Deprescribing psychotropic drugs in a geriatric psychiatry outpatient clinic

Objective: To describe the psychotropic drug deprescription process in older patients of a geriatric psychiatry outpatient clinic. Methods: We conducted a quasi-experimental study of people aged ≥ 60 years who were treated at Hospital São Lucas' Geriatric Psychiatry Outpatient Clinic, which is affiliated with Pontifícia Universidade Católica do Rio Grande do Sul, Brazil. Data on 150 older people were collected from March 2021 to August 2022 and were evaluated by the pharmacists. The inclusion criteria were age ≥ 60 years, being a patient of the hospital's Geriatric Psychiatry Outpatient Clinic, use of at least one psychotropic drug, and agreeing to participate in the study. Those unable to report their medications and those who only came to the first appointment were excluded. Results: Overall, deprescription of at least one psychotropic drug was indicated in 61.3% (n = 92) of the participants, and it was effectively implemented in 68.5% (n = 63) of this group. Deprescribing, which was more frequent in the youngest age group (60­69 years) (p = 0.049), was indicated for 37.4% (n = 136) of psychotropic drugs, 67.6% (n = 92) of which were effectively deprescribed. The main classes indicated for deprescription were hypnotics and sedatives (90.0%; n = 18) and anxiolytics (73.3%; n = 11). Conclusions: At least 1 psychotropic drug was indicated for deprescription in the majority of the patients, and in most cases it was effectively implemented. One-third of the prescribed psychotropic drugs were indicated for deprescription, and more than half were successfully deprescribed. (AU)

Translation and Brazilian adaptation of the Relationship Scales Questionnaire (RSQ).

OBJECTIVES: To describe the process of translating and adapting the Relationship Scales Questionnaire (RSQ) from English into Brazilian Portuguese and to present the results of its test-retest reliability using the version developed for interview application. METHODOLOGY: The process was based on the guidelines of the International Society for Pharmaeconomics and Outcomes Research (ISPOR), which propose 10 steps for the translation and cross-cultural adaptation of self-administered instruments. The original authors of the RSQ have agreed to the translation. The interview version was applied to a sample of 43 healthy elders (≥60 years old) enrolled in a primary health care program in the city of Porto Alegre, state of Rio Grande do Sul, southern Brazil, and then reapplied. The scores of the two applications were compared using the paired sample t-test. RESULTS: Only 6 of the 30 items required the adaptation of words or expressions to maintain its conceptual and semantic equivalence. The self-administered form of the RSQ posed difficulties for elders due to visual deficiencies and lower education level, both common in this age group, demonstrating a need for the development of a version of the RSQ in a structured interview format. Only the measure for secure attachment presented significant differences after the application of the retest, indicating reliability of the version being proposed. CONCLUSION: Translation of the RSQ is the first step towards the validation of an attachment evaluation instrument for use in the elderly population in Brazil, allowing for future studies on this topic.

Influence of childhood abuse and neglect subtypes on late-life suicide risk beyond depression.

The association of childhood maltreatment and suicide has been extensively examined within the population. Depression figures as a main cause for the elevated suicide rate in advanced ages and is often related to childhood maltreatment. The purpose of the present study was to examine the relationship between childhood maltreatment subtypes and suicide risk, testing geriatric depression as a moderator. This is a cross-sectional study looking at a sample of 449 individuals 60 year s old or older from the Multidimensional Study of the Elderly of Porto Alegre Family Health Strategy, Brazil (EMI-SUS/POA). Childhood maltreatment (Childhood Trauma Questionnaire), geriatric depressive symptoms (Geriatric Depression Scale), and suicide risk (Mini International Neuropsychiatric Interview) were assessed. The subtypes of childhood abuse and neglect were significantly associated with suicide risk. In the multivariate analysis, controlling for age, gender, income, marital status, ethnicity, smoking, and geriatric depression symptoms, all trauma subtypes remained associated with suicide risk with the exception of physical neglect (EA = 3.65; PA = 3.16; SA = 5.1; EN = 2.43; PN = 1.76). The present study showed that childhood maltreatment subtypes predicted suicide risk, and geriatric depression does not directly mediate this relation.

The process of deprescribing in older adults: a methodological protocol / Processo de desprescrição em idosos: protocolo metodológico

Objective: To report, by means of a methodological protocol, the process of deprescribing implemented in a geriatric psychiatry outpatient clinic of a teaching hospital. Methods: The topic of interest was comprehensively reviewed in the scientific literature. Instruments and tools necessary to develop the protocol were selected, including the Treatment Adherence Measure, Beers criteria, the EURO-FORTA List, the Brazilian Consensus on Potentially Inappropriate Medications for Older Persons, Drugs.com, and deprescribing algorithms. Results: The protocol consists of the following steps: 1) Review: Assess older patients' physical and behavioral status and family context and list all medications used; 2) Analyze: Review patients' drug therapy; 3) Act: Initiate deprescribing (if indicated); 4) Adjust: Discuss patients' expectations, beliefs, and preferences and adjust the prescription to their real possibilities; 5) Monitor: Identify responses to treatment, assess adherence to the deprescribing process, and detect return of symptoms or worsening of the underlying disease. Conclusions: Health care professionals need to work together to provide comprehensive care for older persons. The inclusion of deprescribing in more research groups focused on the geriatric population will increase attention to the safety of pharmacological treatment for older patients.

