Glittre-ADL test without backpack: A qualitative study of perceptions of people with chronic obstructive pulmonary disease.

BACKGROUND: The Glittre Activities of Daily Living (Glittre-ADL) test without backpack was recently validated to assess the functional capacity of people with chronic obstructive pulmonary disease (COPD) OBJECTIVE: To understand the perceptions of people with COPD about the Glittre-ADL test with and without backpack and the possible similarities with their activities of daily living (ADLs). METHODS: Participants performed 2 Glittre-ADL tests with a backpack (visit 1). On visit 2, participants randomly performed the Glittre-ADL test with and without backpack and completed a semi-structured interview with questions about the tests. Interviews were analyzed according to thematic analysis. RESULTS: Twelve participants aged between 57 and 76 years with mild to severe COPD were included. Interviews were grouped into four thematic categories: (1) Glittre-ADL test with a backpack: does the backpack make the test worse, or does it not matter?; (2) test tasks and ADL: what is in common between them?; (3) "I enjoyed taking the test": the possibility of learning and new expectations; and (4) symptoms during the Glittre-ADL tests. CONCLUSION: The following perceptions while performing the Glittre-ADL test with and without the backpack were observed: dyspnea and fatigue sensation, difficulty using the backpack while performing tasks such as squatting, and similarities to ADLs tasks despite different perspectives regarding the degree of ease and expectations on how to perform test tasks at home.

Did managers of long-term care facilities neglect the functionality of older adults? A survey during the COVID-19 pandemic.

Physical distancing impaired the health of older adults living in long-term care facilities (LTCF). This study aimed to assess the perception of managers of Brazilian LTCF about the loss of functionality of residents and strategies to prevent it. In this cross-sectional study, 276 managers of LTCF from all Brazilian regions responded to an online survey, following the Checklist for Reporting Results of Internet E-Surveys. The managers reported a loss of cognitive (60.2%) and physical (48.2%) functionality and more depressive symptoms (77.9%) and falls (16.3%) in residents. In addition, 73.2% of LTCFs reduced in-person activities, and 55.8% did not perform remote activities. Managers of LTCF neglected the functionality of residents. Thus, health surveillance, prevention, and care must be reinforced for this population.

Long-term care facilities for older people and the COVID-19 pandemic: epidemiological data and preventive measures / Instituições de longa permanência para idosos e a pandemia de COVID-19: dados epidemiológicos e medidas preventiva

Objectives: The COVID-19 pandemic has challenged society, especially residents of long-term care facilities (LTCF). This study investigated rates of infection, hospitalization, and death due to COVID-19 among LTCF residents and staff in Minas Gerais, Brazil and identified strategies to control the spread of the disease.Methods: This cross-sectional study collected data from 164 LTCF (6017 older adults). The owners or managers were invited to answer an electronic questionnaire. The questionnaire included 55 items, divided into 3 sections.Results: Of the participating LTCF, 48.7%, 39.6%, and 32.3% reported COVID-19 infections, hospitalizations, and deaths, respectively, among residents, while 68.9%, 7.3%, and 1.2% reported COVID-19 infections, hospitalizations, and deaths, respectively, among staff. Preventive measures were identified and classified as organizational, infrastructural, hygiene items/personal protective equipment, and staff training.Conclusion: The strategies used in the daily routines of LTCF during the pandemic were classified. The challenges experienced in Brazilian facilities were similar to those observed worldwide. The results highlight the importance of continuity and the need to improve protective measures for LTCF residents, especially in low- and middle-income countries

Objetivos: A pandemia da COVID-19 tem sido desafiadora para a sociedade, principalmente para aqueles que residem em Instituições de Longa Permanência (ILPI). Este estudo teve como objetivo descrever as taxas de infecção, hospitalização e óbito por COVID-19 entre idosos e funcionários de ILPI de Minas Gerais/Brasil e identificar estratégias de prevenção e controle da disseminação da doença.Metodologia: Este estudo transversal foi realizado com 164 ILPI (6.017 idosos). Os gestores ou proprietários foram convidados a responder ao questionário eletrônico. O questionário incluiu 55 itens, divididos em três seções.Resultados: Entre as ILPI estudadas, 48,7% confirmaram a infecção por COVID-19 em idosos, resultando em 39,6% de internação e 32,3% de óbito entre os infectados. Além disso, 68,9% das ILPI confirmaram infecção por COVID-19 na equipe, com 7,3% de internação e 1,2% de óbito. As medidas preventivas foram identificadas e classificadas como organizacionais, infraestrutura, itens de higiene e equipamentos de proteção individual e treinamento de pessoal contra a COVID-19.Conclusão: Essas medidas revelaram estratégias e barreiras vivenciadas no cotidiano das ILPI durante a pandemia. As ILPI no Brasil passaram por desafios semelhantes aos observados mundialmente. Os resultados destacaram a importância da continuidade e melhoria das medidas de proteção para idosos em ILPI, especialmente em países de baixa e média renda

Risk factors for non-specific low back pain in older people: a systematic review with meta-analysis.

