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[Abstract] Bright light therapy (BLT) has demonstrated positive short- and long-term effects in people with cognitive impairment or dementia; however, the immediate impact of BLT sessions has been scarcely investigated. In this study, we aimed to explore the immediate effects of BLT on behavior, mood, and physiological parameters (oxygen saturation/heart rate) in a sample of institutionalized older adults with moderate to very severe dementia, with a median age of 85.0 (interquartile range, IQR, 82.0–90.0), being higher in men (87.0 years, IQR 80.0–94.0) than in women (84.5 years, IQR 82.0–89.5). The BLT protocol consisted of 30-min morning sessions of 10,000 lux, Monday through Friday, for 4 weeks. The physiological parameters were recorded immediately before and after each session by pulse oximetry. Mood and behavior were assessed before, after, and during the sessions using the Interact scale. Post-session Interact scores showed a significant decrease in the items Tearful/sad and Talked spontaneously, and a significant increase in the items Enjoying self, active or alert, and Relaxed, content or sleeping appropriately. Interact scores during the sessions reflected a significant decrease in the speech-related items. Both physiological parameters changed positively from before to after sessions. Our results suggest that BLT provides immediate positive effects on mood, stimulation level, and physiological parameters, as well as a trend toward decreased speech. More robust research is needed to further explore the immediate impact of BLT. This study is registered with Clinicaltrials.gov (NCT04949984).

[Resumen] En Galicia son escasos los estudios socio-comunitarios que exploran la fragilidad y la malnutrición, a pesar de ser dos de los síndromes geriátricos que provocan mayor vulnerabilidad. Los objetivos principales del trabajo han sido examinar los factores que influyen en la progresión natural de la fragilidad; e identificar aspectos sociales y de calidad de vida (CV) relacionados con la fragilidad física y el estado nutricional en función del género. Se realizó una Valoración Geriátrica Integral en una muestra comunitaria representativa de 749 personas de 65 o más años de Galicia, que fueron re-evaluadas (n=537) tras un año de seguimiento. Los factores de riesgo que incrementaron la probabilidad de una transición hacia un peor estado de fragilidad fueron el déficit auditivo, la insuficiencia cardíaca congestiva y la polifarmacia. En las mujeres, el principal determinante de fragilidad y del riesgo de malnutrición o malnutrición fue presentar puntuaciones bajas en el ítem de CV relacionado con la salud física. En los hombres, tener edades comprendidas entre 80-89 años y una mala CV fueron los principales determinantes de fragilidad, mientras que no estar casado y estar poco satisfecho con la salud se asociaron con el riesgo de malnutrición o malnutrición., [Resumo] En Galicia son escasos os estudos socio-comunitarios que analizan a fraxilidade e a malnutrición, a pesar de ser dúas das síndromes xeriátricas que provocan maior vulnerabilidade. Os obxectivos principais deste traballo foron examinar os factores que inflúen na progresión natural da fraxilidade; e determinar aspectos sociais e de calidade de vida (CV) asociados coa fraxilidade física e co estado nutricional en función do xénero. Realizouse unha Valoración Xeriátrica Integral nunha mostra comunitaria representativa de 749 persoas de 65 ou máis anos de Galicia, que foron re-avaliadas (n=537) tras un ano de seguimento. Os factores de risco que incrementaron a probabilidade dunha transición cara un peor estado de fraxilidade foron o déficit auditivo, a insuficiencia cardíaca conxestiva e a polifarmacia. Nas mulleres puntuacións baixas no ítem de CV relacionado coa saúde física asociáronse con presentar risco de malnutrición ou malnutrición e non ser robustas. Nos homes ter idades comprendidas entre 80-89 anos e ter unha pobre CV xeral asociáronse a non ser robustos, mentres que non estar casado e presentar baixa satisfacción coa saúde asociáronse a presentar risco de malnutrición ou malnutrición., [Abstract] There are few socio-community studies analyzing the frailty and malnutrition in Galicia, despite they are two of the geriatric syndromes that cause greater vulnerability. The main objectives of the work were to examine risk factors that led to natural frailty transition; and to determinate social and quality of life aspects associated with physical frailty and nutritional status.A Comprehensive Geriatric Assessment was carried out covering a community-dwelling representative sample (n=749) of adults aged 65 years and older from Galicia, of whom (n=537) were re-interviewed at one-year follow-up. Risk factors that determined the worsening transitions were hearing impairment, congestive heart failure, and polypharmacy. Women showed significant lower scores on physical health-related quality of life that were associated with risk malnutrition or malnutrition and being non-robust. While ages between 80-89 and poor overall quality of life were associated with non-robust status in men. Regarding risk of malnutrition and malnutrition in men were associated with unmarried and having poor satisfaction with their health

