Diseño y validación de las escalas de evaluación del impacto psicológico de sucesos vitales pasados: el papel del pensamiento rumiativo y el crecimiento personal

Introduction

Older people's emotional distress is often related to rumination processes focused on past vital events occurred during their lives. The specific coping strategies displayed to face those events may contribute to explain older adults’ current well-being: they can perceive that they have obtained personal growth after those events and/or they can show a tendency to have intrusive thoughts about those events. This paper describes the development and analysis of the psychometric properties of the Scales for the Assessment of the Psychological Impact of Past Life Events (SAPIPLE): the past life events-occurrence scale (LE-O), ruminative thought scale (LE-R) and personal growth scale (LE-PG).

Material and methods

Participants were 393 community dwelling elderly (mean age=71.5 years old; SD=6.9). In addition to the SAPIPLE scales, depressive symptomatology, anxiety, psychological well-being, life satisfaction, physical function and vitality have been assessed.

Results

The inter-rater agreement's analysis suggests the presence of two factors in the LE-O: positive and negative vital events. Confirmatory Factor Analysis (CFA) supported this two-dimensional structure for both the LE-R and the LE-PG. Good internal consistency indexes have been obtained for each scale and subscale, as well as good criterion and concurrent validity indexes.

Conclusions

Both ruminative thoughts about past life events and personal growth following those events are related to older adults’ current well-being. The SAPIPLE presents good psychometric properties that justify its use for elderly people.     

Efectos del ejercicio físico en la funcionalidad y calidad de vida en mayores institucionalizados diagnosticados de gonartrosis

Introduction

At present, aging and increased life expectancy implies a greater susceptibility to dependence, which then leads to the irreversible loss of quality of life, in many cases due to chronic diseases such as osteoarthritis (OA). The aim of this study was to determine the effect of a treatment based on aerobic exercise in institutionalised elderly people diagnosed with knee osteoarthritis.

Material and method

An experimental, prospective, single blind study was conducted. The sample (n = 31), was divided into two groups. The experimental group (n = 17) was treated based on aerobic exercise for 4 weeks with 2 sessions per week and each lasting 50 minutes. We conducted a pre-test and post-test assessment using a visual analogue scale, WOMAC questionnaire and SF-36 as measuring instruments. The statistical program SPSS15.0 was used for the analysis of the data.

Results

We obtained significant differences in the t-test for paired samples in the three dimensions of the WOMAC questionnaire, P<.001, in the perceived pain P<.001 and in the physical function, vitality and mental health dimensions of the SF-36 with a 95% confidence interval.

Conclusion

Exercise gave positive results in functional (pain, stiffness, physical function) and psychological aspects (mental health and vitality) in the institutionalised elderly.     

La participación de personas con demencia en las reuniones del plan de atención individualizada: impacto en el bienestar y la calidad del cuidado

Introduction

An individualised intervention plan (IIP) offers a new paradigm in the care of the elderly with dementia, with the aim of increasing their quality of life through personalisation, respect for their freedom, and their participation in the decisions that affect their lives.

Objective

To evaluate the impact of the residential home patient with dementia and their quality of care when they take part in the interdisciplinary meeting in which their care plan is decided.

Material and methods

A total of 52 elderly patients with dementia took part in the study. They were distributed into two groups, one experimental (37 residents) and another control (15 residents). The Dementia Care Mapping (DCM) tool was used to assess the well-being and quality of care of the residents. This tool was used twice, before and after the intervention.

Results

The well-being of the resident, evaluated using the DCM, was similar before and after the intervention in the experimental group. No differences were observed either on comparing the control and experimental groups. However, some indicators of carer behaviour were different before and after the intervention, and when the control and experimental group were compared.

Conclusion

The inclusion of elderly persons with dementia in their IIP meeting had a positive effect in the interaction of the staff with the residents, but not on the well-being of the resident.     

Prevalencia y factores asociados a sospecha de malos tratos en la unidad geriátrica del área de urgencias del hospital

Objective

To know the prevalence of mistreatment and to identify the associated factors among elderly people without cognitive impairment, seen in the geriatric unit, located in the hospital emergency area.

