La transición hacia el retiro: adaptación en una muestra de prejubilados españoles de la escala Retirement Satisfaction Inventory

Objectives

This study provides psychometric data for the Spanish adaptation of the scale of Retirement Satisfaction Inventory (RSI). We explore the factor structure and psychometric properties a sample of Spanish early retirees. RSI measures the motivation to retirement, satisfaction with life in retirement and leisure activities.

Material and methods

The RSI scale (Floyd et al, 1992) was applied to a sample of 638 Spanish early-pensioners with a mean age of 61.28 (SD: 5.77) years and a mean age at early retirement of 53.89 years (SD: 2.71). An exploratory factorial analysis was performed using the SPSS statistics package, and a confirmatory factorial using the AMOS 6.0 module. The data collection process was carried out by means of the questionnaires by post method.

Results

The adaptation of the RSI to Spanish showed a three-scale structure:: the reasons for retirement, satisfaction with life in retirement, and leisure activities. These scales showed a structure with four, two and three main factors, respectively, which differ slightly from those reported in the original instrument.The confirmatory factorial analysis demonstrated the optimum fit of the model for the three scales.

Conclusions

The RSI adaptation to Spanish provides a tool that could asses the motivation towards retirement during the leaving work process, satisfaction with retirement life, and the leisure sources in the Spanish early retired population.     

Disnea y psicopatología en el paciente anciano con enfermedad pulmonar obstructiva crónica

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease with dyspnoea perception as a main symptom. In severe stages, dyspnoea can constitute a risk factor for depression, anxiety and somatization disorders.

Objective

The objective was to evaluate the presence of these psychopathologies based on dyspnoea and severity stages in patients with COPD.

Materials and methods

Patients (n=51) were evaluated by means of the Hospital Anxiety and Depression Scale, the dyspnoea scale (MRC), the General Health Questionnaire (GHQ-28) and spirometric criteria.

Results

The increase in dyspnoea level and disease severity lead to a progressive worsening of anxiety, depressive and somatic symptoms with clinical relevance (P<0.05). There was a significant correlation between those parameters (P<0.05).

Conclusions

The early detection and treatment of these psychopathologies associated with dyspnoea and progression of the disease must be taken into account in this complex pathology.     

Resultados de la endarterectomía carotídea en pacientes ancianos

Introduction

Forty-five per cent of stoke patients have a surgically accessible stenosis. The objective of our study is to describe the response to carotid endarterectomy (EA) in patients of advanced age compared to younger ones.

Material and method

Retrospective evaluation of the clinical history of all patients who underwent an endarterectomy in a tertiary hospital between January 1995 and December 2006. The patients were grouped into those 75 years or older and those less than this age. The incidence of peri-operative complications in the first month after surgery, and the long-term mortality was evaluated using a survival analysis.

Results

Data were collected on 147 EA in 134 patients of 75 years or more, and on 201 EA in 177 patients less than 75 years-old. The incidence of peri-operative complications was similar in both groups, with a mortality of 2% in the older age group and a stroke incidence of 2.6% (half transient ischaemic accidents). The older patients had a mean follow-up of 4.1 years, with a survival of 86% at one year and 54% at 5 years and with the main cause of death being heart disease.

Conclusions

Carotid EA is a safe and effective technique for the treatment of extracranial carotid stenosis in the elderly, having the same peri-operative morbidity and mortality as younger ones. Age must not affect our therapeutic attitude, although an exhaustive cardiology study must be made in the elderly prior to the operation.     

Efectos del entrenamiento en estrategias de regulación emocional en el bienestar de cuidadores de enfermos de Alzheimer

Introduction

The present research shows the results of a psychoeducational intervention programme centered on the regulation of the emotion among Alzheimer patients’ caregivers.

Materials and methods

52 informal caregivers of Alzheimer's patients participated. These caregivers were distributed into two groups: the experimental group (n = 20) and the control group (n = 32). All the participants were evaluated before and after the intervention programme through the application of different measurement tools measuring variables related to the care giving process; stressors, modulation variables and care giving consequences.

Results

In the inter group contrast, the experimental group, when compared with the control condition, obtained higher scores in positive affect, subjective well-being, regulation of emotions, and satisfaction with caregiving. However, the experimental group recorded lower values in perceived stress and negative affect. With reference to the intragroup contrast, the experimental group showed a significant decrease in dysfunctional thoughts and emotional attention. The control group registered higher levels of psychosocial support and lower satisfaction with caregiving.

