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OBJECTIVE: Dizziness or vertigo in older population frequently presents in clinical settings, yet its etiology remains elusive. The objective of this study was to delineate global trends and identify frontiers in research concerning dizziness or vertigo among older population. METHODS: We searched the research literature published from 2003 to 2022 on older population with dizziness or vertigo using two databases from the Web of Science Core Collection. A bibliometric and visualization analysis was conducted. Bibliometric tools facilitated co-authorship, co-citation, and keyword co-occurrence analyses, encompassing countries or regions, institutions, authors, journals, and references. RESULTS: The analysis included 1322 publications authored by 6524 individuals from 2244 institutions across 67 countries or regions, spanning 92 subject categories. A steady increase in publications was noted from 2003 to 2022. The University of Munich, Harvard University, and the University of California System emerged as leading institutions with the highest publication outputs. The United States, Germany, and China were predominant in publication counts. Eva Grill was identified as the most prolific author. Otology & Neurotology and Geriatrics & Gerontology emerged as the most prolific journal and subject category, respectively. The most prevalent keywords were "dizziness", "vertigo", "falls", and "geriatric", with "management", "gait", and "association" recognized as the principal research hotspots. CONCLUSION: This study provides a systematic analysis of global scientific research on older population dizziness/vertigo, revealing significant advancements in understanding over the past two decades. Management, gait, and association have emerged as the primary research focuses on recent years. These findings offer valuable insights for directing current research efforts to capture prevailing trends and explore new frontiers in this field.
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Bibliometria , Tontura , Vertigem , Humanos , Idoso , Saúde Global , Pesquisa Biomédica/tendências , Pesquisa Biomédica/estatística & dados numéricosRESUMO
Populational aging is marked by chronic noncommunicable diseases, such as metabolic syndrome (MetS). IL-10 and IL-1ß are pleiotropic cytokines with multiple biological effects linked to metabolic disorders. This cross-sectional study assessed 193 participants' IL-10 and IL-1ß serum levels regarding their role in developing MetS, clinical characteristics, and their IL1B rs1143627 and IL10 rs1800890 variants' genotype frequencies in a population over 60. IL-10 levels correlated weakly with HDL levels and fat mass and inversely with triglycerides, glucose, glycated hemoglobin, and estimated average blood glucose levels. IL-10 levels were also indirectly influenced by the patient's T2DM duration, lean mass amount, and bone mineral content. Participants with altered HDL, elevated serum glucose, raised HbA1c levels, or those over 80 had reduced serum IL-10 levels compared to those with normal levels or other age groups, respectively. Women also had higher serum IL-10 levels than men. Dissimilarly, IL-1ß levels correlated directly only with the number of total leukocytes and segmented neutrophils, showing only significant variations with self-reported alcohol consumption. Our study also found that those with the IL10 AA genotype (lower IL-10 levels) had a significantly higher risk of developing MetS. These findings may help direct future research and more targeted therapeutic approaches in older adults.
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Interleucina-10 , Interleucina-1beta , Síndrome Metabólica , Humanos , Interleucina-10/sangue , Interleucina-10/genética , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/genética , Feminino , Interleucina-1beta/sangue , Interleucina-1beta/genética , Idoso , Estudos Transversais , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/sangue , Genótipo , Variação Genética , Polimorfismo de Nucleotídeo Único , Glicemia/metabolismo , Glicemia/análise , Hemoglobinas Glicadas/metabolismo , Hemoglobinas Glicadas/análiseRESUMO
There is a substantial gap in our knowledge regarding the efficacy of exergames on the reduction of fall risk in older adults. This systematic review analyzes the findings of clinical trials describing the efficacy of exergames to improve balance or reduce the risk of falls in individuals above 60 years of age who are residents in community centers or nursing homes. We searched Google Scholar, PubMed, and Embase up to January 2023. Initially, 52,294 records were screened. After applying the inclusion and exclusion criteria, 20 studies were included in this systematic review. Meta-analyses revealed statistically significant reductions in the risk of falls and improvements in balance. Exergaming tended to produce positive benefits according to the results obtained using different instruments (TUG, PPA, BBS, and others), control groups, and times of intervention. Nevertheless, a substantial proportion of studies exhibited a high risk of bias and only one had a long follow-up period. Although a large body of evidence supports the view that exergaming is suitable for reducing fall risk and improving balance in older adults, some gaps remain in our knowledge about such benefits.