PURPOSE: To conduct a systematic review about risk factors associated with non-specific low back pain (LBP) in older people. METHODS: The study protocol was prospectively registered with Prospero (CRD42020191619). This systematic review with meta-analysis included cohort studies that investigated risk factors for LBP in older people. The following databases were searched up to 12 December 2020: MEDLINE (Ovid), Embase, CINAHL, SCOPUS and Web of Science. Two independent reviewers appraised methodological quality using the Critical Appraisal Checklist for Cohort Studies instrument. RESULTS: We identified 3939 potentially relevant publications. After removing duplicates, screening title, and abstracts, we assessed 86 publications in full text. We included the remaining 11 publications for analysis. There is strong evidence that depressive symptoms are a risk of reporting future back pain onset (I2 = 52,7%, Odds ratio 1.4, CI 1.28-1.53). CONCLUSION: Depressive symptoms are a risk factor for LBP in older people. Due to the limitations of the literature, the role of some risk factors remains unclear. An additional high-quality prospective cohort is needed to better elucidate these relationships.

A qualitative study of patient's perceptions of two cardiac rehabilitation models.

BACKGROUND: Understanding patients' perceptions about rehabilitation can guide healthcare administrators on modifications of program elements, which can ultimately improve cardiac rehabilitation (CR) use, adherence of heart-health behaviors, and improvements in clinical outcomes. OBJECTIVE: To examine the perception of patients about their participation in CR. METHODS: Qualitative study using semi-structured interviews, performed in a public CR center in Brazil. Twenty-eight patients were interviewed 2-years following participation in two CR models: exercise-based and comprehensive CR. RESULTS: Themes identified included: knowledge acquisition, improvement in functionality, and psychosocial well-being. It appeared that the perceived benefits of CR participation were overall positive and similar between the two models; however, those in the comprehensive CR identified additional subthemes: self-care need and knowledge transfer. CONCLUSIONS: This study suggested that patients from two different CR models perceived in the long term that the CR participation positively impacted their disease-related knowledge, promoted functional gains, and improved psychosocial well-being. Structured educational interventions seemed to be associated with improved participants' perception about CR, which could contribute to long-term maintenance of heart-health behavior and better outcomes.

Training Program for Care Professionals in Nursing Homes: Effectiveness and Feasibility.

The aim of the current study was to analyze the effectiveness and feasibility of a training program for care professionals at two nursing homes, investigating the impact on their beliefs, attitudes, and knowledge regarding aging. Twenty-three formal caregivers at a private nursing home and 10 formal caregivers at a philanthropic nursing home participated in the training program, which consisted of five weekly meetings, each lasting 1.5 hours. Characterization of the sample was performed and effectiveness and feasibility of the intervention were analyzed. The training program improved participants' knowledge about older adults; however, their attitudes and beliefs regarding old age were not affected. Results also indicated that the intervention program was feasible at both nursing homes. The positive results of the study underscore the importance of training and continuing education of professionals who work with older adults, especially staff at nursing homes. [Journal of Gerontological Nursing, 46(11), 37-47.].

Trajetórias assistenciais de idosos em uma região de saúde do Distrito Federal, Brasil / Healthcare pathways of the elderly in one health region in the Federal District, Brazil

RESUMO O objetivo foi identificar as trajetórias assistenciais de idosos em uma região de saúde do Distrito Federal e suas percepções acerca desses percursos. Pesquisa qualitativa que analisou, com base na metodologia de caso traçador, 14 percursos assistenciais de idosos. Foram realizadas entrevistas com idosos e cuidadores, processadas por análise de conteúdo; e consulta a prontuários. Mapas das trajetórias descritas foram elaborados por geoprocessamento. Identificou-se que o percurso real feito pelos idosos difere do previsto na legislação, e que as fragilidades apontadas estiveram relacionadas à difícil acessibilidade, ao deficit de profissionais, à falta de medicamentos e ao tempo de espera para atendimento na atenção especializada. As potencialidades relatadas pelos idosos envolveram humanização no atendimento, tais como o bom acolhimento por parte da equipe, a construção de vínculos e escuta qualificada, e sensação de bem-estar após as consultas. Apesar de o modelo de atenção ainda ser fragmentado e estar distante da situação ideal, os usuários se sentem satisfeitos com os cuidados recebidos, evidenciando aspectos positivos no processo do cuidar em saúde. Entretanto, a organização de processos de trabalho e a articulação entre os níveis de atenção à saúde precisam ser revistas e adequadas às especificidades desse ciclo de vida.