Conclusions

The training programme, that we both developed and conducted, has contributed to a greater feeling of emotional well-being amongst the its participant caregivers, who now take more adequate care of their emotions and suffer fewer dysfunctional thoughts in relation to caregiving. In future studies, the stability of the results presented in this investigation should be established due to the progressive character of the skills learned during the programme, and the changing needs associated with the caregiving process.     

Eficiencia de las unidades geriátricas de agudos: metaanálisis de estudios controlados

Objective

After analysing the effectiveness in the reduction in the incidence of functional impairment and a higher probability of returning home between elderly patients hospitalised due to an acute medical illness cared for in acute geriatric units (AGU) compared to conventional care units, we propose to assess the efficiency of this care.

Material and methods

A systematic review and meta-analysis was made of controlled studies (randomised, no randomised and case-control) that compared care in UGA with care in conventional hospital units of patients of 65 years and over with an acute medical illness. Studies on administrative data bases, those that evaluated care of a single disease, and those that assessed units with care in the acute and sub-acute phase were excluded. A literature review was performed on articles published up to 31st of August 2008 in Medline, Embase, Cochrane Library, and references of systematic reviews and reviewed articles. The selection of the studies and the extraction of data on the hospital stay and care costs was made independently by two different researchers.

Results

A total of 11 studies were included, of which 5 were randomised, 4 were non-randomised, and 2 case control, all of them providing data on hospital stay, with 7 of them providing data on hospital costs (4 clinical trials, 2 non-randomised and 1 case-control). The overall analysis of all the studies showed that those admitted to UGA had a statistically significant reduction in hospital length of stay compared to the elderly hospitalised in conventional units (mean difference -1.01 days; 95% CI, -1.66 to -0.36) and hospital care costs (mean difference of -330 US dollars; 95% CI, -540 to -120).

Conclusions

Care in AGU is more efficient than that provided in conventional units, since, as well as achieving a reduction in the incidence of functional impairment at discharge and increasing the probability of returning home, they reduce mean hospital stay and the hospital care costs.     

Envejecer sin ver: evaluación del ajuste a la pérdida visual sobrevenida en la vejez

Introduction

The adjustment process to visual impairment can be approached by using theoretical models. The key variables in these models are usually measured by using psychometric instruments. The measurements can be taken from those already existing for the general population or be specifically designed for the visually impaired population. If the chosen measurements are reasonably valid and behave as the model predicts, they can be further used for designing programs that improve the process of adjusting.We describe the identification, adaptation and validation of some theses measurements.

Method

We selected the psychometrics instruments to be used in the research: the Age-Related Vision Loss Scale (AVL) by Horowitz and Reinhardt; the Nottingham Adjustment Scale (NAS) by Dodds, and the Geriatric Depression Scale (GDS) by Brink and Yesavage. The AVL and NAS were adapted for use in Spain. The referred measurements were applied to a sample of 335 respondents together with the Scale of Subjective Wellbeing (EBS), and their psychometric properties were assessed.

Results

The estimated reliabilities were: AVL (0.80), NASA2 (0.87), NASB (0.81), NASC (0.75), NASE (0.87), GDS (0.90). The relationships between the measurements were all in the expected direction, and the magnitude of the convergent-validity coefficients was considered as acceptable.

Conclusions

Our results suggests that the available measurements discussed above are appropriate for assessing the adjustment process, and are useful tools for individual assessment, as well as for designing intervention programs.All the measurements are available in computerized form in www.proyectotarragona.es.     

Evaluación de un programa de intervención en residencias geriátricas para reducir la frecuentación hospitalaria

Objectives

This study describes the outcomes of an intervention program in Nursing Homes and their effects on emergency room attendance, hospital admissions, and pharmaceutical expenditure.

Material and methods

This involved non-randomised community intervention in Nursing Homes with a control group. The program was implemented gradually from 2007 to 2009 in 10 Nursing Homes (857 beds) which participated voluntarily. The control group consisted of 14 Nursing homes (1,200 beds), which refused to participate or were not assigned to our Primary Care centres. Intervention consisted of comprehensive geriatric assessment and follow-up visits by trained personnel, review and adjustment of drug treatment, case management and staff training.

Results

In the Nursing Homes where the program was carried out, emergency room attendance decreased from 1165‰ (95%CI 1100-1240]) in 2006 to 674‰ (95%CI 620-730) in 2009, while in the control group it increased from 1071 (95%CI 1020-1130) to 1246‰ (95%CI 1190-1310). The hospital admissions also decreased from 48.4% (95%CI 45-52) in 2006 to 32.1% (95%CI 29-35) in 2009, while in the control group increased from 43.5% (95%CI 41-46) to 55.8% (95%CI 53-59). There was also a 9% reduction in pharmacy cost compared with an increase of 11.9% in the control group.

