BackgroundThere is growing evidence that home telemonitoring can be advantageous in societies with increasing prevalence of chronic diseases.The main objective of this study is to evaluate the effect of a primary care-based telemonitoring intervention on the number and length of hospital admissions.MethodsA randomised controlled trial was carried out across 20 health centres in Bilbao (Basque Country, Spain) to assess the impact of home telemonitoring on in-home chronic patients compared with standard care. The study lasted for one year. Fifty-eight in-home patients, diagnosed with heart failure (HF) and/or chronic lung disease (CLD), aged 14 or above and with two or more hospital admissions in the previous year were recruited. The intervention consisted of daily patient self-measurements of respiratory-rate, heart-rate, blood pressure, oxygen saturation, weight, body temperature and the completion of a health status questionnaire using PDAs. Alerts were generated when pre-established thresholds were crossed. The control group (CG) received usual care. The primary outcome measure was the number of hospital admissions that occurred at 12 months post-randomisation. The impact of telemonitoring on the length of hospital stay, use of other healthcare resources and mortality was also explored.ResultsThe intervention group (IG) included 28 patients and the CG 30. Patient baseline characteristics were similar in both groups. Of the 21 intervention patients followed-up for a year, 12 had some admissions (57.1%), compared to 19 of 22 controls (86.4%), being the difference statistically significant (p = 0.033, RR 0.66; 95%CI 0.44 to 0.99). The mean hospital stay was overall 9 days (SD 4.3) in the IG versus 10.7 (SD 11.2) among controls, and for cause-specific admissions 9 (SD 4.5) vs. 11.2 (SD 11.8) days, both without statistical significance (p = 0.891 and 0.927, respectively). Four patients need to be telemonitored for a year to prevent one admission (NNT). There were more telephone contacts in the IG than in the CG (22.6 -SD 16.1- vs. 8.6 -SD 7.2-, p = 0.001), but fewer home nursing visits (15.3 -SD 11.6- vs. 25.4 -SD 26.3-, respectively), though the difference was not statistically significant (p = 0.3603).ConclusionsThis study shows that telemonitoring of in-home patients with HF and/or CLD notably increases the percentage of patients with no hospital admissions and indicates a trend to reduce total and cause-specific hospitalisations and hospital stay. Home telemonitoring can constitute a beneficial alternative mode of healthcare provision for medically unstable elderly patients.Trial registrationCurrent Controlled Trials ISRCTN89041993

BackgroundThe adequate information about the functional capacity of elderly populations is a key for the comprehensive assessment of their health status and autonomy. The Lawton IADL (instrumental activities of daily living) Scale is a very often used scale to assess independent living skills, but has never been validated for its use in Spanish-speaking populations. The purpose of this study was to assess the validity, the reliability, and responsiveness of this widely used scale.MethodsThe validation was based on a prospective cohort of 1,965 patients aged 65 or over who suffered an accidental fall with a hip or wrist fracture as a result. These patients were followed up six months after the production of the fracture. Cronbach’s alpha was used to assess reliability, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) for the construct validity. Convergent and discriminant validity were examined by the correlation of the IADL Scale with the Barthel Index, SF-12, WOMAC short form, and QuickDASH questionnaires. Known-groups validity was also studied comparing IADL Scale according to different groups, and responsiveness was assessed by means of effect sizes.ResultsThe mean age was 80.04 years (SD 8.04). The Cronbach alpha coefficient was 0.94. In the EFA, factor loadings ranged from 0.67 to 0.90, and CFA confirmed the homogeneity of the construct. Regarding the convergent validity, all correlation coefficients were higher than 0.40. Significant differences were found according to different groups, supporting known-groups validity. Responsiveness parameters showed moderate to large changes (effect sizes, 0.79 and 0.84 among patients classified as worsened).ConclusionsThese results confirm that the Spanish version of the Lawton IADL Scale has excellent reliability and validity and a moderate to large sensitivity to change. This study provides a proper validation, not only of the Spanish version of the Lawton IADL Scale, but also of the original instrument.

Background: The adoption of a healthy lifestyle, including physical activity, a healthy diet, moderate alcohol consumption and abstinence from smoking, is associated with a major decrease in the incidence of chronic diseases and mortality. Primary healthcare (PHC) services therefore attempt, with rather limited success, to promote such lifestyles in their patients. The objective of the present study is to ascertain the perceptions of clinicians and researchers within the Basque Health System of the factors that hinder or facilitate the integration of healthy lifestyle promotion in routine PHC setting.

