Search

Non-valvular atrial fibrillation (NVAF) is the most common arrhythmia in older patients. Although direct-acting oral anticoagulants (DOAC) are the antithrombotic treatment of choice, irrespective of age, certain factors may limit their use. The aim of the ACONVENIENCE study was to consult the opinion of a multidisciplinary panel of experts on the appropriateness of using OACs in elderly patients (>75 years) with NVAF associated with certain complex clinical conditions. A consensus project was performed on the basis of a systematic review of the literature, and application of a two-round Delphi survey. The agreement of 79 panellists on 30 Delphi-type statements was evaluated, and their opinion on the appropriateness of different oral anticoagulants in 16 complex clinical scenarios was assessed. A total of 27 consensus statements were agreed upon, including all statements addressing anticoagulation in older patients and in patients at high risk of bleeding complications, and most of those addressing frailty, dementia, risk of falling, and complex cardiac situations. It was almost unanimously agreed upon that advanced age should not influence the anticoagulation decision. Apixaban was the highest-rated therapeutic option in 14/16 situations, followed by edoxaban. There is a high degree of agreement on anticoagulation in older patients with NVAF. Age should not be the single limiting factor when prescribing OACs, and the decision should be made based on net clinical benefit and a comprehensive geriatric assessment. Apixaban, followed by edoxaban, was considered the most appropriate treatment in the various complex clinical situations examined.

Chronic pain remains a leading cause of long-term disability (GBD 2016 Disease Injury Incidence Prevalence Collaborators, 2017), affects 20% of the world's population, imposes higher costs on the society than heart disease, cancer, and diabetes combined (GBD 2016 Disease Injury Incidence Prevalence Collaborators, 2017; Buchbinder et al., 2018), and is associated with increased mortality (Tesarz et al., 2019). Despite this global relevance, therapeutic options remain unsatisfactory to date (Williams et al., 2020). Consequently, in recent years, enormous efforts have been made to expand the knowledge about the development and maintenance of chronic pain disorders and to improve treatment options. The dramatic nature of the situation and the increasing global health burden due to chronic pain even culminated recently in a "global call for action" (Buchbinder et al., 2018).

RESUMEN La familia es la principal fuente de apoyo que asume la responsabilidad de cuidar a las personas mayores. Se realizó una revisión sistemática de diferentes investigaciones, mediante la consulta en seis bases de datos científicas: WoS, Scielo, PubMed, Dialnet, Elsevier y Teseo. La revisión se realizó con 24 documentos de carácter empírico y teórico, se basaron en estudios dentro de territorio español, el tipo de diseño de los documentos elegidos fue muy variado y se excluyeron diseños de meta-análisis y revisión bibliográfica, la edad de la muestra de las cuidadoras fue entre los 50-67 años. Se buscó la relación de la cuidadora con el dependiente, así como el nivel de dependencia que presentan. Los estudios coinciden en la prevalencia significativa de estrés dentro del colectivo de las cuidadoras informales. además de presentar mayoritariamente un estilo de afrontamiento huidizo. Se concluye que el estrés y las diferentes formas de afrontarlo es un fenómeno multifacético y un hecho cada vez más importante y preocupante. Las cuidadoras presentan un menor apoyo social y el riesgo de experimentar sobrecarga es más alto. ABSTRACT The family is the main source of support that assumes the responsibility of caring for the elderly. A systematic review of different investigations was carried out, by consulting six scientific databases: WoS, Scielo, PubMed, Dialnet, Elsevier and Teseo. The review was carried out with 24 empirical and theoretical documents, they were based on studies within Spanish territory, the type of design of the chosen documents was very varied and meta-analysis and bibliographic review designs were excluded, the age of the sample of the caregivers was between 50-67 years old. The relationship of the caregiver with the dependent was sought, as well as the level of dependency they present. The studies agree on the significant prevalence of stress within the group of informal caregivers. In addition to presenting mostly an elusive coping style. It is concluded that stress and the different ways of coping with it is a multifaceted phenomenon and an increasingly important and worrying fact. Female caregivers have less social support and the risk of experiencing overload is higher.

Frailty; Psychometrics; Feasibility Fragilitat; Psicometria; Viabilitat Fragilidad; Psicometría; Viabilidad The study aimed to assess the reliability of the scores, evidence of validity, and feasibility of the Frail-VIG index. A validation study mixing hospitalized and community-dwelling older people was designed. Intraclass correlation coefficient (ICC) was used to assess the inter-rater agreement and the reliability. The construct validity of the Frail-VIG index with respect to the Frailty Phenotype (FP) was evaluated by calculating the area under the receiver operating characteristic curve (AUC-ROC). Convergent validity with the Clinical Frailty Scale (CFS) was assessed using Pearson’s correlation coefficients. The feasibility was evaluated by calculating the average time required to administer the Frail-VIG index and the percentage of unanswered responses. A sample of 527 older people (mean age of 81.61, 56.2% female) was included. The inter-rater agreement and test–retest reliability were very strong: 0.941 (95% CI, 0.890 to 0.969) and 0.976 (95% CI, 0.958 to 0.986), respectively. Results indicated adequate convergent validity of the Frail-VIG index with respect to the FP, AUC-ROC 0.704 (95% CI, 0.622 to 0.786), and a moderate to strong positive correlation between the Frail-VIG index and CFS (r = 0.635, 95% CI, 0.54 to 0.71). The Frail-VIG index administration required an average of 5.01 min, with only 0.34% of unanswered responses. The Frail-VIG index is a reliable, feasible, and valid instrument to assess the degree of frailty in hospitalized and community-dwelling older people.

