Alejandra-Ximena Araya

Frailty is influenced by physical, health, and psychosocial vulnerabilities, yet evidence from rural older populations remains limited. This study examined the associations of sociodemographic, health, and psychosocial factors with multidimensional and physical frailty among community-dwelling older adults in a rural area of northern Chile. A cross-sectional study was conducted with 120 older adults registered at a local Family Health Centre. Multidimensional frailty was assessed using the Tilburg Frailty Indicator (TFI) and physical frailty using the Fried phenotype. Hierarchical logistic regression models examined sociodemographic and health characteristics, followed by loneliness, social network score, and depressive symptoms. Firth penalised regression was used as a sensitivity analysis. Multidimensional frailty was identified in 73.3% of participants and physical frailty in 51.7%; 83.3% had multimorbidity. Loneliness and social network score showed the most consistent associations across both frailty approaches. In the final multidimensional frailty model, greater loneliness, smaller social networks, and higher depressive symptom scores were associated with greater odds of frailty. For physical frailty, older age, greater loneliness, and smaller social networks remained independently associated with frailty, whereas depressive symptoms did not improve model fit. The addition of psychosocial variables substantially improved model fit, and sensitivity analyses generally supported the main findings. Loneliness and social network characteristics were consistently associated with both multidimensional and physical frailty among older adults living in this rural setting, while age and depressive symptoms showed construct-specific patterns. These findings highlight the relevance of incorporating psychosocial vulnerability into frailty assessment in rural older populations, while recognising that territorial and social context may influence how vulnerability is experienced and addressed.

INTRODUCCIÓN. Los profesionales de la salud se encuentran mayormente formados en el modelo biomédico, basado en la medicina occidental y centrado en el enfoque salud-enfermedad. Sin embargo, algunos han ampliado su perspectiva al incorporar la medicina integrativa en su práctica. Esto ha generado la necesidad de explorar las experiencias y percepciones de estos profesionales frente a este modelo de salud. OBJETIVO. Explorar las experiencias y percepciones de profesionales de la salud respecto de la medicina integrativa. METODOLOGÍA. Se realizó una investigación cualitativa de diseño descriptivo, mediante entrevistas en profundidad a profesionales de la salud que practican medicina integrativa junto con su formación principal. Se seleccionaron ocho participantes mediante muestreo intencionado y se consideró la saturación temática de los datos. RESULTADOS. Los profesionales relataron una experiencia percibida como positiva con la medicina integrativa, destacando su enfoque holístico que abarca tanto los aspectos físicos como emocionales de la salud. Desde sus relatos, este enfoque fue descrito como complementario a los tratamientos convencionales en casos complejos percibidos como insuficientemente abordados por la medicina convencional. DISCUSIÓN. Desde la perspectiva de los participantes, la medicina integrativa fue interpretada como una práctica que puede complementar la atención sanitaria y resignificar el ejercicio profesional. CONCLUSIÓN. A pesar de los avances, persisten desafíos en política pública, regulaciones y educación. La principal preocupación radica en la formación de profesionales en medicina integrativa, siendo esencial una sólida formación en salud para asegurar la calidad de la atención.

INTRODUCCIÓN. La soledad no deseada es una experiencia emocional compleja que no solo refleja una disminución en la cantidad de relaciones sociales, sino también un deterioro en su calidad. Afecta a millones de personas mayores en el mundo y constituye un problema de salud pública, dadas sus consecuencias negativas sobre la calidad de vida y su asociación con un incremento de la dependencia, la morbilidad y la mortalidad. El miedo a caer (MaC) es un factor relacionado con la soledad, aun escasamente estudiado, que se entiende como la falta de confianza que experimenta una persona para evitar una caída o para realizar actividades de la vida diaria, y que afecta tanto la percepción de autoeficacia como la capacidad de sostener relaciones sociales fuera del hogar. OBJETIVO. Este ensayo, basado en una revisión narrativa de la literatura, argumenta que el miedo a caer constituye un factor asociado y potencialmente predictor de la soledad no deseada en personas mayores, y propone que sea incorporado al modelo de factores individuales y sociales de De Jong Gierveld y Tesch-Römer. CONCLUSIÓN. El miedo a caer se configura como un factor clave asociado a la soledad no deseada en personas mayores, y como un potencial predictor de esta, al influir simultáneamente en factores individuales y sociales, limitar la movilidad y restringir la participación social. Este fenómeno perpetúa un ciclo de aislamiento que expone las limitaciones del modelo de Gierveld y Tesch-Römer, el cual no incorpora de manera explícita factores contextuales y estructurales esenciales, como el diseño inclusivo de los espacios urbanos, la accesibilidad tecnológica y la calidad de los vínculos significativos. Asimismo, se plantea la necesidad de incorporar la temporalidad en el análisis y la medición de la soledad no deseada, para comprender mejor sus dinámicas y orientar abordajes más efectivos.

