OBJECTIVE: To assess the self-perceived quality of life of institutionalized adults with cerebral palsy and to identify factors that influence their well-being, including sociodemographic, clinical, and diagnostic characteristics, as well as the degree of institutionalization.
METHODS: A descriptive cross-sectional study was conducted using the San Martin Quality of Life Scale among adults with cerebral palsy. Data were collected in 2021 and 2022 in a sample of adults with cerebral palsy in Navarra, Spain. Multivariate regression was used to explore the relationship between quality of life and various influential factors.
RESULTS: The self-determination dimension positively influenced quality of life scores, whereas the social inclusion dimension had the opposite effect. Descriptive and regression analyses revealed that factors such as residing outside the city and a high degree of dependency had a negative influence on quality of life, while the degree of institutionalization had a positive impact.
CONCLUSIONS: It is important to highlight the positive effects of the degree of institutionalization on rehabilitation and well-being, as it seeks to enhance autonomy and social integration when talking about patient-centered models of institutionalization.

BACKGROUND: The objective of our study was to evaluate the long-term association between mortality and frailty in institutionalized patients in Mexico. Worldwide, there are limited lines of research in this population of geriatric patients and this entity generates a significant impact on the quality of life and prognosis of our patients.
METHODS: It is a prospective cohort study of 81 patients in long-term care who met the selection criteria. Frailty was determined using the FRAIL scale. Data on mortality were collected during the follow-up period, and diagnosis was monitored. The risk of presenting this event was determined by logistic regression, Kaplan-Meier, and Cox proportional hazards analysis, adjusted for age and sex.
RESULTS: The mean follow-up time of the patients was 36 months (1094 days), during which 33 subjects died (40.7%). In our population, at the beginning of the study the vast majority of frail patients had pathologies that independently generate risk of adverse events, disability (Barthel=30.9; SD 28.8), sarcopenia (n=40; 71.4%), one to 3 falls in the last year (n=17; 63%), ≥4 falls (n=4; 57.1%). Frail participants had a higher adjusted risk of mortality (HR 2.93; 95% CI 1.33-6.43; p=0.007).
CONCLUSIONS: The frailty entity is associated in the long term with mortality in institutionalized patients in Mexico. Timely treatment and approach may allow a good prognosis and quality of life.

BACKGROUND: It is necessary to analyze the aging process in institutionalized older people. For this purpose, a descriptive and analytical epidemiological study was carried out in nursing homes for older adults before the COVID-19 pandemic.
OBJECTIVE: Provide an in-depth insight into cognitive (MEC), emotional (Geriatric Depression Scale), and functional (Barthel Scale) status within the older adult participants.
METHODS: A sample of 973 participants analyzed the relationship between cognitive status, vulnerability to depression, and autonomous performance in Daily Day Activities (DDA) to predict the impact of the comorbidity of these variables. Therefore, in addition to the general distribution of the sample in the previously mentioned dimensions, differences were analyzed according to gender, age, educational level, and geographic area.
RESULTS: The results confirm the hypothesis that a more impaired cognitive state is associated with higher levels of depression and lower functional capacity. The MEC scores have positive and highly significant correlations with Barthel and Yesavage. The relationship between dementia and autonomy is observed for both sexes, while the relationship between dementia and depression is only observed in women. The educational level influences the MEC scores (the more education, the better performance) and the Barthel scores (the less education, the greater dependency). Statistically significant differences were also found depending on the area of residence location.
CONCLUSIONS: The more deteriorated cognitive state will be associated with a higher level of depression and lower functional capacity in daily life activities.

OBJECTIVE: The experience of family caregivers after nursing home admission has received much less attention, probably because many caregivers experience an initial sense of initial emotional relief. However, for some caregivers nursing home admission is a stressor despite the reduced physical burden of caregiving. Caregiver distress following institutionalization has been related to the new burdens and challenges encountered in the nursing home. Ambivalence and guilt related to the institutionalization decision have been identified as sources of stress. Therefore, this study examined the effect of guilt and well-being on the perceived stress of family caregivers of institutionalized dependent persons.
METHODS: Two hundred and one family caregivers of institutionalized persons in a nursing home (La Rioja, Spain) participated. Perceived stress, caregiving guilt and subjective well-being, sociodemographic and caregiving-related variables were assessed. Linear regression analyses and correlations between variables were performed.
RESULTS: Guilt and five dimensions of well-being (anxiety, vitality, self-control and depression, except general health) significantly predicted stress (R2adj=.552 (F (6, 198)=41.71, P<.001)). The effect size was large (95% CI=.461).
CONCLUSIONS: Paying attention to family caregivers\' feelings of guilt during institutionalization is important. This will enable the design and implementation of psychosocial interventions that improve caregiver adjustment immediately after institutionalization.