Treballs Finals de Grau d'Educació Social, Facultat d'Educació, Universitat de Barcelona, Curs: 2020-2021, Tutora: Elena Duque, [spa] El presente trabajo, Trabajo del cuidado interno en Cataluña y riesgos psicosociales: Impacto en la salud de las mujeres latinoamericanas que trabajan como cuidadoras internas, tiene como finalidad investigar el impacto en la salud que produce el hecho de trabajar como cuidadora interna de personas mayores en situación de dependencia. Para la recogida de información se realizaron diez entrevistas semiestructuradas en profundidad, cinco de las cuales fueron hechas a cuidadoras internas, y las demás a la coordinadora de la asociación Mujeres Migrantes Diversas de trabajadoras de cuidados, al director del Centro de Información a Trabajadores Extranjeros (CITE), a una enfermera del Programa de Atención Domiciliaria y Equipos de Apoyo (PADES) y a dos técnicos de la administración local. También se ha realizado análisis documental. Una vez recogida y analizada la información, se ha observado que, efectivamente, trabajar como cuidadora interna afecta de manera negativa a la salud en general de las trabajadoras internas., [eng] The present work, Live-in care work in Catalonia and psychosocial risks: Impact on the health of Latin American women who work as live-in caregivers, aims to investigate the impact on their health produced by working as a live-in caregiver of a dependent older person. In order to collect the information, ten semi structured in-depth interviews were conducted, of which five of them were conducted with live-in caregivers, and the others with the spokesperson of Mujeres Migrantes Diversas, an association of care workers, the director of the Information Center for Foreign Workers (CITE), to a nurse from the Home Care Programme and Support Teams (PADES) and, finally, to two specialists from the local administration. A documentary analysis has also been carried out. Once the information has been collected and analyzed, it has been observed that, indeed, working as a live-in caregiver negatively affects the general health of live-in workers.

Background The Frail-VIG frailty index has been developed recently. It is an instrument with a multidimensional approach and a pragmatic purpose that allows rapid and efficient assessment of the degree of frailty in the context of clinical practice. Our aim was to investigate the convergent and discriminative validity of the Frail-VIG frailty index with regard to EQ-5D-3L value. Methods We carried out a cross-sectional study in two Primary Health Care (PHC) centres of the Catalan Institute of Health (Institut Català de la Salut), Barcelona (Spain) from February 2017 to January 2019. Participants in the study were all people included under a home care programme during the study period. No exclusion criteria were applied. We used the EQ-5D-3L to measure Health-Related Quality of Life (HRQoL) and the Frail-VIG index to measure frailty. Trained PHC nurses administered both instruments during face-to-face assessments in a participant’s home during usual care. The relationships between both instruments were examined using Pearson’s correlation coefficient and multiple linear regression analyses. Results Four hundred and twelve participants were included in this study. Frail-VIG score and EQ-5D-3L value were negatively correlated (r = − 0.510; P Conclusions Frail-VIG index demonstrated a convergent validity with the EQ-5D-3L value. Its discriminative validity was optimal, as their scores showed an excellent capacity to differentiate between people with better and worse HRQoL. These findings provide additional pieces of evidence for construct validity of the Frail-VIG index.

L'organització de les societats actuals s'enfronta a importants reptes en el curt i el mitjà termini. Entre aquests, un dels més destacables és sens dubte la forta transició demogràfica que està tenint lloc, i que implica un progressiu envelliment de la població. Les baixes taxes de natalitat, juntament amb el creixement sostingut de l'esperança de vida, provoquen un increment continu en l'edat mitjana de la població, així com de la denominada taxa de dependència dels més grans (percentatge de població de 65 i més anys sobre la població en edat de treballar).

Unless contraindicated, anticoagulant therapy should be prescribed to elderly patients with atrial fibrillation. Direct-acting oral anticoagulants (DOACs) are superior to vitamin K antagonists for preventing stroke. This, together with their higher net clinical benefit, makes DOACs the treatment of choice in this population. However, due to the concerns about bleeding and the need for dose adjustment based on clinical variables, underdosing of DOACs is common and the risk of stroke high. Drugs with more easily adjusted doses are likely associated with a lower risk of dosing errors and, therefore, a greater protective effect. Correct dosing can ensure a maximal net benefit of DOACs in elderly patients with atrial fibrillation.

Màster Oficial de Psicogerontologia, Facultat de Psicologia, Universitat de Barcelona, curs: 2019-2020, Tutor: Feliciano Villar Posada, [spa] El cuidado de personas mayores con dependencia significa una ocupación de alta demanda dado el envejecimiento poblacional y el riesgo de presentar demencia. Son numerosos los estudios a este respecto; no obstante, enfocados en las consecuencias negativas y en el cuidado familiar. Esta investigación exploró las narrativas de experiencias positivas del cuidado a personas con demencia por profesionales de residencias en España. Se trabajó con 42 personas, 32 mujeres y 10 hombres, 21 en puestos técnicos y 21 auxiliares de enfermería. Se empleó una entrevista semi-estructurada, de la cual se analizaron las respuestas a dos preguntas: relatar una experiencia positiva del cuidado, y cómo ésta influenció en el trato. Mediante el análisis narrativo de contenido temático se hallaron (1) tres temas de experiencias positivas: de vínculo afectivo, de conexión social y de oportunidades para impulsar cambios, y (2) cuatro tipos de aprendizaje a partir de las historias: cultivar la interacción socioemocional, lograr objetivos instrumentales, ser consciente que la persona cuidada sigue siendo persona, y la influencia personal. Compartir e identificar experiencias positivas puede ser útil para intervenir en el desempeño del cuidado, visibilizar las oportunidades que este trabajo representa, re-diseñar modelos teóricos y optimizar condiciones laborales del sistema de cuidados., [eng] Care of elderly people with dependency means a high-demand occupation given the aging population and the risk of developing dementia. There are numerous studies in this regard; however, are focused on the negative consequences and the family care. This research explored the narratives of positive experiences in caring of people with dementia by professionals from residences in Spain. We worked with 42 people, 32 women and 10 men, 21 in technical positions and 21 nursing assistants. A semi-structured interview was used, from which the answers to two questions were analyzed: narrating a positive experience of care, and how this influenced the treatment. Through the narrative analysis of thematic content, were found (1) three themes of positive experiences were found: of affective bonding, social connection and opportunities to drive changes, and (2) four types of learning from stories: cultivating socio-emotional interaction, achieve instrumental goals, to be aware that the cared person is still a person, and personal influence. Sharing and identifying positive experiences can be useful to intervene in the performance of care, make visible the opportunities that this work represents, re-design theoretical models and to optimize working conditions of the care system.

