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This cross-sectional exploratory study investigated factors associated with unrecovered falls among older patients with a history of falls in the previous year participating in a clinical trial on fall prevention by asking them about their inability to get up independently after the fall. Participants' sociodemographic, clinical, functional (ADL/IADL, TUG, chair-stand test, hand grip, risk of falling) and fall location were investigated. We conducted a multivariate regression analysis adjusted for covariates to identify the main factors associated with unrecovered falls. Out of 715 participants (mean age: 73.4 years; 86% women), 51.6% (95% IC; 47.9 - 55.3%) experienced unrecovered falls. Depressive symptoms, ADL/IADL limitation, mobility limitation, undernutrition, and outdoor falls were associated with unrecovered falls. While assessing the risk of falling, professionals should consider preventive strategies and preparedness procedures for those who are more likely to experience unrecovered falls, such as training to get up from the floor, alarms, and support services.
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Força da Mão , Humanos , Feminino , Idoso , Masculino , Estudos Transversais , Fatores de RiscoRESUMO
BACKGROUND: The early identification of individuals at high risk for adverse outcomes by a Comprehensive Geriatric Assessment (CGA) in resource-limited primary care settings enables tailored treatments, however, the evidence concerning its benefits are still controversial. The main objective of this study was to examine the validity and reliability of the "Multidimensional Assessment of Older People in Primary Care (AMPI-AB)", a CGA for primary care in resource-limited settings. METHODS: Longitudinal study, with median follow-up time of 16 months. Older adults from a public primary care unit in São Paulo, Brazil, were consecutively admitted. Reliability was tested in a sample from a public geriatric outpatient clinic. Participants were classified by the AMPI-AB score as requiring a low, intermediate or high complexity of care. The Physical Frailty Phenotype was used to explore the AMPI-AB's concurrent validity. Predictive validity was assessed with mortality, worsening of the functional status, hospitalizations, emergency room (ER) visits and falls. The area under the ROC curve and logistic regression were calculated for binary outcomes, and a Cox proportional hazards model was used for survival analysis. RESULTS: Older adults (n = 317) with a median age of 80 (74-86) years, 67% female, were consecutively admitted. At the follow-up, 7.1% of participants had died, and increased dependency on basic and instrumental activities of daily living was detected in 8.9 and 41.1% of the participants, respectively. The AMPI-AB score was accurate in detecting frailty (area under the ROC curve = 0.851), predicted mortality (HR = 1.25, 95%CI = 1.13-1.39) and increased dependency on basic (OR = 1.26, 95%CI = 1.10-1.46) and instrumental (OR = 1.22, 95%CI = 1.12-1.34) activities of daily living, hospitalizations (OR = 2.05, 95%CI = 1.04-1.26), ER visits (OR = 1.20, 95%CI = 1.10-1.31) and falls (OR = 1.10, 95%CI = 1.01-1.20), all models adjusted for sex and years of schooling. Reliability was tested in a sample of 52 older adults with a median age of 72 (85-64) years, 63.5% female. The AMPI-AB also had good interrater (ICC = 0.87, 95%CI = 0.78-0.92), test-retest (ICC = 0.86, 95%CI = 0.76-0.93) and proxy reliability (ICC = 0.84, 95%CI = 0.67-0.93). The Cronbach's alpha was 0.69, and the mean AMPI-AB administration time was 05:44 ± 02:42 min. CONCLUSION: The AMPI-AB is a valid and reliable tool for managing older adults in resource-limited primary care settings.
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Atividades Cotidianas , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Imidazóis , Estudos Longitudinais , Masculino , Atenção Primária à Saúde , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Falling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people. METHODS/DESIGN: Multicentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis. DISCUSSION: This study is the first trial to be conducted in Brazil to evaluate the effectiveness of an intervention to prevent falls. If proven to reduce falls this study has the potential to benefit older adults and assist health care practitioners and policy makers to implement and promote effective falls prevention interventions. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01698580).
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Acidentes por Quedas/prevenção & controle , Terapia por Exercício/métodos , Serviços de Assistência Domiciliar , Características de Residência , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Causalidade , Terapia por Exercício/normas , Feminino , Serviços de Assistência Domiciliar/normas , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
OBJECTIVES: To understand the reasons older people engage in a multifactorial fall prevention program and, to identify the barriers and facilitators for adherence. METHODS: Cross-sectional study, with 218 older adults from the intervention group of a 12-week multifactorial fall prevention program (Prevquedas Brazil). We interviewed participants using a semi-structured questionnaire concerning reasons to engage in, barriers, and facilitators to participating in the program. We compared participants with low (0-5 sessions) and moderate/high (6-12 sessions) adherence regarding barriers and facilitators. RESULTS: Physical and mental health problems (55 %), and competing demands (45.2 %) were the most frequent barriers reported. Pleasant environment (97.7 %), a sense of receiving proper care (96.7 %), and empathy with the team (96.7 %) were the main facilitators. Seven out of the twelve facilitators distinguished participants with high adherence from those with low adherence. Only the barriers related to the program characteristics and the lack of social support were able to identify participants with low adherence. Open-ended questions revealed that self-determination, commitment, and the desire of being physically active and fit promoted participation. Anticipated health benefits and functional gains, a need to take action due to fall consequences, and encouragement from others were among the reasons to engage in the program. CONCLUSION: Although barriers should not be neglected, facilitators are critically important for adherence. Health professionals may develop skills to facilitate uptake and optimize older adults' participation. Implementing sustainable fall prevention programs in low and middle-income countries requires overcoming the fragmentation and inflexibility of healthcare services.
