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Fundamento: el envejecimiento es un hecho que afecta a toda la población mundial, y de manera considerable, a los países más desarrollados, en los que la esperanza de vida ha ido aumentando tal y como se refleja en el informe de Naciones Unidas. Objetivo: describir el contexto social y capacidad funcional en gerontos del consultorio # 8 del Área de Salud I del municipio Cienfuegos durante el año 2022. Método: se realizó un estudio descriptivo de corte transversal. Se seleccionó aleatoriamente una muestra del 30 % para un total de 131 ancianos. Se realizó una entrevista estructurada, que recogió las variables generales: edad, sexo, nivel de escolaridad, ocupación, antecedentes patológicos personales, la colaboración de apoyo y para completar la valoración social se aplicó el Cuestionario de Funcionamiento Familiar. Resultados: el grupo de edad de 60 a 65 años tuvo más prevalencia, el 45,5 % estudió hasta la primaria terminada, seguidos de los de secundaria terminada con el 29,0 %. Los jubilados estuvieron representados en un 38,9 %, las principales enfermedades no transmisibles que prevalecieron fueron: la hipertensión arterial, la cardiopatía isquémica y la diabetes mellitus tipo 2, el 40,4 % vivía solo, el 19,8 % tenía cuidador, el 14,5 % no recibían apoyo y el 9,9 % de los ancianos que se encontraban en probable estado de necesidad social. Conclusiones: un adulto mayor bien nutrido, querido, apoyado, con todas las necesidades básicas satisfechas, así como todas las enfermedades asociadas propias de esta etapa de la vida compensadas, tendrá en cualquier sociedad una mejor calidad de vida.

Foundation: aging is a fact that affects the entire world population, and considerably, the most developed countries, in which life expectancy has been increasing as reflected in the United Nations report. Objective: to describe the social context and functional capacity in gerontos of clinic # 8 of Health Area I of the Cienfuegos municipality during the year 2022. Method: a descriptive cross-sectional study was carried out. A 30 % sample was randomly selected for a total of 131 elderly people. A structured interview was carried out, which included the general variables: age, sex, level of education, occupation, personal pathological history, support collaboration and to complete the social assessment, the Family Functioning Questionnaire was applied. Results: the age group of 60 to 65 years had the most prevalence, 45.5 % studied until they completed primary school, followed by those who completed secondary school with 29.0 %. Retirees were represented at 38.9 %, the main non-communicable diseases that prevailed were: high blood pressure, ischemic heart disease and type 2 diabetes mellitus, 40.4 % lived alone, 19.8 % had a caregiver, 14.5 % did not receive support and 9.9 % of the elderly who were in a probable state of social need. Conclusions: a well-nourished, loved, supported older adult, with all basic needs satisfied, as well as all associated diseases typical of this stage of life compensated, will have a better quality of life in any society.

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El envejecimiento poblacional constituye uno de los logros y uno de los retos más importantes del desarrollo de las sociedades. La principal causa del envejecimiento es el descenso de la fecundidad de las mujeres, y en menor proporción la emigración externa, sobre todo de jóvenes. En Cuba, ya mueren más que los que nacen, debido fundamentalmente a los bajos niveles de reemplazo en la fecundidad, situación agravada en los años de la pandemia de COVID-19. Entre las consecuencias negativas del envejecimiento poblacional, se identifican cuatro principales: sanitarias, económicas, socioculturales y legales; entre las positivas, hay algunos reportes de cohortes de personas que llegan a edades avanzadas en mejor estado físico y mental. Los cambios ocurridos en la institución familiar en muchas sociedades y la discriminación por edad de los mayores, tienen consecuencias graves para la salud, el bienestar y los derechos humanos de los ancianos. Se considera que existe mucha información sobre el "diagnóstico" y el "pronóstico" del envejecimiento poblacional, pero hay menos acerca de acciones eficaces para su "tratamiento", aspecto complejo y difícil de enfrentar. Se exponen algunas propuestas de mitigación de estos inevitables cambios demográficos. El propósito de esta comunicación es comentar determinados aspectos del envejecimiento de la población cubana.

