RESUMO
OBJECTIVES: to investigate the association between delirium occurrence in acutely ill older adults and incident dementia after hospital discharge. METHODS: retrospective cohort study examining acutely ill older adults aged +60 years and consecutively admitted to the geriatric ward of a tertiary university hospital from 2010 to 2016. Inclusion criteria were absence of baseline cognitive decline on admission and documented clinical follow-up of +12 months after discharge. Admission data were collected from our local database, including results from a standardized comprehensive geriatric assessment completed for every patient. Pre-existing cognitive decline was identified based on clinical history, CDR and IQCODE-16. Delirium was diagnosed using short-CAM criteria, while post-discharge dementia after 12 months was identified based on medical records' review. We used competing-risk proportional-hazard models to explore the association between delirium and post-discharge dementia. RESULTS: we included 309 patients. Mean age was 78 years, and 186 (60%) were women. Delirium was detected in 66 (21%) cases. After a median follow-up of 24 months, 21 (32%) patients who had experienced delirium progressed with dementia, while only 38 (16%) of those without delirium had the same outcome (P = 0.003). After adjusting for possible confounders, delirium was independently associated with post-discharge dementia with a sub-hazard ratio of 1.94 (95%CI = 1.10-3.44; P = 0.022). CONCLUSION: one in three acutely ill older adults who experienced delirium in the hospital developed post-discharge dementia during follow-up. Further understanding of delirium as an independent and potentially preventable risk factor for cognitive decline emphasizes the importance of systematic initiatives to fight it.
Assuntos
Delírio/complicações , Demência/etiologia , Alta do Paciente/estatística & dados numéricos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Demência/epidemiologia , Feminino , Avaliação Geriátrica , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
Objective To investigate clinical and laboratory characteristics associated with referral of acutely ill older adults to exclusive palliative care. Methods A retrospective cohort study based on 572 admissions of acutely ill patients aged 60 years or over to a university hospital located in São Paulo, Brazil, from 2009 to 2013. The primary outcome was the clinical indication for exclusive palliative care. Comprehensive geriatric assessments were used to measure target predictors, such as sociodemographic, clinical, cognitive, functional and laboratory data. Stepwise logistic regression was used to identify independent predictors of palliative care. Results Exclusive palliative care was indicated in 152 (27%) cases. In the palliative care group, in-hospital mortality and 12 month cumulative mortality amounted to 50% and 66%, respectively. Major conditions prompting referral to palliative care were advanced dementia (45%), cancer (38%), congestive heart failure (25%), stage IV and V renal dysfunction (24%), chronic obstructive pulmonary disease (8%) and cirrhosis (4%). Major complications observed in the palliative care group included delirium (p<0.001), infections (p<0.001) and pressure ulcers (p<0.001). Following multivariate analysis, male sex (OR=2.12; 95%CI: 1.32-3.40), cancer (OR=7.36; 95%CI: 4.26-13.03), advanced dementia (OR=12.6; 95%CI: 7.5-21.2), and albumin levels (OR=0.25; 95%CI: 0.17-0.38) were identified as independent predictors of referral to exclusive palliative care. Conclusion Advanced dementia and cancer were the major clinical conditions associated with referral of hospitalized older adults to exclusive palliative care. High short-term mortality suggests prognosis should be better assessed and discussed with patients and families in primary care settings.