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Acidentes por Quedas , Pessoal de Saúde , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Humanos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To assess the health profile of community-dwelling older adults, according to sex, assisted by the Elderly Caregiver Program of the City of São Paulo. METHODS: Secondary data of 535 older adults, assisted by ten Elderly Caregiver Program teams from the southern region of São Paulo, were collected from medical records and the Multidimensional Evaluation of Older People in Primary Care, after verifying the inclusion and exclusion criteria for the study and obtaining subjects' consent. RESULTS: Older adults assisted by this program were predominantly female (77.6%), mean age of 76.2±8.0 years. They had negative self-rated health (67.8%), difficulties in instrumental activities of daily living (68.4%) and signs of mood changes (60.3%). A high prevalence of older adults with vision problems (58.8%), polypharmacy (58.1%), memory-related complaints (55.8%) and multiple morbidities (50.6%) were observed. The prevalence of multiple morbidities, polypharmacy, cognitive impairment and signs of mood changes were higher in women. On the other hand, men reported more hearing problems than women. CONCLUSION: The poorer health conditions of the older adults in this study, evidenced by a high prevalence of subjects with negative self-rated health, difficulties in instrumental activities of daily living, multiple morbidities, polypharmacy and other complaints (sensorial changes, depressive and cognitive symptoms), reinforce the importance of this program as a long-term care policy and as a way to ensure these older adults can continue living in their communities.
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Avaliação Geriátrica/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Atividades Cotidianas , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Polimedicação , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To describe item reduction and its distribution into dimensions in the construction process of a quality of life evaluation instrument for the elderly. METHODS: The sampling method was chosen by convenience through quotas, with selection of elderly subjects from four programs to achieve heterogeneity in the "health status", "functional capacity", "gender", and "age" variables. The Clinical Impact Method was used, consisting of the spontaneous and elicited selection by the respondents of relevant items to the construct Quality of Life in Old Age from a previously elaborated item pool. The respondents rated each items importance using a 5-point Likert scale. The product of the proportion of elderly selecting the item as relevant (frequency) and the mean importance score they attributed to it (importance) represented the overall impact of that item in their quality of life (impact). The items were ordered according to their impact scores and the top 46 scoring items were grouped in dimensions by three experts. A review of the negative items was performed. RESULTS: One hundred and ninety three people (122 women and 71 men) were interviewed. Experts distributed the 46 items into eight dimensions. Closely related items were grouped and dimensions not reaching the minimum expected number of items received additional items resulting in eight dimensions and 43 items. DISCUSSION: The sample was heterogeneous and similar to what was expected. The dimensions and items demonstrated the multidimensionality of the construct. The Clinical Impact Method was appropriate to construct the instrument, which was named Elderly Quality of Life Index--EQoLI. An accuracy process will be examined in the future.
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Avaliação Geriátrica , Qualidade de Vida/psicologia , Inquéritos e Questionários , Atividades Cotidianas , Fatores Etários , Idoso , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Psicometria , Autoavaliação (Psicologia) , Fatores SexuaisRESUMO
PURPOSE: To describe the initial steps of the construction process of a quality of life evaluation instrument for the elderly - the theoretic-conceptual framework for the construct, Quality of Life in Old Age; the construction methodology; and the generation of relevant items. METHODS: The first step was to conceptualize and define the construct, determining how much the elderly are able to perform of what they believe to be important in their lives and whether they are satisfied with what was possible to perform. The next step was to select and describe the construction methodology (the Clinical Impact Method) and the phase of generation of relevant items for the research object. The necessary procedures were delineated through a pilot study, which helped to establish all phases of the used methodology. The viability of the construction of the Quality of Life in Old Age evaluation instrument was demonstrated along with the needed adaptations. RESULTS: From 1032 answers by older people, 138 relevant items for the construct were identified by the items generation process. The pilot study demonstrated the suitability of the application of the methodology and established modifications to the preliminary items list, resulting in a new 139-item list. DISCUSSION: Now that the theoretical-conceptual framework of the construct as well as the construction methodology and the items generation are established, the next step will consist of administering the resulting list to a sample of elderly people for item reduction and distribution of items into dimensions.
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Qualidade de Vida , Inquéritos e Questionários , Idoso , Características Culturais , Humanos , Projetos Piloto , Reprodutibilidade dos Testes , Fatores SocioeconômicosRESUMO
Objetivo: Conhecer trabalho de profissionais da Saúde e da Assistência Social da região de Cidade Ademar/ Município de São Paulo junto à população idosa, desafios para gestão de planos de cuidados e possibilidades estratégicas. Metodologia: Estudo quali-quantitativo, exploratório e descritivo, realizado por meio de questionário, no ano de 2018. Dados quantitativos foram analisados em frequências e os qualitativos, tematicamente. Resultados: Quatorze profissionais participaram do estudo. Metade delas explicitou realizar plano de cuidado, que engloba o processo de planejamento, ação e revisão de ações, já as demais, desenvolviam atividades correlatas. Os principais desafios à gestão de planos de cuidados abrangem falta de suporte familiar, dificuldades financeiras e de autocuidado dos idosos, falta de acessibilidade, preconceitos em relação ao envelhecimento e velhice, negação de direitos e não efetivação de políticas públicas. Como estratégias de enfrentamento, foram citados o fortalecimento do autocuidado, aproximação à rede familiar, discussões em rede e educação permanente. Conclusão: Os resultados reforçam importância da efetivação das políticas sociais e do apoio regional ao diálogo entre atores envolvidos no cuidado integral às pessoas idosas.
