Background: For effective prevention and intervention, and reduction of dependency, it is essential to determine the presence of frailty in the community.
Objectives: To describe the prevalence of ...frailty among elderly persons living independently, in two primary healthcare areas in Spain; to identify factors correlated with its presence.
Methods: This descriptive cross-sectional study was conducted between May 2015 and July 2016 among non-institutionalized individuals aged ≥70 years living in the primary healthcare areas of Gipuzkoa and Costa del Sol (Spain). The main outcome variable was the prevalence of frailty (determined by modified Fried criteria). The independent study variables were sociodemographic characteristics, anthropometric data and health-related life habits.
Results: The study population consisted of 855 individuals (53% women). The overall prevalence of frailty was 26.2% (Gipuzkoa 14.2%, Costa del Sol 38.0%). Using multiple logistic regression, the following factors were associated with frailty: female sex (OR: 1.98; 95%CI: 1.37-2.86); cumulative illness rating scale (OR: 1.05; 95%CI: 1.00-1.10); self-perceived health status (OR: 0.96; 95%CI: 0.95-0.97); self-perceived unhealthy lifestyle (OR: 3.37; 95%CI: 2.05-8.87); dissatisfaction with the domestic environment (OR: 2.11; 95%CI: 1.18-3.76); and cognitive impairment (OR: 4.10; 95%CI: 2.05-8.19). In the multivariable model, 'geographical area' differences persisted, with an OR of 3.51 (95%CI: 2.29-5.36) for the Costa del Sol area, using Gipuzkoa as reference.
Conclusion: In this population of community-dwelling persons aged 70 years and over, the prevalence of frailty was 26%. Factors correlated with frailty were female sex, comorbidity, poorer self-perceived lifestyle and health status, and dissatisfaction with the domestic environment.
•The Tilburg Frailty Indicator structure was tested by confirmatory factor analysis.•Certain physical domain items do not appear to fit well the postulated model.•Considerable test-retest variation ...was observed.•The social context of the target population is an aspect to consider.•Current results were compared to previous findings, giving a better insight on the TFI properties.
The Tilburg Frailty Indicator (TFI) is a 15-item scale. It diagnoses frailty in the elderly based on three domains: physical, psychological and social. A Spanish cross-cultural adaptation and its psychometric properties are presented here.
Independent, non-institutionalized ≥70 year-olds were recruited. The TFI structure was assessed with Kuder-Richardson (KR-20) and confirmatory factor analyses. Sperman´s correlations (rs) with Timed Up-and-Go, Self-assessed-health, Fried criteria, Short Physical Performance Battery, Gerontopole Frailty tool, assessed convergent validity. Known groups’ validity and test-retest reliability were tested.
Based on n = 856 participants, domain and total scale KR-20 were <0.70. The social domain and certain physical items did not fit adequately. Most physical and total scalers were 0.31-0.48. Social domain rs were <0.30. The TFI differentiated frail and no-frail subjects, but test-retest variation was considerable.
TFI applicability at different social contexts and frailty stages are worth of additional study. Certain scale aspects should be reconsidered.
IntroductionThis project focuses on how frailty is addressed in primary healthcare (PHC) and will evaluate the effectiveness of a multifactorial intervention (considering the appropriateness of the ...pharmaceutical prescription, the nutritional care provided and the exercise intervention) for persons with frailty, in terms of improving their functional capacity and reducing the incidence of adverse events related to frailty. The final evaluation will be made at 12 months’ follow-up.Methods and analysisPragmatic multicentre cluster randomised controlled clinical trial, single blind with two arms: multifactorial intervention in PHC versus usual follow-up. The randomisation unit is the patient list and the analysis unit is the patient. In addition, a cost-effectiveness study and a qualitative study will be carried out, the latter based on semistructured interviews and focus groups. Two hundred persons (100 per study branch) all aged ≥70 years, presenting frailty, but functionally independent and resident in the community, will be recruited. A baseline evaluation will be carried out prior to the intervention, with follow-up at 6 and 12 months. The main study variables considered will be functional capacity and incidence of adverse events; the secondary variables considered will be the patients’ sociodemographic characteristics, nutritional status, level of physical activity and drug consumption, together with data on comorbidity, cognitive and affective status and health-related quality of life. Data will be analysed according to the intention-to-treat principle using a 5% significance level.Ethics and disseminationThe study will at all times be conducted in strict accordance with the provisions of the Declaration of Helsinki and with the national legislation regulating patients’ autonomy. All patients recruited will be asked to provide written informed consent before taking part in the clinical trial. On completion of the study, the principal investigator expects to publish the results of this research in a peer-reviewed open access scientific journal.Trial registration numberISRCTN17143761.
The need of home care services is becoming an increasingly common scenario. These cares are mainly provided by the dependents' relatives specifically, by the women part of the family. This situation ...might take years, decreasing the physical and psychological health of the caregiver. In Spain, the Act of Promotion of Personal Autonomy and Care for dependent persons, guarantees those dependent persons and their caregivers to have access to social services or to financial grants. The aim of this study is to Know the possible effects of the benefits provided by this Act in regards to the mental health, the quality of life and use of health services by the family caregivers assisting their relatives in situation of dependency.
