Postoperative pain management in the elderly. Literature review

Timely post-operative pain management in elderly patients is critically important. Given their physiological changes and comorbidities, management in this group of patients is different from the rest of the population. Knowledge of potentially inappropriate medications (Beers criteria) is relevant because of the presence of comorbidities in this population. Although acetaminophen continues to be safe, non-steroidal anti-inflammatory agents produce several adverse effects which need to be considered before they are used. On the other hand, opioids continue to be one of the pillars in analgesia, with due consideration of their adverse affects and interactions, and the need for dose adjustments. Adequate postoperative pain management prevents adverse effects and the risk of developing chronic pain.

El manejo oportuno del dolor en la población anciana durante el periodo posoperatorio es de vital importancia. Este grupo de pacientes, dado sus cambios fisiológicos y comorbilidades, requieren un manejo diferente al resto de la población. Es relevante conocer cuáles medicamentos son potencialmente inapropiados para su uso (criterios de Beers) ante las comorbilidades de esta población. Si bien el acetaminofén continúa siendo seguro, los antiinflamatorios no esteroideos causan varios efectos adversos que ameritan consideración antes de su uso; por su parte, los opioides siguen siendo uno de los pilares analgésicos, teniendo en cuenta sus efectos adversos y valorando la necesidad de ajuste de dosis e interacciones. El adecuado manejo del dolor posoperatorio previene desenlaces adversos y el riesgo de cronificación.

Persistent and fatal severe acute respiratory syndrome coronavirus 2 infection in a patient with severe hypogammaglobulinemia: a case report.

BACKGROUND: Viruses are constantly changing as a result of mutations, and new viral variants are expected to appear over time. The virus that causes coronavirus disease 2019, severe acute respiratory syndrome coronavirus 2, is not excluded from this condition. Patients with some types of immunodeficiency have been reported to experience symptoms that vary from mild to severe, or even death, after being infected with severe acute respiratory syndrome coronavirus 2. We report a case of a woman with severe hypogammaglobulinemia who developed a prolonged and fatal severe acute respiratory syndrome coronavirus 2 infection. CASE PRESENTATION: A 60-year-old mestizo female with a previous history of severe hypogammaglobulinemia manifested by recurrent pulmonary infections and follicular bronchiolitis. She received a monthly treatment of intravenous immunoglobulins and was admitted after report of a neurological manifestation related to a left thalamic inflammatory lesion, for a duration of 2 weeks of hospitalization, indicated for the study of her neurological condition, including brain biopsy. Both on admission and 1 week later, nasopharyngeal polymerase chain reaction tests for severe acute respiratory syndrome coronavirus 2 were performed and reported negative. In the third week of hospitalization, she developed pulmonary symptoms, and a positive test result for severe acute respiratory syndrome coronavirus 2 was evidenced. On Day 3, the patients' condition worsened as the infection progressed to respiratory failure and required mechanical ventilation. On Day 8 after the coronavirus disease 2019 diagnosis, the polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 showed persistent detection of the virus. Various bacterial coinfections, including Klebsiella pneumoniae and Enterobacter cloacae, were diagnosed and treated. On Day 35, her pulmonary symptoms worsened, and the results of the severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test remained positive. On Day 36, despite all the respiratory support, the patient died. The severe acute respiratory syndrome coronavirus 2 virus was sequenced at the beginning and 8 days after the onset of the disease, and the strain, without obvious mutations in the gene that encodes spike protein, was identified. CONCLUSIONS: This clinical case showed persistent severe acute respiratory syndrome coronavirus 2 detection after 35 days of infection in a patient with severe hypogammaglobulinemia. The sequencing of the virus showed no mutations on the spike protein at 8 days, indicating that, in this case, the persistence of the viral detection was associated with immunodeficiency instead of changes in the viral components.

Occipital encephalocele associated with Dandy-Walker malformation: a case-based review.

INTRODUCTION: Occipital encephalocele is a brain malformation that has been remotely associated with Dandy-Walker; only case reports and very small series have been published so far; therefore, their behavior and management are still under investigation. The goal of the present case-based review is to provide a summary of the state of the art in this association. METHODS AND RESULTS: The pertinent literature has been reviewed, and an exemplary case has been reported (an 11-month-old female with Dandy-Walker malformation and occipital encephalocele). So far, 33 cases have been described, with a mean age at surgery of 5, 1 day). The majority of the cases tend to present with hydrocephalus. There are no specific surgery approaches or global consensus about this association. The management possibly relies on surgery with shunt or encephalocele excision but without a dedicated protocol yet. CONCLUSIONS: The clinical research on occipital encephalocele in association with Dandy-Walker malformation is just at the beginning. New targets and wide-ranging clinical trials are needed to get an optimal management protocol.

Internal manual compression of the aorta-an effective way to temporarily control pelvic bleeding in obstetrical hemorrhage.