Objective: To know the work of health and social care professionals in the region of Cidade Ademar/Municipality of São Paulo with the elderly population, challenges for managing care plans and possibilities for coping. Methodology: This is a qualitative-quantitative, exploratory and descriptive study, carried out through a questionnaire., was carried out in 2018. Quantitative information was analyzed in frequencies and qualitative information, thematically. Results: Fourteen professionals participated in the study. Half of them explicitly carried out a care plan which encompasses the process of planning, action and review of actions, the others developed correlated activities. The main challenges to the management of care plans include lack of family support, financial and self-care difficulties by elderly, lack of accessibility, prejudices regarding aging, denial of rights and non-effectiveness of public policies. Strategies include strengthening self-care, approximation to the family network, network discussions and continuing education. Conclusion: The results reinforce the importance of implementing social policies and regional support for dialogue between actors involved in comprehensive care for the older adult
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ABSTRACT Objective To assess the health profile of community-dwelling older adults, according to sex, assisted by the Elderly Caregiver Program of the City of São Paulo. Methods Secondary data of 535 older adults, assisted by ten Elderly Caregiver Program teams from the southern region of São Paulo, were collected from medical records and the Multidimensional Evaluation of Older People in Primary Care, after verifying the inclusion and exclusion criteria for the study and obtaining subjects' consent. Results Older adults assisted by this program were predominantly female (77.6%), mean age of 76.2±8.0 years. They had negative self-rated health (67.8%), difficulties in instrumental activities of daily living (68.4%) and signs of mood changes (60.3%). A high prevalence of older adults with vision problems (58.8%), polypharmacy (58.1%), memory-related complaints (55.8%) and multiple morbidities (50.6%) were observed. The prevalence of multiple morbidities, polypharmacy, cognitive impairment and signs of mood changes were higher in women. On the other hand, men reported more hearing problems than women. Conclusion The poorer health conditions of the older adults in this study, evidenced by a high prevalence of subjects with negative self-rated health, difficulties in instrumental activities of daily living, multiple morbidities, polypharmacy and other complaints (sensorial changes, depressive and cognitive symptoms), reinforce the importance of this program as a long-term care policy and as a way to ensure these older adults can continue living in their communities.
RESUMO Objetivo Analisar o perfil de saúde de idosos residentes na comunidade, de acordo com o sexo, cadastrados no Programa Acompanhante de Idosos do Município de São Paulo. Métodos Os dados secundários de 535 idosos assistidos por dez equipes do Programa Acompanhante de Idosos da região sul de São Paulo foram coletados a partir da consulta em prontuários e da Avaliação Multidimensional da Pessoa Idosa na Atenção Primária, após verificados os critérios de inclusão e exclusão para o estudo e a autorização dos idosos selecionados. Resultados Os idosos assistidos por este programa eram predominantemente do sexo feminino (77,6%), apresentavam média de idade 76,2±8,0 anos, tinham autoavaliação negativa de saúde (67,8%), comprometimento das atividades instrumentais da vida diária (68,4%) e indícios de alterações de humor (60,3%). Foi observada alta prevalência de idosos com dificuldades para enxergar (58,8%), polifarmácia (58,1%), queixas de problemas de memória (55,8%) e com múltiplas morbidades (50,6%). Na comparação entre os sexos, a presença de múltiplas morbidades, polifarmácia, queixas cognitivas e sinais de alterações de humor foi maior entre as mulheres. Por outro lado, a demanda de maior prevalência entre os homens foi referente a dificuldades em ouvir. Conclusão As piores condições de saúde desses idosos, constatadas pela alta prevalência de autoavaliação negativa de saúde, pelo comprometimento das atividades instrumentais da vida diária, por múltiplas morbidades, pela polifarmácia e outras queixas (alterações sensoriais, sintomas depressivos e alterações cognitivas), reafirmam a importância deste programa como política de cuidados de longa duração e para a manutenção destes idosos residindo na comunidade.
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Humanos , Masculino , Idoso , Idoso de 80 Anos ou mais , Avaliação Geriátrica/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Fatores Socioeconômicos , Brasil/epidemiologia , Atividades Cotidianas , Nível de Saúde , Prevalência , Inquéritos e Questionários , Fatores de Risco , Idoso Fragilizado/estatística & dados numéricos , Fatores Etários , Distribuição por Idade , Polimedicação , Fragilidade/epidemiologia , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To evaluate the effect on quality of life of elderly people enrolled in GAMIA - Multidisciplinary Care Group to Outpatient Elderly Subjects (Grupo de Assistência Multidisciplinar ao Idoso Ambulatorial) of the Geriatric Department, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo. METHODS: Between 2000 and 2002, 83 elderly participants of GAMIA were assessed by the World Health Organization Quality of Life scale (WHOQOL-bref) at the beginning and the end of the program. Functionality was assessed by Katz and Lawton scales and sociodemographic data were obtained from medical charts. RESULTS: Females predominated (79.5%) and overall mean age was 69.30 years. Data analysis showed a reduction in the physical domain of WHOQOL-bref (p = 0.014) and increased psychological health and environment domains (p = 0.029 and p = 0.007, respectively), detecting a trend of increase in social relationships and in general domains (p = 0.062 and p = 0.052, respectively). CONCLUSIONS: The clinical evaluation of the elderly detected previously unknown diseases and determination of the use of new drugs, which might have been the predominant factor for the deterioration of their perception in the physical domain. Improvement in psychological health and the environment can be related to psychological and social support that the elderly received from peers and professionals and the benefits of group activities, as well as the upward trend observed in social relationships and general domains. Participation in a program to promote healthy aging was effective in improving the quality of life of the elderly.
