Carmen María Sarabia-Cobo

The incidence and prognostic implications of dysphagia in elderly patients institutionalized: A multicenter study in Spain

AIM Determine the incidence of dysphagia, identify its consequences and objectify related complications and mortality associated with pneumonia, in the institutionalized elderly. METHODS A prospective observational and multicenter study with a 3-year follow-up period was designed in a cohort of 12 nursing homes within 6 cities in Spain. A total of 2384 patient records were studied. Demographic and clinical data (dementia, cerebrovascular disease), as well as an evaluation of the Barthel Index, dysphagia and aspiration, and mortality at 30 days and 1 year after pneumonia in patients with dysphagia were collected. RESULTS Of the 2384 patients, 69.6% presented clinical signs of oropharyngeal dysphagia. Patients with dysphagia were older and showed lower functional status and higher prevalence of comorbidities. They had higher mortality as well. CONCLUSIONS Oropharyngeal dysphagia is a highly prevalent clinical finding in elderly institutionalized patients. Among this population, there is also a higher prevalence of pneumonia, dementia, and cerebrovascular disease and pneumonia is an indicator of mortality.

Heart coherence: a new tool in the management of stress on professionals and family caregivers of patients with dementia.

We describe a stress management intervention intended to reduce the damage and stress impact on the heart physiology and function of a group of caregivers (professional and non-professional) who work with patients with dementia. The intervention consisted in applying heart coherence techniques in a population of 72 caregivers of patients with dementia (42 professional and 29 non-professional caregivers) who had high scores in heart stress and burden tests. Six months after the training they were able to generate appropriate patterns of heart coherence, with a statistically significant decrease in their heart overload. We conclude that training in techniques of heart coherence and positive psychology had effective results on the stress management of the participant caregivers. This was a simple, inexpensive technique with lasting results. To our knowledge this is the first research in Spain studying the application of heart coherence techniques to caregivers of people with dementia.

Skilful communication: Emotional facial expressions recognition in very old adults

OBJECTIVES The main objective of this study was to assess the changes associated with ageing in the ability to identify emotional facial expressions and to what extent such age-related changes depend on the intensity with which each basic emotion is manifested. METHODS A randomised controlled trial carried out on 107 subjects who performed a six alternative forced-choice emotional expressions identification task. The stimuli consisted of 270 virtual emotional faces expressing the six basic emotions (happiness, sadness, surprise, fear, anger and disgust) at three different levels of intensity (low, pronounced and maximum). The virtual faces were generated by facial surface changes, as described in the Facial Action Coding System (FACS). RESULTS A progressive age-related decline in the ability to identify emotional facial expressions was detected. The ability to recognise the intensity of expressions was one of the most strongly impaired variables associated with age, although the valence of emotion was also poorly identified, particularly in terms of recognising negative emotions. CONCLUSIONS Nurses should be mindful of how ageing affects communication with older patients. In this study, very old adults displayed more difficulties in identifying emotional facial expressions, especially low intensity expressions and those associated with difficult emotions like disgust or fear.

Emotional processing in patients with mild cognitive impairment: The influence of the valence and intensity of emotional stimuli: The valence and intensity of emotional stimuli influence emotional processing in patients with mild cognitive impairment

UNLABELLED We studied the ability of individuals with mild cognitive impairment (MCI) to process emotional facial expressions (EFEs). To date, no systematic study has addressed how variation in intensity affects recognition of the different type of EFEs in such subjects. DESIGN Two groups of 50 elderly subjects, 50 healthy individuals and 50 with MCI, completed a task that involved identifying 180 EFEs prepared using virtual models. Two features of the EFEs were contemplated, their valence (operationalized in six basic emotions) and five levels of intensity. RESULTS At all levels of intensity, elderly individuals with MCI were significantly worse at identifying each EFE than healthy subjects. Some emotions were easier to identify than others, with happiness proving to be the easiest to identify and disgust the hardest, and intensity influenced the identification of the EFEs (the stronger the intensity, the greater the number of correct identifications). Overall, elderly individuals with MCI had a poorer capacity to process EFEs, suggesting that cognitive ability modulates the processing of emotions, where features of such stimuli also seem to play a prominent role (e.g., valence and intensity). Thus, the neurological substrates involved in emotional processing appear to be affected by MCI.