Obstetrical hemorrhage is the leading cause of maternal death, and its treatment frequently involves surgical procedures. In the most serious cases, regardless of the etiology, the priority is to stop the bleeding and obtain the conditions to definitively repair the injury that generates the bleeding. Multiple options for achieving hemostasis have been described, but most of them require extensive training or technological resources that are not available in all hospitals. Internal manual aortic compression is a procedure that is widely used in the management of massive pelvic bleeding; it was first described more than 50 years ago in obstetrics but is rarely used by obstetricians today. We describe in detail the technique for internal manual aortic compression and highlight the simplicity and effectiveness of the procedure, especially as an initial measure, to avoid the metabolic consequences of massive blood loss. We hope that internal manual aortic compression is taken into account by each obstetrician when caring for a pregnant woman with massive bleeding.

Arterial thrombosis after REBOA use in placenta accreta spectrum: a case series.

BACKGROUND: The use of resuscitative endovascular balloon of the aorta (REBOA) is a useful strategy for bleeding control in placenta accreta spectrum (PAS) management. The incidence of complications associated with this procedure is variable. We report three cases of arterial thrombosis associated with REBOA, and we also analyze the factors that facilitated its occurrence. CASE REPORT: Three women with PAS, presented common femoral and external iliac arterial thrombosis after REBOA use. Among the contributing factors probably associated with thrombosis, we identified the absence of ultrasound guidance for vascular access and the not using of heparin during aortic occlusion. CONCLUSIONS: REBOA use is not exempt from complications and must be performed by experienced groups applying strategies to reduce the risks of complications.

Friendly Residential Environments That Generate Autonomy in Older Persons.

OBJECTIVE: This study aimed to explore the housing and residential environment conditions associated with functional autonomy in older persons. METHODS: A quantitative cross-sectional study was conducted, including 175 individuals over the age of 60. Participants were non-institutionalized urban residents of Medellín, Colombia, selected by random two-stage sampling (neighborhoods and blocks). Analysis was done according to functional autonomy of action (dependent variable); and demographic conditions, housing, and the physical and social environment suggested by the World Health Organization (WHO) in the strategy of age-friendly cities (independent variables). Univariate, bivariate, and multivariate analyses were performed with these variables, where the odds ratio (OR), association hypothesis test, and confidence intervals were estimated, using logistic regression models. RESULTS: 89.7% of older persons had moderate physical performance. The performance of intergenerational activities (OR = 5.28) and community actions (OR = 11.28) were part of social environments. The adaptations in public transport (OR = 90.33), sanitary services (OR = 4.1), and lighting in parks (OR = 19.9) of the physical environment were the associations found with functional autonomy. CONCLUSIONS: Exploring how the physical and social environments surrounding housing are associated with the functional performance of older persons can generate useful information to support public health and city infrastructure strategies that improve their physical performance and maintain autonomy.

Análisis Rasch de la escala APGAR-familiar en adultos mayores de Colombia / Rasch analysis of the APGAR-family scale in older adults in Colombia / Analise Rasch da escada APGAR-familiar em adultos maiores da Colômbia

Resumen El objetivo de este estudio fue analizar mediante el modelo Rasch las evidencias de validez de la medida de funcionalidad familiar obtenida a partir del APGAR-familiar en adultos mayores de Colombia. Se encuestaron 1.514 participantes residentes en Medellín, Barranquilla y Pasto. Se realizaron análisis Rasch de ajuste de categorías de respuesta, ajuste de los ítems y de las personas, funcionamiento diferencial de los ítems, dimensionalidad e independencia local de los ítems y confiabilidad. Los principales resultados indicaron que el formato de respuesta se ajusta a los requerimientos de optimización de función de Linacre, todos los ítems muestran medias cuadráticas Infit y Outfit en el rango esperado, la escala es unidimensional y la confiabilidad de Wright se estimó en 0,962. Se concluye que, en adultos mayores colombianos, el APGAR-familiar proporciona una medida de funcionalidad familiar unidimensional, a nivel de intervalo, confiable e insesgada por edad y sexo, que permite clasificar cinco niveles de funcionalidad familiar con fines de tamizaje.

Abstract The objective of this study was to analyze, using the Rasch model, the evidence of validity of the measure of family functionality obtained from the APGAR-family assessment in older adults in Colombia. A total of 1,514 participants residing in Medellín, Barranquilla and Pasto were surveyed. Rasch analysis of adjustment of response categories, adjustment of items and people, differential functioning of the items, dimensionality and local independence of the items and reliability were carried out. The main results indicated that the response format conforms to the Linacre function optimization requirements. All the items show Infit and Outfit means square in the expected range. The scale is one-dimensional and Wright's reliability was estimated at 0.962. It is concluded that the APGAR-family assessment in Colombian older adults provides a one-dimensional measure of family functionality at the interval level, reliable and unbiased by age and gender, which allows classifying five levels of family functionality for screening purposes.

