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BACKGROUND: Rehabilitation pathways are crucial to reduce stroke-related disability. Motivational Interviewing (MI), as a person-centered complex intervention, aimed to empower and motivate, and could be a resource to improve rehabilitation outcomes for older stroke survivors. The IMAGINE project aims to assess the impact of MI, as a complement to standard geriatric rehabilitation, on functional improvement at 30 days after admission, compared to standard geriatric rehabilitation alone, in persons admitted to geriatric rehabilitation after a stroke. Secondary objectives include assessing the impact of MI on physical activity and performance, self-efficacy, safety, cost-utility, participants' experiences and functional status at 3 months. METHODS: We will conduct a multicenter randomized clinical trial in three geriatric rehabilitation hospitals in Spain. Older adults after mild-moderate stroke without previous severe cognitive impairment or disability will be randomized into the control or intervention group (136 per group, total N = 272). The intervention group will receive 4 sessions of MI by trained nurses, including the design of a personalized rehabilitation plan agreed between stroke survivors and nurses based on stroke survivors´ goals, needs, preferences and capabilities. Main outcome will be the Functional Independence Measure (FIM). In-hospital physical activity will be measured through accelerometers and secondary outcomes using validated scales. The study includes a process evaluation and cost-utility analysis. DISCUSSION: Final results are expected by end of 2020. This study will provide relevant information on the implementation of MI as a rehabilitation reinforcement tool in older stroke survivors. A potential reduction in post-stroke disability and dependence would increase person's health-related quality of life and well-being and reduce health and social care costs. IMAGINE has the potential to inform practice and policymakers on how to move forward towards shared decision-making and shared responsibilities in the vulnerable population of older stroke survivors. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03434938 , registered on January 2018.

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Objetivo. Conocer la prevalencia de sospecha de maltrato e identificar los factores asociados en las personas mayores sin déficit cognitivo, que son atendidas por la unidad geriátrica ubicada en el servicio de urgencias del hospital. Métodos. Estudio descriptivo y transversal de una población de 65 años o más, valorada por la Unidad Funcional Interdisciplinaria Sociosanitaria (UFISS) geriátrica del servicio de urgencias del hospital Arnau de Vilanova de Lleida. El total de participantes fue de 127. La sospecha de maltrato se midió con el cuestionario de la American Medical Association (AMA) y la Canadian Task Force (CTF). Las variables estudiadas fueron las características sociodemográficas y la dependencia funcional. Resultados. La prevalencia de sospecha de maltrato fue del 29,1% (IC del 95%: 0,21-0,37). Los subtipos más frecuentes fueron por abandono y psicológico, y menos frecuente por negligencia. Los factores asociados fueron el sexo femenino, profesión previa no remunerada, ser viudo, y vivir solo. Conclusiones. Tres de cada 10 personas mayores fueron identificadas como posibles víctimas de maltrato. Debido al relativo aislamiento de muchos adultos mayores que son maltratados, una visita inesperada al servicio de urgencias puede ser la única oportunidad para su detección. Las unidades geriátricas ubicadas en esta área deberían incluir en la valoración integral, la sospecha de malos tratos a dicha población. Para ello, es necesario poder contar con un instrumento con un alto índice de sensibilidad y especificidad para la detección de los malos tratos en las personas mayores(AU)

Objective. To know the prevalence of mistreatment and to identify the associated factors among elderly people without cognitive impairment, seen in the geriatric unit, located in the hospital emergency area. Methods. Cross-sectional study of a population of 65 years or older assessed by the geriatric Interdisciplinary Social Welfare Functional Unit (ISSFU) of the emergency area in the Arnau de Vilanova hospital of Lleida. We excluded participants with cognitive impairment. The total number of participants was 127. The suspicion of mistreatment was measured using the Questionnaire of the American Medical Association (AMA) and the Canadian Task Force (CTF). The variables studied were social demographic characteristics and functional dependency. Results. Prevalence of suspicion of mistreatment was 29.1% (95% CI: 0.21-0.37). The most frequent subtypes were neglect and psychological, and less frequent was negligence. Associated factors were being female, being in unpaid work, being a widow and living alone. Conclusions. Three out of ten elderly people were identified as possible victims of abuse. Due to the relative isolation of many of the elderly who were abused, an unexpected visit to the emergency area may be the only opportunity for detection. Geriatric units located in this area should include the suspicion of mistreatment of this population in their comprehensive assessment. For this, it is necessary to have tool with a high degree of sensitivity and specificity for detection of abuse in the elderly(AU)

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OBJECTIVE: To know the prevalence of mistreatment and to identify the associated factors among elderly people without cognitive impairment, seen in the geriatric unit, located in the hospital emergency area. METHODS: Cross-sectional study of a population of 65 years or older assessed by the geriatric Interdisciplinary Social Welfare Functional Unit (ISSFU) of the emergency area in the Arnau de Vilanova hospital of Lleida. We excluded participants with cognitive impairment. The total number of participants was 127. The suspicion of mistreatment was measured using the Questionnaire of the American Medical Association (AMA) and the Canadian Task Force (CTF). The variables studied were social demographic characteristics and functional dependency. RESULTS: Prevalence of suspicion of mistreatment was 29.1% (95% CI: 0.21-0.37). The most frequent subtypes were neglect and psychological, and less frequent was negligence. Associated factors were being female, being in unpaid work, being a widow and living alone. CONCLUSIONS: Three out of ten elderly people were identified as possible victims of abuse. Due to the relative isolation of many of the elderly who were abused, an unexpected visit to the emergency area may be the only opportunity for detection. Geriatric units located in this area should include the suspicion of mistreatment of this population in their comprehensive assessment. For this, it is necessary to have tool with a high degree of sensitivity and specificity for detection of abuse in the elderly.

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