[Factors associated with beliefs about adherence to non-pharmacological treatment of patients with heart failure]. / Fatores associados às crenças sobre adesão ao tratamento não medicamentoso de pacientes com insuficiência cardíaca.

This study aimed at assessing beliefs about the benefits and barriers to adherence to daily self-monitoring of weight/edema in patients with heart failure, and the influence of demographic and clinical variables on those beliefs. 105 patients were interviewed. The mean of the subscales Benefits and Barriers were 20.2 (± 5.7) and 30.1 (±7.1), respectively. Patients perceived that adherence to daily self-monitoring of weight/edema could keep them healthy, improve their quality of life and decrease the chances of readmission. Approximately half of patients (46.7%) reported forgetting this measure. Those who controlled weight once a month were more likely to have barriers to adherence (OR= 6.6; IC 95% 1.9-13.8; p=0.01), showing this measure to be the main factor related to perceived barriers. Education in health can contribute with the development of strategies aimed at lowering barriers and increasing benefits of this control.

[Leisure activities for the elderly during hospitalization]. / Atividades de lazer em idosos durante a hospitalização.

This study intended to: 1. Identify the leisure activities available in the hospital and those in which the elderly participate; 2. Relate elderly hospitalization with their participation in leisure activities; 3. Assess the factors that motivate and inhibit elderly participation in leisure activities. This is a descriptive/exploratory study carried out with one hundred hospitalized elderly patients. Available leisure activities were television and magazines. Most participants (99%) said they participate in leisure activities such as family/ friends conversations and visits. Involvement in leisure activities decreases with associated diseases and increases with hospitalization time. Leisure was motivated by the elderly's personal characteristics, the reduction of the hospitalization's negative effects, and the benefits it brings to the health. Its limitation was associated to intrinsic aspects of the elderly and to the institutional context.

[Teaching program for elderly women who care for elderly relatives in their home: report of experience]. / Orientações para idosas que cuidam de idosos no domicílio.

This is a report of experience about the development of a program designed especially for the orientation of elderly people who care for elderly relatives at home. It was carried out by the coordinators of the Group of Attention for Elderly People's Health (GRASI), of the Campinas State University's Clinics Hospital. This program was developed based on the needs reported by elderly caregivers who take part in the activities of the GRASI. The participants reported that the program made coping with the difficulties related to caregiving better; that there had been an improvement in the understanding of the changes brought by the aging process; and that it made possible the development of procedures that make easier the daily relationship with the elderly that is being cared for.

[Quality of life and measure of disease in elderly people with end-stage renal disease]. / Qualidade de vida e severidade da doença em idosos renais crônicos.

The purpose of this research was to identify, in an elderly population with end-stage renal disease (ESRD) undergoing ambulatory hemodialysis, the correlation between a generic index of quality of life (WHOQOL-BREF) and the severity index of the ESRD-SI. The work consisted of a correlational cross-section study conducted at two clinics providing replacement of renal therapy and involved 100 elderly patients suffering from ESRD, who had already been in hemodialytic treatment for at least six months. The WHOQOL-BREF showed a negative correlation with the severity of the ESRD-SI and the technique employed allowed for a distinction to be made between patients with greater and lesser severity of ERSD-SI.

[Health education for people with glaucoma: approach based on Vygotskiana's perspective]. / Educação em saúde a portadores de glaucoma: uma abordagem Vygotskiana.

This study has the objective of discussing the Vygotsky's perspective as a new approach for the health education for people with Glaucoma. This theoretical model is justified by the possibility it offers for understanding that the person is a social being within a process of constant change and transformation. It points out theoretical bases for guiding the educational actions, correlating them with the importance of recognizing emotions, affections, and the potentiality of people as they deal with the illness and learn to take the medication.

[Social representations of the participation of third age groups in leisure activities]. / Representações sociais da participação em atividades de lazer em Grupos de Terceira Idade.

The objective of this research is to study the social representations concerning the participation of third age groups in leisure activities. Thirteen individual interviews were accomplished with the co-operation of men and women over sixty-years-old in a Third Age Coexistence Center. The discourses were analyzed starting from the technique of content analysis, followed by discussion based on the Theory of Social Representations. The "marks of old age", such as, solitude, disease and lack of activity, are the reasons elderly people take part in this kind of leisure activities in the Third Age Coexistence Center. They belong to the "Third Age family" and find medicine and therapeutic assistance for the "signs of old age". The participation in leisure activities represents the "exit from rock-bottom", and brings meaning to the life of elders as well as a sense of rebirth.

Medication adherence and quality of life among the elderly with diabetic retinopathy.