Resumo O objetivo deste estudo foi analisar através do modelo Rasch as evidencias de validez da medida de funcionalidade familiar obtida a partir do APGAR-familiar em adultos maiores da Colômbia. Entrevistaram-se 1.514 participantes residentes em Medellín, Barranquilla e Pasto. Fizeram-se análises Rasch de ajuste de categorias de resposta, ajuste dos itens e das pessoas, funcionamento diferencial dos itens, dimensionalidade e independência local dos itens e confiabilidade. Os principais resultados indicaram que o formato de resposta se ajusta aos requerimentos de optimização de função de Linacre, todos os itens amostram medias quadráticas Infit e Outfit no rango esperado, a escada é unidimensional e a confiabilidade de Wright se estimou em 0,962. Conclui que, em adultos maiores colombianos, o APGAR-familiar proporciona uma medida de funcionalidade familiar unidimensional, a nível de intervalo, confiável e imparcial por idade e sexo, que permite classificar cinco níveis de funcionalidade familiar com fins de triagem.

Descripción clínica y epidemiológica de pacientes con pancreatitis crónica en un hospital de alta complejidad en Cali, 2011 a 2017 / Clinical and epidemiological description of patients with chronic pancreatitis treated at a quaternary care hospital in Cali, 2011-2017

Resumen Introducción: la pancreatitis crónica (PC) es una inflamación progresiva del páncreas que puede llevar a su destrucción e insuficiencia irreversibles. Es una patología desafiante para el médico, debido a que establecer su diagnóstico puede tomar meses e incluso años, el seguimiento de pacientes suele ser problemático y el conocimiento sobre la clínica y epidemiología en Colombia es incompleto. Este estudio pretende hacer una descripción de pacientes con PC en un centro de referencia en gastroenterología de Cali, Colombia. Metodología: estudio de corte transversal de pacientes adultos con PC confirmada por criterios clínicos y radiológicos entre 2011 y 2017. Resultados: se incluyeron 36 pacientes con PC. La mayoría fueron hombres (72,2%) y la media de edad fue 56 (+ 15,1) años. El dolor abdominal crónico fue la presentación clínica más común (83,3%). Cerca de un cuarto de pacientes presentaba diabetes mellitus (22,2%). Se consideró etiología idiopática en 58,3%, alcohólica en el 11,0% y biliar en el 11,0%. La tomografía axial computarizada (TAC), resonancia magnética (RMN) y colangiopancreatografía por RMN fueron los métodos diagnósticos más usados (60,5%), con los que en su mayoría se visualizó atrofia (53,1%), dilatación de conductos (49,0%) y calcificaciones del páncreas (34,7%). Conclusión: los síntomas inespecíficos de la PC en fases iniciales y su largo curso clínico favorecen al subdiagnóstico de esta patología. Los resultados presentados pueden contribuir a la futura creación de escalas clínicas locales que orienten estudios radiológicos y genéticos tempranos, con el fin de lograr un diagnóstico oportuno y mejorar la calidad de vida de estos pacientes.

Abstract Introduction: Chronic pancreatitis (CP) is a progressive inflammation of the pancreas that can lead to irreversible damage and failure. This condition poses great challenges to physicians since its diagnosis can take months or even years. Patient follow-up is often problematic and knowledge about its clinical presentation and epidemiology in Colombia is scarce. This study aims to describe patients with CP treated at a gastroenterology reference center in Cali, Colombia. Methodology: Cross-sectional study in adult patients with CP confirmed based on clinical and radiological criteria between 2011 and 2017. Results: 36 patients with CP were included. The majority were men (72.2%), and the mean age was 56 (+15.1) years. Chronic abdominal pain was the most common clinical presentation (83.3%). About a quarter of patients had diabetes mellitus (22.2%). Etiology was idiopathic in 58.3%, alcoholic in 11.0%, and biliary in 11.0%. Computed tomography (CT), magnetic resonance imaging (MRI), and MRI cholangiopancreatography were the most commonly used diagnostic methods (60.5%), showing mostly atrophy (53.1%), duct dilation (49.0%), and pancreatic calcifications (34.7%). Conclusion: Nonspecific symptoms of CP in early stages and its long clinical course favor the underdiagnosis of this condition. The results presented may contribute to the future creation of local clinical scales that guide early radiological and genetic studies to achieve a timely diagnosis and improve the quality of life of these patients.

Natural Orifice Transluminal Endoscopic Surgery for Correction of Vesicovaginal Fistulas after Hysterectomy Due to Morbidly Adherent Placenta.

BACKGROUND: Vesicovaginal fistula (VVF) is a difficult-to-treat complication of obstetric hysterectomy. There are multiple management options, with a preference for surgical repair via abdominal or vaginal approach. We describe a transurethral natural orifice transluminal endoscopic surgery (NOTES) using barbed suture, in 3 cases of VVF after hysterectomy due to morbidly adherent placenta (MAP). CASES: Three patients with VVFs after hysterectomy due to MAP underwent a transurethral endoscopic suture repair. Two patients had complete resolution of the fistula, and the third required additional repair by laparotomy; however, a decrease was observed in the size of the VVF after the initial endoscopic repair. CONCLUSION: The transurethral NOTES approach for VVF after MAP hysterectomy is a minimally invasive procedure that is valid as an initial approach for this type of complication.

