Factors associated with inflamm-aging in institutionalized older people.

The increase in inflammatory cytokines associated with a reduction in the bioavailability of zinc has been used as a marker for inflammation. Despite the high inflammatory state found in institutionalized older individuals, few studies have proposed verifying the factors associated with this condition in this population. To verify the factors associated with inflamm-aging in institutionalized older people. A total of 178 older people (≥ 60 years old) living in nursing homes in Natal/RN were included in the study. Cluster analysis was used to identify three groups according to their inflammatory state. Analysis anthropometric, biochemical, sociodemographic, and health-related variables was carried out. In sequence, an ordinal logistic regression was performed for a confidence level of 95% in those variables with p < 0.20 in the bivariate analysis. IL-6, TNF-α, zinc, low-density lipids (LDL), high-density lipids (HDL), and triglycerides were associated with inflamm-aging. The increase of 1 unit of measurement of LDL, HDL, and triglycerides increased the chance of inflammation-aging by 1.5%, 4.1%, and 0.9%, respectively, while the oldest old (≥ 80 years old) had an 84.9% chance of presenting inflamm-aging in relation to non-long-lived older people (< 80 years). The association between biochemical markers and inflamm-aging demonstrates a relationship between endothelial injury and the inflammatory state. In addition, the presence of a greater amount of fat in the blood may present a higher relative risk of death.

Factors associated with sarcopenia in institutionalized elderly.

BACKGROUND: The diagnosis of sarcopenia is based on the analysis of strength, functionality and muscle mass. The objective was to verify the factors associated with sarcopenia in institutionalized elderly. METHODS: In total, 219 elderly individuals (≥60 years old) living in long-term institutions in Natal/RN were included in the study. After defining the elderly as sarcopenic or non-sarcopenic, anthropometric, biochemical, sociodemographic and health-related were analyzed. The Student t-test and Mann-Whitney test were used to analyze the quantitative, while the chi-square test was used for the qualitative variables. Finally, Poisson regression was used to provide prevalence ratios for those variables that presented differences in the bivariate analyses. RESULTS: Physical capacity and anthropometry were associated with sarcopenia. For each 1 cm of knee height, the elderly presented 2.71% more chance of not having sarcopenia, and eutrophic or overweight individuals (according to BMI) presented 37.71 and 91.81% chances, respectively, of not presenting sarcopenia. Elderly individuals who ambulate have a 30.08% chance of not being considered sarcopenic. In addition, biochemical and anthropometric indicators demonstrated a relationship of sarcopenia with malnutrition. CONCLUSION: Sarcopenia is associated with a loss of body mass, not only selective muscle mass, and greater physical inability to ambulate.

Frequency of metabolic syndrome and associated factors in institutionalized elderly individuals.

INTRODUCTION: Population aging generally accompanies an increase in chronic noncommunicable diseases, such as metabolic syndrome (MS). Nursing homes have provided a solution for the decreased ability of elderly individuals for self-care and familial difficulties in meeting the health care needs of elderly individuals. PURPOSE: The aim of the present study was to determine the frequency of MS and its associated factors in elderly individuals living in nursing homes. PATIENTS AND METHODS: This cross-sectional study was conducted with 202 institutionalized elderly individuals. MS was diagnosed according to the National Cholesterol Education Program - Adult Treatment Panel III criteria. Sociodemographic, clinical, and lifestyle factors were assessed to verify their association with MS by logistic regression. RESULTS: The MS frequency was 29.2%. The most frequent MS components were low high-density lipoprotein cholesterol level (63.9%) and abdominal obesity (42.7%). Factors associated with MS were female sex (prevalence ratio [PR]=2.16; 95% CI, 1.04-4.49), age-adjusted institutionalization time >50% (PR=2.38, 95% CI, 1.46-3.88), and high concentrations of interleukin-6 (PR=2.01; 95% CI, 1.21-3.32) and tumor necrosis factor-α (PR=1.70; 95% CI, 1.05-2.77). Moreover, it was verified that the likelihood of having MS was 1.85-fold higher (95% CI, 1.11-3.10) in the group with a diet characterized by very high energy, very low fat, and high dietary fiber. CONCLUSION: The occurrence of MS in institutionalized elderly individuals was higher in females, and individuals with longer age-adjusted institutionalization time, higher concentrations of immunologic biomarkers, and a dietary intake consisting of higher energy and fiber and lower total fat. The results of the study are useful for guiding health care programs aimed at institutionalized elderly individuals.

