[Changes in the incidence of falls in an intermediate and long-term care center]

Clinical effectiveness of an intermediate care inpatient model based on integrated care pathways

AIM

The aim of this study was to compare the clinical impact of two intermediate care pathways.

METHODS

A prospective, uncontrolled before-after study was carried out to compare two non-synchronic intermediate care frameworks in Spain. Participants in the control group were transferred to the intermediate care center by hospital request, whereas those in the intervention group (Badalona Integrated Care Model [BICM]) were transferred based on a territory approach considering the assessment of an intermediate care team. The clinical characteristics of study participants were assessed at admission and discharge.

RESULTS

Compared with participants in the control group, those in the BICM group were significantly older (mean age 81.6 years [SD 10.3] vs 78.3 years [10.1], P < 0.001) and had a lower Barthel score (mean score 32.8 [SD 25.9] vs 39.9 [28.4]; P < 0.001), and a higher proportion of participants with total dependence (38.4% vs 32.2%; P = 0.001). The length of stay in intermediate care was similar in both groups; however, stay in acute care was significantly shorter in the BICM group than in the control group (mean 21 days [SD 19.5] vs 25 days [SD 23]; P < 0.001). No significant differences were found regarding the Barthel Index at discharge, although participants in the BICM group had significantly higher functional gain.

CONCLUSIONS

The implementation of a territory-based integrated care pathway in an intermediate care center shifted the profile of admitted patients toward higher complexity. Despite this, patients managed under the integrated care model reduced their dependency and the referral rate to an acute unit during their stay in the intermediate care center. Geriatr Gerontol Int 2020; 20: 366-372.

[Complexity and prevalence of geriatric syndromes in patients treated in intermediate care units in Catalonia: A multicentre study of XARESS project]

BACKGROUND

Descriptive study is presented on the complexity and prevalence of geriatric syndromes (GS) in Intermediate Care Units in Catalonia.

METHODS

A retrospective study was conducted on 6471 stays completed during the year 2014 in the participating centres of the XARESS network. Data was obtained by extracting the information routinely collected on the CMBD-RSS registry (Minimum Basic Dataset for the Intermediate Care Resources). The prevalence and associations between geriatric síndromes (resource group) RG category, length of stay, and destination at discharge is described. Results were stratified by type of unit (convalescence or long stay).

RESULTS

Participants presented a median of 3 GS at admission in long stay units, and 2 GS at admission in convalescence units. The number of GS varied with RG category, although in all RG categories, there were patients without complexity (no SG), and patients with extreme complexity (up to 9 GS). Patients with geriatric syndromes had a longer mean length of stay and greater dependence than patients without syndromes, although with great variability across GS. However, the presence of geriatric syndromes had no impact on the destination at discharge.

CONCLUSIONS

The population cared for in intermediate care units have high complexity and a high prevalence of geriatric syndromes at admission. The CMBD-RSS registry allows the characterisation of complexity of the population admitted to the Catalan convalescence and long term intermediate care units.

[New integrated care model for older people admitted to Intermediate Care Units in Catalonia: A quasi-experimental study protocol]

OBJECTIVE

To evaluate the clinical effectiveness of an intermediate care model based on a system of care focused on integrated care pathways compared to the traditional model of geriatric care (usual care) in Catalonia.

PATIENTS AND METHODS

The design is a quasi-experimental pre-post non-randomised study with non-synchronous control group. The intervention consists of the development and implementation of integrated care pathways and the creation of specialised interdisciplinary teams in each of the processes. The two groups will be compared for demographic, clinical variables on admission and discharge, geriatric syndromes, and use of resources.

DISCUSSION

This quasi-experimental study, aims to assess the clinical impact of the transformation of a traditional model of geriatric care to an intermediate care model in an integrated healthcare organisation. It is believed that the results of this study may be useful for future randomised controlled studies.

Cross-cultural adaptation of the STRATIFY tool in detecting and predicting risk of falling

AIMS

To adapt to Spanish language the STRATIFY tool for clinical use in the Spanish-speaking World.

METHOD

A multicenter, 2 care settings cross-sectional study cultural adaptation study in acute care hospitals and nursing homes was performed in Andalusia during 2014. The adaptation process was divided into 4 stages: translation, back-translation, equivalence between the 2 back-translations and piloting of the Spanish version, thus obtaining the final version. The validity of appearance, content validity and the time required to complete the scale were taken into account. For analysis, the median, central tendency and dispersion of scores, the interquartile range, and the interquartile deviation for the possible variability in responses it was calculated.

RESULTS

Content validity measured by content validity index reached a profit of 1. For the validity aspect the clarity and comprehensibility of the questions were taken into account. Of the 5 questions of the instrument, 2 had a small disagreement solved with the introduction of an explanatory phrase to achieve conceptual equivalence. Median both questions were equal or superior to 5. The average time for completion of the scale was less than 3 minutes.

CONCLUSION

The process of adaptation to Spanish of STRATIFY has led to a semantic version and culturally equivalent to the original for easy filling and understanding for use in the Spanish-speaking world.

[Association between limited joint mobility syndrome and risk of accidental falls in diabetic patients]

INTRODUCTION

Limited joint mobility syndrome (LJMS) appears exclusively in both type 1 and type 2 diabetic patients. It is characterized by a limited range of digital motion, with involvement of small joints of the hands. It initially affects the proximal interphalangeal joints, followed by wrists, elbows, shoulders, knees, and axial skeleton. The diagnosis can be made by the simple "prayer sign" test. The objective was to study the prevalence of diabetic patients with LJMS, and to evaluate the association between LJMS and metabolic control, and the risk of accidental falls.

PATIENTS AND METHODS

A cross-sectional study was conducted in the San Fernando II Health Centre, Madrid (suburbs). The sample consisted of 184 patients with a diagnosis of diabetes of over 5 years from November to March, 2013. The prayer sign was used to define which patients had LJMS. Fall risk was determined using the Timed Up & Go test.

RESULTS

A total of 99 patients (53.8%) (95% CI 46.6 to 61) had a positive prayer sign. No statistically significant relationship was found with HbA1c, but there was an association with the Timed Up & Go test (P<.001) (95% CI 1.173 to 1.611). The patients with LJMS had a moderate risk of falls compared with those without LJMS, which was of low risk.

CONCLUSIONS

The prevalence of LJMS is high. This is the first study that shows a relationship between LJMS and the risk of falls in diabetic patients.

Ocorrência de quedas em idosos não institucionalizados: revisão sistemática da literatura

Revisão sistemática da literatura com o objetivo de identificar a ocorrência de quedas de idosos residentes na comunidade. Utilizando o portal CAPES, realizou-se busca nas bases de dados Academic Search (EBSCO), SciELO e Science Direct (ELSEVIER); e uma busca adicional na base de dados Lecturas Educación Física y Deportes, do site EFDEPORTES. Foram encontrados, com os descritores utilizados, 247 artigos publicados no período de 2000 a 2011. Foram excluídos 230 que não atenderam a um ou mais dos critérios de inclusão. Incluíram-se no estudo 17 artigos, sendo 12 transversais, dois de coorte prospectiva, dois de pesquisa de base populacional e um de coorte retrospectiva. A amostra total envolvida nos estudos foi de 114.911 sujeitos, com média de idade de aproximadamente 70 anos, distribuídos em sete países: Brasil, Estados Unidos, Espanha, Itália, Nigéria, Turquia e China. A ocorrência de quedas variou de 15,9 a 56,3%, com mediana de 28,50%. Embora apresente variação, a ocorrência de quedas na população idosa que reside na comunidade é alta.