Síntomas depresivos y funcionamiento cognitivo de las personas en proceso de reintegración mayores (PPRM) de Colombia / Depressive Symptoms and Cognitive Functioning of Senior Citizens in the Reintegration Process (PPRM) in Colombia

Resumen Algunas personas en procesos de reintegración mayores (PPRM) que participaron en la guerra presentan alteraciones mentales explicadas por el largo tiempo desescola rizados y las situaciones vividas, que le disminuyen la posibilidad de acceso al campo laboral y a la sociedad, el funcionamiento cognitivo alterado fue más prevalente en personas sin educación formal, sin pareja o vivir en familias no funcionales. Entre los factores demográficos de las PPRM que aumentan la probabilidad de tener un sínto ma depresivo fue pertenecer al sexo masculino, tener más de 65 años, no contar con apoyo de una pareja y disminuye esta probabilidad si se cuenta con algún grado de escolaridad. De los factores familiares y sociales que se analizaron, solo se encontró que vivir con una familia no funcional aumenta el riesgo de sufrir síntomas depre sivos. Por lo que se requiere acompañamiento para la aceptación de su proceso de envejecimiento, el aprovechamiento de experiencias y el ejercicio de la ciudadanía.

Abstract Some Senior Citizens in Reintegration Processes (PPRM), who participated in war have mental disturbances explained by the long de-schooling and living situations, which decrease the possibility of accessing the workforce and society. Altered cognitive func tioning was more prevalent in people without formal education, without a partner, or living in non-functional families. Among the PPRM demographic factors of PPRM, which increase the likelihood of having a depressive symptom was belonging to the male sex, being over 65 years old, not having support from a partner. This likelihood decreases if there is any degree of schooling. Among the family and social factors discussed, only living with a non-functional family was found to increase the risk of depressive symptoms. Thus, accompaniment is required for the acceptance of their aging process, the use of experiences, and the exercise of citizenship.

Intermittent Fasting as a Trigger of Ketoacidosis in a Patient With Stable, Long-term Type 1 Diabetes.

Diabetic ketoacidosis (DKA) is an acute complication of type 1 diabetes (T1DM) with a high morbidity and mortality. Diabetic ketoacidosis is usually triggered by metabolic stressors that increase insulin requirements like infection, trauma, surgery, or some medications. Ketogenic diets are nutritional regimes that drastically reduce the intake of carbohydrates in order to increase circulating ketones and reduce appetite. Intermittent fasting diets similarly aim to impact appetite and body weight, but through the restriction of feeding to specific periods of time or days. A 58-year-old woman with T1DM and no prior episodes of DKA since her diagnosis 16 years ago was admitted to the emergency room with severe metabolic acidosis, ketosis, dehydration, and back pain after 9 days of practicing a ketogenic, intermittent fasting diet on the advice of a friend. The standard management of DKA led to the resolution of the symptoms and metabolic alterations, but this might not be the case in other patients. This case highlights the relevance of close professional monitoring of dietary and insulin schemes in patients with T1DM, and of the adequate nutritional education of patients in order to avoid having them follow fashionable dietary trends without knowledge of their implications.

Factors Associated With Suicidal Ideation in Older Adults From Three Cities in Colombia, 2016. / Factores asociados con la ideación suicida del adulto mayor en tres ciudades de Colombia, 2016.

INTRODUCTION: Suicidal ideation refers to thoughts that range from a vague idea of committing suicide to a specific suicide plan. OBJECTIVE: To explore factors such as demographic, social, family, abuse, risk of depression, habits and health conditions, which influence suicidal ideation in the elderly people in the cities of Medellín, Barranquilla, and Pasto (Colombia), with the intention to identify those associated factors that can be used in public health programs focused on this population. METHODS: Cross-sectional analytical study was conducted using a secondary source, demographic, social, clinical variables, social support, discrimination, abuse, happiness, depression, functional capacity, and as a dependent variable were asked the question: "Have you ever thought about committing suicide?" A descriptive, bivariate and multivariate analysis was performed. RESULTS: The median age was ≤ 69 [interquartile range, 11] years, and 58.2% were women. The prevalence of suicidal ideation was 6.4%, and of these, 28.7% had made plans to end their lives, and 66.7% had tried at least once. A statistical association was found with informal employment, cigarette consumption, alcohol and psychoactive substances, risk of depression, having a disability, dissatisfaction with their quality of life, with their health, with their economic situation, as well as feeling unhappy, bad treatment and bad relationships among family members, poor social support, sexual and economic abuse, and finally, discrimination. CONCLUSIONS: Suicidal ideation in older adults in three cities of Colombia is explained by the sexual and economic abuse that this population is suffering, as well as bad personal relationships between the members of the family of the older adult. The risk of depression increases the probability of having thoughts against one's life.