Continuing Education in Patient Safety: Massive Open Online Courses as a New Training Tool.

OBJECTIVES Describe the use of two massive open online courses designed to provide education on patient safety. Review follow-up evaluation data from the courses. DISCLOSURE STATEMENT: Neither the planners nor the authors have any conflicts of interest to disclose. BACKGROUND The Nursing School of the University of Cantabria conducted a training session on patient safety through two massive open online courses (MOOCs) aimed at the general population and especially Spanish-speaking health professionals. This study aimed to analyze the profile of health professionals who have completed the courses, their degree of satisfaction, and the percentage of completion. METHOD In this retrospective and observational study, two MOOCs on clinical safety were created through an online platform (MiríadaX). Quantitative analysis of the profile of health professionals, their degree of satisfaction, and the percentage of completion was performed. RESULTS A total of 12,400 students were enrolled, and the average completion rate was 32%. The profile of the average student was female, 37 years old, college educated, a nurse in a hospital, and interested in the course because it may be useful for performing her work. Fifty-five percent of students were very satisfied with the course. CONCLUSION MOOCs are considered to be effective and easily accessible, with quality content for professional continuing education that encourages interdisciplinary work and meeting professionals from around the world.

Changing negative stereotypes regarding aging in undergraduate nursing students.

OBJECTIVE The aim of this study was to explore the modification of stereotypes and myths regarding aging among third-year nursing students before and after undergoing an Aging Nursing course. METHOD A within-subject repeated-measures descriptive study was conducted. The Negative Stereotypes Questionnaire about Aging (CENVE) was used. RESULTS The overall prevalence of negative stereotypes was 62.0% pre-intervention (P1) and 12.3% post-intervention (P2) measured; these values were 63.5% (P1) and 9.2% (P2) for the health factor, 43.1% (P1) and 4.9% (P2) for the motivation and social factors and 58.3% (P1) and 3.8% (P2) for the character-personality factor. Paired Students t tests confirmed that the differences were statistically significant. CONCLUSIONS There was a high prevalence of negative stereotypes toward aging among the nursing students, even though they had conducted clinical practice and were in their third year. The course was demonstrated to be effective in modifying these stereotypes. The proper training of future professionals markedly contributes the dispensation of proper care and the eradication of ageism, which remains prevalent in the healthcare system.

Emotional intelligence and coping styles: An intervention in geriatric nurses

Current research indicates a relationship between EI, stress, coping strategies, well-being and mental health. Emotional intelligence skills and knowledge, and coping strategies can be increased with training. OBJECTIVE The aims of this study were to use a controlled design to test the impact of theoretically based training on the different components of EI and coping styles in a sample of nurses working with older adults. METHODS A group of 92 professionals (RN and CAN) who attended a workshop on EI were included in the study. They completed a self-reported measure of EI and coping styles on three occasions: pre- and post-workshop and at one year follow-up. The EI workshop consisted of four 4-h sessions conducted over a four-week period. Each session was held at the one-week interval. This interval allowed participants to apply what was taught during the session to their daily life. The instruments to measure the EI and coping were the Trait Meta-Mood Scale and the CAE test. RESULTS There were significant differences between the pre- and post-workshop measures both at the end of the workshop and up to one year for both the Trait Meta-Mood Scale scores and the CAE test. There was a significant increase in the EI and coping styles after the workshop and one year thereafter. CONCLUSION The workshop was useful for developing EI in the professionals. The immediate impact of the emotional consciousness of individuals was particularly significant for all participants. The long-term impact was notable for the significant increase in EI and most coping styles.