METHOD: one hundred (n=100) elderly outpatients with diabetic retinopathy taking antihypertensives and/or oral antidiabetics/insulin were interviewed. Adherence was evaluated by the adherence proportion and its association with the care taken in administrating medications and by the Morisky Scale. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) was used to evaluate HRQoL. RESULTS: most (58%) reported the use of 80% or more of the prescribed dose and care in utilizing the medication. The item "stopping the drug when experiencing an adverse event", from the Morisky Scale, explained 12.8% and 13.5% of the variability of adherence proportion to antihypertensives and oral antidiabetics/insulin, respectively. CONCLUSION: there was better HRQoL in the Color Vision, Driving and Social Functioning domains of the NEI VFQ-25. Individuals with lower scores on the NEI VFQ-25 and higher scores on the Morisky Scale presented greater chance to be nonadherent to the pharmacological treatment of diabetes and hypertension.

Relationship between lower-limb muscle strength and functional independence among elderly people according to frailty criteria: a cross-sectional study.

CONTEXT AND OBJECTIVE: Muscle strength and functional independence are considered to be determinants of frailty levels among elderly people. The aim here was to compare lower-limb muscle strength (LLMS) with functional independence in relation to sex, age and number of frailty criteria, and to ascertain the influence of these variables on elderly outpatients' independence. DESIGN AND SETTING: Quantitative cross-sectional study, in a tertiary hospital. METHODS: The study was conducted on 150 elderly outpatients of both sexes who were in a cognitive condition allowing oral communication, between October 2005 and October 2007. The following instruments were used: five-times sit-to-stand test (FTSST), Functional Independence Measurement (FIM) and Lawton's Instrumental Activities of Daily Living Scale (IADL). Descriptive, comparative, multivariate, univariate and Cronbach alpha analyses were performed. RESULTS: The mean time taken in the FTSST was 21.7 seconds; the mean score for FIM was 82.2 and for IADL was 21.2; 44.7% of the subjects presented 1-2 frailty criteria and 55.3% > 3 criteria. There was a significant association between LLMS and functional independence in relation to the number of frailty criteria, without homogeneity regarding sex and age. Functional independence showed significant influence from sex and LLMS. CONCLUSION: Elderly individuals with 1 or 2 frailty criteria presented greater independence in all FTSST scores. The subjects with higher LLMS presented better functional independence.

Elderly outpatient profile and predictors of falls.

CONTEXT AND OBJECTIVES Falls are a serious public health problem and are one of the biggest reasons for hospitalization, morbidity and mortality among elderly people. Moreover, few studies on predictors of falls have been conducted in low and middle income countries. The aim here was to identify elderly outpatient profiles according to sociodemographic, clinical, physical and functional variables and correlate them with occurrences of falls among these subjects. DESIGN AND SETTING Cross-sectional descriptive study forming part of the project "Quality of Life of Frail Elderly People", carried out in Campinas, Brazil. METHODS The subjects were 145 elderly individuals (76.3 ± 7.8 years old), of whom 65% were women, who were living in the city of Campinas or nearby and were attended at the geriatric outpatient clinic of a University Hospital. Sociodemographic, clinical, physical and functional data, as well as fall occurrence data, were gathered. Cluster analyses and comparisons between groups were carried out. RESULTS Cluster analysis identified two distinct groups related to the study variables, and the determinants for this distinction were: gender, marital status, physical performance, handgrip strength and functional independence. These groups were compared according to occurrences of falls over the last year, and significant differences between them were found. CONCLUSIONS The results showed that greater occurrences of falls were associated with a profile of elderly people comprising female gender, single status, lower muscle strength and physical performance regarding balance and gait, and lower independence in motor tasks for activities of daily living.

Relationship between lower-limb muscle strength and frailty among elderly people.

CONTEXT AND OBJECTIVE: Sarcopenia is the main factor involved in the development of frailty syndrome. The aims here were to investigate relationships between lower-limb muscle strength and the variables of sex, age and frailty criteria; compare lower-limb muscle strength with each frailty criterion; and assess the power of each criterion for estimating the risk of frailty among elderly outpatients. DESIGN AND SETTING: Cross-sectional study at the Geriatrics Outpatient Clinic of a university hospital in Campinas. METHOD: A non-probabilistic convenience sample of 150 elderly people of both sexes who were followed up as outpatients was assessed. Sociodemographic data (sex and age) and physical health data (frailty criteria and the five-times sit-to-stand test) were gathered. Descriptive, comparative and multivariate logistic regression analyses were performed. RESULTS: The majority of the elderly people (77.3%) were 70 years of age or over, with predominance of females (64.2%) and had a low score for the five-times sit-to-stand test (81.4% scored 0 or 1); 55.3% of the elderly people presented three or more frailty criteria. A significant association was found between lower-limb muscle strength and the variables of age and number of frailty criteria. CONCLUSIONS: Lower levels of lower-limb muscle strength were associated with advanced age and greater presence of signs of frailty. Moreover, lower-limb muscle strength was also associated with the criteria of reduced walking speed criteria and hand-grip strength.

