Dinâmica temporal e espacial e fatores relacionados à mortalidade por suicídio entre idosos / Temporal and spatial dynamics and factors related to suicide mortality among the elderly

OBJETIVO: Analisar a dinâmica temporal e espacial e os fatores associados à mortalidade por suicídio entre idosos (≥60 anos de idade) no Nordeste do Brasil. MÉTODOS: Estudo ecológico que analisou os óbitos por suicídio ocorridos entre idosos na região Nordeste do Brasil, no período de 2010 a 2019. Foram realizadas análise temporal por Joinpoint, análise espacial segundo município de residência e análise multivariada pelo modelo Ordinary Least Squares Estimation, considerando-se p < 0,05. RESULTADOS: No período analisado, foi observado crescimento significativo de 3,0% (IC95%: 1,1-4,9; p < 0,001) ao ano na mortalidade por suicídio. Espacialmente, as taxas mais elevadas foram observadas prioritariamente em municípios do Piauí, Ceará e Rio Grande do Norte. Foram identificados quatro clusters de suicídio estatisticamente significativos (p < 0,001). O cluster primário (2010-2019) abrangeu 141 municípios do Ceará, Rio Grande do Norte e Paraíba, que apresentaram risco 2,3 vezes maior de ocorrência de suicídio quando comparados aos demais municípios da região. Os indicadores índice de Gini (ß = 14,02; p = 0,01), taxa de analfabetismo (ß = 0,20; p < 0,001) e taxa de envelhecimento (ß = 0,36; p = 0,02) apresentaram associação positiva com o suicídio entre idosos, enquanto razão de dependência (ß = -0,31; p < 0,001) e taxa de desocupação (ß = -0,25; p < 0,001) apresentaram associação negativa. CONCLUSÃO: Houve aumento significativo do suicídio entre idosos na região Nordeste, com maior concentração em quatro clusters espaciais localizados prioritariamente no Ceará, Paraíba, Piauí e Rio Grande do Norte. A associação com indicadores socioeconômicos reforça aspectos de vulnerabilidade dos idosos a esse tipo de agravo e auxilia na formulação de propostas de intervenções que promovam a sua redução.

OBJECTIVE: To analyze the temporal and spatial dynamics and factors associated with suicide mortality among the elderly (≥60 years of age) in Northeast of Brazil. METHODS: This is an ecological study that analyzed deaths from suicide among elderly people in the Northeast region of Brazil, from 2010 to 2019. Temporal analysis by Joinpoint, spatial analysis according to municipality of residence and multivariate analysis by the Ordinary Least Squares Estimation model were performed, considering p < 0.05. RESULTS: During the analyzed period, a significant increase of 3.0% (95%CI: 1.1-4.9; p < 0.001) per year in suicide mortality was observed. Spatially, the highest rates were observed in municipalities of Piauí, Ceará and Rio Grande do Norte. Four statistically significant suicide clusters were identified (p < 0.001). The primary cluster (2010-2019) covered 141 municipalities in Ceará, Rio Grande do Norte and Paraíba, which presented a 2.3 times higher risk of suicide when compared to other municipalities in the region. The Gini index indicators (ß = 14.02; p = 0.01), illiteracy rate (ß = 0.20; p < 0.001) and aging rate (ß = 0.36; p = 0.02) showed a positive association with suicide among the elderly, while the dependency ratio (ß = -0.31; p < 0.001) and unemployment rate (ß = -0.25; p < 0.001) had a negative association. CONCLUSION: There was a significant increase in suicide among the elderly in the Northeast region, with a greater concentration in four spatial clusters located primarily in Ceará, Paraíba, Piauí and Rio Grande do Norte. The association with socioeconomic indicators reinforces aspects of vulnerability of the elderly to this type of injury and helps in the formulation of intervention proposals that promote its reduction.

