Beyond the stethoscope: ageism in white coats and resident physicians' preferences for elderly patient care.

BACKGROUND: The global increase in life expectancy has significantly raised the elderly population. In Türkiye, the proportion of individuals aged 65 and over rose from 8.8% in 2018 to 10.2% in 2023. This demographic shift necessitates the planning of social and health services for the elderly. Ageism affects elderly health negatively and is prevalent in healthcare settings. This study aimed to determine the prevalence of ageism among resident physicians at Pamukkale University Hospital and identify factors influencing their preferences for providing healthcare to elderly patients. METHODS: This cross-sectional study was conducted at Pamukkale University Hospital between 6 June and 16 June, 2024. A total of 448 resident physicians were selected through simple random sampling. Data were collected using a self-administered questionnaire, which included sociodemographic information, factors affecting ageism, and the Fraboni Scale of Ageism (FSA). Descriptive statistics, Chi-square tests, and logistic regression were used to evaluate factors influencing healthcare preferences. RESULTS: The FSA score averaged 71.89 ± 7.87, indicating a 20.1% (95% CI:16.48-24.10) prevalence of age discrimination among resident physicians. Logistic regression analysis revealed that male participants (odds ratio (OR) = 1.519, P = 0.042), those with moderate to very poor perceived knowledge of elderly health (OR = 2.418, P < 0.001), and higher FSA scores (OR = 1.046, P < 0.001) were more likely to prefer not providing healthcare services to elderly patients. CONCLUSIONS: Ageism among resident physicians is prevalent, impacting their willingness to provide care to elderly patients. Gender, perceived knowledge, and ageist attitudes influence their preferences for providing healthcare to elderly patients. Addressing these factors is crucial for improving healthcare services for the elderly.

Reference values for heart rate variability in older adults: A systematic review.

Heart rate variability (HRV) is an early marker of risk for various health conditions, and its analysis serves as a valuable tool for assessing older adults. This study aimed to describe the reference values of HRV parameters in older adults through a systematic review of the literature. The review included searches in MEDLINE (via PubMed®), EMBASE, Latin American and Caribbean Health Literature, Scopus, and Web of Science (WOS). Studies presenting reference values for at least one HRV linear analysis measure in older adults were considered eligible. Out of 1618 studies identified, only 11 met the inclusion criteria. Sample sizes of older adults ranged from 21 to 6250 subjects. The HRV measures assessed (mean RR intervals, SDNN, RMSSD, PNN50, LF, HF, and LF/HF ratio) varied significantly between studies, with no standardized methods for HRV analysis. We concluded that reference values for HRV measures in older adults vary widely between studies. The scientific literature on HRV reference values in older adults is still limited, and future studies should standardize assessment methods for HRV measures in this population.

Impact of food insecurity on cognitive health in older adults: insights from the NHANES 2011-2014 data.

Purpose: To investigate the relationship between food insecurity and cognitive decline among elderly Americans. Methods: Utilizing NHANES 2011-2014 data, we examined cognitive function via the Immediate Recall Test (IRT), Delayed Recall Test (DRT), Animal Fluency Test (AFT), Digit Symbol Substitution Test (DSST) and assessed food security through the US Food Security Survey Module. Multiple regression models were used to adjust for demographic and health variables. Results: Food insecurity demonstrated a significant association with lower cognitive function scores. The effects of food insecurity on cognitive function were moderated by factors such as smoking and alcohol use, indicating a direct influence of food insecurity on cognitive decline. Conclusion: This study underscores the importance of food security for cognitive health in the elderly and advocates for targeted interventions to address nutritional disparities and enhance cognitive functioning in aging populations.

Frequency of use and characterization of frailty assessments in observational studies on older women with breast cancer: a systematic review.

BACKGROUND: Breast cancer and frailty frequently co-occur in older women, and frailty status has been shown to predict negative health outcomes. However, the extent to which frailty assessments are utilized in observational research for the older breast cancer population is uncertain. Therefore, the aim of this review was to determine the frequency of use of frailty assessments in studies investigating survival or mortality, and characterize them, concentrating on literature from the past 5 years (2017-2022). METHODS: MEDLINE, EMBASE and Cochrane Library were systematically queried to identify observational studies (case-control, cohort, cross-sectional) published from 2017-2022 that focus on older females (≥ 65 years) diagnosed with breast cancer, and which evaluate survival or mortality outcomes. Independent reviewers assessed the studies for eligibility using Covidence software. Extracted data included characteristics of each study as well as information on study design, study population, frailty assessments, and related health status assessments. Risk of bias was evaluated using the appropriate JBI tool. Information was cleaned, classified, and tabulated into review level summaries. RESULTS: In total, 9823 studies were screened for inclusion. One-hundred and thirty studies were included in the final synthesis. Only 11 (8.5%) of these studies made use of a frailty assessment, of which 4 (3.1%) quantified frailty levels in their study population, at baseline. Characterization of frailty assessments demonstrated that there is a large variation in terms of frailty definitions and resulting patient classification (i.e., fit, pre-frail, frail). In the four studies that quantified frailty, the percentage of individuals classified as pre-frail and frail ranged from 18% to 29% and 0.7% to 21%, respectively. Identified frailty assessments included the Balducci score, the Geriatric 8 tool, the Adapted Searle Deficits Accumulation Frailty index, the Faurot Frailty index, and the Mian Deficits of Accumulation Frailty Index, among others. The Charlson Comorbidity Index was the most used alternative health status assessment, employed in 56.9% of all 130 studies. Surprisingly, 31.5% of all studies did not make use of any health status assessments. CONCLUSION: Few observational studies examining mortality or survival outcomes in older women with breast cancer incorporate frailty assessments. Additionally, there is significant variation in definitions of frailty and classification of patients. While comorbidity assessments were more frequently included, the pivotal role of frailty for patient-centered decision-making in clinical practice, especially regarding treatment effectiveness and tolerance, necessitates more deliberate attention. Addressing this oversight more explicitly could enhance our ability to interpret observational research in older cancer patients.