Objetivo: Relatar como ocorre o processo de desprescrição em um ambulatório de Psiquiatria Geriátrica de um hospital universitário, por meio de um protocolo metodológico. Metodologia: O assunto foi revisado na literatura científica e foram selecionados instrumentos e ferramentas necessários para desenvolver o protocolo, incluindo a Medida de Adesão aos Tratamentos, o Critério de Beers, a Lista Fit for the Aged (EURO-FORTA), o Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos, Drugs.com e algoritmos de desprescrição. Resultados: O protocolo elaborado é composto das seguintes etapas: 1) revisar: avaliar o estado físico e comportamental e o contexto familiar do idoso e listar todos os medicamentos utilizados; 2) analisar: revisar a farmacoterapia do paciente; 3) agir: iniciar a desprescrição (se tiver indicação); 4) ajustar: pactuar expectativas, crenças e preferências do paciente, adaptando a prescrição às suas reais possibilidades; 5) monitorar: verificar as respostas ao tratamento, avaliar a adesão à desprescrição, detectar ressurgimento dos sintomas ou agravamento da doença de base. Conclusões: Os profissionais da saúde precisam trabalhar em conjunto para proporcionar atenção completa ao idoso. A inserção da desprescrição em mais grupos de pesquisa com o foco na população geriátrica possibilitará maior atenção à segurança dos tratamentos farmacológicos dos pacientes.

Association between Big Five personality factors and medication adherence in the elderly

Abstract Introduction Adherence to medications can be associated with circumstances related to the patient, with the pathology, with cultural health beliefs, with habits, and with quality of life. Behavioral patterns can also directly influence a patient's pharmacological adherence, since they are related to their perception and understanding of their own health status and of their drug and non-drug treatments. Objective To investigate the association between adherence to pharmacological treatment and personality factors, sociodemographic variables, and economic data in the elderly. Methods Cross-sectional descriptive study. The population studied were elderly people registered with the Family Health Strategy of Porto Alegre and enrolled on the Brain Aging Program (PENCE), from March 2013 to November 2015. Sociodemographic data, pharmacological adherence, and personality traits were evaluated. Exclusion criteria were incomplete data in the personality and pharmacological adherence assessments; cognitive impairment, evaluated using the instrument Mini-Mental State Examination (MMSE), or not having carried out this assessment. Results A total of 123 individuals were included with a mean age of 71.35±7.33 years, 58.6% of whom reported some level of non-adherence to their medication regime (low and moderate adherence). Elderly people with low adherence had significantly higher mean scores in the Neuroticism factor, while those with high adherence had significantly higher mean scores in the Agreeableness and Conscientiousness factors. Conclusion The study suggests that pharmacological adherence among the elderly is negatively associated with the Neuroticism personality trait, while the Agreeableness and Conscientiousness traits are positively associated.

Patterns of alcohol use in an elderly sample enrolled in the Family Health Strategy program in the city of Porto Alegre, Brazil.

This article aims to determine the pattern of alcohol use in the elderly and its associations with sociodemographic characteristics in an elderly sample of patients from the city of Porto Alegre, Rio Grande do Sul, Brazil. A cross-sectional study was conducted involving 557 seniors, aged 60 years or more, through application of the Mini International Neuropsychiatric Interview and a global assessment questionnaire for the elderly. The majority of the 557 senior citizens did not complete elementary school (58.3%), were white (65.1%), married (37.6%), had no caregiver (62.2%), were catholic (65.5%) and practicing their religion (68.6%), were retired (67.7%), and had a personal income of up to one minimum salary (56.1%). The study revealed 67 (12%) elderly people with a history of alcoholism, of which 17 (3.1%) had a diagnosis of current alcoholism, 50 (9%) had a history of alcohol dependence in the past and 16 (2.9%) had a current alcohol abuse problem. Men had a prevalence ratio of 11.6 times for a history of alcoholism in comparison to women. The results confirm that alcoholism is frequent in the population of Brazilian elderly, drawing attention to some socio-demographic characteristics that can make a difference in the early diagnosis of alcoholism.