Estimating the height of elderly nursing home residents: Which equation to use?

Estimating equations can be used when measuring the height of elderly persons is not possible. However, such methods are not always applicable; therefore, it is necessary to consider several aspects, such as sex, age, and ethnicity of the studied population to generate these equations. This study aimed to compare and validate methods of estimating the height of the Brazilian elderly nursing home residents. An accuracy study was conducted with 168 elderly persons. A total of 23 equations were quantitatively evaluated by plotting the differences in means, the Student's t-test for paired samples, the coefficient of determination (R2), the root-mean-square error (RMSE), the interclass correlation coefficient (ICC), and by graphic analysis of the residuals. A significance value of p <0.05 was adopted. An equation was considered applicable when it had R2 >0.7, the lowest RMSE among the equations evaluated, ICC >0.7, and a confidence interval of 95%, with the smallest difference between the upper and lower limits. A greater mean height was noted among younger elderly persons and elderly men compared to up to 80 years and women elderly. Quantitative analysis revealed that equation for Puerto Ricans, using knee height and age, was the most applicable for the overall population (ICC = 0.802). The same equation was applicable for the elderly Brazilian male participants (ICC = 0.838) and for those aged 60-69 years (ICC = 0.895). None of the equations used were applicable for the height estimation of elderly women or individuals aged 70 years or more.

Plasma zinc in institutionalized elderly individuals: Relation with immune and cardiometabolic biomarkers.

Changes in zinc metabolism caused by aging and the institutionalization process may contribute to zinc deficiency in elderly individuals. Hypozincemia results in changes in glycemic, lipid, and inflammatory profiles. The aim of this study was to evaluate plasma zinc concentrations and their relationships with sociodemographic, dietary, inflammatory, and cardiometabolic biomarkers in institutionalized elderly individuals. A cross-sectional study was carried out including 255 elderly adults living in nursing homes. The associations between plasma zinc and dietary zinc intake, sociodemographic indicators, and glycemic, lipid, and inflammatory biomarkers were evaluated. Independent variables were analyzed according to quartiles of plasma zinc concentrations (Q1: <71.1 µg/dL; Q2: 71.1-83.3 µg/dL; Q3: <83.3-93.7 µg/dL; Q4: >93.7 µg/dL). The relationship between plasma zinc concentrations and predictor variables was also tested. In Q1, higher concentrations of the following variables were observed, compared with those in other quartiles: total cholesterol and low-density lipoprotein cholesterol (LDL-c; Q1 > Q2, Q3, Q4; all p <0.001); triglycerides (Q1 > Q3, Q4; all p < 0.001); interleukin (IL)-6 (Q1 > Q3, Q4; p = 0.024 and p = 0.010, respectively); tumor necrosis factor (TNF)-α (Q1 > Q3, p = 0.003). A significant reduction in plasma zinc concentrations was observed with increasing age-adjusted institutionalization time (Δ = - 0.10; 95% confidence interval [CI]: -0.18 to -0.01). The concentrations of total cholesterol (Δ = - 0.19; 95% CI: -0.23 to -0.15), LDL-c (Δ = - 0.19; 95% CI: -0.23 to -0.15), triglycerides (Δ = - 0.11; 95% CI: -0.16 to -0.06), IL-6 (Δ = - 1.41; 95% CI: -2.64 to -0.18), and TNF-α (Δ = - 1.04; 95% CI: -1.71 to -0.36) were also significantly increased. In conclusion, decreased plasma zinc concentrations were associated with longer institutionalization time and worse lipid and inflammatory profiles in elderly institutionalized individuals.