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There is no consensus in the medical literature about the impact of depressive symptoms on the evolution of Alzheimer's disease (AD). OBJECTIVE: To compare the evolution of AD patients, with and without depressive symptoms, in terms of cognition, functionality and caregiver stress. METHODS: The study entailed 2 stages: an initial retrospective stage involving review of medical charts of patients with mild and moderate AD. Patients were divided according to the presence or absence of depressive symptoms, defined by medical interview and questions on depressed mood from the CAMDEX (Cambridge Examination for Mental Disorders of the Elderly) and Neuropsychiatric Inventory (NPI). Twenty-nine patients were evaluated, 37.9% with depression (Group D+) and 62.1% without depression (Group D-). The groups were compared regarding demographic and medical characteristics, cognitive and functional performance, presence of apathy as a separate symptom, and caregiver stress, using standardized tests and questionnaires. In the second transversal step, the same tools were reapplied after 2 to 4 years of follow-up, and evolution for the two groups was compared. RESULTS: The two groups were highly homogeneous in demographic and clinic characteristics, as well as in length of follow-up, and presented no significant difference in cognitive or functional evaluation at the time of diagnoses or after follow-up. Only caregiver stress was greater in Group D+ at the two time points (p<0.001). CONCLUSIONS: No differences in the evolution of AD patients with or without depressive symptoms were evident. Nevertheless, these symptoms were associated to emotional burden of caregivers.
Não há consenso na literatura sobre o impacto dos sintomas depressivos na evolução da doença de Alzheimer (DA). OBJETIVO: Comparar a evolução de pacientes com DA, com e sem sintomas depressivos, quanto à cognição, à funcionalidade e estresse do cuidador. MÉTODOS: O estudo incluiu duas etapas: a primeira retrospectiva, com revisão de prontuários de pacientes com DA leve e moderada, divididos conforme presença ou ausência de sintomas depressivos, definidas por anamnese e questões referentes a humor deprimido do CAMDEX (Cambridge Examination for Mental Disorders of the Elderly) e Interrogatório Neuro-psiquiátrico (INP). Foram avaliados 29 pacientes, 37,9% com (D+) e 62,1% sem depressão (D). Os grupos foram comparados quanto a variáveis demográficas, clínicas e quanto ao desempenho cognitivo, funcionalidade, presença de apatia do paciente e estresse do cuidador, através de questionários e testes padronizados. Na segunda etapa, transversal, foram reaplicados os mesmos instrumentos após 2 a 4 anos de acompanhamento, comparando-se a evolução nos dois grupos. RESULTADOS: Os grupos, homogêneos segundo variáveis demográficas, clínicas e tempo de evolução, não apresentaram diferença significante nos testes cognitivos e na avaliação funcional, no momento do diagnóstico, e ao longo da evolução. Quanto ao estresse do cuidador, foi maior no grupo D+ nos dois momentos (p<0,001). CONCLUSÕES: Não se constatou diferença na evolução de pacientes com DA com ou sem sintomas depressivos. No entanto, tais sintomas se relacionaram a maior sobrecarga emocional do cuidador, no momento do diagnóstico e na evolução.
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INTRODUÇÃO: As redes de atenção à saúde são fundamentais para assistir a população idosa em seus diversos aspectos. A assistência domiciliar, o Programa Acompanhante de Idosos da Secretaria Municipal da Saúde da cidade de São Paulo e as instituições de longa permanência para idosos compõem as redes de assistência à pessoa idosa. Faz-se necessário analisar como a rede entre esses serviços se estabelece e contempla essa demanda de cuidado. OBJETIVO: Descrever e comparar os serviços assistência domiciliar, Programa Acompanhante de Idosos e instituições de longa permanência para idosos quanto às possíveis diferenças e semelhanças, demanda dos usuários, fluxo assistencial e gestão de serviços. METODOLOGIA: Realizou-se uma revisão bibliográfica não exaustiva da literatura nacional publicada nas bases eletrônicas de dados SciELO e LILACS, em referências literárias e eletrônicas, no período de 1997 a 2012. RESULTADOS: No total, 32 estudos foram incluídos na revisão. Observou-se que a população atendida é predominantemente do sexo feminino, com idade avançada, e recebe assistência multiprofissional. Os serviços de assistência domiciliar e o Programa Acompanhante de Idosos valorizam a manutenção da família e da comunidade como ambiente terapêutico, postergando a institucionalização. A presença do cuidador mostrou-se como um dos fatores de maior influência para a permanência dos cuidados domiciliares. CONCLUSÃO: Conclui-se que os serviços revisados possuem objetivos que contemplam as demandas dos idosos. Espera-se que a integração dos equipamentos de saúde estabeleça suas ações de acordo com o perfil dos ...