Potentially inappropriate medication and associated factors such as depression and dementia: An analysis of middle-aged and elderly people / Prevalência de medicamentos potencialmente inapropriados e fatores associados, como depressão e demência: uma análise de pessoas de meia-idade e idosos

AIMS: To establish the frequency potentially inappropriate medications use and the associated factors, such as signs and symptoms of depression and cognitive deficit among middle-aged and elderly people. METHODS: A cross-sectional population study was performed with 2,350 people, aged between 55-103 years, registered in the primary health care. Potentially inappropriate medications were defined by updated 2019 Beers criteria. Studied variables were sociodemographic, lifestyle and health, and signs and symptoms of depression and cognitive deficit. Multinomial regression analysis was executed. RESULTS: The frequency of potentially inappropriate medications use was 65.4%. Former and current smokers, regular self-perception of health, polypharmacy, and individuals with signs and symptoms of depression and cognitive deficit were significantly associated with potentially inappropriate medications use. Antiarrhythmics, antihistamines and antiadrenergic agents were the highest potentially inappropriate medications classes used for individuals with signs and symptoms of depression and cognitive deficit. CONCLUSIONS: The frequency of use of potentially inappropriate medications is high among middle-aged people, a population that was previously under-researched, as well as among elderly people. Cognitive impairment alone or together with depression symptoms were associated factor for a potentially inappropriate medications use. Knowledge of the pharmacoepidemiology of potentially inappropriate medications is an important for the promotion of the rational use of drugs in public health.

OBJETIVOS: Estabelecer a frequência de uso de medicamentos potencialmente inapropriados e fatores associados, tais como sinais e sintomas de depressão e déficit cognitivo, em indivíduos de meia-idade e idosos. MÉTODOS: Estudo transversal de base populacional com 2.350 indivíduos, de idade entre 55 e 103 anos, cadastrados na atenção primária à saúde. Medicamentos potencialmente inapropriados foram definidos pelos Critérios Beers atualizados em 2019. As variáveis estudadas foram sociodemográficas, estilo de vida, clínicas, bem como sinais e sintomas de depressão e déficit cognitivo. Foi realizada análise de regressão multinomial. RESULTADOS: A frequência de uso de medicamentos potencialmente inapropriados foi de 65,4%. O uso de medicações potencialmente inapropriadas foi significativamente associado a indivíduos ex-fumantes e fumantes atuais, com autopercepção de saúde regular, usuários de polifarmácia e com sinais e sintomas de depressão e déficit cognitivo. Antiarrítmicos, anti-histamínicos e antiadrenérgicos foram as classes de medicamentos potencialmente inapropriados mais utilizada pelos indivíduos com sinais e sintomas de depressão e déficit cognitivo. CONCLUSÕES: A frequência de utilização de medicamentos potencialmente inapropriados é alta em pessoas de meia-idade, faixa etária pouco pesquisada, bem como em idosos. O comprometimento cognitivo, isoladamente ou em conjunto com sintomas de depressão, foi um fator associado ao uso de medicações potencialmente inapropriadas. O conhecimento da farmacoepidemiologia de utilização de medicamentos potencialmente inapropriados é importante para a promoção do uso racional de medicamentos na saúde pública.

Prevalence and correlates of generalized anxiety disorder among elderly people in primary health care / Prevalência e correlatos do transtorno de ansiedade generalizada em idosos atendidos em atenção primária

OBJECTIVE: To examine the prevalence of generalized anxiety disorder (GAD) and its associations with sociodemographic and health factors. METHODS: A cross-sectional study with a population-based sample of 578 individuals aged 60 years or older from the Family Health Strategy (FHS) program of Porto Alegre, RS, Brazil. Home visit screening and general data collection were made by trained Community Health Workers (CHWs). Diagnoses of psychiatric disorders were made by board-certified psychiatrists using the Mini International Neuropsychiatric Interview plus (MINIplus) in the Hospital São Lucas of the Pontifical University of Rio Grande do Sul (PUCRS). RESULTS: GAD was found in 9% of the sample (n = 52; CI 95% = 6.9-11.6). The main results of the multivariate analysis show associations between GAD and retirement (PR: 0.43, CI: 0.25-0.76), history of falls (PR: 2.52, CI: 1.42-4.49), cohabitation with four or more people (PR: 1.80, CI: 1.04-3.13), having more than one hospitalization in the last year (PR: 2.53, CI: 1.17-5.48) and self-perception of health as regular (PR: 2.75, CI: 1.02-7.47). Retirement in the elderly shows 2.32x less risk of GAD, although confounding factors may have overestimated this finding and underestimated the association with female gender (PR: 1.61, CI: 0.83-3.10). CONCLUSIONS: We estimate a high prevalence of GAD in this population. Associations were found between GAD and health self-perceived as regular, cohabitation with four or more people, history of falls and more than one hospitalization in the last year. These epidemiological data from the Family Health Strategy are important to develop further strategies for this age group that could improve the health care practice.

