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Introduction: Medications are a fundamental part of the treatment of multiple pathologies. However, despite their benefits, some are considered potentially inappropriate medications for older people given their safety profile. Epidemiological data differences related to potentially inappropriate medications make it difficult to determine their effects on elderly people. Objective: To estimate the prevalence and types of potentially inappropriate medications using the 2019 Beers Criteria® in a cohort of adults older than 65 years. Materials and methods: We performed an observational, multicenter, retrospective, longitudinal study of a four-year follow-up of potentially inappropriate medications in community-dwelling older adults. Results: We followed 820 participants from five cities for four years (2012-2016) and evaluated them in three different moments (m1 = 2012, m2 = 2014, and m3 = 2016). The average age was 69.07 years, and 50.9% were women. The potentially inappropriate medication prevalence in the participants was 40.24%. The potentially inappropriate medications' mean among the studied subjects in the first moment was 1.65 (SD = 0.963), in the second was 1.73 (SD = 1.032), and in the third was 1.62 (SD = 0.915). There were no statistical differences between measurements (Friedman test, value = 0.204). The most frequent potentially inappropriate medications categories were gastrointestinal (39.4%), analgesics (18.8%), delirium-related drugs (15.4%), benzodiazepines (15.2%), and cardiovascular (14.2%). Conclusions: About half of the population of the community-dwelling older adults had prescriptions of potentially inappropriate medications in a sustained manner and without significant variability over time. Mainly potentially inappropriate medications were gastrointestinal and cardiovascular drugs, analgesics, delirium-related drugs, and benzodiazepines.

Introducción. Los fármacos son parte fundamental del tratamiento de múltiples enfermedades. Sin embargo, a pesar de sus beneficios, algunos se consideran medicamentos potencialmente inapropiados en adultos mayores, dado su perfil de seguridad. Las diferencias en los datos epidemiológicos relacionados con los medicamentos potencialmente inapropiados dificultan el establecimiento de sus efectos en adultos mayores. Objetivo. Estimar la prevalencia longitudinal y los tipos de medicamentos potencialmente inapropiados, utilizando los criterios Beers® del 2019 en una cohorte de adultos mayores de 65 años. Materiales y métodos. Se realizó un estudio observacional, multicéntrico, retrospectivo y longitudinal, de cuatro años de seguimiento de los medicamentos potencialmente inapropiados en adultos mayores de la comunidad. Resultados. Se evaluaron 820 participantes de cinco ciudades durante cuatro años (2012 a 2016) en tres momentos (m1: 2012, m2: 2014 y m3; 2016). La edad promedio fue de 69,07 años y el 50,9 % eran mujeres. La prevalencia de medicamentos potencialmente inapropiados en los participantes fue del 40,24 %. El promedio de estos medicamentos entre los sujetos estudiados en el primer momento fue de 1,65 (DE = 0,963), en el segundo fue de 1,73 (DE = 1,032) y en el tercero fue de 1,62 (DE = 0,915). No hubo diferencias estadísticas entre las mediciones (prueba de Friedman, p = 0,204). Las categorías de los medicamentos potencialmente inapropiados más frecuentes fueron: gastrointestinales (39,4 %), analgésicos (18,8 %), relacionados con delirium (15,4 %), benzodiacepinas (15,2 %) y cardiovasculares (14,2 %). Conclusiones. En cerca de la mitad de la población de adultos mayores de la comunidad, se prescribieron medicamentos potencialmente inapropiados de manera sostenida y sin variabilidad importante en el tiempo. Los más recetados fueron aquellos para tratar malestares gastrointestinales y cardiovasculares, analgésicos, para el delirium y benzodiacepinas.

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BACKGROUND AND AIMS: Only one cohort study exists on the incidence of the risk of malnutrition (RM) in older adults, though numerous cross-sectional reports, identified several risk factors associated with the prevalence and incidence of this condition. However, alterations in body composition and impaired physical performance as exposition variables of RM have not been explored. This study assessed the incidence of RM and determined its association with excess fat mass, low total lean tissue, gait speed, and handgrip strength as exposition variables for RM in community-dwelling older adults. METHODS: This is a secondary analysis of older adults (≥60 years) derived from the study "Frailty, dynapenia, and sarcopenia in Mexican adults (FraDySMex)", a prospective cohort project conducted from 2014 to 2019 in Mexico City. At baseline, volunteers underwent body composition analysis and physical performance tests. Several covariates were identified through comprehensive geriatric assessment. At baseline and follow-up, RM was assessed using the long form of the mini nutritional assessment (MNA-LF) scale. Associations between the exposition variables and RM were assessed by multiple logistic regression. RESULTS: The cohort included 241 subjects. The average age was 75.6 ± 7.8 years, and 83.4% were women. The mean follow-up period was 4.1 years, during which 28.6% of subjects developed RM. This condition was less likely to occur in those with an excess fat mass, even after adjusting for several covariates. Regarding total lean tissue, the unadjusted model showed that RM was more likely to occur in men and women with a low TLT by the TLTI classification, compared to the normal group. However, after adjusting for several covariates (models 1 and 2), the association lost significance. Results on the association between gait speed and RM showed that this condition was also more likely to occur in subjects with low gait speed, according to both the unadjusted and adjusted models. Similar results were found for RM in relation to low handgrip strength; however, after adjusting for the associated covariates, models 1 and 2 no longer reached the level of significance. CONCLUSIONS: RM diagnosed by MNA-LF was significantly less likely to occur among subjects with excess fat mass, and a significant association emerged between low gait speed and RM after 4.1 years of follow-up in these community-dwelling older adults. These results confirm the association between some alterations of body composition and impaired physical performance with the risk of malnutrition and highlight that excess fat mass and low gait speed precede the risk of malnutrition, not vice versa.