Análise do Índice de Vulnerabilidade Clínico-Funcional-20 dos idosos usuários do sistema único de saúde / Clinical-Functional Vulnerability Index-20 analysis of older people using the Brazilian Public Health System

Objetivo: Aplicar a versão do profissional de saúde do Índice de Vulnerabilidade Clínico-Funcional-20 em uma população-alvo idosa. Métodos: Foi conduzido um estudo de caráter transversal, observacional e individuado, em idosos cadastrados no Ambulatório Cruz Preta, em Alfenas (MG), sendo aplicado o Índice de Vulnerabilidade Clínico-Funcional-20 na amostra selecionada. Para tanto, foram selecionados 66 idosos, e os dados obtidos foram submetidos à análise multivariada. Resultados: Dentre os participantes, 29% apresentaram alto risco de vulnerabilidade, seguidos de 41% com risco moderado e 30% com baixo risco. Ao se considerar o ponto de corte para fragilidade, 70% da população de idosos classificou-se como frágil ou sob risco de fragilização. Houve correlação entre as características dos idosos com as variáveis do Índice de Vulnerabilidade Clínico-Funcional-20, que foram: redução da capacidade de exercer atividades de vida diária, declínio cognitivo, alteração de humor, dificuldade para caminhar e quedas. Conclusão: A população-alvo de idosos pode ser considerada frágil ou sob risco de fragilização, o que indica a necessidade de ampliação do atendimento geriátrico especializado estudado. Além disso, foi possível identificar os principais fatores que levam à fragilização da população idosa, o que permite delinear estratégias com o objetivo de prevenção da fragilidade e melhorar o atendimento da população fragilizada.

Objective: To apply the Medical Professional version of the Clinical-Functional Vulnerability Index-20 in the target population of older people. Methods: A cross-sectional, observational, and individual study was conducted with older patients enrolled in Ambulatório Cruz Preta, in the city of Alfenas (MG), and the Clinical-Functional Vulnerability Index-20 was applied to the selected sample. For this, 66 older people were selected and data were subjected to multivariate analysis. Results: Of the participants, 29% presented high risk of vulnerability, followed by 41% with moderate risk, and 30% with low risk. When considering the cut-off point for fragility, 70% of the elderly population were classified as frail or under risk of becoming frail. There was a correlation between the characteristics of the older people with Clinical-Functional Vulnerability Index-20 variables, which were: reduced ability to perform activities of daily life, cognitive decline, mood alteration, difficulty walking, and falls. Conclusion: the target population of older individuals may be considered frail or under risk of becoming frail, which indicates the need for expanded specialized geriatric care studied. In addition, it was possible to identify the main factors leading to older population frailty, which allows the development of strategies aimed at preventing frailty and improving care for the frail population.

A puertas cerradas: La vejez en instituciones en Buenos Aires y el Interior: 1850-1950 / Behind closed doors: Old age in institutions in Buenos Aires and in the country: 1850-1950

Un aspecto clave de la historia de la vejez es el de la asistencia a los ancianos pobres, enfermos o sin familia, sobre todo durante el siglo XIX y principios del XX que constituyen la edad de oro del asilo de ancianos. Partiendo de esa constatación y de los principales problemas historiográficos involucrados, se propone como objetivo principal reconstruir la oferta de instituciones existentes y la proporción de personas atendidas. Para ello explora, en primer lugar las posibilidades y límites de las escasas fuentes estadísticas disponibles. En segundo término, propone una comparación exploratoria con el interior del país y con la asistencia a otros grupos de edad, en particular los niños. Tanto por la centralidad de los procesos históricos involucrados (crecimiento urbano, impacto de la inmigración, desarrollo de políticas sociales), como por la consecuente disponibilidad de fuentes, el caso porteño constituye el eje central de la indagación. (AU)

Prospects of activity limitations among older adults in 23 low and middle income countries.

Increasing life expectancy and a growing share of older people around the world spotlight the issue of health during additional years of life. Research on trends of proportions of older people with activity limitations for low and middle income countries is sparse. We use data from the World Health Survey and the UN World Population Prospects to predict prevalence of activity limitations for 23 low and middle income countries for the upcoming 30 years. Our projections highlight huge variation in the proportion of older adults with limitations across investigated countries and this variation is not expected to diminish. However, these countries are facing considerable demographic changes and even though prevalence rates appear almost constant, absolute numbers are changing which require policy interventions. Furthermore, variations across countries reflect not only disparities in health conditions, but also differences in cultural peculiarities of reporting and historical perception of health.

Adverse Consequences of Unmet Needs for Care in High-Need/High-Cost Older Adults.