Population aging constitutes one of the achievements and one of the most important challenges in the development of societies. The main cause of aging is the decrease in the fertility of women and to a lesser extent external emigration, especially of young people. In Cuba, more people die than are born, mainly due to low replacement levels in fertility, a situation aggravated in the years of the COVID-19 pandemic. Among the negative consequences of population aging, four main ones are identified: health, economic, sociocultural and legal; among the positive ones, there are some reports of cohorts of people who reach advanced ages in better physical and mental condition. The changes that have occurred in the family institution in many societies and the age discrimination of the elderly have serious consequences for the health, well-being and human rights of the elderly. It is considered that there is a lot of information about the "diagnosis" and "prognosis" of population aging, but there is less about effective actions for its "treatment", a complex and difficult aspect to face. Some proposals are presented to mitigate these inevitable demographic changes. The purpose of this communication is to comment on certain aspects of the aging of the Cuban population.

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Latin America is aging rapidly. Thus, governments in the region are reformulating their social protection policies. In 2022, Costa Rica passed a national long-term care law. A discussion developed on how to provide such care, whether through public or private in-kind benefits or cash-for-care (CfC) to beneficiaries. CfC has been used in developed countries with various outcomes. However, there are still no evaluations of its effects in middle-income countries. The objective of this study was to evaluate the impact of CfC pilot study on female caregivers in a middle-income country. The expectations of the program were to find positive effects of CfC on caregivers. After conducting a literature review, we developed four domains of analysis: labor market participation, time for personal activities, use of CfC, and caregiver burnout. The results indicate that CfC has no significant impact on caregivers' integration into the labor market, or ability to have leisure time. However, there was a positive effect on the funding of basic needs and mitigation of factors predicting burnout.

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El número de personas que conviven con algún tipo de discapacidad ha ido en aumento en el último siglo. Esta tendencia se asocia al elevado número de pacientes con enfermedades crónicas no transmisibles y al envejecimiento poblacional. Se desarrolló una revisión de documentos, artículos científicos y noticias publicadas en los últimos cinco años para conocer las nuevas tendencias en cuanto a los pacientes mayores de 60 años. El objetivo del presente trabajo es describir la relación entre discapacidad y envejecimiento, sus características particulares y la atención de salud bucal de esta población. Se constató que los pacientes conforme avanza la edad, sufren cambios morfológicos a nivel de sus tejidos y sistemas. Las enfermedades bucales más comunes reportadas son la caries dental, enfermedad periodontal, edentulismo total o parcial y cáncer oral. Las actividades planificadas presentan un aumento en el enfoque de promoción y prevención de salud, así como el rediseño de planes de mantenimiento a largo plazo. Se concluye que el estudio resulta pertinente y necesario para la actualización y preparación de los profesionales de la estomatología en tiempos donde el aumento de la esperanza de vida es una tendencia. El estudio se desarrolla en el año actual como parte de un proyecto de investigación.

The number of people that you/they cohabit with some disability type has gone in increase in the last century. This tendency associates to the high number of patient with chronic illnesses not transferable and to the populational aging. A revision of documents, scientific articles and news published in the last five years to know the new tendencies as for the patients bigger than 60 years was developed. The objective of the present work is to describe the relationship among disability and aging, its particular characteristics and the attention of this population's buccal health. It was verified that the patients conform the age it advances, they suffer morphological changes to level of their fabrics and systems. The reported more common buccal illnesses are the dental cavity, illness periodontal, total or partial edentulism and oral cancer. The planned activities present an increase in the promotion focus and prevention of health, as well as the one redraws of plans of long term maintenance. It is concluded that the study is pertinent and necessary for the updating and preparation of dentistry professionals in times where the increase in life expectancy is a trend. The study is developed in the current year as part of an investigation project.

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The home care workforce contributes significantly to older adults' health and well-being. The Community Elder Care (Companion) Program in Barbados employs Companions to engage with socially isolated older adults in their homes for a few hours per day. In this qualitative study we explored Companions' experiences in the program 1 year since its commencement. Opportunity to earn, love and concern for older adults, and previous caregiving experiences were among the factors which motivated participants to seek employment in the program. They commonly reported going beyond the scope of their duties to meet clients' critical needs. While they saw themselves as positively impacting their clients, some noted that they too benefitted from the engagement. Better compensation packages and training were seen as necessary actions for program improvement. Our findings can be incorporated in a comprehensive program review and can inform home care workforce development and Companion Program structure and delivery.

