Frailty in people 50 years or older living with HIV: A sex perspective.

OBJECTIVE: To estimate prefrailty and frailty prevalence and associated factors in people living with HIV (PLHIV) from a sex perspective. METHODS: Cross-sectional study on PLHIV at specialized public health centres in Brazil. Data were obtained from individuals aged ≥50 years using antiretroviral therapy (ART) and with an undetectable viral load through personal interviews, clinical evaluations and medical records. Frailty and prefrailty were characterized using the Fried Frailty Phenotype tool. Multinomial regression models were performed, and the associated factors were selected through the backward stepwise method. RESULTS: Among 670 patients, 373 men and 297 women were included. The prevalence of frailty and prefrailty was significantly higher for women (16.2% and 56.2%, respectively) than for men (11.5% and 46.4%, respectively). Low socioeconomic and educational level, multimorbidity, depression, subjective cognitive complaints, and low scores on the Mini-Mental State Exam (MMSE) were associated (P < 0.05) with frailty for both sexes. However, in the sex-specific analysis, while smoking (OR = 3.66, 95% CI: 1.58-8.48) and a history of low adherence to ART (OR = 3.10, 95% CI: 1.33-7.23) were associated with frailty in men, depression (OR = 3.39, 95% CI: 1.36- 8.44) and the absence of functional dentition (OR = 3.77, 95% CI: 1.36- 10.43) were associated with frailty in women. CONCLUSIONS: This study adds self-reported cognitive complaints as a potential predictor of frailty in both sexes and supports the known deleterious effect of multimorbidity on frailty in adults living with HIV. Furthermore, it suggests that other possible predictors, such as depression, oral health status and adherence to ART, may be sex-specific.

The association of continuous-use medications and sleep parameters in a sample of working adults.

PURPOSE: Although polypharmacy is linked to health outcomes in the elderly, the use of multiple medications is increasing in middle-aged adults. This study analyzed whether or not the increased number of continuous-use medications (C-UM) is associated with objective and subjective sleep parameters in a working population. METHODS: Cross-sectional study with schoolteachers from public schools in Londrina, Brazil. The participants were classified according to the self-reported number of C-UM. Sleep data were obtained with actigraphy and a concomitant sleep diary for 7 days. The analyses were adjusted for socio-demographic, lifestyle, and morbidity variables. RESULTS: A total of 17% of the participants were classified as using ≥3C-UM. In fully adjusted analyses, the use of ≥3C-UM was associated with lower actigraphic sleep duration (<6 h) (odds ratio [OR] = 2.51; 95% confidence interval [CI] = 1.01,6.21), higher actigraphic sleep onset latency (SOL) (OR = 2.65; 95%CI = 1.00,7.02), and with a higher number of awakenings during sleep measured by actigraphy (OR = 3.30; 95%CI = 1.32,8.28). The use of ≥3 C-UM was also associated with higher SOL (OR = 3.76; 95%CI = 1.36,10.5) and lower sleep efficiency (OR = 11.6; 95%CI = 2.92,46.1), as measured with the sleep diary. A 1-unit increment in the number of continuous-use medications was associated with higher self-reported SOL and lower subjective sleep efficiency. CONCLUSION: The continuous use of ≥3 medications is associated with worse objective and subjective parameters of sleep duration and quality in schoolteachers.

Association of lead, cadmium and mercury with paraoxonase 1 activity and malondialdehyde in a general population in Southern Brazil.

Metal exposure is associated with increased oxidative stress (OS), which is considered an underlying mechanism of metal-induced toxicity. Malondialdehyde (MDA) is a final product of lipid peroxidation, and it has been extensively used to evaluate metal-induced OS. Pro-oxidant effects produced by metals can be mitigated by paraoxonase 1 (PON1), an antioxidant enzyme known to prevent cardiovascular disease and atherosclerosis. Among other factors, the Q192R polymorphism and the exposure to heavy metals have been known to alter PON1 activity. Here, we evaluated the association of blood lead (Pb), cadmium (Cd) and mercury (Hg) levels with PON1 activity, and with MDA concentrations in a randomly selected sample of Brazilian adults aged 40 years or older, living in an urban area in Southern Brazil. A total of 889 subjects were evaluated for blood Pb and Cd levels, and 832 were tested for Hg. Geometric mean of blood Pb, Cd and Hg was 1.93µg/dL, 0.06µg/L and 1.40µg/L, respectively. PON1 activity was significantly different among various genotypes: QQ (PON1=121.4U/mL), QR (PON1=87.5U/mL), and RR (PON1=55.2U/mL), p<0.001. PON1 genotypes were associated only with Cd blood levels. Those with QR genotype had Cd concentrations higher (0.07µg/L) than those with the RR genotype (0.04µg/L) with p=0.034. However, PON1 activity was not significantly associated with metal concentrations. Cluster analysis showed that men who reported to be current smokers and drinkers with higher blood Pb and Cd levels, had significantly lower PON1 activity than non-smokers or -drinkers, and women with lower Pb and Cd levels. RR genotype carriers had lower PON1 activity than those with the QR genotype, and had higher levels of Pb and Cd compared with other genotype carriers. For blood Hg, no association with PON1 activity or genotype was noted. We found low levels of Pb, Cd and Hg in environmentally exposed Brazilian adults. Cd concentrations were increased in subjects with QR genotype. Those with RR genotype had lower PON1 activity and higher levels of Pb and Cd than other genotype carriers. The results of cluster analysis suggested that smoking status exerts a significant influence on PON1 activity. Other studies with environmentally exposed populations are required to further clarify whether low blood levels of metals influence OS biomarkers.