BACKGROUND: Hip fractures are very common injuries in elderly patients and are associated with increased mortality.
OBJECTIVE: To identify the factors associated with mortality in patients after one year of being operated for hip fracture in an Orthogeriatric Program.
METHODS: We design an observational analytical study in subjects older than 65 years admitted to the Hospital Universitario San Ignacio for hip fracture who were treated in the Orthogeriatrics Program. Telephone follow-up was performed one year after admission. Data were analyzed using a univariate logistic regression model and a multivariate logistic regression model was applied to control the effect of the other variables.
RESULTS: Mortality was 17.82%, functional impairment was 50.91%, and institutionalization was 13.9%. The factors associated with mortality were moderate dependence (OR=3.56, 95% CI=1.17-10.84, p=0.025), malnutrition (OR=3.42, 95% CI=1.06-11.04, p=0.039), in-hospital complications (OR=2.80, 95% CI=1.11-7.04, p=0.028), and older age (OR=1.09, 95% CI=1.03-1.15, p=0.002). The factor associated with functional impairment was a greater dependence at admission (OR=2.05, 95% CI=1.02-4.10, p=0.041), and with institutionalization was a lower Barthel index score at admission (OR=0.96, 95% CI=0.94-0.98, p=0.001).
CONCLUSIONS: Our results shows that the factors associated with mortality one year after hip fracture surgery were: moderate dependence, malnutrition, in-hospital complications and advanced age. Having previous functional dependence is directly related to greater functional loss and institutionalization.

BACKGROUND: Hip fractures are very common injuries in elderly patients and are associated with increased mortality.
OBJECTIVE: To identify the factors associated with mortality in patients after one year of being operated for hip fracture in an Orthogeriatric Program.
METHODS: We design an observational analytical study in subjects older than 65 years admitted to the Hospital Universitario San Ignacio for hip fracture who were treated in the Orthogeriatrics Program. Telephone follow-up was performed one year after admission. Data were analyzed using a univariate logistic regression model and a multivariate logistic regression model was applied to control the effect of the other variables.
RESULTS: Mortality was 17.82%, functional impairment was 50.91%, and institutionalization was 13.9%. The factors associated with mortality were moderate dependence (OR=3.56, 95% CI=1.17-10.84, p=0.025), malnutrition (OR=3.42, 95% CI=1.06-11.04, p=0.039), in-hospital complications (OR=2.80, 95% CI=1.11-7.04, p=0.028), and older age (OR=1.09, 95% CI=1.03-1.15, p=0.002). The factor associated with functional impairment was a greater dependence at admission (OR=2.05, 95% CI=1.02-4.10, p=0.041), and with institutionalization was a lower Barthel index score at admission (OR=0.96, 95% CI=0.94-0.98, p=0.001).
CONCLUSIONS: Our results shows that the factors associated with mortality one year after hip fracture surgery were: moderate dependence, malnutrition, in-hospital complications and advanced age. Having previous functional dependence is directly related to greater functional loss and institutionalization.

In order to know the social and health consequences of hip fractures (HF).
A retrospective cohort study of an entire health area was carried out in patients aged 75 or more, over a period of 5 years. SITE: Segovia Health Area.
All patients older than 75 years with a diagnosis of HF, excluding displaced and passerby.
The socio-sanitary changes that occur after the HF in respect to their baseline situation (family situation, comorbidities, dependence and mental situation) and the variables which most influence mortality and institutionalization after the HF were analyzed.
One thousand one hundred fifty-nine HF were recorded, with a constant annual incidence of 10.7‰. The prevalence was higher in women: 7.4% versus 3.7%.
The baseline profile is a pluripatological, non-institutionalized, 87-year-old woman, who retains her independent in her daily life and suffers from a HF due to an accidental fall in her home. At the end of the study period 51% were permanently institutionalized, negatively influencing having worse mental deterioration, worse dependence and subsequent readmissions and in addition, 45.5% died, 25.5% during the first year. The most unfavorable conditions were being previously dependent, having severe mental deterioration, male and within the comorbidities the most influential was previously having an anemia.
Our data confirms the deterioration of the autonomy-functional capacity after a HF, in line with what has been published, and has allowed to identify which elderly people are at the greatest risk of complications in the short and medium term (institutionalization and death).