Factores asociados con la ideación suicida del adulto mayor en tres ciudades de Colombia, 2016 / Factors Associated With Suicidal Ideation in Older Adults From Three Cities in Colombia, 2016

RESUMEN Introducción: La ideación suicida se refiere a pensamientos que abarcan desde una vaga idea de suicidarse a un plan específico de suicidio. Objetivo: Explorar factores demográficos, sociales y familiares, maltrato, riesgo de depresión y hábitos y condiciones de salud que influyen en la ideación suicida del adulto mayor en las ciudades de Medellín, Barranquilla y Pasto, para identificar aquellos en los que se puede intervenir con programas de salud pública enfocados en esta población. Métodos: Estudio analítico transversal con fuente secundaria; se consideraron variables demográficas, sociales y clínicas, apoyo social, discriminación, maltrato, felicidad, depresión y capacidad funcional, y como variable dependiente, la pregunta: «¿ha pensado en atentar contra su vida?¼. Se realizaron análisis descriptivo, bivariable y multivariable. Resultados: La mediana de edad fue ≤ 69 (intervalo intercuartílico, 11) años; el 58,2% eran mujeres; la prevalencia de ideación suicida fue del 6,4%; el 28,7% de estos había hecho planes para terminar con su vida y el 66,7% lo había intentado al menos una vez. Se encontró asociación estadística con el empleo informal, el consumo de cigarrillos, alcohol y sustancias psicoactivas, el riesgo de depresión, tener discapacidad, la insatisfacción con la calidad de vida, la salud y la situación económica, sentirse infeliz, los maltratos y las malas relaciones entre los miembros de la familia, el escaso apoyo social, el maltrato sexual y económico y, por último, la discriminación. Conclusiones: La ideación suicida de los adultos mayores en 3 ciudades de Colombia se explica por el maltrato sexual y económico que sufre esta población; asimismo las malas relaciones personales entre los miembros de la familia del adulto mayor y el riesgo de depresión aumentan la probabilidad de que se presenten pensamientos contra la propia vida.

ABSTRACT Introduction: Suicidal ideation refers to thoughts that range from a vague idea of committing suicide to a specific suicide plan. Objective: To explore factors such as demographic, social, family, abuse, risk of depression, habits and health conditions, which influence suicidal ideation in the elderly people in the cities of Medellín, Barranquilla, and Pasto (Colombia), with the intention to identify those associated factors that can be used in public health programs focused on this population. Methods: Cross-sectional analytical study was conducted using a secondary source, demographic, social, clinical variables, social support, discrimination, abuse, happiness, depression, functional capacity, and as a dependent variable were asked the question: "Have you ever thought about committing suicide?" A descriptive, bivariate and multivariate analysis was performed. Results: The median age was ≤ 69 [interquartile range, 11] years, and 58.2% were women. The prevalence of suicidal ideation was 6.4%, and of these, 28.7% had made plans to end their lives, and 66.7% had tried at least once. A statistical association was found with informal employment, cigarette consumption, alcohol and psychoactive substances, risk of depression, having a disability, dissatisfaction with their quality of life, with their health, with their economic situation, as well as feeling unhappy, bad treatment and bad relationships among family members, poor social support, sexual and economic abuse, and finally, discrimination. Conclusions: Suicidal ideation in older adults in three cities of Colombia is explained by the sexual and economic abuse that this population is suffering, as well as bad personal relationships between the members of the family of the older adult. The risk of depression increases the probability of having thoughts against one's life.

Factores que explican el apoyo social del adulto mayor en tres ciudades de Colombia. 2016 / Factors that explain the social support of the elderly in three cities of Colombia. 2016

Resumen Objetivo: Identificar los factores asociados a las dimensiones del apoyo social del adulto mayor en tres ciudades de Colombia: Medellín, Barranquilla y Pasto. Método: Estudio cuantitativo, transversal analítico, de fuente de información primaria, obtenida a partir de encuestas realizadas a adultos mayores sobre aspectos demográficos, familiares y sociales, y escalas de medición validadas que permitieron evaluar aspectos como funcionamiento familiar, felicidad, maltrato, depresión, riesgo nutricional y discriminación. El apoyo social percibido se evaluó mediante el Cuestionario de Estudio de Desenlaces Médicos de Apoyo Social (Medical Outcomes Study- Social Support Survey (MOS)). La muestra fue de 1452 personas seleccionadas por muestreo probabilístico por conglomerado, bietápico, en las ciudades de Medellín, Barranquilla y Pasto (Colombia). Se realizó análisis univariado, bivariado y multivariado, se calcularon medidas estadísticas y epidemiológicas. Se consideraron asociaciones estadísticas aquellas con un valor p inferior a 5%. Resultados: Los adultos mayores participantes percibieron un apoyo social adecuado en sus diferentes dimensiones: 92% emocional, 93,5% instrumental, 92% interacción social positiva y 93% apoyo afectivo, y 91,9% en el índice global de apoyo. Percibir buen apoyo social fue una condición predominante en los adultos mayores: con pareja, sin riesgo de depresión, afiliados al Sistema General de Seguridad Social en Salud, que se sienten felices, que conviven con al menos dos familiares, que perciben un adecuado funcionamiento familiar, no reciben malos tratos al interior de su familia, tienen al menos cuatro amigos cercanos, no se sienten discriminados, que están acompañados y tienen alguien que los cuidan permanentemente.