Prevalence of Frailty Phenotypes in Older People Living with HIV: A Cross-Sectional Study from Brazil.

BACKGROUND: Frailty may affect people living with HIV (PLHIV) prematurely. Fried's frailty phenotype, composed of 5 criteria, is one of the most used instruments for its assessment. This study aimed to determine the prevalence of these criteria among PLHIV classified as prefrail and frail in Brazil. METHODS: A cross-sectional study analyzed the prevalence of the Frailty Phenotype in Brazil with 670 individuals aged ≥ 50 years and undetectable viral load. RESULTS: The prevalence of prefrail and frail individuals was 50.7% and 13.6%, respectively. A low level of physical activity was the most prevalent criterion (50.9%). Except for unintentional weight loss, all other criteria were more prevalent among individuals with lower education levels. All criteria were more prevalent among individuals of lower socioeconomic status than among those of moderate or high status (P < .05). CONCLUSIONS: A low level of physical activity was the component that most contributed to PLHIV being considered prefrail or frail.

Lipids and all-cause mortality among older adults: a 12-year follow-up study.

This is a 12-year follow-up cohort study with 800 people (60-85 years old). The association between lipid disorders and mortality was analysed by Cox proportional hazard adjusted model. All-cause mortality was considered the dependent variable, and lipid disorders as independent variables: total cholesterol (TC) >200 and <170 mg/dl, HDL-c <35 and 40, LDL-c >100 and 130, and triglycerides (TG) >50. An initial analysis of all subjects was performed and a second was carried out after having excluded individuals with a body mass index (BMI) <20 kg/m² or mortality in ≤ 2 years. The mortality showed a positive association with low TC and a negative association with high TC and high LDL-c. After the exclusion of underweight and premature mortality, there was a positive association only with TC <170 mg/dl (HR = 1.36, CI95%: 1.02-1.82). The data did not show a higher risk with high levels of TC, LDL-c, and TG. However, they showed higher mortality among older adults with low TC.

[The use of anticholinergic drugs and associated factors in middle-aged adults and the elderly]. / O uso de fármacos anticolinérgicos e fatores associados em adultos de meia-idade e idosos.

The objective of this article was to describe the use of anticholinergic drugs and possible factors associated with their use, in middle-aged adults and in the elderly. This is a cross-sectional study, based on data from a population-based study called VIGICARDIO. All respondents aged 44 or older interviewed in 2015 were included. Anticholinergic Drug Scale (ADS) was used to determine anticholinergic burden (ACB), categorized as significant (≥3) and non-significant (< 3). Poisson regression was conducted with crude and adjusted analysis to investigate the factors associated with ACB. There was a prevalence of 20.7% of significant ACB among respondents, higher among middle-aged adults (24.1%). After adjusted analysis, significant ACB (≥ 3) remained in the non-elderly age group with polypharmacy and sporadic use of two or more drugs. In the elderly, sporadic use of two or more medications and hospitalization in the last year continued to be associated with significant ACB. The results indicate a higher prevalence of ACB among middle-aged adults, polymedicated and in sporadic use of medications, which suggests that the investigation of the use of anticholinergicsin this age group requires greater attention.

O objetivo deste artigo foi descrever o uso de medicamentos anticolinérgicos e possíveis fatores associados ao seu uso em adultos de meia idade e idosos. Trata-se de um estudo transversal em que foram incluídos todos os respondentes de 44 anos ou mais entrevistados em 2015. Foi utilizada a Anticholinergic Drug Scale (ADS) para determinação da carga anticolinérgica (CAC), categorizada em elevada (≥ 3) e não-elevada (< 3). Conduziu-se regressão de Poisson com análise bruta e ajustada para investigar os fatores associados à CAC, com cálculo da razão de prevalência (RP) e intervalo de confiança 95% (IC95%). Constatou-se prevalência de 20,7% de CAC elevada entre os respondentes, maior entre adultos de meia idade (24,1%). Após análise ajustada, mantiveram-se associadas à CAC elevada na faixa etária não idosa a polifarmácia e uso esporádico de dois ou mais medicamentos. Nos idosos, continuaram associados à CAC elevada o uso esporádico de dois ou mais medicamentos e internação no último ano. Os resultados indicam maior prevalência de CAC entre adultos de meia-idade, polimedicados e em uso esporádico de medicamentos, o que sugere que a investigação do uso de anticolinérgicos nessa faixa etária demanda maior atenção.

[The relationship between the assessment of performance of primary health care and infant mortality in Brazil]. / Relação entre a avaliação de desempenho da atenção básica e a mortalidade infantil no Brasil.

