Moreno C, González Correa JA. [Adherence to treatment, by active ingredient, in patients over 65 years on multiple medication]. Aten Primaria 2013; 46:238-45. [PMID: 24378196 PMCID: PMC6983607 DOI: 10.1016/j.aprim.2013.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 09/30/2013] [Accepted: 10/11/2013] [Indexed: 11/29/2022] Open
Abstract
AIM To assess the level of adherence, by active ingredient, to treatment and associated factors in polymedicated patients over 65 years-old. DESIGN Observational, descriptive and cross-sectional study over polymedicated patients over 65 years of the Costa del Sol Health District and the North Malaga Health Area. The study was performed between January 2011 and September 2012 on 375 subjects obtained by simple random sampling from lists provided by each health centre. Data was collected by means of an interview with structured questions. Informed consent was given and signed by all patients before interview. STUDY VARIABLES Main results variable adherence to treatment (Morisky-Green's test). PREDICTABLE VARIABLES Prescription by active ingredient, socio-demographic variables, health care centre variables, and treatment associated variables. A descriptive analysis of variables was performed. Statistical inference was determined using univariate analysis (t test of Student or Mann-Whitney U, and Chi-squared), and controlling for confounding factors by multivariate analysis (linear and logistic regression). RESULTS The result for therapeutic compliance was 51.7%. No statistically significant differences were observed as regards sex and age. A relationship was found in those who resided in rural areas (P=.001), lived with family (P<.05), and were not at risk of suffering from anxiety (P=.046). CONCLUSIONS We found similar patient adherence to treatment despite the prescribing generic drugs. Failure to therapeutic compliance was greater in those patients who lived by themselves, in a city close to the coast, or in those patients who were at risk of suffering from anxiety.
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Moreno-Gaviño L, Bernabeu-Wittel M, Mendoza-Giraldo D, Sanz-Baena S, Galindo-Ocaña FJ. Caregivers' features and social support in patients with advanced medical diseases. Eur J Intern Med 2013; 24:e72-3. [PMID: 23385009 DOI: 10.1016/j.ejim.2013.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 12/24/2012] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
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Alfaro N, Lázaro P, Gabriele G, Garcia-Vicuña R, Jover JÁ, Sevilla J. Perceptions, attitudes and experiences of family caregivers of patients with musculoskeletal diseases: a qualitative approach. ACTA ACUST UNITED AC 2013; 9:334-9. [PMID: 23871505 DOI: 10.1016/j.reuma.2013.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 03/29/2013] [Accepted: 04/07/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the perceptions, attitudes and experiences among family caregivers of patients with musculoskeletal diseases (MSD). METHODS Descriptive, exploratory, qualitative study. Two discussion groups were organized with family caregivers of MSD patients, representing the caregiver profile: gender (men/women) and age (31-45 years/46-65 years); and patient profiles: MSD type (rheumatoid arthritis/ankylosing spondylitis), work status (yes or no for the variables housewife, at least 3 episodes of sick leave, patients who abandoned their work, and patients with permanent work disability). A content analysis based on the Grounded Theory was done to detect and explore emerging categories. RESULTS The emerging dimensions were: alterations in daily life activities, need for caregiver support, physical and psychological impact on the caregiver, characteristics of the patient, and several aspects of care. Relevant experiences mentioned were: the diagnosis of a MSD changes the patient and their family members' life affecting work, financial, social, psychological and physical spheres, making it necessary help for basic activities of daily living. Early age at onset or severe MSDs require dedication and effort on the part of caregivers which increases with time. This leads to a great emotional overload on the caregivers, which may be modulated by the support they receive when providing care. CONCLUSION The primary consequences for caregivers are loss of purchasing power, work problems, social isolation and emotional stress. Programs for effective at-home support need to be developed with streamlined administrative processes to quickly classify the level of disability and provide official assistance.