[Medicine adhesion in eldery people in an ambulatorial attendance]. / Adesão medicamentosa em idosos em seguimento ambulatorial.

The objectives of this study were to evaluate the elderly drug adhesion in an outpatient geriatric service linked to the State University Hospital of Campinas (São Paulo, Brazil) as well as to identify the related events to this adhesion. One hundred sixty five elders were submitted to an interview. It was used an instrument to collect information about the patients' identification, besides the self-reported state of health and drug utilization. The data were evaluated through the descriptive and comparative analysis. They showed that most of the elderly (88.5%) have confirmed the drug adhesion and among them 91.1% were living with company. The elderly who were living alone presented three-time more chance of non-adhesion to the drug therapy (OR: 3.655). Those that have referred drug side effects presented seven-time more chance of non-adhesion (OR: 7.092). The associated events which better predict the drug non-adhesion were: "living alone" (OR: 4.346) and "side effects" (OR: 8.219).

Health-related quality of life among the elderly with heart failure: a generic measurement.

CONTEXT AND OBJECTIVE: Health-related quality-of-life (HRQoL) instruments have been greatly used among patients with heart failure (HF), although few of them are specific for elderly people. Among the generic instruments, the Medical Study 36-item Short-Form Health Survey (SF-36) is widely used. The aim here was to evaluate HRQoL among elderly individuals with HF through this generic instrument. DESIGN AND SETTING: Cross-sectional study at two university hospitals in São Paulo, Brazil. METHODS: 170 elderly people with HF who were being followed up as outpatients were interviewed. To evaluate HRQoL, SF-36 was used. RESULTS: The sample was composed of subjects with a mean age of 67.5 (± 6.2) years, with a diagnosis of HF for 65.9 (± 42.4) months, in functional class I (38.8%; 66) or II (42.9%; 73) and with reduced left ventricular ejection fraction (LVEF) (51.2%). The mental and social HRQoL domains did not seem to be compromised, since they presented high scores. Patients with HF typically had impaired physical capacity, which may explain the lower scores in the physical domain. Cronbach's alpha coefficients were greater than 0.77 for all dimensions, except for general health status. CONCLUSION: The HRQoL measurements using SF-36 presented a high level of reliability when applied to Brazilian elderly individuals with HF. This population presented lower scores for the functional capacity and physical dimensions. This provides support for intervention studies aiming towards optimization of HRQoL in this group.

Visão, qualidade de vida e adesão medicamentosa em idosos com retinopatia diabética / Vision, quality of life and medication adherence in older adults with diabetic retinopathy / Visión, calidad de vida y adhesión a la terapia medicamentosa en los ancianos con retinopatía diabética

O estudo objetivou analisar a influência da qualidade de vida relacionada à função visual (QVRFV) sobre a adesão medicamentosa e o efeito moderador da acuidade visual (AV) na relação QVRFV – adesão em idosos com retinopatia diabética. Trata-se de uma pesquisa transversal envolvendo idosos em uso de antidiabéticos orais/ insulina e anti-hipertensivos. Avaliou-se aproporção de adesão e os cuidados no uso dos medicamentos. Utilizou-se o National Eye Institute Visual Function Questionnaire para avaliação da QVRFV. Empregou-se a análise de relação conjunta e a variância bivariada para testar o efeito moderador da AV na relação QVRFV – adesão. Dos 100 idosos avaliados, 58% foram classificados como aderentes. Aqueles com pior QVRFV e baixa visão grave para longe mostraram 3.34 e 2.95 mais chance de não adesão, respectivamente. O efeito moderador estudado, entretanto, não foi observado. Os resultados ratificam que o efeito da AV e da QVRFV sobre a adesão ocorre de forma independente.

This cross-sectional study examined the influence of vision-related quality of life (VRQoL) on medication adherence,and the moderator effect of visual acuity (VA) in the relationship of VRQoL to adherence, in older adults with diabetic retinopathy. The study sample comprised elderly patients taking oral antidiabetic/ insulin and antihypertensive drugs. Medication adherence rate, and its association with care taken in drug administration, were assessed. The National Eye Institute Visual Function Questionnaire was used to evaluate VRQoL. Analysis of the joint relationship and bivariate analysis of variance were applied to test the moderator effect of VA in the relationship between VRQoL and adherence. Of the 100 patients tested, 58% classified as adherent. Those with worse VRQoL and severe visual impairment or blindness showed, respectively, 3.34 and 2.95 higher probability of non-adherence. However, the moderator effect studied was not observed. The data confirmed thatthe effects of VA and VRQoL on adherence were independent of each other.