The article assesses the relationship between the Infant Mortality Rate (IMR) and the percentage of health units that obtained good performance ratings in the appraisal by the National Program to Improve Access and Quality (PMAQ) of Primary Care in Brazilian states and the relation to the variables involved. Using a descriptive study, the results of the performance assessment of the participating units of the third cycle of PMAQ (2015-2017) and the relationship with the IMR (2015-2017) were analyzed. Descriptive, Pearson correlation, and cluster analysis were performed. The results revealed that there is a negative and moderate correlation (-0.534) between the IMR and the units with a good and statistically significant (p=0.005) performance rating. With cluster analysis, it was possible to confirm that Brazilian states from different regions reveal similarities in the variables of the study. Thus, there is a relationship between IMR and units with a good performance rating. The results also showed that the similarities between the states are not restricted to the region in which they are located. Therefore, the importance of investing in primary care training is paramount in terms of an effective impact on the health of the population.

O artigo verifica se há relação entre a Taxa de Mortalidade Infantil (TMI) e o percentual de unidades de saúde que obtiveram boa classificação de desempenho na avaliação do Programa Nacional de Melhoria do Acesso e da Qualidade da atenção básica (PMAQ) nos estados brasileiros, e a similaridade entre estes estados em relação a essas variáveis. Utilizando-se de um estudo descritivo, foram analisados os resultados da avaliação de desempenho das unidades participantes do 3º ciclo do PMAQ (2015-2017) e a relação com a TMI (2015-2017). Foram realizadas análises descritivas, de correlação de Pearson e análise de cluster. Os resultados demonstraram que há correlação negativa e moderada (-0,534) entre a TMI e as unidades com boa classificação de desempenho e estatisticamente significante (p=0,005). Com a análise de cluster, foi possível verificar que estados de diferentes regiões apresentam similaridade nas variáveis do estudo. Enfim, existe relação entre a TMI às unidades com boa classificação de desempenho, além disso, verificou-se que a similaridade entre os estados vai além da região a que pertencem. Portanto, fica evidente a importância do investimento na qualificação da AB para o impacto efetivo na saúde da população.

[Characterization of chronic pain and analgesic approaches among community-dwelling elderly]. / Caracterização da dor crônica e métodos analgésicos utilizados por idosos da comunidade.

OBJECTIVE: To characterize chronic pain and analgesic approaches in community- dwelling elderly of the northern district of Londrina - Brazil. METHODS: Cross-sectional study with individuals 60 years old and more, resident in the local area of a Basic Health Unit (UBS) of Londrina, by home inquiry. Chronic pain was defined as pain lasting for six months or more. The elderly with pain, were questioned about characteristics of the pain as regards location, duration, frequency, intensity, improvement and worsening situations, as well as the impact of pain in the quality of life and also about analgesic approaches. RESULTS: One hundred and seventy two elderly were interviewed (101 women and 71 men). Presence of chronic pain was observed in 107 (62.%) of these 69.3% were female and 52.1% male (p = 0.004). The very old people, 80-year-old or more (p=0.01) and the depressive elderly (p=0.0008) presented higher frequency of chronic pain. Most prevalent pains were in the legs and back, with 31.2% each, and the majority of elderly referred to continuous, daily high intensity pain. Regarding analgesic approaches, the pharmacologic method was mentioned by 86 elderly (80.4%) and simple analgesic (32.6%) was the most used. CONCLUSION: Facts show that there is a high predominance of chronic pain in the population of elderly, mainly in women, in very old people and in depressive individuals.

Relationship between anticholinergic load and self-perceived health in a population aged 44 years or older / Relação entre carga anticolinérgica e autopercepção de saúde em população com mais de 44 anos

OBJECTIVE: To investigate the relationship between anticholinergic load (ACL) and self-perceived general health in adults in a medium-sized municipality in southern Brazil. METHODS: This cross-sectional study was based on 2015 data from a medium-sized municipality in southern Brazil. All respondents aged 44 years or older who reported using drugs in the 2 weeks before the interview were included (n = 662). The Anticholinergic Drug Scale was used to measure the ACL. Self-perceived health was categorized as positive self-perception (PSP) or negative self-perception (NSP). Crude and adjusted Poisson regression analyses were conducted to investigate the association between ACL and self-perceived health. RESULTS: NSP was found in 50.91% of 662 respondents. Significant ACL, older age, lower economic status, lower education, polypharmacy, and depression correlated with a higher frequency of NSP. Individuals with significant ACL had a prevalence of NSP of 1.27 (95% confidence interval: 1.02 ­ 1.58), and each additional ACL level represented a 6.10% higher chance of worse self-perceived health, regardless of confounding factors. CONCLUSIONS: An association was found between significant ACL and NSP, with an effect dependent on ACL level