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RESUMO Incontinência urinária (IU) e disfunção sexual feminina (DSF) são disfunções que afetam a qualidade de vida. Com a mudança na pirâmide etária brasileira, a prevalência de tais disfunções tende a aumentar. O objetivo deste estudo foi estabelecer a relação entre a IU, a DSF e a contração muscular perineal em idosas ativas fisicamente. Trata-se de estudo transversal, do qual participaram 35 idosas ≥60 anos. Inicialmente foram aplicados a ficha diagnóstica e os questionários International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI-SF) e Female Sexual Function Index (FSFI). Em seguida foram avaliados os músculos do assoalho pélvico (MAP) por meio do toque vaginal, de acordo com o que propõe o esquema perfect. Entre as idosas, 20% apresentaram ambas as disfunções dos MAP. No total, 17 (48,6%) apresentavam IU e 16 (45,7%) DSF. Observou-se diferença significativa no número de partos vaginais (p=0,028) e no item rapidez do esquema perfect (p=0,033) entre as idosas com e sem DSF. Não houve diferença estatística entre os grupos com e sem IU. A análise apontou uma correlação inversamente proporcional entre a gravidade da IU e a função sexual nas idosas incontinentes (p=0,008; r=−0,622), de forma que, para cada aumento na gravidade da IU pelo ICIQ-SF, diminuiu-se 0,507 de função sexual avaliada pelo FSFI (p=0,034; r=0,516). Há uma associação entre IU e DSF em idosas fisicamente ativas. Algumas idosas apresentam ambas as disfunções dos MAP, apesar de serem ativas fisicamente. Dessa forma, é necessário reforçar a importância de avaliações minuciosas, da atividade física orientada e da atuação multiprofissional em saúde.
RESUMEN La incontinencia urinaria (IU) y la disfunción sexual femenina (DSF) son trastornos que afectan la calidad de vida de las personas. Con el cambio en la pirámide de edad brasileña se aumentará la prevalencia de tales disfunciones. El objetivo de este estudio fue establecer la relación entre la IU, la DSF y la contracción del músculo perineal en mujeres mayores físicamente activas. Este es un estudio transversal, en el que participaron 35 mujeres ≥60 años. Inicialmente se aplicó el formulario de diagnóstico y los cuestionarios International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI-SF) e Índice de Función Sexual Femenina (FSFI). Luego, se evaluó la musculatura del piso pélvico (MAP) mediante toque vaginal siguiendo lo que propone el esquema perfect. Entre las ancianas, el 20% tenía ambas disfunciones de MAP. En total, 17 (48,6%) tenía IU, y 16 (45,7%) DSF. Hubo una diferencia significativa en el número de partos vaginales (p=0,028) y en el ítem rapidez del esquema perfect (p=0,033) entre mujeres ancianas con y sin DSF. No hubo diferencia estadística entre los grupos con y sin IU. El análisis mostró una correlación inversamente proporcional entre la gravedad de la IU y la función sexual en mujeres ancianas con incontinencia (p=0,008; r=−0,622), de modo que por cada aumento en la gravedad de la IU por el ICIQ-SF se disminuyó 0,507 de función sexual evaluada por el FSFI (p=0,034; r=0,516). Existe una asociación entre la IU y la DSF en mujeres ancianas físicamente activas. Algunas ancianas tuvieron ambas disfunciones del MAP a pesar de ser físicamente activas. Por lo tanto, es necesario reforzar la importancia de las evaluaciones detalladas, la actividad física orientada y la acción multiprofesional en salud.
ABSTRACT Urinary incontinence (UI) and female sexual dysfunction (FSD) are disorders that affect quality of life. With the change in the Brazilian age pyramid, the prevalence of such disorders tends to increase. The aim of the present study was to correlate the relationship between UI, FSD and the functionality of the pelvic floor muscles (PFM) in physically active older women. This is a cross-sectional study, in which 35 older women ≥60 years old participated. Initially, the diagnostic form, the International Consultation on Incontinence Questionnaire - Short form (ICIQ-UI-SF) and Female Sexual Function Index (FSFI) were applied. Then, the PFM were evaluated by vaginal touch, following what is proposed in the perfect scheme. Among older women, 20% had both PFM dysfunctions. In total, 17 (48.6%) had UI and 16 (45.7%) FSD. There was a significant difference in the number of vaginal deliveries (p=0.028) and in the perfect schedule (p=0.033) between older women with and without FSD. There was no statistical difference between the groups with and without UI. The analysis showed an inversely proportional correlation between UI severity and sexual function in incontinent older women. (p=0.008; r=−0.622). Since, for each increase in UI severity by the ICIQ-SF, 0.577 of sexual function assessed by the FSFI is decreased (p=0.034; r=0.516). There is an association between UI and FSD in physically active older women. Some older women have both PFM dysfunctions despite being physically active. Thus, it is important to reinforce the importance of thorough evaluations, oriented physical activity and multiprofessional action in health.