[Resumen] Introducción. En las últimas décadas, se ha incrementado exponencialmente la investigación sobre los efectos de la realidad virtual en diferentes trastornos neurológicos. Sin embargo, la bibliografía centrada en los beneficios de la realidad virtual sobre el deterioro cognitivo en personas mayores es limitada. Objetivo. Explorar la aplicación de la realidad virtual como herramienta preventiva, diagnóstica o de tratamiento del deterioro cognitivo en personas mayores. Pacientes y métodos. Se llevó a cabo una búsqueda bibliográfica en las bases de datos Medline y Web of Science, incluyendo toda la bibliografía publicada desde sus inicios hasta diciembre de 2019. Resultados. De las 270 publicaciones encontradas, 15 cumplieron los criterios de inclusión: dos examinaron el efecto de la realidad virtual como herramienta de prevención del deterioro cognitivo; seis, su aplicabilidad diagnóstica; y siete, su efectividad como tratamiento. Conclusiones. Existe evidencia del potencial efecto de la realidad virtual como estrategia preventiva frente al desarrollo de deterioro cognitivo en personas mayores. Existe también evidencia de su aplicabilidad como herramienta diagnóstica de detección de desarrollo de deterioro cognitivo leve o demencia, y de su efectividad como tratamiento, ya que mejora el funcionamiento cognitivo de personas mayores con deterioro cognitivo. Son necesarios futuros estudios metodológicamente más robustos y con amplios tiempos de seguimiento para examinar el impacto real de la realidad virtual y poder generalizar su aplicación en los diferentes ámbitos de manejo del deterioro cognitivo

[Abstract] Physical frailty is closely associated with cognitive impairment. We aim to investigate the neuropsychological profiles of prefrail and non-frail dementia-free community-dwelling older adults using a comprehensive neuropsychological evaluation, and to examine the association between specific frailty criteria and clinical and neuropsychological scores. Participants completed a comprehensive standardized neuropsychological evaluation (covering cognitive domains such as memory, executive functions, language and attention), and frailty assessment. Frailty was assessed according to biological criteria: unintentional weight loss, exhaustion, low physical activity, slowness, and weakness. The sample comprised 60 dementia-free community-dwelling adults, aged 65 years or older (range 65–89 years; 60.0% women). Forty-two participants were classified as robust (no frailty criteria present), and 18 as prefrail (1 or 2 frailty criteria present). We explored neurocognitive differences between the groups and examined the association between specific criteria of frailty phenotype and clinical and neuropsychological outcomes with bivariate tests and multivariate models. Prefrail participants showed poorer cognitive performance than non-frail participants in both memory and non-memory cognitive domains. However, delayed episodic memory was the only cognitive subdomain that remained significant after controlling for age, gender, and educational level. Gait speed was significantly associated with general cognitive performance, immediatememory, and processing speed, while grip strength was associated with visual episodic memory and visuoconstructive abilities. Both gait speed and grip strength were negatively associated with depressive scores. Our results suggest that prefrailty is associated with cognitive dysfunction. The fact that specific cognitive domains may be susceptible to subclinical states of physical frailty may have important clinical implications. Indeed, early

[Abstract] Objective: The aim of this pilot study was to investigate differences on dual- and triple-task performance in institutionalized prefrail and frail older adults. Performance on these tasks is relevant since many activities of daily living involve simultaneous motor and cognitive tasks. Methods: We used a phenotypic description of frailty based on the presence or absence of five criteria related to physical fitness and metabolism (unintentional weight loss, self-reported exhaustion, muscle weakness, low gait speed, and low physical activity). Thirty-three institutionalized older adults (≥ 65 years, 78.8% females) were divided according to their frailty status. Participants completed cognitive tasks (a phonemic verbal fluency task and a visuospatial tracking task) while cycling on a stationary cycle (upper- and lower-extremity function was assessed). Cycling (number of arm and foot cycles) and cognitive (number of correct answers) performances were measured during single-, dual-, and triple-task conditions. Performances and costs of dual -and triple- tasking on cycling and cognitive performances were compared between prefrail and frail groups. Results: Prefrail and frail older adults did not differ in their performance in dual-tasks; however, frail older adults showed a poorer performance in the triple-task. Conclusions: Although future studies need to confirm our observations in larger samples, this pilot study suggests that developing new tools based on triple tasking could be useful for the comprehensive assessment of frailty.