OBJETIVO: Investigar a relação entre carga anticolinérgica (CAC) e autopercepção de saúde em adultos de um município de médio porte do sul do Brasil. METODOLOGIA: Trata-se de um estudo transversal com dados de 2015, realizado em um município de médio porte do sul do Brasil. Todos os entrevistados com 44 anos ou mais que relataram uso de drogas nas duas semanas anteriores à entrevista foram incluídos (n = 662). A Anticholinergic Drug Scale (ADS) foi utilizada para medir a CAC. A autopercepção da saúde foi categorizada em autopercepção positiva (APP) ou autopercepção negativa (APN). Análises de regressão de Poisson bruta e ajustada foram realizadas para investigar a associação entre CAC e autopercepção de saúde. RESULTADOS: Entre os 662 participantes, a CAC foi encontrada em 50,91% dos respondentes. CAC significativa, idade avançada, situação econômica mais baixa, menor escolaridade, polifarmácia e depressão foram correlacionados com maior frequência de APN. Indivíduos com CAC significativo apresentaram prevalência de APN de 1,27 (intervalo de confiança de 95%: 1,02 ­ 1,58), e cada nível adicional de CAC representou uma chance 6,10% maior de pior autopercepção de saúde, independentemente de fatores de confusão. CONCLUSÕES: Encontrou-se associação entre ACL significativo e APN, com efeito dependente do valor do CAC

[Salivary flow and psychoactive drug consumption in elderly people]. / Fluxo salivar e uso de drogas psicoativas em idosos.

OBJECTIVE: To analyze the association between low saliva flow rates and the use of psychoactive drugs among the elderly. METHODS: A cross-sectional study was carried out with 267 elderly people from 60 to 74 years of age who lived in a borough of the city of Londrina, Paraná State, Brazil. Individuals with high functional dependence or restricted to bed were excluded. Saliva flow rate was the dependent variable with values under the first tercile being considered as low flow rates (less than 0.44 ml/min). The continuous use of psychoactive drugs (antidepressant, antiepileptic, sedative, antipsychotic, hypnotic or sedative-hypnotic drugs) was the independent variable. Multivariate analysis was performed taking into account gender, age and smoking status. RESULTS: The majority of the elderly were women (80.5%), with a mean age of 66.5 years. Use of psychoactive drugs was observed among 31 elderly (11.6%). Mean saliva flow rate was 0.76 ml/min, lower among users of psychoactive drugs (0.67 ml/min). In the multivariate analysis, use of psychoactive drugs was associated with low saliva flow rates (<0.44 ml/min), independent of gender, age or smoking. CONCLUSION: Results show that there is an association between use of psychoactive drugs and low saliva flow rates in this group of independent and non-institutionalized elderly. These conclusions stress the need of a rational use of these drugs, particularly among the elderly.

Frequency and factors associated with falls in adults aged 55 years or more.

OBJECTIVE: The objective of this study is to analyze the frequency and factors associated with falls in adults aged 55 years or more. METHODS: This is a study inserted into another population-based study with representative sample of persons aged 40 years or more of the urban area in a medium-sized municipality of the State of Paraná, Brazil, in 2011. That study obtained demographic and socioeconomic data and characteristics related to life habits, health conditions, and functional capacity (n = 1,180). In 2012, we selected all persons aged 55 years or more (n = 501). We have estimated grip strength and the occurrence of a fall since the last interview in 80.6% of the adults. The crude and adjusted odds ratios (OR) have been calculated by logistic regression according to a hierarchical model. RESULTS: The rate of fall was 24.3%. After adjustments, we could observe higher chances of falls among women (OR = 3.10; 95%CI 1.79-5.38), among persons aged 65 years or more (OR = 2.39; 95%CI 1.45-3.95), with poor sleep quality (OR = 1.78; 95%CI 1.08-2.93), and with low grip strength (OR = 2.31; 95%CI 1.34-3.97). CONCLUSIONS: Poor sleep quality and low muscle strength can be indicators of increased risk of falls and need assessments and interventions aimed at preventing them. OBJETIVO: Analisar a frequência e fatores associados à ocorrência de quedas em adultos de 55 anos ou mais. MÉTODOS: Estudo inserido em outro de base populacional com amostra representativa de pessoas com 40 anos ou mais da área urbana de município de médio porte do Paraná em 2011. Foram obtidos dados demográficos e socioeconômicos, características referentes aos hábitos de vida, às condições de saúde e à capacidade funcional (n = 1.180). Em 2012, selecionaram-se todas as pessoas com idade igual ou superior a 55 anos (n = 501). Foram estimadas a força de preensão palmar e a ocorrência de queda desde a última entrevista em 80,6% delas. Foram calculadas odds ratios (OR) brutas e ajustadas por regressão logística segundo modelo hierarquizado. RESULTADOS: A frequência de queda foi de 24,3%. Após ajustes, observaram-se chances maiores de queda entre mulheres (OR = 3,10; IC95% 1,79-5,38), entre pessoas com idade igual ou superior a 65 anos (OR = 2,39; IC95% 1,45-3,95), com qualidade do sono ruim (OR = 1,78; IC95% 1,08-2,93) e com baixa força de preensão palmar (OR = 2,31; IC95% 1,34-3,97). CONCLUSÕES: Qualidade ruim do sono e a baixa força muscular podem ser indicadores de maior risco de quedas e merecem avaliações e intervenções visando à prevenção desse agravo.