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Resumen En el ámbito de la discapacidad intelectual, el desarrollo de una vida independiente se ha configurado como un derecho humano y civil que permite a estas personas articular planes de vida deseados. Esta investigación analiza, mediante un estudio de caso, los significados que un grupo asesor compuesto por ocho personas adultas con discapacidad intelectual tiene sobre el concepto de vida independiente en el contexto chileno. Para la recopilación de los datos se diseñó una entrevista grupal semiestructurada acompañada de moodboards que facilitaron la verbalización de las respuestas. Sobre los relatos obtenidos a partir de las entrevistas se realizó un análisis de contenido temático. Los resultados muestran cómo el desempeño de una actividad laboral remunerada o el establecimiento de relaciones afectivas sólidas se conforman como elementos imprescindibles para la independencia personal. La dificultad para ser económicamente independientes o la falta de accesibilidad en el entorno laboral se identifican también como principales barreras para la concreción de este derecho. Igualmente, se destaca el rol que desempeñan la pareja y las amistades como figuras de apoyo constante a la independencia y al empoderamiento personal. Estos resultados sugieren algunas orientaciones para la planificación de intervenciones sobre este constructo, las cuales deben procurar la adquisición de habilidades que fortalezcan la capacidad de autocuidado de este colectivo, promover el incremento de oportunidades para la realización de elecciones significativas en el ámbito laboral, personal y comunitario, y adaptarse a los espacios en los que se desenvuelven las personas con discapacidad intelectual en la edad adulta.

Abstract In the field of intellectual disability, the development of an independent life has been configured as a human and civil right that allows these people to articulate desired life plans. Despite the advances, at the international level, research on aspects related to independent living in people with intellectual disabilities continues to be very scarce. Generally, the approaches to the study of this construct are based on broader investigations dedicated to evaluating the levels of quality of life or self-determination of this population in residential services or sheltered housing. Precisely, this study analyzes, through a case study, the meanings that an advisory group made up of eight adults with intellectual disabilities has on the concept of independent living in the Chilean context in order, on the one hand, to identify relevant elements for the definition of the construct from the perceptions and experiences of this population; and on the other, to propose guidelines at various levels that allow progress in the realization of this right. To collect the data, a semi-structured group interview was designed whose questions were grouped around four themes: previous conceptions of the participants about the construct of independent life, satisfaction with life and possibilities of the context for the development of personal independence, role of family, friendship and partner in independent life, and opportunities of the work context for the achievement of personal independence. During the interview, another strategy was incorporated in which visual language gained more relevance. Specifically, a set of ten moodboards were used that allowed participants to delve into the different topics addressed. The results of the code validation process were calculated using Krippendorff's alpha statistics (.954) and Cohen's kappa (.953), which showed a high level of inter-judge agreement. As a result of this process, categories (N = 6) and subcategories (N = 17) were established. The results show how various needs, barriers and facilitators for the development of independent life are identified from the interviews of the interviewees. Among the main needs is the performance of a paid work activity or the establishment of solid affective relationships. With regard to the barriers that hinder personal independence, the most notorious are related to the difficulty of being financially independent or to the lack of accessibility in the work environment. Regarding the elements that facilitate the development of an independent life, the role of the couple stands out as a constant figure of support for independence and personal empowerment. These results suggest some guidelines for planning interventions on this construct. Among others, they should seek the acquisition of skills that strengthen the self-care capacity of this group; should promote increased opportunities for making meaningful choices in the workplace, personal and community; and they must adapt to the spaces in which people with intellectual disabilities operate in adulthood. On the other hand, it is assumed that one of the main limitations of this research is that the results are not generalizable. However, this study has some strengths. Among others, it contributes to enriching the bulk of research on independent living, this being an aspect barely addressed in the literature. It also complements the results of other research regarding the elements that can condition the development of skills for personal independence. This allows for the design of interventions that provide opportunities for independent living based on the felt needs of these people. In addition, it raises future lines of research related, for example, to the importance of the informed choice of the residential environment or to the study of the possibilities of the digital world as an incident phenomenon in the acquisition of skills for personal independence.

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BACKGROUND: Since the onset of the coronavirus (COVID-19) pandemic its negative effects have been highlighted globally. There is little literature that examines the positive impact on daily living. AIMS: To examine the positive influences of government-imposed COVID-19 public health restrictions on adults throughout Trinidad and Tobago (TT) and their associated factors. METHOD: A cross-sectional study, using an adapted pretested online survey instrument, was conducted amongst non-institutionalised, community-dwelling adults using convenience sampling. RESULTS: Of 1287 completed and weighted responses, the mean age (S.D.) was 39.2 (14.6) years, 49% were males, and 61% completed secondary level education. The top 5 positive experiences were more time spent with family (80%), more down-time (78%), learning new skills (68%), more time for hobbies (66%), self-care (57%), more time spent with friends (55%) and eating healthier (50%). The importance of religion, working from home, and an increase in marijuana use emerged as positive correlates for certain positive experiences, while participants with chronic illness, and a positive anxiety or depression screen, were negatively associated with most positive experiences. CONCLUSIONS: Despite the negative consequences of the COVID19 pandemic, several positives were highlighted in this study. These findings have implications for social policies toward building resilience within the community.

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Resumo Objetivo Identificar os conceitos e perspectivas teóricas que fundamentam os estudos sobre Cidade Amiga da Pessoa Idosa. Métodos Revisão de escopo utilizando seis bancos de dados para identificar estudos publicados em revistas indexadas entre 2007 e 2021 usando as palavras-chave 'age-friendly' OR 'age friendly' OR 'cidade amiga'. Resultados Foram encontrados 2.975 estudos que após aplicação de critérios de exclusão resultaram em 227. Observou-se ampla variação no conceito do termo, porém muitos autores o fizeram replicando a OMS, sendo que em 59,5% dos estudos não houve menção de nenhuma perspectiva teórica. A teoria ecológica foi o referencial mais frequente (26%), sendo o termo usado como um equivalente a envelhecimento ativo. Autores de quatro países respondem pela maioria dos artigos (61%). Conclusão É necessário articular o conceito de Cidade Amiga da Pessoa Idosa com uma abordagem teórica e cultural para compreender mais profundamente as perspectivas do urbano e do social sob a lógica do envelhecimento populacional principalmente para a América Latina. A análise teórica nestes estudos e na gerontologia favorecerão discussões mais críticas sobre o envelhecimento, o idadismo e a crescente desigualdade social em curso.