[Abstract] Background: We explored sex-related differences in sociodemographic, medical, psychological, and functional conditions in older adults attending to senior citizens’ centers. Materials and Methods: An exploratory study was conducted as part of the VERISAÚDE project, a cross-sectional population-based study of individuals aged ≥65 years enrolled in senior community centers located in Galicia, Northwest of Spain (n = 749). A comprehensive gerontological evaluation was used to assess the social, medical, psychological, and functional characteristics of the sample. Results: Women presented a higher prevalence of frailty (p = 0.017), a higher risk of malnutrition (p = 0.029), more medication consumption (p = 0.002), and polypharmacy (p = 0.008), higher depressive scores (p = 0.007), and lower cognitive scores (p = 0.045) than men, who showed a higher prevalence of hearing impairment (p = 0.034), toxic habits (all ps = 0.0001), and comorbidity (p = 0.002), and better quality of life (p = 0.030), and social resources (p = 0.002). Participants considered that attending and being involved in senior centers has a positive influence on their health and promotes successful aging. Discussion: Important differences were found between women and men in health variables, suggesting that sex exerts a powerful influence on health status in older age. These differences should be identified and taking into account when designing interventions to promote active aging and to improve the quality of life of older adults. Taking a sex perspective during the evaluation process could lead to a higher number of older people being effectively treated in clinical practice.

Centro de Formación de la Cooperación Española, Cartagena de Indias (Colombia): 2 y 3 de diciembre de 2019, El objeto fundamental que persiguen todos los encuentros es promover el aprendizaje y la reflexión conjunta entre instituciones y organizaciones dedicadas a trabajar cuestiones de género y por los derechos de las mujeres, con énfasis en políticas y acciones centradas en la violencia basada en género. En esta IV edición, se dio especial énfasis a compartir experiencias de éxito e innovadoras, al igual que buenas prácticas en gestión y articulación entre los actores clave a la hora de abordar las diferentes violencias basadas en género.

[Abstract] Objectives: Greater understanding of changes in the degree of frailty is important for clarifying the natural history of frailty and may help clinical decision-making regarding preventive interventions. The objectives of this study were to explore natural frailty transition rates at 1-year follow-up and to identify the main determinants of such transitions. Study design: Prospective longitudinal study covering a representative sample of community-dwelling older adults aged ≥65 years (n = 749) at baseline, and transition information at 1-year follow-up (n = 537). Mean outcome measures: The assessment of frailty status was based on phenotypic criteria (unintentional weight loss, weakness, exhaustion, slow walking speed, low physical activity). Frailty transitions (progressed, regressed, no change, or death) and associated factors were assessed. Results: Most participants remained unchanged from their baseline status (57.1% non-frail, 83.4% pre-frail, 66.7% frail). Regarding frailty transitions, 42.9% of non-frail older adults at baseline had progressed to a pre-frail status by the 1-year follow-up, and 7.9% of pre-frail older adults had become frail. Importantly, 33.3% of frail older adults regressed to a pre-frail status and 8.7% of pre-frail adults had regressed to a non-frail status. Non-frail females tended to progress to pre-frailty significantly more than males (p = 0.006), and mortality was higher among participants classified as frail at baseline (10.7%). Logistic regression showed that the main determinants of worsening frailty were hearing impairment (OR 3.180; 95% CI 1.078–9.384), congestive heart failure (OR 10.864; 95% CI 1.379–85.614), and polypharmacy (OR 2.572, 95% CI 1.096–6.037). Conclusion: Our results confirm the dynamic of frailty and the bidirectional nature of frailty transitions, and indicate the need for preventing and treating these conditions in later life in order to minimize the burden of frailty.