O uso de fármacos anticolinérgicos e fatores associados em adultos de meia-idade e idosos / The use of anticholinergic drugs and associated factors in middle-aged adults and the elderly

Resumo O objetivo deste artigo foi descrever o uso de medicamentos anticolinérgicos e possíveis fatores associados ao seu uso em adultos de meia idade e idosos. Trata-se de um estudo transversal em que foram incluídos todos os respondentes de 44 anos ou mais entrevistados em 2015. Foi utilizada a Anticholinergic Drug Scale (ADS) para determinação da carga anticolinérgica (CAC), categorizada em elevada (≥ 3) e não-elevada (< 3). Conduziu-se regressão de Poisson com análise bruta e ajustada para investigar os fatores associados à CAC, com cálculo da razão de prevalência (RP) e intervalo de confiança 95% (IC95%). Constatou-se prevalência de 20,7% de CAC elevada entre os respondentes, maior entre adultos de meia idade (24,1%). Após análise ajustada, mantiveram-se associadas à CAC elevada na faixa etária não idosa a polifarmácia e uso esporádico de dois ou mais medicamentos. Nos idosos, continuaram associados à CAC elevada o uso esporádico de dois ou mais medicamentos e internação no último ano. Os resultados indicam maior prevalência de CAC entre adultos de meia-idade, polimedicados e em uso esporádico de medicamentos, o que sugere que a investigação do uso de anticolinérgicos nessa faixa etária demanda maior atenção.

Abstract The objective of this article was to describe the use of anticholinergic drugs and possible factors associated with their use, in middle-aged adults and in the elderly. This is a cross-sectional study, based on data from a population-based study called VIGICARDIO. All respondents aged 44 or older interviewed in 2015 were included. Anticholinergic Drug Scale (ADS) was used to determine anticholinergic burden (ACB), categorized as significant (≥3) and non-significant (< 3). Poisson regression was conducted with crude and adjusted analysis to investigate the factors associated with ACB. There was a prevalence of 20.7% of significant ACB among respondents, higher among middle-aged adults (24.1%). After adjusted analysis, significant ACB (≥ 3) remained in the non-elderly age group with polypharmacy and sporadic use of two or more drugs. In the elderly, sporadic use of two or more medications and hospitalization in the last year continued to be associated with significant ACB. The results indicate a higher prevalence of ACB among middle-aged adults, polymedicated and in sporadic use of medications, which suggests that the investigation of the use of anticholinergicsin this age group requires greater attention.

Relação entre a avaliação de desempenho da atenção básica e a mortalidade infantil no Brasil / The relationship between the assessment of performance of primary health care and infant mortality in Brazil

Resumo O artigo verifica se há relação entre a Taxa de Mortalidade Infantil (TMI) e o percentual de unidades de saúde que obtiveram boa classificação de desempenho na avaliação do Programa Nacional de Melhoria do Acesso e da Qualidade da atenção básica (PMAQ) nos estados brasileiros, e a similaridade entre estes estados em relação a essas variáveis. Utilizando-se de um estudo descritivo, foram analisados os resultados da avaliação de desempenho das unidades participantes do 3º ciclo do PMAQ (2015-2017) e a relação com a TMI (2015-2017). Foram realizadas análises descritivas, de correlação de Pearson e análise de cluster. Os resultados demonstraram que há correlação negativa e moderada (-0,534) entre a TMI e as unidades com boa classificação de desempenho e estatisticamente significante (p=0,005). Com a análise de cluster, foi possível verificar que estados de diferentes regiões apresentam similaridade nas variáveis do estudo. Enfim, existe relação entre a TMI às unidades com boa classificação de desempenho, além disso, verificou-se que a similaridade entre os estados vai além da região a que pertencem. Portanto, fica evidente a importância do investimento na qualificação da AB para o impacto efetivo na saúde da população.

Abstract The article assesses the relationship between the Infant Mortality Rate (IMR) and the percentage of health units that obtained good performance ratings in the appraisal by the National Program to Improve Access and Quality (PMAQ) of Primary Care in Brazilian states and the relation to the variables involved. Using a descriptive study, the results of the performance assessment of the participating units of the third cycle of PMAQ (2015-2017) and the relationship with the IMR (2015-2017) were analyzed. Descriptive, Pearson correlation, and cluster analysis were performed. The results revealed that there is a negative and moderate correlation (-0.534) between the IMR and the units with a good and statistically significant (p=0.005) performance rating. With cluster analysis, it was possible to confirm that Brazilian states from different regions reveal similarities in the variables of the study. Thus, there is a relationship between IMR and units with a good performance rating. The results also showed that the similarities between the states are not restricted to the region in which they are located. Therefore, the importance of investing in primary care training is paramount in terms of an effective impact on the health of the population.

Cognitive and Functional Decline among Individuals 50 Years of Age or Older in Cambé, Paraná, Brazil: A Population-Based Study.