OBJECTIVES: We explore adverse consequences of unmet needs for care among high-need/high-cost (HNHC) older adults. METHOD: Interviews with 4,024 community-dwelling older adults with ADL/IADL/mobility disabilities from the 2011 National Health and Aging Trends Study (NHATS). Reports of socio-demographics, disability compensatory strategies, and adverse consequences of unmet needs in the past month were obtained from older adults with multiple chronic conditions (MCC), probable dementia (DEM), and/or near end-of-life (EOL) and compared older adults not meeting these criteria. RESULTS: Older adults with MCC (31.6%), DEM (39.6%), and EOL (48.7%) reported significantly more adverse consequences than low-need older adults (21.4%). Persons with MCC and DEM (53.4%), MCC, and EOL (53.2%), and all three (MCC, DEM, EOL, 65.6%) reported the highest levels of adverse consequences. HNHC participants reported more environmental modifications, assistive device, and larger helper networks. HNHC status independently predicted greater adverse consequences after controlling for disability compensatory strategies in multivariate models. DISCUSSION: Adverse consequences of unmet needs for care are prevalent among HNHC older adults, especially those with multiple indicators, despite more disability-related compensatory efforts and larger helper networks. Helping caregivers provide better informal care has potential to contain healthcare costs by reducing hospitalization and unplanned readmissions.

The Role of a Health Protection Scheme in Health Services Utilization Among Community-Dwelling Older Persons in Ghana.

OBJECTIVES: This study examines the relationships between National Health Insurance Scheme (NHIS) enrollment and the frequency and "timing" of health services utilization among community-dwelling older Ghanaians. It also investigates whether the NHIS policy has improved equity in access to health care in later life. METHODS: Cross-sectional data were derived from an Ageing, Health, Psychological Wellbeing and Health-seeking Behavior Study collected between August 2016 and January 2017 (N = 1,200). Descriptive and bivariate analyses described the sample. Generalized Poisson and logit regression models, respectively estimated the predictors of frequency of health services utilization and time from onset of illness to health facility use and during last illness episode. RESULTS: Older persons with active NHIS membership frequently used health facilities (ß = 0.237, standard error [SE] = 0.0957, p ˂ .005), but the association was largely a function of health-related factors. The NHIS enrollees were more likely to attend health facility earlier (ß = 1.347, SE = 0.3437, p ˂ .001) compared with nonenrollees, after adjusting for theoretically relevant covariates. Moreover, given the NHIS enrollment, the rich (eß = 2.149, SE = 0.240, p ˂ .005), social support recipients (eß = 1.366, SE = 0.162, p ˂ .05) and those living with relevant others (eß = 2.699, SE = 0.175, p ˂ .001) were more likely to consume health services. DISCUSSION: Ghana's NHIS policy generally increases health services utilization but at present lacks the capability to improve equitable access to health care, especially between poor and nonpoor older adults. This may hamper the progress toward universal health coverage (UHC), indicating the need for further refinements in the policy including ways to improve the health status of older persons.

Impactos da estrutura etária sobre o desempenho econômico das regiões do Brasil entre 1991 e 2010 / Impacts of the age structure on the economic performance of Brazilian regions between 1991 and 2010 / Impactos de la estructura de edad sobre el desempeño económico de las regiones brasileñas entre 1991 y 2010

Este estudo objetiva analisar como a estrutura etária afetou o desempenho econômico das regiões brasileiras nas décadas de 1990 a 2010. Para a investigação proposta, são usadas, principalmente, as informações disponibilizadas pelo Instituto Brasileiro de Geografia e Estatística (IBGE) nas edições de 1991, 2000 e 2010 do Censo Demográfico. A estratégia empírica adotada consiste na estimação de um modelo de autocorrelação espacial pelo método de mínimos quadrados em dois estágios espaciais. Os resultados mostraram que tanto a razão de dependência infantil quanto a de idosos possuem impacto negativo sobre o crescimento econômico, sendo que os efeitos são mais acentuados nas regiões menos desenvolvidas. Ainda, observou-se que, quando significativo, o efeito da razão de dependência de idosos é mais acentuado em relação à infantil.