Methods

Cross-sectional study of a population of 65 years or older assessed by the geriatric Interdisciplinary Social Welfare Functional Unit (ISSFU) of the emergency area in the Arnau de Vilanova hospital of Lleida. We excluded participants with cognitive impairment. The total number of participants was 127. The suspicion of mistreatment was measured using the Questionnaire of the American Medical Association (AMA) and the Canadian Task Force (CTF). The variables studied were social demographic characteristics and functional dependency.

Results

Prevalence of suspicion of mistreatment was 29.1% (95% CI: 0.21-0.37). The most frequent subtypes were neglect and psychological, and less frequent was negligence. Associated factors were being female, being in unpaid work, being a widow and living alone.

Conclusions

Three out of ten elderly people were identified as possible victims of abuse. Due to the relative isolation of many of the elderly who were abused, an unexpected visit to the emergency area may be the only opportunity for detection. Geriatric units located in this area should include the suspicion of mistreatment of this population in their comprehensive assessment. For this, it is necessary to have tool with a high degree of sensitivity and specificity for detection of abuse in the elderly.     

El anciano con enfermedad avanzada de órgano. Consideraciones desde la geriatría,la medicina paliativa y la bioética

Objective

To analyze the literature as regards the knowledge, skills and attitudes that these disciplines can provide in improving technical, ethical and human quality health care in the elderly with advanced organ failure, multimorbidity, frailty and progressive dementia.

Material and methods

A comprehensive review focused on available references on the interrelationship between geriatric medicine and palliative medicine, education in bioethics, prognostic tools, functional status, and the humanization of health care.

Results

Advance care planning, comprehensive geriatric assessment, the study of the values of the patient and their introduction in decision-making process, as well as the need to promote moral, care, and healthcare organizational ethics, are essential elements to achieve this objective.

Conclusions

Practitioners and healthcare organizations should seek excellence as a moral requirement. To achieve this, there is a priority to acquire virtues of care and fundamental concepts of geriatric and palliative medicine, assessing functional status, advance care planning and patient/family needs as essential issues to protect, care for and promote them in all care settings.     

Valoración de la fuerza,la flexibilidad,el equilibrio,la resistencia y la agilidad en función del índice de masa corporal en mujeres mayores activas

Introduction

Overweight and obesity are increasing at an alarming rate among older people. This is mainly because this population is predominantly sedentary. The aim of this study was to classify, according to the body mass index (BMI), a group of older active women and to evaluate the different basic physical abilities as a function of this.

Material and methods

The BMI and fitness were evaluated in 60 elderly active women (mean age: 66.14 ± 6.59 years) using the 2-minute step test, arm curl test, chair stand test, back scratch test, chair-sit and reach-test, flamenco test, and 8-foot up-and-go test.

Results

It was found that 52.23% of the women studied had a normal BMI and 47.76% were slightly overweight. There were no cases of obesity or underweight. Women with normal BMI had better values in all tests than overweight women. Significant differences were found in the flamenco test (P < .05), and 8-foot up-and-go test (P < .01).

Conclusions

Older women who usually do physical activity had a normal or slightly overweight BMI. It was also found that women with lower BMI have better resistance, flexibility, balance and strength.     

Desarrollo de un instrumento de registro de implicación/engagement en la actividad para la observación sistemática de personas mayores con deterioro cognitivo

Introduction

As the level of cognitive impairment in people with dementia increases, it seems that the interventions aimed at this group do not obtain the expected results. Thus, it is clear that there is a need to develop specific assessment tools. One of the important aspects in people with dementia is the engagement, involvement in task and activities. Engagement is considered a quality of life and quality of care indicator. The aim of the study is to develop an Engagement recording tool for mapping people with dementia, and to obtain reliability measures.

Method

The present paper aims to present the current development of engagement behaviours. The pilot study had a sample of 19 people distributed into two groups, which were observed in order to obtain inter-rater reliability measurements using the percentage of inter-rater agreement.

Results

An observational mapping instrument was developed that achieved a high inter-rater reliability.