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RESUMO O objetivo deste estudo foi avaliar os benefícios da abordagem fisioterapêutica da IU em idosos em uma unidade básica de saúde (UBS) de Belém (PA). Trata-se de uma proposta para treinamento dos músculos do assoalho pélvico (MAP) em 10 encontros semanais com atividades progressivas. Foram incluídos idosos de ambos os sexos, e excluídos os indivíduos com prejuízo cognitivo, instabilidade hemodinâmica e mobilidade impossibilitada, além dos idosos com participação inferior a 50% dos encontros. Foi realizada avaliação por meio de dados sociodemográficos e clínicos, e da QV, por meio do King's Health Questionaire (KHQ), que foi reaplicado ao final dos encontros. A amostra inicial contou com 10 idosos, com idade de 70,3±5,01 anos, sendo 80% do sexo feminino, 80% dos idosos relataram cirurgias pélvicas prévias, prolapsos em 3 idosos, destes, 2 eram de bexiga. Os domínios do KHQ com escores mais altos, e consequente pior QV, foram impacto da IU (54,1±24,8), percepção de saúde (43,7±11,5) e medidas de gravidade (31,2±23,8). Houve significância estatística em vários domínios da QV dos idosos submetidos a abordagem fisioterapêutica, demonstrando que, mesmo em um nível mais baixo de atenção à saúde é possível ter efeitos relevantes sobre a IU e a QV desse público.
RESUMEN El objetivo de este estudio fue evaluar los beneficios del enfoque fisioterapéutico de la incontinencia urinaria (IU) en ancianos de una Unidad Básica de Salud (UBS) en Belém (PA, Brasil). Este enfoque consiste en una propuesta de entrenamiento de los músculos del suelo pélvico (MSP) durante 10 sesiones semanales con actividades progresivas. Se incluyeron a ancianos de ambos sexos, y se excluyeron a personas con deterioro cognitivo, inestabilidad hemodinámica y movilidad reducida, además de los ancianos con menos del 50% en asistencia a las reuniones. La evaluación se llevó a cabo con datos sociodemográficos y clínicos y de calidad de vida (CV) utilizando King's Health Questionnaire (KHQ), que lo volvieron a aplicar al final de las reuniones. La muestra inicial estuvo formada por 10 ancianos de 70,3±5,01 años; el 80% de ellos eran del sexo femenino y el 80% informaron haber realizado cirugías pélvicas previas, con prolapsos en 3 ancianos; de estos, 2 eran de vejiga. Los dominios KHQ con las puntuaciones más altas y, en consecuencia, la peor calidad de vida fueron el impacto de la IU (54,1±24,8), de la percepción de la salud (43,7±11,5) y de medidas de gravedad (31,2±23,8). Hubo una significación estadística en varios dominios de CV de los ancianos que se sometieron al enfoque fisioterapéutico, lo que demuestra que incluso en un nivel más bajo de asistencia sanitaria es posible generar efectos relevantes sobre la IU y la CV de esta población.
ABSTRACT The aim of this study was to evaluate the benefits of the physiotherapeutic approach to urinary incontinence (UI) in the older population in a health center of Belém (PA). This is a proposal for strengthening pelvic floor muscles (PFM) in ten weekly meetings with progressive activities. Patients of both genders were included, and individuals with cognitive impairment, hemodynamic instability and immobility were excluded, as well as those with less than 50% participation in the meetings. Sociodemographic and clinical data were evaluated and quality of life (QoL) was analyzed through the King's Health Questionnaire (KHQ), which was reapplied at the end of the meetings. The initial sample consisted of ten older adults, aged 70.3±5.01 years, 80% female; 80% of the sample reported previous pelvic surgeries, three reported prolapses, of which two were in the bladder. The KHQ domains with higher scores and consequent worse QoL were the impact of UI (54.1±24.8), health perception (43.7±11.5), and severity measures (31.2±23.8). There was statistical significance in several domains of QoL of the patients undergoing the physiotherapeutic approach, demonstrating that even in a lower level of health care it is possible to have relevant effects on the UI and QoL of this public.