[Abstract] Background. Frailty is a multidimensional clinical geriatric syndrome that may be reversed in its early stages. Most studies have paid attention to its physical or phenotypic boundaries, however, little is known about the social aspects surrounding this geriatric syndrome. The study examined the relationship between socio-demographic factors, social resources, quality of life and frailty in older adults. Methods. This cross-sectional study included a representative sample (n = 749) of adults aged ≥65 years enrolled in forty-three senior centers located in North-West Spain. Socio-demographic data, social resources by the Older Americans Resources and Services Scale, quality of life by the World Health Organization’s Quality of Life measure-brief version (WHOQOL-BREF), and frailty status diagnosed by the Frailty phenotype were measured. Results. Female gender, age older than 75 years, single marital status, a poor quality of life, and low scores in the physical health domain of the WHOQOL-BREF were the main determinants of being non-robust. Together, these variables explained 24.4% of the variance. Age between 80 and 89 years, and a poor quality of life were the main determinants for non-robust men, whilst the physical health domain of the WHOQOL-BREF was the single main determinant for women. Conclusions. Our study found evidence that physical frailty is associated with social determinants and several quality of life domains. More research on this understudied topic is needed to avoid healthcare expenditures and improve the quality of life of non-robust elders.

[Abstract] Background & aims. Malnutrition is an important and growing health problem in elderly people. The main aim of this research was to examine the relationship between socio-demographic factors, social resources, functional status and quality of life and malnutrition or risk of malnutrition in elders. Methods. A cross-sectional study was conducted with a representative sample of 749 community-dwelling elders aged 65 years and over. A comprehensive assessment was carried out, including the collection of socio-demographic factors, social resources by the Older Americans Resources and Services Scale, nutritional status by the Mini-Nutritional Assessment-Short Form, functional status by the Lawton's instrumental activities of daily living scale and quality of life by the World Health Organizations's Quality of Life measure-brief version (WHOQOL-BREF). Results. Being female, the presence of totally impaired social resources and low scores in the physical health domain of the WHOQOL-BREF were the strongest determinants of malnutrition/risk of malnutrition. This model predicted 85.7% of the cases correctly. In men, the best determinants were being unmarried and having poor satisfaction with their health, with a percentage of 89.8% of cases of poor nutritional status correctly predicted. The best determinant for women was also the physical health domain of the WHOQOL-BREF, reaching a correct prediction of 83.0% of malnutrition/risk of it. Conclusions. Nutritional status assessment and potential determinant factors should be incorporated as part of comprehensive assessments for early identification of malnutrition and to determine appropriate intervention strategies to address this public health problem in older adults.

[Abstract] Frailty is a dynamic clinical syndrome considered as part of an age-associated continuum of severity, including pre-frailty as an intermediate frailty status with potential reversibility to robustness. The main purpose of this study was to analyse the relationship between the different domains of quality of life, functional dependence and depressive symptomatology in older adults diagnosed as pre-frail, before progression to frailty occurs. Logistic regression analyses were conducted to examine whether sex, age, level of education and scores in the Geriatric Depression Scale 15-item Short Form (GDS-SF) and the Instrumental Activities of Daily Living Lawton scale determine the worst score in the WHOQOL-BREF (World Health Organization Quality of Life) in older adults meeting one or two frailty phenotypic criteria. Depressive symptomatology (GDS-SF score) was the main determinant of poor quality of life in both groups, and in all areas of WHOQOL-BREF. Age was only associated with poor satisfaction with own health. Female sex and low educational level were linked to low physical QOL and poor self-rated health, respectively, but only in older adults meeting one frailty criterion. Association between functional status and WHOQOL-BREF scores was only found in the univariate analysis. These results underline the importance of identifying multiple aspects, but mainly the presence of depressive symptomatology, as risk factors for all dimensions of quality of life in the pre-frailty process, where interventions might be targeted to reduce the progression of pre-frailty and frailty in older adults.

[Abstract] Our aim was to estimate the prevalence of cognitive impairment in rural and urban elderly populations and to examine the relationship between lifetime occupation and general cognitive performance. A cross-sectional study was carried out covering a representative sample (n = 749) of adults aged ≥65 years. Two categories were created to define the degree of urbanization using a criterion of geographical contiguity in combination with a minimum population threshold: densely populated (urban) areas and intermediate-thinly populated (rural) areas. Occupational histories were ranked by skill level requirements according to the Spanish National Classification of Occupations. Prevalence estimates of cognitive impairment were measured with the Mini-Mental State Examination. Results show that rural residence was not significantly associated with higher risk of cognitive impairment. A protective effect of cognitive demands at work against age-related cognitive decline was observed. However, this effect was not independent of confounder factors, such as age and education. A low overall prevalence of cognitive impairment was observed (6.5%), compared with previous estimates, possibly due to the sample selection in senior centers. Occupation during active life is not an isolated protective factor against cognitive impairment, and it is closely related to educational level. In future geriatric programs, description of both factors should be taken into consideration in screening older adults at increased risk of cognitive impairment and dementia.