Background & Aims: Limited data on treatment of elderly patients with hepatocellular carcinoma (HCC) increase the unmet need. REACH and REACH-2 were global phase III studies of ramucirumab in patients with HCC after prior sorafenib, where patients with alpha-fetoprotein (AFP) ≥400ng/mL showed an overall ssurvival (OS) benefit for ramucirumab. These post-hoc analyses examined efficacy and safety of ramucirumab in patients with HCC and baseline AFP≥400ng/mL by three prespecified age subgroups (

Aging is the prime risk factor for the broad-based development of diseases. Frailty is a phenotypical hallmark of aging and is often used to assess whether the predicted benefits of a therapy outweigh the risks for older patients. Senescent cells form as a consequence of unresolved molecular damage and persistently secrete molecules that can impair tissue function. Recent evidence shows senescent cells can chronically interfere with stem cell function and drive aging of the musculoskeletal system. In addition, targeted apoptosis of senescent cells can restore tissue homeostasis in aged animals. Thus, targeting cellular senescence provides new therapeutic opportunities for the intervention of frailty-associated pathologies and could have pleiotropic health benefits. The authors acknowledge support for MB from Dutch Cancer Society Grant UMCIJ-7141 awarded to PdK, and for EP and PMC from ERC-2016-AdG-741966 (STEM-AGING), SAF2015-67369-R, MDA and AFM. The DCESX/UPF is recipient of a `Maria de Maeztu' Program for Units of Excellence in R\&D MDM-2014-0370 (Government of Spain). Sí

Background Demographic changes have led to an increase in the number of elderly frail persons and, consequently, systematic geriatric assessment is more important than ever. Frailty Indexes (FI) may be particularly useful to discriminate between various degrees of frailty but are not routinely assessed due, at least in part, to the large number of deficits assessed (from 30 to 70). Therefore, we have developed a new, more concise FI for rapid geriatric assessment (RGA)—the Frail-VIG index (“VIG” is the Spanish/Catalan abbreviation for Comprehensive Geriatric Assessment), which contains 22 simple questions that assess 25 different deficits. Here we describe this FI and report its ability to predict mortality at 24 months. Methods Prospective, observational, longitudinal study of geriatric patients followed for 24 months or until death. The study participants were patients (n = 590) admitted to the Acute Geriatric Unit at the at the University Hospital of Vic (Barcelona) during the year 2014. Participants were classified into one of seven groups based on their Frail-VIG score (0–0.15; 0.16–0.25; 0.26–0.35; 0.36–0.45; 0.46–0.55; 0.56–0.65; and 0.66–1). Survival curves for these groups were compared using the log-rank test. ROC curves were used to assess the index’s capacity to predict mortality at 24 months. Results Mean (standard deviation) patient age was 86.4 (5.6) years. The 24-month mortality rate was 57.3% for the whole sample. Significant between-group (deceased vs. living) differences (p

Our society is facing new economic, political, social and demographic challenges that will require health care services capable of responding to the population's growing health needs, especially chronic processes linked to ageing. Comprehensive assessment of the frail elderly people represents one of the most important matters in providing proper geriatric care in primary health care (PHC). A cross-sectional descriptive study was conducted on a final sample of 105 patients > 90 years of age cared for by a PHC team. 75.2% of the population were women. 17.1% of the population as a whole and 18.9% of women lived alone. Close to 40% of the population had experienced one or more falls. 65.7% were taking more than 4 drugs/day and approximately 50% had been properly vaccinated. On a cognitive level, the majority of the population suffered from mild decline, despite their advanced age. We must progress towards comprehensive, proactive and patient-centred care. Good comprehensive geriatric assessment coupled with good care from PHC teams provides elderly persons with a better state of health.

Pilar Isla Pera,1 Ma Carmen Olivé Ferrér,1 Montserrat Nuñez Juarez,2 Esther Nuñez Juarez,3 Loreto Maciá Soler,4 Carmen López Matheu,1 Assumpta Rigol Cuadra,1 María Honrubia Pérez,1 Diana Marre5 1School of Nursing, University of Barcelona, 2Department of Rheumatology, Musculoskeletal Clínic Institute Hospital Clínic, 3Institut Català de la Salut, Barcelona, 4Nursing Department, University of Alicante, Alicante, 5Universitat Autònoma de Barcelona, Barcelona, Spain Aim: We aimed to explore the meaning of obesity in elderly persons with knee osteoarthritis (KO) and to determine the factors that encourage or discourage weight loss.Background: Various studies have demonstrated that body mass index is related to KO and that weight loss improves symptoms and functional capacity. However, dietary habits are difficult to modify and most education programs are ineffective.Design: A phenomenological qualitative study was conducted. Intentional sampling was performed in ten older persons with KO who had lost weight and improved their health-related quality of life after participating in a health education program. A thematic content analysis was conducted following the stages proposed by Miles and Huberman.Findings: Participants understood obesity as a risk factor for health problems and stigma. They believed that the cause of obesity was multifactorial and criticized health professionals for labeling them as “obese” and for assigning a moral value to slimness and diet. The factors identified as contributing to the effectiveness of the program were a tolerant attitude among health professionals, group education that encouraged motivation, quantitative dietary recommendations, and a meaningful learning model based on social learning theories.Conclusion: Dietary self-management without prohibitions helped participants to make changes in the quantity and timing of some food intake and to lose weight without sacrificing some foods that were deeply rooted in their culture and preferences. Dietary education programs should focus on health-related quality of life and include scientific knowledge but should also consider affective factors and the problems perceived as priorities by patients. Keywords: obesity, elderly, polypathology, therapeutic education, diet, nursing, knee osteoarthritis