ABSTRACT The aim was to identify the healthcare pathways of the elderly in one health region in the Federal District and their perceptions about these pathways. A qualitative study analyzed 14 healthcare pathways of elderly people, using tracer methodology. Interviews were conducted with the elderly and caregivers, processed by content analysis; and medical records were reviewed. Maps of the paths described were prepared by geoprocessing. It was found that the actual healthcare pathways taken by the elderly differ from what law would predict, and that the weaknesses detected were related to poor accessibility conditions, lack of professionals, lack of medicines, and the long waiting time for specialized health care. The expectations reported by the elderly involved humanization of care, emerging elements such as being well received by the personnel, the building of bonds, qualified listening, and a feeling of well-being after the medical consultation. Although the care model is still fragmented and far from ideal, users feel satisfied with the care provision and identify positive aspects in the health care process. However, the organization of work processes and the articulation between levels of health care need to be reviewed and adapted to the specificities of this life phase.

Physiological risk of falls, physical and aerobic capacity in community-dwelling elderly / Risco fisiológico de quedas, capacidade física e aeróbica em idosos comunitários

Abstract Introduction: Falls are multifactorial and are related to the aging process, reduced functional capacity, comorbidities, sensory deficits, muscle weakness, postural instability and decreased protective response. Objective: To verify the correlation between physiological risk of falls and physical and aerobic capacity of the community-dwelling elderly. Method: Participated elderly individuals from the community, aged ≥65 years, without distinction of sex, race, and/or social class. We excluded cognitive impairments, locomotion incapacity, neurological diseases or sequelae, and/or severe pain that prevented the performance of the tests. We evaluated risk of falls (Physiological Profile Assessment - PPA), physical capacity (Short Physical Performance Battery - SPPB) and aerobic capacity (Shuttle Walk Test - ISWT). Results: Participated 59 elderly (71.8±5.0 ys). The mean performance in PPA was 0.4±0.4; SPPB was 10.4±1.7 and ISWT was 281±111.7 meters. PPA presented a moderate and statistically significant correlation (P<0.001) for SPPB (r= -0.53) and ISWT (r= -0.46). Conclusion: There is a moderate correlation between the physiological risk of falls (PPA) and functional (SPPB) and aerobic capacity (ISWT). Preventive measures to reduce the risk of falls should include strategies to increase functional and aerobic capacity. It is suggested the systematic use of SPPB in clinical practice.

Resumo Introdução: Quedas são multifatoriais e estão relacionadas com o processo de envelhecimento, redução da capacidade funcional, presença de comorbidades, déficits sensoriais, fraqueza muscular, instabilidade postural e redução da resposta protetora. Objetivo: Verificar a correlação entre risco fisiológico de quedas e capacidade física e aeróbica em idosos comunitários. Método: Participaram idosos da comunidade, com 65 anos e mais, sem distinção de sexo, raça e/ou classe social. Excluiu-se aqueles com déficit cognitivo, incapacidade de locomoção, doenças e sequelas neurológicas e, dor que incapacitasse a realização dos testes. Avaliou-se risco de quedas (Physiological Profile Assessment - PPA), capacidade física (Short Physical Performance Battery - SPPB) e capacidade aeróbica (Incremental Shuttle Walk Test - ISWT). Resultados: Participaram 59 idosos (71,8±5,0 anos). A performance média no PPA foi 0,4±0,4; no SPPB foi 10,4±1,7 e no ISWT foi 281±111,7 metros. PPA apresentou uma negativa, moderada e estatisticamente significante correlação (p<0.001) com o SPPB (r= -0,53) e ISWT (r= -0,46). Conclusão: Medidas preventivas para reduzir o risco de quedas devem incluir estratégias para aumentar capacidade funcional e aeróbica. Sugere-se ainda, o uso do SPPB na prática clínica, como medida de rastreio.

Evaluation of micro-level managementof older person carein primary healthcenters in a health region in the Federal District of Brazil. / Avaliação da microgestão em Unidades Básicas de Saúde em ações para idosos em uma região de saúde do Distrito Federal, Brasil.

Primary health centers (PHCs) should consider the demographic and epidemiological profile of the health region to respond to population aging and structure service delivery around networks based on macro and micro-level management to ensure the provision of comprehensive services. A normative evaluation of micro-level management in four PHCs in a health region in the Federal District of Brazil was conducted to inform the development of recommendations for enhancing the delivery of comprehensive and integrated long-term care for older persons. A management evaluation matrix was used where management stages were classified as advanced, intermediate and incipient. The findings show that none of the PHCs were at the advanced stage, three were at the intermediate stage, and one at the incipient stage. The lowest scores were obtained for the subdimensions care model (which was shown to be predominantly traditional) and humanization (fragmentation of care). Lack of infrastructure and staff absenteeism were shown to be constraining factors, while effective communication with local administrators was as facilitating factor. Improvements need to be made in micro-level management to enhance the delivery of comprehensive and timely care to older persons in this health region.