Resumen Objetivo Identificar los conceptos y perspectivas teóricas que fundamentan los estudios sobre Cuidades Amigables con las Personas Mayores. Métodos Revisión de alcance utilizando seis bancos de datos para identificar estudios publicados en revistas indexadas entre 2007 y 2021, con las palabras clave 'age-friendly' OR 'age friendly' OR 'ciudad amigable'. Resultados Se encontraron 2975 estudios que, luego de aplicar los criterios de exclusión, quedaron 227. Se observó una amplia variación del concepto del término, aunque muchos autores replicaron a la OMS. En el 59,5 % de los estudios no se mencionó ninguna perspectiva teórica. La teoría ecológica fue la referencia más frecuente (26 %), y el término se usó como un equivalente al envejecimiento activo. La mayoría de los artículos (61 %) son de autores de cuatro países. Conclusión Es necesario unir el concepto de Cuidades Amigables con las Personas Mayores con un enfoque teórico y cultural para comprender más profundamente las perspectivas de lo urbano y lo social de acuerdo con la lógica del envejecimiento poblacional, principalmente en América Latina. El análisis teórico en estos estudios y en la gerontología permitirán discusiones más críticas sobre el envejecimiento, el edadismo y la creciente desigualdad social en curso.

Abstract Objective To identify the concepts and theoretical perspectives that underlie studies on age-friendly city. Methods This is a scoping review using six databases to identify studies published in indexed journals between 2007 and 2021 using the keywords 'age-friendly' OR 'age friendly' OR 'cidade amiga'. Results A total of 2,975 studies were found, which, after applying the exclusion criteria, resulted in 227. There was wide variation in the concept of the term, but many authors did so by replicating the WHO, and in 59.5% of studies there was no mention of any theoretical perspective. The ecological theory was the most frequent reference (26%), the term being used as an equivalent to active aging. Authors from four countries account for most articles (61%). Conclusion It is necessary to articulate the concept of age-friendly city with a theoretical and cultural approach to understand more deeply the urban and social perspectives under the logic of population aging, mainly for Latin America. Theoretical analysis in these studies and in gerontology will favor more critical discussions about aging, ageism and the growing social inequality in progress.

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La investigación tuvo por objetivo identificar, analizar y sistematizar las experiencias teóricas con respecto al estudio de casos como metodología investigativa. El objetivo primario fue evidenciar el estigma y el estereotipo sobre los adultos mayores contrastado con la realidad actual. Para esto se realizó una serie de estudios de casos a adultos mayores de manera remota y presencial debido a la reciente pandemia de COVID-19 donde fueron seleccionados los más destacados. Los resultados obtenidos fueron utilizados para comparar con la estigmatización social atribuida a este grupo etario. Se considera que mediante la entrega de herramientas necesarias para el desarrollo social a las personas mayores para que logren manejar su salud y su estilo de vida, un adulto mayor puede ser capaz de gestionar su autonomía e incluirse en la sociedad de forma eficaz y placentera[AU]

The objective of the research w as to identify, analyze and systematize the theoretical experiences regarding the case study as a research methodology. The primary objective was to demonstrate the stigma and stereotype about the elderly over reality. For this, a series of case studies were carried out on elderly people remotely and in person due to the recent COVID-19 pandemic, where the most prominent were selected. The results obtained were used to contrast the social stigmatization attributed to this age group. We believe that by providing the necessary tools for social development to older people so that they can manage their health and lifestyle, an older adult may be able to manage their autonomy and include themselves in society in an effective and pleasant way[AU]

A pesquisa teve como objetivo identificar, analisar e sistematizar as experiências teóricas sobre o estudo de caso como metodologia de pesquisa. O objetivo principal foi destacar o estigma e estereótipo sobre os idosos sobre a realidade. Para isso, foi realizada uma série de estudos de caso em idosos de forma remota e presencial devido à recente pandemia de COVID-19, onde foram selecionados os mais destacados. Os resultados obtidos foram utilizados para contrastar com a estigmatização social atribuída a essa faixa etária. Em conclusão, propomos que, ao fornecer as ferramentas necessárias para o desenvolvimento social dos idosos, para que eles possam gerenciar sua saúde e estilo de vida, o idoso poderá gerenciar sua autonomia e se incluir na sociedade de maneira eficaz e agradável[AU]

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Resumen: Objetivo: Determinar los efectos de un programa de telerehabilitación (TR) en el nivel de independencia funcional y el número de caídas en personas mayores, asistentes a un centro de cuidados diurno. Materiales y método: 14 personas mayores ( χ =74 años), sometidas a un programa de kinesiterapia/fisioterapia/ terapia física (TF) a través de tele rehabilitación por un período de 12 semanas. El grupo control recibió intervención educativa a través de un cuadernillo de actividad física que debieron desarrollar de forma autónoma, con supervisión telefónica semanal; mientras que el grupo experimental recibió 15 sesiones de kinesiterapia/fisioterapia/terapia física por video llamada mediante aplicación WhatsApp TM . Ambos grupos fueron evaluados pre y post intervención con escala índice de Barthel (IB) y el número de caídas, mediante el cuestionario de la valoración geriátrica integral (VGI). Resultados: El grupo experimental aumentó el puntaje del índice de Barthel (↑3.6), mientras que el grupo control disminuyó este puntaje (↓6.9). Ambos grupos disminuyen el número de caídas, sin encontrar diferencias entre grupos. Al comparar ambos grupos, las personas mayores sometidas a un programa de kinesiterapia/fisioterapia/ terapia física a través de tele rehabilitación presentaron mejoras significativamente mayores en el índice de Barthel que el grupo control (p<0.05). Conclusión: Las personas mayores que participaron en un programa kinesiterapia/ fisioterapia/ terapia física a través de tele rehabilitación presentaron un mayor nivel de independencia funcional que las personas con la intervención con cuadernillo de actividad física guiado por llamada telefónica, lo que sugiere considerar a los programas de terapia física como una alternativa terapéutica para mejorar el nivel de independencia en personas mayores.

