RESUMO
OBJECTIVE: To analyze in out clinic elderly patients of both sexes for the prevalence of risk factors for atherosclerosis and study their association with the complications of atherosclerosis. METHODS: Five hundred and sixteen outpatients, 152 men and 364 women, 60 years or older, were studied. The prevalences of hypertension, dyslipidemia, diabetes mellitus, cigarette smoking and obesity were determined in both sexes and compared using the chi-square test. The association between these factors and the presence of atherosclerotic complications was analyzed by logistic regression. RESULTS: The comparative analysis of the factors in both sexes showed that hypertension, total cholesterol > or = 240 mg/dL, LDL-cholesterol > or = 160 mg/dL, and body mass index > 27.5 were more frequent among women, but HDL-cholesterol < 35 mg/dL and cigarette smoking were more frequent among men, and no difference occurred between sexes in relation to the frequency of triglycerides > or = 250 mg/dL and diabetes mellitus. After adjustment of the variables in the regression model, we observed that in the total of elderly patients, risk factors for complications of atherosclerosis were: triglycerides > or = 250 mg/dL, hypertension, and male sex. Among men, the risk factors were: LDL-cholesterol > or = 160 mg/dL, diabetes mellitus, HDL-cholesterol < 35 mg/dL and hypertension. Among women, the risk factors were: triglycerides > or = 250 mg/dL and hypertension. CONCLUSION: The results showed that, in the elderly, the risk factors for atherosclerosis persist, but with different behaviors between men and women. The study suggests that the relative importance of the risk factors can change with the aging process.
Assuntos
Arteriosclerose/etiologia , Pacientes Ambulatoriais , Fatores Etários , Idoso , Arteriosclerose/epidemiologia , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pacientes Ambulatoriais/estatística & dados numéricos , Prevalência , Análise de Regressão , Fatores de Risco , Fatores SexuaisRESUMO
PURPOSE: To evaluate the iatrogenic complications in hospitalized elderly patients. MATERIAL AND METHOD: Review of the medical records of 96 patients, 48 men and 48 women, aged 60 to 93 years (75.7 years on average), hospitalized in a geriatric ward during 1995. RESULTS: The study of the medical records of the patients showed: 1) forty-two (43.7%) of the elderly had one or more iatrogenic illnesses, with a total of 56 occurrences; 2) complications due to diagnostic tests corresponded to 17.9% of the iatrogenic disorders; 3) complications relating to therapeutic procedures corresponded to 58.9% of the iatrogenic disorders, 32.1% being caused by drugs and 26.8% caused by other therapeutic measures; 4) complications not directly related to diseases, like pressure sores, falls and fractures, corresponded to 23.2% of iatrogenic disorders, 5) iatrogenic illnesses were associated with an extended hospital stay; 6) in five elderly patients the iatrogenic complication was believed to have contributed to the death of the patient. CONCLUSION: Iatrogenic disorders occur frequently in elderly hospitalized patients and sometimes cause major and even fatal complications. As many of these complications are potentially preventable, we must identify the causes and develop technics to prevent or reduce their effects.
Assuntos
Doença Iatrogênica/epidemiologia , Pacientes Internados , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Doença Iatrogênica/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
A doença vascular como complicaçäo da aterosclerose constitui-se na principal causa de morbidade e mortalidade, principalmente em indivíduos idosos, tanto do sexo masculino como feminino. Como a mulher, em média, vive 5 a 8 anos mais que o homem, o número absoluto de mortes relacionadas às doenças vasculares é maior no sexo feminino. Assim, em 1988, 503.542 mulheres e 476.246 homens faleceram nos Estados Unidos da América (EUA) em consequência de doenças cardivoasculares. Por outro lado, aproximadante uma em cada duas mulheres falece em consequência de algum processo vascular, sobrepujando largamente os óbitos devidos a todas a neoplasias. No entanto, a importância das doenças vasculares na mulher tem sido minimizada e mesmo ignorada. Embora as mulheres apresentem menor prevalência dessas afecçöes em grupos etários mais jovens, a incidência aumenta progressivamente com o avançar da idade. Entre os 25 e 35 anos os homens apresentam menor prevalência de coronariopatia 2 a 3 vezes maior, entre 36 e 9anos 1,7 vezes maior, mantendo a mairo prevalência até os 70 anos. Apenas após os 75 anos observa-se que a frequência torna-se igual em ambos os sexos. Este aspecto também tem sido verificado em nosso meio. Levantamento do Sistema Estadual de Análise de Dados (SEADE) e do Instituto Brasileiro de Geografia e Estatística (IBGE) mostraram que em 1985, no município de Säo Paulo, a prevalência de coronariopatias era miaor no sexo masculino até os 74 anos, porém após essa idade era praticamente igual nos doi sxos. Aterosclerose é uma afecçäo que se desenvolve pela açäo de múltiplos fatores sobre a parede arterial, sendo evidente que a intensidade dos fatores inuriantes, assim como o tempo de duraçäo de sua atuaçäo, têm importância na gravidade das alteraçöes. As complicaçöes da aterosclerose e, principalmente a mais frequente, a coronariopatia, têm sido tradicionalmente consideradas como afecçöes do sexo masculino. A maioria das pesquisas, relativa às causas, prevençäo e mesmo diagnóstico e tratamento foi ondzida em homens e, mais especificamente, homens brancos de meia idade sendo a razäo fundamental para essa conduta a incidência precoce das complicaçöes da aterosclerose no sexo masculino. Atualmente existe consenso entre os pesquisadores de que säo necessários mais estudos sobre os fatores de risco (FR) de aterosclerose em mulheres, pricipalmente idosas. Há também necessidade de informaçäo sobre se as medidas preventivas da aterosclerose...
Assuntos
Feminino , Menopausa , Fatores de Risco , AteroscleroseRESUMO
PURPOSE: To evaluate the different aspects of chronic atrial fibrillation (CAF) in elderly patients. METHODS: Forty nine patients with CAF (18 men) aged 66 to 87 years (76.1 years on average) were studied. Their evaluation consisted of clinical examination, blood tests, electrocardiogram, chest X-Ray and echocardiogram. RESULTS: The frequency of CAF in the out-patient Geriatric Clinic was 4.8% and it rose with aging. Cardiocirculatory diseases were observed in 39 (79.6%) patients: 25 (51.0%) had systemic arterial hypertension, 11 (22.4%) had mitral valve disease and six (11.2%) had aortic valve disease. Thirty patients had diseases of other systems, eight (16.3%) of whom were diabetic and seven (14.3%) had hyperthyroidism. Vascular brain disease was observed in four (8.2%) patients. Electrocardiographic changes other than CAF were observed in 41 (83.7%) patients. Changes in the ST-T segment were the more frequent, being observed in 28 (57.1%) patients, followed by left ventricular hypertrophy in 15 (30.1%). Cardiomegaly was seen in 36 (78.3%) out of 46 patients who did the chest radiography. An echocardiogram was performed in 35 patients, being found normal in seven (20.0%). In the remaining cases, the abnormality more frequently seen was the left atrial enlargement, seen in 16 (45.7%) patients. Four patients didn't show clinical, electrocardiographic, radiological or echocardiographic evidence of cardiocirculatory disease and in these, the thyroid function was normal. Digitalis therapy was used in 37 patients. Of the remaining 12, 10 had normal ventricular frequency without the use of the drug. CONCLUSION: The CAF in the elderly patient is observed not only in patients with cardiocirculatory diseases, but in thyrotoxic patients and sometimes without known etiology.