Abstract Introduction: Dementia in the elderly is one of the factors that most reduces the quality of life, together with the comorbidities that it entails, such as sleep disturbances. However, numerous studies point to a causal bidirectionality between these two factors. The aim of the study is to elaborate a systematic review of the available data base on the relationship between sleep disturbances and dementia. Methodology: The search sources were PubMed, Scopus and Cochrane, following the search strategy “((Dementia) OR (“ Alzheimer Disease “)) AND ((“ Sleep Wake Disorders “) OR (circadia *) OR (“ sleep disorders, intrinsic “) OR (“ Sleep Disorders “) OR (“Circadian Rhythm”) OR (“Circadian Clocks”) OR (“sleep disorders, circadian rhythm”) OR (“circadian dysregulation”))”and according to the inclusion / exclusion criteria, 35 articles were extracted. Results: The literature reviewed supports the feedback relationship between sleep disturbances and dementia. Amyloid-beta, characteristic of neurofibrillary plaques and tangles in Alzheimer disease, increases after sleep deprivation. Its accumulation is usually generated in the suprachiasmatic nucleus, the main regulator of the sleep-wake cycle and circadian rhythms. Conclusions: Sleep disturbances are possible predictors of AD and, for the most part, a modifiable factor of the severity and time of onset of the pathology. Both are interrelated in a mutual synergy.

Resumen Introducción: La demencia en la persona mayor es uno de los factores que más disminuye la calidad de vida, junto a las comorbilidades que conlleva, como las alteraciones del sueño. Sin embargo, numerosos estudios apuntan a una bidireccionalidad causal entre estos 2 factores. El objetivo del trabajo consiste en elaborar una revisión sistemática de las bases de datos disponibles acerca de la relación entre alteraciones en el sueño y la demencia. Metodología: Las fuentes de búsqueda fueron PubMed, Scopus y Cochrane. Se siguió la estrategia de búsqueda “((Dementia) OR (“Alzheimer Disease”)) AND ((“Sleep Wake Disorders”) OR (circadia*) OR (“sleep disorders, intrinsic”) OR (“Sleep Disorders”) OR (“Circadian Rhythm”) OR (“Circadian Clocks”) OR (“sleep disorders, circadian rhythm”) OR (“circadian dysregulation”))”, se atendieron a los criterios de inclusión/exclusión y se extrajeron 35 artículos. Resultados: La bibliografía revisada sustenta la relación de retroalimentación entre las alteraciones del sueño y la demencia. El beta-amiloide, característico de las placas y ovillos neurofibrilares en la enfermedad del Alzheimer, aumenta tras la privación de sueño, lo que, a su vez, suele generar acúmulo en el núcleo supraquiasmático, principal regulador del ciclo sueño-vigilia y de los ritmos circadianos. Conclusiones: Las alteraciones del sueño son posibles predictores de la enfermedad del Alzheimer y, en su mayor parte, son un factor modificable de la gravedad y tiempo de inicio de la patología. Ambos se interrelacionan en una sinergia mutua.

ABSTRACT Introduction: Frailty, understood as a state of vulnerability and prediscapability in the geriatric patient, is associated with a significant increase in the risk of morbidity and mortality, and with it an important impact on the quality of life and functionality of elderly with chronic diseases and/or degenerative. In this sense, it has been verified how physical exercise appears as an optimal non-pharmacological tool to preserve and / or improve the quality of life of the elderly. Objectives: To analyze the influence of the practice of multicomponent physical exercise in improving the frailty state of the elderly enrolled in maintenance gym classes. Methods: Crosssectional and analytical study that evaluated (pre- and postprogram) the level of frailty, physical condition and vital signs of 118 elderly people. All participants received 12-week multicomponent physical exercise training 3 hours a week, lasting one hour. Results: Data show improvement in physical condition after the intervention program regardless of the starting physical level. On the other hand, a decrease in the number of pre-fragile people was observed after the program. Conclusions: Multicomponent physical exercise programs optimize quality of life, improve health, and prevent frailty in the elderly.