Abstract: Objective: To determine the effects of a telerehabilitation (TR) program on the level of functional independence and the number of falls in older people attending a day care center. Materials and method: 14 older people ( χ = 74 years), submitted to a kinesitherapy / physiotherapy / physical therapy (PT) program through telerehabilitation for a period of 12 weeks. The control group received educational intervention through a physical activity booklet which they had to develop independently, with weekly telephone supervision, while the experimental group received 15 kinesitherapy / physiotherapy / physical therapy sessions via video calls through WhatsApp TM application. Both groups were evaluated pre and post intervention with the Barthel index scale (BI) and the number of falls using the comprehensive geriatric assessment (CGA). Results: The experimental group increased the Barthel index scale score (↑3,6) while the control group decreased this score (↓6,9). Both groups decreased the number of falls, without differences between groups. When comparing both groups, the elderly who underwent a kinesitherapy / physiotherapy / physical therapy program through telerehabilitation showed significantly greater improvements in Barthel index scale than the control group (p <0.05). Conclusion: Older people who participated in a kinesitherapy / physiotherapy / physical therapy program through telerehabilitation presented a higher level of functional independence compared to participants in the intervention with a phone call-guided physical activity booklet, which suggests a telerehabilitation programs as an alternative therapeutics to improve the level of independence in older people.

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BACKGROUND: Multimorbidity is defined as the co-occurrence of multiple chronic or acute diseases and medical conditions in the same individual and can be grouped into different patterns based on the type of disease. These patterns are associated with poorer quality of life and premature death. It is believed that these patterns entail functional limitations, which may contribute to the fear of falling; however, this association remains unknown. Identifying this possible association is fundamental for developing individual and collective care approaches aimed at preventing the different patterns of chronic diseases in older adults in order to decrease the fear of falling. The objective of this study was to investigate the association between multimorbidity patterns and fear of falling in older adults. METHODS: This was a cross-sectional study including 308 older adults. The exposure variables were the presence of three multimorbidity patterns (cardiopulmonary, musculoskeletal, and vascular-metabolic) and pattern association assessed by self-report of two or more similar coexisting chronic diseases. The outcome was fear of falling assessed by the Brazilian version of Falls Efficacy Scale-International (cut-off point ≥ 23 points). Multivariable logistic regression was used to analyze the association between variables. RESULTS: Older adults with cardiopulmonary, musculoskeletal, vascular-metabolic patterns and pattern association had 3.49 (95%CI 1.13; 10.78), 2.03 (95%CI 1.13; 3.64), 2.14 (95%CI 1.20; 3.82), and 4.84 (95%CI 2.19; 10.68), respectively, greater chances of presenting fear of falling when compared to older adults without the patterns. CONCLUSIONS: The presence of multimorbidity patterns is associated with higher chances of reporting fear of falling. It is emphasized that the introduction of public health programs aimed at preventing multimorbidity patterns is essential to reduce possible adverse health outcomes, including fear of falling and its negative consequences for older adult health.

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BACKGROUND: Since fear of falling is associated with a history of falls and is more prevalent in women, it is important to define cut-off points differentiated between genders on the Falls Efficacy Scale International Brazil (FES-I Brazil) to implement early prevention and/or rehabilitation strategies. AIMS: To determine cut-off points on the FES-I Brazil differentiated between genders which discriminate falls and verify their association with the history of falls. METHODS: This was a cross-sectional study including 306 community-dwelling older adults. Fear of falling score from the FES-I Brazil was the independent variable and the outcome was the history of falls in the last 12 months. The cut-off points differentiated between genders were established according to sensitivity and specificity values evaluated by the Receiver Operating Characteristic Curves (ROC). The multivariable logistic regression was used to verify the association between fear of falling and history of falls. RESULTS: The cut-off points on the FES-I Brazil to discriminate falls were > 25 points [AUC: 0.67 (95% CI 0.59-0.73)] for women, and > 19 points [AUC: 0.66 (95% CI 0.57-0.74) for men, suggesting that women present a greater fear of falling than men, due to the higher cut-off point found for women. Women and men with fear of falling, respectively, had 2.14 (95% CI 1.11-4.13) and 2.62 (95% CI 1.10-6.85) higher odds of suffering falls compared to those without this condition. CONCLUSIONS: The FES-I can be used to discriminate falls in the elderly and shows that women have a higher cut-off point than men on the scale.

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Fear of falling and history of falls are frequent situations in older adults, which can be aggravated by sedentary behavior (SB). The objective was to establish SB cutoff values which discriminate falls and fear of falling in older adults and verify the association between these conditions. This was a cross-sectional study including 308 community-dwelling older adults. The SB was assessed by International Physical Activity Questionnaire. The outcomes were history of falling in the last 12 months and fear of falling (higher or equal than 23 points in Falls Efficacy Scale International-Brazil). The cutoff points found were >4.14 (area under curve = 0.60, 95% confidence intervals [CIs] [0.54, 0.65]) and >3.90 hr per day (area under curve = 0.59, 95% CI [0.53, 0.64]) for fear of falling and history of falls, respectively. Older adults with SB had 1.71 (95% CI [1.03, 2.84]) and 1.75 (95% CI [1.06, 2.89]) greater odds of having greater fear of falling and suffering falls, respectively.