La inmensa mayoría de personas dependientes son cuidadas por su familia. Este cuidado suele denominarse"cuidado informal"* o familiar, que es el prestado por parientes, amigos o vecinos en el ámbito doméstico. El apoyo informal se define como"el cuidado y atención que se dispensan de manera altruista y gratuita a las personas que presentan algún grado de discapacidad o dependencia, fundamentalmente por sus familiares y allegados, pero también por otros agentes y redes distintos...

Resumen Hacerse cargo del cuidado de un familiar dependiente puede afectar negativamente a la salud del cuidador/a en su vida afectiva y laboral. Las repercusiones del cuidado informal preocupan a las diferentes administraciones y tambien a los profesionales sanitarios, quienes se proponen ofrecer el soporte mas adecuado a los cuidadores familiares, para que puedan seguir desempenando las actividades derivadas del cuidado y a su vez minimicen el cansancio y la carga que supone cuidar. Desde hace una decada se ha venido acrecentando el interes por planificar y desarrollar programas de soporte, desde la iniciativa publica y privada, dirigidos a cuidadores familiares. Los contenidos de estos programas son de diversa indole, y ofrecen asesoramiento e informacion, apoyo emocional, ayuda economica o descargas temporales del cuidado de las personas dependientes. La literatura cientifica revisada coincide en la importancia y la necesidad de coordinacion y complementariedad que debe darse entre las redes informales y formales en el soporte a los cuidadores de las personas dependientes.

El objetivo del presente artículo es contribuir a reflexionar sobre el papel que el educador social puede ejercer como formador y promotor del acompañamiento sociolaboral de los futuros profesionales de atención directa de residencias y centros de día de mayores. Se focaliza la atención en las competencias que dispone el educador social y que aportaciones puede realizar en la preparación de la persona que se forma para ser gerocultor.

Resumen Objetivo Analizar los resultados de eliminar las sujeciones fisicas en mayores con demencia que viven en residencias. Este objetivo se enmarca en un proceso mas amplio de modificacion del modelo de atencion residencial. Metodo Estudio cuasi experimental en dos residencias desde mayo de 2010 hasta mayo de 2012. Se recoge informacion en 7 momentos temporales y se efectua un analisis longitudinal. Tras formar al personal se retiraron progresivamente las sujeciones fisicas en el centro El Puig, mientras que en el centro Conarda se mantuvieron las sujeciones. Las variables principales medidas fueron: caidas, psicofarmacos administrados, asi como diversos indicadores de estado mental y funcional (Norton, NPI, Minimental, Tinetti, Barthel). Resultados En el centro en el que se eliminan todas las sujeciones fisicas (El Puig), se observa una ligera mejoria en el numero de caidas y sus consecuencias mejoran levemente, aunque no son estadisticamente significativas. Los ANOVA mostraron mejoras significativas en el centro que ha eliminado las sujeciones respecto a la prescripcion de psicofarmacos, al deterioro cognitivo y a las alteraciones de conducta. Discusion Se constata que retirar sujeciones fisicas no repercute negativamente en las caidas y sin embargo mejora ciertos aspectos del bienestar y la autonomia de los mayores (alteraciones de conducta y deterioro mental). Ademas, se evidencia que este programa debe ser complementado con un programa de desatar quimico (retirada de psicofarmacos).

Este artículo pretende reflexionar sobre aquellos aspectos que antes de la crisis económica ya estaban apuntando hacia una revisión de la normativa del Sistema de Autonomía y Atención de la Dependencia en España (SAAD). Existe abundante literatura que señala los graves efectos ocasionados por las políticas de recortes durante el periodo de la crisis económica. Igualmente otros autores mencionan que la variabilidad regional en la provisión, producción y financiación de los s ervicios; las innovaciones derivadas de la atención centrada en la persona; la incertidumbre entre complementariedad/sustitución entre responsables del cuidado; los procesos de privatización y las obligaciones europeas, generan otros desafíos al SAAD que deben ser solucionados. Además, en estos nuevos planteamientos de las normativas estatales y regionales sobre cuidados a mayores y dependientes, las entidades del tercer sector encontrarán más espacio de acción por su fomento del empleo y de innovación y responsabilidad social.

