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.     

Predictores de mala salud autopercibida en una población de personas mayores

Introduction

Self-Rated Health is part of the comprehensive concept of Quality of Life and is a valid measurement of health status. The main objective of this study was to test the predictive value of some different variables on the poor Self-Rated Health among elders.

Material and methods

We performed a cross-sectional study on a sample consisting of 140 participants. Measurements: age, gender, level of education, environment, cognitive status, physical impairment, diseases, health perception and social support. The influence of the studied variables on the poor Self-Rated Health was performed with a logistic regression analysis and a ROC curve to establish the cut-off values for these variables with the best sensitivity and specificity to predict the poor Self-Rated Health.

Results

A poor Self-Rated Health was significantly associated with age, comorbidity, and the perception of poor functional social support, whereas no association was found with gender, environment and educational level.

Conclusions

Old age, the number of diagnosed diseases, and functional social support are Self-Rated Health risk factors, while the characteristics and repercussions of the diseases should not be considered.     

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.     

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.     

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.     

Resiliencia en cuidadores de personas con demencia: estudio preliminar

Introduction

Caring for a relative with dementia often has negative effects on the caregive?s physical and psychological health. However, many caregivers successfully cope with the stress factors arising from care, and even have uplifts during their experience, showing high resilience levels. This study presents a preliminary analysis of resilience in caregivers of patients with dementia, exploring its relationship with different variables.

Material and methods

Resilience was assessed (by CD-RISC) in 53 family caregivers of patients with dementia. Resilience was correlated to the following variables: caregiving context, stressors (e.g., cognitive impairment), appraisals (e.g., burden), moderators (e.g., personality traits and resources), and caregiving consequences (physical and psychological health).

Results

The participants showed moderate scores on resilience. Resilience was associated with poor emotional and physical status (significant inverse correlations with anxiety, depression, psycho-active drug use, health habits…). High resilience scores were significantly correlated to burden, neuroticism and extraversion, self-efficacy, self-esteem and less use of emotion focused coping strategies.

Conclusions

Higher resilience relates to a good emotional and physical status in caregivers. Moreover, resilience is more associated with caregiver variables (e.g., appraisal and coping with care, personality features), than to situational variables. The data highlight the strengthening of these types of appraisal and coping as a way to improve caregivers’ resilience and, consequently, their health.     

Detección de disfagia en mayores institucionalizados

Objective

To determine the prevalence of dysphagia in a population of institutionalised elderly people, and the effectiveness of a clinical method for its detection.

Methodology

A prospective study was conducted on a random sample of elderly residents. A clinical evaluation along with an assessment with different volumes and viscosities (MECVV) were used. Specific care and follow up was arranged following this assessment.

Results

Forty residents were studied. The prevalence of unrecognised dysphagia was 42.5%. Following assessment by the MECVV, the prevalence rose from 22.5% to 65% (P=.012). Dysphagia detected by MECVV was related to nutritional risk, as measured by the Mini-Nutritional Assessment (MNA) (P=.007), and to the diagnosis of dementia (P=.028).

Conclusions

The diagnosis of dysphagia in this sample of institutionalised elderly people increases when applying a clinical method for detection, reaching a prevalence similar to other studies.     

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.     

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.     

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.     

Planificación anticipada de decisiones en las enfermedades crónicas avanzadas

Introduction

Advanced care planning (ACP) helps in make decisions on the health problems of people who have lost the capacity for informed consent. It has proven particularly useful in addressing the end of life. The aim of this study was to determine the prevalence of ACP in patients with severe chronic diseases.

Material and methods

Review of medical records of patients with dementia, amyotrophic lateral sclerosis, Parkinson's disease, chronic obstructive pulmonary disease or interstitial lung disease, heart failure, chronic kidney disease on dialysis and cancer, all in advanced stages. We collected data on living wills or registered prior decisions by the physician according to clinical planned.

Results

A total of 135 patients were studied. There was a record of ACP in 22 patients (16.3%). In most of them it was planned not to start any vital treatment in the event of high risk of imminent death and lacking the ability to make decisions. Only two patients were had a legal living will.

Conclusion

The registration of ACP is relatively low, and this can affect decision-making in accordance with the personal values of patients when they do not have the capacity to exercise informed consent.     

Trasplante renal en mayores de 60 años en un hospital de Colombia

Introduction

Kidney transplantation is the treatment of choice in patients with end- stage renal disease. Renal transplantation in without fear of ethical conflicts is the best treatment option in the elderly. The objective is to describe the demographic and clinical characteristics of patients over 60 years old with at least one year of renal transplantation in a single center of Colombia.

Methods

This is a cohort study of patients over 60 years old from a single center in Bogota, Colombia. About 28 patients were analyzed between June 2004 and March 2012.

Results

The mean age was 65 years old, with 89% males. The main cause of chronic kidney disease was diabetic nephropathy, followed by hypertensive nephrosclerosis. Most of them (96.4%) were deceased donor transplants with a mean age of 40 years old, cold ischemia time was 12 hours and there was a mismatch of 3.25 (±1.29). Major comorbidities were hypertension, diabetes, dyslipidemia, and coronary arterial disease. Almost 17% had delayed graft dysfunction. Serum creatinine at 6 and 12 months was 1.27 mg/dl (±0.31) and 1.25 mg/dl (±0.33), respectively. Only 10% of patients had acute cellular rejection. Humoral rejections were not documented. The patient survival at 1 year was 89.7%, and death-censored graft survival was 96.4%. The most frequent cause of death was acute myocardial infarction.

Conclusions

Proper selection of kidney transplant recipients shows satisfactory results in survival, with low morbidity in patients older than 60 years.     

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.     

Características y manejo del cáncer de mama primario en pacientes octogenarias: estudio retrospectivo

Background

The number of elderly patients with breast cancer is increasing, and a large proportion of these older patients do not receive conventional treatment. Clinical and biological characteristics of tumours at this age and survival according to local or systemic therapy were analysed.

Material and method

A total of 96 consecutive early breast cancer patients over 80 years of age diagnosed in our Unit between January 2002 and September 2008 were retrospectively investigated. Of them, 54 underwent surgery with or without adjuvant hormonal treatment, and 42 received primary hormonal therapy.

Results

Tumours of patients 80 years old or older had more favourable biological characteristics, including expression of steroid receptors, and absence of c-erb B2 expression. Overall survival was 50 months for the group subjected to surgery, and 44 months for the group who did not undergo surgery. The survival free of local recurrence in the surgery group was 44 months, whereas it was 18 months in the non-surgery group.

Conclusion

In a cohort of patients aged 80 years and older, survival was similar in those who received hormonal or surgical therapy, although the former had a shorter period of progression-free survival or local recurrence.