What is the impact of the European Consensus on the diagnosis and prevalence of sarcopenia among institutionalized elderly persons? / Qual o impacto do consenso europeu no diagnóstico e prevalência de sarcopenia em idosos institucionalizados?

Abstract Objective: To verify the impact of the European Consensus on the diagnosis and prevalence of sarcopenia among institutionalized elderly persons in Natal, Rio Grande do Norte, Brazil. Method: 219 elderly persons (≥60 years) of both genders were recruited for the study. Two criteria were initially used to calculate the prevalence of sarcopenia: criterion A, based on the European Consensus, considering only elderly persons with good physical and cognitive conditions and criterion B, considering all elderly individuals, regardless of their physical and/or cognitive condition. The association between sarcopenia and gender, age and body mass index (BMI) in the two groups was investigated using the chi-square test and the Student's t-test, with a significance level of 5%. Result: the diagnosis of sarcopenia according to Criterion A revealed a prevalence of 32% (95% CI: 22.54-43.21), whereas Criterion B identified a prevalence of 63.2% (95% CI: 56; 45-69,13). Despite the difference in the prevalence of sarcopenia using the two criteria employed (p<0.001), no differences were observed in terms of the association with gender (p=0.149, p=0.212), BMI (p<0.001, p<0.001), and age (p=0.904, p=353). Conclusion: including only elderly people with good physical and cognitive abilities to calculate sarcopenia, based on the European Consensus, underestimates the prevalence of this condition among institutionalized elderly. As elderly persons with physical or cognitive limitations are extremely typical in the population of care facilities and increased diagnostic calculation for sarcopenia did not interfere with the distribution of associated factors, it is recommended that these individuals are considered in the basis of calculation for future studies of the diagnosis and prevalence of sarcopenia. AU

Resumo Objetivo: verificar o impacto do consenso europeu no diagnóstico e prevalência de sarcopenia em idosos institucionalizados em Natal, RN, Brasil. Método: 219 idosos (≥60 anos) de ambos os sexos foram recrutados para o estudo. Inicialmente, foram comparados dois critérios para cálculo de prevalência da sarcopenia: critério A, segundo o consenso europeu, considerando apenas idosos com boas condições físicas e cognitivas e critério B, considerando todos idosos, independente da sua condição física e/ou cognitiva. Na sequência, foi investigada a associação da sarcopenia com sexo, idade e Índice de Massa Corporal (IMC) nos dois critérios diagnósticos, através do teste do qui-quadrado ou teste t deStudent, sendo considerado nível de significância de 5%. Resultados :O diagnóstico de sarcopenia segundo o Critério A apresentou uma prevalência de sarcopenia de 32% (IC95%: 22,54-43,21), enquanto o Critério B apresentou uma prevalência de 63,2% (IC95%: 56,45-69,13). Apesar da diferença encontrada na prevalência de sarcopenia entre os dois critérios utilizados (p<0,001), não foram observadas diferenças com relação à associação com sexo (p=0,149;p=0,212), IMC (p<0,001; p<0,001) e idade (p=0,904;p=0,353). Conclusão :Incluir apenas idosos com boa capacidade física e cognitiva para cálculo de sarcopenia, conforme estipulado pelo Consenso Europeu, subestima a prevalência de sarcopenia em idosos institucionalizados. Considerando que idosos com limitações físicas ou cognitivas são extremamente representativos para a população de idosos institucionalizados e que o acréscimo deles no cálculo diagnóstico para sarcopenia não interferiu na distribuição dos seus fatores associados, recomenda-se considerá-los na base de cálculo para estudos futuros de diagnóstico e prevalência de sarcopenia. AU

Estimating weight in elderly residents in nursing homes: which equation to use? / Estimativa de peso em idosos institucionalizados: qual equação utilizar?