OBJECTIVES: estimation of functional loss incidence and identification of risk factors associated with new disability onset in people aged 75 and older without severe dependence in a rural primary care setting. PATIENTS AND METHOD: Prospective cohort study of a representative sample of people aged 75 years or older without severe dependence (Barthel Index>20 and Lawton Index>1) at a primary care center, with a 12-month follow-up. The baseline geriatric assessment recorded activities of daily living (ADL), sociodemographic information, numbers of drugs prescribed, previous hospital admissions and falls, cognitive function, hearing and visual capacity, body mass index, blood pressure, and the Short Physical Performance Battery to evaluate lower limb function. ADL was re-assessed after 12 months, defining functional loss as a fall of ≥10 points on the Barthel Index and/or ≥2 instrumental activities of the Lawton Index. Bivariate and multivariate analyses using logistic regression models were conducted to identify factors independently associated with functional loss. RESULTS: Mean age was 81.7 years, 58.7% of patients were men, and 23.4% presented functional loss at the 12-month follow-up. Variables identified as independent predictors of functional loss were hospital admissions (aOR 3.92; 95%CI: 1.35-11.39), cognitive impairment (aOR 2.60; 95%CI: 1.39-4.92) and lower limbs functional limitation (aOR 2.01; 95%CI: 1.02-3.97). CONCLUSIONS: Our results support the use of performance batteries in primary care for identifying elderly persons at risk of functional decline; and they also highlight the relevance of appropriate management of hospital admissions and planned discharges in order to preserve patients' functional status. Health Research Fund (PI042370) and the European Regional Development Fund (FEDER). III Research Grant of Osona promoted by the Foundation of the Medical and Health Sciences Academy of Catalonia and the Balearics, the Medical Science Group of Osona and the Osona Branch of the Catalan Society of Family and Community Medicine.

En les darreres dècades, l’esperança de vida ha augmentat notablement. Aquesta realitat no tan sols implica que visquem més anys sinó que, també, tinguem més possibilitats de patir tota mena de malalties pròpies de l’edat (com les demències, les degeneratives, etc.) i de patir-les més anys. Per edat, els que cuidaven ahir, són els cuidador d’avui: més grans, més envellits i que, a més, cuiden durant més anys. Un cuidador són dues vides. Així que, com la que s’està cuidant, la vida del cuidador també necessita ser cuidada ja que, sinó, la cura pot esdevenir una càrrega i un factor negatiu en el desenvolupament del mateix cuidador amb conseqüències tant físiques, com psíquiques i psicològiques. Aquesta investigació es centra en la realitat d’aquests cuidadors, en la seva qualitat de vida i en la seva experiència; tenint en compte també, els diversos punts de vista dels professionals que, des de institucions distintes, treballen i actuen en aquests casos. In recent decades, life expectancy has increased dramatically. This does not mean that only live longer but also more likely to suffer from all kinds of diseases typical of the age (such as dementia, degenerative, etc.) and years of suffering the most. For age, who took care of yesterday are the caregiver today: bigger, aging and also care for more years. A caregiver are two lives. So, as being caring, life caregiver also need to be careful because, but care can become a burden and a negative factor in the development of the same caregiver consequences both physical and mental and psychological. This research focuses on the reality of these carers in their quality of life and their experience; taking into account the various views of professionals from different institutions, work and act in such cases.

Resumen: El estudio analiza la relación entre competencias emocionales, situación socio-familiar y sintomatología depresiva de 211 cuidadores familiares de personas mayores de 65 años dependientes. Se utilizó el Cuestionario de Desarrollo Emocional para Adultos, versión reducida (CDE-R, Pérez-Escoda, Bisquerra, Filella & Soldevila, 2010), el Inventario para la Depresión de Beck-II (BDI-II; Sanz, Vázquez & Perdigón, 2003) y el Cuestionario de situación socio-familiar elaborado ad hoc. Los resultados mostraron un nivel medio-bajo de competencia emocional, un 46,2 % de sintomatología depresiva en los cuidadores y una relación negativa estadísticamente significativa entre ambas variables. Mediante un análisis de regresión logística se obtuvo un modelo explicativo de la sintomatología depresiva que comprende 5 variables: horas dedicadas, ayuda del servicio de atención domiciliaria, regulación emocional, competencias de vida y bienestar y autonomía emocional. Se propone el desarrollo de la competencia emocional de los cuidadores familiares como intervención preventiva.

En este trabajo proponemos un seguro de fallecimiento en el que al asegurado se le anticipa parte de la cuantía del seguro en el caso que se convierta en dependiente o agrave su situación de dependencia. El importe del anticipo estará en función del grado de dependencia que haya alcanzado. El asegurado podrá utilizar este anticipo para financiar la adquisición, o adecuación, de una determinada infraestructura como consecuencia de la falta de autonomía. Calcularemos las primas así como las provisiones matemáticas y realizaremos la comparación con el seguro de fallecimiento tradicional; también plantearemos la problemática de la carencia.

