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BACKGROUND: Depression in ageing adults is a public health problem. Worldwide studies have identified social and health risk factors for depressive symptoms. However, little is known about their longitudinal determinants in Mexico. OBJECTIVES AND SETTING: To find the prevalence of depressive symptoms and their longitudinal individual and contextual risk factors in Mexican adults aged 50 and older. DESIGN: Secondary data of 6460 persons aged 50 years and older from the Mexican Health and Aging Study were analysed using a 'between-within' panel data analysis approach. RESULTS: The prevalence of depressive symptoms increased from 35% in 2003 to 38% in 2015. The significantly longitudinal factors associated with these symptoms were getting older (OR 1.02, 95% CI 1.01 to 1.03), being a woman (OR 2.39, 95% CI 2.16 to 2.64), less time spent in formal education (0 years and less than 6 years OR 1.52, 95% CI 1.32 to 1.75 and OR 1.33, 95% CI 1.19 to 1.50, respectively), lower net worth (OR 1.13, 95% CI 1.08 to 1.17), being recently unemployed (OR 1.25, 95% CI 1.10 to 1.25), increased (OR 1.17, 95% CI 1.10 to 1.25) or increasing number (OR 1.23, 95% CI 1.15 to 1.31) of chronic conditions, poor (OR 4.68, 95% CI 4.26 to 5.15) or worsened (OR 1.71, 95% CI 1.61 to 1.81) self-rated health and having impairments on instrumental activities of daily living (IADLs) (OR 2.94 95% CI 2.35 to 3.67) or a new IADL impairment (OR 1.67, 95% CI 1.48 to 1.89), as well as having impairments on ADLs (OR 1.51, 95% CI 1.23 to 1.86) or a new ADL impairment (OR 1.34, 95% CI 1.21 to 1.48). CONCLUSIONS: The prevalence of depressive symptoms in Mexican adults aged 50 and older is high. Our findings show that they are longitudinally associated with the individual's demographic, socioeconomic, health and disability characteristics. Efforts in public policy should focus on preventing chronic conditions and disability, as well as fighting inequalities to reduce the prevalence of depressive symptoms.
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Depressão , Humanos , México/epidemiologia , Feminino , Masculino , Estudos Longitudinais , Pessoa de Meia-Idade , Idoso , Depressão/epidemiologia , Fatores de Risco , Prevalência , Fatores Socioeconômicos , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Atividades CotidianasRESUMO
INTRODUCTION: Worldwide, the prevalence of degenerative diseases such as dementia and mild cognitive impairment (MCI) is increasing with population ageing and increasing life expectancy. Both conditions share modifiable risk factors. Physical inactivity is one of these modifiable risk factors, and research points to the protective effect of physical activity on the incidence of dementia and MCI. However, this association tends to change according to type, intensity, frequency, duration and volume of physical activity. Furthermore, it remains unclear which of these characteristics offers the greatest protective effect. Therefore, this study aims to evaluate the impacts of different types, intensities, frequencies, duration and volume of physical activity on dementia and cognitive decline in older adults. METHODS AND ANALYSIS: The search will be carried out from October 2023, using the following databases: PubMed, Embase, Scopus, CINAHL and Web of Science. Cohort studies with a follow-up time of 1 year or longer that have investigated the incidence of dementia and/or MCI in older adults exposed to physical activity will be included. There will be no limitations on the date of publication of the studies. Studies published in English, Spanish or Portuguese will be analysed. Two researchers will independently screen the articles and extract the data. Any discrepancies will be resolved by a third reviewer. Association measures will be quantified, including OR, HR, relative risk and incidence ratio, with a 95% CI. If the data allow, a meta-analysis will be performed. To assess the methodological quality of the selected studies, the Grading of Recommendations, Assessment, Development and Evaluations instrument, and the Downs and Black instrument to assess the risk of bias, will be used. ETHICS AND DISSEMINATION: Ethical approval is not required. The results will be submitted for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42023400411.