Assuntos
Estado Terminal/mortalidade , Mortalidade Hospitalar , Cuidados Paliativos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil , Tomada de Decisões , Feminino , Hospitalização , Humanos , Masculino , Estudos ProspectivosRESUMO
OBJECTIVES: To investigate the association between delirium motor subtypes and hospital mortality and 12-month mortality in hospitalized older adults. DESIGN: Prospective cohort study conducted from 2009 to 2015. SETTING: Geriatric ward of a university hospital in Sao Paulo, Brazil. PARTICIPANTS: We included 1,409 consecutive admissions of acutely ill patients aged 60 years and over. We excluded admissions for end-of-life care, with missing data on the main variables, length of stay shorter than 48 hours, or when consent to participate was not given. MAIN OUTCOMES AND MEASURES: Delirium was detected using the Confusion Assessment Method and categorized in hypoactive, hyperactive, or mixed delirium. Primary outcomes were time to death in the hospital, and time to death in 12 months (for the discharged sample). Comprehensive geriatric assessment was performed at admission and included socio-demographic, clinical, functional, cognitive, and laboratory variables. Further clinical data were documented upon death or discharge. Multivariate analyses used Cox proportional hazards models adjusted for possible confounders. RESULTS: We included 1,409 admissions, with a mean age of 80 years. The proportion of in-hospital deaths was 19%, with a cumulative mortality of 38% in 12 months. Delirium occurred in 47% of the admissions. Hypoactive delirium was the predominant motor subtype (53%), followed by mixed delirium (30%) and hyperactive delirium (17%). Hospital mortality rates were respectively 33%, 34% and 15%. We verified that hypoactive and mixed delirium were independently associated with hospital mortality, with respective hazard ratios of 2.43 (95%CI = 1.64-3.59) and 2.31 (95%CI = 1.53-3.50). Delirium motor subtypes were not independently predictive of 12-month mortality. CONCLUSIONS: One in three acutely ill hospitalized older adults who suffered hypoactive or mixed delirium died in the hospital. Clinicians should be aware that hypoactive symptoms of delirium, whether shown exclusively or in alternation with hyperactive symptoms, are indicative of a worse prognosis in this population.
Assuntos
Delírio/fisiopatologia , Hospitalização , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Masculino , Prognóstico , Estudos ProspectivosRESUMO
ABSTRACT Objective To investigate clinical and laboratory characteristics associated with referral of acutely ill older adults to exclusive palliative care. Methods A retrospective cohort study based on 572 admissions of acutely ill patients aged 60 years or over to a university hospital located in São Paulo, Brazil, from 2009 to 2013. The primary outcome was the clinical indication for exclusive palliative care. Comprehensive geriatric assessments were used to measure target predictors, such as sociodemographic, clinical, cognitive, functional and laboratory data. Stepwise logistic regression was used to identify independent predictors of palliative care. Results Exclusive palliative care was indicated in 152 (27%) cases. In the palliative care group, in-hospital mortality and 12 month cumulative mortality amounted to 50% and 66%, respectively. Major conditions prompting referral to palliative care were advanced dementia (45%), cancer (38%), congestive heart failure (25%), stage IV and V renal dysfunction (24%), chronic obstructive pulmonary disease (8%) and cirrhosis (4%). Major complications observed in the palliative care group included delirium (p<0.001), infections (p<0.001) and pressure ulcers (p<0.001). Following multivariate analysis, male sex (OR=2.12; 95%CI: 1.32-3.40), cancer (OR=7.36; 95%CI: 4.26-13.03), advanced dementia (OR=12.6; 95%CI: 7.5-21.2), and albumin levels (OR=0.25; 95%CI: 0.17-0.38) were identified as independent predictors of referral to exclusive palliative care. Conclusion Advanced dementia and cancer were the major clinical conditions associated with referral of hospitalized older adults to exclusive palliative care. High short-term mortality suggests prognosis should be better assessed and discussed with patients and families in primary care settings.