INTRODUCTION: Health care networks are critical in assisting the elderly population in several aspects. Home care, the Senior Companion Program [Programa Acompanhante de Idosos] of São Paulo Municipal Health Departament and institutions for the aged compose networks to assist the elderly. It is necessary to analyze how the network is established between these services and features that demand care. OBJECTIVE: To describe and compare home care services, the Senior Companion Program, and institutions for the aged as to possible differences and similarities, user's demand, flow and care management services. METHODS: We carried out a non-exhaustive literature review of national literature published in electronic databases SciELO and LILACS in literary and electronic references in the period from 1997 to 2012. RESULTS: In total, 32 studies were included in the review. It was observed that the served population is predominantly female, with advanced age, and receive multidisciplinary care. Home care services and the Senior Companion Program value the maintenance of family and community as a setting, delaying institutionalization. The presence of the caregiver showed up as one of the most influential factors for the permanence of home care. CONCLUSION: It is concluded that the revised services have objectives that address the needs of the elderly. It is expected that the integration of health facilities establish their actions according to the profile of the elderly and characteristics of care offered at each service. .
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Introdução: Quedas são um problema clínico comum nos idosos, que pode reduzir sua mobilidade e independência. O uso de instrumentos simples para detecção do risco de quedas é fundamental para prevenção e tratamento de tais eventos. Não há, porém, consenso quanto aos testes mais adequados para cada situação. Objetivo: Revisar estudos sobre eficácia, sensibilidade e especificidade dos testes Timed Up and Go Test e Berg Balance Scale, a fim de verificar qual é o mais apropriado para predizer quedas em idosos. Métodos: Realizou-se revisão bibliográfica nas bases de dados MEDLINE, PubMed, ISI, LILACS e Portal de Periódicos CAPES, entre os anos de 2001 e 2011. Resultados: Foram selecionados 37 artigos, sendo 17 sobre a Berg Balance Scale e 20 sobre o Timed Up and Go Test. A revisão mostrou que os dois testes podem ser bons preditores de quedas, mas os artigos diferiram quanto à definição de queda e caidor, tipo de estudo, quantidade e característica da amostra e avaliação de quedas, levando a diferentes resultados quanto a nota de corte, sensibilidade, especificidade e predição de quedas. Há controvérsias quanto à capacidade de predição em perfis específicos, como os idosos ativos. Conclusão: Os testes avaliados são eficazes para predição de quedas, desde que adaptados para cada perfil. Novos estudos devem ser realizados com metodologia homogênea, a fim de favorecer a comparação de resultados sobre a eficácia desses testes. .
Introduction: Fall is a common problem in the elderly and it can reduce their mobility and independence. The use of simple tools to detect risk of falls is essential to prevent and treat such events. However, there is no consensus about the most appropriate tools for each situation. Objective: To review studies about efficacy, sensitivity and specificity of Timed Up and Go Test (TUGT) and Berg Balance Scale (BBS) in order to ascertain which is the most appropriate to predict falls in the elderly. Methods: We performed a literature review from MEDLINE, PubMed, ISI, LILACS and Portal de Periódicos CAPES databases, between 2001 and 2011. Results: We selected 17 different articles about BBS and 20 articles about TUGT. The review showed the two tools can be good predictors of falls. However, the articles differed in definition of fall and faller, type of study, quantity and characteristics of sample and assessment of falls, leading to different results as cutoff scores, sensitivity, specificity and prediction of fall. There is controversy about the ability of tools to predict falls in specific samples, such as active elderly. Conclusion: TUGT and BBS are effective to predict falls, provided they are adapted to each sample. Further studies should be performed using articles with homogeneous methods in order to support comparison of results about the effectiveness of tools. .
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Dementia is a common disabling disease in the elderly. In such patients, general health conditions may worsen the functional decline and loss of autonomy. The Comprehensive Geriatric Assessment (CGA) is a validated and recommended instrument for multidimensional evaluation of the aged. Nonetheless, it has yet to be assessed in demented patients. OBJECTIVES: To analyze the functional, emotional and clinical status in elderly with dementia measured by the CGA. We also compared the results obtained in the same patients stratified for severity of dementia. METHODS: Transversal study with demented elderly outpatients. Subjects were evaluated by the CGA consisting of clinical data, Clinical Dementia Rating, performance-oriented mobility assessment of gait and balance (POMA), Cornell scale for depression, activities of daily living, Mini Mental Status Examination (MMSE), Mini Nutritional Assessment, Whispered and Snellen Test. RESULTS: Fifty-two patients with mean age of 77 years were evaluated. Majority of patients had Alzheimer disease (77%). Depression was the most prevalent comorbidity. The POMA score was related to the number of falls in the previous year. Also, there was correlation between complaints of visual and hearing impairment and the results on the Snellen and Whispered Tests. Regarding severity, 56% presented mild, 33% moderate and 11% severe condition. Patients with moderate/severe dementia had less leisure activities, greater risk of falls, along with worse performance on the MMSE, POMA and activities of daily living. CONCLUSIONS: The CGA was applied in demented elderly with the help of their caregivers, and was able to better characterize patient state of health. Subjects with moderate/severe dementia obtained poor results in several assessed criteria.