The present pilot study focuses on the adaptive processes of babies who are placed during their first months of life. It used an ethological approach to explore the behavioural adjustment of 19 infants from their arrival in placement through their first 6 weeks in Residential Care (RC; France), a Foster Family (FF; Québec) or an Infant-Mother Centre (IMC; Québec). Direct observations were conducted once a week during feeding sessions. Observed behaviours were as follows: sleep-wake state, self-soothing, burp, visual exploration, motor activity, facial and vocal expressions. Then, a Kruskal-Wallis test was conducted to examine differences in babies\' adaption as a function of placement setting. Results showed that, in RC, the duration of the post-feeding phase is the shortest. Moreover, these institutionalized babies showed the most modes of self-protection and the fewest vocalizations. By contrast, babies placed in the IMC spent the least time in withdrawal, expressed motor activity more regularly and were never placed back in their recliner before burping. Larger differences appear comparing placement in RC and that in the IMC, the placement in FF showing intermediate results.
El presente estudio piloto se enfoca en los procesos adaptivos de los bebés que son colocados durante sus primeros meses de vida. El estudio utilizó un acercamiento etológico para explorar la adaptación de comportamiento de diecinueve infantes a partir de su llegada al lugar donde se les colocó y a lo largo de sus primeras seis semanas en cuidado residencial (Francia) o dentro de una familia que les dio acogida (Quebec), o en un centro de infante-madre (Quebec). Se llevaron a cabo observaciones directas una vez por semana durante las sesiones de alimentación. Los comportamientos observados fueron: el estado de dormir-despertar, el auto-calmarse, el eructo, la exploración visual, la actividad motora, las expresiones faciales y vocales. Luego, un examen Kruskal-Wallis se llevó a cabo para examinar las diferencias en la adaptación de los bebés como una función del escenario de colocación. Los resultados mostraron que, en el cuidado residencial, la duración de la fase posterior a la alimentación es la más corta. Es más, estos bebés colocados en instituciones mostraron más maneras de auto-protección y memos vocalizaciones. En contraste, los bebés colocados en el centro de infante-madre pasaron el menor tiempo en retracción, expresaron actividad motora más regularmente y nunca se les puso de vuelta en el sillón reclinable antes de los eructos. Diferencias mayores aparecen, comparando el lugar de colocación en cuidado residencial y en el centro de infante-madre, mientras que la colocación en familias que les acogen mostró resultados intermedios.
Cette étude pilote porte sur les processus d\'adaptation des bébés qui sont placés en famille durant les premiers mois de leur vie. Nous avons utilisé une approche éthologique afin d\'explorer l\'ajustement comportemental de dix-neuf nourrissons depuis leur arrivée en placement et au fil de leurs six premières semaines en soin résidentiel (en France) et en famille d\'accueil (au Québec) ou dans un centre nourrisson-mère (au Québec). Des observations directes ont été faites une fois par semaine durant les séances d\'allaitement. Les comportements observés étaient: l’état de sommeil-éveil, l\'auto-apaisement, le rot, l\'exploration visuelle, l\'activité motrice, les expressions faciales et vocales. Ensuite un test Kruskal-Wallis a été fait afin d\'examiner les différences dans l\'adaptation des bébés comme une fonction du contexte de placement. Les résultats ont montré qu\'en soin résidentiel la durée de la phase d\'après allaitement est la plus courte. De plus ces bébés placés en institution ont fait preuve du plus de modes d\'auto-protection et de moins de vocalisations. En contraste, les bébés placés en centre nourrisson-mère ont passé le moins de temps en sevrage, ont exprimé une activité motrice plus régulièrement et n\'ont jamais été remis dans leur siège inclinable avant le rot. On constate des différences plus importantes en comparant ces données entre le placement résidentiel et celui en centre nourrisson-mère, le placement en famille d\'accueil montrant des résultats immédiats.
Anpassung von Babys an drei Arten der Unterbringung: Ein ethologischer Ansatz Die vorliegende Pilotstudie konzentriert sich auf die Anpassungsprozesse von Babys, die in ihren ersten Lebensmonaten untergebracht werden. Es wurde ein ethologischer Ansatz verwendet, um 6 Wochen lang die Verhaltensanpassung von neunzehn Säuglingen zu untersuchen, die in der Heimpflege (Frankreich), einer Pflegefamilie (Québec) oder einem Mutter-Kind-Zentrum (Québec) untergebracht wurden. Einmal pro Woche wurden während des Fütterns direkte Beobachtungen durchgeführt. Beobachtete Verhaltensweisen waren: Schlaf-Wach-Zustand, Selbstberuhigung, Bäuerchen, visuelle Erkundung, motorische Aktivität, Gesichtsausdruck und Lautäußerungen. Anschließend wurde ein Kruskal-Wallis-Test durchgeführt, um Unterschiede in der Anpassung der Babys in Abhängigkeit zu ihrer Unterbringung zu untersuchen. Die Ergebnisse zeigten, dass bei der Heimpflege die Dauer der Nachfütterungsphase am kürzesten war. Darüber hinaus zeigten diese in ein Heim eingewiesenen Babys die meisten Formen des Selbstschutzes und die wenigsten Lautäußerungen. Im Gegensatz dazu verbrachten Babys, die in Mutter-Kind-Zentren untergebracht waren, die geringste Zeit in einer Rückzugshaltung, zeigten regelmäßigere motorische Aktivität und wurden nie in ihre Liege zurückgelegt, bevor sie ihr Bäuerchen gemacht hatten. Beim Vergleich von Heimunterbringung und der Unterbringung in Mutter-Kind-Zentren traten größere Unterschiede auf, während die Unterbringung in Pflegefamilien dazwischenliegende Ergebnisse erzielte.
3タイプの委託における乳児の適応:動物行動学的アプローチ 本予備研究では、生後初期の数か月間に各施設に委託された赤ちゃんの適応的な 過程に焦点を当てている。動物行動学的アプローチを用いて、19人の新生児が乳 児院 (フランス) 、里親家庭 (ケベック) 、または母子センター (ケベック) へ の委託に際し、到着から6週間経過するまでの行動的な調整を検討した。週に1回、 哺乳時間中に直接観察が行われた。観察された行動は、睡眠覚醒状態、自己鎮静 行動、げっぷ、視覚的探索、身体活動、顔の表情および発声であった。次に、 Kruskal-Wallis 検定により、委託による機能としての赤ちゃんの適応の差を分 析した。 その結果、乳児院では、哺乳後段階にかける時間が最も短いことが示された。さ らに、これらの施設入所した赤ちゃんは、自己防衛とみられる様式のほとんどを 示し、発声は最も少ないことが判明した。対照的に、母子センターに預けられた 乳児は、うちにこもる時間が最も短く、より規則的に体を動かしており、げっぷ する前にベビーラックに戻されることはなかった。乳児院と母子センターへの委 託を比較すると、より顕著な差が認められ、里親家庭への委託はその中間の結果 を示していた。.
本文的试点研究侧重于婴儿出生后头几个月的适应过程。它使用了一种行为学的方法来探索19名婴儿到达安置点后, 寄宿式护理 (法国) 、或寄养家庭 (魁北克) 、或母婴中心 (魁北克) , 前六周的行为调整。在喂食期间, 每周进行一次直接观察。观察到的行为有:睡眠-觉醒状态、自我安慰、打嗝、视觉探索、自主活动、面部和声音表达。然后, 进行了Kruskal-Wallis检验, 以考察婴儿对安置环境适应的差异。结果表明, 在RC中, 后喂食阶段的持续时间最短。此外, 这些被收容的婴儿表现出的自我保护方式最多、发声最少。相比之下, 放置在IMC中的婴儿撤走花费的时间最少, 他们表现出更规律的自主活动, 而且在打嗝之前从未被放回躺椅上。与安置在寄养家庭的中等效果对比, 安置在RC和IMC中的婴儿表现出更大的差异。.
تكيف الأطفال في ثلاثة أنواع من الإيداع: دراسة في إطار المنهج السلوكي تركز هذه الدراسة التجريبية على العمليات التكيفية للأطفال الذين يوضعون في الرعاية خلال الأشهر الأولى من حياتهم. استخدمت الدرسة نهجاً سلوكياً لاستكشاف التكيف السلوكي لتسعة عشر رضيعاً منذ وصولهم إلى مكانهم خلال الأسابيع الستة الأولى من إيداعهم في الرعاية السكنية في (فرنسا)، أو مع أسرة حاضنة في (كيبيك) أو مركز الأمومة والطفولة في (كيبيك). وأجريت ملاحظات مباشرة مرة في الأسبوع أثناء جلسات التغذية. وكانت السلوكيات الملحوظة هي: حالة النوم والاستيقاظ، تهدئة الذات، والتجشؤ، والاستكشاف البصري، والنشاط الحركي، وتعبيرات الوجه والصوت. وبعد ذلك تم إجراء اختبار كريسكال-واليس لاكتشاف الاختلافات في تكيف الأطفال حسب اختلاف مكان الإيداع. أظهرت النتائج أن في الرعاية السكنية كانت مدة مرحلة ما بعد التغذية هي الأقصر. كما أظهر هؤلاء الأطفال المودعون في المؤسسات مظاهر أكثر من الحماية الذاتية وقلة الأصوات. وعلى النقيض من ذلك، أمضى الأطفال الذين يوضعون في مركز الأمومة والطفولة أقل وقت في الانسحاب، وكان نشاطهم الحركي أكثر انتظاماً. تشير النتائج بشكل عام إلى اختلافات أكبر عند مقارنة الرعاية السكنية (RC) مع مركز الأمومة والطفولة (IMC) في حين كانت نتائج الأسرة الحاضنة متوسطة.