RESUMO Objetivo Investigar as características clínicas e laboratoriais associadas à indicação de cuidados paliativos exclusivos em idosos gravemente enfermos. Métodos Neste estudo retrospectivo de coorte, foram incluídas 572 admissões de pacientes gravemente enfermos com idade igual ou superior a 60 anos, em um hospital universitário, em São Paulo, no período de 2009 a 2013. O desfecho primário foi a indicação clínica de cuidados exclusivamente paliativos. Empregamos avaliações geriátricas amplas padronizadas para mensurar preditores de interesse, incluindo informações sociodemográficas, clínicas, cognitivas, funcionais e laboratoriais. Utilizamos modelos de regressão logística stepwise para identificar preditores independentes de cuidados paliativos. Resultados Foram indicados cuidados exclusivamente paliativos em 152 (27%) casos. No grupo de cuidados paliativos, a mortalidade hospitalar foi de 50%, sendo que a mortalidade acumulada em 12 meses atingiu 66%. Os diagnósticos mais frequentemente apontados como motivadores de cuidados paliativos foram demência avançada (45%), câncer (38%), insuficiência cardíaca congestiva (25%), insuficiência renal estágios 4 e 5 (24%), doença pulmonar obstrutiva crônica (8%) e cirrose (4%). As complicações mais comuns no grupo de cuidados paliativos foram delírio (p<0,001), infecções (p<0,001) e úlceras por pressão (p<0,001). Após análise multivariada, sexo masculino (OR=2,12; IC95%: 1,32-3,40), câncer (OR=7,36; IC95%: 4,26-13,03), demência avançada (OR=12,6; IC95%: 7,5-21,2) e níveis de albumina (OR=0,25; IC95%: 0,17-0,38) foram identificados como preditores independentes da indicação de cuidados exclusivamente paliativos. Conclusão Demência avançada e câncer foram as condições clínicas mais frequentemente associadas à indicação de cuidados paliativos exclusivos em idosos hospitalizados. A elevada mortalidade a curto prazo sugere que o prognóstico deva ser melhor avaliado e discutido com os pacientes e suas famílias no ambiente de Atenção Primária.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Cuidados Paliativos/estatística & dados numéricos , Mortalidade Hospitalar , Estado Terminal/mortalidade , Brasil , Estudos Prospectivos , Tomada de Decisões , HospitalizaçãoRESUMO
BACKGROUND: Despite general recognition that enteral tube feeding (ETF) is frequently employed in long-term care facilities and patients with dementia, remarkably little research has determined which factors are associated with its use in acutely ill older adults. In this study, we aimed to investigate determinants of ETF introduction in hospitalized older adults. METHODS: We examined a retrospective cohort of acutely ill patients, aged 60 years and older, admitted to a university hospital's geriatric ward from 2014-2015, in São Paulo, Brazil. The main outcome was the introduction of ETF during hospitalization. Predictors of interest included age, sex, referring unit, comorbidity burden, functional status, malnutrition, depression, dementia severity, and delirium. Multivariate analysis was performed using backward stepwise logistic regression. RESULTS: A total of 214 cases were included. Mean age was 81 years, and 63% were women. Malnutrition was detected in 47% of the cases, dementia in 46%, and delirium in 36%. ETF was initiated in 44 (21%) admissions. Independent predictors of ETF were delirium (odds ratio [OR], 4.83; 95% CI, 2.12-11.01; P < .001) and total functional dependency (OR, 8.95; 95% CI, 2.87-27.88; P < .001). Malnutrition was not independently associated with ETF. CONCLUSION: One in five acutely ill older adults used ETF while hospitalized. Delirium and functional dependency were independent predictors of its introduction. Risks and benefits of enteral nutrition in this particular context need to be further explored.