Este estudio tuvo como objetivo analizar la influencia de la calidad de vida relacionada con la función visual (CVRFV) sobre la adhesión a la terapéutica medicamentosa y el efecto moderador de la agudeza visual (AV) en relación CVRFV – adhesión en los ancianos con retinopatía diabética. Se trata de un estudio transversal involucrando a ancianos que usaban antidiabéticos orales/ insulina y fármacos antihipertensivos. Se evaluó la proporción de la adhesión y los cuidados en cuanto al uso de medicamentos. Se utilizó el National Eye Institute Visual Function Questionnaire para evaluar CVRFV. Se utilizaron análisis de prueba conjunta y varianza bivariada para evaluar el efecto moderador de la AV en relación CVRFV – adhesión. De los 100 ancianos evaluados, un 58% fue clasificado como adherentes. Los que obtuvieron peor CVRFV y discapacidad visual severa de distancia mostraron de 3.34 y 2.95 más posibilidad de no adhesión, respectivamente. No se observó, sin embargo, el efecto moderador estudiado. Estos datos confirman que el efecto de AV y CVRFV sobre la adhesión se produce de forma independiente.

Factors associated with beliefs about adherence to non-pharmacological treatment of patients with heart failure / Fatores associados às crenças sobre adesão ao tratamento não medicamentoso de pacientes com insuficiência cardíaca / Factores asociados a las creencias sobre la adherencia al tratamiento no farmacologico de pacientes con insuficiencia cardiaca

This study aimed at assessing beliefs about the benefits and barriers to adherence to daily self-monitoring of weight/edema in patients with heart failure, and the influence of demographic and clinical variables on those beliefs. 105 patients were interviewed. The mean of the subscales Benefits and Barriers were 20.2 (± 5.7) and 30.1 (±7.1), respectively. Patients perceived that adherence to daily self-monitoring of weight/edema could keep them healthy, improve their quality of life and decrease the chances of readmission. Approximately half of patients (46.7%) reported forgetting this measure. Those who controlled weight once a month were more likely to have barriers to adherence (OR= 6.6; IC 95% 1.9-13.8; p=0.01), showing this measure to be the main factor related to perceived barriers. Education in health can contribute with the development of strategies aimed at lowering barriers and increasing benefits of this control.

Este estudo teve como objetivos avaliar as crenças relativas aos benefícios e às barreiras para a adesão ao automonitoramento diário do peso/edema em pacientes com insuficiência cardíaca e verificar a influência das variáveis sociodemográficas e clínicas sobre essas crenças. Foram entrevistados 105 pacientes. A média das subescalas Benefícios e Barreiras foram 20,2 (± 5,7) e 30,1 (±7,1), respectivamente. Os pacientes percebiam que a adesão ao automonitoramento diário do peso/edema poderia mantê-los saudáveis, melhorar a qualidade de vida e diminuir as chances de reinternação. Aproximadamente a metade (46,7%) relatou esquecimento dessa medida. Os que controlavam peso uma vez por mês apresentaram maior chance de barreiras à adesão (OR= 6,6; IC 95% 1,9-13,8; p=0,01), revelando essa medida como o principal fator relacionado às barreiras percebidas. A educação em saúde pode contribuir para o desenvolvimento de estratégias direcionadas a diminuição das barreiras e aumento dos benefícios desse controle.

Este estudo teve como objetivos avaliar as crenças relativas aos benefícios e às barreiras para a adesão ao automonitoramento diário do peso/edema em pacientes com insuficiência cardíaca e verificar a influência das variáveis sociodemográficas e clínicas sobre essas crenças. Foram entrevistados 105 pacientes. A média das subescalas Benefícios e Barreiras foram 20,2 (± 5,7) e 30,1 (±7,1), respectivamente. Os pacientes percebiam que a adesão ao automonitoramento diário do peso/edema poderia mantê-los saudáveis, melhorar a qualidade de vida e diminuir as chances de reinternação. Aproximadamente a metade (46,7%) relatou esquecimento dessa medida. Os que controlavam peso uma vez por mês apresentaram maior chance de barreiras à adesão (OR= 6,6; IC 95% 1,9-13,8; p=0,01), revelando essa medida como o principal fator relacionado às barreiras percebidas. A educação em saúde pode contribuir para o desenvolvimento de estratégias direcionadas a diminuição das barreiras e aumento dos benefícios desse controle.