Environmental microbial colistin resistance in an elderly south Brazilian long-term care facility.

Colistin resistance is a global health concern, with antibiotics being the last treatment for Gram-negative bacteria infections. We aimed to identify colistin-resistant enterobacteria on environmental surfaces of a long-term care facility (LTCF) for the elderly in southern Brazil. Samples were collected and screened on MacConkey agar plus colistin, followed by API20E identification and PCR. Two isolates were founded and identified as Klebsiella pneumoniae and Providencia stuartii harboring mcr-1 gene with MICs > 128 µg mL-1 for colistin. This is the first isolation of microorganisms resistant to colistin in the environment of a LTCF for the elderly in south Brazil, urging monitoring programs to reduce environmental contamination by multiresistant microorganisms.

The impact of outdoor blue spaces on the health of the elderly: A systematic review.

Research on natural health has identified the potential benefit of outdoor blue spaces for human health and wellbeing. However, the existing evidence has relatively limited attention to the elderly. This study aims to review the available evidence on outdoor blue spaces and health outcomes among older individuals and identify knowledge gaps. In accordance with the PRISMA guidelines, specific keywords were used to search for articles published in English from inception to October 2023. Five databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO) were searched, and 22 studies were identified in this review. We classified articles based on elderly health as general health (e.g., self-reported, perceived health and wellbeing), physical health (e.g., physical activity, physical function index), and mental health and wellbeing (e.g., depression). The findings indicated a positive correlation between outdoor blue space and the health of the elderly. In terms of the characteristics of exposure to outdoor blue spaces, direct contact (e.g., sensory-based) has not been well documented compared to indirect contact (e.g., distance, percentage, region-based). Although encouraging, the available body of evidence is limited and lacks consistency. Future research is needed to provide complementary evidence between outdoor blue spaces and elderly health.

Prevalência de Candida sp. no meio ambiente bucal e fatores associados em pessoas idosas acamadas e domiciliadas / Prevalence of Candida sp. in the oral environment and associated factors in bedridden and homebound elderly people

Introdução: Espera-se, com o aumento da expectativa de vida, cada vez mais pessoas idosas domiciliadas e acamadas. Neste contexto, o meio ambiente bucal também sofre consequências, pois, como a Candida albicans e muitas outras espécies de Candida fazem parte da microbiota suplementar, quando o sistema imunológico do hospedeiro está comprometido, esses fungos podem causar candidose. Objetivo: Analisar a prevalência de Candida sp. em meio ambiente bucal e fatores associados em pessoas idosas acamadas e domiciliadas. Metodologia: Uma amostra de 397 pessoas idosas foi avaliada, no município de Natal/RN, no período de agosto a novembro de 2023, as quais foram examinadas clinicamente e realizada a coleta e análise de amostras de saliva para diagnóstico da presença das leveduras. A análise dos dados foi feita a partir da presença ou ausência das espécies de Candida sp., e os fatores associados foram determinados através do teste Quiquadrado e regressão robusta de Poisson para um nível de confiança de 95%. Resultados: A Candida sp. esteve presente em 63,1% dos indivíduos da amostra (IC 95% 57,3-68,9), destacando as espécies C. albicans em 44,5%, C. tropicalis em 19%, C. krusei em 17,5% e C. glabrata em 12,5%. As variáveis que tiveram associação com a presença de Candida sp. foram a candidose (RP = 1,32), falta de visita frequente do agente comunitário de saúde (RP = 1,13) e polifarmácia (RP= 1,14). Conclusão: A prevalência de Candida sp. no meio ambiente bucal de pessoas idosas acamadas e domiciliadas foi elevada e o uso em excesso de medicamentos, a falta de cuidado por parte do sistema de saúde e a manifestação clínica da presença em excesso da levedura Candida sp., especialmente a Candida albicans, foram determinantes para a presença desta levedura no meio ambiente bucal destas pessoas idosas (AU).

Introduction: With increasing life expectancy, it is expected that more and more elderly people will be housebound and bedridden. In this context, the oral environment also suffers consequences, since, as Candida albicans and many other Candida species are part of the supplementary microbiota, when the host's immune system is compromised, these fungi can cause candidosis. Objective: To analyze the prevalence of Candida sp. and associated factors in bedridden and homebound elderly people. Methodology: A sample of 397 elderly people was evaluated, who were clinically examined and saliva samples were collected and analyzed to diagnose the presence of yeast. Data analysis was carried out based on the presence or absence of Candida sp. species, and associated factors were determined using the Chi-square test and robust Poisson regression for a confidence level of 95%. Results: Candida sp. was present in 63.1% volunteers (95% CI 57.3-68.9), highlighting the species C. albicans in 44.5%, C. tropicalis in 19%, C. krusei in 17.5% and C .glabrata in 12.5%. The variables that were associated with the presence of Candida sp. were candidosis (RP = 1.32), lack of frequent visits by the community health agent (RP = 1.13) and polypharmacy (RP = 1.14). Conclusion: The prevalence of Candida sp. in the oral environment of bedridden and homebound elderly people was high and that the excessive use of medications, the lack of care on the part of the health system and the clinical manifestation of the excess presence of the yeast Candida sp., especially the Candida albicans, were decisive for the presence of this yeast in the oral environment of these elderly people (AU).