AIMS: To identify the frequency of cognitive and functional decline (CFD) among adults 50 years of age and older by a population-based study. METHODS: Cognitive function was analyzed by the Mini-Mental State Examination, and the functional conditions were based on instrumental activities of daily living (IADL). Cases of CFD included individuals with cognitive decline and 2 or more compromised IADL. RESULTS: A total of 693 individuals were studied. The frequency of CFD was 16.3%. A low socioeconomic profile was associated with greater CFD independent of gender, age, education, and presence of depression (OR = 2.46; 95% CI: 1.53-3.97). CONCLUSIONS: These data show a high frequency of CFD among adults 50 years and older. Individuals with less education and a lower socioeconomic level exhibited poorer cognitive and functional conditions.

Death in hospital and at home: population and health policy influences in Londrina, State of Paraná, Brazil (1996-2010).

An aging population and epidemiological transition involves prolonged terminal illnesses and an increased demand for end-stage support in health services, mainly in hospitals. Changes in health care and government health policies may influence the death locations, making it possible to remain at home or in an institution. The scope of this article is to analyze death locations in the city of Londrina, State of Paraná, from 1996 to 2010, and to verify the influence of population and health policy changes on these statistics. An analysis was conducted into death locations in Londrina in Mortality Information System (SIM) considering the main causes and locations of death. There was an increase of 28% in deaths among the population in general, though 48% for the population over 60 years of age. There was an increase of deaths in hospitals, which were responsible for 70% of the occurrences, though death frequencies in others locations did not increase, and deaths in the home remained at about 18%. The locations of death did not change during this period, even with health policies that broadened care in other locations, such as the patient´s home. The predominance of hospital deaths was similar to other Brazilian cities, albeit higher than in other countries.

Avaliação dos fatores determinantes da autoeficácia em idosos da comunidade com dor crônica musculoesquelética / Evaluation of self-efficacy determinants in community-dwelling older adults with chronic musculoskeletal pain

INTRODUÇÃO: A autoeficácia pode ser definida como a força das convicções que se tem de poder executar determinada atividade obtendo o resultado esperado. Ela pode funcionar como potente mediador entre a dor crônica musculoesquelética e a maneira como o idoso lida com suas próprias incapacidades. OBJETIVO: Avaliar os fatores determinantes das crenças de autoeficácia e do medo do exercício em idosos da comunidade com dor crônica musculoesquelética. METODOLOGIA: Estudo transversal com idosos que sofrem de dor crônica musculoesquelética. Incluíram-se apenas indivíduos da área urbana que relataram dor há mais de três meses. Selecionou-se a amostra de forma não probabilística por conveniência. As variáveis estudadas basearam-se em dados sociodemográficos, na caracterização da dor pelo inventário breve de dor e pela escala Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), na autoeficácia pela escala de autoeficácia para dor crônica e, para a crença sobre o exercício físico, elaboraram-se questões simples. Para as análises estatísticas aplicaram-se frequência absoluta e relativa, teste x2 e teste de Mann-Whitney U quando pertinentes. RESULTADOS: A amostra compreendeu 193 idosos, em sua maioria mulheres com baixa escolaridade. A autoeficácia foi mais bem avaliada por idosos que moravam sós e por aqueles que foram classificados com dor exclusivamente nociceptiva. CONCLUSÃO: Ainda que possuam dores crônicas, idosos com melhor autoeficácia sentem-se confiantes na realização de suas tarefas e possuem melhor capacidade para o enfrentamento das mudanças relacionadas ao envelhecimento e para o autocuidado.

INTRODUCTION: Self-efficacy is defined as the strength of a person's convictions in being able to perform a given activity and obtain the expected result. It may act as a potent mediator between chronic musculoskeletal pain and how older adults cope with their disabilities. OBJECTIVE: To evaluate the determinants of self-efficacy beliefs and fear of physical exercise in community-dwelling older adults with chronic musculoskeletal pain. METHODS: This cross-sectional study recruited older adults with chronic musculoskeletal pain. Only individuals living in an urban area in southern Brazil and who reported pain for more than 3 months were included. A convenience sample was selected in a nonprobabilistic fashion. The study variables consisted of sociodemographic data; pain based on the Brief Pain Inventory and the Leeds Assessment of Neuropathic Symptoms and Signs for Patients with Chronic Pain; and self-efficacy based on the Chronic Pain Self-Efficacy Scale. Also, simple questions were created for physical exercise beliefs. For statistical analysis, absolute and relative frequency, x2 test, and Mann-Whitney U test were used as appropriate. RESULTS: The sample consisted of 193 older adults, mostly women with low level of education. Self-efficacy was best rated by older adults living alone and by those who were classified as exclusively nociceptive pain. CONCLUSION: Despite having chronic pain, older adults with higher self-efficacy feel confident in performing their tasks and have greater ability to cope with changes related to aging and to engage in self-care.