Textos de Lectura Fàcil

Tutor: Esther Cabrera Torres Antecedentes: La población ha experimentado cambios sociodemográficos, con un/nenvejecimiento progresivo y a la vez un aumento de la población dependiente. Con los avances científicos y las nuevas alternativas terapéuticas están habiendo más personas dependientes frágiles, complejas y multipatológicas en los domicilios, los cuales requieren de un cuidador principal./nObjetivo principal: Conocer los factores sociales y emocionales de los cuidadores y personas dependientes de Mataró que realizaron una formación psicoeducativa./nMetodología: Estudio observacional, descriptivo y transversal sobre una muestra de 15/ncuidadores principales./nResultados: El perfil del cuidador es el de una mujer (66,7%) de 59 años, casada (66,7%), con un nivel de estudios igual o superior al graduado escolar (80%) y actualmente en el paro (60%). El perfil de la persona dependiente es igual en relación al género, de 85 años y viuda (62,5%). El 40% tienen un deterioro cognitivo grave y el 80% una dependencia leve. El cuidador y la persona cuidada son cónyuges (33%) y el 80% conviven juntos. El 53% de los cuidadores principales llevan más de dos años cuidando y una media de 18 horas al día./nConclusiones: Hay una tendencia al reagrupamiento familiar cuando se produce una situación de dependencia. Las principales causas de esta situación son las enfermedades y el deterioro cognitivo de las personas cuidadas. Los cuidadores manifestaron sentirse privilegiados de poder cuidar a su familiar dependiente,/nque su relación ha mejorado y que realmente quieren asumir este rol de cuidador principal. Hay una gran cantidad de cuidadores principales en los domicilios con pocos conocimientos sobre los cuidados y a la vez con ganas de aprender para poder realizarlos correctamente. El papel de la enfermera es el de cuidar por este motivo quien mejor para formar a estos cuidadores y que tengan una alta autoestima y confianza en sí mismos para poder realizar los cuidados. Background: The population has experienced social and demographic changes, with a/nprogressive aging of the population and, therefore, a rising on the number of dependent/npeople. With the new technologies and therapeutical alternatives theres even more/ndependent people who are fragile, complex and multipathological who are at home and need/na care/nObjectives: To get to know the social and emotional factors of the care and the dependent/npeople in Mataró that had some sort of psychoeducational training./nMethods: Observational study, descriptive and transverse about a sample of 15 main cares./nResults: The profile of the care is that of a woman (66,7%) of 59 years old, married (66,7%),/nwith a level of education similar or higher than school graduate (80%) and currently/nunemployed (60%). The profile of the dependent person is that of a female as well, aged 85/nand widows (62,5%). A 40% of them have a serious cognitive impairment and an 80% of them/nhave a small dependence. The care and the person being taken care of are usually a married/ncouple (33%) and an 80% of them live together. A 53% of the cares have been taking care of/ntheir loved ones for over two years and 18 hours a day on average./nConclusions: There is a tendency unity within the family members when a situation of/ndependence arises. The principal causes of these situations are long term illnesses and the/ncognitive impairment of the people being taken care of./nThe care givers stated they felt very good about being able to take care of their relatives, and/nsaid their relationship has improved a lot ever since and they are willing to take this role as/ncare./nThere is a big amount of care in the homes with very little knowledge about how to take care/nof a dependent person, but who at the same time are willing to learn these things. The role of/nthe nurse is to take care of a patient, that’s why they are the best ones to train these care/ngivers on how to do everything, and at the same time make them have a very good self-esteem/nand confidence for them to do their best when taking care of their loved ones. Heart failure (PC) is the accident that causes more mortality and neurological sequelae in the current population. Many who have recovered spontaneous circulation (ROSC) die hours later or they are left with severe cognitive dysfunction. This is why we are researching to improve the prognosis of "Post cardiac arrest syndrome". Scientific evidence suggests that induction of mild hypothermia (32-35°C) is very promising and of great national and international interest in neurological care in the hours after cardiac arrest and can reduce and prevent permanent injury treatment./nIt was conducted an integrative literature review from December 2013 to June 2014 that discusses available literature in electronic format of therapeutic hypothermia. The objective was to know the accurate information that's available of different treatments and their effectiveness, duration, side effects and when, how and under what conditions should be conducted therapeutic hypothermia. The articles were selected from three databases: MEDLINE, CINAHL and SCIELO. Of the total of 1833 original articles were found between the three databases, were discarded 1802 did not meet the inclusion criteria and because they weren’t interesting to the study, resulting in a final sample of 31 articles that were analysed into categories and also discussed.Of the 31 articles analysed, only one has made mention of the nurse professional and the importance of this specialization in the care of the HT, which shows a lack of involvement and nursing position versus this procedure. Research shows gaps in studies on the effectiveness of outpatient HT, as well as in the field of paediatrics. A field of need opens, and they should focus the envestigations on specialized nursing care, the usefulness of the in situ cooling, the use of HT during CPR, and the introduction of HT with or without hospital shockable rhythm.

[spa] Objetivo: Identificar el tipo de cuidados que prestan los cuidadores informales de pacientes intervenidos de cirugía abdominal en el Consorcio Hospitalario de Vic (Barcelona), comparar la carga que suponen estos cuidados en las diferentes fases del proceso quirúrgico (preoperatorio, transición del hospital al domicilio, convalecencia y; conocer las repercusiones del cuidar sobre su salud. Metodología: Estudio observacional longitudinal con una sola cohorte de cuidadores informales no remunerados y mayores de edad, de pacientes con patología quirúrgica abdominal. La muestra se obtuvo de manera consecutiva y no probabilística, entre Febrero de 2011 y Marzo de 2012. Las variables estudiadas fueron: características sociodemográficas de los cuidadores informales y de los pacientes, cuidados que presta el cuidador informal y repercusiones sobre su estado de salud según el cuestionario ICUB97-R y la taxonomía NOC. Se realizó un análisis estadístico descriptivo bivariado y multivariado de todas las variables, obtenidas durante el ingreso, el alta y la convalecencia domiciliaria. Resultados: Se incluyó una muestra de 317 cuidadores y pacientes quirúrgicos. La mayoría de los cuidadores eran mujeres casadas, con una edad media de 52,9± 13,7 años y no tenían experiencia previa como cuidadoras (99,9%). Los pacientes tenían un edad media de de 64,1 ± 14,9 años, el 51,1% eran hombres, el 10,1% eran dependientes antes de la intervención quirúrgica y el 48,3% presentaban un diagnóstico de neoplasia. La mediana (min-máx) de cuidados prestados durante el preoperatorio fue de 0,0(0-30), en la transición del hospital al domicilio de 14,0(0-32) y de 11,0(0-29) en la convalecencia (p, [eng] Objective: To identify the kind of care given by informal caregivers to patients who undergo abdominal surgeries at the Consorci Hospitalari of Vic (Barcelona). To compare the responsibility chores that these caregivers have in all the different stages of the surgical process (preoperative stage, the transfer from hospital to the patient’s home, the convalescence period). To know the consequences of the care itself in the caregiver’s health. Methodology: A longitudinal recording study with only one cohort of non-paid eventual and of legal age caregivers of patients who present abdominal surgical pathologies. The sample was obtained in a consecutive but not probabilistic form. This study was carried out from February 2011 to March 2012. The studied variables were: sociodemographic characteristics of informal caregivers and patients, the care that the informal caregiver gives the patient and the consequences of his health state according to the ICUB97-R questionnaire and the NOC taxonomy. A bivaried and multivaried descriptive statistic analysis of all the variables was carried out. These had been obtained in three different stages: when the patient was admitted to hospital, when the patient was discharged home and his convalescence at home. Results: A sample of 317 caregivers and surgical patients was included. Most of the caregivers were married women, with an average age of 52,9±13,7 without previous experience as caregivers (99%). Average age of patients was of 64,1±14,9; 51,1% of which were elderly men. There was a 10,1% of these last elderly patients who were dependent before surgery and 48,3% of these suffered from neoplasm. The average care given during in the preoperative stage (min-max) was of 0,0(0-30), during transfer from hospital to the patient’s home was that of 14,0(0-32) and during the convalescence stage was 11,0(0-29) (p