As Unidades Básicas de Saúde (UBS) devem considerar o perfil demográfico e epidemiológico de sua região de saúde para se adequar ao envelhecimento populacional e se estruturar em redes, cujas bases estão na macro e microgestão, com vistas à integralidade da atenção. Foi conduzida avaliação normativa da microgestão de quatro UBS de uma Região de Saúde do Distrito Federal (DF) para posterior proposta de melhorias para ações voltadas a idosos. Utilizou-se matriz de avaliação da gestão, cuja classificação resultou em: avançada, intermediária e incipiente. Os resultados mostraram que nenhuma UBS está em estágio Avançado, três em Intermediário e uma Incipiente. Menores pontuações foram quanto ao Modelo de Atenção (maiormente tradicional) e à Humanização (com fragmentação do cuidado). Estrutura física deficitária e absenteísmo de profissionais foram dificultadores. Comunicação efetiva com gestão local foram identificadas como facilitadores. As UBS necessitam de avanços na microgestão para a qualificação do cuidado ofertado, principalmente quanto à implementação de modelo de atenção cuja integralidade seja atingida, de modo a ser garantido acesso oportuno e resolutivo para a população idosa nesta região de saúde.

Avaliação da microgestão em Unidades Básicas de Saúde em ações para idosos em uma região de saúde do Distrito Federal, Brasil / Evaluation of micro-level managementof older person carein primary healthcenters in a health region in the Federal District of Brazil

Resumo As Unidades Básicas de Saúde (UBS) devem considerar o perfil demográfico e epidemiológico de sua região de saúde para se adequar ao envelhecimento populacional e se estruturar em redes, cujas bases estão na macro e microgestão, com vistas à integralidade da atenção. Foi conduzida avaliação normativa da microgestão de quatro UBS de uma Região de Saúde do Distrito Federal (DF) para posterior proposta de melhorias para ações voltadas a idosos. Utilizou-se matriz de avaliação da gestão, cuja classificação resultou em: avançada, intermediária e incipiente. Os resultados mostraram que nenhuma UBS está em estágio Avançado, três em Intermediário e uma Incipiente. Menores pontuações foram quanto ao Modelo de Atenção (maiormente tradicional) e à Humanização (com fragmentação do cuidado). Estrutura física deficitária e absenteísmo de profissionais foram dificultadores. Comunicação efetiva com gestão local foram identificadas como facilitadores. As UBS necessitam de avanços na microgestão para a qualificação do cuidado ofertado, principalmente quanto à implementação de modelo de atenção cuja integralidade seja atingida, de modo a ser garantido acesso oportuno e resolutivo para a população idosa nesta região de saúde.

Abstract Primary health centers (PHCs) should consider the demographic and epidemiological profile of the health region to respond to population aging and structure service delivery around networks based on macro and micro-level management to ensure the provision of comprehensive services. A normative evaluation of micro-level management in four PHCs in a health region in the Federal District of Brazil was conducted to inform the development of recommendations for enhancing the delivery of comprehensive and integrated long-term care for older persons. A management evaluation matrix was used where management stages were classified as advanced, intermediate and incipient. The findings show that none of the PHCs were at the advanced stage, three were at the intermediate stage, and one at the incipient stage. The lowest scores were obtained for the subdimensions care model (which was shown to be predominantly traditional) and humanization (fragmentation of care). Lack of infrastructure and staff absenteeism were shown to be constraining factors, while effective communication with local administrators was as facilitating factor. Improvements need to be made in micro-level management to enhance the delivery of comprehensive and timely care to older persons in this health region.

The Brazilian Back Complaints in the Elders (Brazilian BACE) study: characteristics of Brazilian older adults with a new episode of low back pain.

OBJECTIVE: Low back pain (LBP) is little explored in the aging population especially when considering age-relevant and culturally dependent outcomes. We aimed to describe socio-demographic and clinical characteristics of Brazilian older people with a new episode of LBP presenting to primary care. METHODS: We sourced baseline information on socio-demographic, pain-related and clinical characteristics from 602 older adults from the Brazilian Back Complaints in the Elders (Brazilian BACE) study. We analyzed differences in pain, disability, functional capacity and psychosocial factors between sub-groups based on age (i.e. participants aged 55-74 or ≥75 years), education (i.e. those with four years or less of schooling or those with more than four years of schooling) and income (i.e. participants who reported earning two or less minimal wages or three and more). RESULTS: Participants presented severe LBP (7.18/10, SD: 2.59). Younger participants were slightly more disabled (mean difference 1.29 points, 95% confidence interval [CI]: 0.03/5.56), reporting poorer physical health, and less fall-related self-efficacy (mean difference of 2.41, 95% CI 0.35/4.46). Those less educated, and those with income equal or less than two minimum wages had more disability, pain catastrophizing and worse functional capacity. CONCLUSIONS: This was the first study showing that Brazilian older adults with LBP present high levels of functional disability and psychological distress, especially those with low socioeconomic status.

Disability in older adults with acute low back pain: the study Back Complaints in the Elderly - (Brazil).