This study aims to analyze how age structure affected the economic performance of Brazilian regions between the 1990s and 2010. For this research, information is mainly taken from that provided by the Brazilian Institute of Geography and Statistics (IBGE) through the 1991, 2000 and 2010 editions of the Demographic Census. The empirical strategy adopted consists of the estimation of a model of spatial autocorrelation by the two-stage least squares method. The results showed that both child and elderly dependency ratio have a negative impact on economic growth, with the effects being more pronounced in less developed regions. Still, it was found that, when significant, the effect of the elderly dependency ratio is more pronounced in relation to children.

Este estudio tiene como objetivo analizar cómo la estructura de edad afectó el desempeño económico de las regiones brasileñas desde la década del noventa hasta la primera del siglo xxi. Para la investigación propuesta, se utilizan principalmente las informaciones proporcionadas por el Instituto Brasileño de Geografía y Estadística (IBGE) a través de las ediciones de 1991, 2000 y 2010 del censo demográfico. La estrategia empírica adoptada consiste en la estimación de un modelo de autocorrelación espacial por el método de mínimos cuadrados en dos etapas. Los resultados mostraron que tanto el índice de dependencia infantil como el de ancianos tienen un impacto negativo en el crecimiento económico, y los efectos son más pronunciados en las regiones menos desarrolladas. Aun así, se encontró que, cuando es significativo, el efecto de la relación de dependencia de ancianos es más pronunciado en relación con los niños.

Health Inequality Among the Elderly in Rural China and Influencing Factors: Evidence from the Chinese Longitudinal Healthy Longevity Survey.

Based on data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this paper calculates the health distribution of the elderly using the Quality of Well-Being Scale (QWB) score, and then estimates health inequality among the elderly in rural China using the Wagstaff index (WI) and Erreygers index (EI). Following this, it compares health inequalities among the elderly in different age groups, and finally, uses the Shapley and recentered influence function-index-ordinary least squares (RIF-I-OLS) model to decompose the effect of four factors on health inequality among the elderly in rural China. The QWB score distribution shows that the health of the elderly in rural China improved with social economic development and medical reform from 2002 to 2014. However, at the same time, we were surprised to find that the health level of the 65-74 years old group has been declining steadily since 2008. This phenomenon implies that the incidence of chronic diseases is moving towards the younger elderly. The WI and EI show that there is indeed pro-rich health inequality among the rural elderly, the health inequality of the younger age groups is more serious than that of the older age groups, and the former incidence of health inequality is higher. Health inequality in the age group of 65-74 years old is higher than that in other groups, and the trend of change fluctuated downward from 2002 to 2014. Health inequality in the age group of 75-84 years old is lower than that in the group of 65-74 years old, but higher than that in the other age groups. The results of Shapley decomposition show that demographic characteristics, socioeconomic status (SES), health care access, and quality of later life contributed 0.0054, 0.0130, 0.0442, and 0.0218 to the health inequality index of the elderly, which accounted for 6.40%, 15.39%, 52.41%, and 25.80% of health inequality index. From the results of RIF-I-OLS decomposition, this paper has analyzed detailed factors' marginal effects on health inequality from four dimensions, which indicates that the health inequality among the elderly in rural China was mainly caused by the disparity of income, medical expenses, and living arrangement.

Medication in older patients reviewed multiple ways (MORE) study.

Background Polypharmacy in older patients can lead to potentially inappropriate prescribing. The risk of the latter calls for effective medication review to ensure proper medication usage and safety. Objective Provide insight on the similarities and differences of medication review done in multiple ways that may lead to future possibilities to optimize medication review. Setting This study was conducted in Zuyderland Medical Centre, the second largest teaching hospital in the Netherlands. Method This descriptive study compares the quantity and content of remarks identified by medication review performed by a geriatrician, outpatient pharmacist, and Clinical Decision Support System. The content of remarks is categorized in seven categories of possible pharmacotherapeutic problems: 'indication without medication', 'medication without indication', 'contra-indication/interaction/side-effect', 'dosage problem', 'double medication', 'incorrect medication' and 'therapeutic drug monitoring'. Main outcome measure Number and content of remarks on medication review. Results The Clinical Decision Support System (1.8 ± 0.8 vs. 0.9 ± 0.9, p < 0.001) and outpatient pharmacist (1.8 ± 0.8 vs. 0.9 ± 0.9, p = 0.045) both noted remarks in significantly more categories than the geriatricians. The Clinical Decision Support System provided more remarks on 'double medication', 'dosage problem' and 'contraindication/interaction/side effects' than the geriatrician (p < 0.050), while the geriatrician did on 'medication without indication' (p < 0.001). The Clinical Decision Support System noted significantly more remarks on 'contraindication/interaction/side effects' and 'therapeutic drug monitoring' than the outpatient pharmacist, whereas the outpatient pharmacist reported more on 'indication without medication' and 'medication without indication' than the Clinical Decision Support System (p ≤ 0.007). Conclusion Medication review performed by a geriatrician, outpatient pharmacist, and Clinical Decision Support System provides different insights and should be combined to create a more comprehensive report on medication profiles.