INTRODUCTION: When it is impossible to measure weight in the elderly, estimation methods can be employed. However, such methods are not always applicable and can lead to estimation errors that compromise both the clinical practice and the results in epidemiological studies. OBJECTIVE: To compare and validate weight estimation methods in the elderly living in nursing homes in Natal, Rio Grande do Norte, Brazil. METHODS: The equations were evaluated qualitatively, by the reproducibility of the measurements that comprised them, and quantitatively, by the mean difference between the measured and the estimated weights, using Student's t -test for paired samples or ANOVA, the coefficient of determination (R²), root mean square error (RMSE), intra-class correlation coefficient (ICC) and graphical analysis of residuals. The significance value adopted was of p < 0.05. It was considered applicable when the equation presented R² > 0.7; lowest RMSE among the evaluated equations; ICC > 0.7; and respective 95% confidence interval with less distance between the upper and lower limits. RESULTS: We evaluated 315 elderly from 10 nursing homes in Natal. The mean body weight was higher in the younger elderly and those without mobility restriction. The qualitative analysis showed the equation 5 as having the best reproducibility, since it does not use skinfold measurements. The quantitative analysis revealed the equation 5 as the one with the best applicability across the studied population and in the different genders, age groups (60 - 69 years, 70 - 79 years, and 80 years or more), and mobility restriction conditions. CONCLUSION: The equation 5 was applicable for estimating weight in the evaluated population and in the different strata analyzed.

Estimativa de peso em idosos institucionalizados: qual equação utilizar? / Estimating weight in elderly residents in nursing homes: which equation to use?

RESUMO: Introdução: Na impossibilidade de mensuração do peso em idosos, métodos de estimativa podem ser empregados. Entretanto, tais métodos nem sempre são aplicáveis, podendo levar a erros de estimativa que comprometem tanto a prática clínica quanto resultados em estudos epidemiológicos. Objetivo: Comparar e validar métodos de estimativa de peso em idosos residentes em instituições de longa permanência de Natal, Rio Grande do Norte. Métodos: Avaliaram-se as equações qualitativamente pela reprodutibilidade das medidas que as compunham e, quantitativamente, pela diferença média entre o peso mensurado e os estimados, e utilizado o teste t de Student para amostras pareadas ou ANOVA, coeficiente de determinação (R²), raiz do erro quadrático médio (REQM), coeficiente de correlação intraclasse (CCI) e análise gráfica de resíduos. Adotou-se como valor de significância p < 0,05. Considerou-se aplicável quando a equação apresentava R² > 0,7; menor REQM dentre as equações avaliadas; CCI > 0,7; e respectivo intervalo de confiança 95% com menor distância entre os limites inferior e superior. Resultados: Avaliaram-se 315 idosos de 10 instituições de longa permanência de Natal. O peso corporal médio foi maior nos idosos mais jovens e sem restrição de mobilidade. A análise qualitativa mostrou a equação 5 como a de melhor reprodutilidade, uma vez que não utiliza medidas de dobras cutâneas. A análise quantitativa revelou a equação 5 como a de melhor aplicabilidade em toda a população avaliada e nos diferentes sexos, faixas etárias (60 a 69 anos, 70 a 79 anos e 80 anos ou mais) e condição de restrição de mobilidade. Conclusão: A equação 5 foi aplicável para a estimativa de peso na população avaliada e nos diferentes estratos analisados.

ABSTRACT: Introduction: When it is impossible to measure weight in the elderly, estimation methods can be employed. However, such methods are not always applicable and can lead to estimation errors that compromise both the clinical practice and the results in epidemiological studies. Objective: To compare and validate weight estimation methods in the elderly living in nursing homes in Natal, Rio Grande do Norte, Brazil. Methods: The equations were evaluated qualitatively, by the reproducibility of the measurements that comprised them, and quantitatively, by the mean difference between the measured and the estimated weights, using Student's t -test for paired samples or ANOVA, the coefficient of determination (R²), root mean square error (RMSE), intra-class correlation coefficient (ICC) and graphical analysis of residuals. The significance value adopted was of p < 0.05. It was considered applicable when the equation presented R² > 0.7; lowest RMSE among the evaluated equations; ICC > 0.7; and respective 95% confidence interval with less distance between the upper and lower limits. Results: We evaluated 315 elderly from 10 nursing homes in Natal. The mean body weight was higher in the younger elderly and those without mobility restriction. The qualitative analysis showed the equation 5 as having the best reproducibility, since it does not use skinfold measurements. The quantitative analysis revealed the equation 5 as the one with the best applicability across the studied population and in the different genders, age groups (60 - 69 years, 70 - 79 years, and 80 years or more), and mobility restriction conditions. Conclusion: The equation 5 was applicable for estimating weight in the evaluated population and in the different strata analyzed.

