Open Access
A paradigm shift on deinstitutionalization and dementia care: a narrative review
(SAGE, 2024-05-13) Carcavilla González, Nuria; Escalada San Adrián, Gema; Minobes-Molina, Eduard; Pàmies-Tejedor, Sandra; Roncal Belzunce, Victoria; Atarés-Rodríguez, Laura; García-Navarro, José Augusto; Ciencias de la Salud; Osasun Zientziak
This narrative explores the impact of deinstitutionalization policies on the quality of life and care outcomes for individuals with Alzheimer's disease and related dementias. We offer a historical perspective on these policies, their implications on dementia care, and the barriers to deinstitutionalization. The potential benefits of deinstitutionalization, such as improved quality of life and access to community-based support and services, are highlighted. Challenges and controversies surrounding safety, caregiver burden, and resource allocation are also examined. Ethical considerations related to the autonomy and decision-making capacity of people living with dementia are discussed. We present best practices and innovative models in dementia care that balance deinstitutionalization with appropriate care. We further put forth recommendations for future research and policy development in dementia care and deinstitutionalization, emphasizing the need for a balanced approach that respects the autonomy and preferences of people living with dementia while ensuring their safety and well-being.
Open Access
Impact of a multidisciplinary approach to polypharmacy management in community-dwelling older adults: insights from a specialized outpatient clinic
(Wiley, 2025-02-18) Roncal Belzunce, Victoria; Gutiérrez Valencia, Marta; Cedeño Veloz, Bernardo Abel; San Miguel Elcano, Ramón; Marín Epelde, Itxaso; Galbete Jiménez, Arkaitz; Preciado Goldaracena, Javier; Ezpeleta, María Irache; Garaioa-Aramburu, Karmele; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak
Objectives: The increase in polypharmacy among older adults increases the risk of drug-related problems, making multidisci-plinary interventions essential. This study evaluated the impact of a multidisciplinary polypharmacy consultation on medicationmanagement and outcomes in older outpatients.Methods: This prospective observational study at a Spanish teaching hospital involved geriatricians, clinical pharmacists, andnurses. Older adults (≥ 75 years) with polypharmacy underwent medication review at baseline and at 3 and 6 months. Data onmedication use, adherence to Screening Tool of Older Person's Prescriptions (STOOP) criteria, and anticholinergic burden wereanalyzed.Results: The study included 104 older adults (mean age 86.2 years; 66% female). An average of 3.6 recommendations per par-ticipant was made (63.8% acceptance rate). Common drug-related problems were adverse effects (20%), non-adherence (18.1%), and incorrect dose/regimen (14.4%). Interventions led to an average reduction of 1.7 medications per patient, with 1.3 dosage orregimen changes and 1.1 new prescriptions. The mean number of medications decreased from 9.6 at baseline to 8.9 at 3 months(p < 0.001) and remained below baseline at 6 months. STOPP criteria violations per patient dropped from 1.2 to 1.0 (p = 0.036). Of the 126 medications flagged by STOPP criteria, 68.3% were addressed, 24.6% discontinued, mainly psychotropics, and 89.3%of these discontinuations were maintained. The anticholinergic burden decreased from 1.3 to 1.1 at 3 months (p = 0.036) andremained below baseline at 6 months.Conclusions: A multidisciplinary clinic effectively managed polypharmacy in older adults by reducing medication load andimproving appropriateness per STOPP criteria, highlighting the importance of proactive medication management.Trial Registration: ClinicalTrials.gov: NCT05408598 (March 1, 2022).
Open Access
Clinical outcomes of out-of-office versus in-office blood pressure monitoring in adults with hypertension
(Wiley, 2025-05-06) Roncal Belzunce, Victoria; Ramón Espinoza, Fernanda; Gutiérrez Valencia, Marta; Leache, Leire; Saiz Fernández, Luis Carlos; Erviti López, Juan; Ciencias de la Salud; Osasun Zientziak
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: to assess the effects of out-of-office compared to in-office blood pressure (BP) monitoring for improving clinical outcomes in adults with hypertension.
