RESUMO
BACKGROUND AND PURPOSE: Older adults face increased risk of loss of functional capacity both before and during hospitalization, so identifying older adults at risk for loss in functional capacity during hospitalization would help researchers and clinicians make informed decisions. This study aims to evaluate functional changes from preadmission (baseline) until discharge of hospitalized older adults and identify predictors of loss in functional capacity. METHODS: This is a prospective cohort study conducted at a tertiary care hospital in Natal, Brazil, and enrolled all consecutive patients aged 60 years and older between January 1, 2014, and April 30, 2015. Independent variables included personal characteristics, instrumental activities of daily living (IADL) (evaluated by the Lawton and Brody scale), cognition (evaluated by the Leganés cognitive test), depression (assessed by the Geriatric Depression Scale-15), and in-hospital mobility (evaluated by the Short Physical Performance Battery). The dependent variable functional capacity was assessed by the Katz scale. These instruments were applied at 2 different times: upon admission (within first 24 hours) and at discharge (12-24 hours before). Functional trajectories were defined as the course of functioning from preadmission until discharge using functional capacity data. A multivariate analysis with generalized estimating equation estimated the longitudinal changes in functional capacity. RESULTS AND DISCUSSION: The final sample consisted of 1191 older adults and 53.9% were less than 70 years of age. Regarding changes in functional capacity, 52.5% of the older adults presented worse functional capacity at discharge than at baseline. Being dependent for IADL instrumental daily living activities, the presence of depressive symptoms, low levels of cognition, and in-hospital mobility were risk factors for greater loss in functional capacity during a hospitalization event. CONCLUSION: Hospitalization events may be catastrophic for functional capacity in older adults in Brazil. Functional, cognitive, and emotional status and in-hospital mobility must be carefully assessed at hospital admission and monitored during hospitalization. Effective strategies for preventing loss in functional capacity in older people must improve in the Brazilian hospital system.
Assuntos
Avaliação Geriátrica/métodos , Desempenho Físico Funcional , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Centros de Atenção TerciáriaRESUMO
Frailty at older ages is an adverse health condition that is more prevalent in women than men and the excess prevalence in women cannot be adequately explained by common risk factors. Reproductive history events may be among contributing factors. This study aims to examine associations between age at first childbirth, lifetime parity, and history of hysterectomy with frailty status in community dwelling older women. This is a cross-sectional study of 1047 women participating in the International Mobility in Aging Study at baseline (2012, aged between 65 and 74 years old). Fried's phenotype of frailty was used to identify frail, pre-frail and non-frail groups. Measured reproductive history variables include age at first birth (before 20 years old; 20 years old or older), lifetime parity (0; 1-2 children; 3-4 children; 5 children or more) and hysterectomy (yes/no). We constructed multinomial regression models adjusted for possible confounders to examine the relationships of interest; non frail women were the reference category. Early maternal age (before 20 years-old) was associated with increased risk of frailty (OR 2.15, 95%CI: 1.24-3.72). Compared to women who delivered five or more children, those who had 1-2 children showed significantly lower odds of pre-frail status (OR 0.54, 95%CI 0.36-0.82) and frailty (OR 0.43 95%CI 0.22-0.86). Hysterectomy was independently associated with frailty (OR 1.74 95%CI 1.04-2.89) Age at first birth, parity and hysterectomy are associated to a greater likelihood of frailty in later life. This study reinforces the importance of considering the reproductive characteristics of women as indicators of health status.
Assuntos
Envelhecimento/fisiologia , Fragilidade , Nível de Saúde , Histerectomia/efeitos adversos , Paridade , História Reprodutiva , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Vida Independente , Idade Materna , Gravidez , Estudos RetrospectivosRESUMO
BACKGROUND: Visceral leishmaniasis (VL) is a zooanthroponosis affecting both rural and periurban areas, and can also spread into urban areas. VL has emerged in many countries in the world, presenting new cases in new countries of occurrence. Thus, studies concerning epidemiological aspects in different world regions are very meaningful. METHODS: With this purpose, this study analyzed 89 cases of VL, treated between June 2006 and June 2014 at Eduardo de Menezes Hospital (HEM), a Reference Center of Infectious Diseases situated in Belo Horizonte, in Minas Gerais state, Brazil. RESULTS: According to the results, it was observed that males are mostly infected (84%/n=75) and the most affected age range was 20-49 years old (83%/n=74). The treatment liposomal amphotericin B (33%/n=29) was mostly used. Recurrences were more frequent in patients treated with Glucantime® (17%/n=9). No side effects were reported among the 29 patients treated with liposomal amphotericin B. On the other hand, there were 23 cases related to the occurrence of acute renal failure (ARF) and the use of conventional amphotericin B, both when it was administered alone or in combination with other drugs. Additionally, we observed a close relationship between the VL and HIV infection, observing a coinfection rate of 28.1% (n=25). CONCLUSION: From the survey data, it was possible to conclude that the majority of VL patient treated at HEM is male, classified as brown racial group, economically active, and may be drug addicts, chronic alcoholics and/or smokers. They may present some Non-communicable diseases (NCD), such as hypertension, diabetes mellitus, dyslipidemia and/or obesity and, predominantly present a great chance of being a carrier of the Human Immunodeficiency Virus, associated or not with tuberculosis. As symptoms, these patients possibly will present hepatosplenomegaly, fever and pronounced weight loss.