Apathy and Leukoaraiosis in Mild Cognitive Impairment and Alzheimer's Disease: Multicenter Diagnostic Criteria according to the Latest Studies

Aims: The aim is to study the prevalence and possible relationship of apathy and leukoaraiosis in cases of cognitive impairment of varying severity in Spain. Methods: We conducted a cross-sectional, descriptive, multicenter study involving 109 patients with Alzheimers disease (AD) and 59 with mild cognitive impairment (MCI). Results: The older group with AD had a higher prevalence of leukoaraiosis and apathy, with significant differences compared to the MCI group. Conclusions: To our knowledge, this is the first multicenter study in our country that jointly analyzes the presence of apathy and leukoaraiosis in the institutionalized elderly with varying degrees of cognitive impairment according to the most recent criteria for detecting apathy in dementia.

Validation of the Spanish Version of the ICECAP-O for Nursing Home Residents with Dementia

Background Measurement of health-related quality of life (HRQoL) is important for a chronic disease, such as dementia, which impairs the quality of life of affected patients in addition to their length of life. This is important in the context of economic evaluations when interventions do not (only) affect HRQoL and these other factors also affect overall quality of life. Objective To validate the Spanish translation of the ICECAP-O’s capability to measure Health-related quality of life in elderly with dementia who live in nursing homes. Method Cross-sectional study. For 217 residents living in 8 Spanish nursing homes, questionnaires were completed by nursing professionals serving as proxy respondents. We analyzed the internal consistency and other psychometric properties. We investigated the convergent validity of the ICECAP-O with other HRQoL instruments, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer’s Disease Related Quality of Life (ADRQL) measures, and the Barthel Index measure of activities of daily living (ADL). Results The ICECAP-O presents satisfactory internal consistency (alpha 0.820). The factorial analysis indicated a structure of five principal dimensions that explain 66.57% of the total variance. Convergent validity between the ICECAP-O, EQ-5D+C, ADRQL, and Barthel Index scores was moderate to good (with correlations of 0.62, 0.61, and 0.68, respectively), but differed between dimensions of the instruments. Discriminant validity was confirmed by finding differences in ICECAP-O scores between subgroups based on ADL scores (0.70 low, 0.59 medium, and 0.39 high level care), dementia severity (0.72 mild, 0.63 medium, and 0.50 severe), and ages (0.59 below 75 years and 0.84 above 75 years). Conclusions This study presented the first use of a Spanish version of the ICECAP-O. The results indicate that the ICECAP-O appears to be a reliable Health-related quality of life measurement instrument showing good convergent and discriminant validity for people with dementia.

Variables to Predict Mortality in Hip Fractures in Patients Over 65 Years of Age: A Study on the Role of Anticoagulation as a Risk Factor.

The objective of this research was to study the possible relationship between the consumption of dicoumarinic agents (understanding the consumption of acenocoumarol as regulated and monitored anticoagulation) and the mortality rate in people older than 65 years undergoing a hip fracture (HF) intervention. It was a retrospective, observational and descriptive study. Nine hundred fifty-seven patients were included who underwent an intervention for HF between the years 2012 and 2014 in a third-level hospital. Patients took acenocoumarol (16.1%), which compared with nonanticoagulated patients took longer in receiving intervention, they remained hospitalized for more days, and they presented greater mortality within the first year after the intervention. Likewise, those who presented greater risk according to the classification system used by the American Society of Anesthesiologists (ASA) to estimate the risk of anesthesia for the different states of the patients who were anticoagulated also suffered greater mortality. The next factors increased the mortality in the first year: advanced age, delayed surgery, male sex, need for transfusion, high international normalized ratio, consumption of acenocoumarol, and a high ASA risk. We concluded the consumption of acenocoumarol increased the risk of mortality within the first year after surgery in 1.3 of possible cases. Other risk factors that also independently increased the risk of mortality included advanced age, male sex, delayed surgery, the need for transfusions, and surgical risk (for high levels in the ASA classification).