Background The purpose of this study is to identify which variables –among those commonly available and used in the primary care setting– best predict mortality in a cohort of elderly dependent patients living at home (EDPLH) that were included in a home care program provided by Primary Care Teams (PCT). Additionally, we explored the risk of death among a sub-group of these patients that were admitted to hospital the year before they entered the home care program. Methods A one-year longitudinal cohort study of a sample of EDPLH patients included in a home care programme provided by 72 PCTs. Variables collected from each individual patient included health and social status, carer’s characteristics, carer’s burden of care, health and social services received. Results 1,001 patients completed the study (91.5%), 226 were admitted to hospital the year before inclusion. 290 (28.9%) died during the one-year follow-up period. In the logistic regression analysis women show a lower risk of death [OR= 0.67 (0.50-0.91)]. The risk of death increases with comorbidity [Charlson index OR= 1.14 (1,06-1.23)], the number of previous hospital admissions [OR= 1,16 (1.03-1.33)], and with the degree of pressure ulcers [ulcers degree 1–2 OR = 2.94 (1.92-4.52); ulcers degree 3–4 OR = 4.45 (1.90-10.92)]. The logistic predictive model of mortality for patients previously admitted to hospital identified male sex, comorbidity, degree of pressure ulcers, and having received home care rehabilitation as independent variables that predict death. Conclusions Comorbidity, hospital admissions and pressure ulcers predict mortality in the following year in EDPLH patients. The subgroup of patients that entered home care programs with a previous record of hospital admission and a high score in our predictive model might be considered as candidates for palliative care.

Tras un repaso del estado de la cuestión sobre el tema del maltrato a las personas mayores, tanto en estudios internacionales como en los realizados en España, nos detendremos en el maltrato psicológico y emocional, en el abandono emocional y el trato infantilizador en los centros residenciales para personas mayores. Insistiremos en el elderspeak, ahondando en las consecuencias que tiene para la persona mayor este tipo de comunicación basada en los estereotipos negativos hacia la persona mayor. Finalizaremos con una propuesta formativa de cambio de actitudes para la mejora del trato llevada a cabo en la Comunidad Valenciana

One of the most important issues of nowadays is the increasing of life expectancy implying an aging population. Taking account this magnitude, this is an important topic on the current society life. In Spain, at the beginning of 2009, the population over 65 years represented 16.7% of the total population (Libro Blanco, 2011). According to Dooghe (1993), between 10% - 20% of these individuals have serious addiction problems, considering all developed countries. Some data of IMSERSO (2005) reveal that 17 % of people over 65 years need help to make their daily activities (Rogero - Garcia, 2009). Fernandez de Larrinoa et al. (2011) refer to the caregiver as the person who assumes the care duties, activity that is unpaid and is taken by the family, seen as the only responsible of the dependent person. Due to the amount of obstacles associated to dependency situation, the caregiver devotes his time to take care of your family. This causes a number of e ects associated with the perceived caregiver¿s burden, since it in uences many aspects of health, social, economic and personnel life (Zarit , Reever & Bach - Peterson , 1980) . This caregiver¿ status is an overall measure of the stress e ect and can a ect the quality of life, understood as the general satisfaction that they have in all domains of their life: professional, social and family. The objectives of this study are the follow: we intend to examine the perceived overburden of caregivers/family that use a day care center; and describe the appreciation of caregivers¿ quality of life before and after look ?.

L’ atenció a les persones grans en un establiment residencial ha experimentat una evolució important en els darrers anys: hem passat de l’atenció per beneficència dels ‘asils’ (marcada per un model clarament assistencialista, on l’usuari era un receptor passiu del servei) a l’atenció gerontològica integral (marcada per un model professionalitzat de servei, on l’usuari esdevé un consumidor actiu informat). Hi ha força acord que aquesta maduresa i professionalització ha de tenir en compte els aspectes ètics en l’atenció a la gent gran amb dependència, tant pel que fa a l’ètica assistencial pròpiament dita com a l’ètica de l’organització. Així, l’ètica esdevé un aspecte més a gestionar en aquestes organitzacions. Això requereix planificar com abordar els aspectes ètics en la dinàmica de l’organització, desenvolupar el treball planificat, avaluar els resultats i introduir millores a partir dels resultats obtinguts. En primer lloc hem de tenir identificats els temes ètics a contemplar en un centre gerontològic, que són diferents dels que es puguin plantejar en un centre sanitari, o en un centre educatiu, per exemple. Tot això, però, requereix un mètode i uns elements de mesura. Seria útil poder confeccionar una mena de radiografia de l’organització amb identificació del grau d’assoliment dels aspectes ètics. Es fa necessari disposar d’un instrument per mesurar la qualitat ètica en una residència. Una eina per assolir-ho seria l’auditoria ètica. Caldria disposar d’un model d’auditoria ètica adaptat a les necessitats d’un centre gerontològic d’atenció a persones grans amb dependència (popularment conegut per una ‘residència d’avis’). En aquest treball em proposo els següents objectius: 2.1.- Recerca documental per identificar sistemes d’auditoria ètica específics per a residències de gent gran; 2.2.- Si n’existeixen, fer una anàlisi i comparació dels diferents sistemes trobats, amb el punts forts i punts febles de cadascun d’ells i 2.3.- Valorar la seva idoneïtat en una residència per a gent gran