Conclusion

The Engagement recording tool makes it possible to gather promising results on the effects of the interventions for people with severe dementia. On the other hand, these results point to the possibilities of more specific tools to assess the different interventions which aim is to improve quality of life and quality of care in people with dementia.     

Prevalencia de sarcopenia en consultas de geriatría y residencias. Estudio ELLI

Background

There are few systematic studies on the prevalence of sarcopenia using the new diagnostic criteria in different geriatric care settings.

Objective

To estimate the prevalence of sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP) criteria in older subjects living in nursing homes and in those who attend geriatric outpatient clinics.

Material and methods

A single country multicentre study in two samples of older subjects: patients cared for in outpatient geriatric clinics, and individuals living in nursing homes. Data collected will include demographic variables, medical history, medication, geriatric syndromes, functional status (assessment of basic and instrumental activities of daily living), mobility, cognitive status, comorbidity, quality of life, nutritional status, and laboratory parameters. For the diagnosis of sarcopenia, 4 m walking speed, handgrip strength, and body composition measured by bioelectrical impedance analysis will be assessed.

Results

Using the EWGSOP algorithm, the prevalence of sarcopenia in an elderly Spanish population will be estimated. In addition, concordance and correlation between the three parameters included in the definition (muscle mass, muscle strength, and physical performance) will be analysed, using the different existing cut-off points, and examining the diagnostic accuracy of each. Finally, demographic, anthropometric and functional data that define subjects with sarcopenia will be investigated.

Conclusions

The ELLI study should improve knowledge on the prevalence and characteristics of sarcopenia in older people in our population.     

Adaptación y validación de la versión española de la escala de evaluación de dolor en personas con demencia avanzada: PAINAD-Sp

Introduction

Pain in elderly people is considered a major concern in nursing home facilities affecting between 49% and 83% of the residents. Progression of Alzheimer's Disease causes more communication difficulties in patients with advanced dementia and therefore more problems to understand even the most simple pain evaluation scales. Identification and implementation of appropriate pain management strategies depends on an adequate pain assessment.

Material and methods

The main objective of the study was to validate the Spanish version of the PAINAD Scale (PAINAD-Sp) and to assess its applicability in Spanish Geriatric Nursing Homes. The 20 patients diagnosed with severe dementia from a Geriatric Centre in Spain were observed by five observers with different professional profiles for 5 minutes to each participant, and PAINAD-Sp Scale was administered simultaneously to a Visual Analogical Scale-VAS. Three different observational conditions were established: resting condition, during presumably pleasant activity and during presumable painful activity.

Results

Cronbach's alpha ranged between 0.467 and 0.827 (average 0.692), and rose if Breathing item was deleted. Inter-rater reliability ranged between 0.587 and 0.956. Correlation between PAINAD-Sp Scale total measures and VAS was statistically significant (P<.05) in all measures and ranged from 0.517 to 0.868.

Conclusions

Findings in the study showed that the scale is useful to measure pain in non communicative patients suffering from dementia. The scale maintains good levels of reliability for different healthcare professionals even when they have little training.     

Presencia y representación de las personas mayores en la publicidad televisiva: el caso español

Introduction

The demographic shift towards aging population generates a series of socioeconomic and cultural changes that are beginning to transform the role and public image of older people. The elderly have become one of the market segments with a greater future. This fact has attracted little scientific interest in the field of advertising communication and for this reason there is little research that is actually looking into this Spain. This research examines the use that is made of the image of the elderly in the television advertising in Spain, looking at the differences between the advertisement dedicated to the targeting people over 65, and those that are not directed at the elderly, but use older people in their content as actors or main characters in the advertisement.

Material and methods

A content analysis study was conducted on a sample of 2,065 spots obtained from prime time slots (from 20:30 to 22:30 p.m.) from the five major Spanish television channels (TVE 1, La 2, Tele 5, Antena 3 and Cuatro). Two independent judges coded all the advertisements. The reliability coefficient between judges was 0.91.

Results and conclusions

In general, older people, particularly women, are not very often shown in Spanish advertising. Their presence is much stronger and visible in campaigns which aim their communication strategy at different age groups. In those cases, advertising presents the elderly with a stereotyped, self-interested and traditional image.     