It is predicted that by 2050, 22% of the world’s population will be over 60 years old. Informal caregivers of dependent older adults face a significant physical, psychological and social burden. However, interventions designed to support these caregivers have predominantly been evaluated through quantitative outcomes. Qualitative evidence on the experiences and perceptions of these interventions reported by caregivers themselves remains largely unsynthesised. This review aims to identify and synthesise qualitative evidence on how informal caregivers of dependent older people experience and perceive interventions designed to alleviate the burden of caregiving and enhance their biopsychosocial well-being. For this purpose, a systematic search will be conducted in the following databases: MEDLINE (PubMed), CINAHL, PsycINFO, Web of Science Core Collection and ProQuest Dissertations & Theses Global. Publications in English and Spanish from 2014 onwards will be included. Grey literature will also be included. Search strategies will be developed with a research librarian and peer-reviewed using the PRESS checklist. Regarding selection criteria, primary qualitative studies and mixed-methods studies with accessible qualitative data exploring the experiences of informal caregivers of dependent older adults (60+) who have received interventions targeting burden reduction and biopsychosocial well-being will be included. Studies focused exclusively on palliative cancer care or on caregivers of people with cognitive impairment will be excluded. Data extraction will be conducted independently by two reviewers. Thematic synthesis will be conducted using Thomas and Harden’s method. The methodological quality will be assessed using the CASP Qualitative Checklist and the confidence in the findings will be evaluated using GRADE-CERQual.

Introduction: Social frailty is a multidimensional concept that includes general and social resources, activities, and the fulfillment of needs; understanding and assessing it helps guide interventions for older adults. Objective: To clarify the concept of social frailty in older adults to improve its application in research, clinical practice, and education. Materials and Methods: The Walker and Avant method was used to analyze social frailty in older adults, following stages such as concept selection, purpose definition, identification of uses, attributes, and related cases. Systematic searches were conducted in PubMed, ScienceDirect, Web of Science, and CINAHL, along with manual searches of references and dictionaries. Results: Social frailty in older adults is primarily defined as the loss of social resources, reduced ability to meet basic social needs, and diminished participation in meaningful activities such as maintaining close relationships, engaging in volunteering, having an occupation (paid or unpaid), and participating in religious or community activities. Factors such as loneliness, isolation, and lack of social support are associated with negative health outcomes. Discussion: Social frailty must be addressed from an interdisciplinary perspective. Health professionals should play an active role in identifying social frailty and implementing community-based strategies, psychosocial programs, and support networks that strengthen inclusion and social connection, thereby contributing to the prevention of functional and emotional decline. Conclusion: Social frailty impacts the physical, mental, and emotional health of older adults, underscoring the importance of inclusive, preventive, and care-centered policies.

We explored the factors related to the perception of psychosocial or health support needs among 1,900 carers for people with disabilities or functional impairments in Chile. Being widowed or divorced, providing more hours of care and more personal care tasks, and experiencing higher caregiving difficulty were independently linked with an increased likelihood of reporting support needs. Experiencing low energy, anxious feelings and a low sense of control were linked with 1.7, 1.7 and 2.5 times higher odds of having needs, respectively. The implications of such findings are discussed.