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Disfunção Cognitiva , Demência , Humanos , Idoso , Revisões Sistemáticas como Assunto , Metanálise como Assunto , Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Demência/prevenção & controle , Demência/psicologia , Exercício FísicoRESUMO
INTRODUCTION: Exergames are used in the clinical practice of geriatric rehabilitation to increase physical activity levels and motivate players/patients. Their use in the home environment makes it possible to perform fun, engaging and interactive training with a large number of repetitions, thereby reducing the negative repercussions of postural imbalance in older adults. The aim of this systematic review is to collate and analyse evidence on the usability of exergames as a tool for home-based balance training for older adults. METHODS AND ANALYSIS: We will include randomised controlled trials involving healthy older adults (aged 60 years or older) who are described as having impaired static or dynamic balance using any subjective or objective assessment criteria. We will search Web of Science, MEDLINE, Embase, Scopus, ScienceDirect and the Cochrane Library from database inception to December 2022. CLINICALTRIALS: gov, the WHO International Clinical Trials Registry Platform and ReBEC will be searched for ongoing or unpublished trials. Two independent reviewers will screen the studies and extract the data. The findings will be presented in the text and tables, and if possible, relevant meta-analyses will be performed. The risk of bias and the quality of evidence will be assessed based on the recommendations of the Cochrane Handbook and Grading of Recommendations, Assessment, Development and Evaluation, respectively. ETHICS AND DISSEMINATION: Ethical approval was not required because of the nature of this study. Findings will be disseminated through peer-reviewed publications, conference presentations and through clinical rehabilitation networks. PROSPERO REGISTRATION NUMBER: CRD42022343290.
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Jogos Eletrônicos de Movimento , Nível de Saúde , Humanos , Idoso , Revisões Sistemáticas como AssuntoRESUMO
INTRODUCTION: Studies have indicated that gait intervention programmes with minimalist shoes are effective for reducing pain, improving functionality and reducing knee joint overload in older women with knee osteoarthritis (OA). Other clinical trials with knee and foot muscle strength training and/or dynamic balance training have also shown clinical and functional effectiveness. Despite promising strategies, there is no evidence of the combination of shoes with gait intervention programmes. Thus, the objective of this randomised clinical trial is to investigate the effects of therapeutic programme of muscular resistance, balance and gait exercises with and without the use of low-cost, flexible shoes on the clinical, functional and biomechanical aspects of older women with medial knee OA. METHODS AND ANALYSIS: This randomised controlled trial with blinded evaluators will involve 36 older women. Twenty-four older women with knee OA (medial compartment) will be randomised to the intervention groups with minimalist shoes (GIC; n=12) or in a barefoot condition (GID; n=12), and 12 older women to the control group (n=12). The intervention protocol will consist of knee-foot muscle resistance and static balance training, reactive and proactive dynamic balance training, and gait training with visual feedback. The intervention will have a duration of two consecutive months, twice a week, totalling 16 sessions. The primary outcomes will be walking pain measured by Visual Analogue Scale and questionnaires: Western Ontario McMaster Universities Osteoarthritis Index and Lequesne Algofunctional. The secondary outcomes will be: 6-min walk test, Falls Risk Awareness Questionnaire, Timed Up and Go Test, and distribution of plantar load during gait and balance by pressure platform. Data will be analysed according to an intention-to-treat approach. ETHICS AND DISSEMINATION: This study involves human participants and was approved by the ethics committee of the Universidade Santo Amaro, School Medicine, São Paulo/SP, Brazil (N°4.091.006). Participants gave informed consent to participate in the study before taking part. Investigators will communicate trial results to participants and healthcare professionals through scientific databases, social media, publications and conferences. TRIAL REGISTRATION NUMBER: RBR-10j4bw25 in Brazilian Clinical Trial Registry.