Màster en Lideratge i Gestió d'Infermeria, Universitat de Barcelona. Escola Universitària d'Infermeria, curs: 2011-2012, Director: Montserrat Roca, Objectiu: Determinar les característiques a l’ingrés i de procés assistencial de les persones traslladades a l’hospital d’aguts durant l’ingrés a les unitats d’atenció intermèdia (UAI). Àmbit d’estudi: UAI de l’Hospital Sociosanitari del Parc Sanitari Pere Virgili (PSPV) a Barcelona. El centre disposa d’atenció infermera i mèdica 24 hores i proves bàsiques (RX, ECG i laboratori). Metodologia: Disseny: Estudi quantitatiu, observacional, descriptiu, transversal i retrospectiu. Participants: Totes les persones ingressades a la UAI del PSPV el 2011. Recollida de dades: S’utilitzen la base de dades assistencial del PSPV 2011 i altres registres de les històries clíniques dels pacients. Variables d’estudi: Variables sociodemogràfiques, funcionals, clínic-assistencials, relatives als trasllats a l’hospital i de detecció precoç per infermeria. Anàlisi de dades: Anàlisi estadística descriptiva i bivariant mitjançant el programa SPSS, versió Pasw19.0. α=0.5; nivell de confiança 95%

El objetivo del trabajo consistía en analizar y extraer algunas conclusiones de futuro sobre el tratamiento tributario específico de las situaciones de dependencia. Para ello, se ha estudiado, en primer lugar, la normativa existente en nuestro ordenamiento jurídico sobre la Dependencia y el Sistema de Atención a la Dependencia; así como su financiación. De una manera generalizada en España, y más particularmente, en la Comunidad Autónoma de Cataluña. A continuación, se ha realizado un análisis de las propuestas que el Defensor del Pueblo realizó en un informe rendido en 2002 sobre el régimen fiscal de la discapacidad. A partir de su contenido, se ha examinado si sus propuestas se han atendido o no, y si son o no sostenibles dentro del sistema actual.

Population ageing brings new challenges to long-term household economic decisions. In the event of old-age dependency, housing assets become a key self-insurance device. However, little empirical evidence has been reported regarding an individual's expectations of having to use their housing wealth for such a purpose. This paper draws upon two complementary data sources to empirically examine: (1) the influence of housing assets on an individual's willingness-to-sell (WTS) their dwelling for care purposes, and (2) the willingness to take out a reverse mortgage contract loan in the event of old-age dependency. The paper's findings suggest that homeowners' WTS in old age is unaffected by their income or housing assets and is, rather, determined by socio-environmental housing characteristics and the individual's health and personal needs. Conversely, the study finds that the uptake of home reversion loans is largely dependent on income or education, but not on a household's housing assets.

La valoración del grado de dependencia de los pacientes en diálisis ha sido objeto de interés como indicador clínico y organizativo. El objetivo del estudio es conocer el grado de dependencia que presentan las personas sometidas a tratamiento con diálisis en Cataluña, según los criterios de la Ley sobre Promoción de la Autonomía Personal y Atención a las personas en situación de dependencia. Se ha realizado un estudio descriptivo transversal en 42 centros de Cataluña sobre el grado de dependencia de los pacientes en hemodiálisis. La recogida de datos se hizo mediante una encuesta basada en el baremo de la Ley más datos sociodemográfico y características del tratamiento. De los pacientes que componían la población renal de Cataluña fueron considerados por los profesionales sanitarios con algún grado de dependencia 806, de ellos 425 eran hombres y 381 mujeres; un 61% tienen edades superiores a 70 años. El 53% viven en pareja y el 80,1% tenían uno o más hijos. El 77,4 %de los pacientes habían sido trabajadores no cualificados, y el 65,4% dijeron no tener estudios. Se consideraron no dependientes 137 pacientes, con dependencia moderada 350, con dependencia importante 237 y con gran dependencia 82. Fue significativa (p

This paper reviews the main theories and results of the existing research to date about the concept of the informal caregiver's burden. The explanation of the burden concept, the theoretical approaches which attempt to explain it, the variables which have emerged in the investigation, the predictors of its appearance, as well as the intervention programs developed to relieve burden, allow us to approach the appropriate solutions to deal with the current social and political reality of this problem. In this sense, the psycho-educational intervention programs framed within the respite services jointly with the knowledge of the determining variables of the burden can comprise the first optimal approach in order to effectively deal with the burden problem of the informal caregivers of dependent senior citizens.

The study aims at analyzing the psychosocial variables associated with the informal caregivers" burden of dependent older people. A sample of 296 dependent people and their informal caregivers (n= 153) was randomly selected among users and non-users of the Spanish public In-Home Help Service (HHS) in an autonomous Spanish region (Comunidad Valenciana). Diverse variables in reference to the care context and the caregiver as well as the care recipient show major associations with the burden: those associated to disease and the social situation of the dependent person, the greater frequency and intensity of care, and the low frequency in which the caregiver receives help from others. The obtained data makes possible to establish guidelines based on the psychological and educational interventions which relieve the informal caregivers" burden of dependent senior citizens, which must be combined with respite services, in order to promote the permanence of this population group in the community environment.