OBJETIVO: Examinar a prevalência do transtorno de ansiedade generalizada (TAG) em idosos e suas associações com fatores sociodemográficos e de saúde. MÉTODOS: Estudo transversal, composto por uma amostra de base populacional de 578 indivíduos com 60 anos ou mais, participantes do programa Estratégia Saúde da Família (ESF) de Porto Alegre, RS, Brasil. Agentes de saúde treinados realizaram coleta de dados dos indivíduos durante as visitas domiciliares. A avaliação diagnóstica psiquiátrica foi realizada por psiquiatras, no Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), por meio da aplicação do Mini International Neuropsychiatric Interview plus (MINIplus). RESULTADOS: O TAG foi encontrado em 9% (n = 52; IC 95% = 6,9-11,6) da amostra. Os principais resultados da análise multivariada evidenciaram associações entre TAG e aposentadoria (RP: 0,43; IC: 0,25-0,76), história de quedas (RP: 2,52; IC: 1,42-4,49), coabitação com quatro ou mais pessoas (RP: 1,80; IC: 1,04-3,13), ter mais de uma hospitalização no último ano (RP: 2,53, IC: 1,17-5,48) e autopercepção de saúde avaliada como regular (RP: 2,75, IC: 1,02-7,47). Idosos aposentados apresentaram risco 2,32 menor de TAG, embora fatores confundidores possam ter superestimado esse achado e subestimado a associação com gênero feminino (RP: 1,61; IC: 0,83-3,10). CONCLUSÕES: Estimou-se uma alta prevalência de TAG nessa população de idosos. Foram encontradas associações de TAG com autopercepção de saúde regular, coabitação com quatro ou mais pessoas, mais de uma hospitalização no último ano e história de quedas. Esses dados oriundos da Estratégia Saúde da Família são importantes para o desenvolvimento de estratégias adicionais que possam melhorar a prática de assistência à saúde na população idosa.

Screening for depressive symptoms in older adults in the Family Health Strategy, Porto Alegre, Brazil.

OBJECTIVE To analyze the prevalence of depression in older adults and associated factors. METHODS Cross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity. RESULTS The prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p < 0.001). The variables independently associated with depression were: female gender (PR = 1.4, 95%CI 1.1;1.8); low education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression. CONCLUSIONS A high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults.

Associação entre maus-tratos na infância e declínio cognitivo no idoso: uma revisão integrativa / Association between maltreatment in childhood and cognitive decline in the elderly: an integrative review

A violência contra a criança representa um importante problema de saúde pública, assim como o declínio cognitivo. A ligação entre essas variáveis vem sendo analisada cada vez mais, porque o estresse experimentado nos primeiros anos de vida pode estar relacionado a mudanças estruturais, funcionais e epigenéticas nas regiões cerebrais envolvidas na cognição. O objetivo deste estudo foi analisar essa associação, por meio de uma revisão integrativa da literatura, pelo meio da pesquisa bibliográfica das seguintes bases de dados: SciELO, LILACS, PUBMED e PsycINFO. O período de seleção dos artigos compreendeu os últimos cinco anos. No total, foram 33 artigos, dos quais dez eram artigos originais que focaram na relação entre maus-tratos na infância e declínio cognitivo em idosos. A presença de maus-tratos na infância possui associação com o declínio da função cognitiva no idoso, agravando-o sobremaneira e inclusive podendo colocar os indivíduos em risco de declínio cognitivo acentuado. Uma das limitações deste estudo foi a percepção de que a temática ainda carece de mais e melhores estudos que abordem esta relação na prática, por meio de estudos longitudinais.

Violence against children and cognitive decline are highly relevant issues for health. The bond between the variables is increasingly being analyzed, since stress early in life may be related to structural, functional and epigenic changes in brain regions involving cognition. Current study analyzes such association through an integrative review of the literature and by bibliographical research retrieved from SciELO, LILACS, PUBMED and PsycINFO during the last five years. Thirty-three original scientific articles were analyzed, with ten related to maltreatment in childhood and cognitive decline in the elderly. Maltreatment in childhood is associated with possible high cognitive decline in old age. A limit in current study was the perception that the theme required more investigation within longitudinal studies.

Suicide risk in the elderly: data from Brazilian public health care program.

OBJECTIVE: Examine prevalence and level of suicide risk, and its associations with sociodemographic factors and mood disorders. METHODS: A cross-sectional study with a random sample of 530 individuals aged 60 years or more from Family Health Strategy of Porto Alegre, Brazil. Diagnosis was made by psychiatrists using the Mini International Neuropsychiatric Interview plus (MINIplus). RESULTS: Suicide risk was found in 15.7% of the sample. Female gender, elderly with no income or with no paid activity and those who have lost one or more of his sons presented association with suicide risk. Bipolar disorder shows association with suicide risk for those with or without current episode. For unipolar depression only elderly with a current episode shows association with suicide risk. LIMITATIONS: The cross-sectional design limits the examination of causative relationships. The MINIplus questions are not broad enough to assess other important self-destructive behaviors. CONCLUSIONS: A high rate of suicide risk was found. As expected an increased rate of mood disorders were related to the risk of suicide. The loss of sons may partly explain a subtype of late-life risk of suicide or mood disorders especially in the oldest-old. These findings can be a useful to generate other research hypothesis and for health professionals who care older persons. Detecting characteristics linked to suicide, therefore opening up the possibility of preventing tragic outcomes providing a proper treatment.