Assuntos
Delírio/epidemiologia , Demência/epidemiologia , Depressão/epidemiologia , Nutrição Enteral , Hospitalização , Desnutrição/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Brasil , Delírio/terapia , Demência/terapia , Depressão/terapia , Feminino , Avaliação Geriátrica , Humanos , Incidência , Modelos Logísticos , Masculino , Desnutrição/terapia , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de RiscoRESUMO
A síndrome de Plummer-Vinson ou Patterson-Kelly é doença rara caracterizada pela tríade disfagia intermitente, ferropenia e membrana esofágica. São poucos os dados na literatura sobre sua prevalência. Embora seja atualmente uma síndrome rara, seu reconhecimento é importante, pois identifica um fator de risco para câncer de trato gastrointestinal alto. Aqui descrevemos um caso desta síndrome com revisão de literatura
Assuntos
Idoso , Anemia Ferropriva , Transtornos de Deglutição , Síndrome de Plummer-VinsonRESUMO
Objective: To detect the effects of Tai Chi Chuan practice on the cognition of elderly subjects with Mild Cognitive Impairment. Methods: This is a pilot study with 26 elderly patients (mean age of 74 years) with Mild Cognitive Impairment. The evaluation instruments were Subjective Memory Complaint Scale (SMC), Rivermead Behavioral Memory Test (RBMT) and Digit Span Forward and Backward (DSF and DSB) from the Wechsler Adult Intelligence Scale (WAIS). One group of 13 patients received two weekly 60-minute classes of Tai Chi Chuan (Yang style) for 6 consecutive months, and the rest formed the Control Group. The Tai Chi Chuan Group was also evaluated as to learning of the Tai Chi Chuan practical exercises by means of a Specific Learning Test applied after three months of intervention. Results: After six months of intervention, the TCC Group showed significant improvement on the RBMT and the SMC (p = 0.007 and p = 0.023, respectively). The Control Group showed no significant differences in the cognitive tests during the study. There was a significant correlation between the Tai Chi Chuan Learning Test and RBMT (p = 0.008), showing that patients with a better performance in exercising TCC also showed a better performance in memory. Conclusions: In this study, a six-month program of Tai Chi Chuan afforded a significant improvement of the performance of memory complaints in the elderly with Mild Cognitive Impairment. Additional randomized studies with larger samples and more prolonged follow-up are needed to confirm these benefits.
Objetivo: Detectar os efeitos da prática de Tai Chi Chuan na cognição de idosas com comprometimento cognitivo leve. Métodos: Estudo piloto com 26 idosas (média de idade de 74 anos) com comprometimento cognitivo leve. Os instrumentos de avaliação foram: Escala Subjetiva de Queixas de Memória (EQM), Teste Comportamental de Memória de Rivermead (RBMT) e Amplitude de Dígitos Verbal Direta e Indireta (DD e DI, respectivamente) derivadas do Weschler Adult Intelligence Scale (WAIS). Um grupo de 13 pacientes recebeu duas aulas semanais de 60 minutos de Tai Chi Chuan (estilo Yang) por 6 meses consecutivos, e o restante formou o Grupo Controle. O grupo Tai Chi Chuan também foi avaliado quanto ao aprendizado da prática dos exercícios de Tai Chi Chuan através de um Teste de Aprendizado Específico aplicado após três meses de intervenção. Resultados: Após seis meses de intervenção, o grupo Tai Chi Chuan apresentou melhora significativa no RBMT e na EQM (p = 0,007 e p = 0,023, respectivamente). O Grupo Controle não apresentou diferenças significativas nos testes cognitivos no decorrer do estudo. Houve correlação significativa entre o Teste de Aprendizado de Tai Chi Chuan e o RBMT (p = 0,008), apontando que os pacientes com melhor performance na prática de Tai Chi Chuan apresentaram melhor desempenho da memória. Conclusões: Neste estudo, um programa de seis meses de Tai Chi Chuan propiciou uma melhora significativa do desempenho e das queixas de memória de idosas com comprometimento cognitivo leve. Estudos adicionais randomizados com casuística maior e seguimento mais prolongado são necessários para confirmar estes benefícios.