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Alterações no sono são comuns em idosos e alguns fatores de risco podem agravar essa condição. Entender a associação do comportamento sedentário com o histórico de problemas de sono poderá auxiliar na elaboração de programas de intervenção. Verificar a associação entre tipologias do comportamento sedentário e histórico de problemas no sono em idosos comunitários brasileiros. Estudo transversal, com dados de 43.554 idosos participantes da Pesquisa Nacional de Saúde (PNS), de 2019. As tipologias do comportamento sedentário foram avaliadas por: (1) tempo assistindo televisão; (2) atividades de lazer; e (3) tempo despendido total (televisão + lazer). O comportamento sedentário foi categorizado em < 3; 3-6 e > 6 horas/dia. O desfecho foi histórico de problemas de sono (dificuldade para adormecer, acordar frequentemente à noite ou dormir mais do que de costume) avaliados por meio do autorrelato nos últimos 15 dias. As associações foram verificadas pela regressão logística multivariável. Idosos que permaneceram tempo > 6 horas/dia em comportamento sedentário assistindo televisão tiveram 13% (OR = 1,13; IC95%: 1,02; 1,26) maiores probabilidades de relatarem problemas de sono. Referente ao comportamento sedentário total, idosos que permaneceram entre 3-6 horas e mais do que 6 horas/dia apresentaram 13% (OR = 1,13; IC95%: 1,04; 1,22) e 11% (OR = 1,11; IC95%: 1,01; 1,23) maiores probabilidades de problemas de sono, respectivamente. Os idosos amostrados que relataram permanecer por períodos superiores a 6 horas por dia em comportamento sedentário assistindo à televisão e > 3 horas em comportamento sedentário total tiveram maiores chances de terem problemas no sono. Estes achados podem contribuir nas orientações sobre a necessidade de redução no comportamento sedentário em idosos.

Alterations in sleep are common in older persons, and some risk factors may aggravate this condition. Understanding the association between sedentary behavior and history of sleep problems can assist the elaboration of intervention programs. The study aimed to verify the association between typologies of sedentary behavior and history of sleep problems in community-dwelling older Brazilians. A cross-sectional study was performed with data from 43,554 older persons participating in the Brazilian National Health Survey (2019). Typologies of sedentary behavior were assessed by: (1) time watching television; (2) leisure-time inactivity; and (3) total inactivity (TV + leisure-time inactivity). Sedentary behavior was categorized as < 3, 3-6, and > 6 hours/day. The outcome was history of sleep problems (difficulty falling asleep, waking up frequently at night, or sleeping more than usual) assessed by self-report in the last 15 days. Associations were verified with multivariate logistic regression. Older persons that spent more 6 hours/day watching TV had 13% higher odds (OR = 1.13, 95%CI: 1.02; 1.26) of reporting sleep problems. For total sedentary behavior, older persons that were inactive 3-6 hours and more than 6 hours/day showed 13% (OR = 1.13; 95%CI: 1.04; 1.22) and 11% (OR = 1.11; 95%CI: 1.01; 1.23) higher odds of sleep problems, respectively. Older persons in the sample that reported more than 6 hours a day watching TV and > 3 hours in total sedentary behavior had higher odds of sleep problems. The findings call attention to the need to reduce sedentary behavior in the elderly.

Las alteraciones en el sueño son comunes en ancianos y algunos factores de riesgo pueden agravar esa condición. Entender la asociación del comportamiento sedentario con el historial de problemas de sueño podrá ayudar en la elaboración de programas de intervención. El objetivo fue verificar la asociación entre tipologías del comportamiento sedentario y el historial de problemas en el sueño en ancianos de comunidades con pocos recursos brasileños. Estudio transversal, con datos de 43.554 ancianos participantes en la Encuesta Nacional de Salud (2019). Las tipologías del comportamiento sedentario se evaluaron por el: (1) Tiempo viendo televisión; (2) Actividades de ocio y (3) Tiempo invertido en total (televisión + ocio). El comportamiento sedentario se categorizó en < 3; 3-6 y > 6 horas/día. El resultado fue el historial de problemas de sueño (dificultad para dormirse, despertarse frecuentemente por la noche o dormir más que de costumbre), evaluados a través del autoinforme en los últimos 15 días. Las asociaciones se verificaron a través de una regresión logística multivariable. Los ancianos que permanecieron tiempo > 6 horas/día en comportamiento sedentario viendo televisión tuvieron un 13% (OR = 1,13; IC95%: 1,02; 1,26) de mayores probabilidades de que informaran problemas de sueño. En lo referente al comportamiento sedentario total, los ancianos que permanecieron entre 3-6 horas y más de 6 horas/día presentaron un 13% (OR = 1,13; IC95%: 1,04; 1,22) y un 11% (OR = 1,11; IC95%: 1,01; 1,23) mayores probabilidades de problemas de sueño, respectivamente. Los ancianos de la muestra que informaron permanecer por períodos superiores a 6 horas al día en comportamiento sedentario viendo televisión y > 3 horas en comportamiento sedentario total tuvieron mayores probabilidades de tener problemas de sueño. Estos resultados pueden contribuir al fortalecimiento en la necesidad de reducción en el comportamiento sedentario en ancianos.