Demência é uma doença comum e incapacitante entre os idosos. Nesses pacientes, condições gerais de saúde podem agravar ainda mais o declínio funcional e a perda da autonomia. A Avaliação Geriátrica Global (AGG) é um instrumento validado e recomendado para uma abordagem multidimensional do idoso, porém, ainda pouco estudada em pacientes com demência. OBJETIVO: Analisar o estado funcional, emocional e clínico dos idosos portadores de demência através da aplicação da AGG. Nós também comparamos os resultados obtidos nos mesmos pacientes classificados de acordo com a gravidade da demência. MÉTODOS: Estudo transversal com idosos ambulatoriais portadores de demência. Eles, acompanhados de seus cuidadores, foram submetidos à AGG que constava de dados clínicos, escore clínico de demência, escala do equilíbrio e marcha de Tinetti (EEMT), escala de Cornell para depressão, atividades de vida diária, mini exame do estado mental (MEEM), mini avaliação nutricional e Testes do Sussurro e Snellen. RESULTADOS: Cinqüenta e dois idosos com idade média de 77 anos. A maioria possuía doença de Alzheimer (77%). A comorbidade mais prevalente foi depressão. A pontuação na EEMT relacionou-se com o número de quedas no último ano. Houve também correlação entre a queixa de déficit auditivo e visual com os resultados dos Testes do Sussurro e Snellen. Em relação à gravidade obteve-se: 56% leve, 33% moderada e 11% grave. Os pacientes com demência moderada/grave apresentaram menos atividades de lazer, maior risco para quedas, pior desempenho no MEEM, na EEMT e nas atividades de vida diária. CONCLUSÕES: A AGG foi realizada nos idosos portadores de distúrbios cognitivos com o auxílio do cuidador, e foi capaz de caracterizar melhor o estado geral de saúde desses pacientes. Indivíduos com demência moderada/grave obtiveram piores resultados em diversos critérios avaliados.
RESUMO
Objective: To evaluate the effect on quality of life of elderly people enrolled in the Grupo de Assistência Multidisciplinar ao Idoso Ambulatorial (GAMIA) of the Geriatric Service of the Hospital das Clínicas of the Faculdade de Medicina of Universidade de São Paulo. Methods: In 83 elderly participants of group between 2000 and 2002 the quality of life was assessed by the World Health Organization Quality of Life (WHOQOL-bref) at the beginning and the end of the program. Functionality was assessed by the Katz and Lawton scales and socio-demographic data were obtained from medical charts. Results: Females predominated (79.5%) and overall mean age was 69.30 years. Data analysis showed a reduction in the physical domain of WHOQOL-bref (p = 0.014) and increased psychological health and environment domains (p = 0.029 and p = 0.007 respectively), detecting a trend of increase in social relationships and in general domains (p = 0.062 and p = 0.052 respectively). Conclusions: The clinical evaluation of elderly may have the predominant factor for the deterioration of their perception in the physical domain because of the detection of previously unknown diseases and determination of the use of new drugs. Improvement in psychological health and the environment can be related to psychological and social support that the elderly received from peers and professionals and the benefits of group activities, as well as the upward trend observed in the social relationships and general domains. Participation in a program to promote healthy aging was effective in improving the quality of life of the elderly.
Objetivo: Avaliar os efeitos na qualidade de vida de idosos matriculados no Grupo de Assistência Multidisciplinar ao Idoso Ambulatorial (GAMIA) do Serviço de Geriatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Métodos: Nos 83 idosos participantes do grupo entre 2000 e 2002, a qualidade de vida foi avaliada pelo World Health Organization Quality of Life (WHOQOL-bref) no início e no fim do programa. A funcionalidade foi avaliada pelas Escalas de Katz e Lawton e os dados sociodemográficos foram obtidos nos prontuários. Resultados: Houve predomínio do sexo feminino (79,5%) e a média geral de idade foi de 69,30 anos. A análise dos dados mostraram uma redução no domínio físico do WHOQOL-bref (p = 0,014) e a elevação dos domínios psicológico e meio ambiente (p = 0,029 e p = 0,007, respectivamente), detectando-se tendência de elevação nos domínios relações sociais e geral (p = 0,062 e p = 0,052, respectivamente). Conclusões: Como a avaliação clínica desses idosos revelou doenças desconhecidas previamente e determinou a utilização de novos medicamentos, a percepção que os idosos tinham, em relação à sua saúde, pode ter sido o fator preponderante para a piora no domínio físico. A melhora dos domínios psicológico e meio ambiente pode estar relacionada ao suporte psicológico e social que o idoso recebeu dos colegas e profissionais e dos benefícios das atividades em grupo, bem como às tendência de elevação observada nos domínios relações sociais e geral. A participação em um programa de promoção do envelhecimento saudável mostrou-se eficaz na melhora da qualidade de vida do idoso.
Assuntos
Humanos , Feminino , Idoso , Masculino , Envelhecimento , Qualidade de Vida , Inquéritos e QuestionáriosRESUMO
There is no consensus in the medical literature about the impact of depressive symptoms on the evolution of Alzheimers disease (AD). Objective: To compare the evolution of AD patients, with and without depressive symptoms, in terms of cognition, functionality and caregiver stress. Methods: The study entailed 2 stages: an initial retrospective stage involving review of medical charts of patients with mild and moderate AD. Patients were divided according to the presence or absence of depressive symptoms, defined by medical interview and questions on depressed mood from the CAMDEX (Cambridge Examination for Mental Disorders of the Elderly) and Neuropsychiatric Inventory (NPI). Twenty-nine patients were evaluated, 37.9% with depression (Group D+) and 62.1% without depression (Group D). The groups were compared regarding demographic and medical characteristics, cognitive and functional performance, presence of apathy as a separate symptom, and caregiver stress, using standardized tests and questionnaires. In the second transversal step, the same tools were reapplied after 2 to 4 years of follow-up, and evolution for the two groups was compared. Results: The two groups were highly homogeneous in demographic and clinic characteristics, as well as in length of follow-up, and presented no significant difference in cognitive or functional evaluation at the time of diagnoses or after follow-up. Only caregiver stress was greater in Group D+ at the two time points (p<0.001). Conclusions: No differences in the evolution of AD patients with or without depressive symptoms were evident. Nevertheless, these symptoms were associated to emotional burden of caregivers.