Perda dentária: fatores associados e impacto na qualidade de vida de pessoas idosas residentes em zona rural / Tooth loss: associated factors and impact on the quality of life of elderly people living in rural areas

A saúde bucal das pessoas idosas residentes em áreas rurais é considerada como mais comprometida que aquelas que vivem em áreas urbanas. O reflexo desse quadro pode ser um elevado impacto relacionado à qualidade de vida em saúde bucal. Nesse sentido, o objetivo do estudo foi avaliar a prevalência de perda dentária - expressa pelo edentulismo total, edentulismo funcional, pares em oclusão, dentes funcionais e raízes residuais -, os fatores associados e impacto na qualidade de vida em pessoas idosas residentes em zona rural. Para tanto, uma amostra de 213 pessoas idosas foi avaliada, havendo uma perda de 26 indivíduos, a partir de um sorteio com as listas de pessoas idosas de cada Unidade Básica de Saúde da zona rural do município de São Bento/PB. Os indivíduos foram examinados clinicamente em relação à perda dentária e a qualidade de vida em saúde bucal foi avaliada pelo GOHAI. A análise dos dados foi realizada a partir do teste do qui quadrado e regressão robusta de Poisson para um nível de significância de 5%. A perda dentária nas pessoas idosas residentes na zona rural representada pelo edentulismo total foi de 48,8% (IC 95% 42,2 ­ 55,5%), edentulismo funcional de 95,3% (IC 95% 95,0 ­ 98,1%), nenhum par em oclusão de 82,6% (IC 95% 77,5 ­ 87,7%), poucos ­ menos que 5 - dentes funcionais de 68,5% (IC 95% 62,2 ­ 74,7%) e número elevado de raízes residuais de 14,6% (IC 95% 9,9 ­ 19,3%). Os fatores associados ao edentulismo, representando a perda dentária, foram o sexo feminino (RP = 1,15), a avaliação da saúde bucal como boa ou muito boa (RP = 1,18), a higiene da boca realizada com métodos preventivos individuais ou apenas água (RP = 1,32), polifarmácia (RP = 1,12) e última consulta do dentista há mais de 3 anos (RP = 1,09). Não houve associação da perda dentária com o impacto relacionado à qualidade de vida em saúde bucal. Conclui-se que a perda dentária nas pessoas idosas residentes na zona rural foi elevada, assim como também o foi a pouca funcionalidade dos dentes presentes e a ausência de cuidado em saúde bucal a essa população, evidenciada pela grande presença de edentulismo total (AU).

The oral health of elderly people living in rural areas is considered to be more compromised than those who live in urban areas. The reflection of this situation may be a high impact related to quality of life in oral health. In this sense, the objective of the study was to evaluate the prevalence of tooth loss - expressed by total edentulism, functional edentulism, pairs in occlusion, functional teeth and residual roots -, the associated factors and impact on quality of life in elderly people living in rural areas. . To this end, a sample of 213 elderly people was evaluated, with a loss of 26 individuals, based on a draw with the lists of elderly people from each Basic Health Unit in the rural area of the municipality of São Bento/PB. Subjects were clinically examined for tooth loss and oral health quality of life was assessed by the GOHAI. Data analysis was performed using the chi-square test and robust Poisson regression for a significance level of 5%. Tooth loss in elderly people living in rural areas represented by total edentulism was 48.8% (95% IC 42.2 ­ 55.5%), functional edentulism was 95.3% (95% IC 95.0 ­ 98.1%), no pair in occlusion of 82.6% (95% IC 77.5 ­ 87.7%), few ­ less than 5 ­ functional teeth of 68.5% (95% IC 62.2 ­ 74,7%) and a high number of residual roots of 14.6% (95% IC 9.9 ­ 19.3%). The factors associated with edentulism, representing tooth loss, were female gender (RP = 1.15), assessment of oral health as good or very good (RP = 1.18), oral hygiene performed with individual preventive methods or just water (RP = 1.32), polypharmacy (RP = 1.12) and last dentist appointment more than 3 years ago (RP = 1.09). There was no association between tooth loss and the impact on oral health quality of life. It is concluded that tooth loss in elderly people living in rural areas was high, as was the low functionality of the teeth present and the lack of oral health care for this population, evidenced by the large presence of total edentulism (AU).

The effects of 6-week home-based static stretching, dynamic stretching, or eccentric exercise interventions on muscle-tendon properties and functional performance in older women.

Background: Joint inflexibility is acknowledged as a significant contributor to functional limitations in the older adult, with lengthening-type exercises identified as a potential remedial approach. Nevertheless, the responses to eccentric exercise in female older adults have not been extensively studied especially in home-based environment. Here, we aimed to assess the effectiveness of home-based static stretching (ST), dynamic closed-chain stretching (DCS), or eccentric exercise (ECC) interventions on flexibility, musculotendinous architecture, and functional ability in healthy older women. Methods: We randomly assigned 51 healthy older women (age 65.9 ± 3.4 years) to one of three interventional exercise groups: DCS (N = 17), ECC (N = 17), or ST (N = 17). The training was performed 3 times a week for 6 weeks. The participants' musculotendinous stiffness, fascicle length, eccentric strength, and functional capacities were measured before the intervention, after 6 weeks of exercise, and at a 1-month follow-up. Results: The results showed that all three interventions improved hamstring flexibility and passive ankle dorsiflexion (p < 0.001), with increased biceps femoris and medial gastrocnemius fascicle length (p < 0.01). However, there was no significant change in musculotendinous stiffness. The ECC intervention produced a greater improvement in knee flexor and calf eccentric peak torque (p < 0.05), and gait speed (p = 0.024) than the other two interventions. The changes in flexibility and knee flexor strength remained for up to 4 weeks after detraining. Conclusion: In conclusion, the present study suggests that home-based ECC may be more beneficial in enhancing physical capacities in older women compared with either DCS or SS interventions.