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INTRODUCTION: For the first time in human history, the number of older people will be higher than the number of children. The prevalence of chronic diseases, such as hypertension, cardiovascular disease, diabetes and mental disorders in older adults is high. Given that, it is essential to make usage of related technology to provide improved health conditions and reduce the costs for promoting ageing in place, and that is precisely the aim of Ambient Assisted Living technology. Considering that these systems provide significant benefit to a vast number of stakeholders, can be applied to the functional diversity of application domains and have high economic and social impacts, it is essential to create reusable and interoperable platforms and standards that are able to deal with the heterogeneity of applications and domains. In this sense, reference architectures have been proposed and evaluated. A comprehensive scoping review concerning the reference architectures must clarify specific aspects, such as what the main domains are and how the solutions effectively deal with them. METHODS: This scoping review will follow the methodology framework defined in 'Scoping studies: advancing the methodology'. In this methodological framework, six stages are proposed for scoping review studies: identifying the research question; identifying relevant studies; study selection; charting the data; collating, summarising and reporting the results; and consultation. The research questions aim to investigate what are the motivations, stakeholders, benefits, domains, approaches, architectural components and governance aspects of the proposed reference architectures and models. The team will focus on the Scopus Document Search, PubMed (MEDLINE), IEEE Xplore Digital Library, ACM Digital Library and Science Direct electronic research databases. The search query is a combination of terms related to Ambient Assisted Living AND Reference Architecture. ETHICS AND DISSEMINATION: This is a scoping review study and there is no requirement for ethical approval, as primary data will not be collected. The results from this scoping review will be published in a peer-reviewed journal and reported at scientific meetings. We intend to share the results with the International Standards and Conformity Assessment - SyC AAL from Canada to use the review as a basis for establishing an assessment model of reference architectures.

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ANTECEDENTES Y OBJETIVO La desinstitucionalización se refiere al cambio en la atención de personas con enfermedad mental, desde el hospital a entornos comunitarios. La intervención denominada servicios residenciales o vida independiente son un medio para lograrla. En este contexto el Departamento de Salud Mental solicita esta síntesis de evidencia con el objetivo de evaluar la efectividad y consideraciones de implementación de servicios residenciales para personas con enfermedad mental grave, informando así a la toma de decisiones. METODOLOGÍA Se buscó revisiones sistemáticas que respondieran la pregunta abordada 4 bases de datos. También se utiliza la metodología GRADE. Se incluyen documentos que refieran a servicios residenciales para personas adultas con enfermedad mental grave con antecedentes de hospitalizaciones de al menos 6 meses. Se excluyen estudios centrados en población con discapacidades cognitivas, en situación de calle, con trastornos alimenticios, por abuso de sustancias. Además, de intervenciones de hospitalización breve, dado que no necesariamente estaban asociadas a un servicio residencial. RESULTADOS Se utilizaron 3 revisiones sistemáticas, de las cuales se obtuvieron los siguientes resultados: -Los servicios residenciales en comparación a los que permanecen en atención cerrada, podrían hacer poca o ninguna diferencia sobre la calidad de vida (certeza de la evidencia MUY BAJA). -Los servicios residenciales podrían mejorar ligeramente la psicopatología general síntomas negativos y positivos, si se compara con el grupo que permanece en atención cerrada. Además, podrían mejorar ligeramente la salud mental, si se compara con el grupo que permanece en atención cerrada (certeza de evidencia MUY BAJA). -Desde la perspectiva de los cuidadores y el paciente, los servicios residenciales podrían mejorar ligeramente el desempeño y expectativas en las actividades sociales y de tiempo libre, respecto al grupo que permanece en atención cerrada (certeza de evidencia MUY BAJA). -Al 1er y 5to año, el número promedio de amigos y confidentes del grupo de servicios residenciales podría ser levemente mayor respecto al grupo de atención cerrada (certeza de la evidencia MUY BAJA). Los servicios residenciales podrían aumentar el número personas que desean permanecer el lugar en el que se encuentran (certeza de evidencia MUY BAJA).

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Introdução: A craniectomia descompressiva (CD) é o procedimento cirúrgico capaz de reduzir a mortalidade em pacientes com edema cerebral secundário a um AVE maligno, porém não garante a recuperação funcional. Objetivo: Descrever o perfil clínico e funcional de pacientes submetidos a CD durante o tempo de internação hospitalar. Métodos: Estudo transversal realizado em uma Unidade de Acidente Vascular Cerebral (U-AVC) no período de setembro de 2018 a março de 2019. Coletaram-se dados sociodemográficos, estudo detalhado dos prontuários e dados referentes à funcionalidade, incapacidade e alcances funcionais por meio de questionários e avaliação física e neurológica. Resultados: A amostra foi composta por 21 participantes. A maioria do sexo masculino, idade média de 55±10 anos, casados, baixa escolaridade, exerciam algum tipo de atividade remunerada com renda de um a dois salários mínimos. Os fatores de risco mais prevalentes foram hipertensão arterial sistêmica, tabagismo, etilismo, sedentarismo e sobrepeso. Durante o período de internação hospitalar, a maioria dos pacientes evoluiu com altos índices de incapacidade e baixos níveis de independência e funcionalidade cognitiva e motora. Conclusão: Além de apresentarem combinações de diferentes fatores de risco relacionados ao desenvolvimento de AVE, a maioria dos pacientes avaliados apresentaram altos índices de incapacidade e baixos níveis de independência e funcionalidade, necessitando de assistência máxima ou total para realizar a maioria de suas atividades de vida diária. (AU)

Introduction: Decompression craniectomy (DC) is a surgical procedure that can reduce mortality in patients with cerebral edema secondary to malignant stroke, but does not guarantee functional recovery. Objective: To describe the clinical and functional profile of patients undergoing DC during their hospital stay. Methods: It is a cross-sectional study conducted in a Stroke Unit from September 2018 to March 2019. Sociodemographic data, detailed study of medical records, and data on functionality, disability and functional range were collected through questionnaires and physical and neurological evaluation. Results: The sample consisted of 21 participants. Most were male, mean age 55 ±10 years, married, with low education, had paid activity with income of one to two minimum wages. The most prevalent risk factors were systemic arterial hypertension, smoking, alcoholism, physical inactivity and overweight. During hospitalization, most patients evolved with high levels of disability and low levels of independence and cognitive and motor functionality. Conclusion: In addition to presenting combinations of different risk factors related to the development of stroke, most of the patients evaluated had high levels of disability and low levels of independence and functionality, requiring maximum or total assistance to develop most of their daily living activities. (AU)

