Search

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.

The coronavirus disease 2019 (COVID-19) produces severe respiratory symptoms such as bilateral pneumonia associated to a high morbidity and mortality, especially in patients of advanced age. Vitamin D deficiency has been reported in several chronic conditions associated with increased inflammation and dysregulation of the immune system. Vitamin D in modulates immune function too. Vitamin D receptor (VDR) is expressed by most immune cells, including B and T lymphocytes, monocytes, macrophages, and dendritic cells and the signalling of vitamin D and VDR together has an anti-inflammatory effect. Some studies have reported that vitamin D treatment could be useful for the prevention and treatment of COVID-19 because vitamin D plays an important role as a modulator of immunocompetence. Over the last few months, some studies have hypothesized the possible beneficial effect of vitamin D supplementation in patients with COVID-19 in order to improve the immune balance and prevent the hyperinflammatory cytokine storm. Some preliminary studies have already shown promising results with vitamin D supplementation in hospitalized COVID-19 patients. Vitamin D should be administered daily until adequate levels are achieved due to vitamin D behaves as a negative acute phase reactant (APR). Despite the lack of evidence on specific doses of vitamin D to treat COVID-19 in older adults, authors consider it is necessary to standardize the use in clinical practice. These recommendations advice supplement vitamin D in a protocoled fashion based on expert opinions, level of evidence 5.

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.

A number of subjects aged over 65 suffer from some kind of chronic pain. The constant growth of this demographic group makes research of new and efficacious treatment strategies necessary. Transdermal buprenorphine has shown to be a safe and efficacious pharmacotherapy for patients with moderate to severe chronic pain in clinical trials. This paper provides the outcome of this drug in routine clinical practice.A prospective, uncontrolled observational study that included a 3-month follow-up of patients starting transdermal buprenorphine was performed. Information was collected systematically on pain relief, quality of life (EuroQol-5D questionnaire), comfort of patch use and adverse events. Missing data were imputed by theworst case.Out of 1,188 patients with known age, 564 were under 65, 337 were between 65 and 75, and 287 were over 75 years. Within these respective age groups, 63.9%, 66.3% and 67.7% of patients showedgoodorvery goodpain relief; 60.4%, 60.7% and 65.2% showed improvement of sleep quality; and the mean increases of the score of the EuroQol-5D visual analogue scale were 16.0 mm, 15.8 mm and 16.8 mm. Drug-related adverse events were reported in 39.6%, 35.4% and 31.9% of patients, respectively.This study performed in the routine-care setting supports the findings from previous randomised controlled clinical trials of transdermal buprenorphine.