Depressive Symptoms and Associated Factors in Institutionalized Elderly.

Background/Study Context: Depression is a common psychiatric disorder in the elderly that leads to a decrease in quality of life and functional impairment, among other health problems. The study of depressive symptoms in institutionalized elderly is scarce in Latin America and can contribute to plan prevention and treatment actions in order to improve health conditions for the residents as well as quality of life. Therefore, the aim of this study is to determine the prevalence of depressive symptoms and identify its associated factors in institutionalized elderly. METHODS: A cross-sectional study is presented herein, carried out in 10 nursing homes of the municipality of Natal (Northeast Brazil). All individuals over the age of 60 were included. The Geriatric Depression Scale (GDS-15) was applied to verify the depressive symptoms, as well as sociodemographic variables related to the institution and health conditions (comorbidities, medication, body mass index, level of physical activity, mobility, and functional and cognitive capacities). Bivariate analysis was carried out using the chi-square Pearson's test (or Fisher's test) and the linear trend chi-square. Finally, logistic regression was utilized for multivariate analysis. RESULTS: The final sample was constituted of 142 elderly, mostly of the female sex (78.9%), with an average age of 79.3 (SD: 8.2). Of these, 65 individuals presented depressive symptoms, with a 45.77% prevalence (95% confidence interval [CI]: 37.80-53.97%). The final model verified an association between the presence of depressive symptoms and functional impairment, prevalence ratio (PR) = 1.58 (95% CI: 1.04-2.42), and arterial hypertension, PR = 1.57 (95% CI: 1.07-2.31), adjusted by fecal incontinence, sex, and age. CONCLUSION: Depressive symptoms were present in almost half of the sample of institutionalized elderly, and this condition was associated with functional impairment and arterial hypertension. The results of this work indicate the importance of monitoring depression as well as intervening on these modifiable aspects, to avoid the cascade of negative outcomes associated with this disease and also improve the quality of life of this population group.

Knowledge levels among elderly people with Diabetes Mellitus concerning COVID-19: an educational intervention via a teleservice.

AIM: To investigate knowledge levels concerning COVID-19 in elderly patients with T2DM. METHODS: This cross-sectional, quantitative, observational, and descriptive study was undertaken among elderly individuals with T2DM involved in a body balance rehabilitation program that had been suspended due to social isolation. The study participants comprised elderly individuals with T2DM, contactable using fixed or mobile telephones. Data concerning participants' socioeconomic variables and knowledge of COVID-19 were collated, using a Brazil Ministry of Health guidelines checklist. Mann-Whitney and Spearman's correlation tests were used to analyze their responses. RESULTS: Of 30 elderly participants, 76.7% were women and 63.3% were married. The average age was 69.96 ± 4.46 years. The most cited information medium was television (96.6%). Of a possible 24 correct responses on the checklist, the median correct response score was 7.5. No significant relationship was observed between the total checklist score and the variables studied. CONCLUSION: Elderly participants did not have in-depth knowledge concerning COVID-19, which suggests that their knowledge sources may be deficient or that their capacity to retain information was inadequate.

Dissemination of COVID-19 in inland cities of Northeastern Brazil.

BACKGROUND: SARS-CoV-2 causes the new coronavirus disease (COVID-19) and it is weakening all health systems. Therefore, the most vulnerable populations are exposed to harmful consequences, such as illness and death. Thus, this study aims to estimate the temporal effect of COVID-19 dissemination on social indicators of the Northeastern region of Brazil. METHODS: An ecological time-series study was developed with the following: diagnosed cases of COVID-19 in the largest inland cities of Northeast Brazil, Human Development Index (HDI), poverty incidence, and Gini coefficient. Cities with high HDI, poverty rate, and Gini presented a larger number of patients. RESULTS: It was observed by evaluating case trends that COVID-19 spreads unevenly in inland cities of the Northeastern region of Brazil. CONCLUSIONS: In this sense, we emphasize that regional health managers should support small cities with vulnerable population and social assistance.

Factors related to depressive symptoms in older adult patients with type 2 Diabetes Mellitus.

BACKGROUND: The association of type 2 Diabetes Mellitus (DM2) with depressive symptoms may affect the quality of life of older adults and increase their risk of morbidity and deterioration in functional activities. This study aimed to investigate the variables related to depressive symptoms in older adult patients with DM2. METHODS: This cross-sectional, descriptive, analytical study included 102 older adult patients with DM2, treated in northeastern Brazil. We evaluated demographic, clinical, and functional variables [Timed Up and Go (TUG) test, a scale to assess performance (WHO Disability Assessment Schedule), and psycho-cognitive variables (using the Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS)). RESULTS: There was a significant correlation between the GDS and body mass index (p = 0.04, ρ = 0.20) and intensity of pain (p = 0.09, ρ = 0.26); and scores on the MMSE (p = 0.01, ρ = -0.25); WHODAS (p < 0.001, ρ = 0.61); TUG test (p = 0.016, ρ = 0.25), and TUG dual task (p = 0.029, ρ = 0.23). CONCLUSION: Depressive symptoms in older adult patients with DM2 were associated with being female, being single, being illiterate, having poor overall health, using a walking aid, having higher body mass index, having a greater intensity of dizziness, exhibiting functional impairment, and having gait and cognition deficits.