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BACKGROUND: Institutionalization is a global phenomenon and its impact on elderly's quality of life (QoL) is under discussion. This systematic review and meta-analysis evaluated the influence of the institutionalization on elderly's QoL. METHODS: Searches were performed in Medline, Scopus, Web of Science, Lilacs, Cochrane Library and SIGLE by two independent reviewers up to May 2019. The eligibility criteria were based on PECO strategy, considering observational studies in elderly (P), which were (E) or not (C) institutionalized to identify differences in their QoL (O). For qualitative synthesis, data were extracted and risk of bias was evaluated through a validated guideline. Meta-analysis was based on Mean Difference (MD) and Standard Mean Difference (SMD) calculation (p ≤ 0.05). The evidence was quality-tested using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: The initial search identified 3841 articles. Duplicates were removed, titles and abstracts were read and eligibility criteria were applied, remaining 16 sixteen cross-sectional studies that were included for data extraction and qualitative synthesis. Out of 16 articles, 14 evaluated the Health-Related Quality of Life, using Leipad (n = 2), WHOQOL-BREF and/or OLD (n = 8), SF-36 or RAND-36 (n = 4) questionnaires, and two assessed the Oral Health-Related Quality of Life, through GOHAI questionnaire. One eligible article was considered as low risk of bias. In the meta-analysis, 12 studies were included. Leipad questionnaire did not show differences on elderly's QoL (MD 0.11 [- 0.10, 0.32] I2 = 76%). Differences on elderly's QoL were detected through WHOQOL-BREF (SMD -0.70 [CI95%: - 0.94, - 0.47] I2 = 93%), WHOQOL-OLD (SMD -1.13 [- 1.47, - 0.80] I2 = 91%) and SF-36/RAND-36 (MD -5.97 [CI95%: - 11.29, - 0.64] I2 = 90%). All studies had very low or low certainty of evidence, since the study design influenced evidence classification, and show high heterogeneity. CONCLUSION: Although the institutionalization influences negatively the elderly's QoL, further well-designed studies are needed to confirm this evidence.

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Purpose: Even though assistive technology (AT) can overcome disabilities, Hispanics are among the least likely to use AT. We aimed to assess the feasibility of an assistive technology AT and disability self-management intervention concerning recruitment, retention, adherence, acceptability, preliminary evaluation of participants' responses to intervention and preliminary efficacy.Methods: We used mixed-method intervention design with a pre- and post-test quantitative model with an experimental intervention and qualitative data obtained after the intervention. Ten older Hispanics were enrolled in an eight weeks group intervention. Instruments to measure feasibility and pre/post participants' report outcomes of quality of life (Psychosocial Impact of Assistive Device Scale [PIADS] Short Form), global health (PROMIS General Health Short Form), self-efficacy (Self-efficacy Scale) and performance difficulties (Individualized Prioritized Problem Assessment [IPPA]) were used.Results: Recruitment, retention and adherence rates were high, the intervention was acceptable, and the participants reported outcomes, such as: new knowledge and skills, enhanced activity performance and participation, increased safety and willingness to use AT, decreased performance difficulties and enhanced quality of life.Conclusion: The intervention was feasible and acceptable and is promising in decreasing performance difficulties in daily activities as well as in having a positive impact in older Hispanics' quality of life.IMPLICATIONS FOR REHABILITATIONOlder Hispanics living in Puerto Rico experience a high prevalence of disabilities in independent living.In a relative small sample this study shows that an assistive technology (AT) and disability self-management intervention for older Hispanics living in Puerto Rico is feasible to be delivered in a group format and in the community context.Older Hispanics living in Puerto Rico can potentially decrease performance difficulties in daily living activities and improved their quality of life through assistive technology and disability self-management interventions.

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ABSTRACT OBJECTIVE: To identify the strategies developed by people in the aging process to keep living in their own home, despite the weaknesses and difficulties they face. METHODS: The research was carried out based on a survey of population aged 65 years or older in the Portuguese municipality of Portimão. Data were collected by questionnaire, in 2017, and submitted to statistical and content analysis. RESULTS: Most respondents own their household, where they feel safe and satisfied, and they show awareness and concern about the changes they have to make in their home to stay there. In addition to housing and livability conditions, health, economic resources, social network, and available services play a major role in the community. CONCLUSIONS: We identified several strategies used by older adults to stay in their households as they age and the ways they mobilize their available resources, as well as constraints of aging in place.

RESUMO OBJETIVO: Identificar as estratégias desenvolvidas por pessoas em processo de envelhecimento para se manter residindo na própria casa, apesar das fragilidades e das dificuldades com que deparam. MÉTODOS: A pesquisa foi realizada a partir de um inquérito a uma população com 65 anos ou mais no município português de Portimão. Os dados foram recolhidos por questionário, em 2017, e submetidos a análise estatística e análise de conteúdo. RESULTADOS: A maioria dos inquiridos tem habitação própria, onde se sente segura e satisfeita, e revela ter consciência e preocupação em relação às alterações que deve executar em sua casa para ali poder permanecer. Além das condições habitacionais e de habitabilidade, as condições de saúde, os recursos económicos, a rede social e os serviços disponíveis assumem um papel preponderante no envelhecimento na comunidade. CONCLUSÕES: Foi possível identificar uma diversidade nas estratégias utilizadas para permanecerem em suas casas à medida que envelhecem e uma multiplicidade de formas como mobilizaram os recursos que têm à disposição, bem como constrições do ageing in place.

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ABSTRACT Populational aging led to the emergence of chronic diseases, all potentially incapacitating, thus affecting functional capacity (FC) of elders. Despite health evidences in favour of having regular physical activity, the majority of elders are not sufficiently active. Baseline data of an urban elder cohort in Brazil showed that only 28% were active and 68% had some functional loss, a figure that went up to 73% among the inactives. FC was associated with a network of sociodemographic, health and behavioral factors. In a multivariate analysis, the inactives showed twice the odds of being severely dependent when compared to the actives. Noteworthy that inactivity is as a modifiable factor that might prevent FC loss. Longitudinal studies are needed to verify.

