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Background: The detection of elder mistreatment is emerging as a public health priority; however, abusive behaviors exercised by caregivers are little known and rarely detected among primary health care professionals. This study aims to estimate the prevalence of risk of abuse against community-residing elderly with moderate to severe dependency whose caregivers are relatives. In addition, we aim to describe the association between such a risk and socio-demographic variables, cognitive and dependency state of the victim, and the scale of the caregiver's anxiety, depression, and burden., Methods: Cross-sectional study developed in 72 Primary Health Care teams from Barcelona, Spain. Participants were caregivers and their dependent care recipients (N = 829). Home interviews included the Caregiver Abuse Screen (CASE); self-reported abuse from care recipient; activities of daily living and cognitive state of the care recipient; anxiety and depression in caregivers and Caregiver Burden Scale. The relationship prior to the dependency, positive aspects of caregiving, and social support for the caregiver were also assessed. Multivariate analysis was performed using logistic regression with risk of abuse as dependent variable., Results: Caregivers were mainly women (82.8%) with a mean age of 63.3 years. Caregivers and care recipients lived in the same household in 87.4% of cases, and 86.6% had enjoyed a good previous relationship. Care recipients were women (65.6%), with a mean age of 84.2 years, and 64.2% had moderate to severe cognitive impairment. CASE demonstrated a prevalence of 33.4% (95% CI: 30.3-36.7) of abuse risk by the caregiver. Logistic regression showed as statistically significant: caregiver burden (OR = 2.75; 95% CI: 1.74-4.33), caregiver anxiety (OR = 2.06; 95% CI: 1.40-3.02), caregiver perception of aggressive behavior in the care recipient (OR = 7.24; 95% CI: 4.99-10.51), and a bad previous relationship (OR = 4.66; 95% CI: 1.25-17.4)., Conclusions: Prevalence of risk of abuse is high among family caregivers. Our study has found risk factors in family caregivers that are preventable to an extent, namely: anxiety and feelings of burden. It is essential to become aware of these risk factors and their causes to intervene and help primary as well secondary prevention.

Background: Clinical Practice Guidelines recommend using peripheral blood pulse measuring as a screening test for Atrial Fibrillation. However, there is no adequate evidence supporting the efficacy of such procedure in primary care clinical practice. This paper describes a study protocol designed to verify whether early opportunistic screening for Atrial Fibrillation by measuring blood pulse is more effective than regular practice in subjects aged 65 years attending primary care centers., Methods/design: An cluster-randomized controlled trial conducted in Primary Care Centers of the Spanish National Health Service. A total of 269 physicians and nurses will be allocated to one of the two arms of the trial by stratified randomization with a 3:2 ratio (three practitioners will be assigned to the Control Group for every two practitioners assigned to the Experimental Group). As many as 12 870 patients aged 65 years or older and meeting eligibility criteria will be recruited (8 580 will be allocated to the Experimental Group and 4 290 to the Control Group). Randomization and allocation to trial groups will be carried out by a central computer system. The Experimental Group practitioners will conduct an opportunistic case finding for patients with Atrial Fibrillation, while the Control Group practitioners will follow the regular guidelines. The first step will be finding new Atrial Fibrillation cases. A descriptive inferential analysis will be performed (bivariate and multivariate by multilevel logistic regression analysis)., Discussion: If our hypothesis is confirmed, we expect Primary Care professionals to take a more proactive approach and adopt a new protocol when a patient meeting the established screening criteria is identified. Finally, we expect this measure to be incorporated into Clinical Practice Guidelines., Trial Registration: The study is registered as NCT01291953 (ClinicalTrials.gob).

Objective: To determine the prevalence of suspected ill treatment of the elderly (ITE) in the population cared for in a health district and to analyse the associated variables., Design: Cross-sectional study.Setting. Les Planes (Sant Joan Despí, Barcelona). Urban Health District., Patients: 307 patients over 70 years old seen in the Health District. The study had 39 losses, 31 exclusions because of cognitive disorder and 18 because it was impossible to hold the interview. 219 completed the study., Measurements and Results: The Pfeiffer test was administered through an interview, social and demographic variables were collected, a questionnaire on ill treatment was filled in (a positive reply was considered ITE), and physical dependence was evaluated (Katz index). Prevalence of ITE was 26 people or 11.9% (95% CI, 7.6-16.2), breaking down into 6 physically ill-treated, 20 psychologically, one sexually, 3 by negligence and 3 by neglect. Nine people suffered more than one kind of ill treatment. Significant associated variables were: being a woman 18% (p < 0.01), receiving social assistance 46% (p < 0.001), being a widow/widower 21% (p < 0.01), not having had paid employment 20% (p < 0.04) and having a rotating residence 28% (p < 0.003). On application of multivariate analysis, being a woman (OR 4.99) and receiving social assistance (OR 7.55) maintained their significance. The presumed perpetrators were son/daughter (57%), spouse (8%), son/daughter-in-law (23%). 19% of these were drug-dependent and 15% suffered psychiatric disorders., Conclusions: The high prevalence of ITE is clear. These results should alert doctors to a previously under-rated health problem.