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Osteoartrite do Joelho , Idoso , Brasil , Feminino , Marcha , Humanos , Dor/complicações , Equilíbrio Postural , Ensaios Clínicos Controlados Aleatórios como Assunto , Sapatos , Estudos de Tempo e Movimento , Resultado do TratamentoRESUMO
BACKGROUND: Identifying muscle weakness is challenging, because the reduction of strength with aging does not depend only on sarcopenia, but also on sensorimotor deficits. Nevertheless, this identification is improved by adjusting muscle strength allometrically, by removing the influence of body size. However, the effectiveness of foreign models to normalize these (dys)functionalities is not yet tested. This study aimed to compare and apply foreign allometric exponents for normalizing isokinetic knee extension strength in Portuguese older adults to identify muscle weakness/mobility limitation. Additionally, to attest any populational difference, data of these people and Brazilian older adults were compared METHODS: This is a cross-sectional study encompassing 226 Portuguese (n = 132) and Brazilian (n = 94) older adults. Mobility limitation (six-minute walk test, at lowest quartile), lower limb strength (knee extension isokinetic strength at 60º/s), and body dimensions measures were taken. Foreign allometric exponents (b) were used to normalize Portuguese strength (strength/body-size variablesb). Non-normalized and normalized strength were compared (ROC) to generate the most accurate cut-point for identifying muscle weakness/mobility limitation. RESULTS: Older Portuguese men and women had better mobility than their Brazilian counterparts. Older Portuguese women had superior muscle strength to Brazilian women. Normalization from 11 foreign models removed the influence of body size on muscle strength, with a negligible correlation (r ≤ 0.30). In contrast to the non-normalized strength, the normalized strength cut-off points were sufficiently accurate (AUC ≥ 0.70) to avoid identifying false-negative cases of weakness/mobility limitation. CONCLUSIONS: Portuguese older women were stronger and had superior functional capacity compared to Brazilian ones. Normalized foreign models improved the accuracy in identifying muscle weakness/mobility limitation in Portuguese older adults. The isokinetic knee extension muscle strength normalized, even using foreign allometric exponents, should be better than no adjustment.
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Limitação da Mobilidade , Debilidade Muscular , Idoso , Estudos Transversais , Feminino , Força da Mão/fisiologia , Humanos , Extremidade Inferior , Masculino , Debilidade Muscular/diagnóstico , Portugal/epidemiologiaRESUMO
INTRODUCTION: Stigma and discrimination among healthcare workers can hinder diagnosis and the provision of appropriate care in dementia. This study is aimed at developing, delivering and evaluating the feasibility of a group antistigma intervention to improve knowledge, attitudes and behaviours in relation to people living with dementia among community health workers (CHWs). METHODS AND ANALYSIS: This will be a randomised controlled feasibility trial conducted with 150 CHWs from 14 primary care units (PCUs) in São Paulo, Brazil. PCUs will be randomly allocated (1:1) in two parallel groups-experimental group or control group. Participants from PCUs allocated to the experimental group will receive a 3-day group intervention involving audio-visual and printed materials as well as elements of social contact. The control group will keep their usual routine. Knowledge, attitude and intended behaviour stigma-based outcomes will be assessed at baseline and at follow-up (30 days after intervention) to both groups, with additional questions on feasibility for the experimental group at follow-up. Around 10-15 participants will take part in follow-up semistructured interviews to further explore feasibility. Quantitative analyses will follow an 'intention to treat' approach. Qualitative data will be analysed using content analysis. ETHICS AND DISSEMINATION: This study was approved by the National Commission for Ethics in Research in Brazil (n. 5.510.113). Every participant will sign a consent form. Results will be disseminated through academic journals and events related to dementia. The intervention materials will be made available online.
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OBJECTIVE: To map in the current literature instruments for the assessment and stratification of frailty in community-dwelling older people, as well as to analyse them from the perspective of the Brazilian context. DESIGN: Scoping review. STUDY SELECTION: The selection of studies took place between March and April 2020. Includes electronic databases: Medline, Latin American and Caribbean Literature in Health Sciences, Scopus, Web of Science and Cumulative Index of Nursing and Literature Health Alliance, in addition to searching grey literature. DATA EXTRACTION: A data extraction spreadsheet was created to collect the main information from the studies involved, from the title to the type of assessment and stratification of frailty. RESULTS: In summary, 17 frailty assessment and stratification instruments applicable to community-dwelling older people were identified. Among these, the frailty phenotype of Fried et al was the instrument most present in the studies (45.5%). The physical domain was present in all the instruments analysed, while the social, psychological and environmental domains were present in only 10 instruments. CONCLUSIONS: This review serves as a guideline for primary healthcare professionals, showing 17 instruments applicable to the context of the community-dwelling older people, pointing out advantages and disadvantages that influence the decision of the instrument to be used. Furthermore, this scoping review was a guide for further studies carried out by the same authors, which aim to compare instruments.