Medication adherence and quality of life among the elderly with diabetic retinopathy / Adesão medicamentosa e qualidade de vida em idosos com retinopatia diabética / Adhesión a la medicación y calidad de vida en ancianos con retinopatía diabética

METHOD: one hundred (n=100) elderly outpatients with diabetic retinopathy taking antihypertensives and/or oral antidiabetics/insulin were interviewed. Adherence was evaluated by the adherence proportion and its association with the care taken in administrating medications and by the Morisky Scale. The National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) was used to evaluate HRQoL. RESULTS: most (58%) reported the use of 80% or more of the prescribed dose and care in utilizing the medication. The item "stopping the drug when experiencing an adverse event", from the Morisky Scale, explained 12.8% and 13.5% of the variability of adherence proportion to antihypertensives and oral antidiabetics/insulin, respectively. CONCLUSION: there was better HRQoL in the Color Vision, Driving and Social Functioning domains of the NEI VFQ-25. Individuals with lower scores on the NEI VFQ-25 and higher scores on the Morisky Scale presented greater chance to be nonadherent to the pharmacological treatment of diabetes and hypertension. .

OBJETIVO: investigar os fatores relacionados à adesão medicamentosa e sua relação com a qualidade de vida relacionada à saúde em idosos com retinopatia diabética. MÉTODO: foram entrevistados 100 idosos, em acompanhamento ambulatorial, em uso de anti-hipertensivos e/ou antidiabéticos orais/insulina. A adesão foi avaliada pela proporção de adesão e sua associação com os cuidados no uso dos medicamentos e pela Escala de Morisky. O National Eye Institute Visual Funcioning Questionnaire foi utilizado para avaliar a qualidade de vida relacionada à saúde. RESULTADOS: A maioria (58%) relatou o uso de 80% ou mais das doses prescritas e os cuidados na tomada dos medicamentos. O item "interromper o uso dos medicamentos por se sentir pior", da Escala de Morisky, explicou 12,8 e 13,5% da variabilidade da proporção de adesão aos anti-hipertensivos e aos antidiabéticos orais/insulina, respectivamente. CONCLUSÃO: observou-se melhor qualidade de vida relacionada à saúde nos domínios visão de cores, dirigir automóvel e apectos sociais do National Eye Institute Visual Funcioning Questionnaire. Indivíduos com menor pontuação na National Eye Institute Visual Funcioning Questionnaire e maiores escores na Escala de Morisky apresentaram maiores chances de serem não aderentes aos medicamentos do diabetes e da hipertensão arterial. .

OBJETIVO: investigar los factores relacionados a la adhesión a la medicación y su relación con la Calidad de Vida Relacionada a la Salud (CVRS) de ancianos con retinopatía diabética. MÉTODO: fueron entrevistados cien (n=100) pacientes ancianos de ambulatorio con retinopatía diabética que toman medicamentos antihipertensivos y/o antidiabéticos orales/insulina. La adhesión fue evaluada mediante la proporción de adhesión y su asociación con el cuidado tomado en la administración de medicamentos y mediante la Escala de Morisky. El National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) fue usado para evaluar la CVRS. RESULTADOS: la mayoría (58%) relató el uso de 80% o más de la dosis prescrita y cuidado con el uso de la medicación. El ítem "suspender la droga cuando vivencia un evento adverso", de la Escala de Morisky, explicó 12.8% y 13.5% de la variabilidad en la proporción de adhesión a los antihipertensivos y antidiabéticos orales/insulina, respectivamente. CONCUSIÓN: fue encontrada mejor CVRS en los dominios de Visión Cromática, Dirección y Funcionamiento Social del NEI VFQ-25. Individuos con puntuaciones menores en el NEI VFQ-25 y puntuaciones mayores en la Escala de Morisky revelaron mayor chance de no adhesión al tratamiento farmacológico de la diabetes y hipertensión. .

Relationship between lower-limb muscle strength and functional independence among elderly people according to frailty criteria: a cross-sectional study / Relação entre força muscular de membros inferiores e independência funcional de idosos segundo critérios de fragilidade: um estudo transversal

CONTEXT AND OBJECTIVE: Muscle strength and functional independence are considered to be determinants of frailty levels among elderly people. The aim here was to compare lower-limb muscle strength (LLMS) with functional independence in relation to sex, age and number of frailty criteria, and to ascertain the influence of these variables on elderly outpatients' independence. DESIGN AND SETTING: Quantitative cross-sectional study, in a tertiary hospital. METHODS: The study was conducted on 150 elderly outpatients of both sexes who were in a cognitive condition allowing oral communication, between October 2005 and October 2007. The following instruments were used: five-times sit-to-stand test (FTSST), Functional Independence Measurement (FIM) and Lawton's Instrumental Activities of Daily Living Scale (IADL). Descriptive, comparative, multivariate, univariate and Cronbach alpha analyses were performed. RESULTS: The mean time taken in the FTSST was 21.7 seconds; the mean score for FIM was 82.2 and for IADL was 21.2; 44.7% of the subjects presented 1-2 frailty criteria and 55.3% > 3 criteria. There was a significant association between LLMS and functional independence in relation to the number of frailty criteria, without homogeneity regarding sex and age. Functional independence showed significant influence from sex and LLMS. CONCLUSION: Elderly individuals with 1 or 2 frailty criteria presented greater independence in all FTSST scores. The subjects with higher LLMS presented better functional independence. .