OBJECTIVE: Dementia is one of the most frequent diseases in the elderly, being its prevalence of up to 64% in institutionalized people. In this population, in addition to antidementia drugs, it is common to prescribe drugs with anticholinergic/sedative burden that, due to their adverse effects, could worsen their functionality and cognitive status. The objective is to estimate the prevalence of the use of drugs with anticholinergic/ sedative burden in institutionalized older adults with dementia and to assess the associated factors.
METHODS: A cross-sectional study developed in older with dementia living in nursing homes. The prevalence of prescription of anticholinergic/sedative drugs was estimated according to the Drug Burden Index (DBI). A comparative analysis of the DBI score was performed between different types of dementia as well as among various factors and according to the anticholinergic/sedative risk, establishing as a cut-off point of DBI≥1 (high anticholinergic/sedative risk).
RESULTS: 178 residents were included. 83.7% had some drug with anticholinergic/sedative burden according to DBI. 50% had a DBI≥1 score. Residents with vascular dementia had a mean DBI of 1.34 (SD 0.84), a significantly higher score than residents with Alzheimer\'s disease (0.41, 95% CI 0.04-0.78).). Likewise, a higher DBI was associated with more polypharmacy (3.36; 95% CI 2.64-4.08), more falls, hospital admissions and emergency room visits (P<.05).
CONCLUSIONS: Polypharmacy and prescription of anticholinergic/sedative drugs is frequent among institutionalized older adults with dementia, finding an association between DBI, falls and hospital admissions or emergency department visits. Therefore, it is necessary to propose interdisciplinary pharmacotherapeutic optimization strategies.