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INTRODUCTION: Institutionalized older adults have fewer opportunities to participate in daily living activities and tasks in an independent manner, with greater deleterious effects on the physiological losses inherent to aging and with increased gait and balance impairment compared to community-dwelling older adults. The use of a treadmill for rehabilitation, with or without partial weight support, has been studied in different groups, but not on institutionalized older adults. OBJECTIVES: To assess the effects of a treadmill walking program on the postural balance and quality of life of institutionalized older adults. METHODS: Thirty-seven institutionalized older adults: intervention group (n = 23, 75.7 ± 7.8 years) and control group (n = 14, 78.9 ± 10.2 years). A total of 10 weeks of treadmill walking, twice a week (intervention group) vs. no training (control group). Postural balance was assessed by the Tinetti test, 6-min walk test (6MWT), and 10-m walk test and Quality of life with the WHOQOL-Bref questionnaire. RESULTS: Significant improvement was observed in balance parameters (6MWT distance: p < 0.001; gait speed 6MWT: p < 0.001; gait speed 10MWT: p < 0.001; Tinetti scale: p = 0.001), and in the physical (p = 0.01), psychological (p = 0.002), self-assessed quality of life (p = 0.01) and overall quality of life domains (p = 0.002). CONCLUSIONS: Treadmill walking program had positive effects on the postural balance and quality of life of institutionalized older adults.

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Objective: To examine whether the effect of population aging on healthcare expenditures as a share of Gross Domestic Product (GDP) is attenuated in more educated countries. Method: The analysis is based on a dataset of 22 Latin American countries between 1995 and 2013. We estimate panel data models with country and time fixed effects, and control for potential nonlinear effects of population aging on health expenditure. Results: We find population aging increases health expenditure as a share of GDP in economies characterized by low levels of education, but this effect is mitigated in economies with higher levels of education. Results are driven by private health expenditures. Discussion: Results suggest population aging and education have a stronger influence on healthcare expenditures in less developed countries. This finding is important in a context in which the rapid growth of the aging population is likely to lead to significant costs in terms of health expenditures, but less so in more educated societies.

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Introducción: El aumento del envejecimiento de la población es un hecho universal y uno de los problemas fundamentales del actual siglo, puesto que la salud integral de los ancianos está directamente relacionada con su calidad de vida. Objetivo: Evaluar el proceso de atención al anciano en unidades del nivel primario de salud. Métodos: Se realizó una investigación en sistemas y servicios de salud de tipo evaluativo de la calidad de la atención al anciano en dos policlínicos de Santiago de Cuba (policlínicos docentes Carlos Juan Finlay y Camilo Torres Restrepo), durante el año 2018, para lo cual se aplicaron formularios ya validados. De un universo constituido por 11 992 pacientes correspondientes a ambas instituciones sanitarias y por 280 historias clínicas de los ancianos frágiles atendidos por los grupos básicos de trabajo, se tomó una muestra de 260 y 40 historias clínicas, respectivamente. Resultados: En los consultorios médicos de la familia la evaluación realizada al anciano se estimó como mala; solo se remitía al geriatra una décima parte del total y las consultas y visitas a domicilios se cumplieron según lo planificado solo en una tercera parte de los pacientes, lo que condujo a resultados muy desfavorables en aspectos fundamentales como la realización del examen periódico de salud, la escala geriátrica de evaluación funcional y la evaluación del anciano. Por su parte, en el equipo básico de salud no se consideraron ni el examen periódico de salud como la herramienta con que se cuenta para evaluar a los ancianos en los aspectos sociales, funcionales, psicológicos y biomédicos, ni el valor de un plan de seguimiento médico; todo esto influenciado por un interrogatorio y un examen físico desfavorables. Conclusiones: La calidad del proceso de atención en el consultorio médico de la familia y en el grupo básico de trabajo evaluada como mal evidencia la falta de competencias al respecto y el desconocimiento de lo establecido para una adecuada atención al adulto mayor.

Introduction: The increase of population aging is an universal fact and one of the fundamental problems of this century, since the comprehensive health of elderly is directly related to their life quality. Objective: To evaluate the process of elderly care in units of the health primary level. Methods: An investigation in health systems and services of evaluative type of the quality of the elderly care in two polyclinics from Santiago de Cuba was carried out (Carlos Juan Finlay and Camilo Torres Restrepo teaching polyclinics), during 2018, for which validated forms were already implemented. A sample of 260 and 40 medical records was taken, respectively from a universe constituted by 11 992 patients belonging from both health institutions and by 280 medical records of frail elderly assisted by the work basic groups. Results: The evaluation carried out to elderly in the family doctor offices was considered as poor; just a tenth part of the total was referred to the geriatrician; the consultations and home visits were fulfilled according to schedule just in a third part of the patients, what led to very unfavorable results in fundamental aspects as the realization of the health periodic exam, geriatric scale of functional evaluation and elderly evaluation. On the other hand, in the health basic team neither health periodic exam was taken into consideration as the tool with which elderly are evaluated in the social, functional, psychological and biomedical aspects, nor the value of medical follow up schedule; all this influenced by an unfavorable interrogation and physical exam. Conclusions: The quality of the care process in the family doctor office and in the basic group of work evaluated as poor evidences the lack of competence in this respect and the ignorance of what is established for an appropriate care to the elderly.