A longitudinal descriptive study following-up a cohort of patients and caregivers. The study shall be carried out in Andalusia. It shall include the baseline assessment of the variables in those caregivers free from the exposure factor (reception of assistance pursuant to the Act). Following, once the benefits have been received, this cohort shall be followed-up.The study shall take three years, and the starting date for its development as well as its funding is January 2011.
The longitudinal assessment of the rate of change of the variables studied shall allow us to know the implications which might be potentially generated as well as the natural evolution of those.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In the last few years several indices and tools, aimed at identifying frail subjects in various care settings have been developed. However, to date none of them has been incorporated into usual ...practice in the primary care setting. The purposes of this study are: 1) to evaluate the predictive capacity of the Tilburg Frailty Indicator (TFI), the Gérontopôle Frailty Screening Tool (GFST) and the KoS model together with two biomarker levels (SOX2 and p16INK4a) for adverse events related to frailty; 2) to determine differences in the use of healthcare services according to frailty.
Prospective multicentre cohort study with a 2-year follow-up. The study will be performed in primary care centres of Gipuzkoa and Costa del Sol, both located in Spain. Autonomous, non-institutionalized individuals aged 70 and over that agree to participate in this study will constitute the study population. A total of 900 individuals will be randomly selected from the healthcare administrative data bases of the participating health services. Data will be collected at baseline and at 1 and 2 years. The main independent variables assessed at baseline will be TFI outcomes, GFST and the KoS model, together with the expression of SOX2 and p16INK4a levels. During follow-up, loss of autonomy, the occurrence of death and consumption of healthcare resources will be assessed.
The main focus of this work is the identification and evaluation of several instruments constructed under different rationales to identify frail subjects in primary care settings. The resulting outcomes have potential for direct application to the primary care practice. Early identification of the onset of functional impairment of elderly is an essential, still unresolved aspect in the prevention of dependence in the scope of primary care.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Resumen Objetivo Evaluar la validez y la fiabilidad del cuestionario de «Conocimientos y actitudes de los profesionales sanitarios en el proceso de declaración de voluntades vitales anticipadas» ...(VVA). Diseño Estudio transversal en 3 fases: a) pilotaje con cuestionario administrado en papel para valorar pérdidas y problemas de ajuste del cuestionario; b) valoración de la validez y fiabilidad interna del cuestionario, y c) evaluación de la estabilidad (test-retest) del cuestionario filtrado de la fase previa. Emplazamiento Área Sanitaria Costa del Sol (Málaga). Enero de 2014 a abril de 2015. Participantes Profesionales sanitarios del Distrito de Atención Primaria Costa del Sol y la Agencia Sanitaria Costa del Sol. Contestaron 391 (23,6%). Cien participaron en la evaluación de la estabilidad (83 respuestas). Mediciones principales El cuestionario constaba de 2 bloques: a) Conocimientos (5 dimensiones y 41 ítems), y b) Actitudes (2 dimensiones y 17 ítems). Resultados En el estudio piloto, en ningún ítem las perdidas superaron el 10%. En la fase de evaluación de la validez y la fiabilidad, el cuestionario se redujo a 41 ítems (29 de conocimientos y 12 de actitudes). En la fase de evaluación de la estabilidad, todos los ítems evaluados, bien cumplieron criterio de kappa superior a 0,2, o tenían un porcentaje de acuerdo absoluto superior al 75%. Conclusiones El cuestionario permitirá identificar el estado y las áreas de mejora en el entorno sanitario, y posibilitar posteriormente una mejora de la cultura de las VVA en la población general.