RESUMO
OBJECTIVE: To detect the effects of Tai Chi Chuan practice on the cognition of elderly subjects with Mild Cognitive Impairment. METHODS: This is a pilot study with 26 elderly patients (mean age of 74 years) with Mild Cognitive Impairment. The evaluation instruments were Subjective Memory Complaint Scale (SMC), Rivermead Behavioral Memory Test (RBMT) and Digit Span Forward and Backward (DSF and DSB) from the Wechsler Adult Intelligence Scale (WAIS). One group of 13 patients received two weekly 60-minute classes of Tai Chi Chuan (Yang style) for 6 consecutive months, and the rest formed the Control Group. The Tai Chi Chuan Group was also evaluated as to learning of the Tai Chi Chuan practical exercises by means of a Specific Learning Test applied after three months of intervention. RESULTS: After six months of intervention, the TCC Group showed significant improvement on the RBMT and the SMC (p = 0.007 and p = 0.023, respectively). The Control Group showed no significant differences in the cognitive tests during the study. There was a significant correlation between the Tai Chi Chuan Learning Test and RBMT (p = 0.008), showing that patients with a better performance in exercising TCC also showed a better performance in memory. CONCLUSIONS: In this study, a six-month program of Tai Chi Chuan afforded a significant improvement of the performance of memory complaints in the elderly with Mild Cognitive Impairment. Additional randomized studies with larger samples and more prolonged follow-up are needed to confirm these benefits.
RESUMO
Desequilíbrios hídricos são comuns no idoso hospitalizado. Quando não é possível utilizar a via oral, opta-se freqüentemente pela hidratação intravenosa (IV), visando-se manter uma adequada hidratação. A prescrição de hidratação IV em idosos deve estar baseada em aspectos de sua fisiologia cardiorrenal e nas modificações de sua composição corpórea. É comum que pacientes idosos recebam grandes volumes de água livre ou sobrecargas de sódio através da solução salina 0,9%. As sobrecargas salinas devem ser evitadas, pois estão associadas a um pior prognóstico clínico. Discutiremos neste artigo aspectos referentes ao diagnóstico precoce de desidratação no idoso e estratégias para a prescrição de soluções para hidratação venosa de manutenção.
RESUMO
Objetivo: Relacionar estresse dos cuidadores de pacientes dementes com características dos pacientes e cuidadores. Método: Análise de prontuários. Variáveis do paciente: sociodemográficas, comorbidades, medicamentos (atual e prévio), tempo de história e diagnóstico, tipo da demência e gravidade (cognitiva e funcional), sintomas neuropsiquiátricos e comportamentais. Variáveis do cuidador: sociodemográficas, vínculo com paciente, tempo de cuidado e se residia com paciente. Sobrecarga avaliada pelo questionário de Zarit. Resultados: 67 pacientes (76,8 anos, 53,7% mulheres). 82% cuidadores mulheres. Relação direta entre estresse e sintomas comportamentais (p<0,001), prejuízo funcional (p=0,003), tempo de história (p=0,016) e de cuidado (p<0,001), diagnóstico prévio (p=0,016) e fato de residir com paciente (p=0,002). Pontuações nos testes cognitivos (Minimental e Camcog) inversamente proporcionais à sobrecarga (p=0,005 e p=0,023). Cuidadores negros apresentaram menor estresse (p=0,012). Conclusão: Relacionou-se estresse aos sintomas neuropsiquiátricos e comportamentais, comprometimento funcional e cognitivo, tempo de história, cuidado e convivência. Encontrada menor sobrecarga em cuidadores negros.
RESUMO
OBJECTIVE: To verify the correlation between caregiver burden in dementia and characteristics of patients and caregivers. METHODS: Analysis of medical records. Patient data: socio-demographic characteristics, comorbidities, medications (previous and current), onset of diagnosis and symptoms, type of dementia and severity (cognitive impairment and functional abilities), behavioral disorders. Caregiver data: socio-demographic characteristics, kinship, duration of caregiving and co-residency with the patient. Caregiver burden assessed by the Zarit interview. RESULTS: Sixty seven patients (76.8 years (+/-6.2), 53.7% women) and 82% female caregivers were surveyed. Correlation between burden and behavior disorders (p<0.001), dependencies (p=0.003), onset of symptoms (p=0.016) and of caregiving (p<0.001), previous diagnosis (p=0.016) and co-residency (p=0.002) was studied. Cognitive test scores (Mini Mental and CAMCOG) were inversely proportional to distress (p=0.005 and p=0.023). Black caregivers demonstrated lower levels of stress (p=0.012). CONCLUSION: Burden was associated with behavioral disorders, dependencies, cognitive impairment, and onset of symptoms, caregiving and co-residency. Black caregivers demonstrated lower levels of stress.