OBJECTIVE: Society is ageing, and as a consequence, the population with increased frailty and comorbidity is growing. The aim is to analyse the mortality and its potential factors, as well as the use of healthcare resources in elderly patients, and to study the differences between institutionalised patients and those included in a home care program.
METHODS: An observational, longitudinal and prospective cohort study was conducted in Seville during 2016. The study subjects consisted of 1314 elderly patients (1061 institutionalised and 253 at home). The variables studied included mortality and its potential factors, and the use of healthcare resources.
RESULTS: No differences were found in mortality between institutionalised and home care program patients (RR=1.044; 95% CI; 0.74-1.46; P=.799). The leading cause of death was circulatory diseases followed by respiratory diseases. Among the factors explaining the mortality, it is important to highlight: age, dependency and admissions in the hospital or the emergency department. The patient\'s functional independence is associated with a higher survival rate. Differences were found between both groups in the number of calls to the Critical Care and Emergency Services (P=.022) or the primary care doctor (P<.001) and in the hospital admissions (P<.001), the first 2differences being higher in home care program patients, and the latter in institutionalised patients.
CONCLUSIONS: There are no differences between groups either in the mortality or in the cause of death. Age, functional dependency and admissions in the hospital are factors which explain the mortality. The use of healthcare resources is higher in patients at home.