Abstract Objective: Identify the factors that explain the social support components of the elderly. Methods: Quantitative, cross-sectional, analytical study of a source of primary information, obtained from surveys of older adults. The sample was 1452 people selected by probabilistic sampling by cluster, two-stage. In Medellín, Barranquilla and Pasto. To measure the perceived social support, the Medical. Results Study Social Support Survey was applied. Univariate, bivariate and multivariate analyzes were performed, statistical and epidemiological measures were calculated. Statistical associations considered with a p value of less than 5% were considered. Results: In relation to the social support components of the elderly, with an adequate condition: emotional support (92%); instrumental support (93.2%); positive social interaction (92.2%); affective support (93.2%) and in the total evaluation (91.9%). The city of Pasto was the one that selected the lowest percentages, in the different components. Perceiving good social support was a predominant condition in older adults: with a partner, without depression, affiliated with the General System of Social Security in Health, happy (through the Lima happiness scale), who live with at least two relatives, with proper family functioning, they do not perceive ill-treatment within their family, they have at least four close friends, they do not feel discriminated against, they do not leave them constantly alone and they have someone to take care of them permanently. Conclusion: Being from the city of Medellín, having a partner, feeling happy, not being alone, as well as not having depression, important factors in each of the components of social support.

Capacidad laboral de las personas mayores de 50 años, en proceso de reintegración, adscritos a la Agencia para la Reincorporación y la Normalización / Work capacity in people being over 50 years old, in the process of reincorporation, registered in the Agency for Reincorporation and Normalization / Capacidade de trabalho de pessoas com mais de 50 anos, em processo de reintegração, vinculados à Agência para a Reintegração e a vida Normal

Resumen Objetivo: Identificar los factores asociados a la capacidad laboral de las personas mayores de 50 años, excombatientes de los grupos al margen de la ley, adscritos a la Agencia para la Reincorporación y la Normalización. Metodología: Estudio observacional, analítico de fuente de información primaria, con 239 personas mayores en proceso de reintegración, encuestados en cinco lugares de Colombia. Se calculó la razón de prevalencia cruda y ajustada, mediante una regresión logística no condicional, con valor de p< 0,05, considerada una asociación estadísticamente significativa. Resultados: El 71,5 % de las personas mayores de 50 años se encuentran laborando, principalmente, en el sector informal. La dependencia funcional se asocia, aunque no de forma significativa, con ser hombre, soltero, no tener limitaciones para ver o moverse, y mostrar habilidades en la conducción de vehículos y el manejo de computadores. Presentaron mayor limitación en el campo laboral los que tienen dificultades para hablar y un menor nivel educativo. Conclusión: La adaptación a la vida laboral de las personas mayores excombatientes de los grupos al margen de la ley puede facilitarse con la implementación de enfoques diferenciales, programas educativos formales e informales, el uso de ayudas ortopédicas, la generación de estrategias de acceso al empleo y estrategias saludables que promuevan su salud y atención a los efectos de la guerra.

Abstract Objective: To identify factors associated with work capacity in people being over 50 years old, who used to be ex-combatants from groups outside the law, and who are now registered in the Agency for Reincorporation and Normalization. Methodology: Observational analytic study using primary sources of information from 239 senior subjects in the reincorporation process. All of them were surveyed in five different locations in Colombia. Crude and adjusted prevalence ratios were calculated through unconditional logistic regression, with a p-value of < 0.05, which is considered a statistically significant association. Results: 71.5 % of subjects being over 50 years old work mainly in the informal sector. A functional dependency is associated, though not significantly, with being a single man, or a man without sight or movement disabilities, or a man having driving and computer skills. Those with speech disorders and a lower educational level presented greater limitations in the labor field. Conclusion: Adaptation processes to work life for senior ex-combatants from groups outside the law may be facilitated through the implementation of differential approaches, formal and informal educational programs, use of orthopedic aids, generation of strategies for access to employment and health strategies that promote their wellbeing and attention to the effects of war.