Assuntos
Cuidadores/psicologia , Demência/enfermagem , Estresse Psicológico/diagnóstico , Inquéritos e Questionários , Idoso , Brasil/epidemiologia , Comorbidade , Demência/epidemiologia , Demência/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Valor Preditivo dos Testes , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Estresse Psicológico/epidemiologiaRESUMO
We report a case history of an 84-year-old elderly male patient that presented with a clinical picture suggestive of adrenal failure and bilateral adrenal nodules detected by abdominal computed tomography. A fine needle-guided biopsy was inconclusive for achieving a final diagnosis. The patient died due to septic shock and the autopsy disclosed histoplasmosis with extensive bilateral necrosis of the adrenal glands. Although the adrenal involvement in chronic disseminated histoplasmosis has been described, there have been few reports of the infection being associated with adrenal insufficiency.
Assuntos
Doenças das Glândulas Suprarrenais/microbiologia , Glândulas Suprarrenais/microbiologia , Histoplasmose/diagnóstico , Doenças das Glândulas Suprarrenais/diagnóstico , Doenças das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/patologia , Idoso de 80 Anos ou mais , Doença Crônica , Evolução Fatal , Histoplasma/isolamento & purificação , Histoplasmose/patologia , Humanos , Masculino , NecroseRESUMO
We report a case history of an 84-year-old elderly male patient that presented with a clinical picture suggestive of adrenal failure and bilateral adrenal nodules detected by abdominal computed tomography. A fine needle-guided biopsy was inconclusive for achieving a final diagnosis. The patient died due to septic shock and the autopsy disclosed histoplasmosis with extensive bilateral necrosis of the adrenal glands. Although the adrenal involvement in chronic disseminated histoplasmosis has been described, there have been few reports of the infection being associated with adrenal insufficiency.
Assuntos
Idoso de 80 Anos ou mais , Humanos , Masculino , Doenças das Glândulas Suprarrenais/microbiologia , Glândulas Suprarrenais/microbiologia , Histoplasmose/diagnóstico , Doenças das Glândulas Suprarrenais/diagnóstico , Doenças das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/patologia , Doença Crônica , Evolução Fatal , Histoplasma/isolamento & purificação , Histoplasmose/patologia , NecroseRESUMO
OBJETIVOS: Relacionar estresse dos cuidadores de pacientes dementes com características dos pacientes e cuidadores. MÉTODOS: Análise de prontuários. Variáveis do paciente: sóciodemográficas, comorbidades, medicamentos (atual e prévio), tempo de história e diagnóstico, tipo da demência e gravidade (cognitiva e funcional), sintomas neuropsiquiátricos e comportamentais. Variáveis do cuidador: sóciodemográficas, vínculo com paciente, tempo de cuidado e se residia com paciente. Sobrecarga avaliada pelo questionário de Zarit. RESULTADOS: Sessenta e sete pacientes (76,8 anos (± 6,2), 53,7 por cento mulheres). Oitenta e dois por cento dos cuidadores são mulheres. Relação direta entre estresse e sintomas comportamentais (p<0,001), prejuízo funcional (p=0,003), tempo de história (p=0,016) e de cuidado (p<0,001), diagnóstico prévio (p=0,016) e fato de residir com paciente (p=0,002). Pontuações nos testes cognitivos (Mini Mental e CAMCOG) inversamente proporcionais à sobrecarga (p=0,005 e p=0,023). Cuidadores negros apresentaram menor estresse (p=0,012). CONCLUSÃO: Relacionou-se o estresse aos sintomas neuropsiquiátricos e comportamentais, comprometimento funcional e cognitivo, e tempo de história, cuidado e convivência. Encontrada menor sobrecarga em cuidadores negros.