Percepção sobre abandono afetivo em idoso institucionalizado / Perception of emotional neglect in institutionalized elderly / Percepción del abandono afectivo en adultos mayores institucionalizado

Objetivo: Compreender a percepção dos idosos institucionalizados quanto ao abandono afetivo por parte de seus familiares.Método: Trata-se de um estudo exploratório, comabordagemqualitativa. Conduzido por meio de entrevistas semiestruturadas. A organização e análise dos dados foram baseadas na técnica de Minayo. O estudo foi realizado em uma Instituição de Longa Permanência para Idosos, localizada em uma cidade do nordeste de Santa Catarina.Resultados: Participaram do estudo nove idosos, com idades entre 60 e 89 anos, com diferentes estados civis (viúvos, casados e divorciados), variando sua escolaridade do nível básico ao superior, além de serem aposentados ou pensionistas. Foram identificadas quatro categorias analíticas: (1) vivência na instituição, (2) motivos para a institucionalização, (3) relacionamento familiar e (4) percepção do abandono familiar.Conclusão: alguns idosos enfatizaram sentir-se esquecidos na instituição, o que os deixa tristes e deprimidos. É crucial para a prática de a enfermagem compreender a realidade dos idosos nas Instituições de Longa Permanência, pois essa compreensão está diretamente ligada à prestação de cuidados em todos os níveis de assistência à saúde

Objective: To understand the perception of institutionalized elderly individuals regarding the emotional abandonment by their family members.Methodology: This is an exploratory study, using qualitative methods. Conducted through semi-structured interviews. Data organization and analysis were based on Minayo's technique. The study was conducted at a Long-Term Care Institution for the Elderly located in a city in northeastern Santa Catarina.Results: Nine elderly individuals participated in the study, ranging in age from 60 to 89 years old, with different marital statuses (widowed, married, and divorced), ranging in education from basic to higher levels, and being retirees or pensioners. Four analytical categories were identified: (1) experience in the institution, (2) reasons for institutionalization, (3) family relationships, and (4) perception of family abandonment.Conclusion: Some elderly individuals emphasized feeling forgotten in the institution, which makes them feel sad and depressed. Understanding the reality of the elderly in Long-Term Care Institutions is crucial for nursing practice, as this understanding is directly linked to providing care at all levels of healthcare assistance in the Health Care Network

Objetivo: Comprender la percepción de las personas mayores institucionalizadas con respecto al abandono afectivo por parte de sus familiares. Metodología:Se trata de un estudio exploratorio, utilizando métodos cualitativos. Realizado a través de entrevistas semiestructuradas. La organización y análisis de los datos se basaron en la técnica de Minayo. El estudio se llevó a cabo en una Institución de Larga Estadía para Personas Mayores lubicada en una ciudad del noreste de Santa Catarina. Resultados:Nueve personas mayores participaron en el estudio, con edades comprendidas entre 60 y 89 años, con diferentes estados civiles (viudos, casados y divorciados), variando en educación desde niveles básicos hasta superiores, y siendo jubilados o pensionistas. Se identificaron cuatro categorías analíticas: (1) experiencia en la institución, (2) motivos para la institucionalización, (3) relaciones familiares y (4) percepción del abandono familiar. Conclusión:Algunas personas mayores enfatizaron sentirse olvidadas en la institución, lo que los hace sentir tristes y deprimidas. Es crucial para la práctica de enfermería comprender la realidad de los adultos mayores en las Instituciones de Larga Estancia, ya que esta comprensión está directamente vinculada con la prestación de cuidados en todos los niveles de asistencia sanitaria en la Red de Atención a la Salud.

Avaliação das propriedades psicométricas da versão brasileira do Short Portable Mental Status Questionnaire (SPMSQ) de Pfeiffer / Evaluation of the psychometric properties of the Brazilian version of the Short Portable Mental Status Questionnaire (SPMSQ) by Pfeiffer