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Affiliation(s)
- Noelia Alfaro
- Técnicas Avanzadas de Investigación en Servicios de Salud, Madrid, España
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12
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Álvarez-Tello M, Casado-Mejía R, Ortega-Calvo M, Ruiz-Arias E. [Overload in the informal caregivers of patients with multiple comorbidities in an urban area]. ENFERMERIA CLINICA 2012. [PMID: 23183159 DOI: 10.1016/j.enfcli.2012.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of the study was, to determine the profile of the family caregiver of patients with multiple pathologies, identify factors associated with overload, and construct predictive models using items from the Caregiver Strain Index (CSI). METHOD A cross-sectional study of caregivers of patients with multiple comorbidities who attended an urban health centre. Data were collected from health records and questionnaires (Barthel index, Pfeiffer index, and CSI). Statistical analysis was performed using measures of central tendency and dispersion, and by building multivariate models with binary logistic regression with the CSI items as predictors (program R version 2.14.0). RESULTS The sample included 67 caregivers, with a mean age of 64.69 years (standard deviation=12.71, median 62 years), of whom 74.6% were women, 35.8% were wives, and 32.8% were daughters. The level of dependence of the patients cared for was total/severe in 77.6%, and moderate in 12% (Barthel), and 47.8% had some level of cognitive impairment (Pfeiffer). A CSI equal or greater than 7 was seen in 47.8% of caregivers, identifying life problems in more than 40% of them such as, restriction of social life, physical exertion, discomfort with change, bad behaviour, personal and family emotional changes, and sleep disturbances. Item 4 of the CSI, analysing the social restriction, was the one that showed a greater significance in the predictive multivariate model. Item 12 (economic burden) was the most significant with age in patients with cognitive impairment. CONCLUSIONS Women tend to take the role of caregiver at an earlier age than men in the urban environment studied, and items from CSI showed that items 4 (social restrictions) and 12 (economic burden) have more significance in the predictive models constructed with Binary Logistic Regression.
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Affiliation(s)
- Margarita Álvarez-Tello
- Centro de Salud Inmaculada Vieira Fuentes «Las Letanías», Distrito Sanitario Sevilla, Servicio Andaluz de Salud, Sevilla, España.
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Impact of Cognitive Impairment in a Multicentric Cohort of Polypathological Patients. INT J GERONTOL 2012. [DOI: 10.1016/j.ijge.2011.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Functional Decline Over 1-year Follow-up in a Multicenter Cohort of Polypathological Patients: A New Approach to Functional Prognostication. INT J GERONTOL 2012. [DOI: 10.1016/j.ijge.2011.09.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Domínguez J, Ruíz M, Gómez I, Gallego E, Valero J, Izquierdo M. Ansiedad y depresión en cuidadores de pacientes dependientes. Semergen 2012. [DOI: 10.1016/j.semerg.2011.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Vázquez-Sánchez MÁ, Aguilar-Trujillo MP, Estébanez-Carvajal FM, Casals-Vázquez C, Casals-Sánchez JL, Heras-Pérez MC. Influencia de los pensamientos disfuncionales en la sobrecarga de los cuidadores de personas dependientes. ENFERMERIA CLINICA 2012; 22:11-7. [DOI: 10.1016/j.enfcli.2011.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 07/07/2011] [Accepted: 07/12/2011] [Indexed: 01/23/2023]
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Bernabeu-Wittel M, Barón-Franco B, Murcia-Zaragoza J, Fuertes-Martín A, Ramos-Cantos C, Fernández-Moyano A, Galindo F, Ollero-Baturone M. A multi-institutional, hospital-based assessment of clinical, functional, sociofamilial and health-care characteristics of polypathological patients (PP). Arch Gerontol Geriatr 2011; 53:284-91. [DOI: 10.1016/j.archger.2010.12.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 12/04/2010] [Accepted: 12/05/2010] [Indexed: 01/23/2023]