Medidas de prevenção de queda em idosos hospitalizados / Fall prevention strategies in hospitalized older adults

Objetivo: Avaliar medidas de prevenção de quedas prescritas e realizadas em idosos hospitalizados. Método: Estudo quantitativo, transversal, realizado em hospital público terciário, entre 2015 e 2016. Resultados: A amostra foi composta por 153 idosos, 101 (66,0%) eram mulheres. O risco de queda foi de 60,9% (92), sendo as mulheres com maior chance de queda (p=0,0016). A medida de prevenção relacionada a sinalização do risco de queda no leito não foi prescrito para 75,0% (69) dos idosos com risco, entretanto, este cuidado foi realizado para 92,4% (85) dos idosos. O uso de grade elevada do leito foi prescrito para 78,3% (72) dos idosos com risco de queda (p=0,006) e este cuidado foi realizado para 70,7% (65) dos idosos com risco e 54,2% (32) sem risco de queda. Conclusão: As medidas para prevenção de queda foram realizadas com maior frequência do que prescritas para todos os idosos, independente do risco de queda. (AU)

Objective: To evaluate fall prevention strategies prescribed and performed for hospitalized older adults. Methods: This was a quantitative, cross-sectional study conducted in a tertiary public hospital between 2015 and 2016. Results: The sample consisted of 153 older adults, 101 (66.0%) of whom were women. Risk of falling was found in 60.9% (92), and women had a higher chance of falling (p=0.0016). Visual signaling of fall risk on the bed was not prescribed for 75.0% (69) of the elderly patients at risk, however, this precaution was taken for 92.4% (85) of those patients. Maintaining bed rails elevated was prescribed for 78.3% (72) of the elderly patients at risk of falling (p=0.006). This precaution was taken for 70.7% (65) of the patients at risk and 54.2% (32) of those not at risk of falling. Conclusion: Fall prevention strategies were performed more frequently than prescribed for every elderly inpatients, regardless of risk for falling. (AU)

Objetivo: Evaluar medidas de prevención de caídas, prescritas y realizadas en ancianos hospitalizados. Métodos: Estudio cuantitativo, transversal, realizado en un hospital público terciario, entre 2015 y 2016. Resultados: La muestra fue compuesta por 153 ancianos; 101 (66,0%) fueron mujeres. El riesgo de caída fue de 60,9% (92), predominando en las mujeres la mayor posibilidad de caídas (p=0,0016). La medida de prevención, relacionada a la señalización del riesgo de caída de la cama, no fue prescrito para 75,0% (69) de los ancianos con riesgo; sin embargo, este cuidado fue realizado para el 92,4% (85) de los ancianos. El uso de rejilla elevada en la cama fue prescrito para 78,3% (72) de los ancianos con riesgo de caída (p=0,006); este cuidado fue realizado para 70,7% (65) de los ancianos con riesgo y 54,2% (32) sin riesgo de caída. Conclusión: Las medidas para prevención de caídas, fueron realizadas con mayor frecuencia que las prescritas para todos los ancianos, independientemente de los riesgos de caídas. (AU)

[Non-adherence to continuous treatment and associated factors: prevalence and determinants in adults 40 years and older]. / Não adesão ao tratamento medicamentoso contí nuo: prevalência e determinantes em adultos de 40 anos e mais.

This study investigates factors associated with non-adherence to continuous drug therapy in individuals 40 years and older. A population-based survey was conducted in Cambé, Paraná State, Brazil. Treatment adherence was assessed with the four-item Morisky et al. medication adherence scale. The study also assessed socio-demographic variables and health services access and use of medication. Among 1,180 interviewees, 78% reported use of medication, with continuous use in 55%. The study analyzed 639 individuals, the majority female, ranging from 40 to 59 years of age, with low schooling, and from socioeconomic stratum C (on a scale from A to E). Prevalence of non-adherence was 63.5%. Mean therapeutic complexity was 8.1. After adjusted analysis, the following factors remained associated with non-adherence: not being assisted by community health workers, discontinuous access to medication, and high frequency of medication throughout the day. The results indicate high prevalence of non-adherence, with potentially negative impacts for individuals and society.

Estudo SABE: fatores associados ao uso de medicamentos para controle da dor crônica em idosos / SABE study: factors associated with the use of drugs to control chronic pain in the elderly

OBJETIVO: Analisar os fatores associados ao uso de medicamentos para controle da dor crônica por idosos do município de São Paulo. MÉTODOS: Estudo transversal com utilização de dados do Estudo Saúde, Bem-Estar e Envelhecimento (SABE) que teve início no ano 2000, com reentrevistas em 2006 e 2010. Para esta pesquisa, inicialmente, foram utilizados dados dos idosos que foram reentrevistados em 2010. Dessa amostra, os idosos que apresentaram dor crônica foram selecionados para a análise de fatores associados ao uso de medicamentos para controle da dor. Para a identificação desses fatores utilizou-se o teste de Rao Scott. Por se tratar de estudo com desenho amostral complexo, para todas as análises considerou-se pesos amostrais estimados para o seguimento de 2010. RESULTADOS: Da amostra inicial de 978 idosos, 303 (30,98%) relataram dor crônica. Entre esses idosos, observou-se menor frequência de utilização de analgésicos para os que referiram ter realizado a última consulta médica em convênio/particular (OR= 0,55; IC 95%: 0,31-0,96); menor frequência de utilização de antidepressivos para os que referiram não ter plano de saúde (OR=0,49; IC 95%: 0,24-0,98); e maior utilização de sintomáticos para dispepsia para os com autopercepção de saúde regular (OR=2,20; IC 95%: 1,12-4,32) e para os que referiram sentir dor diariamente (OR=2,24; IC 95%: 1,31-3,81). CONCLUSÕES: Dessa maneira conclui-se que a dor é um fator que afeta diretamente a vida do idoso e, estes, muitas vezes, buscam o alívio para seu sofrimento nos medicamentos, e o fato de realizar consultas médicas em serviço privado ou conveniado aumentam a frequência de utilização de determinados medicamentos.