Resumo Objetivo Avaliar as propriedades psicométricas, contemplando validade, confiabilidade, sensibilidade e especificidade do SPMSQ-BR. Método A análise foi realizada em 93 idosos, avaliados com a versão brasileira do SPMSQ, Mini-Exame do Estado Mental (MEEM), Teste do Desenho do Relógio (TDR) e Teste de Fluência Verbal (TFV). A consistência interna foi estimada pelo coeficiente alfa de Cronbach. Para avaliar a estabilidade intra-avaliador e a reprodutibilidade inter-avaliador, utilizou-se o coeficiente de correlação intraclasse (CCI) com intervalo de confiança de 95%. Para a validade concorrente e convergente, utilizou-se o coeficiente de correlação de Spearman. A acurácia para estabelecer o ponto de corte do SPMSQ-BR para rastreamento da sensibilidade e especificidade realizou-se através da curva ROC. Resultado: O SPMSQ-BR demonstrou excelente consistência interna (α=0,803), alta confiabilidade intra e inter-avaliador (CCI-0,977) e (CCI-0,973) respectivamente. Na validade concorrente apresentou forte correlação linear com o MEEM (-0,799 p<0,001), já com TDR (-0,584 p<0,01) e TFV (-0,569 p<0,01) foram encontradas correlações moderadas. O SPMSQ-BR mostrou-se capaz de discriminar o comprometimento cognitivo com ponto de corte a partir de 3 erros, conforme a escala original. A área sob a curva considerando a escolaridade foi de AUC=0,905 (S=81,3% e E=76,9%) e sem considerar a escolaridade AUC=0,927 (S=87,5% e E=80,8%) apresentando uma boa sensibilidade e especificidade em ambos os casos. Conclusão O estudo demonstrou que a versão brasileira do SPMSQ estabelecida como Breve Escala de Capacidade Cognitiva apresentou-se estável, reprodutível, válida e confiável para avaliar a capacidade cognitiva de idosos, além de ser sensível na identificação de comprometimento cognitivo.

Abstract Objective To evaluate the psychometric properties, including validity, reliability, sensitivity, and specificity of the SPMSQ-BR. Method The analysis was conducted on 93 older adults, assessed with the Brazilian version of the SPMSQ, Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), and Verbal Fluency Test (VFT). Internal consistency was estimated using Cronbach's alpha coefficient. In order to assess intra-rater stability and inter-rater reproducibility, the intraclass correlation coefficient (ICC) with a 95% confidence interval was employed. For concurrent and convergent validity, Spearman's correlation coefficient was utilized. Accuracy in establishing the cutoff point for the SPMSQ-BR to screen sensitivity and specificity was assessed through ROC curve analysis. Result The SPMSQ-BR demonstrated excellent internal consistency (α=0.803), high intra-rater and inter-rater reliability (ICC=0.977 and ICC=0.973), respectively. In terms of concurrent validity, it showed a strong negative linear correlation with the MMSE (-0.799, p<0.001), while moderate correlations were found with the CDT (-0.584, p<0.01) and VFT (-0.569, p<0.01). The SPMSQ-BR proved capable of discriminating cognitive impairment with a cutoff point of 3 errors, following the original scale. The area under the curve (AUC) considering education level was 0.905 (sensitivity=81.3%, specificity=76.9%), and without considering education level, the AUC was 0.927 (sensitivity=87.5%, specificity=80.8%), indicating good sensitivity and specificity in both cases. Conclusion The study demonstrated that the Brazilian version of the SPMSQ, established as a Brief Cognitive Capacity Scale, proved to be stable, reproducible, valid, and reliable for assessing the cognitive capacity of older adults. Furthermore, it showed sensitivity in identifying cognitive impairment.

Avaliação da qualidade do sono e sonolência diurna de um grupo de idosos / Assessment of sleep quality and daytime sleepiness in a group of elderly people

O objetivo do estudo foi avaliar a qualidade do sono e sonolência diurna de um grupo de idosos, verificar se há associação com prática de atividade física, presença de doença crônica, e Índice de Massa Corporal (IMC) e se há correlação com IMC, idade e qualidade de vida. Trata-se de um estudo transversal e descritivo. Para avaliação da qualidade do sono utilizou-se o Pittsburgh Sleep Quality Index (PSQI), para avaliação da sonolência diurna a Escala de Sonolência de Epworth (ESE) e para avaliação da qualidade de vida o WHOQOL-BREF. Foram avaliados 47 idosos com mediana (intervalo interquartil 25-75%) de 66 (62-70) anos de idade e IMC de 28,58 (26,21-30,44). 74,5% apresentaram sono ruim, 61,7% apresentaram Sonolência Diurna Normal e 97,8% classificados com boa qualidade de vida, com destaque para os domínios relações sociais (80%) e autoavaliação da qualidade de vida (80%). Apenas apresentou associação estatisticamente significativa a presença de qualidade de sono ruim com a prática de atividade física. Não houve associação entre presença de qualidade de sono ruim ou sonolência com IMC e presença de doença crônica. Houve uma correlação fraca, negativa e estatisticamente significativa apenas entre qualidade do sono com qualidade de vida (ρ=-0,466) e idade (ρ=-0,297). Conclui-se que os idosos apresentaram qualidade do sono ruim, sonolência diurna normal e qualidade de vida geral boa.

The objective of the study was to evaluate the quality of sleep and daytime sleepiness of a group of elderly people, checking whether there is an association with physical activity, presence of chronic disease, and Body Mass Index (BMI) and whether there is a correlation with BMI, age and quality of life. This is a cross-sectional and descriptive study. To assess sleep quality, the Pittsburgh Sleep Quality Index (PSQI) was used, the Epworth Sleepiness Scale (ESE) was used to assess daytime sleepiness, and the WHOQOL-BREF was used to assess quality of life. 47 elderly people were evaluated with a median (interquartile range 25-75%) of 66 (62-70) years of age and BMI of 28.58 (26.21-30.44). 74.5% had poor sleep, 61.7% had Normal Daytime Sleepiness and 97.8% classified as having a good quality of life, with emphasis on the domains of social relationships (80%) and self-assessment of quality of life (80%). There was only a statistically significant association between the presence of poor sleep quality and the practice of physical activity. There was no association between the presence of poor sleep quality or sleepiness with BMI and the presence of chronic disease. There was a weak, negative and statistically significant correlation only between sleep quality and quality of life (ρ=-0.466) and age (ρ=- 0.297). It is concluded that the elderly had poor sleep quality, normal daytime sleepiness and good general quality of life.