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Bernabeu-Wittel M, Ollero-Baturone M, Moreno-Gaviño L, Barón-Franco B, Fuertes A, Murcia-Zaragoza J, Ramos-Cantos C, Alemán A, Fernández-Moyano A. Development of a new predictive model for polypathological patients. The PROFUND index. Eur J Intern Med 2011; 22:311-7. [PMID: 21570654 DOI: 10.1016/j.ejim.2010.11.012] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 10/31/2010] [Accepted: 11/25/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a concern about the accuracy of the available prognostic indexes when applying them to the emergent population of polypathological patients (PP). METHODS To develop a 1-year mortality predictive index on PP, we developed a multicenter prospective cohort-study recruiting 1.632 PP after hospital discharge, outpatient clinics, or home hospitalization, from 33 hospitals. Potential risk factors were obtained in the 1.525 PP who completed follow-up. Each factor independently associated with mortality in the derivation cohort (757 PP from western hospitals) was assigned a weight, and risk scores were calculated by adding the points of each factor. Accuracy was assessed in the validation cohort (768 PP from eastern hospitals) by risk quartiles calibration, and discrimination power, by ROC curves. Finally, accuracy of the index was compared with that of the Charlson index. RESULTS Mortality in the derivation/validation cohorts was 35%/39.5%, respectively. Nine independent mortality predictors were identified to create the index (age ≥85 years, 3 points; No caregiver or caregiver other than spouse, 2 points; active neoplasia, 6 points; dementia, 3 points; III-IV functional class on NYHA and/or MRC, 3 points; delirium during last hospital admission, 3 points; hemoglobinemia <10 g/dl, 3 points; Barthel index <60 points, 4 points; ≥4 hospital admissions in last 12 months, 3 points). Mortality in the derivation/validation cohorts was 12.1%/14.6% for patients with 0-2 points; 21.5%/31.5% for those with 3-6 points; 45%/50% for those with 7-10 points; and 68%/61.3% for those with ≥11 points, respectively. Calibration was good in derivation/validation cohorts, and discrimination power by area under the curve was 0.77/0.7. Calibration of the Charlson index was good, but discrimination power was suboptimal (area under the curve, 0.59). CONCLUSIONS This prognostic index provides an accurate and transportable method of stratifying 1-year death risk in PP.
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Affiliation(s)
- M Bernabeu-Wittel
- Internal Medicine Department. Hospital Universitario Virgen del Rocío. Avda Manuel Siurot, s/n. 41013 Sevilla, Spain.
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Orueta-Sánchez R, Gómez-Calcerrada RM, Gómez-Caro S, Sánchez-Oropesa A, López-Gil MJ, Toledano-Sierra P. [Impact on the primary carer of an intervention carried out on dependent elderly people]. Aten Primaria 2011; 43:490-6. [PMID: 21536350 DOI: 10.1016/j.aprim.2010.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 08/31/2010] [Accepted: 09/07/2010] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the impact of joining a home care program on primary caregivers of dependent elderly people. DESIGN Non-randomised "before-after" intervention study. SETTING Primary Care. PARTICIPANTS Primary carers of elderly dependent people included in a home care program (n=156; 7.8% loss to follow up). INTERVENTIONS Inclusion in a home care program for chronically dependent elderly and the assessment of the primary carer in the same year. VARIABLES ASSESSED: perceived health, frequency of visits, questionnaires of quality of life (Nottingham questionnaire), psychological health (Goldberg questionnaire), social support (Duke-UNC scale) and overburden of caregivers (Zarit questionnaire) and satisfaction with care received. RESULTS There were no significant changes in perceived health. Improvement in the areas of energy, sleep, emotional and social relationship of the quality of life. Decreased attendance (8.4 vs. 7.5, p<0.05) and the percentage of overusers (30.1 vs 6.9%, P<.01). A reduced percentage of caregivers expressed low social support (8.3 vs 2.8%, P<.05) and caregiver overburden (56.4 vs 44.4%, P<.05). 90.3% of caregivers believed that care had improved at the end of intervention, with a significant improvement of satisfaction of overall medical and nursing care received (7.6 vs 8, 4, 7.9 vs 8.5 and 7 vs 8.5; P<.05). CONCLUSIONS Joining a home care program for dependents has a positive impact on their primary caregiver and improves their perception of care received, reducing their use of health services, reducing the level of overburden and their perceived lack of social support.