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OBJECTIVE: Analyzing the survival of older people hospitalized due to COVID-19 in Brazil and identifying its main predictive factors for death. METHOD: This is a retrospective, multicenter cohort study, based on 20,831 records of hospitalizations of older people due to SARS-CoV-2 in Brazil. The observation period was from February 28 to May 18, 2020. RESULTS: There was a reduced overall survival time of 47.70% (95% confidence interval [CI] = [46.72%, 48.67%]) in 10 days. The variables age, race, education, intensive care unit (ICU), region, day of hospitalization, time elapsed between the first symptom and hospitalization, and the municipality that provided assistance showed increased risk of death using the multiple Cox proportional-hazards model. CONCLUSION: These results emphasize the relevance of inequality and access to health services as determinants for the death of older people with COVID-19.

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Resumo Introdução O Brasil experimentou, ao longo do século XX, uma profunda mudança em relação à expectativa de vida ao nascer. Nesse processo, foi importante não somente a queda do nível da mortalidade para o grande aumento da expectativa de vida, mas também a mudança no padrão da mortalidade. Recentemente, vêm sendo discutidas mudanças no padrão de mortalidade nas idades mais avançadas, bem como o impacto no envelhecimento populacional. Entretanto, no Brasil, as discussões sobre a longevidade e o comportamento da mortalidade nas idades avançadas ainda são incipientes. Especialistas sugerem que projeções de mortalidade incorporem novas tendências de desaceleração da mortalidade em idades avançadas e explorem abordagens de coortes para suas formulações de tendências. Objetivo Estudar o efeito causado pelas mudanças no comportamento da mortalidade e da expectativa de vida na predição do tamanho da população idosa do estado de São Paulo. Método Método estendido de coortes componentes. Resultados Alterações no nível e no padrão da mortalidade têm um efeito maior na predição da população de 80 anos ou mais em comparação com a população de 60 anos ou mais. Ademais, considerar o gap da expectativa de vida entre os sexos é relevante para determinar o número futuro de idosos. Conclusão Ao utilizar países em diferentes estágios da transição epidemiológica como cenário futuro do padrão e do nível da mortalidade de São Paulo, o método estendido de coortes componentes se torna uma possibilidade metodológica interessante para avaliar o impacto dessas modificações para a projeção da população idosa, podendo ser uma ferramenta para a avaliação de políticas públicas.

Abstract Background Brazil experienced a significant change in life expectancy at birth in the 20th century. In this process, it is important to observe not only the decrease in mortality level and the increase in life expectancy, but also the change in mortality pattern, that is, how mortality occurred and which ages were most impacted. Recently, these changes in the mortality pattern at more advanced ages and their impact on population aging have been discussed more intensively. However, in Brazil, discussions about human longevity and mortality behavior in advanced ages are still incipient. Experts suggest that future studies and mortality projections incorporate new trends in decelerating mortality at advanced ages and explore cohort approaches in their trend formulations. Objective To study the effect of changes in mortality and life expectancy on predicting the elderly population size in the state of Sao Paulo, Brazil. Method Extended cohort-component study. Results Changes in the level and pattern of mortality have a greater effect on the population aged ≥80 compared with that on the population aged ≥60. In addition, considering the life expectancy gap between sexes is relevant to determine the future number of older people. Conclusion The extended cohort component method is an interesting methodological approach to assess the impact of mortality changes on the elderly population projection by using different stages of the epidemiological transition as a future scenario

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PURPOSE: Depression and impairment of quality of life (QoL) reduce the survival of individual on hemodialysis (HD). However, few studies evaluated the impact of these conditions on the survival of older patients undergoing HD. METHODS: A retrospective cohort study was performed including patients aged ≥ 60 years on HD in Recife, Brazil, assessed in 2013 and monitored until 2017. Depression was evaluated with the Mini-International Neuropsychiatric Interview and QoL with the Control, Autonomy, Self-realization, and Pleasure Questionnaire (CASP-16). Survival differences according to the depression and QoL status were measured by Kaplan-Meier analysis and Cox regression. Death Certificates were analyzed to assess the cause of death. RESULTS: A total of 171 patients were included (mean age 68.7 ± 6.9 years). The mean follow-up time was 3 years (maximum 4.5 years) and there were 98 deaths (57.3% of the sample). In a multivariate model that included depression and QoL, only QoL impairment was associated with a higher risk of death (HR 1.62, p = 0.035). Among CASP domains, only "Control" was associated with survival (HR 0.90, p = 0.014). Depression was unrelated to the cause of death, but there was a trend for death by endocrine diseases if QoL was impaired (p = 0.057). CONCLUSION: QoL impairment is a key predictor of prognosis in older patients on HD and may be more important than depression. It is important that teams dealing with this population include in protocols an assessment of QoL, in order to offer a range of care according to the needs of these patients.