Translation and Brazilian adaptation of the Relationship Scales Questionnaire (RSQ) / Tradução e adaptação brasileira do Relationship Scales Questionnaire (RSQ)

Abstract Objectives To describe the process of translating and adapting the Relationship Scales Questionnaire (RSQ) from English into Brazilian Portuguese and to present the results of its test-retest reliability using the version developed for interview application. Methodology The process was based on the guidelines of the International Society for Pharmaeconomics and Outcomes Research (ISPOR), which propose 10 steps for the translation and cross-cultural adaptation of self-administered instruments. The original authors of the RSQ have agreed to the translation. The interview version was applied to a sample of 43 healthy elders (≥60 years old) enrolled in a primary health care program in the city of Porto Alegre, state of Rio Grande do Sul, southern Brazil, and then reapplied. The scores of the two applications were compared using the paired sample t-test. Results Only 6 of the 30 items required the adaptation of words or expressions to maintain its conceptual and semantic equivalence. The self-administered form of the RSQ posed difficulties for elders due to visual deficiencies and lower education level, both common in this age group, demonstrating a need for the development of a version of the RSQ in a structured interview format. Only the measure for secure attachment presented significant differences after the application of the retest, indicating reliability of the version being proposed. Conclusion Translation of the RSQ is the first step towards the validation of an attachment evaluation instrument for use in the elderly population in Brazil, allowing for future studies on this topic.

Resumo Objetivos Descrever o processo de tradução e adaptação cultural do questionário Relationship Scales Questionnaire (RSQ) do inglês para o português do Brasil e apresentar os resultados de confiabilidade teste-reteste utilizando a versão desenvolvida para aplicação em entrevista. Metodologia O método utilizado teve como diretriz a proposta da International Society for Pharmaeconomics and Outcomes Research (ISPOR), de 10 passos para a tradução e adaptação transcultural de instrumentos autoaplicáveis. Os autores originais do RSQ concordaram com a tradução. A versão para entrevista dirigida foi aplicada em uma amostra de 43 idosos saudáveis (≥60 anos) cadastrados em um programa de atenção primária à saúde na cidade de Porto Alegre, RS, sendo então reaplicada. As pontuações das duas aplicações foram comparadas usando o teste t de Student para amostras pareadas. Resultados Apenas 6 dos 30 itens precisaram de adaptação cultural de palavras ou expressões para manter sua equivalência conceitual e semântica. O formato autoaplicável do RSQ mostrou-se pouco adequado entre idosos, devido à presença comum de déficits visuais e baixa escolaridade, demonstrando a necessidade do desenvolvimento de uma versão do RSQ em formato de entrevista dirigida. Apenas a medida de apego seguro apresentou diferença significativa após a aplicação do reteste, indicando a confiabilidade da versão proposta. Conclusão A tradução do RSQ é o primeiro passo para a validação de um instrumento de avaliação de apego para a população idosa no Brasil, permitindo futuros estudos sobre o tema.

Prevalence and patterns of alcohol misuse in a community-dwelling elderly sample in Brazil.

OBJECTIVE: The aim of this study was to estimate prevalence and patterns of lifetime alcohol misuse. METHOD: This was a cross-sectional study of a representative sample of 1,078 individuals aged 60 or more. Structured interview included sociodemographic, lifestyle, health data, and the five alcohol misuse screening questions of the Self-Reporting Questionnaire. RESULTS: Prevalence of misuse was 6.5%. Men, aged 60 to 69, low educational level, separated/divorced, and tobacco smoking were independently associated with lifetime alcohol misuse. Odds ratios show increasing association with levels of alcohol misuse groups in males, low-educated, and tobacco users. Persons aged 60 to 69, 4 to 7 education years, and non-White ethnicity were significantly associated with the major alcohol misuse score. DISCUSSION: Younger elderly were more exposed to alcohol than previous cohorts. Thus, problems with alcohol in old age will possibly increase as they grow older. The results of this study call attention to a field of lacking evidence in alcohol-related problems of older persons.

Direitos trabalhistas dos cuidadores de idosos: uma revisão integrativa / Labor rights of caregivers of the elderly: integrative review / Derechos laborales de los cuidadores de ancianos: una revisión integrative

Revisão integrativa sobre os direitos trabalhistas dos cuidadores de idosos. Para tanto, foram selecionados artigos originais publicados nas bases de dados PePSIC; Lilacs; Medline; BDJur; Biblioteca Digital da Unicamp; Jurisprudência Unificada do Conselho de Justiça Federal; LATINDEX; LexML; NDLTD; OCLC-OAIster, encontrando-se seis estudos. Sugere-se que haja mais atenção com os direitos trabalhistas, a fim de tornar o cuidado efetivo tanto para quem cuida quanto para quem é cuidado.

Is an integrative review about labor rights of caregivers of the elderly. Articles published in databases were selected:PePSIC; Lilacs; Medline; BDJur; Digital Library of Unicamp; Unified Jurisprudence of the Federal Justice Council; LATINDEX; LexML; NDLTD; OCLC-OAIster, founding 6 studies. It is suggested that more attention with their labor rights, in order to make effective care for both caregivers and caregivers.