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Fragilidade , Idoso , Brasil , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Pessoal de Saúde , Humanos , Vida IndependenteRESUMO
INTRODUCTION: Regular oral health assessment among older adults living in long-term care facilities (LTCF) can improve their oral health. Different instruments have been developed and used to evaluate the oral health of institutionalised older people by non-dental professionals. These instruments must demonstrate adequate measurement properties. This systematic review aims to examine the studies describing the instruments employed to assess the oral health of older adults living in LTCF by non-dental professionals. The study will also evaluate the measurement properties of such instruments using the checklist proposed by the Consensus-based Standards to select health Measurement Instruments (COSMIN). METHODS AND ANALYSIS: Studies describing the development of instruments for assessing oral health of institutionalised older adults by non-dental professionals will be included. Studies assessing at least one measurement property (validity, reliability or responsiveness) will be also considered. Electronic searches will be conducted on MEDLINE (PubMed, Ovid), Embase, Web of Science, Scopus and LILACS databases. Two independent reviewers will select the studies and will extract data concerning the characteristics of the research and the instrument. The measurement properties will be evaluated using the COSMIN checklist. The Grading of Recommendations, Assessment, Development and Evaluation approach will be used to grade the quality (or certainty) of evidence and strength of recommendations. ETHICS AND DISSEMINATION: No ethical approval is required. The results will be submitted for publication to a peer-review journal and presented at relevant conferences. PROSPERO REGISTRATION NUMBER: CRD42020191479.
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Assistência de Longa Duração , Saúde Bucal , Idoso , Instalações de Saúde , Humanos , Reprodutibilidade dos Testes , Instituições de Cuidados Especializados de Enfermagem , Revisões Sistemáticas como AssuntoRESUMO
INTRODUCTION: Faced with the continuous growth in the number of older people at a global level, some concerns are raised about the way people age. Health conditions such as depressive symptoms and depression have a direct or indirect impact on the quality of life of this population segment. The objective of this study is to verify the incidence of the various presentations of the depressive spectrum in the community-dwelling older population, as well as to analyse the predictive factors. METHODS AND ANALYSIS: This systematic review and meta-analysis protocol follows the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Searches will be conducted in PubMed, Web of Science, Scopus, Latin-American and Caribbean Literature on Health Sciences, Scientific Electronic Library Online and Cochrane databases, as well as grey literature. The search strategy involves terms related to ageing and the depressive spectrum found in observational studies. There will be no language restriction and the material included will be the ones whose publications took place until December 2020. ETHICS AND DISSEMINATION: Formal ethical approval is not required on this research, since it only aims secondary data. After publishing the results in a scientifically supported journal, our findings may be disseminated to fill in the gaps and guide the production of more effective public policies directed at a more adequate care to the older population at a global level. The search process began in January 2021 and it is expected that all stages of the review will be completed by 30 November 2021. PROSPERO REGISTRATION NUMBER: CRD42019121616.
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Depressão , Vida Independente , Idoso , Região do Caribe , Depressão/epidemiologia , Humanos , Incidência , Metanálise como Assunto , Qualidade de Vida , Projetos de Pesquisa , Revisões Sistemáticas como AssuntoRESUMO
INTRODUCTION: The development of multiple coexisting chronic diseases (multimorbidity) is increasing globally, along with the percentage of older adults affected by it. Multimorbidity is associated with the concomitant use of multiple medications, a greater possibility of adverse effects, and increased risk of hospitalisation. Therefore, this systematic review study protocol aims to analyse the impact of multimorbidity on the occurrence of hospitalisation in older adults and assess whether this impact changes according to factors such as sex, age, institutionalisation and socioeconomic status. This study will also review the average length of hospital stay and the occurrence of hospital readmission. METHODS AND ANALYSIS: A systematic review of the literature will be carried out using the PubMed, Embase and Scopus databases. The inclusion criteria will incorporate cross-sectional, cohort and case-control studies that analysed the association between multimorbidity (defined as the presence of ≥2 and/or ≥3 chronic conditions and complex multimorbidity) and hospitalisation (yes/no, days of hospitalisation and number of readmissions) in older adults (aged ≥60 years or >65 years). Effect measures will be quantified, including ORs, prevalence ratios, HRs and relative risk, along with their associated 95% CI. The overall aim of this study is to widen knowledge and to raise reflections about the association between multimorbidity and hospitalisation in older adults. Ultimately, its findings may contribute to improvements in public health policies resulting in cost reductions across healthcare systems. ETHICS AND DISSEMINATION: Ethical approval is not required. The results will be disseminated via submission for publication to a peer-reviewed journal when complete. PROSPERO REGISTRATION NUMBER: CRD42021229328.