Mortalidade e fatores prognósticos em idosos residentes em Instituições de Longa Permanência / Mortality and prognostic factors in elderly people living in Long-Term Care Institutions

O envelhecimento populacional é um fenômeno mundial. No Brasil, o aumento da proporção de idosos na população vem sendo acompanhado por mudanças no perfil epidemiológico, onde prevalecem as doenças crônicas e agravos não transmissíveis, sendo estas as principais causas de morbidade, incapacidade e mortalidade, especialmente nos idosos que residem em Instituições de Longa Permanência. A escassez de trabalhos envolvendo a situação de saúde e de mortalidade dos idosos institucionalizados motivou a realização desta pesquisa, que tem como objetivo determinar a mortalidade e seus fatores prognósticos em idosos institucionalizados no município de Natal-RN. Trata-se de um estudo de prognóstico, com população dinâmica, iniciado em Outubro de 2013, com duração de 18 meses de acompanhamento a todos os idosos residentes (n=345) em instituições de longa permanência, com e sem fins lucrativos. Durante este período, foram realizados sete ondas de avaliação, onde foram mensuradas as seguintes variáveis antropométricas: peso (kg), altura (cm), perímetros braquial (cm) e da panturrilha (cm). A triagem nutricional foi realizada utilizando a Mini Avaliação Nutricional. As informações referentes ao consumo alimentar e a concentração de albumina sérica foram obtidas a partir da análise de dados de uma outra pesquisa a qual esse estudo faz parte. Já as informações sobre as morbidades, hospitalizações, tipo de dieta e número de medicamentos, foram obtidas por meio dos prontuários. Os dados socioeconômicos, sociodemográficos e socioculturais foram coletados através de entrevistas estruturadas com auxílio de questionários. As informações sobre a mortalidade foram obtidas após a análise do atestado de óbito. Realizou-se a análise estatística mediante a análise de sobrevida pelo método de Kaplan-Meier e, em seguida, regressão de Cox na análise multivariada, com os respectivos hazards ratios (HR). Os 345 idosos avaliados apresentaram média de idade igual a 81,2 (9,3) anos, com maior proporção da população ≥75 anos (74,8%). A maioria dos institucionalizados é do sexo feminino (76,5%), são solteiros (45,8%) e possuem algum grau de escolaridade (61,4%). Um total de 179 idosos (51,9%) possui restrição de mobilidade, 89,0% foram diagnosticados com doenças crônicas, 54% com desnutrição e 45,2% utilizam mais de cinco medicamentos ao dia. As doenças crônicas como a hipertensão (45,5%) e o diabetes (25,0%), são as mais frequentes. Durante o seguimento, 70 idosos (20,3%, IC 95%=16,25% - 25,00%) foram a óbito, nos quais as doenças do aparelho respiratório (44,3%) e circulatório (30,0%) foram as suas principais causas. A probabilidade de sobrevida global dos idosos institucionalizados foi de 78,7% (IC, 0,74-0,83) ao final da coorte, onde os principais fatores prognósticos identificados na análise de Cox foram a idade ≥ 75 anos (HR=3,85), perímetro da panturrilha inferior a 31cm (HR=2,58), alimentação por sonda (HR=2,59), alimentação pastosa (HR=2,23), com restrição de mobilidade (HR= 1,76), sexo masculino (HR= 1,75) e polifarmácia (HR=1,55). Dessa forma, melhorias nas condições de saúde, com ações voltadas a prevenção de doenças respiratórias e cardiovasculares, bem como a recuperação do estado nutricional e adequação na prescrição de alimentos e medicamentos podem resultar na redução do risco de mortalidade precoce (AU).