[Abstract] Objective Malnutrition is a common and relevant syndrome in elderly people due to its influence on quality of life. The main aim of the present study was to identify health determinants of malnutrition or risk of malnutrition. Design Cross-sectional study collecting information on sociodemographic and health factors (co-morbidity, cognitive or affective problems, prescription medication use, frailty status, self-rated health) as determinants of nutritional status, assessed by the short form of the Mini Nutritional Assessment. Setting Forty-three senior centres from Galicia (north-western Spain) participated to recruit participants. Subjects A representative community-dwelling sample of 749 elderly people aged ≥65 years. Results Of the total participants, 14·3 % were malnourished/at risk of malnutrition. Presence of overweight or obesity, depressive symptoms, polypharmacy (use of five or more prescription medications), presence of pre-frailty or frailty status and poor self-rated health showed the strongest relationship to malnutrition/risk of malnutrition. This model predicted 86·0 % of the cases correctly. The best determinants for women were polypharmacy and poor self-rated health, reaching 82·8 % of cases of malnourishment/risk of malnutrition predicted correctly. In men, the main determinants were overweight or obesity, depressive symptomatology and polypharmacy, with 89·8 % of cases of malnourishmen/risk of malnutrition predicted correctly. Conclusions Screening for nutritional status and its determinant factors should be included as part of comprehensive assessments to ensure an early screening of malnutrition and to propose possible intervention strategies that would be important for both elderly people and the health-care system.

[Resumen] INTRODUCCIÓN: La hipertensión arterial resistente se produce cuando la presión arterial se mantiene por encima de los límites establecidos a pesar de estar tratándose con tres antihipertensivos a dosis óptimas, incluyendo un diurético. Los pacientes con esta dolencia suponen un reto en la práctica clínica por su mal control terapéutico y su mayor riesgo de lesión orgánica, en comparación con aquellos con hipertensión controlada. METODOLOGÍA: Se realizó una revisión bibliográfica en las bases de datos nacionales e internacionales: Medline, Scopus, Web of Science y Dialnet, utilizando como criterios de inclusión: artículos originales científicos y revisiones, textos publicados en los últimos diez años, escritos en inglés y español. RESULTADOS: Para lograr su correcto diagnóstico es preciso realizar una monitorización ambulatoria de la presión arterial para descartar seudohipertensión, incumplimiento terapéutico, hipertensión clínica aislada, interacciones medicamentosas y situaciones de hipertensión secundaria. La combinación de agentes antihipertensivos de mayor uso, junto a un diurético, son inhibidores de la enzima convertidora de angiotensina o antagonistas de los receptores de la aldosterona o un bloqueante de los receptores de angiotensina, y un calcioantagonista. El cuarto medicamento más usado es un antagonista de la aldosterona, si los niveles séricos de potasio de los pacientes están bajos. CONCLUSIONES: Tras la elaboración de esta revisión se puede afirmar que el tratamiento de la HTAR debe establecerse de forma individualizada, adaptando las recomendaciones de los protocolos en función a las características del paciente., [Abstract] INTRODUCTION: Resistant hypertension is defined as blood pressure that remains above target in spite of using three optimally dosed antihypertensive drugs of different classes, including a diuretic. Patients with resistant hypertension are more likely to experience an adverse cardiovascular event compared with those with controlled blood pressure using three or less antihypertensive agents. METHODOLOGY: Literature review was revised on the basis of national and international data: Medline, Scopus, Web of Science y Dialnet. Inclusion criteria were: original scientific articles and reviews, texts published in the last ten years, written in English and Spanish. RESULTS: For diagnosis is necessary to perform an ambulatory blood pressure monitoring, rule out the pseudohypertension, therapeutic failure, hypertension isolated clinic, drug interactions and situations of secondary hypertension. All three drugs to be used in a patient with refractory hypertension are: a diuretic, an angiotensin converting enzyme inhibitors or receptor antagonists aldosterone, or blocking angiotensin receptor and a calcium antagonist. The fourth most commonly used drug is an aldosterone antagonists, if serum potassium levels of patients are low. CONCLUSIONS: The most important conclusion is that for a correct treatment must be individualized by adapting the recommendations of the protocols based on patient characteristics.