CONTEXTO E OBJETIVO: A força muscular e a independência funcional são consideradas indicadores de níveis de fragilidade em idosos. O objetivo foi comparar a força muscular de membros inferiores (FM de MMII) com a independência funcional em função de sexo, idade e número de critérios de fragilidade e verificar a influência dessas variáveis na independência em idosos ambulatoriais. TIPO DE ESTUDO E LOCAL: Estudo transversal quantitativo, em hospital terciário. MÉTODOS: Estudo realizado entre outubro de 2005 e outubro de 2007 com 150 idosos ambulatoriais de ambos os sexos, com condições cognitivas suficientes para comunicação oral, sendo utilizados os seguintes instrumentos: teste de levantar e sentar da cadeira cinco vezes consecutivas, Medida de Independência Funcional (MIFm) e Escala de Atividades Instrumentais (AIVDt) de Lawton. Foram realizadas análises descritivas, de comparação, multivariadas, univariadas e de alfa de Cronbach. RESULTADOS: O tempo médio no teste de levantar e sentar da cadeira foi de 21,7 segundos, a pontuação média da MIFm de 82,2 e da AIVDt de 21,2; 44,7% dos sujeitos apresentaram 1-2 critérios de fragilidade e 55,3% > 3 critérios. Houve associação significativa entre FM de MMII e independência funcional em função do número de critérios de fragilidade, sem homogeneidade em relação ao sexo e idade. A independência funcional sofreu influência significativa de sexo e FM de MMII. CONCLUSÕES: Os idosos com um ou dois critérios de fragilidade apresentaram melhor independência em todos os escores do teste de levantar e sentar da cadeira. Os sujeitos com maior FM de MMII apresentaram melhor independência funcional. .

Índice de qualidade de vida de Spitzer na população idosa: propriedades psicométricas / Spitzer quality of life index and the elderly population: psychometric properties / Indice de calidad de vida de Spitzer" en la población anciana: propiedades psicométricas

Os instrumentos genéricos de avaliação da qualidade de vida para a população idosa são escassos e apresentam limitações para essa faixa etária.O objetivo com esta pesquisa foi avaliar a confiabilidade do índice de qualidade de vida de Spitzer em idosos em seguimento ambulatorial e avalidade discriminante em relação ao número de comorbidades e medicações. Trata-se de pesquisa metodológica com 200 idosos entre 60 e 89anos, utilizando os seguintes instrumentos: caracterização dos sujeitos e índice de qualidade de vida de Spitzer. A pontuação média do escoretotal do Índice de Qualidade de Vida de Spitzer foi 8,0, com coeficiente alfa de Cronbach 0,55. Por meio do instrumento os idosos foram avaliadosem relação ao número de comorbidades (p=0,0011) e medicamentos (p=0,0045). O estudo remete a futuras investigações a fim de verificar sea confiabilidade desse instrumento mostra valores elevados em sujeitos em condições clínicas mais graves em relação à da amostra estudada.

Generic instruments to evaluate the quality of life in the elderly population are scarce and present limitations for this age range. To evaluatethe reliability of the Spitzer quality of life index in elderly individuals in follow-up at outpatient clinic and discriminant validity in relation to thenumber of comorbidities and medication. Methodological research with 200 elderly individuals, between 60 and 89 years of age, through thefollowing instruments: Characterization of subjects and Spitzer Quality of Life Index. The total average score of the Spitzer Quality of Life Indexwas 8.0 with Cronbach’s alpha coefficient of 0.55. The instrument discriminated individuals in relation to the number of comorbidities (p=0.0011)and medication (p=0.0045). Conclusion: The study refers to further research so as to verify whether the instrument reliability shows high values inindividuals with clinical conditions more severe than of the studied sample.

Los instrumentos genéricos para medir la calidad de vida en la población de adultos mayores son escasos y presentan limitaciones para su aplicaciónen este grupo de edad. En este estudio se busca evaluar la confiabilidad del Índice de Calidad de Vida de Spitzer en adultos mayores en tratamientoambulatorio y la validez discriminante según el número de comorbilidades y medicamentos. Se trata de una investigación metodológica, con 200adultos mayores entre 60 y 89 años empleando los siguientes instrumentos: Caracterización de los Sujetos e Índice de Calidad de Vida de Spitzer. Lapuntuación media total del Índice de Calidad de Vida de Spitzer fue 8,0, y el coeficiente alfa de Cronbach 0,55. El instrumento discriminó los adultosmayores según el número de comorbilidades (p=0,0011) y medicamentos (p=0,0045). El estudio sugiere más investigaciones con miras a verificarsi la confiabilidad de este instrumento indica valores más altos en los adultos mayores con condiciones clínicas más severas que los del muestreo.