Activity Limitations in Brazilian Institutionalized Older Adults.

BACKGROUND AND PURPOSE: Although functional assessments and programs to prevent activity limitations are fundamental for efficient geriatric evaluations and interventions, these procedures have not been satisfactorily explored at nursing homes in Brazil. Literature is scarce on the evaluation of disability in Brazilian institutionalized older people. METHODS: A cross-sectional study was conducted in 10 nursing homes in the city of Natal (Northeast Brazil). Sociodemographic and health data were collected and activity limitations were assessed by the Katz Index. RESULTS AND DISCUSSION: The prevalence of activity limitations was 72.9% (95% confidence interval: 67.8-77.5) and the most affected activity was "bathing" (71.6%), followed by "dressing" (65.4%) and "toileting" (62.0%). The final model revealed associations with private (for-profit) institutions (odds ratio [OR] = 3.33; P < .001), age ≥ 83 years (OR = 2.34; P = .003), institutionalization due to lack of caregiver (OR = 1.80; P = .033), and presence of osteoporosis (OR = 2.94; P = .045), adjusted by sex. CONCLUSIONS: Activity limitations affected almost 73% of institutionalized older people in this sample and were associated with private nursing homes, age, osteoporosis, and institutionalization due to lack of caregiver. Activity limitations exact high socioeconomic impacts and affect the quality of life of older people. The results obtained herein emphasized the importance of planning strategies for their prevention and treatment, directed to reduce the prevalence of this health issue.

Fatores sociodemográficos e clínico-funcionais em idosos com diabetes mellitus tipo 2 pré-frágeis e frágeis relacionados ao baixo nível de atividade física / Sociodemographic and clinical functional factors in pre-frail and frail older adults with type 2 Diabetes Mellitus in relation to low levels of physical activity

OBJETIVO: determinar os fatores sociodemográficos e clínico-funcionais relacionados com o baixo nível de atividade física (BNAF) em idosos com diabetes mellitus tipo 2 (DM2) pré-frágeis e frágeis. MÉTODO: trata-se de estudo observacional, analítico, de caráter transversal. A amostra foi composta por idosos com idade igual ou superior a 60 anos e com diagnóstico clínico de DM2 atendidos no Hospital Universitário Onofre Lopes (HUOL). Foram avaliados dados sociodemográficos e clínico-funcionais com os seguintes instrumentos: Timed Up and Go (TUG), Mini Exame do Estado Mental (MEEM), Geriatric Depression Scale (GDS) de 15 itens, Questionário Internacional de Atividade Física (IPAQ) e fenótipo de fragilidade. Foram utilizados os testes de Qui-quadrado e Mann Whitney para análise dos dados. RESULTADO: a amostra do estudo foi composta por 113 indivíduos classificados como pré-frágeis (52,2%) e frágeis (47,8%). O BNAF foi verificado em 79,6% da amostra. As variáveis que apresentaram diferença estatística significante com o BNAF foram: anos de escolaridade (p=0,02), participação social (p=0,005), insulinoterapia (p=0,02), dor em membros inferiores (p=0,03) e sintomas depressivos (p=0,04). Também, foram encontradas diferenças significantes entre o BNAF e idade (p=0,04) e anos de escolaridade (p=0,05). CONCLUSÃO: O BNAF está associado a alguns fatores sociodemográficos e clínico-funcionais, sendo alguns destes modificáveis e, identificá-los é relevante para elaboração de intervenções em saúde adequadas para prevenção e tratamento tanto do DM2 quanto da Síndrome da Fragilidade (SF).

OBJECTIVE: To determine the sociodemographic and clinical-functional factors related to low levels of physical activity in pre-frail and frail older adults with type 2 diabetes mellitus (DM2). METHOD: an observational, analytical, cross-sectional study was performed. The sample consisted of older adults aged 60 years or over with a clinical diagnosis of DM2 who were treated at the Onofre Lopes University Hospital (or HUOL). Sociodemographic and clinical-functional data were evaluated with the following instruments: the Timed Up and Go (TUG) test, the Mini Mental State Examination (MMSE), the 15-item Geriatric Depression Scale (GDS), the International Physical Activity Questionnaire (IPAQ) and the frailty phenotype. The Chi-square and Mann Whitney tests were used for data analysis. RESULT: the study sample consisted of 113 individuals classified as pre-frail (52.2%) and frail (47.8%). Low levels of physical activity were verified in 79.6% of the sample. The most closely related variables that showed a statistically significant difference with low levels of physical activity were: years of schooling (p=0.02), social participation (p=0.005), insulin therapy (p=0.02), pain in the lower limbs (p=0.03) and depressive symptoms (p=0.04). Also, significant differences were found between low levels of physical activity and age (p=0.04) and years of schooling (p=0.05). CONCLUSION: Low levels of physical activity are associated with certain sociodemographic and clinical-functional factors, some of which are modifiable. Identifying these is important for the development of appropriate health interventions for the prevention and treatment of both DM2 and the Frailty Syndrome (FS)