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Os efeitos econômicos do envelhecimento populacional é um tema ainda pouco estudado em países em desenvolvimento. No contexto brasileiro, o Rio Grande do Sul é um dos estados com maiores taxas de envelhecimento populacional. Esta mudança demográfica altera o perfil do consumo da economia, influenciando outras variáveis relacionadas. O objetivo deste trabalho é analisar os impactos das mudanças demográficas na arrecadação de impostos sobre consumo no Rio Grande do Sul. Para isso, utilizou-se um modelo de insumo-produto regional. Os resultados mostram que o envelhecimento populacional gera um perfil de consumo que reduz a carga destes impostos na economia.

The economic effects of population ageing are rarely addressed in developing countries. In the Brazilian context, Rio Grande do Sul is one of the states with the higher rates of population ageing. This demographic change modifies the economy's consumption pattern, affecting other related variables. The aim of this paper is to analyze the impact of the demographic changes in consumption taxes revenues in Rio Grande do Sul. To that end, a regional input-output model is used. The results show that the aging population generates a consumption profile that reduces the burden of these taxes on the economy.

Los efectos económicos del envejecimiento de la población son un tema todavía poco estudiado en los países en desarrollo. En el contexto brasileño, Rio Grande do Sul es uno de los estados con mayores tasas de envejecimiento de la población. Este cambio demográfico altera el perfil de consumo de la economía e influye en otras variables relacionadas. El objetivo de este trabajo es analizar los impactos de los cambios demográficos en la recaudación de los impuestos al consumo en Rio Grande do Sul. Para esto, se utiliza un modelo regional de insumos y productos. Los resultados muestran que el envejecimiento de la población genera un perfil de consumo que reduce la carga de estos impuestos en la economía.

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Introducción: El envejecimiento poblacional es un reto para las sociedades modernas. La esperanza de vida condiciona un incremento en la población anciana, cada vez es mayor el número de personas que precisan de cuidados. Objetivo: Caracterizar a los cuidadores de adultos mayores del consultorio médico de familia No 9. Métodos: Se realizó un estudio descriptivo de corte transversal, en 57 cuidadores informales de ancianos encuestados, pertenecientes al Consultorio Médico No 9 del Policlínico Docente Ramón González Coro entre octubre-diciembre 2017. Resultados: Los resultados mostraron que por lo general el cuidador es un miembro de la familia del sexo femenino, con nivel de escolaridad secundaria terminada y edad entre 45-60 años, la cual asume la mayor parte de la responsabilidad de los cuidados del anciano, a tiempo completo, sin ayuda y sin vínculo laboral. Estas tienen pocos conocimientos relacionados con los cuidados del anciano y desconocen la forma de evitar o disminuir el grado de sobrecarga o estrés. Los cuidadores necesitan capacitación mediante seminarios, cursos en las escuelas para cuidadores domiciliares los cuales pueden estar dirigidas a cómo realizar el manejo de los ancianos que dependen de alguna persona; todo lo relacionado a la transición de los conocimientos sobre el autocuidado y el bienestar de ambas partes. Conclusión: Los cuidadores del área de salud en estudio se caracterizan por ser familiares femeninos, de edad madura, con nivel educacional medio a alto, pero con conocimientos insuficientes para la atención del anciano y su autocuidado(AU)

Introduction: Population aging is a challenge for modern societies. Life expectancy conditions an increase in the elderly population, resulting in a greater number of people requiring care. Objective: To characterize the caregivers of older adults in family doctor's office No. 9. Methods: A descriptive cross-sectional study was conducted in 57 informal caregivers of surveyed elderlies from the Medical Office No. 9, Ramón González Coro Teaching Polyclinic from October to December 2017. Results: The results showed that the caregiver is generally a female member of the family, with a high school level completed and aging between 45-60 years. This person takes most of the responsibility for the full-time care of the elderly, with no help and with no employment relationship. They have little knowledge related to the care of the elderly and do not know how to avoid or reduce the degree of overload or stress. Caregivers need training through seminars, courses at schools for home caregivers, which can be directed at how to manage the elderly who depend on someone; everything related to the transition of knowledge about self-care and the well-being of both parties. Conclusion: The caregivers of the health area under study are characterized by being female family relatives, middle age, high school or higher educational level, but with insufficient knowledge for providing care to the elderly and their self-care(AU)