OBJECTIVE: To verify the correlation between caregiver burden in dementia and characteristics of patients and caregivers. METHODS: Analysis of medical records. Patient data: socio-demographic characteristics, comorbidities, medications (previous and current), onset of diagnosis and symptoms, type of dementia and severity (cognitive impairment and functional abilities), behavioral disorders. Caregiver data: socio-demographic characteristics, kinship, duration of caregiving and co-residency with the patient. Caregiver burden assessed by the Zarit interview. RESULTS: Sixty seven patients (76.8 years (± 6.2), 53.7 percent women) and 82 percent female caregivers were surveyed. Correlation between burden and behavior disorders (p<0.001), dependencies (p=0.003), onset of symptoms (p=0.016) and of caregiving (p<0.001), previous diagnosis (p=0.016) and co-residency (p=0.002) was studied. Cognitive test scores (Mini Mental and CAMCOG) were inversely proportional to distress (p=0.005 and p=0.023). Black caregivers demonstrated lower levels of stress (p=0.012). CONCLUSION: Burden was associated with behavioral disorders, dependencies, cognitive impairment, and onset of symptoms, caregiving and co-residency. Black caregivers demonstrated lower levels of stress.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidadores/psicologia , Demência/enfermagem , Inquéritos e Questionários , Estresse Psicológico/diagnóstico , Brasil/epidemiologia , Comorbidade , Demência/epidemiologia , Demência/psicologia , Modelos Logísticos , Testes Neuropsicológicos , Valor Preditivo dos Testes , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Estresse Psicológico/epidemiologiaRESUMO
A prevalência de insuficiência cardíaca aumenta com o progredir da idade, chegando a comprometer 10 porcento dos indivíduos com mais de 65 anos de idade. Em idosos, além da insuficiência cardíaca congestiva, que se caracteriza pela disfunçäo sistólica ventricular esquerda, observa-se elevada freqüencia de insuficiência cardíaca diastólica, caracterizada pela funçäo sistólica normal e disfunçäo diastólica. As duas formas de insuficiência cardíaca apresentam diferenças epidemiológicas, fisiopatológicas, etiológicas, clínicas e prognósticas. É importante determinar se o paciente apresenta primariamente disfunçäo sistólica ou diastólica, porque as medidas terapêuticas diferem nos dois tipos. Nos pacientes muito idosos os sintomas e sinais de insuficiência cardíaca podem ser mascarados pela presença de alteraçöes do envelhecimento e pela associaçlo de outras afecçöes que dificultam o diagnóstico, retardando a terapêutica. Devido às alteraçöes da farmacicinética e da farmacodinâmica das drogas nos idosos, a terapêutica deve ser cautelosa, iniciando-se com menores doses, para evitar efeitos colaterais que podem aumentar a morbidade e a mortalidade.(au)
Assuntos
Humanos , Idoso , Envelhecimento , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapiaRESUMO
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 ü240mg/dL, LDL-cholesterol ü160mg/dL, and body mass index >27.5 were more frequent among women, but HDL-cholesterol <35mg/dL and cigarette smoking were more frequent among men, and no difference occurred between sexes in relation to the frequency of triglycerides ü250mg/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 ü250mg/dL, hypertension, and male sex. Among men, the risk factors were: LDL-cholesterol ü160mg/dL, diabetes mellitus, HDL-cholesterol <35mg/dL and hypertension. Among women, the risk factors were: tryglicerides ü250mg/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
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Assistência Ambulatorial , Aterosclerose/etiologia , Fatores Etários , Aterosclerose/complicações , Aterosclerose/epidemiologia , Brasil/epidemiologia , Análise Multivariada , Prevalência , Fatores de Risco , Fatores SexuaisRESUMO