Conclusions

The intervention has proved effective at reducing hospital admissions and emergency room attendance in institutionalised patients, thereby streamlining pharmacy costs.     

El Instrumento de Fragilidad para Atención Primaria de la Encuesta de Salud, Envejecimiento y Jubilación en Europa (SHARE-FI): resultados de la muestra española

Background

Frailty is a syndrome with important epidemiological and clinical implications in older adults. One of the most accepted definitions of frailty is that of Fried and Walston, who operationalised it according to five well defined criteria. However, their criteria are not readily applicable in primary care, where practitioners need tools to identify patients who require priority access to more specialised resources. With that objective in mind, our research group published the Frailty Instrument of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI). The present paper reports the results of the Spanish sample.

Methods

In the wave 1 of SHARE (2004), the Spanish sample was composed of 1,279 women and 933 men, all living in the community (mean age: 65.6 years). For each sex, a latent class analysis was used to summarise the five (adapted) frailty criteria into three incremental frailty classes. We tested the association of the frailty classes against a biopsychosocial range of wave 1 variables; the predictive validity of the frailty classes was tested using mortality data from the second wave of SHARE (2006-2007), which were available for 846 women and 660 men.

Results

The frailty classes had the expected cross-sectional associations. The age-adjusted Odds ratio for mortality (with 95% confidence interval) associated with the frail class was 3.2 (1.0-10.2) for women and 8.3 (3.1-22.1) for men.

Discussion

SHARE-FI is a valid and freely accessible instrument, which is intended to facilitate the adoption of the frailty paradigm in primary care.     

Relación entre el rendimiento en la prueba de estación unipodal y la velocidad del centro de presión en adultos mayores

Introduction

Frequent falls are one of the most important health problems in the elderly population. The unipedal stance test (UPST), asses postural stability and is used in fall risk measures. Despite this, there is little information about its relationship with posturographic parameters (PP) that characterizes postural stability. Center of pressure velocity (CoPV) is one of the best PP that describes postural stability. The aim of this study was to analyze the relation between UST score and CoPV in elderly population.

Materials and methods

A sample of 38 healthy elderly subjects where divided in two groups according to their UPST score, low performance (LP, n = 11) and high performance (HP, n = 27). The correlation between UPST score and COP mean velocity (CoPmV), recorded from a posturographic test, was analyzed between both groups.

Results

An inverse correlation between UPST score and CoPmV was found in both groups. However, this was higher in the LP group (r = −0.69, P = .02) compared to the HP (r = −0.39, P = .04).

Conclusions

Based on the results of this investigation, it may be concluded that the achievement on UPST has an inverse relationship with CoPmV, especially in subjects with low performance in the UPST.     

Calidad de vida percibida por las personas mayores. Consecuencias de un programa de estimulación cognitiva a través de la motricidad «Memoria en movimiento»

Introduction

This article presents the results of evaluation of health related quality of life in a group of elderly people who were engaged in the program of cognitive stimulation «Memory in movement».

Materials and methods

A content analysis was conducted to determine the type of experience that the subjects stated in the context of an interview. The statements were classified into categories created ad hoc. The sample consisted of 32 participants with a mean age of 69.92 ± 4.98 years. The software QSR NVivo-8 was used for data processing.

Results

The results show that the 48% of the elderly perceive some improvements in their memorisation abilities, 47% in attention and concentration, and 10% in the satisfaction with life after being in the program. They are especially worried about the loss of memory -stated by the 65.62%- and they came to the cognitive stimulation program with the aim of improving this capacity. The feelings that participants reported having experienced during the program have to do with fun, vitality and energy.

Conclusions

Programs on cognitive stimulation that incorporate some physical activities, together with a clear playful and social component, improve the psychic and social capacities and they open an important line of intervention due to their good acceptance by the elderly.     

Utilización del servicio de urgencia de un hospital universitario por los adultos mayores en Santiago de Chile

Introduction

An increase in visits to Emergency Departments by older adults has been reported, but there are no data available on this in countries in the early phases of demographic and epidemiological transition. This paper describes the characteristics of people over 60 years-old (AM) who visited the Emergency Department of the Hospital Clínico Universitario de la Pontificia Universidad Católica, Chile (SU-PUC), compared to those less than 60 years-old (AJ).

Material and methods

Demographic data and reasons for admission and re-admission were collected retrospectively from the SU-PUC monthly statistics report. Obstetrics, paediatrics and «scheduled admissions» were excluded. The frequencies were compared using Chi-squared (significance: P < .05).