Não há consenso na literatura sobre o impacto dos sintomas depressivos na evolução da doença de Alzheimer (DA). Objetivo: Comparar a evolução de pacientes com DA, com e sem sintomas depressivos, quanto à cognição, à funcionalidade e estresse do cuidador. Métodos: O estudo incluiu duas etapas: a primeira retrospectiva, com revisão de prontuários de pacientes com DA leve e moderada, divididos conforme presença ou ausência de sintomas depressivos, definidas por anamnese e questões referentes a humor deprimido do CAMDEX (Cambridge Examination for Mental Disorders of the Elderly) e Interrogatório Neuro-psiquiátrico (INP). Foram avaliados 29 pacientes, 37,9% com (D+) e 62,1% sem depressão (D?). Os grupos foram comparados quanto a variáveis demográficas, clínicas e quanto ao desempenho cognitivo, funcionalidade, presença de apatia do paciente e estresse do cuidador, através de questionários e testes padronizados. Na segunda etapa, transversal, foram reaplicados os mesmos instrumentos após 2 a 4 anos de acompanhamento, comparando-se a evolução nos dois grupos. Resultados: Os grupos, homogêneos segundo variáveis demográficas, clínicas e tempo de evolução, não apresentaram diferença significante nos testes cognitivos e na avaliação funcional, no momento do diagnóstico, e ao longo da evolução. Quanto ao estresse do cuidador, foi maior no grupo D+ nos dois momentos (p<0,001). Conclusões: Não se constatou diferença na evolução de pacientes com DA com ou sem sintomas depressivos. No entanto, tais sintomas se relacionaram a maior sobrecarga emocional do cuidador, no momento do diagnóstico e na evolução.
Assuntos
Humanos , Doença de Alzheimer , Cognição , Demência , Depressão , Pessoal de SaúdeRESUMO
JUSTIFICATIVA E OBJETIVOS: Os idosos representam uma população heterogênea, principalmente nos extremos etários, em que há predomínio de doenças crônico-degenerativas com diferentes impactos sobre a qualidade de vida (QV). O objetivo deste estudo foi avaliar e comparar a QV de idosos jovens e muito idosos.MÉTODO: Estudo transversal constituído por idosos em seguimento ambulatorial de um hospital-escola, distribuídos por faixa etária em dois grupos: G1 - idosos jovens (60-70 anos) e G2 - muito idosos (85 anos ou mais). Utilizou-se um questionário auto-aplicativo de QV para idosos, da Organização Mundial de Saúde (WHOQOL-OLD), composto por 6 domínios: funcionamento dos sentidos, autonomia, morte e morrer, atividades passadas, presentes e futuras, participação social e intimidade. As respostas dos dois grupos foram avaliadas e comparadas.RESULTADOS: Foram avaliados 69 idosos, sendo 35 do G1 e 34 do G2. Em ambos, houve predomínio do sexo feminino, sedentários, independentes para atividades básicas de vida diária, com média de 8 comorbidades. A média do escore total do WHOQOL-OLD foi 84,08 para o G1 e 83,32 para o G2. CONCLUSÃO: Observou-se boa qualidade de vida na população estudada. A comparação entre os grupos mostrou que a QV não parece decair com a idade.
BACKGROUND AND OBJECTIVES: Elderly represents a heterogeneous population, mainly in the extreme age, in which there is a predominance of chronic-degenerative diseases with different impacts on the quality of life (QL). This study aimed to evaluate and compare the quality of life of elderly young and very old.METHOD: Cross-sectional study consisting of elderly in outpatient follow-up of a hospital, distributed into two groups: G1 - elderly young (60-70 years) and G2 - very old (85 and over). The World Health Organization questionnaire (WHOQOL-OLD) was used composed of 6 domains: sensory function, autonomy, death-dying, past-present-future activities, social participation and intimacy. The answers of two groups were evaluated and compared.RESULTS: This study evaluated 69 elderly, 35 in G1 and 34 in G2. In both, there was a predominance of females, averaging 8 comorbidity, sedentary and independent for basic activities of daily living. The total average score WHOQOL-OLD was 84.08 between G1 and 83.32 between G2.CONCLUSION: A good quality of life was observed in the studied population. The comparison between groups showed that the QF does not seem to decline with age.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Idoso , Longevidade , Qualidade de VidaRESUMO
Introdução: O pé é uma unidade funcional importante no controle da postura, manutenção do equilíbrio e na execução dos movimentos. Essas funções dependem da integridade anatômica e funcional de suas estruturas que, com frequência, são alteradas com o envelhecimento. Objetivos: identificar alterações dos pés; verificar requisitos cinético-funcionais(equilíbrio, mobilidade, flexibilidade do tornozelo, força muscular), queda no último ano e a correlação entre eles e com a incidência de quedas. Método: Trata-se de um estudo transversal, na qual participaram 25 indivíduos (70,68+-4,7 anos) do Grupo de Atendimento Multidisciplinar ao Idoso Ambulatorial do Serviço de Geriatria do Hospital das Clínicas de São Paulo. Foram utilizados: 1) questionário para identificar as alterações dos pés e ocorrência de quedas, 2)flexímetro para a flexibilidade do tornozelo, 3) alcance funcional ântero-posterior e o 'Timed get-up and go" para equilíbrio, e 4) teste de levantar-sentar da cadeira para medida indireta da força dos membros inferiores. Foi realizada análise estatística descritiva das variáveis e a correlação de Pearson para verificar a correlação entre os dados (pmenor 0,05). Resultados: As alterações mais frequentes dos pés foram: calosidades nos dedos (80 por cento), rachaduras nos calcanhares (80 por cento), unhas quebradiças, encravadas e compridas (76 por cento; 32 por cento e 28 por cento respectivamente) e deformidades nos dedos (24 por cento). Unha encravada, deformidades nos dedos e unhas quebradiças apresentaram correlação significativa com a flexibilidade do tornozelo direito (r=0,451 e p=0,02) e quedas (r=0,459 e p=0,02), respectivamente. Conclusões: Há uma correlação entre as alterações dos pés com os requisitos cinético-funcionais e com a incidência de queda do idoso. A maioria das alterações identificadas é potencialmente modificável através da presenvação, tratamento curativo e reabilitação.