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Multimorbidade , Projetos de Pesquisa , Idoso , Doença Crônica , Estudos Transversais , Hospitalização , Humanos , Revisões Sistemáticas como AssuntoRESUMO
Polyarteritis nodosa (PAN) is a necrotising systemic vasculitis involving medium-sized and small-sized vessels. PAN limited to a single organ is rare, particularly in the elderly population. Herein, we present a 73-year-old-woman who developed severe abdominal pain. Mesenteric angiography showed multifocal areas of segmental dilation and narrowing of the superior mesenteric, ileocolic and right colonic arteries. Exploratory laparotomy revealed multiple areas of necrosis of the jejunum for which resection was performed. Histopathological exam disclosed mesenteric vasculitis with fibrinoid necrosis of the arterial wall with leucocytic infiltrates and haemorrhages consistent with PAN. She was started on high-dose corticosteroids with an initial good response. However, 6 months later, she developed intestinal pseudo-obstruction for which oral cyclophosphamide was started. After 5 months of cyclophosphamide therapy, she remained stable without further relapses. Our case suggests that PAN should be considered in elderly patients presenting with abdominal pain even in the absence of systemic involvement.
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Poliarterite Nodosa , Dor Abdominal/etiologia , Idoso , Angiografia , Ciclofosfamida/uso terapêutico , Feminino , Humanos , Intestinos , Poliarterite Nodosa/complicações , Poliarterite Nodosa/diagnóstico , Poliarterite Nodosa/tratamento farmacológicoRESUMO
BACKGROUND: The prevalence of drug-drug interactions (DDIs) in hospital settings is variable, and elderly patients are considered a high risk population for DDIs. There are no systematic reviews describing the prevalence of DDIs in hospitalised elderly patients. OBJECTIVES: To assess and summarise the available data on the prevalence of DDIs in hospitalised elderly patients and to describe which drugs, drug classes and drug combinations are most commonly involved in DDIs. DATA SOURCE: A systematic electronic literature search was conducted on Medline/PubMed, Embase, Lilacs, SciElo, Web of Science, Cinahl, Scopus, Cochrane, OpenGrey, Capes Thesis Bank, OasisBR, OpenAire and abstracts from scientific events, without limitation on language or period of publication. Study selection was completed on 21 September 2018. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Original observational studies that reported the prevalence of actual or potential DDIs during hospitalisation in patients aged 60 years or older were included. The main outcome measure was prevalence of DDIs and number of DDIs per patient. Subgroup analysis was performed in studies that reported the prevalence of DDIs in geriatric units. STUDY APPRAISAL AND SYNTHESIS METHODS: Study quality was assessed using the Agency for Healthcare Research and Quality methodological checklist for cross sectional and prevalence studies. RESULTS: 34 studies were included, involving 9577 patients. The prevalence of DDIs ranged from 8.34% to 100%. In studies conducted in geriatric units, the prevalence ranged from 80.5% to 90.5%. The number of DDIs per patient ranged from 1.2 to 30.6. Single drugs most commonly involved in DDIs were furosemide, captopril, warfarin and dipyrone. Drug classes mostly involved were potassium sparing diuretics and angiotensin converting enzyme inhibitors. LIMITATIONS: The main limitation is the heterogeneity between the included studies that precluded a meta-analysis. Several different methods were used to identify DDIs, majorly, and potential DDIs. Few studies have reported measures to control the quality of the collected data. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: The prevalence of DDIs ranged widely, and the variation may reflect differences in the conditions of the elderly patients and level of attention (or complexity of care), as well as methodological differences, especially the methods and/or software used to identify DDIs. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42018096720.