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En el texto de autodefensa "La historia me absolverá", el doctor Fidel Castro caracterizó la nefasta situación de salud del pueblo de Cuba y la vinculó de manera directa con el desfavorable estado socio-económico y de explotación en que se encontraba la mayoría de la población cubana. Se sintetiza esa situación con datos estadísticos de la época, se compara con la morbi-mortalidad de los últimos años, el aumento de la esperanza de vida, el envejecimiento poblacional y otros indicadores. Estos se han modificado por la atención priorizada que ha brindado la Revolución al mejoramiento de la salud y los determinantes sociales que influyen en ella, se muestran los avances en el cumplimiento del Programa del Moncada y su continuidad en los lineamientos aprobados por el VII Congreso del Partido Comunista de Cuba. Se aborda el incremento de los recursos humanos y del presupuesto anual destinado a la salud, se mencionan los resultados donde se evidencia la participación de las ideas y decisiones de Fidel en el prestigio internacional de la salud pública cubana. Este trabajo reconoce y destaca el papel de Fidel sobre los determinantes sociales de la salud en Cuba, en base al cumplimiento del Programa del Moncada, el desarrollo del sistema nacional de salud y su proyección hacia otros países.

In the self-defense text, "History will absolve me", Dr. Fidel Castro characterized the disastrous health situation of the people in Cuba and he linked it directly with the unfavorable socio-economic situation and exploitation for most of the Cuban population. Statistical data of those times is synthesized and compared with recent morbidity and mortality, life expectancy, population aging and other indicators. These indicators have been modified by the Revolution prioritized attention to the improvement of health and the social determinants. The progress in the fulfillment of Moncada Program and the continuity in the guidelines approved by the VII Congress of the Cuban Communist Party are shown. This paper addresses the increase in human resources and the annual budget allocated to health. The results are mentioned where the participation of Fidel's ideas and decisions is evident in the international prestige of Cuban public health. This work recognizes and highlights Fidel's role on the social determinants of health in Cuba, based on compliance with the Moncada Program, the development of the National Health System and its projection to other countries.

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Globally, the proportion of elderly individuals in the population has increased substantially in the last few decades. However, the risk factors that should be managed in advance to ensure a natural process of mental decline due to aging remain unknown. In this study, a dataset consisting of a Brazilian elderly sample was modelled using a Bayesian Network (BN) approach to uncover connections between cognitive performance measures and potential influence factors. Regarding its structure (a Directed Acyclic Graph), it was investigated the probabilistic dependence mechanism between two variables of medical interest: the suspected risk factor known as Metabolic Syndrome (MetS) and the indicator of mental decline referred to as Cognitive Impairment (CI). In this investigation, the concept known in the context of a BN as D-separation has been employed. Results of the conducted study revealed that the dependence between MetS and Cognitive Variables (CI and its direct determinants) in fact exists and depends on both Body Mass Index (BMI) and age.

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We offer a new approach for modeling past trends in the quantiles of the life table survivorship function. Trends in the quantiles are estimated, and the extent to which the observed patterns fit the unit root hypothesis or, alternatively, an innovative outlier model, are conducted. Then a factor model is applied to the detrended data, and it is used to construct quantile cycles. We enrich the ongoing discussion about human longevity extension by calculating specific improvements in the distribution of the survivorship function, across its full range, and not only at the central-age ranges. To illustrate our proposal, we use data for the UK from 1922 to 2013. We find that there is no sign in the data of any reduction in the pace of longevity extension during the last decades.