Assuntos
Humanos , Masculino , Feminino , Idoso , Equilíbrio Postural , Força Muscular , Geriatria , Idoso , MaleabilidadeRESUMO
OBJECTIVE: To describe item reduction and its distribution into dimensions in the construction process of a quality of life evaluation instrument for the elderly. METHODS: The sampling method was chosen by convenience through quotas, with selection of elderly subjects from four programs to achieve heterogeneity in the "health status", "functional capacity", "gender", and "age" variables. The Clinical Impact Method was used, consisting of the spontaneous and elicited selection by the respondents of relevant items to the construct Quality of Life in Old Age from a previously elaborated item pool. The respondents rated each items importance using a 5-point Likert scale. The product of the proportion of elderly selecting the item as relevant (frequency) and the mean importance score they attributed to it (importance) represented the overall impact of that item in their quality of life (impact). The items were ordered according to their impact scores and the top 46 scoring items were grouped in dimensions by three experts. A review of the negative items was performed. RESULTS: One hundred and ninety three people (122 women and 71 men) were interviewed. Experts distributed the 46 items into eight dimensions. Closely related items were grouped and dimensions not reaching the minimum expected number of items received additional items resulting in eight dimensions and 43 items. DISCUSSION: The sample was heterogeneous and similar to what was expected. The dimensions and items demonstrated the multidimensionality of the construct. The Clinical Impact Method was appropriate to construct the instrument, which was named Elderly Quality of Life Index - EQoLI. An accuracy process will be examined in the future.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação Geriátrica , Qualidade de Vida/psicologia , Inquéritos e Questionários , Atividades Cotidianas , Fatores Etários , Brasil , Atividade Motora/fisiologia , Psicometria , Autoavaliação (Psicologia) , Fatores SexuaisRESUMO
PURPOSE: To describe the initial steps of the construction process of a quality of life evaluation instrument for the elderlythe theoretic-conceptual framework for the construct, Quality of Life in Old Age; the construction methodology; and the generation of relevant items. METHODS: The first step was to conceptualize and define the construct, determining how much the elderly are able to perform of what they believe to be important in their lives and whether they are satisfied with what was possible to perform. The next step was to select and describe the construction methodology (the Clinical Impact Method) and the phase of generation of relevant items for the research object. The necessary procedures were delineated through a pilot study, which helped to establish all phases of the used methodology. The viability of the construction of the Quality of Life in Old Age evaluation instrument was demonstrated along with the needed adaptations. RESULTS: From 1032 answers by older people, 138 relevant items for the construct were identified by the items generation process. The pilot study demonstrated the suitability of the application of the methodology and established modifications to the preliminary items list, resulting in a new 139-item list. DISCUSSION: Now that the theoretical-conceptual framework of the construct as well as the construction methodology and the items generation are established, the next step will consist of administering the resulting list to a sample of elderly people for item reduction and distribution of items into dimensions.
OBJETIVO: Descrever os passos iniciais do processo de construção de um instrumento de avaliação de qualidade de vida de idosos: a base teórico-conceitual do constructo Qualidade de Vida na Velhice, a metodologia escolhida para a construção e a geração dos itens relevantes. MÉTODOS: O primeiro passo foi conceituar e definir o constructo, evidenciando o quanto os idosos realizam do que consideram importante para suas vidas e se estão satisfeitos com o que foi possível concretizar. O segundo, escolher e descrever a metodologia de construção (Método do Impacto Clínico) e a fase de geração de itens relevantes ao objeto de estudo. Através de estudo piloto, foram delineados os procedimentos necessários, estabelecendo-se todas as fases da metodologia. Demonstrou-se a viabilidade de seu emprego na construção de um instrumento de avaliação de qualidade de vida de idosos, com as adaptações necessárias. RESULTADOS: A geração de itens selecionou, de 1032 respostas de idosos, 138 itens relevantes ao constructo. O estudo-piloto mostrou a viabilidade de aplicação da metodologia e estabeleceu modificações na lista preliminar de itens, resultando nova lista (139 itens). DISCUSSÃO: Estabelecida a base teórico-conceitual do constructo e a metodologia de construção, selecionados os itens e realizado o piloto, a etapa seguinte consistirá em submeter a lista a uma amostra de idosos, para redução dos itens e distribuição em dimensões.