AIMS: This study aims to analyze the factors associated with the use of medications to control chronic pain in the elderly, study carried out in the city of São Paulo. METHODS: This a cross-sectional study using data from the Health, Welfare and Ageing Study (SABE), which began in 2000 with reinterviews in 2006 and 2010. For this research, data from elderly people re-interviewed in 2010 were initially used. From this sample, elderly individuals showed chronic pain were selected for the analysis of factors associated with the use of medications for pain control. The Rao Scott test was used to identify these factors. Since this is a study with a complex sample design, estimated sample weights for the 2010 follow-up were considered for all analyses. RESULTS: From the initial sample of 978 elderly people, 303 (30.98%) reported chronic pain. Among these elderly people, there was a lower frequency of using analgesics for those who reported having made the last medical consultation in a health care/private (OR=0,55; IC 95%: 0,31-0,96); lower frequency of using antidepressants for those who reported not having health insurance (OR=0,49; IC 95%: 0,24-0,98); greater use of symptomatic for dyspepsia; for those with regular health self-perception (OR=2,20; IC 95%: 1,12-4,32); and for those who reported feeling pain daily (OR=2,24; IC 95%: 1,31-3,81). CONCLUSIONS: Thus, it is concluded that pain is a factor that directly affects the life of the elderly and they often seek relief for their suffering in medications, and the fact of performing medical consultations in a private care or health service increases the frequency of use of certain medications.

Preditores de dependência funcional em pessoas de 50 anos ou mais: estudo de seguimento de 4 anos / Predictors of functional dependence among individuals aged 50 years and older: a 4-year follow-up study

OBJECTIVE: To verify the effect of change and/or maintenance of poor sociodemographic factors, lifestyle and health conditions on the incidence of functional dependence for instrumental activities of daily living (IADLs) in people aged 50 years or older living in urban settings. METHODS: The relationship between IADLs and risk factors was analyzed in a prospective 4-year follow-up study involving 412 participants. Relative risk (RR) and 95% confidence intervals (95%CI) were calculated using Poisson regression models, adjusted for sex, age and education. RESULTS: The incidence of dependence for IADLs was 18.9%. Functional dependence was independently associated with lower socioeconomic status (RR = 2.03, 95%CI 1.24­3.32), lack of occupational activity (RR = 2.46, 95%CI 1.31­4.61), inadequate fruit and vegetable intake (RR = 1.90, 95%CI 1.06­3.38) and poor performance in the Mini Mental State Examination (RR = 2.52, 95%CI 1.53­4.17). The association between functional dependence and diabetes mellitus approached statistical significance (RR = 1.39, 95%CI 0.92­2.10). CONCLUSIONS: The results showed that worse socioeconomic conditions and chronic health issues were associated with the incidence of dependence for IADLs. These findings highlight the importance of comprehensive and interdisciplinary health care for populations with these characteristics.

OBJETIVO: Verificar o efeito de alterações de fatores sociodemográficos, estilo de vida e condições de saúde na incidência de dependência funcional para as atividades instrumentais de vida diária (AIVD) em pessoas de 50 anos ou mais em área urbana. MÉTODO: A relação entre AIVD e fatores de risco foi analisada em 412 indivíduos por meio de estudo longitudinal prospectivo com seguimento de quatro anos usando o cálculo do risco relativo (RR) e intervalo de confiança 95% (IC95%) em modelos de regressão de Poisson, ajustados por sexo, faixa etária e escolaridade. RESULTADO: A incidência de dependência de IAVD foi de 18,9% e estava associada de maneira independente a indivíduos com pior condição socioeconômica (RR = 2,03, IC95% 1,24­3,32), ausência de atividade laboral (RR = 2,46, IC95% 1,31­4,61), consumo irregular de frutas e vegetais (RR = 1,90, IC95% 1,06­ 3,38), e pior perfomance no miniexame do estado mental (RR = 2,52, IC95% 1,53­4,17). A diabetes apresentou uma tendência de associação com a incidência de dependência funcional (RR = 1,39, IC95% 0,92­2,10). CONCLUSÃO: Os resultados demonstram que piores condições socioeconômicas e de saúde estão associadas a maior incidência de dependência funcional por AIVD. Esses achados contribuem na elaboração de programas de promoção de saúde mais abrangentes e efetivos para esta população.