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O modelo de precificação de planos de saúde no Brasil prevê a imposição de limites de variação das mensalidades por faixa etária, possibilitando a transferência de recursos dos mais jovens, que têm menor risco de utilização, para aqueles em idades mais avançadas. O aumento da proporção de idosos nas carteiras dos planos de saúde poderá inviabilizar as transferências intergeracionais e a atual estrutura de precificação. O objetivo deste artigo é estimar a magnitude das transferências intergeracionais (entre diferentes grupos de idade) e intrageracionais (em um mesmo grupo de idade) na saúde suplementar brasileira, por meio da análise de dados de uma amostra representativa de operadoras de planos de saúde. Segundo os resultados encontrados, os saldos das transferências intergeracionais foram positivos e ocorrem dos mais jovens para beneficiários de 66 anos ou mais. Os resultados mostram ainda a ocorrência de transferências intrageracionais em duas das faixas etárias definidas pela legislação vigente: 0 a 18 anos e 59 anos ou mais. Finalmente, o exercício de retroprojeção demonstrou que nos últimos 15 anos a sinistralidade nos planos individuais apresentou constante aumento, indicando risco crescente de insuficiência das mensalidades para fins de custeio das despesas no médio prazo, em razão do envelhecimento populacional.

The health insurance pricing model in Brazil prohibits large variations of monthly fees by imposing strict premium rules by age. Therefore, intergenerational transfers may occur from younger age groups, who are lower-risk, to older ones. Population aging will result in a larger share of policyholders at older ages, increasing intergenerational transfers and making the current pricing structure unsustainable in the future. The aim of this article is to estimate the magnitude of intergenerational and intragenerational transfers (within the same age group) in the Brazilian private health care plans, by examining data from a representative sample of health insurance providers. We found intergenerational transfers to occur, on average, from policy holders younger than 66 years of age to older ones. Results also show significant intragenerational transfers within two of the age groups defined by existing legislation: 0 to 18 and 59 years and older. Finally, simulations using changes in the age structure over the last 15 years confirm population aging may result in larger intergenerational transfers with increasing loss-ratio over time.

El modelo de fijación de precios de seguros de salud en Brasil prohíbe grandes variaciones de las tarifas mensuales mediante la imposición de reglas estrictas por franja etaria, lo que posibilita transferencias intergeneracionales desde los grupos de edades más jóvenes, que son de menor riesgo, hacia los de edades más avanzadas. El envejecimiento de la población asegurada a la salud implicará un aumento de las transferencias intergeneracionales y hará que la estructura actual de precios sea insostenible en el futuro. El objetivo de este artículo es estimar la magnitud de las transferencias intergeneracionales (entre diferentes grupos de edad) e intrageneracionales (dentro del mismo grupo etario) en los planes de salud privados brasileños, mediante el análisis de los datos de una muestra representativa de los proveedores de seguros de salud. Según los resultados obtenidos, los saldos de las transferencias intergeneracionales fueron positivos y ocurren desde los más jóvenes hacia los asegurados de 66 años o más. Los resultados muestran también la ocurrencia de transferencias intrageneracionales en dos franjas etarias definidas por la legislación vigente: de cero a 18 años y de 59 años o más. Finalmente, el ejercicio de retroproyección demostró que en los últimos 15 años la siniestralidad en los planos individuales presentó un aumento constante, que indica un riesgo creciente de insuficiencia de las mensualidades para costear las transferencia en el mediano plazo, a causa del envejecimiento poblacional.

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Objetivo: analisar os fatores associados à visita domiciliar na população idosa e suas características segundo os preceitos da Estratégia Saúde da Família. Método: estudo transversal de base populacional com amostra representativa de 340 indivíduos com 60 anos ou mais residentes na zona urbana de São Paulo, SP. Resultados: a única variável que apresentou efeito estatisticamente significativo na visita domiciliar foi “passar em consulta médica na UBS” (p-valor = 0,0022). O odds ratio estimado para essa variável foi de 2,369, com intervalo de 95% de confiança. Conclusão: os resultados do presente estudo mostraram que os idosos avaliados eram mulheres na faixa etária de 60 a 69 anos, com baixa escolaridade, renda familiar insuficiente, vivendo sem cônjuge,dependentes do Sistema único de Saúde, havendo presença de doenças crônicas com destaque para hipertensão arterial e incapacidade para desempenho de atividades instrumentais da vida diária.

Objective: to analyze the factors associated with home visits in the elderly population and their characteristics, in accordance with the principles of the Family Health Strategy. Method: A cross-sectional population-based study with a representative sample of 340individuals aged 60 years or older residing in the urban area of São Paulo, SP. Results: The only variable that presented astatistically significant effect on the home visit was a medical visit at the UBS (p-value = 0.0022). The estimated odds ratio for thisvariable was 2,369, with a 95% confidence interval. Conclusion: the results of the present study showed that the evaluated elderly were the women in the age group of 60 to 69 years, low schooling, insufficient family income, living without spouse, dependents ofthe Single Health System, with the presence of chronic diseases with a prominence for hypertension arterial, inability to perform instrumental activities of daily living.