RESUMO O envelhecimento populacional gera o surgimento de doenças crônicas, todas potencialmente incapacitantes, afetando a capacidade funcional (CF) dos idosos. Apesar das evidências de saúde em favor da atividade física regular, a maioria dos idosos não é suficientemente ativa. Dados da linha de base de uma coorte de idosos no Brasil mostraram que 28% eram ativos e 68% tiveram alguma perda funcional, número que subiu para 73% entre os inativos. A CF se associou a uma rede de fatores sociodemográficos, de saúde e comportamentais. Na análise multivariada, os inativos mostraram duas vezes mais chances de serem dependentes graves quando comparados aos ativos. Destaca-se a inatividade como um fator modificável que pode prevenir a perda da CF. Estudos longitudinais são necessários para verificar a causalidade.

RESUMEN El envejecimiento poblacional causa aparición de enfermedades crónicas, potencialmente incapacitantes, afectando la capacidad funcional (CF) del anciano. A pesar de evidencias se salud a favor de la actividad física regular, la mayoría de los ancianos no son suficientemente activos. Una cohorte de ancianos brasileños mostró que 28% estaban activos y 68% tenían alguna pérdida funcional, cifra que subió al 73% entre los inactivos. La CF se ha asociado con una red de factores sociodemográficos, de salud y comportamiento. En análisis multivariante, los inactivos tenían el doble de probabilidades de ser dependientes severos comparándolos con los activos. La inactividad se destaca como un factor modificable que puede prevenir la pérdida de CF. Se necesitan estudios longitudinales para verificar la causalidad.

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Depression and hypertension are highly prevalent among elderly people. Although the relationship between these conditions is well recognized, however, the factors that may influence such association are not clearly understood. Objective: To analyze the association between depression and hypertension in community-dwelling elders. Methods: Two-hundred and thirty-one community-dwelling elders provided information regarding the following variables: sex, age, ethnicity, smoking habit, physical activity level (PA), body mass index (BMI) and diabetes mellitus (DM). These variables can potentially influence depression and hypertension, as well as its relationship. Screening for depression was made using the Geriatric Depression Scale (GDS). The presence of hypertension was defined based on self-reported data and/or the use of antihypertensive drugs. The logistic regression technique was applied, using hypertension as the dependent variable and depressive state as a predictive variable. Logistic regression was applied with and without adjustment for the potential intervening variables. Results: The prevalence of depressive state and hypertension in the studied population was 14% and 59%, respectively. The association between depression and hypertension without adjustments was not significant (odds ratio [OR] = 2.28, 95% confidence interval [95%CI] = 0.98 - 5.32; p = 0.06). However, after adjusting for PA, BMI and DM, the strength of association between depression and hypertension significantly increased (OR = 3.08, 95%CI = 1.12 - 8.46; p = 0.03). Conclusion: The association between depression and hypertension in the elderly is directly influenced by PA, BMI and DM. This finding may guide strategies to increase the adherence to a healthier lifestyle

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ABSTRACT OBJECTIVE: Evaluate the association between contextual income and the incidence of disability in basic and instrumental activities of daily living. METHODS: This is a cohort study, with sample of elderly individuals (n = 1,196) residing in Florianópolis, state of Santa Catarina, Brazil. The incidence of disabilities was evaluated using reports of difficulty or inability to perform six basic activities of daily living and nine instrumental activities of daily living after four years. Contextual income was obtained from the 2010 Census. We conducted multilevel logistic regression analyses with adjustment models for individual variables. RESULTS: The incidence of disability in basic activities of daily living was 15.8% (95%CI 13.8-17.9) and in instrumental activities of daily living incidence was 13.4% (95%CI 11.6-15.5). We observed significant association between contextual income and incidence of disability in basic activities of daily living. Having as reference the elderly living in the lower income tercile, those who lived in the intermediary terciles and in that of highest income had 37% (95%CI 0.41-0.96) and 21% (95%CI 0.52-1.19) lower chances of developing disability, respectively. For the incidence of disability in instrumental activities of daily living we observed no statistically significant associations. CONCLUSIONS: Contextual income influences the development of disability in basic activities of daily living in the elderly and should be the subject of actions to reduce socioeconomic inequalities and promote longevity with independence.

RESUMO OBJETIVO: Avaliar a associação entre a renda contextual e a incidência de incapacidade nas atividades básicas e instrumentais da vida diária. MÉTODOS: Trata-se de estudo de coorte, com amostra de idosos (n = 1.196) residentes em Florianópolis, SC. As incidências de incapacidades foram avaliadas por meio do relato de dificuldade ou inabilidade para realizar seis atividades básicas da vida diária e nove atividades instrumentais da vida diária após quatro anos. A renda contextual foi obtida a partir do Censo Demográfico 2010. Foram realizadas análises de regressão logística multinível com modelos de ajuste para variáveis individuais. RESULTADOS: A incidência de incapacidade nas atividades básicas da vida diária foi de 15,8% (IC95% 13,8-17,9) e nas atividades instrumentais da vida diária de 13,4% (IC95% 11,6-15,5). Houve associação significativa entre a renda contextual e a incidência de incapacidade nas atividades básicas da vida diária. Tendo como referência os idosos residentes no tercil inferior de renda, aqueles que moravam nos tercis intermediários e no de maior renda tiveram 37% (IC95% 0,41-0,96) e 21% (IC95% 0,52-1,19) menores chances de desenvolver incapacidade, respectivamente. Para a incidência de incapacidade nas atividades instrumentais da vida diária não foram verificadas associações estatisticamente significativas. CONCLUSÕES: A renda contextual influencia no desenvolvimento de incapacidade nas atividades básicas da vida diária em idosos, devendo ser alvo de ações para redução de iniquidades socioeconômicas e promoção da longevidade com independência.

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