RESUMEN Introducción: La fragilidad, entendida como un estado de vulnerabilidad y prediscapacidad en el paciente geriátrico, lleva asociada un aumento significativo del riesgo de morbimortalidad y, con ello, un impacto importante en la calidad de vida y la funcionalidad de las personas mayores con enfermedades crónicas y/o degenerativas. En este sentido, se ha constatado como el ejercicio físico aparece como una herramienta óptima no farmacológica para preservar y/o mejorar la calidad de vida de las personas mayores. Objetivos: Analizar la influencia de la práctica de ejercicio físico multicomponente en la mejora del estado de fragilidad de las personas mayores inscritas en clases de gimnasia de mantenimiento. Metodología: Estudio transversal y analítico que evaluó (pre- y posprograma) el nivel de fragilidad, la condición física y las constantes vitales de 118 personas mayores. Todos los participantes recibieron un entrenamiento de ejercicio físico multicomponente durante 12 semanas con una frecuencia de 3 días por semana con 1 h de duración. Resultados: Los datos muestran mejora en la condición física tras el programa de intervención con independencia del nivel físico de partida. Por otro lado, se observó una disminución del número de personas prefrágiles tras el programa. Conclusiones: los programas de ejercicio físico multicomponente optimizan la calidad de vida, mejoran la salud, y previenen la fragilidad de las personas mayores.

SUMMARY Shift work increases the risk of suffering physiological and psychological alterations, due to the sleep disorders that it usually produces in the staff with this type of workday. OBJECTIVE: Analyze the influence of shift work on sleep quality in the nursing staff of the emergency department of the University Hospital of Leon. METHODS: A total of 70 emergency department nurses aged between 24-56 years were divided into two groups (rotating shift and fixed morning or afternoon shift). The Pittsburgh sleep quality index was used for this purpose. In order to establish differences between the two groups, a bivariate analysis was performed using the χ² test. RESULTS: The results showed that both groups had “rather poor” subjective sleep quality, with scores of 8.5 for fixed shift versus. 6.3 for a rotating shift. The group of nurses’ rotating shifts slept an average of 5.39 hours compared to 7.47 hours for a fixed shift. Significant differences were found in sleep latency, sleep disturbances, and the use of sleep medication, with more negative results for the rotating shift. CONCLUSIONS: Rotating shift produces a poor quality of sleep compared to a fixed morning or afternoon shift, and it would be interesting for the center itself to establish sleep improvement and sleep hygiene programs.

Abstract Introduction: Delirium is considered one of the great geriatric syndromes due to the impact on the behavior of patients and the confusion and frustration that it causes in professionals and family members. Objective: identify and describe the predictors of the risk of developing delirium in hospitalized octogenarian patients with hip fracture. Methodology: prospective cohort study carried out with a sample of 287 ortho-geriatric patients (87.2 ± 3.2 years), recruited from the Traumatology Unit of the University Hospital of León (Spain). Predisposing, precipitating and risk factors were included, including sociodemographic, baseline, surgical, pharmacological comorbidities and complications variables. Results: the results of the study show that the presence of anemia, ASA (in category 3-4), cognitive impairment, UTI, visual disturbances and RAO, variables, in this order, can be considered as predictive variables of delirium in hospitalized octogenarian patients with fracture of hip. Conclusion: this study shows that the type of predictive factors that most impact the development of delirium could be controlled from the moment the patient is hospitalized. Therefore, it is possible to minimize the effect of confusion that usually causes this syndrome in patients, family members, and health professionals.