Revisión integrativa sobre los derechos laborales de los cuidadores de ancianos. Para ello, se seleccionaron artículos originales publicados en las bases de datos PePSIC; Lilacs; Medline; BDJur; Biblioteca Digital de la Unicamp; Jurisprudencia Unificada del Consejo de Justicia Federal; LATINDEX; LexML; NDLTD; OCLC-OAIster, encontrando 6 estudios. Se sugiere que haya más atención con los derechos laborales, a fin de hacer el cuidado efectivo tanto para quien cuida cuanto para quien es cuidado.

Prevalence of bipolar disorder in a sample of older adults / Prevalência de transtorno bipolar em uma amostra de idosos

AIMS: To estimate the prevalence of bipolar disorder in a sample of older adults and to examine associated socio-demographic and clinical factors. METHODS: Cross-sectional population-based study of individuals aged 60 years or older registered with the Family Health Strategy in Porto Alegre, Rio Grande do Sul, Brazil, selected randomly from 30 different basic health units. Participants were subjected to diagnostic assessment for bipolar disorder and suicide risk using the Mini International Neuropsychiatric Interview Plus 5.0.0. Categorical variables were described as absolute and relative frequencies. Quantitative variables were expressed as means and standard deviations. The Pearson chi-square or Fisher's exact tests were used as appropriate to evaluate potential associations between the independent variables suicide attempt and risk of suicide. To control for possible confounders and assess variables independently associated with the outcome of interest, the strength association among different risk factors was assessed by means of prevalence ratios, which were estimated with a controlled Poisson model or multivariate Poisson regression. The significance level was set at 5% (p≤0.05). RESULTS: The sample comprised 550 older adults. The lifetime prevalence of bipolar disorder in the sample was 5.8% and the point prevalence was 1.5%. In those with bipolar disorder, 59.4% were type I and 40.6% type II. Significant associations were observed between bipolar disorder regardless of type and female gender (prevalence rate [PR] 2.42, 95% confidence interval [CI] 1.01-5.81), living with a partner (PR 2.52, 95%CI 1.21-5.24), history of suicide attempt (PR 3.16, 95%CI 1.53-6.25), and suicide risk (PR 2.98, 95%CI 1.47-6.06). When analyzed each type of bipolar disorder, statistically significant associations were found between age under 70 years and type I bipolar disorder; having companion and type II bipolar disorder; and risk of suicide was associated with both types of bipolar disorder. CONCLUSIONS: Regardless of the type of bipolar disorder, women and those living with a partner were more affected. History of suicide attempts and suicide risk were more frequent in elderly subjects with bipolar disorder than in those without the disorder.

OBJETIVOS: Estimar a prevalência do diagnóstico de transtorno bipolar em idosos e examinar fatores sociodemográficos e clínicos associados. MÉTODOS: Um estudo transversal de base populacional incluiu indivíduos com 60 anos ou mais cadastrados na Estratégia de Saúde da Família, em Porto Alegre, Rio Grande do Sul, selecionados aleatoriamente de 30 diferentes unidades básicas de saúde. Os participantes realizaram avaliação diagnóstica para transtorno bipolar usando o Mini International Neuropsychiatric Interview Plus 5.0.0. Variáveis categóricas foram descritas como frequência absoluta e relativa. Variáveis quantitativas foram expressas como média e desvio padrão. O teste qui-quadrado de Pearson ou o exato de Fisher quando apropriado foram usados para avaliar associações potenciais entre as variáveis independentes tentativa de suicídio e risco de suicídio. Para controlar para possíveis confundidores e avaliar as variáveis independentemente associadas com o desfecho de interesse, a força da associação entre diferentes fatores de risco foi avaliada por meio de taxas de prevalência, que foram estimadas através de um modelo controlado de Poisson ou regressão multivariada de Poisson. O nível de significância foi de 5% (p≤0.05). RESULTADOS: A amostra foi composta por 550 idosos. A prevalência ao longo da vida de transtorno bipolar foi 5,8% e a prevalência pontual foi 1,5%. Naqueles com transtorno bipolar, 59,4% eram do tipo I e 40,6% do tipo II. Foram observadas associações significativas de transtorno bipolar, independentemente do tipo, com gênero feminino (razão de prevalência [RP] 2,42, intervalo de confiança (IC) 95% 1,01-5,81), morando com um parceiro (RP 2,52, IC 95% 1,21-5,24), história de tentativa de suicídio (RP 3.16, IC 95% 1.53-6.25) e risco de suicídio (RP 2.98, IC 95% 1.47-6.06). Quando analisados separadamente cada tipo de transtorno bipolar, associações estatisticamente significativas foram encontradas entre idade inferior a 70 anos e transtorno bipolar tipo I; ter companheiro e transtorno bipolar tipo II; e o risco de suicídio foi associado a ambos os tipos de transtorno bipolar. CONCLUSÕES: Independentemente do tipo de, as mulheres e os que viviam com parceiros foram mais afetados. História de tentativa de suicídio e risco de suicídio foram mais frequentes entre os indivíduos idosos que apresentavam transtorno bipolar do que entre os que não o apresentavam.