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Hospitalização , Idoso , Estudos Transversais , Interações Medicamentosas , Humanos , Pessoa de Meia-Idade , Prevalência , Estados UnidosRESUMO
INTRODUCTION: Cognitive and physical declines are frequent causes of disability among older adults (OAs) in Mexico that imposes significant burden on the health system and OAs' families. Programmes to prevent or delay OAs' cognitive and physical decline are scarce. METHODS AND ANALYSIS: A double-blind randomised clinical trial will be conducted. The study will aim to evaluate two 24-week double-task (aerobic and cognitive) square-stepping exercise programmes for OAs at risk of cognitive decline-one programme with and another without caregiver participation-and to compare these with an aerobic-balance-stretching exercise programme (control group). 300 OAs (100 per group) affiliated with the Mexican Institute of Social Security (IMSS) between 60 and 65 years of age with self-reported cognitive concerns will participate. They will be stratified by education level and randomly allocated to the groups. The intervention will last 24 weeks, and the effect of each programme will be evaluated 12, 24 and 52 weeks after the intervention. Participants' demographic and clinical characteristics will be collected at baseline. The outcomes will include: (1) general cognitive function; (2) specific cognitive functions; (3) dual-task gait; (4) blood pressure; (5) carotid intima-media thickness; (6) OAs' health-related quality of life; and (7) caregiver burden. The effects of the interventions on each outcome variable will be examined using a repeated-measures analysis of variance (ANOVA), with study groups as the between-subjects variable and time as the within-subject variable. ETHICS AND DISSEMINATION: The study was approved by the IMSS Ethics and Research Committees (registration number: 2018-785-095). All participants will sign a consent form prior to their participation. The study results will be disseminated to the IMSS authorities, healthcare providers and the research community. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT04068376).
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Disfunção Cognitiva , Qualidade de Vida , Idoso , Espessura Intima-Media Carotídea , Cognição , Disfunção Cognitiva/prevenção & controle , Método Duplo-Cego , Exercício Físico , Terapia por Exercício , Humanos , MéxicoRESUMO
INTRODUCTION: Parkinson's disease (PD) is the second most common neurodegenerative disorder in Brazil. Physical activity is a complementary intervention in managing inherent declines associated with the disease like strength, balance, gait, and functionality and benefit health-related outcomes. Here, we report the PARK-BAND Study protocol, which aims to investigate potential benefits of power training using elastic devices in participants with PD. Our intervention will be provided in patients with PD using elastic devices like elastic bands and tubes. Therefore, we used the term Park from Parkinson's disease and band from elastic bands. METHODS AND ANALYSIS: This randomised single-blind single-centre two-arm parallel, superiority trial will include 50 participants with PD attending the clinical setting. Those who meet the eligibility criteria and provide consent to participate will be randomised in a 1:1 ratio to either the exercise group, which will receive power training programme or the health education group, which will receive the education programme. Randomisation will be performed by permuted block randomisation with a block size of eight. Both groups will receive a 12-week intervention. The exercise group will have two sessions per week and the health education group will have one session per week. Changes from baseline in bradykinesia, as assessed by the Unified Parkinson's Disease Rating Scale motor examination subscore and physical functional performance, will be the primary outcomes. Secondary outcomes include other neurological, neurophysiological and physical variables, as well as the quality of life, depression, cognition, sleep quality and disturbances, assessed before and after interventions. We hypothesise that the exercise group will have greater improvement in primary and secondary outcomes than the health education group. ETHICS AND DISSEMINATION: The study is approved by the Research Ethics Committee of Hospital Universitário Walter Cantidio and all participants will provide their written informed consent (register number 91075318.1.0000.5045).Trial results will be disseminated via peer reviewed journal articles and conference presentations, reports for organisations involved with PD and for participants. TRIAL REGISTRATION NUMBER: Registro Brasileiro de Ensaios Clínicos Registry (RBR-5w2sqt); Pre-results.