Resumen Introducción: El delirium es considerado como uno de los grandes síndromes geriátricos por el impacto sobre el comportamiento de los pacientes y el desconcierto y frustración que origina en los profesionales y familiares. Objetivo: identificar y describir los factores predictores del riesgo de desarrollar delirium en pacientes octogenarios hospitalizados con fractura de cadera. Método: estudio de cohorte, prospectivo realizado con una muestra de 287 pacientes (87.2 ± 3.2 años) ortogeriátricos reclutados de la Unidad de Traumatología del Hospital Universitario de León (España). Se incluyeron factores predisponentes, precipitantes y de riesgo que incluyen variables sociodemográficas, basales, quirúrgicas, farmacológicas, comorbilidades y complicaciones. Resultados: la presencia de anemia, ASA (en categoría 3-4) deterioro cognitivo, ITU, alteraciones visuales y RAO, por este orden, pueden ser consideradas como variables predictivas del delirium en pacientes octogenarios hospitalizados con fractura de cadera. Conclusión: el tipo de factores predictivos que más impactan en el desarrollo del delirium podrían ser controlados desde el mismo momento de la hospitalización del paciente. Por consiguiente, es posible minimizar el efecto de desconcierto que ocasiona habitualmente el cuadro en pacientes, familiares y sanitarios.

RESUMO OBJETIVO: Determinar boas práticas para a recuperação da ambulação de octogenárias posterior à alta hospitalar após cirurgia por fratura da pelve. METODOLOGIA: Um estudo prospectivo realizado no segundo semestre de 2019 com 192 mulheres (85,95 ± 5,1 anos) com fratura da pelve. O histórico médico, tipo de fratura, complicações, tratamento cirúrgico, e avaliação do nível de ambulação foram registrados antes da alta hospitalar e após seis meses. RESULTADOS: De todas as pacientes, 100 viviam com a família e 92 em alguma instituição, 68.2% tinham fratura peritrocantérica e uma média de 3,7 comorbidades; todas receberam anastesia espinhal e ficaram internadas por 11,4 dias em média. Após seis meses, as pacientes apresentaram uma perda significativa da independência funcional em relação à situação anterior à fratura, tanto em relação à capacidade de ambulação e atividades cotidianas. É importante ressaltar que o prognóstico negativo em relação à recuperação da ambulação está relacionado a níveis intermediários de ambulação e que o nível funcional de saída tem menor influência do que o local onde a recuperação é feita. CONCLUSÃO: A idade é um fator que influencia a recuperação de fraturas da pelve. Porém, há outros fatores com influência, já que as pacientes que ficam com familiares têm um prognostico funcional melhor do que aquelas que se recuperam em instituições, após seis meses da alta hospitalar.

SUMMARY OBJECTIVE: Determine good recovery practices for ambulation of octogenarian women after hospital discharge after being operated on for hip fracture. METHODS: Prospective study during the second half of 2019, with 192 women (85.95 ± 5.1 years) with hip fracture. A medical history, fracture types, complications, surgical treatment, and assessment of the level of ambulation were recorded before and after six months of hospital discharge. RESULTS: 100 patients lived in the family home and 92 in an institutional center, 68.2% provided pertrochanteric fracture and a total of 3.7 comorbidities, all of them received spinal anesthesia and were admitted an average of 11.4 days. After six months, the patients showed a significant loss of functional independence with respect to the situation prior to the fracture, both for the ability to wander and for activities of daily living. It is noteworthy that the worst prognosis in the recovery of ambulation has to do with intermediate levels of ambulation and that the functional level of departure influences to a lesser extent than the place where they perform the recovery. CONCLUSIONS: Age is a factor that influences the recovery of hip fracture, but there are other influential factors since patients who remain in the family home have a better functional prognosis than those who recover in institutionalized centers, after six months of hospital discharge.