High prevalence and prescription of benzodiazepines for elderly: data from psychiatric consultation to patients from an emergency room of a general hospital.

OBJECTIVES: The aim of this study is to compare the use and prescription of psychotropic drugs, with emphasis on benzodiazepines, in elderly and non-elderly patients who are assisted at the emergency room by a psychiatric consultation of a university teaching hospital. METHOD: This is a cross-sectional study. We analyzed all records of psychiatric consultation in an emergency room of a general hospital from March 2009 until March 2010. Sociodemographic and clinical variables were compared between the group of elderly and non-elderly in two cutoff points (≥60 and ≥65 years), with emphasis on the use and prescription of benzodiazepines. RESULTS: Five hundred seventy-five records were found with 71 elderly and 504 nonelderly for the first cutoff point and 51 elderly and 524 nonelderly in the second. Differences between groups were found in all sociodemographic variables (gender, marital status, education, current occupational status). Elderly patients treated at emergency rooms used more psychotropic drugs, particularly antidepressants and benzodiazepines, than non-elderly. About 25% of the patients received benzodiazepine treatment in the emergency setting, and there was no statistical difference between age groups. CONCLUSION: There is a wide prevalence of benzodiazepine use among elderly patients in a psychiatric emergency service. Despite the recommendations for its judicious use, benzodiazepines were the most commonly used drug by psychiatrists on duty, regardless of patient's age. These results call for caution in prescribing these drugs and require alternatives to the treatment of psychiatric disorders in the elderly.

Patterns of alcohol use in an elderly sample enrolled in the Family Health Strategy program in the city of Porto Alegre, Brazil / Padrões do uso de álcool em uma amostra de idosos no município de Porto Alegre, Brasil

Abstract This article aims to determine the pattern of alcohol use in the elderly and its associations with sociodemographic characteristics in an elderly sample of patients from the city of Porto Alegre, Rio Grande do Sul, Brazil. A cross-sectional study was conducted involving 557 seniors, aged 60 years or more, through application of the Mini International Neuropsychiatric Interview and a global assessment questionnaire for the elderly. The majority of the 557 senior citizens did not complete elementary school (58.3%), were white (65.1%), married (37.6%), had no caregiver (62.2%), were catholic (65.5%) and practicing their religion (68.6%), were retired (67.7%), and had a personal income of up to one minimum salary (56.1%). The study revealed 67 (12%) elderly people with a history of alcoholism, of which 17 (3.1%) had a diagnosis of current alcoholism, 50 (9%) had a history of alcohol dependence in the past and 16 (2.9%) had a current alcohol abuse problem. Men had a prevalence ratio of 11.6 times for a history of alcoholism in comparison to women. The results confirm that alcoholism is frequent in the population of Brazilian elderly, drawing attention to some socio-demographic characteristics that can make a difference in the early diagnosis of alcoholism.

Resumo O objetivo do artigo é determinar o padrão do uso de álcool em idosos e suas associações com as características sociodemográficas em uma amostra de pacientes do município de Porto Alegre, Rio Grande do Sul, Brasil. Este foi um estudo transversal com aplicação do Mini International Neuropsychiatric interview e Questionário de Avaliação Global do Idoso, em 557 idosos com 60 anos ou mais. Dos 557 idosos, a maioria não completou o ensino fundamental (58,3%), era branca (65,1%), casada (37,6%), não apresentava cuidador (62,2%), era católica (65,5%) e praticante de sua religião (68,6%), estava aposentada (67,7%), possuia renda de um salário mínimo (56,1%). O estudo apresentou 67 (12%) idosos com história de alcoolismo sendo que 17 (3,1%) mantinham esse diagnóstico, 50 (9%) tinham história de dependência de álcool no passado e 16 (2,9%) possuíam abuso de álcool atual. Em todas categorias os homens são maioria; o sexo masculino tem 11,6 vezes a prevalência de história de alcoolismo quando comparado com o sexo feminino. Os resultados confirmam que o alcoolismo é frequente na população de idosos brasileira, chamando a atenção para algumas características sociodemográficas que podem fazer a diferença no diagnóstico precoce do alcoolismo.

Patterns of chronic benzodiazepine use in the elderly

Abstract Background In several countries, prevalence studies demonstrate that chronic use of BZD in the elderly population is very high. This scenario has reached pandemic proportions for decades and is an important public health problem. Objectives To examine the independent association between chronic benzodiazepine use in depression, anxiety and bipolar disorder, as well as other clinical and sociodemographic factors. Methods This cross-sectional study was developed from a population-based survey and conducted from March, 2011 to December, 2012 using a random sample of 550 elderly people who were enrolled in the Family Health Strategy in Porto Alegre, Brazil. Data was collected from identifying epidemiological and health data (sociodemographic, self-perception health, self-reported diseases, smoking, alcohol and pharmacotherapeutic evaluation) and from the diagnoses of mood and anxiety disorders. Results Elderly patients diagnosed with depression, anxiety, concomitant depression/anxiety and bipolar disorders, and those who were using antidepressants have a higher risk of benzodiazepine use. Individuals who self-reported drinking alcohol had a lower risk of benzodiazepine use. Discussion Benzodiazepines are often used by the elderly for long periods, which has a direct impact on the treatment of mood and anxiety disorders and on vulnerable groups such as the elderly, who may be unnecessarily taking these drugs.