Results

A total of 37,660 visits to the SU-PUC were recorded (81% AJ; 19% AM; with 8% being older than 75 years). No statistical differences were found in the visit time (70% daytime), or by season between the groups.A total of 7,414 (19.6%) of those who visited were hospitalised, with differences being detected between groups (AM: 48.9% vs 12.9% AJ; P < .001), particularly in those over 75 years (59%). The primary cause of admission was cardiopulmonary in AM (22%) and gastrointestinal in AJ (31%). Re-admissions were 10% in AM and 6% in AJ (P < .001).

Conclusion

The use of SU by AM and some characteristics of their care process (hospitalisation) are similar to those found in countries in more advanced phases of demographic transition.     

Síntomas depresivos en adultos mayores participantes de una universidad abierta a la tercera edad

Introduction

Although depressive disorders prevalence among older adults usually is less than in the younger population, the presence of significant symptoms of depression is common in elderly people. Studies show that taking part in social, educational and pleasure activities is associated with a reduction in depressive symptoms in this population. The purpose of this study was to examine the prevalence of depressive symptoms above the elderly participants of a Third Age Open University, taking the time taking part as a reference.

Material and methods

A cross-sectional design was implemented, with a participation of 95.2% (n = 140) of the total enrolled in the first trimester of 2009 in the activities of the Third Age Open University of the Schools of Arts, Sciences and Humanities of the University of São Paulo. They all answered a socio-demographic questionnaire and the Geriatric Depression Scale (GDS-15).

Results

The prevalence of depressive symptoms found was 3.57%. The statistical analysis showed a relationship between participation formore than one semester in the Third Age Open University and a lower index of depressive symptoms (p < .05).

Conclusions

Participating for longer than one academic semester is associated with less depressive symptoms, possibly being a protector factor against depression.     

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.     

Factores asociados a la polifarmacia en población anciana no institucionalizada. Análisis de la submuestra de la Encuesta Nacional de Salud 2006 para personas mayores de Castilla y León

Background

The increase in chronic and degenerative diseases in the elderly leads to increased and multiple drug usage, which in turn leads to problems associated with adverse reactions and drug interactions.

Material and methods

We analysed the subsample of the National Health Survey 2006, for adults over 65 living in Castile-León (n = 458). Using a logistic regression model and correlation analysis the variables having more influence on polypharmacy were evaluated.

Results

A total of 86% of those interviewed claimed to be taking drugs and 93.9% had a chronic illness. The most common health problems included arthrosis, arthritis or rheumatism (53.5%) and hypertension (48.3%), and most frequently used drugs were hypotensives (45%), pain medications (37.1%) and those for rheumatism (21.4%). Both the mean number of illnesses suffered and the drugs consumed are significantly higher in those who claimed to have, “or or fair health, used the health services, had impaired eyesight and hearing, dependent for personal care and domestic tasks, and mobility (P < .05). The variables associated with polypharmacy are three or more chronic diseases (OR = 18.3), regular-poor self perceived health (OR = 3.4) and females (OR = 1.9).

Conclusions

Given the magnitude of the problem it would be appropriate to include a review of the medications in health examinations of the elderly, particularly in women older than 75 years, with regular or self-perceived poor health and who have 3 or more diseases.     

Resultados preliminares de un programa comunitario de prevención de caídas: estudio Precari (prevención de caídas en La Ribera)

Objective

To evaluate the results of a fall prevention programme designed to be applied to the elderly living in the community.

Material and methods

The sample consisted of 249 participants ≥70 years of age, who were randomly assigned to one of three groups. The monthly intervention group (GIM): instructions on fall prevention and healthy exercises to improve physical function and balance at beginning of the study, and a monthly theoretical and practical refresher session. The quarterly intervention group (GIT), with the same beginning intervention and a refresher session every three months. The control group (GC), the same beginning intervention but no refresher sessions.

Results

The mean age of the sample was 74.47 years (SD 5.33), with 64% women. The incidence of falls was reduced from 0.64 per patient year in the previous year to 0.39 in the post-intervention year in GIM, from 0.49 to 0.47 in GIT, and in the GC it remained at 0.47 before and twelve months after, but with no significant differences in the reduction between groups (P=.062). At the end of the study there was a decrease in Rizzo scale of 0.72 points (95% CI: 0.57-0.88, P<.001).

Conclusion

An interdisciplinary community intervention programme can contribute to reducing the incidence of falls. Further studies are required to continue research into the incidence of falls in the elderly living in the community.     