Association of growth differentiation factor 15 with other key biomarkers, functional parameters and mortality in community-dwelling older adults.

BACKGROUND: Growth differentiation factor 15 (GDF-15) has been associated with many adverse age-related outcomes and other age-related disorders. The aim of the study was to investigate if baseline levels of GDF-15 are associated with total mortality in community living, older adults during eight years of follow-up after simultaneous consideration of key biomarkers and functional parameters. METHODS: prospective cohort study including 1,470 community-dwelling older adults aged 65 years or older. GDF-15 was measured by ElectroChemi-Lumisnescence Immunoassays (Roche, Mannheim, Germany). We used Cox-proportional hazards regression to estimate the association of GDF-15 levels with 8-year all-cause mortality. RESULTS: GDF-15 levels were independently of age and sex strongly associated with many biomarkers such as CRP, IL-6, NT-proBNP, hs-troponines as well as with lipids, metabolic and endocrine markers and kidney function (all P-values < 0.001). GDF-15 showed also a statistically significant correlation to gait speed, hand grip strength and walking duration. In addition, we found a consistent association between levels of GDF-15 and risk of subsequent all-cause mortality which persisted after additional adjustment for key markers of inflammation, cardiac function and damage, and physical function. The hazard ratio (HR) per unit increase of log-transformed GDF-15 was 1.72 (95% CI 1.35; 2.18). CONCLUSIONS: GDF-15 levels were not only strongly associated with many functional parameters and key biomarkers independently of age and sex, but also with 8-year all-cause mortality even after adjusting for gait speed, NT-proBNP and hs-TnT.

Survival of the elderly and exposition to polypharmacy in the city of São Paulo, Brazil: SABE Study. / Sobrevida de idosos e exposição à polifarmácia no município de São Paulo: Estudo SABE.

INTRODUCTION: The use of polypharmacy may be due to the concomitant presence of chronic conditions, medical care by several doctors simultaneously and self-medication. Combined with the vulnerability of the elderly to the effects of drugs due to pharmacokinetic and pharmacodynamic changes, polypharmacy makes this population more susceptible to adverse outcomes. In Brazil, studies show that polypharmacy is a common problem among elderly people. However, few information is available on the association between polypharmacy and mortality. OBJECTIVE: It was assessed the survival of the elderly from São Paulo city exposed to the use of polypharmacy (five or more medications). METHODS: That was a population-based cohort, the Health, Well-Being and Aging Study (SABE Study), conducted from 2006 to 2010. The sample was composed of 1,258 individuals aged 60 years or more. The Kaplan-Meier method and Cox proportional risks model were used to examine the association between polypharmacy and mortality. RESULTS: The probability of survival after five years of the users of polypharmacy at baseline was 77.2%, while among the non-users was 85.5%. Polypharmacy remained as a risk factor for death even after adjustment in other conditions associated with mortality, such as age, gender, income, chronic diseases and hospitalization. CONCLUSION: The results point polypharmacy as an indicator of mortality in elderly people. The use of multiple medications by the elderly should be carefully assessed to avoid or minimize the damage to this population.