Resumo Objetivo: Identificar os fatores associados à capacidade laboral de pessoas acima de 50 anos, excombatentes de grupos fora da lei, vinculados à Agência de Reintegração e a vida Normal. Metodologia: Estudo observacional e analítico da fonte primária de informações, com 239 idosos em processo de reintegração, pesquisados em cinco locais da Colômbia. Calculou-se a razão de prevalência bruta e ajustada, através de uma regressão logística não condicional, com valor de p <0,05, considerada uma associação estatisticamente relevante. Resultados: O 71,5% das pessoas com mais de 50 anos estão trabalhando principalmente no setor informal. A dependência funcional está associada, embora não significativamente, a ser homem, solteiro, sem limitações para ver ou se mover e mostrar habilidades em dirigir veículos e trabalho com computadores. Apresentaram maiores limitações no trabalho aqueles que têm dificuldades para falar e com menor nível educacional. Conclusão: A adaptação à vida profissional dos idosos excombatentes dos grupos fora da lei pode ser facilitada com a implementação de abordagens diferenciais, programas educacionais formais e informais, uso de aparelhos ortopédicos, geração de estratégias de acesso ao emprego e estratégias saudáveis que promovam sua saúde e atenção aos efeitos da guerra.

La felicidad como predictor de funcionalidad familiar del adulto mayor en tres ciudades de colombia / Happiness as a predictor of family functionality of the elderly in three cities of colombia / Felicidade como indutor de funcionalidade familiar do idoso em três cidades de colômbia

Resumen Objetivo: Determinar la capacidad predictiva de la felicidad sobre el funcionamiento familiar del adulto mayor en tres ciudades de Colombia. Materiales y métodos: Estudio analítico, transversal, de fuente primaria, con 1514 encuestas aplicadas a personas de 60 años en adelante, en 2016, residentes en las ciudades de Medellín, Barranquilla y Pasto. Se indagó por la funcionalidad familiar a través del APGAR familiar; aunado a las características demográficas, sociales y del estado de salud físico, mental y funcional de la persona mayor. Se realizó análisis univariado, bivariado y multivariado con el fin de ajustar por las variables confusoras y se calculó un modelo predictivo con el método backward (Wald). Resultados: Las características asociadas al funcionamiento familiar fueron: ciudad de residencia; sexo femenino; tener pareja sentimental; alto nivel educativo; no padecer trastornos mentales; percepción de felicidad, sin riesgo de depresión; baja vulnerabilidad y contar con apoyo social. Las que aportan a su predicción fueron ser mujer, ser feliz, no tener depresión, no ser vulnerable, tener apoyo instrumental y social adecuado y no haber sido maltratado. La felicidad es el mayor predictor, según el modelo calculado, con sensibilidad del 92,6 % y especificidad del 40,8 %. Conclusión: Si se fortalece el bienestar subjetivo de la persona mayor se permitirá ver la vejez con una imagen positiva como facilitador de buenas relaciones familiares e integrante activo de la sociedad.

Abstract Objective: To determine the predictive capacity of happiness on the family functioning of the elderly in three cities of Colombia. Materials and methods: Analytical, cross sectional, primary source study with 1514 surveys applied to people aged 60 and older, residents in the cities of Medellín, Barranquilla and Pasto in 2016. Family functionality was explored with the family APGAR scale, along with demographic, social and the physical, mental, functional and health status of the elderly. Univariate, bivariate and multivariate analyzes were carried out to adjust the confounding variables and a predictive model was calculated with the backward method (Wald). Results: The characteristics associated to family functioning were: city of residence, female gender, having a sentimental partner, high educational level, not suffering from mental disorders, perception of happiness without risk of depression, low vulnerability, and having social support. The characteristics that contributed to this prediction were: being a woman, being happy, not having depression, not being vulnerable, having adequate instrumental and social support, and not having been mistreated. Happiness is the greatest predictor according to the calculated model with sensitivity of 92.6% and specificity of 40.8%. Conclusion: if the subjective well-being of the elder is strengthened, it will be possible to see old age with a positive image as a facilitator of good family relationships and an active member of society.

Resumo Objetivo: Determinar a capacidade preditiva da felicidade sobre o funcionamento familiar do adulto maior em três cidades de Colômbia. Materiais e métodos: Estudo analítico, transversal, de fonte primaria, com 1514 enquetes aplicadas a pessoas de 60 anos em adiante, em 2016, residentes nas cidades de Medellín, Barranquilla e Pasto. Pesquisou-se pela funcionalidade familiar a través do APGAR familiar; aunado às caraterísticas demográficas, sociais e do estado de saúde físico, mental e funcional dos idosos. Realizou-se analise uni variado, bivariado e multivariado com o fim de ajustar as variáveis confessoras e se calculou um modelo indutivo com o método backward (Wald). Resultados: As características associadas ao funcionamento familiar foram: cidade de residência; sexo feminino; ter casal sentimental; alto nível educativo; não padecer transtornos mentais; percepção da felicidade, sem risco de depressão; baixa vulnerabilidade e contar com apoio social. As que ajudam a sua predição foram ser mulher, ser feliz, não ter depressão, não ser vulnerável, ter apoio instrumental e social adequado e não ter sido maltratado. A felicidade é o maior indutor, segundo o modelo calculado, com sensibilidade do 92,6 % e especificidade do 40,8 %. Conclusão: Sim se fortalece o bem estar subjetivo do idoso se permitirá ver a velhice com uma imagem positiva como facilitador de boas relações familiares e integrante ativo da sociedade.