BACKGROUND: The increase in the older adult and oldest old population in Brazil is growing. This phenomenon may be accompanied by an increase in musculoskeletal symptoms such as low back pain. This condition is usually associated with disability. OBJECTIVE: To verify the association between pain intensity and disability in older adults with acute low back pain and assess whether these variables differ depending on the age group and marital status. METHODS: This is a cross-sectional study conducted with 532 older adults with acute low back pain episodes. Pain intensity was assessed through the Numeric Pain Scale and disability through the Late Life Function and Disability Instrument, which shows two dimensions: "frequency" and "limitation" in performing activities. The association between pain and disability was analyzed. RESULTS: For the interaction effect between age groups and marital status, we found that the oldest old living with a partner performed activities of the personal domain less often compared to the oldest old living alone. The oldest old group living with a partner had a lower frequency of performing activities, but did not report feeling limited. The association of pain with disability was minimal (rho<0.20) and thus considered irrelevant. CONCLUSION: Disability in older adults with acute low back pain was influenced by the interaction between age groups and marital status and is not associated with pain intensity.

Incapacidade funcional de idosos com demência / Functional disability in elderly with dementia

Introdução: A demência corresponde a uma das principais causas de incapacidade e dependência na velhice e pode repercutir na capacidade funcional em todas as áreas de desempenho ocupacional, incluindo as atividades básicas e instrumentais de vida diária (ABVD e AIVD), o lazer, a participação social e outras. Objetivos: Caracterizar o nível de incapacidade funcional de idosos com demência e verificar a existência de correlação entre a funcionalidade e o estágio ou tipo de demência. Método: Estudo quantitativo, exploratório, de corte transversal, com amostra constituída por 25 cuidadores de idosos com demência. Para a caracterização dos participantes foram utilizados questionários estruturados e para avaliação da incapacidade funcional, a Escala de Avaliação de Incapacidade em Demência ­ DAD (Disability Assessment for Dementia) foi aplicada. Resultados: Identificou-se maior incapacidade no subitem AIVD. Tal achado é compatível com a literatura que discorre sobre a hierarquização do declínio funcional em idosos, iniciando-se pelas AIVD, enquanto as ABVD permanecem preservadas por um período maior de tempo. Não houve correlação significativa entre o tipo de demência, idade ou sexo e incapacidade funcional. Verificou-se por meio do coeficiente de spearman (rho = 0,87), correlação significativa de alta magnitude entre incapacidade funcional e estágio da demência (p=0,0001). Conclusão: Tais achados reiteram a relevância de priorizar a detecção precoce e prevenção do declínio funcional, que representa a manifestação de vulnerabilidade entre os idosos.

Introduction: Dementia represents one of the major causes of disability and dependence in old age and can affect functional capacity in all areas of occupational performance, including basic and instrumental activities of daily living (BADL and I ADL, respectively), leisure, social participation and others. Objectives: To characterize the functional disability level in elderly people with dementia and verify the existence of correlation between functionality and the stage or type of dementia. Method: Quantitative, exploratory, cross-sectional study, with a sample of 25 caregivers of elderly with dementia. For the characterization of the participants were used structured questionnaires and to assess functional disability, the Disability Assessment Scale for Dementia - DAD was applied. Results: Greater incapacity was observed in the IADL sub item. This finding is compatible with the literature on the hierarchy in functional decline in the elderly: decline begins in IADL, while BADL remain unaffected for a longer period. There was no significant correlation between the type of dementia, age or gender and disability. It was verified through the Spearman coefficient (rho = 0.87), a significant correlation of high magnitude between functional disability and stage of dementia (p = 0.0001). Conclusion: Such findings reiterate the importance of giving priority to early detection and prevention of the functional decline, which is the manifestation of vulnerability among the elderly.

Factors that impact functional performance of elderly with low back pain / Fatores que impactam o desempenho funcional de idosos com dor lombar

Abstract Introduction: Low back pain is a common condition among older adults and an important cause of disability. Objective: To evaluate the relationship between functional performance of older adults with low back pain and the following variables: sociodemographic and clinical factors, self-perceived health and back pain beliefs. Methods: A cross-sectional study that used data from the Back Complaints in the Elders international consortium. Information about sociodemographic factors (sex, age, marital status, formal education), clinical factors (intensity and frequency of pain, comorbidities), self-perceived health, back pain beliefs and functional performance (measured by the disability component of the Late Life Function and Disability Instrument - LLFDI) were collected through self-report. 191 older adults above 60 years with a new episode of back complaints who did not have any cognitive disorder, visual or hearing impairment, or motor disabilities participated in the study. A bivariate analysis was conducted between each independent variable and each outcome. Associations with p < 0.20 were selected for the multiple linear regression analysis, which was carried out for each LLFDI domain. Results: The multiple regression coefficients of determination were significant despite the modest magnitude. The variables related to functional performance were back beliefs, self-perceived health, formal education, pain frequency and marital status. Conclusion: These results may contribute to the expansion of health professionals' work in the therapeutic approach of low back pain, broadening its focus beyond clinical aspects in order to value beliefs of older adults and their self-perceived health.