Abstract Objective: To identify the main clinical, functional and cognitive characteristics of hospitalized octogenarian women diagnosed with hip fracture at the University Hospital of León (Spain). In addition, to determine the influence home, to which patients are transferred upon discharge from the recovery from wandering. Method: Prospective descriptive pilot study cross-sectional analysis of the physiological characteristics of hospitalized older women with a diagnosis of hip fracture at the Hospital de León. Results: It included 96 women with an average age of 85.95 ± 5.1 years. The total number of comorbidities presented by patients was 3.7. The most common type of fracture frequent was the pertrochanteric. All patients worsened with respect to the capacity of basal wandering, finding the greatest differences in those who were institutionalized as opposed to those who remained at their usual residence. Conclusions: The address to which patients are transferred when they are discharged from hospital is a determining factor in the recovery of mobility and independence of themselves. In this regard, it is important to note that the usual practice of institutionalisation of older people after a hip fracture is associated with a worse recovery.

Resumen Objetivo: Identificar las principales características clínicas, funcionales y cognitivas de las mujeres octogenarias hospitalizadas con diagnóstico de fractura de cadera en el Hospital Universitario de León (España). Además, determinar la influencia del domicilio, al que se trasladan los pacientes al recibir el alta hospitalaria en la recuperación de la deambulación. Método: Estudio piloto prospectivo descriptivo transversal que analiza las características fisiológicas de mujeres mayores hospitalizadas con diagnóstico de fractura de cadera en el Hospital de León. Resultados: Se incluyeron 96 mujeres con una edad media de 85,95 ± 5,1 años. El número total de comorbilidades presentadas por las pacientes fue de 3,7. El tipo de fractura más frecuente fue la pertrocantérica. Todos los pacientes empeoraron respecto a la capacidad de deambulación basal, encontrando las mayores diferencias en los que fueron institucionalizados frente a los que permanecieron en su residencia habitual. Conclusiones: El domicilio al que se trasladan los pacientes al recibir el alta hospitalaria es un factor determinante para la recuperación de la movilidad e independencia de los mismos. En este sentido, es importante señalar que la práctica habitual de institucionalización de las personas mayores después de una fractura de cadera se asocia con una peor recuperación.

Social and sanitary professionals are overwhelmed by the growing demand of services. This fact calls for the creation of terapeutical formulas promoting the active implication of users with their own health. Objective: Observe the level of prosocial communication among social and health professionals while interacting with seniors in either medical consultation or leisure supervision. Metodology: 4 observers have assessed the prosociability of 20 social and sanitary professionals. The evaluation tool was the Test of Best Practices for Prosocial Communication, designed and developed by our own research team. It includes 9 factors related to prosocial competence and 22 items related to specific behaviours and attitudes. Results: The sanitary centers and professionals exhibit higher prosocial scores. While sanitary centers take care of users on a personal basis, social centers handle users on a groupal basis. Conclusions: More research is required on strategies to incorporate prosocial conducts under groupal attention. The study manifests that more training is needed on prosocial competence in order to aminorate the expert role, which is dominant among professionals in this study.

Los profesionales sociales y de la salud están desbordados ante la creciente demanda de servicios, lo que requiere crear fórmulas dirigidas a una implicación más activa de los usuarios en su propia salud. Objetivo: diseñar un cuestionario de prosociabilidad y aplicarlo a profesionales del ámbito social y sanitario en vivo. Metodología: Cuatro observadores valoraron la prosociabilidad de 20 profesionales que interaccionaban con mayores en situación de consulta y/o actividades de ocio. La herramienta de evaluación fue un Cuestionario de buenas prácticas de comunicación prosocial, elaborado por nuestro equipo. Nueve factores relacionados con la competencia prosocial fueron observados mediante 22 ítems de conductas y actitudes. Resultados: los centros y profesionales de la salud emplean más la prosociabilidad, posiblemente ya que atienden de forma personalizada, mientras que centros y profesionales sociales atienden grupalmente. Conclusiones: Se precisan más investigaciones sobre cómo incorporar conductas prosociales en atención grupal. Además, se necesita más entrenamiento de competencias prosociales para disminuir el estilo de rol de experto, dominante entre los profesionales del estudio.