Population aging is a global phenomenon. In Brazil, the increase in the proportion of elderly in the population has been accompanied by changes in the epidemiological profile, which are prevalent noncommunicable chronic diseases, which are the leading causes of morbidity, disability and mortality, especially in the elderly residing in nursing homes. The shortage of studies involving the situation of health and mortality in institutionalized elderly motivated this research, which aims to determine the mortality and its prognostic factors in institutionalized elderly in the city of Natal-RN. This is a prognostic study with dynamic population, started in October 2013 with duration of 18 months follow-up to all elderly residents (n = 345) in nursing homes, with and without profit. During this period, were realized seven assessment waves, where the following anthropometric variables were measured: weight (kg), height (cm), brachial perimeters (cm) and calf (cm). The nutritional screening was performed using the Mini Nutritional Assessment. Information about the food consumption and serum albumin concentration were obtained from the data analysis of a survey which this study is part. As for the information about morbidities, hospitalizations, diet type and number of medications they were obtained through medical records. Socioeconomic, demographic and sociocultural data were collected through structured interviews with questionnaires assistance. The information on mortality was obtained after analysis of death certificate. The statistical analysis was carried out through the analysis of survival by the Kaplan-Meier method, and then Cox regression at multivariate analysis, with the respective hazards ratios (HR). Thes 345 elderly evaluated presented mean age equal to 81.2 (9.3) years, with the largest proportion of the population ≥ 75 years (74,8%). Most institutionalized are female (76.5%), are single (45.8%) and have some degree of schooling (61.4%). A total of 179 elderly (51.9%) have mobility restriction, 89.0% were diagnosed with chronic diseases, 54% with malnutrition and 45.2% use more than five drugs a day. Chronic diseases such as hypertension (45.5%) and diabetes (25.0%) are the most frequent. During follow-up, 70 elderly (20.3%, CI 95%:16.25%- 25.00%) died, in which respiratory diseases (44.3%) and circulatory (30.0%) were the its main causes. The probability of overall survival of institutionalized elderly was 78.7% (CI: 0.74-0.83) at the end of the cohort, where the main prognostic factors identified in the Cox analysis were age ≥ 75 years (HR = 3 85), calf perimeter less than 31cm (HR = 2.58), tube feeding (HR = 2.59), doughy food (HR = 2.23), with mobility restrictions (HR = 1, 76), male (HR = 1.75) and polypharmacy (HR = 1.55). In this way, improvements in health, with actions directed to prevention of cardiovascular and respiratory diseases, as well as the recovery of nutritional status and fitness on prescription food and medications can result in reducing the risk of early mortality (AU).

The construction of ergonomic demands: application on artisan fishing using jangada fishing rafts in the beach of Ponta Negra.

The present article seeks the process of construction of ergonomics demand referring to the artisan fishing activityfound in Ponta Negra beach located in the city of Natal, Brazil. The instruction/construction of demands correspond to the first stage of Work Ergonomic Analysis and allows the understanding of real issues existent in a work situation, rank them and route the providences. The demand presented on this study, features itself as a induced demand, process which some potential demands or hypothetical demands are taken to an organization, after a preview analysis of the work aimed by the study, resulting from a theoretical research (state of the art) and/or from analysis of a reference situation (state of practice), where demands hypothesis are taken in consideration about the pretended work. The demands construction process using interactional methods and techniques, observation methods and techniques and bibliographic research, researches in state of reference or document. This article demonstrates the efficiency of the methodological choice to construct real ergonomic demands and highlights the importance of social construction on that process, which main goal is to refer the ergonomic actions that allow the improvement of work and life conditions for the fishers and sustainability to Jangadeira activity.