New concerns have been raised in Iberoamérica regarding the effectiveness of universities, especially in terms of their quality. It is an undisputed premise that the management of university ...governance is one of the determining factors to improve administrative tasks and, from there, academic duties. The purpose of this work is to make an analysis based on the Agency Theory (AT) as an estimate that may help detect and correct management problems in university governance, understanding that it is a theoretical drift and not a doctrinal one. In order to achieve this purpose, more than a hundred texts and papers published in internationally recognized academic journals were reviewed. As relevant findings, it is possible to highlight the identification and reflection about determining elements and factors considered by the AT, which are applicable to the world of university management (GU, by its Spanish acronym). En Amérique Latine se sont suscitées des préoccupations au sujet de l'efficacité des universités, en particulier en ce qui concerne leur qualité. L'idée que la gestion de la gouvernance des universités est l'un des facteurs déterminants pour améliorer les tâches administratives et, à partir de là, les tâches académiques, est tenue pour une prémisse incontestable. Le but de cet article est d'entreprendre une analyse qui part de la théorie de l'agence (TA) comme une approche qui peut aider à découvrir et corriger les problèmes de gestion du gouvernement de l'Université, tout en comprenant qu'il s'agit d'une évolution théorique plutôt que doctrinale. À cette fin, on a procédé à réviser plus d'une centaine de textes et d'articles publiés dans des revues de prestige international. Comme des conclusions pertinentes, on peut remarquer l'identification et la réflexion autour d'éléments et de facteurs déterminants tenus en compte par la TA qui sont applicables dans le domaine de la gestion des universités (GU). Na Ibero-América surgiram preocupacöes com respeito à efetividade das universidades, especialmente quanto à sua qualidade. Possui como premissa inquestionável que a gestâo do governo universitario é um dos fatores determinantes para melhorar o trabalho administrativo e, a partir disso, as tarefas académicas. proposito deste trabalho é realizar uma análise a partir da teoria de agencia como urna aproximacäo que pode ajudar a detectar e corrigir problemas de gestäo do governo universitario, entendendo que se trata de urna deriva teorica e nao doutrinária. Para atingir este objetivo, procedeu-se a revisar mais de urna centena de textos e artigos publicados em revistas académicas de prestigio internacional. Como descobertas relevantes, destacam-se a identificaçāo e a reflexäo sobre elementos e fatores determinantes considerados pela TA, que sao aplicáveis ao mundo da gestáo universitária (GU). En Iberoamérica han surgido inquietudes con respecto a la efectividad de las universidades, particularmente respecto de su calidad. Se tiene como premisa indiscutida que la gestión del gobierno universitario es uno de los factores determinantes para mejorar el quehacer administrativo y, desde ahí, las tareas académicas. El propósito de este trabajo es realizar un análisis desde la teoría de agencia (TA) como una aproximación que puede ayudar a detectar y corregir problemas de gestión del gobierno universitario, entendiendo que se trata de una deriva teórica y no doctrinaria. Para lograr este propósito, se procedió a revisar más de un centenar de textos y artículos publicados en revistas académicas de prestigio internacional. Como hallazgos relevantes, se pueden destacar la identificación y la reflexión en torno a elementos y factores determinantes considerados por la TA, que son aplicables al mundo de la gestión universitaria (GU).
Resumen Objetivo Identificar áreas de interés subyacentes en el proceso de Declaración de Voluntades Vitales Anticipadas (DVVA) y consensuar un cuestionario de conocimientos y actitudes dirigido a ...profesionales de la salud. Diseño Estudio a través de técnica Delphi con método Rand. Dos fases: 1) propuestas de dimensiones: generación de ideas y posterior priorización de estas; 2) propuesta y priorización de ítems agrupados en bloques de conocimientos y actitudes. Desarrollado entre agosto de 2012 y enero de 2013. Emplazamiento El trabajo se realizó por contacto inicial telefónico con panelistas y posteriormente vía correo electrónico. Los panelistas pertenecen al Sistema Sanitario Público Andaluz. Participantes Los criterios para la selección de los 8 componentes del panel fueron los conocimientos y la experiencia en el ámbito de la autonomía del paciente en Andalucía. Resultados Se identificó en Conocimientos: 1.°A) aspectos legales/generales; 2.°A) definición conceptual; 3.°A) documentación normalizada de las voluntades vitales anticipadas; 4.°A) experiencia práctica; 5.°A) procedimiento y registro de las DVVA. El segundo bloque fueron de Actitudes: 1.°B) actitudes del profesional en el momento de la aplicación del DVVA en la práctica clínica; 2.°B) actitudes del profesional ante escenarios éticos «complejos». Los 7 panelistas que finalmente participaron propusieron 165 ítems. Tras aplicar los criterios de priorización, puntuación y selección de escenarios, se identificaron 58 (35,2%) ítems como escenario adecuado. Conclusiones El cuestionario propuesto recoge amplias parcelas de conceptos y contenidos, y una vez validado ayudará a medir las intervenciones formativas realizadas en profesionales sanitarios para la mejora del conocimiento y las actitudes sobre el entorno de las DVVA.
To identify the underlying interests of the Living Will Declaration (LWD) process and to determine the consensus, using a questionnaire, of the knowledge and attitudes of health professionals.
A ...study was performed in two phases using a Delphi technique with a Rand method. 1. Dimensions proposed: generation of ideas and their subsequent prioritizing; 2. Proposal and prioritizing of items grouped into blocks of Knowledge and Attitudes, developed between August 2012 and January 2013.
The work was carried out by initial telephone contact with panellists, and then later by the panellists belonged to the Andalusia Public Health System.
The criteria for selecting the eight components of the panel were knowledge and experience in the field of the freedom of the patient in Andalusia.
The Knowledge identified included: 1 A) Legal and general aspects; 2 A) A conceptual definition; 3 A) Standardised LWD documents: 4 A) Practical experience; 5 A) Procedure and registering of the LWDs. The second block included Attitudes: 1 B) Attitudes of the professional in the application of LWDs in clinical practice, and 2 B) Attitudes of the professional in «complex» ethical scenarios The 7 panellists who finally took part proposed 165 items. After applying the prioritizing criteria, scores, and scenario selection, 58 (35.2%) items were identified as suitable scenarios.
The proposed questionnaire included wide parcels of concepts and contents that, once validated, will help to measure the training interventions carried out on health professionals in order to improve knowledge and attitudes on the subject of LWDs.
PDF