Oral health of elderly with different frailty levels from the city of Campinas, São Paulo / Saúde oral em idosos com diferentes estágios de fragilidade na cidade de Campinas, São Paulo

Objective: Oral changes in the elderly affect their quality of life, as it hinders eating, sociability and emotional and psychological functions. This study evaluated the oral health of elderly with different levels of frailty. Methods: The study included a community dwelling sample seen at the Geriatric Out patient Clinic of the Universidade Estadual de Campinas School of Medical Sciences. The oral cavity was examined and the frailty phenotype determined. The sample was then divided into the pre-frail and frail groups. The Mann-Whitney and Chi-Square test for tren were used for comparing the results. Results: The results are expressed as mean a standard deviation. The sample consisted of 67 elderly aged 77 5+- 8,0, of which 61,2% (n=41) were edentulous. Theu had 4,8 +- 7,5 teeth, a decayed missing and filled teeth index 0f 28,8 + - 5,1 mainly due to the missing component (94,4%) and a decayed and filled root index of 0,45 +- 1,21. The lower anterior sextant had the worst Community Periodontal index. Most participants need a complete denture and 82,4% of those who already had complete dentures needed to have them replaced. Thirty-four 950,7%) elderly were pre-frail and 33 (49,3%)were frail. the pre-frail group had better oral health (p,0,05), but not periodontal health. Conclusion: The sample had poor oral health, clearly worse in the frail group

Objetivo:Alterações orais em idosos afetam a qualidade de vida e interferem na alimentação, na sociabilidade e nas funções emocionais e psicológicas. Este estudo avaliou as condições de saúde bucal em uma população de idosos com diferentes graus de fragilidade. Métodos: Trabalhou-se com amostra não institucionalizada atendida em ambulatório da Clínica de Geriatria da Faculdade de Medicina da Universidade Estadual de Campinas. Foram realizados exame das condições bucais e avaliação para verificar o fenótipo da fragilidade, a partir do qual os idosos foram divididos em dois grupos: pré-frágeis e frágeis. Na análise dos dados, foram utilizados o teste Mann Whitney e o Qui-quadrado de tendência para comparação dos resultados. Resultados: A amostra foi composta por 67 idosos, com média de idade de 77,5 anos (±8,0). Eram edêntulos 61,2% (n=41); a média de dentes presentes foi de 4,8 (±7,5), e o índice de dentes cariados, perdidos ou obturados, de 28,8 (±5,1), com a maior parte do índice composta pelo componente perdido (94,4%); o índice de média de raízes cariadas e/ou restauradas foi de 0,45 (±1,21). O índice periodontal comunitário foi pior nos extante que correspondeu aos dentes anteriores inferiores. A maioria das necessidades protéticas era referente às próteses totais. Dos indivíduos que utilizavam prótese, 82,4% necessitavam substituí-la. Quanto à classificação de fragilidade, 50,7% (n=34) foram considerados pré-frágeis e 49,3% (n=33), frágeis. Quando as variáveis odontológicas foram comparadas com a condição de fragilidade na população, todas as condições orais avaliadas foram melhores nos indivíduos pré-frágeis (p<0,05), com exceção das condições peridontais. Conclusão: Concluiu-se que a saúde bucal dos todos os idosos avaliados era precária e que nos idosos frágeis uma pior condição bucal era claramente observada.

Elderly outpatient profile and predictors of falls / Perfil de idosos em acompanhamento ambulatorial e preditores de quedas

Falls are a serious public health problem and are one of the biggest reasons for hospitalization, morbidity and mortality among elderly people. Moreover, few studies on predictors of falls have been conducted in low and middle income countries. The aim here was to identify elderly outpatient profiles according to sociodemographic, clinical, physical and functional variables and correlate them with occurrences of falls among these subjects.

Cross-sectional descriptive study forming part of the project “Quality of Life of Frail Elderly People”, carried out in Campinas, Brazil.

The subjects were 145 elderly individuals (76.3 ± 7.8 years old), of whom 65% were women, who were living in the city of Campinas or nearby and were attended at the geriatric outpatient clinic of a University Hospital. Sociodemographic, clinical, physical and functional data, as well as fall occurrence data, were gathered. Cluster analyses and comparisons between groups were carried out.

Cluster analysis identified two distinct groups related to the study variables, and the determinants for this distinction were: gender, marital status, physical performance, handgrip strength and functional independence. These groups were compared according to occurrences of falls over the last year, and significant differences between them were found.