Avaliação da comunicação interpessoal de profissionais de saúde em uma instituição de longa permanência para idosos / Evaluation of interpersonal communication of healthcare professionals in a long-stay institution for the elderly

Introdução: Em instituições de longa permanência para idosos a comunicação é um elemento fundamental para o relacionamento interpessoal entre os profissionais e moradores, a fim de proporcionar adequada compreensão do planoterapêutico e melhor desenvolvimento das relações de confiança e satisfação. Objetivo: Avaliar a comunicação interpessoal de profissionais de saúde em instituição de longa permanência para idosos. Materiais e Métodos: Trata-sede uma pesquisa transversal, descritiva, analítica com abordagem quantitativa, realizada em uma entidade filantrópicasem fins lucrativos de assistência e moradia à pessoa idosa - Lar São Vicente de Paulo, em um município no interior doestado de São Paulo. A coleta de dados ocorreu entre junho e julho de 2023. Utilizaram-se dois questionários, sendo um instrumento para dados sociodemográficos e a Escala de Competência em Comunicação Interpessoal para avaliar a comunicação dos profissionais de saúde. Foram realizadas análises descritivas e inferenciais. Resultados: Participaram 23 profissionais de saúde, 95,7% do sexo feminino, com média de idade de 45,2 anos, 91,3%, com renda mensal menor que três salários-mínimos e o mesmo percentual de profissionais que não possui outro trabalho. A pontuação mediana do escore total da Escala de Competência em Comunicação Interpessoal foi 64,8 pontos, com consistência interna média (Alpha de Cronbach= 0,58). Conclusões: Houve boa habilidade de comunicação interpessoal entre os profissionais de saúde, com diagnóstico situacional da comunicação interpessoal, além de conhecimento e possibilidade de aprimoramento dos processos de comunicação da equipe multidisciplinar, para maior qualidade e segurança no cuidado à pessoa idosa

Introduction: In long-term care institutions for elderly, communication is a fundamental element for the interpersonal relationship between professionals and residents, in order to provide adequate understanding of the therapeutic plan and better development of relationships of trust and satisfaction. Objective: To evaluate the interpersonal communication of health professionals in a long-term care institution for elderly. Materials and Methods: This is a cross-sectional, descriptive, analytical research with a quantitative approach, carried out in a non-profit philanthropic entity providing assistance and housing to elderly people - Lar São Vicente de Paulo, in a municipality of the State of São Paulo. Data collection occurred between June and July 2023. Two questionnaires were used, one instrument for sociodemographic data and the Interpersonal Communication Competence Scale to evaluate the communication of health professionals. Descriptive and inferential analyzes were carried out. Results: 23 health professionals participated, 95.7% female, with an average age of 45.2 years, 91.3% with a monthly income of less than three minimum wages, and the same percentage of professionals who did not have another job. The median score of the Interpersonal Communication Competence Scale total score was 64.8 points, with average internal consistency (Cronbach's Alpha= 0.58). Conclusions: There was good interpersonal communication skills among health professionals, with situational diagnosis of interpersonal communication, in addition to knowledge and the possibility of improving the communication processes of the multidisciplinary team, for greater quality and safety in the care of elderly people

Introduction: In long-term care institutions for elderly, communication is a fundamental element for the interpersonal relationship between professionals and residents, in order to provide adequate understanding of the therapeutic plan and better development of relationships of trust and satisfaction. Objective: To evaluate the interpersonal communication of health professionals in a long-term care institution for elderly. Materials and Methods: This is a cross-sectional, descriptive, analytical research with a quantitative approach, carried out in a non-profit philanthropic entity providing assistance and housing to elderly people - Lar São Vicente de Paulo, in a municipality of the State of São Paulo. Data collection occurred between June and July 2023. Two questionnaires were used, one instrument for sociodemographic data and the Interpersonal Communication Competence Scale to evaluate the communication of health professionals. Descriptive and inferential analyzes were carried out. Results: 23 health professionals participated, 95.7% female, with an average age of 45.2 years, 91.3% with a monthly income of less than three minimum wages, and the same percentage of professionals who did not have another job. The median score of the Interpersonal Communication Competence Scale total score was 64.8 points, with average internal consistency (Cronbach's Alpha= 0.58). Conclusions: There was good interpersonal communication skills among health professionals, with situational diagnosis of interpersonal communication, in addition to knowledge and the possibility of improving the communication processes of the multidisciplinary team, for greater quality and safety in the care of elderly people en un municipio del Estado de São Paulo. La recolección de datos se realizó entre junio y julio de 2023. Se utilizaron dos cuestionarios, un instrumento para datos sociodemográficos y la Escala de Competencia en Comunicación Interpersonal para evaluar la comunicación de los profesionales de la salud. Se realizaron análisis descriptivos e inferenciales. Resultados: Participaron 23 profesionales de la salud, 95,7% del sexo femenino, con edad promedio de 45,2 años, 91,3% con ingresos mensuales inferiores a tres salarios mínimos, e igual porcentaje de profesionales que no tenían otro trabajo. La mediana de la puntuación total en la Escala de Competencia en Comunicación Interpersonal fue de 64,8 puntos, con consistencia interna media (Alfa de Cronbach= 0,58). Conclusiones: Hubo buenas habilidades de comunicación interpersonal entre los profesionales de la salud, con diagnóstico situacional de la comunicación interpersonal, además de conocimiento y posibilidad de mejorar los procesos de comunicación del equipo multidisciplinario, para mayor calidad y seguridad en la atención a las personas mayores