Resumo Introdução: A dor lombar é condição comum em idosos e importante causa de incapacidade nessa população. Objetivo: Avaliar a relação das variáveis sóciodemográficas, clínicas, autopercepção de saúde e crenças com o desempenho funcional de idosos com dor lombar. Métodos: Estudo transversal que utilizou dados do projeto multicêntrico Back Complaints in the Elders. A amostra foi de 191 idosos que relataram novo episódio de dor lombar em menos de 6 semanas e não apresentavam alterações cognitivas, deficiências visuais, auditivas e motoras graves. Através do auto relato, foram coletadas informações sobre características sóciodemográficas (sexo, idade, estado civil, escolaridade), clínicas (intensidade e frequência da dor, comorbidades), autopercepção de saúde, crenças em relação às consequências da dor lombar e desempenho funcional (componente de incapacidade do Late Life Function and Disability Instrument - LLFDI). Foi realizada a análise bivariada de cada variável independente com cada desfecho (6 diferentes escores fornecidos pelo componente de incapacidade do LLFDI) e aquelas que apresentaram significância p < 0,20 entraram nos modelos de regressão múltipla para cada domínio do LLFDI. Resultados: Os coeficientes de determinação dos modelos multivariados foram significativos, apesar da modesta magnitude. As variáveis que se relacionaram com o desempenho funcional foram crenças, autopercepção de saúde, escolaridade, frequência da dor e estado civil. Conclusão: Esses resultados poderão contribuir para ampliação da atuação dos profissionais de saúde para além dos aspectos clínicos, valorizando as crenças dos idosos e sua autopercepção de saúde na abordagem terapêutica com foco na dor lombar.

Declínio funcional em idosos com comprometimento cognitivo leve / Functional decline in elderly people with mild cognitive impairment

Introdução: idosos com comprometimento cognitivo leve (CCL) manifestam dificuldades no desempenho de atividades de vida diária (AVD), contudo, existem dificuldades relacionadas à identificação e classificação das atividades comprometidas. Objetivo: avaliar se há evidência na literatura de comprometimento de AVD em idosos com CCL.Métodos: realizada revisão de literatura a partir de busca nas bases de dados PUBMEDe LILACS, com as palavras-chave: ?mild cognitive impairment? AND ?activities of daily living? e seus correlatos em português e espanhol, resultando no total de 759 publicações.Foram excluídos estudos repetidos, de revisão, validação, editoriais, guidelines,cartas ao editor e comentários. Selecionaram-se os ensaios clínicos, estudos descritivos,comparativos e coortes nos idiomas inglês, espanhol e português, publicados até o ano de 2012, cujo objetivo principal foi investigar AVD em idosos com CCL. Os critérios de inclusão foram preenchidos por 41 estudos para esta revisão. Resultados: foram medidas variáveis clínicas, cognitivas e funcionais. Houve variação quanto ao tamanho da amostra de indivíduos com CCL, quanto à idade (71,3 a 76,8 anos), nível de escolaridade (2,5 a 15,8 anos) e sexo dos participantes, predominando o feminino. Apenas dois estudos foram realizados no Brasil. O declínio funcional esteve presente em todos os estudos analisados e mensurado com diferentes testes padronizados e medidas não padronizadas. Conclusões: foram identificados déficits sutis em AVDs avançadas e instrumentais, que geralmente passariam despercebidos, comprometendo a qualidade de vida e constituindo-se em risco de estágio pré-demencial para demência de Alzheimer.

Introduction: elderly people with mild cognitive impairment (CCL) manifest difficulties in performing daily living activities (AVD), however, there are difficulties related to identification and classification of impaired activities. Objective: to assess whether there is evidence in the literature of AVD impairment in older adults with CCL. Methods: literature reviewbased on search in the PUBMED and LILACS databases using the keywords: ?mild cognitive impairment? AND ?activities of daily living? and their correlates in Portuguese and Spanish that resulted in 759 publications. Repeated studies, reviews, validation, editorials, and guidelines studies, and letters to the editor and commentaries were excluded. Clinicaltrials, descriptive, comparative, and cohorts studies in English, Spanish, and Portuguese,published up to 2012 were selected, whose main objective was to investigate AVD in older adults with CCL. The inclusion criteria were met by 41 studies for this review. Results: clinical,cognitive, and functional variables were measured. There was variation in the sample princisize of individuals with CCL, according to age (from 71.3to 76.8 years), educational level (2.5 to 15.8 years), andgender of participants, predominantly females. Only twostudies were conducted in Brazil. The functional declinewas present in all the studies analyzed and measuredusing different standardized tests and non-standard measurements.Conclusions: subtle deficits were identified in advanced and instrumental AVDs, which usually go unnoticed, thereby compromising the quality of life and constituting a risk of pre-dementia stage to develop intoAlzheimer?s dementia.