BackgroundA restriction in functional capacity occurs in all hip fractures and a variety of factors have been shown to influence patient functional outcome. This study sought to provide new and comprehensive insights into the role of factors influencing functional recovery six months after an accidental hip fracture.MethodsA prospective cohort study was conducted of patients aged 65 years or more who attended the Emergency Room (ER) for a hip fracture due to a fall. The following were studied as independent factors: socio-demographic data (age, sex, instruction level, living condition, received help), comorbidities, characteristics of the fracture, treatment performed, destination at discharge, health-related quality of life (12-Item Short Form Health Survey) and hip function (Short Western Ontario and McMaster Universities Osteoarthritis Index). As main outcome functional status was measured (Barthel Index and Lawton Instrumental Activities of Daily Living Scale). Data were collected during the first week after fracture occurrence and after 6 months of follow-up. Patients were considered to have deteriorated if there was worsening in their functional status as measured by Barthel Index and Lawton IADL scores. Factors associated with the outcome were studied via logistic regression analysis.ResultsSix months after the fall, deterioration in function was notable, with mean reductions of 23.7 (25.2) and 1.6 (2.2) in the Barthel Index and Lawton IADL Scale scores respectively. Patients whose status deteriorated were older, had a higher degree of comorbidity and were less educated than those who remained stable or improved. The multivariate model assessing the simultaneous impact of various factors on the functional prognosis showed that older patients, living with a relative or receiving some kind of social support and those with limited hip function before the fall had the highest odds of having losses in function.ConclusionIn our setting, the functional prognosis of patients is determined by clinical and social factors, already present before the occurrence of the fracture. This could make it necessary to perform comprehensive assessments for patients with hip fractures in order to identify those with a poor functional prognosis to tackle their specific needs and improve their recovery.

BackgroundHealth-related quality of life (HRQL) is a key indicator of elderly people’s health status that can be affected by different factors. However, little is known about which variables are associated with it in functionally independent elderly people. The aim of this project was to study HRQL and a wide variety of health, lifestyle, social and contextual aspects and their relation to HRQL in a sample of functionally independent, non-cognitively impaired community-dwelling adults, over 65 years of age, from a northern region of Spain.MethodsA cross-sectional study for which data was collected by face-to-face interviews with the selected individuals. HRQL was measured with the EuroQol-5D scale, consisting of a 5 item descriptive system and a visual analogue scale (VAS). VAS values lower than 70 were considered poor HRQL. Binary logistic regression was used to identify factors related to the outcome.ResultsSix hundred and thirty-four individuals were included in the study. The mean age was 74.8 (SD 6.7) years, 55% of the participants were women and 46% rated their HRQL as poor. Several variables were found to be significantly associated with a poor HRQL in the multivariate model, adjusted for age and sex: polypharmacy (OR: 2.32, 95% CI: 1.62–3.31), the presence of sensory impairment (OR: 1.83, 95% CI: 1.24–2.69), not being engaged in cognitively stimulating activities (OR: 2.51, 95% CI: 1.03–6.16), or in group social activities (OR: 1.57, 95% CI: 1.11–2.22), low level of social support (OR: 3.12, 95%CI: 1.78–5.46) and the presence of obstacles in the closest home environment (OR: 1.83, 95%CI: 1.11–3.02).ConclusionsThe study identified a set of health, social and contextual variables as strongly related to HRQL in functionally independent community-dwelling older people. The results highlight the multidimensional nature of HRQL. They also reveal the importance of a comprehensive assessment of HRQL when designing adequate health-related programmes aiming to enhance active and healthy ageing and delay the onset of dependence.

The great variety and characteristics of instruments identified in this review confirm the complexity and multidimensionality of the effects of elderly caregiving on the informal carer's life and explain the difficulties to assess these effects in practice. According to the classification provided, caregiver burden and emotional and mental health are the most evaluated dimensions. However, further work is required to develop integrated and caregiving focused procedures that can appraise this complexity across different countries and cultures.

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BackgroundSelf-perceived health (SPH) is a powerful indicator of the health status of elderly people. This issue has been widely studied in oldest populations considering altogether functionally independent and dependent individuals. The objective of this study was to describe SPH and to identify the main factors that have an impact on SPH in a sample of functionally independent community-dwelling older adults.MethodsFor this cross-sectional study, face-to-face interviews were carried out with non-institutionalized functionally independent older individuals in a northern region of Spain. Participants were asked: “Overall, you would say that your health is excellent, very good, good, fair or poor?”. SPH responses were grouped in two categories: good and poor. Binary logistic regression was used to identify factors associated with poor SPH.ResultsA sample of 634 individuals was studied, of whom 55 % were women. The mean age was 74.8 (SD 6.7) years. About 18 % of the respondents rated their health as poor. In the multivariate model adjusted for age and sex, reported poor health was significantly associated with polypharmacy (≥3 drugs per day) (OR: 5.76, 95 % CI: 3.60–9.18), the presence of sensory impairment (OR: 1.87, 95 % CI: 1.15–3.04), bad sleep quality (OR:1.82, 95 % CI: 1.02–3.28), a bad nutrition pattern (OR: 2.37, 95 % CI: 1.08–5.21), not engaging in cognitively stimulating activities (OR: 4.08, 95 % CI: 1.64–10.20), or group social activities (OR: 2.62, 95 % CI: 1.63–4.23).ConclusionsThe study indicates that several health and social variables are strongly related to SPH in independent community-dwelling older adults. This finding highlights the need for thorough assessment of factors related to SPH in older independent adults, this being essential to develop health-related programmes for promoting active and healthy ageing and to delay the onset of dependence in this population.