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Perceived quality of healthcare in a multicenter, community-based population of polypathological patients. Arch Gerontol Geriatr 2011; 52:142-6. [DOI: 10.1016/j.archger.2010.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 02/25/2010] [Accepted: 02/26/2010] [Indexed: 01/23/2023]
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Bernabeu-Wittel M, Jadad A, Moreno-Gaviño L, Hernández-Quiles C, Toscano F, Cassani M, Ramírez N, Ollero-Baturone M. Peeking through the cracks: an assessment of the prevalence, clinical characteristics and health-related quality of life (HRQoL) of people with polypathology in a hospital setting. Arch Gerontol Geriatr 2009; 51:185-91. [PMID: 19913928 DOI: 10.1016/j.archger.2009.10.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 10/08/2009] [Accepted: 10/12/2009] [Indexed: 12/21/2022]
Abstract
Little is known about the prevalence of the recently defined polypathology notion in hospital populations. Patients admitted to medical wards were assessed using established criteria of polypathology. Prevalence of polypathology, interobserver reliability, clinical features, nutritional status, and HRQoL were assessed using clinical data and interview, mini-nutritional assessment (MNA), and the 12-item short-form health survey (SF-12) scales. Of a total of 812 patients studied, 196 (24%) met polypathology criteria (65% men, of mean age 71.3+/-11.6 years, mean defining chronic diseases 2.4+/-0.046, and other comorbidities 2.6+/-0.094). Interobserver reliability for the detection of cases was good (kappa=0.628). Their mean Charlson index/prescribed drugs were 3.3/6, respectively. Severe dyspnea, delirium, or active neoplasia were present in 44, 15, and 11%. A bad nutritional status/risk of malnutrition was evident in 10.3/52.6%, and correlated with the number of previous hospitalizations (p=0.041), and the presence of active neoplasia (p=0.037). Mean physical/mental summaries of HRQoL were 33.9+/-10, and 42+/-13, and correlated with a better nutritional status (p=0.011, and p=0.001, respectively). Polypathology affects one quarter of inpatients in a hospital setting, and can be easily and reliably identified. The diversity and complexity of patient needs underscore the need for continuity of care between community and hospital, crossing sub-speciality lines and institutional boundaries.
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Affiliation(s)
- M Bernabeu-Wittel
- Department of Internal Medicine, Hospitales Universitarios Virgen del Rocío, Avda. Manuel Siurot, s/n, 41013 Sevilla, Spain.
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Mesa-Gresa P, Ramos-Campos M, Redolat R. Cuidado de pacientes oncológicos: una revisión sobre el impacto de la situación de estrés crónico y su relación con la personalidad del cuidador y otras variables moduladoras. PSICOONCOLOGIA 1970. [DOI: 10.5209/psic.55814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objetivo: La incidencia y prevalencia de enfermedades de larga duración como el cáncer se ha incrementado en los últimos años. En este contexto, nuestro principal objetivo será el análisis de las principales consecuencias que la exposición a una situación de estrés crónico, como es el cuidado de un paciente oncológico, tiene sobre la salud psicosocial y la función cognitiva del cuidador informal y su relación con variables moduladoras. Método: Se realizó una revisión bibliográfica en las bases de datos PubMed y PsychINFO sobre las consecuencias de la situación de cuidado en pacientes crónicos. Resultados: Diversos estudios sugieren que la condición de cuidador de un paciente oncológico puede considerarse una situación estresante que conlleva consecuencias tanto a nivel de salud física como psicosocial del cuidador además de un deterioro en su funcionamiento cognitivo que pueden estar modulados por diferentes variables. Conclusión: Estos datos sugieren la importancia de implementar programas de intervención que amortigüen las consecuencias deletéreas de la labor de cuidado.
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