Características sociales y familiares asociadas al maltrato al adulto mayor de Pasto, Colombia 2016 / Social and family characteristics associated with elder abuse in Pasto, Colombia 2016

Resumen Objetivo: determinar la prevalencia de maltrato en el adulto mayor de la ciudad de Pasto (Colombia) y la asociación con factores sociodemográficos y familiares. Método: estudio transversal de fuente de información primaria obtenida a partir de encuestas. La muestra fue de 506 adultos mayores seleccionados por muestreo probabilístico, por conglomerado, bietápico. Para la detección del maltrato se utilizó la Escala Geriátrica de Maltrato. Se realizó análisis univariado para describir y análisis bivariado y multivariado por regresión logística binaria, para identificar factores asociados. Resultados: La prevalencia de maltrato al adulto mayor en la ciudad de Pasto para el año 2016 fue de 13,0%; la tipología más reportada fue el maltrato psicológico (5,4%). Los principales factores asociados fueron dependencia, disfuncionalidad severa del adulto mayor, malos tratos entre miembros de la familia y escaso apoyo social. Conclusión: La prevalencia de adultos mayores maltratados en Pasto es alta, considerando que corresponde a acciones que se presentan al interior de la familia; el deterioro en las relaciones sociales y familiares del adulto mayor son factores que incrementan el maltrato en la vejez, por lo cual deben fortalecerse vínculos y redes de apoyo en esta etapa.

Abstract Objective: To determine the prevalence of elder abuse in the city of Pasto, Colombia and its association with sociodemographic and family factors. Material and Methods: A cross-sectional study of primary information source obtained from surveys was conducted. The sample consisted of 506 elder adults selected by probabilistic sampling, by conglomerate, two-stage. The Geriatric Abuse Scale was used for the detection of abuse. Descriptive statistics were obtained by performing univariate analyses. Bivariate and multivariate analyses by binary logistic regression were conducted to identify associated factors. Results: The prevalence of abuse was 13% and the most reported typology was psychological (5.4%). The main factors associated with abuse were dependence, severe dysfunctionality, family member maltreatment and poor social support. Conclusion: Abuse of elderly adults is high due to specific behaviors that are present within families. The deterioration in social and family relationships of elder adults are factors that increase the abuse in old age. For this reason, support networks must be strengthened to support the elderly population.

Depression in the elderly: A study in three cities of Colombia / Depresión en el adulto mayor: Un estudio en tres ciudades de Colombia

Abstract Objective: To explore the demographic, health and functional factors associated with depression in the elderly in three cities from Colombia: Medellin, Barranquilla and Pasto. Materials and methods: An analytical cross-sectional study. The study population corresponded to a probabilistic sample of 1514 adult whose age is 60 years or over. A sample was selected by a probabilistic sampling, in two-stage, and conglomerate, according to the geographical and administrative distribution of each city. Results: The results support that the city of Pasto presents the highest number of elderly people with depression; conditions such as low educational level (PR = 4.11), hyperthyroidism / hypothyroidism (PR = 3.43), and dependence on activities of daily living such as using the telephone (PR = 3.80) increase the prevalence of the disease. Conclusion: Depression is present in an important part of the population of older adults and is associated with conditions not only of health but also demographic and functional capacity. It is necessary to address these components from the public health that promotes the prevention of this condition if you want to contribute to the goals of active, satisfactory and healthy aging in Colombia and a better quality of life for this population.

Resumen Objetivo: Explorar los factores demográficos, de salud y de funcionalidad asociados con la depresión en los adultos mayores en tres ciudades de Colombia: Medellín, Barranquilla y Pasto. Material y métodos: Estudio analítico transversal. La población del estudio correspondió a una muestra probabilística de 1514 adultos de 60 años y más. La muestra fue seleccionada mediante un muestreo probabilístico, por conglomerado, bietápico, según la distribución geográfica y administrativa de cada ciudad. Resultados: Los resultados muestran que la ciudad de Pasto presenta el mayor número de adultos mayores con depresión; condiciones como el bajo nivel educativo (RP=4,11), el hipertiroidismo/hipotiroidismo (RP=3,43), y la dependencia en actividades básicas de la vida diaria como usar el teléfono (RP=3,80) incrementan la prevalencia de la enfermedad. Conclusión: La depresión está presente en una parte importante de la población de adultos mayores y está asociada a condiciones no solo de salud sino también demográficas y de la capacidad funcional. Se hace necesario el abordaje de estos componentes desde la salud pública que promueva la prevención de esta condición si se quiere contribuir con las metas de envejecimiento activo, satisfactorio y saludable en Colombia y una mejor calidad de vida para esta población.