Avaliar em população idosa ambulatorial os resultados do emprego de um teste mental abreviado (TMA) de rápida aplicação, procurando-se verificar sua utilidade na avaliação do desempenho cognitivo de idosos em nível populacional
Assuntos
Masculino , Feminino , Humanos , Assistência Ambulatorial , Avaliação Geriátrica , Saúde Mental , Doença de Alzheimer , Nível de Saúde , Transtornos MentaisRESUMO
A hipertensão arterial sistólica isolada (Hasi) é o mais frequente tipo de hipertensão arterial no paciente idoso, constituindo-se em importante fator de risco de morbidade cárdio e cerebrovascular. Os principais mecanismos determinantes da Hasi são: a) redução da complacência arterial; b)aumento da resistência arterial periférica; c) aumento do tônus simpático; d)alterações do débito cardíaco. A avaliação clínica deve ser cuidadosa para permitir o grau de comprometimento cardíaco, o estado da circulação cerebral e periférica, a intensidade da alteração renal e ocular. O tratamento deve ser realizado com medidas não farmacológicas e farmacológicas. Entre estas últimas, o único estudo a longo prazo, randomizado, duplo-cego e com plecebo realizada, foi o Systolic Hypertesion in the Elderly Program (Shep) que evidenciou dos níveis pressóricosmcom clortalidona em 88(por cento) dos casos e significativa redução das complicações cárdio e cerebrovasculares. A curto prazo, bloqueadores dos canais de cálcio e inibidores da enzima conversora mostraram efeito anti-hipertensivo satisfatório e os beta-bloqueadores foram geralmente utilizados associados aos tiazídicos
Assuntos
Hipertensão , IdosoRESUMO
Purpose - To evaluate the different aspects of chronic atrialfibrillation (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 outpatient 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 morefrequent, 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 morefrequently seen was the left atrial enlargment, seen in 16 (45.7%) patients. Four patients didn't show clinical, electrocardiographic, radiological or echocardiographic evidence of cardiocirculatory disease and in these, the thyroidfunction was normal. Digitalis therapy was used in 37 patients. Of the remaining 12,10 had normal ventricular frequency without the use of the drug...
Assuntos
Doenças do Sistema Endócrino/complicações , Doenças Cardiovasculares/complicações , Fibrilação Atrial/complicações , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Ecocardiografia , Eletrocardiografia , Doenças do Sistema Endócrino/diagnóstico , Doenças do Sistema Endócrino/epidemiologia , Doença Crônica , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Prontuários MédicosRESUMO
Foram estudados retrospectivamente os prontuários de 20 pacientes idosos internados no Hospital das Clínicas da FMUSP, durante o período de 1974 a 1984, com diagnóstico de anemia megaloblástica. Dez doentes eram do sexo masculino e dez do feminino, com idades variando de 62 a 84 anos (média: 70,4 anos). Em todos os casos as manifestaçöes foram múltiplas e acentuadas, predominando as hematológicas, cardiocirculatórias, neurológicas, digestivas e o grave comprometimento do estado geral. Anemia com volume corpuscular médio elevado, aumento do índice de segmentaçäo dos neutrófilos, leucopenia, plaquetopenia e hemólise foram os achados hematológicos mais freqüentes, ocorrendo muitas vezes associadamente. Em todos os casos em que foi realizado o estudo endoscópico e a biópsia gástrica, encontraram-se alteraçöes. Näo houve diferença quanto às manifestaçöes entre os portadores de deficiência de vitamina B12 ou de ácido fólico. A resposta à terapêutica foi observada em 18 pacientes (90,0%) sendo, em geral, brilhante e rápida; porém, certas manifestaçöes neurológicas podem persistir. Por outro lado, os casos näo tratados podem até evoluir para óbito, em decorrência principalmente de complicaçöes cardiocirculatórias, hemorrágicas e infecciosas