Paraneoplastic syndrome in mice bearing high-angiogenic variant of Lewis lung carcinoma: relations with tumor derived VEGF

Background

It is well-known that tumor exerts nonmetastatic systemic effect on organism caused the development of paraneoplastic syndrome (PNS). Recent findings point to relationships between development of PNS and tumor-derived vascular endothelial growth factor (VEGF).

Aim

Comparative study of PNS manifestations in mice with transplanted two variants of Lewis lung carcinoma with different angiogenic potential.

Methods

Plasma VEGF level was determined by immunoenzyme method, hematological indices were estimated with the use of hematological analyzer, the weight and cellularity of spleen and thymus were registered and histological analysis of tissue section of these organs was performed.

Results

Manifestations of anemia, extramedullary hemopoiesis and tumor-associated inflammatory disease was observed in animals with high angiogenic LLC/R9 variant and was not registered in low angiogenic LLC. The emergence of PNS symptoms correlated with elevated level of circulating VEGF at the early stages of LLC/R9 growth.

Conclusion

Manifestation of the paraneoplastic hematological syndrome most likely is conditioned on the ability of cancer cell to secrete VEGF in a high rate.     

Evaluación breve del estado cognitivo de la demencia en estadios avanzados: resultados preliminares de la validación española del Severe Mini-Mental State Examination

Introduction

The cognitive assessment of patients with advanced dementia needs proper screening instruments that allow obtain information about the cognitive state and resources that these individuals still have. The present work conducts a Spanish validation study of the Severe Mini Mental State Examination (SMMSE).

Material and methods

Forty-seven patients with advanced dementia (Mini-Cognitive Examination [MEC]<11) were evaluated with the Reisberg's Global Deterioration Scale, MEC, SMMSE and Severe Cognitive Impairment Profile scales.

Results

All test items were discriminative. The test showed high internal ( α = 0.88), test-retest (0.64 to 1.00, P < .01) and between observers reliabilities (0.69-1.00, p < 0.01), both for scores total and for each item separately. Construct validity was tested through correlations between the instrument and MEC scores (r = 0.59, P < 0.01). Further information on the construct validity was obtained by dividing the sample into groups that scored above or below 5 points in the MEC and recalculating their correlations with SMMSE. The correlation between the scores in the SMMSE and MEC was significant in the MEC 0-5 group (r = 0.55, P < .05), but not in the MEC>5 group. Additionally, differences in scores were found in the SMMSE, but not in the MEC, between the three GDS groups (5, 6 and 7) (H = 11.1, P < .05).

Conclusions

The SMMSE is an instrument for the assessment of advanced cognitive impairment which prevents the floor effect through an extension of lower measurement range relative to that of the MEC.From our results, this rapid screening tool and easy to administer, can be considered valid and reliable.     

Características de la fractura de cadera y posterior recuperación en pacientes mayores de 65 años con historia de caídas recurrentes

Recurrent falls affect between 14.8% and 19% of the elderly population, and are associated with an increased risk of fracture. We know little about the influence the history of recurrent falls may have on recovery after hip fracture.

Methods

Cohort study. The patients included were, over 65 years admitted during a 1 year period to the General University Hospital of Albacete with a hip fracture due to a fall. Recurrent falls were defined as a history of two or more falls within the 6 months prior to the fracture. Variables: demographic data, circumstances of fall, number of falls in the previous 6 months, type of fracture and its repair, comorbidity and drug treatment, cognitive status at admission (Pfeiffer test) and independence for activities of daily living (Barthel Index - BI) were collected. A subsample of patients with pre-fracture BI≥60 and Pfeiffer at admission≤4 was followed up at 3, 6 and 12 months.

Results

A total of 335 patients were admitted. Data were collected on 279 of them, 19.4% of whom had previously suffered two or more falls. The recurrent fallers had a worse mental status on admission, a higher number of associated diseases, a lower percentage of independence in dressing and in bed-chair transferring than patients without history of recurrent falls, all statistically significant. In the 201 patients followed up, the impairment on the BI after 12 months compared to the BI previous to fracture was higher in recurrent fallers (-20.8 ± 31.54 vs -10.73 ± 20.21, P = .04), focusing more on independence in eating (76% vs 91.9%, P < .05), grooming (72% vs 91,9%, P < .01), faecal continence (60% vs 78.7%, p < .05) and walking indoors (80% vs 93.3%, P < .05).

Conclusions

The recovery of independence after hip fracture is significantly lower in the group of recurrent fallers in patients without moderate or severe functional impairment previous to fracture and cognitively stable.