Efectos del Modelo de Atención Centrado en la Persona en la calidad de vida de personas con deterioro cognitivo de centros gerontológicos

Introduction

The Model of Person Centered Care has attracted increasing interest for use in gerontology centers. Therefore, the contributions about its impact are scarce in our context. The objective of this paper is to establish the impact that the interventions associated with the Model of Person Centered Care in the «Etxean Ondo» Project have on the quality of life of residents with cognitive impairment.

Material and methods

One hundred and ninetten residents with cognitive impairment were selected: 59 in the control group and 60 in the experimental group. Subjects in each group were sorted by cognitive impairment: mild or severe. Changes were implemented in the physical and organizational environments for the promotion of autonomy and wellbeing. Quality of life was assessed before and 6 months after intervention using the Fumat Scales (mild cognitive impairment) and Qualid (severe cognitive impairment). The t-Student test was used for comparison of means.

Results

In intergroup comparisons, significant differences in the Fumat Scale for the control group with mild cognitive impairment were initially identified. These differences were not recorded in the post assessment. The experimental group with severe cognitive impairment was significantly improved in the Qualid Scale post assessment. In intragroup comparisons, significant improvements were evident in the quality of life of experimental subjects, both with severe cognitive impairment (Qualid) and mild (Fumat).

Conclusions

The findings support the effectiveness of the interventions and identify methodological and conceptual issues that have been considered to analyze the Model of Person Centered Care efects.     

Regulación de la expresión sexual de los mayores ingresados en residencias: la visión de los profesionales

Introduction

The purpose of this study is to determine the opinion of professionals working in residential aged care facilities on the regulation of sexuality in these settings.

Materials and methods

Fifty-three professionals from five residential aged care facilities located in the metropolitan area of Barcelona answered several questions regarding the advisability of establishing measures for the regulation of sexuality in RACFs, the elements that could contribute to this, and the aspects that such regulations should consider.

Results

Around 50% of the participants recognized the advisability of having some type of measures for sexuality regulation in residential aged care facilities. According to their responses this should be developed taking into account professional opinions, but also the points of view of the residents and their relatives. The most frequently mentioned regulations were those that ensured that any kind of sexually charged situation occurred in a private environment. The development of strategies are suggested to distinguish those people with dementia that are competent to consent to sexual acts from those who are not.

Conclusions

The opinion of professionals working in RACFs regarding the advisability of establishing measures for sexuality regulation seems to be considerably divided. Thus, whilst around 50% of them recognize their potential usefulness, the other half consider them unnecessary or even counterproductive for the sexual freedom of residents. Associating regulation with prohibition and sexuality with sexual activity was not uncommon among the responses of the participants.     

Impacto del apoyo familiar en la presencia de quejas depresivas en personas mayores de Santiago de Chile

Introduction

Epidemiological changes can have an effect on social and, and in particular, family ties, which are important elements in the mental health of older people. The objective of this study was to evaluate the impact of family support on depressive disorders in older people of the community.

Material and methods

Face to face interviews were conducted on a representative sample of adults 60 years and older, living in urban area of Santiago de Chile. The information on depressive disorders was related to family composition, emotional and instrumental support, presence of conflict, health self-perception, functionality and self-efficiency. Data were analyzed using logistic regression models.

Results

From a total of 394 participants, 62% females, mean age 74 years (SD=8.1), 16% felt depressed almost every day. Depressive disorders were significantly associated in regression models with impaired self-perception of health and efficacy, lower instrumental support, and with the presence of conflict. The variable that most contributed to the model was self-rated poor health, increasing the odds of depressive disorders by 3.2.

Conclusions

Poor perception of health was the main determining factor for depressive complaints in older people, followed by lower family support, specifically instrumental support, and the presence of conflict. This information can help future programs in order to improve the quality of life in older people.     

Enfermedad de Alzheimer y calidad de vida del cuidador informal

Background

Along with an ageing population, a higher incidence of chronic diseases leads to increasingly complex health profiles. The relationship between survival, dependence, and social and demographic trends affecting caregiving, has led to an increase in the negative consequences associated with care provision. In this context, an assessment needs to be made on the impact that caregiving has on the well-being of the caregivers. The main aim of this article is to study the factors that determine the Quality of Life (QoL) of those who provide informal care to people suffering from Alzheimer's disease (AD).