The results showed that greater occurrences of falls were associated with a profile of elderly people comprising female gender, single status, lower muscle strength and physical performance regarding balance and gait, and lower independence in motor tasks for activities of daily living. .

Quedas são um sério problema de saúde pública e um dos maiores responsáveis por hospitalização, morbidade e mortalidade em idosos. Além disso, existem poucos estudos sobre preditores de quedas em países de renda baixa e média. O objetivo foi identificar perfis de idosos em acompanhamento ambulatorial segundo variáveis sociodemográficas, clínicas, físicas e funcionais e relacioná-los à ocorrência de quedas desses sujeitos.

Estudo transversal e descritivo, parte do Projeto “Qualidade de Vida de Idosos Frágeis”, realizado em Campinas, Brasil.

Os sujeitos eram 145 idosos (76,3 ± 7,8 anos), sendo 65% mulheres, residentes na região de Campinas, São Paulo, atendidos no ambulatório de geriatria de um hospital universitário de Campinas. Os dados coletados foram: sociodemográficos, clínicos, físicos, funcionais e ocorrência de quedas. Foram realizadas as análises de conglomerados (cluster analysis) e de comparação entre os grupos.

A análise de conglomerados identificou dois grupos distintos em relação às variáveis do estudo, sendo as determinantes para esta distinção as seguintes: gênero, estado civil, desempenho físico, força de preensão manual e independência funcional. Esses grupos foram comparados segundo a ocorrência de quedas no último ano e identificaram-se diferenças significativas entre eles.

Os resultados apontam que a maior ocorrência de quedas relacionou-se ...

Relationship between lower-limb muscle strength and frailty among elderly people / Relação entre força muscular de membros inferiores e fragilidade em idosos

CONTEXT AND OBJECTIVE: Sarcopenia is the main factor involved in the development of frailty syndrome. The aims here were to investigate relationships between lower-limb muscle strength and the variables of sex, age and frailty criteria; compare lower-limb muscle strength with each frailty criterion; and assess the power of each criterion for estimating the risk of frailty among elderly outpatients. DESIGN AND SETTING: Cross-sectional study at the Geriatrics Outpatient Clinic of a university hospital in Campinas. METHOD: A non-probabilistic convenience sample of 150 elderly people of both sexes who were followed up as outpatients was assessed. Sociodemographic data (sex and age) and physical health data (frailty criteria and the five-times sit-to-stand test) were gathered. Descriptive, comparative and multivariate logistic regression analyses were performed. RESULTS: The majority of the elderly people (77.3%) were 70 years of age or over, with predominance of females (64.2%) and had a low score for the five-times sit-to-stand test (81.4% scored 0 or 1); 55.3% of the elderly people presented three or more frailty criteria. A significant association was found between lower-limb muscle strength and the variables of age and number of frailty criteria. CONCLUSIONS: Lower levels of lower-limb muscle strength were associated with advanced age and greater presence of signs of frailty. Moreover, lower-limb muscle strength was also associated with the criteria of reduced walking speed criteria and hand-grip strength.

CONTEXTO E OBJETIVO: A sarcopenia é o principal fator envolvido no desenvolvimento da síndrome de fragilidade. O objetivo foi investigar a relação entre força muscular de membros inferiores e as variáveis sexo, idade e critérios de fragilidade; comparar a força muscular de membros inferiores com cada critério de fragilidade e verificar seu poder de estimativa do risco para fragilidade em idosos ambulatoriais. TIPO DE ESTUDO E LOCAL: Estudo transversal no Ambulatório de Geriatria de um hospital universitário de Campinas. MÉTODO: Foi avaliada uma amostra de conveniência não-probabilística de 150 idosos de ambos os sexos em acompanhamento ambulatorial, com coleta de dados sócio-demográficos (sexo e idade) e de saúde física (critérios de fragilidade e teste de levantar e sentar da cadeira cinco vezes consecutivamente). Foram realizadas análises descritivas, de comparação e de regressão logística multivariada. RESULTADOS: A maioria dos idosos (77,3%) apresentou idade igual ou superior a 70 anos, com predomínio do sexo feminino (64,0%) e baixo escore no teste de levantar e sentar da cadeira cinco vezes consecutivas (81,4% escore 0 ou 1), 55,3% dos idosos apresentaram três ou mais critérios de fragilidade. Verificou-se associação significativa entre a força muscular de membros inferiores e as variáveis idade e número de critérios de fragilidade. CONCLUSÕES: Menores níveis de força muscular de membros inferiores estão associados a idade avançada e maior presença de sinais de fragilidade. Além disso, a força muscular de membros inferiores também está associada com os critérios redução da velocidade de marcha e da força de preensão palmar.