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Doença de Parkinson , Treinamento Resistido , Humanos , Doença de Parkinson/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-CegoRESUMO
AIMS: This study aimed to compare the sociodemographic and epidemiological profiles between Brazilian and French older people with type 2 diabetes mellitus. METHODS: Quantitative analytical study of 248 type 2 diabetes patients aged 65+ years receiving care in a center for integrated diabetes and hypertension care. The data were compared with the GERODIAB study conducted in France. RESULTS: The participants' mean age was 73.16 ± 6.4 years, with 162 (65.4%) participants aged less than 75 years and 38 (15.3%) over 80 years old. Almost all the participants (99.2%) lived at home, 35 (14.1%) were uneducated, and 17 (6.9%) had completed higher education. The majority (232 older people) were retired. Most of the median values of the variables differed statistically (p < 0.001) between the two populations. Peripheral vascular disease, diabetic neuropathy, foot wound, amputation, hypoglycemia, hyperosmolarity and other intercurrent infections differed statistically (p < 0.001) between the two populations. Most of the medication use variables differed significantly (p < 0.05) between Brazilians and the French. CONCLUSIONS: The statistically significant differences between the two populations reveal better conditions among the French participants, which highlights the importance of the scientific evidence found in the French study for developing public health actions targeted at Brazilian diabetic older people.
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Diabetes Mellitus Tipo 2/epidemiologia , Idoso , Brasil , Estudos de Coortes , Estudos Transversais , Feminino , França/epidemiologia , Humanos , Masculino , Estudos ProspectivosRESUMO
OBJECTIVE: To describe the experience of a Brazilian medical school in implementing different active methods to teach Geriatric Medicine, reporting the students' opinions and satisfaction with the classes and comparing pre- and postcourse measurements of knowledge, attitudes and skills. METHODS: A total of 166 third-year medical students received different active theoretical-practical activities for teaching Geriatric Medicine and their knowledge, attitudes, clinical skills and satisfaction were investigated. RESULTS: All activities had good acceptance among students ranging from 8.54 in the activity "Walking aids" to 9.81 in the activity "Nursing Home visit" (ranging 0-10). After the course, students had better attitudes towards older persons (r = 0.55-0.81, P < 0.001), better knowledge (r = 0.84, P < 0.001), greater empathy (r = 0.51, P < 0.001) and better clinical skills (r = 0.86, P < 0.001). Finally, the course was evaluated positively by the students. CONCLUSION: New active Geriatric Medicine learning activities resulted in improvement in medical students knowledge, attitudes and skills.
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Competência Clínica , Geriatria/educação , Conhecimentos, Atitudes e Prática em Saúde , Estudantes de Medicina , Ensino , Adulto , Feminino , Humanos , MasculinoRESUMO
ABSTRACTObjectives:The aim of the present study was to evaluate the association between depression and SSRI monotherapy and frailty both baseline and prospectively in older adults. DESIGN: Prospective cohort study, 12-month follow-up. SETTING: Geriatric outpatient clinic in São Paulo, Brazil. PARTICIPANTS: A total of 811 elderly adults aged 60 or older. MEASUREMENTS: Depression was diagnosed as follows: (1) a diagnosis of major depression disorder (MDD) according to DSM-5; or (2) an incomplete diagnosis of MDD, referred to as minor or subsyndromic depression, plus Geriatric Depression Scale 15-itens ≥ 6 points, and social or functional impairment secondary to depressive symptoms and observed by relatives. Frailty evaluation was performed through the FRAIL questionnaire, which is a self-rated scale. Trained investigators blinded to the baseline assessment conducted telephone calls to evaluate frailty after 12-month follow-up. The association between depression and the use of SSRI with frailty was estimated through a generalized estimating equation adjusted for age, gender, total drugs, and number of comorbidities. RESULTS: Depression with SSRI use was associated with frailty at baseline (OR 2.82, 95% CI = 1.69-4.69) and after 12 months (OR 2.75, 95% CI = 1.84-4.11). Additionally, depression with SSRI monotherapy was also associated with FRAIL subdomains Physical Performance (OR 1.99, 95% CI = 1.29-3.07) and Health Status (OR 4.64, 95% CI = 2.11-10.21). SSRI use, without significant depressive symptoms, was associated with subdomain Health Status (OR 1.52, 95% CI = 1.04-2.23). CONCLUSION: It appears that depression with SSRI is associated to frailty, and this association cannot be explained only by antidepressant use.