Características antropométricas,funcionales y de fuerza explosiva de mujeres mayores de 50 años físicamente activas de la ciudad de Bogotá, Colombia

Objective

To analyze the relationship between different test measuring explosive strength and functionality of active women participating in a leisure sport program in order to describe the caracteristics of health status and look for tools for diagnosing and monitoring degenerative process.

Methods

This study was conducted on 102 women physically active and without risk factors. Anthropometric, functional independence and explosive strength tests were applied.

Results

Mean age 60.08±5.35 years; body mass index: 26.81±3.91; percentage of fat: 52.45±4.75; percentage of muscle mass: 37.24±6.77; tests of functional independence: maximum speed (30 meters): 9.39±1.92 s; speed-agility (30 meters): 12.93±1.59 s, and dynamic balance (6 meters): 21.9±8.01 s. Explosive Strength (Bosco test): Squat Jump: 12.23±3.05 cm, Countermovement Jump: 13.18±3.04 cm and Countermovement Jump Arm swing: 14.80±4.01 cm.

Conclusion

The statistical relationships found between body composition, explosive strength and functionality tests, are important tools for diagnosing and monitoring, and could improve the intervention models on the elderly.     

Descripción de los resultados y costes de una intervención preventiva a nivel respiratorio en el anciano institucionalizado: ensayo controlado aleatorizado

Introduction

The institutionalized elderly with functional impairment show a greater decline in respiratory muscle (RM) function. The aims of the study are to evaluate outcomes and costs of RM training using Pranayama in institutionalized elderly people with functional impairment.

Material and methods

A randomized controlled trial was conducted on institutionalized elderly people with walking limitation (n = 54). The intervention consisted of 6 weeks of Pranayama RM training (5 times/week). The outcomes were measured at 4 time points, and were related to RM function: the maximum respiratory pressures and the maximum voluntary ventilation. Perceived satisfaction in the experimental group (EG) was assessed by means of an ad hoc questionnaire. Direct and indirect costs were estimated from the social perspective.

Results

The GE showed a significant improvement related with strength (maximum respiratory pressures) and endurance (maximum voluntary ventilation) of RM. Moreover, 92% of the EG reported a high satisfaction. The total social costs, direct and indirect, amounted to €21,678.

Conclusions

This evaluation reveals that RM function improvement is significant, that intervention is well tolerated and appreciated by patients, and the intervention costs are moderate.     

Asociación entre la realización de ejercicio e indicadores de funcionamiento físico y cognitivo. Comparativa de resultados en función de la edad

Background

Gerontology research shows the importance of physical exercise for active aging. This study demonstrates the relationship between the practice of aerobic exercise, and physical fitness (muscle strength, respiratory capacity and motor speed) and cognitive performance (memory and visual-perceptual speed) and analyzes whether age is a modulating factor of this relationship.

Material and methods

The sample included 690 subjects with an age range of 30-85 years. The level of physical exercise was assessed using self-report form. Two sub-scales were used for the evaluation of cognitive performance: Digit Span Backwards and Digit Symbol (both are sub-scales of the Wechsler Adult Intelligence Scale - WAIS). The physical fitness was assessed using bio-behavioral measurements (strength, lung capacity, speed). To test the combined effect of exercise and age on the two variables (physical fitness and cognitive performance) two separate factorial analysis of variance were performed (procedure - general linear model: Univariate).

Result

The most significant result showed that scores on cognitive performance is a function of the intensity of the physical activity (F=4.8; P<0.002). With regard to physical fitness, its relationship with physical exercise is also significant (F=4.10; P<0.007) as well as the interaction between exercise and age (F=2.2; P<0.001).

Conclusions

The intensity in achieving aerobic exercise is associated with physical fitness and cognitive performance. Age has a specific weight in the association between exercise and physical fitness, this effect is higher in the older age groups (65-74 and 75-85 years for 30-49 and 50-64 years). These data suggest the compensatory effect of exercise on decline in old age.