Objetivo: analizar los factores asociados a la visita domiciliaria en la población anciana y sus características, según los preceptos dela Estrategia Salud de la Familia. Método: Estudio transversal de base poblacional con muestra representativa de 340 individuos con 60 años o más residentes en la zona urbana de São Paulo, SP. Resultados: La única variable que presentó efecto estadísticamente significativo en la visita domiciliaria fue pasar en consulta médica en la UBS (p-valor = 0,0022). El odds ratioestimado para esta variable fue de 2,369, con un intervalo de confianza del 95%. Conclusión: los resultados del presente estudiomostraron que los ancianos evaluados eran las mujeres en el grupo de edad entre 60 y 69 años, baja escolaridad, ingreso familiar insuficiente, viviendo sin cónyuge, dependientes del Sistema Único de Salud, presencia de enfermedades crónicas con destaque para hipertensión, incapacidad para el desempeño de actividades instrumentales de la vida diaria.

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It is estimated that in 2025, Brazil will have the sixth largest elderly population in the world. Beyond the economic consequences of this projection, this changing demographic portends significant changes in the social realm. The aim of this study was to review and consider a range of government documents, developed during the past thirty years and directed toward elderly Brazilian citizens, to explore the ways that caregivers of older persons are positioned in daily care practices through the discourses such documents deploy. The analysis draws on Foucault's genealogical approach, and begins with a review of the historicity of policies, regulations, and legislation related to older people, followed by an analysis of the discourses embedded in the Practical Guide for the Caregiver, a document created by the Brazilian Ministry of Health to provide guidance to informal caregivers in the actual provision of care to elders. The analysis shows that throughout the Guide, caregivers are portrayed as multifaceted subjects; yet at the same time, three primary positionings for the caregiver and her or his work are emphasized: the almost-angel, the almost-healthcare professional, and the almost-household professional.

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Resumen El envejecimiento poblacional, es una realidad que enfrentan la mayoría de países desarrollados y un reto que empiezan a plantearse los países en desarrollo. Tener una vida más larga, es un logro de la humanidad, pero es también una constante preocupación por las repercusiones demográficas, económicas, laborales, sanitarias y éticas que se plantean. Con los cambios asociados a la edad, la prevalencia de enfermedades crónicas, la polimedicación y la pérdida de autonomía, el objetivo es ahora procurar una vida en condiciones de calidad y bienestar. Dentro de las enfermedades comunes y asociadas a dependencia, en las poblaciones mayores están las demencias. Con las consecuencias que tiene, por el impacto físico, psicológico, social y económico, sobre la calidad de vida de los pacientes, familias y sus cuidadores. El odontólogo tiene un papel fundamental, dentro del equipo multidisciplinario que debe estar a cargo del cuidado y soporte de calidad de vida de éstos pacientes. Fue esa la motivación para realizar éste artículo, que tuvo como objetivo revisar las consideraciones de manejo y terapéutica odontológica, indicadas para cada etapa en la que evoluciona la demencia. Concluyendo que, involucrar al paciente en medidas preventivas tempranas es fundamental para facilitar el manejo y disminuir las complicaciones a medida que progresa la demencia; el adecuado manejo de la salud del paciente con demencia debe involucrar al círculo de cuidadores del paciente y la valoración de las intervenciones terapéuticas odontológicas deberán ser desde una mirada real, más que ideal, ajustada a cada caso individual.

Abstract Population aging is a reality faced by most developed countries and a challenge that developing countries are beginning to face. To have a longer life is an achievement of humanity, but it is also a constant concern for the demographic, economic, labor, health and ethical repercussions that arise. With the changes associated with age, prevalence of chronic diseases, polymedication and loss of autonomy, the aim is now to seek a life in conditions of quality and well-being. Within the common diseases and associated to dependence, in the populations majors are dementias. With the consequences it has, the physical, psychological, social and economic impact on the quality of life of patients, families and their caregivers. The dentist has a fundamental role, within the multidisciplinary team that must be in charge of the care and support of quality of life of these patients. This was the motivation to perform this article, which aimed to review the management and dental treatment considerations, indicated for each stage in which dementia evolves. Concluding that involving the patient in early preventive measures is essential to facilitate management and decrease complications as dementia progresses; The proper management of the health of the patient with dementia should involve the circle of caregivers of the patient and the assessment of therapeutic dental interventions should be from a real, rather than an ideal look adjusted to each individual case.