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A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a “nosocomiun”, i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below.

Objective: Acute pain is frequent and underestimated in older persons, especially when they suffer from cognitive impairment. Algoplus is an observational scale for acute pain evaluation, validated in French in older persons with communication disorders. We present the validation by an international expert team of the Algoplus scale in five languages: English, Spanish, Italian, Portuguese, and Turkish. Methods: A total of 181 older consecutive patients were included in five countries (Spain, Australia, Italy, Portugal, and Turkey). Test-retest and inter-rater reliabilities were determined by weighted kappa coefficient for each item and internal consistency by Kuder-Richardson-20 (KD). Results: Regarding test-retest reliability, the kappa coefficient for the five items ranged from 0.68 to 0.84. Inter-rater reliability kappa values ranged from 0.64 to 0.82. Internal consistency was indicated at a KD greater than 0.6. Satisfaction was good to excellent for all teams. Results show that reliability tests are good to excellent for all items of Algoplus. Conclusions: This study shows evidence that Algoplus is an acceptable, reproducible, reliable, and easy-to-use tool. It provides a unique opportunity to include the translated Algoplus scale in daily assessment of older persons with communication disorders in many countries.

Fundamento y objetivo Una importante proporcion de personas mayores de 65 anos experimenta algun tipo de dolor cronico. Debido al crecimiento demografico de este segmento de poblacion, es necesario investigar nuevas estrategias de tratamiento eficaces. Los estudios clinicos han mostrado que la buprenorfina por via transdermica es una farmacoterapia eficaz y segura en pacientes con dolor cronico de moderado a intenso. El presente estudio presenta resultados obtenidos en condiciones de practica clinica habitual. Pacientes y metodo Se ha realizado un estudio de postautorizacion observacional, prospectivo y no controlado, en el que se siguio durante 3 meses a pacientes que comenzaron tratamiento con buprenorfina transdermica. Se recogio informacion sistematica sobre el grado de alivio del dolor, la calidad de vida (mediante el cuestionario EuroQol-5D), el manejo del parche y los acontecimientos adversos. Los datos que faltaban se cubrieron empleando la estrategia del «peor caso». Resultados De los 1.188 pacientes con edad conocida, 564 tenian menos de 65 anos, 337 entre 65 y 75 anos, y 287 mas de 75 anos. En estos grupos de edad, un 63,9, un 66,3 y un 67,7%, respectivamente, presentaron alivio del dolor «bueno» o «muy bueno», y un 60,4, un 60,7 y un 65,2%, respectivamente, mejoria de la calidad del sueno. Los aumentos medios de puntuacion en la escala analogica visual del EuroQol-5D fueron de 16,0; 15,8, y 16,8 mm, respectivamente. Presentaron acontecimientos adversos relacionados con la buprenorfina el 39,6, el 35,4 y el 31,9%, respectivamente. Conclusiones Este estudio confirma, en condiciones de practica clinica habitual, los Resultados obtenidos con la buprenorfina transdermica en los ensayos clinicos aleatorizados y controlados.