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Resumo Vários autores têm refletido sobre a questão do acesso aos serviços de saúde, considerando a existência de várias dimensões, nas quais se inclui a disponibilidade e a acessibilidade. No contexto de envelhecimento que caracteriza as sociedades, a população idosa precisa de mais cuidados de saúde, e a acessibilidade a essas unidades assume importância acrescida. O objetivo do estudo é caracterizar o acesso da população idosa aos serviços de saúde, confrontando as possibilidades decorrentes da oferta de serviços com os padrões de procura. Do confronto entre oferta e procura resulta a possibilidade de identificar as dinâmicas intrarregionais e associá-las às diferentes condições socioeconômicas dos idosos, ao seu enquadramento familiar, modo de transporte e tipo de serviço. Esta abordagem considera duas fases metodológicas: o cálculo do potencial de cobertura populacional das unidades de cuidados primários, considerando a acessibilidade física recorrendo aos modos pedonal e rodoviário; e o confronto desses valores com a procura dos serviços, determinada a partir de inquéritos realizados aos residentes. Concluiu-se que, apesar dos equipamentos de saúde prestadores de cuidados primários terem sido programados como serviço de proximidade, a forma de prestação do serviço, as características socioeconômicas da população idosa e o modelo de urbanização apontam para diferenças relevantes no contexto da Área Metropolitana de Lisboa.
Abstract Several authors have reflected upon access to health services considering several dimensions, such as availability and accessibility. Due to the aging of societies, the older population's demands for healthcare increase, and accessibility to these units acquires special importance. Our study aims to characterize the access of older people to healthcare services, facing the possibilities arising from service supply and demand patters. From the supply and demand confrontation, comes the possibility of identifying intraregional dynamics and associating them with the various socioeconomic conditions of older people, family background, modes of transportation, and type of service. This approach considers two methodological phases: calculating the potential for primary healthcare coverage, considering physical accessibility for pedestrian and highway modes; and confronting these values with services demand, determined from surveys conducted with residents. We concluded that, although healthcare centers were designed as a proximity service, service provision, socioeconomic aspects, and the urbanization model entail meaningful inequalities of access in the context of the Lisbon Metropolitan Area.
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Atenção Primária à Saúde , Idoso , Envelhecimento , Zonas Metropolitanas , Saúde do Idoso , Serviços Urbanos de Saúde , Acessibilidade aos Serviços de SaúdeRESUMO
Resumen Objetivo: Entre los años del 2000 y 2050 el número de habitantes mayores de 60 años de edad en Costa Rica se duplicarán. Un número considerable de ellos llegarán a ser frágiles. Estudios han demostrado la relación entre la condición de fragilidad y pobres desenlaces. El objetivo del presente trabajo fue identificar los eventos adversos asociados a la fragilidad en la población adulta mayor de Costa Rica. Métodos: Para realizar el análisis, se emplea la totalidad de los casos disponibles en la base de datos del estudio de CRELES en el 2005, que pertenecen a la cohorte que da seguimiento en el periodo 2005-2009. En el año de partida de esta cohorte, se cuenta con un total de 2827 pacientes. El fenotipo de la fragilidad fue construido basado en el modelo fenotípico. Se realizó un análisis longitudinal, y se examinó los años iniciales y finales de esta cohorte. Los desenlaces analizados fueron la mortalidad, los ingresos hospitalarios, el deterioro funcional, las caídas y la autopercepción de la salud en el año 2009. Se utilizó una técnica de regresión logística multinomial, utilizando variables de desenlaces como variables dependientes. La condición de fragilidad se utilizó como variable independiente. Como resultado, se obtuvo una odds ratio para la incidencia de cada categoría de desenlaces con un 95% de confianza. Resultados: La condición de fragilidad se asoció con mayor deterioro funcional, aumento en los ingresos hospitalarios y empeoramiento en la autopercepción de la salud. Conclusión: La fragilidad se relacionó con pobres desenlaces en la población costarricense. La identificación de esta condición proporciona una oportunidad para una intervención temprana.
Abstract Objective: Between 2000 and 2050 the number of inhabitants aged 60 years or older in the World and in Costa Rica will double. A considerable number of them will become frail. Studies have shown the relationship between the frailty condition and poor outcomes. The aim of this study was to identify the adverse outcomes of frailty in the older Costa Rican population. Methods: To carry out the analysis, all the available cases of the CRELES study database in 2005 which belong to the cohort that follows in the period 2005-2009 were used. In the year of the initial cohort there was a total of 2827 patients. A frailty phenotype was constructed based on the phenotypic model. A longitudinal analysis was conducted, and it examined the initial and final years of this cohort. The outcome variables analysed were mortality, hospital admittances, functional deterioration, falls, and self-perception of worsening health in the year 2009. A multinomial logistic regression technique was used, using outcome variables as dependent variables. The frailty condition was used as an independent variable. As a result, there was an odds ratio obtained for the incidence of each outcome category with 95% confidence. Results: Frailty was associated with functional declines, hospital admittances, and worsening of the self-perception. Conclusion: Frailty was related to adverse outcomes in Costa Rica. Identifying this provides an opportunity for an early intervention.