Confiabilidade do Late-Life Function and Disability Instrument (LLFDI) versão português do Brasil em amostra de idosos com alta escolaridade / Reliability of the Late Life Function and Disability Instrument (LLFDI) Brazilian Portuguese version in a sample of senior citizens with high educational level

: Contextualização: O Late-Life Function and Disability Instrument (LLFDI) traduzido para o português do Brasil apresenta uma estrutura inovadora que incorpora componentes de funcionalidade e de incapacidade para avaliar idosos da comunidade. Considerando que a qualidade de um instrumento é determinada pelas suas propriedades de medida, entre elas, a confiabilidade, é aconselhável a investigação dessa propriedade após o processo de tradução e adaptação cultural. Objetivos: Avaliar a confiabilidade intra e interexaminadores da versão em português do LLFDI. Métodos: Índices de correlação intraclasse (CCI) e de concordância (CCC) foram utilizados para testar as confiabilidades intra e interexaminadores ao administrar-se o instrumento em uma amostra de 45 voluntários (idade média de 70,13 ± 6,88 anos) residentes no município de Belo Horizonte, Minas Gerais. Resultados: Observaram-se altos índices de confiabilidade intraexaminador (CCI = 0,91 e CCI = 0,97) e interexaminadores (CCC = 0,87 e CCC = 0,92), respectivamente nos componentes Incapacidade (limitação total) e Função (função total) do instrumento. Conclusão: A versão traduzida para o português do Brasil do LLFDI apresentou estabilidade em ambos componentes do instrumento, mostrando-se adequada para uso no Brasil.

O questionário de atividades funcionais de Pfeffer: revisão integrativa da literatura brasileira / Pfeffer’s functional activities questionnaire: an integrative review of the brazilian literature

O Questionário de Atividades Funcionais (Functional Activities Questionnaire – FAQ) tem grande importância clínica em razão da sua capacidade de identificar perdas funcionais em indivíduos com suspeita de demência. O presente estudo tem o objetivo de: 1) Identificar os grupos clínicos com os quais o instrumento é utilizado no Brasil; 2) Identificar qual versão do questionário é usada nos estudos brasileiros; 3) Avaliar o instrumento quanto ao estágio de validação, à confiabilidade e à adaptação para o contexto brasileiro, identificando as lacunas existentes e as necessidades de aprimoramento; e 4) Identificar o método de administração e o ponto de corte mais formal desse instrumento no Brasil. Realizou-se uma revisão integrativa da literatura a partir de busca nas bases de dados Lilacs, SCIELO Brasil e PUBMED, sendo que 45 estudos compuseram a amostra. Constatou-se que diferentes versões baseadas no FAQ são usadas no Brasil, não sendo possível concluir se a versão original é a mais utilizada. Esses questionários são amplamente empregados em idosos com alterações cognitivas. Foram encontrados 18 estudos de validade de construto, 15 de validade de critério e um de confiabilidade. Não foram encontrados estudos sobre a validade ecológica do FAQ. O ponto de corte utilizado com maior frequência como indicador de incapacidade funcional é o de 5 pontos. A entrevista com informante é a forma de aplicação mais utilizada. Em razão da diversidade de versões do FAQ no contexto nacional, é fundamental que o profissional tenha clareza sobre as evidências de validade da versão que utiliza para a prática clínica e de pesquisa.

Among the different assessment tools employed to measure functional capacity, the Functional Activities Questionnaire (FAQ) stands out due to its capacity for identifying functional damages in individuals with suspected dementia. The aims of the present study were: 1) identify clinical groups for which the FAQ is used in Brazil; 2) identify what version of the questionnaire is used in Brazilian studies; 3) evaluate the FAQ with regard to the stage of validation, reliability and adaptation to Brazilian culture; and 4) identify the most frequent administration method and cutoff point used for the FAQ in Brazil. An integrative review of the literature was performed based on a search of the Lilacs, SCIELO Brazil and PUBMED databases. Forty-five studies were selected to compose the sample. Different versions of the FAQ are used in Brazil and it was not possible to conclude whether the original version is the most employed. These questionnaires are widely used for older adults with cognitive impairment. Eighteen studies on construct validity, 15 on criterion validity and one on reliability were found. No study was found addressing the ecological validity of the FAQ. The most frequent cutoff point used as an indicator of functional disability was 5 points. An interview with the informant was the most frequent form of administering the questionnaire. Considering the diversity of versions of the FAQ in the national context, it is essential that the professional has clarity about the evidence of validity of the version which uses for clinical practice and research.

Reflexões epistêmicas sobre a Terapia Ocupacional no campo da Saúde Mental / Epistemic reflections on Occupational Therapy in Mental Health

A Terapia Ocupacional, junto às demais profissões, é provocada a pensar sua atuação na área da saúde mental, tendo em vista as novas perspectivas de assistência à pessoa com sofrimento mental. Considerando a Reforma Psiquiátrica como pano de fundo, o objetivo deste artigo é refletir sobre as concepções teóricas que subsidiaram as intervenções da Terapia Ocupacional neste campo e as novas demandas apresentadas aos profissionais. Para tanto, foi realizado um estudo de revisão narrativa, cuja pesquisa foi feita nas bases de dados Lilacs, Medline e Scielo, com os descritores Terapia Ocupacional, Saúde Mental, Atenção à Saúde, no período de 1990 a 2012, e foram levantados 116 artigos indexados: 109 na base de dados Lilacs e sete no Scielo, sendo analisados 25 artigos. Os resultados revelam as abordagens que fundamentaram a Terapia Ocupacional, do modelo asilar ao modelo de atenção à saúde mental, apontando os desafios a serem enfrentados pela profissão no processo de transição para o atual modelo de saúde mental. Concluiu-se que cabe ao terapeuta ocupacional mediar a reinvenção da interação do usuário da saúde mental com o seu cotidiano multifacetado de atividades/ações, no sentido de contribuir com o processo de transformação do cuidado à saúde mental, produzindo novas formas de pensar e de exercer a Terapia Ocupacional.