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Depressão/tratamento farmacológico , Idoso Fragilizado/psicologia , Fragilidade/complicações , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Atividades Cotidianas , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Brasil/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Idoso Fragilizado/estatística & dados numéricos , Avaliação Geriátrica , Humanos , Masculino , Pacientes Ambulatoriais , Prevalência , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: Self-rated health (SRH) is a predictor of objective health measures, including mortality and morbidity. The link between resilience and SRH among the elderly is unclear. We aim to examine whether resilience aligns with SRH and, secondarily, whether resilience can override the negative health consequences of adverse childhood experiences (ACE). DESIGN AND SETTING: We use 2012, 2014 and 2016 data from the International Mobility in Aging Study, a longitudinal cohort study that collects survey and biophysical data from Albania, Brazil, Colombia and Canada. The main independent variables were resilience and ACE (social and economic). PARTICIPANTS: Community-dwelling 65-74 year olds (in 2012) were recruited through primary care registers. The sample size of the study was 1506. PRIMARY OUTCOME: The outcome measure was SRH. RESULTS: We found that sex, site, economic ACE, current income sufficiency, current depressive symptoms, current physical function and current resilience were associated with current SRH. In regression analyses, we showed that the association between ACE and SRH disappeared once factors such as sex, site, income, depression, physical health and resilience were considered. CONCLUSIONS: The association between resilience and health poses a compelling argument for building resilience throughout life.
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Experiências Adversas da Infância , Envelhecimento/psicologia , Autoavaliação Diagnóstica , Avaliação Geriátrica , Nível de Saúde , Resiliência Psicológica , Idoso , Albânia , Brasil , Canadá , Criança , Estudos de Coortes , Colômbia , Estudos Transversais , Depressão/complicações , Etnicidade , Feminino , Humanos , Renda , Estudos Longitudinais , Masculino , Fatores Sexuais , Fatores Socioeconômicos , Estresse Psicológico/etnologia , Estresse Psicológico/etiologiaAssuntos
Acidentes por Quedas , Medo , Idoso , Exercício Físico , Avaliação Geriátrica , Humanos , Fatores de RiscoRESUMO
AIM: To investigate the influence of breathing patterns and blood pressure behavior postural control in older adults. METHODS: A total of 20 older adults carried out spontaneous, controlled (15 cycles/min) and deep (6 cycles/min) breathing trials, in random order. In this session, the heart rate was recorded continuously and blood pressure measured every 3 min. In addition, the challenge from sitting to an active standing position was carried out with eyes closed during 6 min on a baropodometer plate with electromyography recording. The root mean square (RMS) of electromyography was calculated. RESULTS: There were significant differences in the postural control with spontaneous breathing from the first minute (center of pressure [COP]-area 216.40 ± 116.70 mm2 ) in comparison with the third minute (COP-area 79.35 ± 68.11 mm2 ; d = 0.89; P < 0.01) and the sixth minute (COP-area 70.24 ± 41.26 mm2 ; d = 0.60; P < 0.05) of active standing. Furthermore, deep breathing significantly increases the COP-area (158.50 ± 126.2 mm2 ) at the sixth minute of active standing in comparison with spontaneous breathing (70.24 ± 41.26 mm2 ; d = 0.80; P < 0.01). There were also significant differences in systolic blood pressure during spontaneous breathing between the baseline measures (sitting position 123 ± 11 mmHg) and the first minute of active standing (117 ± 13 mmHg; d = 0.24; P < 0.05). Furthermore, electromyography activity of the tibialis anterior increased during the deep (17.52 ± 9.21 RMS) and controlled breathing (16.75 ± 5.26 RMS) compared with the spontaneous condition (14.93 ± 5.56 RMS; d = 0.17; P < 0.05). CONCLUSIONS: The present data provide important insight into the respiratory and hemodynamics effects of postural control in older adults. The current data confirm that deep breathing causes periodic perturbation in the neuromuscular compensation of the lower limbs. Geriatr Gerontol Int 2018; 18: 692-697.