Open Access
Optipharm: enhancing pharmacological management skills in healthcare students for geriatric care through gamified e-learning
(Elsevier, 2024-07-14) Roncal Belzunce, Victoria; Gutiérrez Valencia, Marta; Echeverría-Beistegui, Icíar; Martínez Velilla, Nicolás; Ciencias de la Salud; Osasun Zientziak
Background: Complexities in older patient care and frequent polypharmacy requires tailored tools, specific skills and interdisciplinary collaborations. Traditional disease-centered education often overlooks these issues. Despite digital gamification's relevance in health education, limited exploration exists for gamified platforms addressing polypharmacy, especially within comprehensive geriatric assessment (CGA). Objective: This study outlines Optipharm's design, a gamified e-learning tool designed to enhance health students' education in managing polypharmacy among older adults. It also assesses its usability using a validated scale. Methods: Optipharm development utilized gamification techniques guided by pedagogical principles. Learning objectives addressed clinical and educational gaps in older adult care. Hosted on a Moodle system, the platform housed a structured clinical case as a SCORM file, a usability scale, a certificate of achievement, and a literature library. Optipharm was assessed by 304 medical students from the University of Navarre, Spain, using the SUS-G-Sp scale. Results: An immersive gamified e-learning tool simulating clinical practice settings was developed, requiring users to assume the role of healthcare professionals in multidisciplinary outpatient consultations. The interface, with a 2D cartoon-style aesthetic, aligns with learning objectives, integrating engaging storytelling and clear instructions for CGA in Phase 1 and pharmacological optimization in Phase 2. The evaluation of Optipharm's usability revealed very positive perceptions among users, with high agreement rates on usability items. Conclusion: Optipharm represents a pioneering gamified tool designed to simulate clinical scenarios, allowing users to engage as healthcare professionals within multidisciplinary teams and address medication-related challenges in older patients with polypharmacy. It provides a secure, interactive learning environment with clear educational objectives and seamless integration of gamification elements, enhancing users¿ knowledge and skills in managing complex medication regimens. As a platform for experiential learning and knowledge exchange, Optipharm contributes to shaping the future of health education and fostering a culture of patient-centred care among future healthcare professionals.
Open Access
Prevalence of strong anticholinergic use in residents with and without cognitive impairment and frailty: analysis from 106 nursing homes in 12 Asia-Pacific and European countries
(Elsevier, 2025-09-11) Cross, Amanda J.; Villani, Emanuele R.; Jadczak, Agathe D.; Pitkälä, Kaisu H.; Hamada, Shota; Zhao, Meng; Gutiérrez-Valencia, M.; Aalto, Ulla; Dowd, Laura A.; Li, Li; Liau, Shin J.; Liperoti, Rosa; Martínez Velilla, Nicolás; Ooi, Choon Ean; Onder, Graziano; Petrie, Kate; Roitto, Hanna M.; Roncal Belzunce, Victoria; Saarela, Riitta; Sakata, Nobuo; Visvanathan, Renuka; Zhang, Tiange G.; Bell, J. Simon; Ciencias de la Salud; Osasun Zientziak
Purpose: there is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty. Methods: secondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0-2 (non-frail), 3-6 (frail) and 7-14 (most-frail). Data were analyzed using descriptive statistics. Results: overall, 17.4 % (n = 1010) residents used >= 1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %). Conclusions: one in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm.
Open Access
First steps towards the deinstitutionalization of older adults: a protocol for the implementation of a complex intervention
(Elsevier, 2023-12-15) Roncal Belzunce, Victoria; Atarés-Rodríguez, Laura; Escalada San Adrián, Gema; Minobes-Molina, Eduard; Pàmies-Tejedor, Sandra; Carcavilla González, Nuria; García-Navarro, José Augusto; Ciencias de la Salud; Osasun Zientziak
Introducción: las residencias de personas mayores cobran cada vez más importancia como centros de atención al final de la vida. Sin embargo, muchos adultos mayores desean permanecer en sus casas mientras envejecen. Objetivo: se pretende evaluar la viabilidad de un proceso de desinstitucionalización en adultos mayores seleccionados que viven en las residencias y que expresen la voluntad para iniciar el proceso. Métodos: este estudio, dividido en dos fases, se llevará a cabo durante 15 meses en 241 sujetos que viven en dos residencias de personas mayores en Navarra (España). La primera fase tiene un diseño transversal en donde se identificarán los factores y covariables asociadas a la viabilidad y voluntad para participar en un proceso de desinstitucionalización a través de un análisis bivariante, los recursos imprescindibles para el proceso y los residentes que quieran participar en él. La segunda fase tiene un diseño de intervención compleja en la que se implementa un proceso de desinstitucionalización. Se realizará un análisis exploratorio descriptivo y comparativo para caracterizar a los participantes, los servicios prescritos y el efecto de la intervención de desinstitucionalización a lo largo del tiempo (la calidad de vida será la variable principal; las secundarias serán las referentes a la salud, las psicosociales y de uso de recursos). Este estudio irá acompañado de un subestudio pseudocualitativo y emergente para identificar las barreras y los elementos facilitadores relativos a la implementación de este proceso y comprender cómo los componentes de la intervención y el contexto influyen en los resultados del estudio principal. Los componentes de la intervención y su ejecución serán de gran relevancia en el análisis. Discusión: las alternativas a la institucionalización con viviendas adaptadas y apoyos comunitarios pueden permitir a las personas que así lo desean el retorno a la comunidad. Registro del estudio NCT05605392.