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Humanos , Idoso , Idoso de 80 Anos ou mais , Saúde do Idoso , Idoso Fragilizado , Costa Rica , FragilidadeRESUMO
BACKGROUND: Under static conditions, the objective and subjective measures of postural stability correlate well. However, age-related changes in postural control and task-related anxiety may modify the relationship between these subjective and objective measures. Ultimately, patients' symptoms represent subjective reports, thus understanding this relationship has clinical implications. AIMS: This study investigates the relationship between subjective-objective measures of postural stability in dynamic conditions and whether this relationship is influenced by age or task-related anxiety. METHODS: 50 healthy participants (aged 18-83 years) stood on a platform oscillating at variable amplitudes, with-without a fall-preventing harness to modulate task-related anxiety. Trunk sway path, hip velocity and foot lifts (objective measures) and subjective scores of instability and task-related anxiety were recorded. RESULTS: The subjective perception of stability accurately matched objective body sway, following a logarithmic function profile (r2 = 0.72, p < 0.001). This function did not change significantly with age, harness or task presentation order. A strong relationship was observed between subjective measures of stability and task-related anxiety for all subjects (r = 0.81, p < 0.001). Task repetition reduced anxiety in the young, uncoupling anxiety changes from subjective instability, but not in the elderly who retained higher anxiety levels in line with subjective unsteadiness. DISCUSSION: Subjects accurately rate their own instability during dynamic postural challenges, irrespective of age and actual fall risk. However, anxiety may selectively modulate the perception of instability in older subjects. The perception of stability relies upon the integration of sensory afferents but also recruits emotional-cognitive processes, particularly in older individuals. The use of a safety harness has no influence on subjective or objective postural stability.
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Acidentes por Quedas/prevenção & controle , Ansiedade/fisiopatologia , Pé/fisiopatologia , Percepção/fisiologia , Equilíbrio Postural/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
ABSTRACT Objective: To evaluate epidemiological aspects of urinary tract infection in older patients with urinary incontinence living in long-term care institutions in Belo Horizonte. Method: Concurrent cohort held from April 1st to October 1st, 2015. The study was conducted in two long-term care institutions in the city of Belo Horizonte, Minas Gerais, with 84 incontinent older people. Results: Cumulative incidence of urinary tract infection was 19% (95% CI: 7.83-23.19) and the incidence density was 3.6 cases/100 people-month of follow-up period. The variables Bacteriuria and Institution presented statistical association with the occurrence of urinary tract infection. Conclusion: It is observed that the incidence of urinary tract infection in the study was smaller than in other similar international and national studies, however this is an important world health problem for the older population, with impact on mortality of these individuals.
RESUMEN Objetivo: Analizar los aspectos epidemiológicos de infección del tracto urinario en ancianos con incontinencia urinaria, en residencias para ancianos de Belo Horizonte, Brasil. Método: Se realizó una cohorte del 1º de abril al 1º de octubre de 2015. Se realizó el estudio en dos residencias para ancianos de la ciudad de Belo Horizonte, del cual participaron 84 ancianos con incontinencia urinaria. Resultados: La incidencia acumulada de infección en el tracto urinario fue del 19% (IC 95%: 7,83-23,19) y la densidad de la incidencia fue de 3,6 casos/100 personas-mes por seguimiento. Las variables Bacteriuria y la residencia presentaron asociación estadística en la aparición de este tipo de infección. Conclusión: A pesar de que la incidencia de infección del tracto urinario en este estudio fue menor que en otros estudios nacionales e internacionales de mismo tema, es un grave problema de salud para los ancianos por todo el mundo, puesto que implica la mortalidad de ellos.