Acidentes por quedas na população idosa: análise de tendência temporal de 2000 a 2020 e o impacto econômico estimado no sistema de saúde brasileiro em 2025 / Fall accidents in older people: a time trend analysis of the period 2000-2020 and the estimated economic burden on the Brazilian health system in 2025

Resumo O acompanhamento longitudinal de indicadores, como os relacionados às quedas acidentais, pode facilitar o planejamento de ações mais eficazes de assistência e prevenção. O objetivo deste artigo é analisar a tendência temporal das variáveis relacionadas aos acidentes de quedas na população idosa no Brasil e no estado de São Paulo entre 2000 e 2020 e estimar o impacto econômico para o SUS em 2025. Este é um estudo observacional retrospectivo com abordagem quantitativa, com dados do Sistema de Informação em Saúde. Foram utilizados os softwares Joinpoint Regression Program versão 4.7.0 e SPSS versão 20.0 para a realização de regressões lineares, além da análise Average Annual Percent Change (AAPC), adotando um intervalo de confiança de 95%. No país, houve aumento das internações nos dois períodos analisados, assim como os gastos totais, em todos os segmentos analisados. Em concordância no estado de São Paulo, o valor total e as internações apresentaram aumento (AAPC, sendo 8,5% e 4,3% respectivamente). No ano de 2025, as internações por quedas no Brasil estarão próximas a 150 mil, gerando custos em torno de R$ 260 milhões. Houve o aumento das variáveis analisadas, mostrando a importância de programas de prevenção de quedas associados a políticas públicas nacionais.

Abstract Longitudinal monitoring of indicators of accidental falls can facilitate the planning of effective care and prevention actions. This article aims to analyze temporal trends in variables related to falls among older persons in Brazil and in the state of São Paulo during the period 2000-2020 and estimate the projected economic burden on the health system in 2025. We conducted a quantitative retrospective observational study using data from the Health Information System. The Joinpoint Regression Program version 4.7.0 and SPSS version 20.0 were used to perform linear regression and calculate the Average Annual Percent Change (AAPC), adopting a 95% confidence interval. There was an increase in mean and total admissions costs due to falls at national level in both intervals of the study period. There was an increase in total admissions costs and the total number of admissions due to falls in the state of São Paulo (AAPC of 8.5% and 4.3%, respectively). Projections for the year 2025 suggest that the total number of admissions due to falls in Brazil will be around 150,000, resulting in costs of approximately R$ 260 million. There was an increase in the variables analyzed by this study, revealing the importance of fall prevention programs associated with national public policies.

Idosos Domiciliados: Saúde Geral x Higiene Bucal / Elderly People Living at Home: General Health x Oral Hygiene

O Serviço Integrado da Assistência Domiciliar (SIAD) foi criado a fim de prestar atendimento integral domiciliar a idosos que apresentam incapacidade de se locomover para as unidades de atendimento de saúde da Marinha do Brasil (MB). Com a finalidade de avaliar o perfil de saúde geral e de higiene dental desses pacientes, foi realizado um estudo transversal, quantitativo e descritivo, no qual foram incluídos idosos com 60 anos ou mais, assistidos entre fevereiro de 2017 a dezembro de 2022. Pode-se observar que a maioria dos idosos eram longevos, com média de idade de 82,52 anos (±8,66), mulheres (63,52%) e possuíam dependência total para realizar atividades básicas de vida diária (88,9%). Conclui-se que a síndrome demencial foi o diagnóstico principal mais encontrado (44,3%), a maioria possuía comorbidade associada (71,9%), sendo a Hipertensão Arterial Sistêmica (59,2%) e o Diabetes Mellitus (28,9%) as mais recorrentes. Foi encontrada uma elevada prevalência de idosos domiciliados com higiene bucal insatisfatória (34,7%) ou irregular (57,2%). No entanto, não houve associação entre higiene dental, comorbidades e grau de dependência. Assim sendo, é imprescindível que os idosos domiciliados recebam orientações e sejam submetidos a um acompanhamento rigoroso e constante, juntamente com seus cuidadores, a fim de promover a melhoria da higiene oral desses pacientes.

The Integrated Home Assistance Service (IHAS) was created to provide integral home care for elderly people who are unable to go to the health care units of the Brazilian Navy. A cross-sectional, quantitative, and descriptive study was carried out to evaluate the general health and dental hygiene profile of these patients. The study included elderly people aged 60 years or older who were assisted between February 2017 and December 2022. Most of them were long-lived, with a mean age of 82.52 (±8.66) years, women (63.52%) and totally dependent on performing basic activities of daily living (88.9%). The most common diagnosis among them was dementia syndrome, accounting for 44.3% of cases. Additionally, a large portion of the elderly had associated comorbidities (71.9%), with Systemic Arterial Hypertension (59.2%) and Diabetes Mellitus (28.9%) as the most recurrent conditions. The study found a high prevalence of elderly with unsatisfactory (34.7%) or irregular (57.2%) oral hygiene. Nevertheless, there was no significant association between dental hygiene and comorbidities or the degree of dependence. Therefore, it is imperative that elderly people living at home receive guidance and undergo meticulous and ongoing monitoring, in conjunction with their caregivers to promote improvements in the oral hygiene of these patients.

Under-spending, over-spending or substitution among services? Spatial patterns of unexplained shares of health care expenditures.