Tattooing: profile and discourse of individuals with marks in the body.

BACKGROUNDS: Tattooing is an atavist and diffuse phenomenon of interest to various areas of knowledge. Its practice by specific groups such as prisoners and psychiatric patients has turned it into a stigma. OBJECTIVES: To investigate the discourse of tattooed individuals about the discrimination and the construction of stigmas resulting from marks in the body. METHODS: 42 individuals were interviewed and the data were analyzed. RESULTS: The profile of the participants was as follows: most were women; with 2 to 4 tattoos; who were about 23 years old when they got their first tattoo; with an undergraduate degree; who viewed tattooing as a trend; who did not report any important fact that made them get a tattoo; who classified the pain of getting a tattoo as tolerable, who stated that never felt discriminated and never felt the need to hide the tattoos; who find that tattoos make them more sexually attractive; who do not view tattooing as a form of cultural resistance; who said they would not have done it if they believed it caused them professional problems; who stated that they were not drunk when they got the tattoos; who said they were not habitual drugs users, who believed that tattooing is a form of expression and aesthetic sense. CONCLUSION: A difference between the discourse of tattooed individuals and their acts was observed in relation to the social context. In addition, there has been an important shift in the meaning of the practice to tattooed individuals.

Screening for depressive symptoms in older adults in the Family Health Strategy, Porto Alegre, Brazil / Rastreamento de sintomas depressivos em idosos na Estratégia Saúde da Família, Porto Alegre

OBJECTIVE To analyze the prevalence of depression in older adults and associated factors. METHODS Cross-sectional study using a stratified random sample of 621 individuals aged ≥ 60 from 27 family health teams in Porto Alegre, RS, Southern Brazil, between 2010 and 2012. Community health agents measured depression using the 15-item Geriatric Depression Scale. Scores of ≥ 6 were considered as depression and between 11 and 15 as severe depression. Poisson regression was used to search for independent associations of sociodemographic and self-perceived health with both depression and its severity. RESULTS The prevalence of depression was 30.6% and was significantly higher in women (35.9% women versus 20.9% men, p < 0.001). The variables independently associated with depression were: female gender (PR = 1.4, 95%CI 1.1;1.8); low education, especially illiteracy (PR = 1.8, 95%CI 1.2;2 6); regular self-rated health (OR = 2.2, 95%CI 1.6;3.0); and poor/very poor self-rated health (PR = 4.0, 95%CI 2.9;5.5). Except for education, the strength of association of these factors increases significantly in severe depression. CONCLUSIONS A high prevalence of depression was observed in the evaluations conducted by community health agents, professionals who are not highly specialized. The findings identified using the 15-item Geriatric Depression Scale in this way are similar to those in the literature, with depression more associated with low education, female gender and worse self-rated health. From a primary health care strategic point of view, the findings become still more relevant, indicating that community health agents could play an important role in identifying depression in older adults. .

OBJETIVO Analisar a prevalência de depressão em idosos e os fatores associados. MÉTODOS Delineamento transversal com amostra aleatória estratificada de 621 indivíduos ≥ 60 anos provenientes de 27 equipes de saúde da família de Porto Alegre, RS, Brasil, no período entre 2010 e 2012. A depressão foi mensurada por agentes comunitários de saúde utilizando a Escala de Depressão Geriátrica de 15 itens. Escores ≥ 6 foram considerados depressão e entre 11 e 15, depressão severa. A regressão de Poisson foi o método de análise robusta utilizado para busca de associações independentes de variáveis sociodemográficas e autopercepção de saúde com a depressão e sua severidade. RESULTADOS A prevalência de depressão foi de 30,6%, significativamente maior em mulheres (35,9% mulheres versus 20,9% homens; p < 0,001). As seguintes variáveis apresentaram associações independentes com depressão: sexo feminino (RP = 1,4; IC95% 1,1;1,8); baixa escolaridade, sobretudo analfabetismo (RP = 1.8; IC95% 1,2;2,6); e autopercepção de saúde regular (RP = 2,2; IC95% 1,6;3,0) e ruim/péssima (RP = 4,0; IC95% 2,9;5,5). Houve aumento da força de associação desses fatores na depressão severa, exceto para escolaridade. CONCLUSÕES Alta prevalência de depressão foi observada na avaliação realizada por agentes comunitários de saúde, profissionais sem alta especialização. Esse modelo de aplicação da Escala de Depressão Geriátrica de 15 itens identificou achados similares aos encontrados na literatura, em que a depressão associou-se à baixa escolaridade, ao sexo feminino e à pior autopercepção de saúde. Do ponto de vista estratégico no âmbito da atenção ...