RESUMO Objetivo: Avaliar aspectos epidemiológicos da infecção do trato urinário em pacientes idosos com incontinência urinária, residentes em instituições de longa permanência, de Belo Horizonte. Método: Coorte concorrente realizada no período de 01 de abril a 01 de outubro de 2015. O estudo foi realizado em duas instituições de longa permanência, na cidade de Belo Horizonte, MG, com 84 idosos incontinentes. Resultados: A incidência acumulada de infecção do trato urinário foi de 19% (IC 95%: 7,83-23,19) e a densidade de incidência foi de 3,6 casos/100 pessoas-mês de seguimento. As variáveis Bacteriúria e Instituição apresentaram associação estatística com a ocorrência de infecção do trato urinário. Conclusão: Observa-se que a incidência de infecção do trato urinário no estudo foi menor que em outros estudos nacionais e internacionais semelhantes, no entanto trata-se de um importante problema de saúde mundial para os idosos, com impacto na mortalidade desses indivíduos.
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Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Incontinência Urinária/epidemiologia , Infecções Urinárias/epidemiologia , Brasil/epidemiologia , Comorbidade , Incidência , Estudos de Coortes , Seguro de Assistência de Longo Prazo/estatística & dados numéricos , Pessoa de Meia-IdadeRESUMO
Aging populations and the prevalence of poverty in old age have led to the introduction of noncontributory pensions in many countries. We consider a number of alternative targeting approaches and simulate their effects in an empirical application in the State of Yucatan, Mexico. We compare the approaches with respect to leakage, under-coverage, and their effects on government budgets. We are also able to compare the simulated effects of one alternative with the observed effect of a recently introduced demogrant and find that the simulation is a close approximation of the empirical outcomes. We discuss issues of implementation and political feasibility.
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OBJECTIVES: To assess the contribution of chronic conditions to the disability burden in the older men and women in Brazil. METHODS: Data from 10,290 participants of the Brazilian National Health Survey in 2013 aged 60 years or older were used. Disability was defined based on limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). Binomial additive hazards models were fitted to assess the contribution of chronic conditions to the disability prevalence. RESULTS: Back pain was the most common condition, followed by diabetes and heart diseases in men and arthritis and diabetes in women. Stroke and mental disorders were by far the most disabling conditions in men and women. A higher disability prevalence was observed in women (34.4 %, CI 32.4; 36.2 %) compared to men (28.4 %; CI 25.9; 30.8 %). The most important contributors to the disability prevalence were stroke, back pain, and arthritis among men, and diabetes, heart diseases, and arthritis in women. CONCLUSIONS: Interventions to reduce disability in the older population in Brazil should take into account the gender gap in the occurrence of chronic conditions, focusing on the main contributors to the disability burden.
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Doença Crônica/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Artrite/epidemiologia , Dor nas Costas/epidemiologia , Brasil/epidemiologia , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Disparidades nos Níveis de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Fatores SocioeconômicosRESUMO
Population aging coupled with high poverty rates among older persons and a lack of access to social-security benefits or traditional support systems have led governments in low and middle-income countries to introduce non-contributory pension programs for the elderly. This article reviews a non-contributory pension program introduced in Mexico in 2007 that has since expanded greatly. We use a variety of sources to estimate current and future costs of this program.
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Idoso/estatística & dados numéricos , Pensões/estatística & dados numéricos , Política Pública/economia , Aposentadoria/economia , Demografia , Humanos , MéxicoRESUMO
BACKGROUND: circulating measures of inflammatory markers, such as C-reactive protein (CRP) have been associated with an increased risk of future cognitive decline. However, the nature of the relationship among the very old (>75 years) is unclear. Cross-sectional evidence suggests that elevated CRP may even be protective in this age group. This study examines these associations longitudinally. METHODS: logistic regression was used to investigate the association between CRP and drop in cognitive performance (≥3 point change on the Mini-Mental State Examination) over a 4-year period in a population of 266 people, mean age 77 years. RESULTS: increased levels of CRP were associated with a decreased risk of a drop in cognitive performance; however, this association was only seen in those without an APOE e4 allele [odds ratio of decline per unit increase in ln(CRP) 0.57, P = 0.04]. The magnitude of the finding remained consistent after adjustment for cardiovascular confounders (smoking, drinking, MI, stroke, diabetes, education, medication and blood pressure). For those with an e4 allele, the relationship with longitudinal cognitive decline was neither statistically significant nor in a consistent direction after controlling for acute inflammation. CONCLUSIONS: this study strengthens previous cross-sectional findings and shows elevated levels of CRP to be linked to a decreased risk of longitudinal cognitive decline in the very old. However, as with prior analyses, this was only observed in those not carrying an APOE e4 allele. Future work on larger APOE e4 allele carrying samples is required to determine the nature of the association in this population.