Using individual-level administrative data, we investigate the spatial patterns of unexplained shares of health care expenditures (HCE) at the municipality level. The focus is on the elderly population in the Italian Region Friuli-Venezia Giulia observed over the period 2017-2019. The empirical analysis comprises two steps. First, random-effects two-part models are estimated to analyze the effect of age, morbidity, and death on the probability and amount of positive individual total HCE and its components. Second, the unexplained shares of HCE at the municipality level are examined to identify areas with under- or over-spending and substitution among services. Results confirm the existing findings on the determinants of HCE and reveal geographic patterns in the unexplained shares of expenditures. We identify clusters of municipalities with observed HCE higher than predicted for each type of service and clusters with substitution between home care and all other services. These findings are associated with the degree of urbanization of these areas and, consequently, with the ease of access to health care. This is crucial from a policy perspective, as it indicates specific policy targets for public health intervention.

Relação entre duração do sono, sintomas depressivos e estresse em pessoas idosas da comunidade / Relationship between sleep duration, depressive symptoms and stress in older people in the community

RESUMO Objetivo Verificar se existe relação entre duração do sono, sintomas depressivos e estresse em pessoas idosas da comunidade. Métodos Estudo transversal, realizado com 116 idosas residentes em áreas de Unidades de Saúde da Família no município de São Carlos/SP. Foram utilizados os seguintes instrumentos: questionário de caracterização sociodemográfica; Índice de Qualidade do Sono de Pittsburgh; Escala de Depressão Geriátrica e Escala de Estresse Percebido. Os testes estatísticos utilizados foram teste de qui-quadrado de Pearson, Kruskall-Wallis, teste de Mann-Whitney e regressão linear múltipla. Resultados Entre as idosas, 50% referiram ter boa qualidade do sono e 49,1% dormiam entre sete e nove horas de sono noturno. Quando comparadas, as idosas com maior duração do sono apresentaram mais sintomas depressivos e escores mais elevados para o estresse percebido. Conclusão O modelo com aplicação do método hierárquico aponta que existe relação entre duração do sono, sintomas depressivos e estresse.

ABSTRACT Objective To verify whether there is a relationship between sleep duration, depressive symptoms and stress in elderly people in the community. Methods A cross-sectional study carried out with 116 older people living in areas of Family Health Units in the city of São Carlos/SP. The following instruments were used: sociodemographic characterization questionnaire; Pittsburgh Sleep Quality Index; Geriatric Depression Scale and Perceived Stress Scale. The statistical tests used were Pearson's chi-square test, Kruskall-Wallis, Mann-Whitney test and Multiple Linear Regression. Results 50% of the older people reported a good quality of sleep and 49.1% slept between seven and nine hours of sleep at night. When compared, older women with longer sleep duration had more depressive symptoms and higher scores for perceived stress. Conclusion The model with application of the hierarchical method points out that there is a relationship between sleep duration, depressive symptoms and stress.

Built environment influence on the incidence of elderly pedestrian collisions in a medium-large city in southern Brazil: a spatial analysis.

Trauma disproportionately affects vulnerable road users, especially the elderly. We analyzed the spatial distribution of elderly pedestrians struck by vehicles in the urban area of Maringa city, from 2014 to 2018. Hotspots were obtained by kernel density estimation and wavelet analysis. The relationship between spatial relative risks (RR) of elderly run-overs and the built environment was assessed through Qualitative Comparative Analysis (QCA). Incidents were more frequent in the central and southeast regions of the city, where the RR was up to 2.58 times higher. The QCA test found a significant association between elderly pedestrian victims and the presence of traffic lights, medical centers/hospitals, roundabouts and schools. There is an association between higher risk of elderly pedestrians collisions and specific elements of built environments in Maringa, providing fundamental data to help guide public policies to improve urban mobility aimed at protecting vulnerable road users and planning an age-friendly city.

Evaluating the Effectiveness of Rural Digital Social Prescribing in Korea: Protocol for a Cohort Study.

BACKGROUND: The UK National Health Service (NHS) has introduced a digital social prescribing (DSP) system to improve the mental health of the aging population. In Korea, an ongoing pilot social prescribing project has been implemented for older individuals in rural areas since 2019. OBJECTIVE: This research aims to develop a DSP program and to evaluate the effectiveness of the digital platform in rural areas of Korea. METHODS: This study was designed as a prospective cohort method for the development and effectiveness evaluation of rural DSP in Korea. The study divided participants into four groups. Group 1 will continuously implement the existing social prescribing program, group 2 implemented the existing social prescribing program but was switched to DSP in 2023, group 3 newly started the DSP, and the remaining group is the control. The research area of this study is Gangwon Province in Korea. The study is being conducted in Wonju, Chuncheon, and Gangneung. This study will use indicators to measure depression, anxiety, loneliness, cognitive function, and digital literacy. In the future, the interventions will implement the digital platform and the Music Story Telling program. This study will evaluate the effectiveness of DSP using difference-in-differences regression and cost-benefit analysis. RESULTS: This study was approved for funding from the National Research Foundation of Korea funded by the Ministry of Education in October 2022. The results of the data analysis are expected to be available in September 2023. CONCLUSIONS: The platform will be spread to rural areas in Korea and will serve as the foundation for effectively managing the feelings of solitude and depression among older individuals. This study will provide vital evidence for disseminating DSP in Asian countries such as Japan, China, Singapore, and Taiwan as well as for studying DSP in Korea. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/46371.