Occupational therapy, along with other professions, is provoked to think its performance in the area of mental health in light of the new perspectives of assistance to people with mental distress. Considering the psychiatric reform as a backdrop, the aim of this paper is to discuss the theoretical conceptions that supported the interventions of occupational therapy in this field, and the new demands presented to professionals.To this end, a study of narrative review, whose search was conducted in the Lilacs, Medline and SciELO databases , with the descriptors 'Occupational Therapy', 'Mental Health' and 'Health Care', between 1990 and 2012. One hundred sixteen indexed articles were found: 109 in LILACS and seven in SciELO, and 25 articles were analyzed. The results reveal the approaches that have underpinned occupational therapy, from the asylum model to the care model in mental health, indicating the challenges to be faced by the profession in the transition process to the current model of mental health. We conclude that the occupational therapist should be the one responsible to mediate the reinvention of the mental health users' interaction with their multifaceted everyday activities/actions in order to contribute to the process of mental health care transformation, producing new ways of thinking and practicing occupational therapy.

Adherence of older women with strength training and aerobic exercise.

BACKGROUND: Participation of older people in a program of regular exercise is an effective strategy to minimize the physical decline associated with age. The purpose of this study was to assess adherence rates in older women enrolled in two different exercise programs (one aerobic exercise and one strength training) and identify any associated clinical or functional factors. METHODS: This was an exploratory observational study in a sample of 231 elderly women of mean age 70.5 years. We used a structured questionnaire with standardized tests to evaluate the relevant clinical and functional measures. A specific adherence questionnaire was developed by the researchers to determine motivators and barriers to exercise adherence. RESULTS: The adherence rate was 49.70% in the aerobic exercise group and 56.20% in the strength training group. Multiple logistic regression models for motivation were significant (P=0.003) for the muscle strengthening group (R(2)=0.310) and also significant (P=0.008) for the aerobic exercise group (R(2)=0.154). A third regression model for barriers to exercise was significant (P=0.003) only for the muscle strengthening group (R(2)=0.236). The present study shows no direct relationship between worsening health status and poor adherence. CONCLUSION: Factors related to adherence with exercise in the elderly are multifactorial.

Mobilidade sobre rodas: a percepção de pais de crianças com paralisia cerebral / Wheeled mobility: the perception of parents of children with cerebral palsy

Children with cerebral palsy (CP) often use mobility devices as facilitators of their functionality and independence, and these devices may have a positive impact on their caregivers' quality of life. Considering a family-centered approach, parents assume a decisive role in different stages of the therapeutic process, guiding several actions of the rehabilitation professionals during the search, development and/or adaptation of equipment that meet the specific needs of customers. The aim of this research was to understand the perceptions of parents of children with CP on the use of the wheelchair in the daily routines of their children. This qualitative study used semi-structured interviews with 16 parents of CP children who were wheelchair users assisted at "Associação Mineira de Reabilitação". Content analysis grounded the categorization of themes that emerged from the interviews. The results expressed in themes such as "The look on the daily routine" and "The look on the equipment" pointed out characteristics related to the benefits of the use of the wheelchair in promoting child participation at home, at school, and in community environments, as well as different features of wheelchairs that facilitate or hamper their use in children's daily routine.

Crianças com paralisia cerebral (PC) frequentemente utilizam dispositivos de mobilidade como facilitadores de sua funcionalidade e independência, o que impacta positivamente também na qualidade de vida do cuidador. Considerando a abordagem da prática centrada na família, os pais assumem papel decisivo em diferentes etapas do processo terapêutico, norteando diversas ações de profissionais da área da reabilitação na busca, desenvolvimento e/ou adaptação de equipamentos que atendam às necessidades específicas da clientela interessada. Neste estudo objetivou-se compreender a percepção dos pais de crianças com PC sobre a utilização da cadeira de rodas no cotidiano de seus filhos. O presente estudo qualitativo utilizou entrevistas semiestruturadas com 16 pais de crianças cadeirantes com paralisia cerebral, atendidas na Associação Mineira de Reabilitação. Análise de conteúdo pautou a categorização de temas que emergiram das entrevistas. Os resultados expressos nas categorias temáticas "O olhar sobre o uso cotidiano" e "O olhar sobre o equipamento" apontaram características relacionadas aos benefícios do uso da cadeira de rodas na promoção da participação da criança nos ambientes de casa, escola e comunidade, bem como diferentes aspectos da cadeira de rodas que favoreceram e dificultaram a sua utilização no dia a dia dessas crianças.