INTRODUÇÃO: O uso de polifarmácia pode ser resultante da presença concomitante de condições crônicas, atendimento por diversos médicos e automedicação. Combinada com a vulnerabilidade de idosos aos efeitos dos medicamentos devido a alterações farmacocinéticas e farmacodinâmicas, a polifarmácia torna essa população mais suscetível a desfechos adversos. No Brasil, estudos mostram que a polifarmácia é um problema frequente entre idosos, mas faltam informações sobre sua associação com mortalidade. OBJETIVO: Avaliar a sobrevida de idosos do município de São Paulo expostos ao uso de polifarmácia (cinco ou mais medicamentos). MÉTODOS: Trata-se de uma coorte de base populacional, o Estudo Saúde, Bem-Estar e Envelhecimento (Sabe), da qual se pesquisou o seguimento de 2006 a 2010. A amostra foi composta por 1.258 indivíduos com 60 anos ou mais. O método de Kaplan-Meier e o modelo de riscos proporcionais de Cox foram usados para examinar a associação entre mortalidade e polifarmácia. RESULTADOS: A probabilidade de sobrevida após cinco anos dos indivíduos usuários de polifarmácia na linha de base foi de 77,2%, enquanto nos não usuários foi de 85,5%. Apolifarmácia permaneceu como fator de risco para óbito mesmo após ajuste de demais condições associadas à mortalidade, como idade, sexo, renda, doenças crônicas e internação hospitalar. CONCLUSÃO: Os resultados apontam para a polifarmácia como um preditor de mortalidade para pessoas idosas. O uso de múltiplos medicamentos por idosos deve ser cuidadosamente avaliado para evitar ou minimizar danos a essa população.

Self-medication practice trend among the Brazilian elderly between 2006 and 2010: SABE Study. / Tendência da prática de automedicação entre idosos brasileiros entre 2006 e 2010: Estudo SABE.

INTRODUCTION: Self-medication involves the concept of the spontaneous search by the individual for some drug that he or she considers appropriate to solve a health problem. Self-medication practice is little explored by the elderly according to other studies based in population data. OBJECTIVE: To examine the trends in self-medication practice among the Brazilian elderly between 2006 and 2010. METHODS: This is a population-based study whose data were obtained from the Health, Well-being and Ageing Study (SABE Study). Thesample consisted of 1,257 elderly people in 2006 and 865 in 2010, who used drugs. RESULTS: The findings showed self-medication reduction from 42.3% in 2006 to 18.2% in 2010. In both periods, predominant utilized therapeutic classes were those acting on the nervous system (27.9% in 2006, and 29.6% in 2010) and on the alimentary tract and metabolism (25.5% in 2006, and 35.9% in 2010). The most commonly used medicines in 2006 and 2010 were analgesics, anti-inflammatories, and vitamins. There was a tendency to decrease the use of potentially inappropriate medicines between 2006 (26.4%) and 2010 (18.1%). The elderly themselves were the main responsible for the decision about the drug use in 2006 (62.5%) and 2010 (66.5%). CONCLUSION: Theextent of self-medication practice among the elderly who participated in the study decreased between 2006 and 2010, but the use of medicines that offer risks to health was still reported. Thus, the findings reinforce the importance of monitoring, evaluating, and continuously educating the elderly about risks and benefits of drug consumption, particularly over-the-counter medicines.

INTRODUÇÃO: Automedicação retrata o princípio do próprio indivíduo buscar espontaneamente por algum medicamento que considere adequado para resolver um problema de saúde. Essa prática é ainda pouco explorada entre idosos de acordo com outros estudos baseados em dados populacionais. Objetivo: Examinar as tendências da prática de automedicação dos idosos do Estudo SABE entre 2006 e 2010. MÉTODO: Estudode base populacional cujos dados foram obtidos do Estudo Saúde, Bem-Estar e Envelhecimento (SABE). Aamostra de 2006 foi constituída de 1.258 idosos e a de 2010, de 865 idosos que utilizaram medicamentos. RESULTADOS: Observou-se redução da automedicação de 42,3% em 2006 para 18,2% em 2010. Em ambos os períodos, as classes terapêuticas predominantes foram as dos medicamentos com ação no sistema nervoso (27,9% em 2006 e 29,6% em 2010) e trato alimentar e metabolismo (25,5% em 2006 e 35,9% em 2010). Entreos medicamentos mais usados nos anos de 2006 e 2010 estão os analgésicos/anti-inflamatórios e vitaminas. Houve tendência a declínio da utilização de medicamentos potencialmente inapropriados entre 2006 (26,4%) e 2010 (18,1%). Oidoso foi o principal responsável pela indicação da automedicação em 2006 (65,2%) e 2010 (66,5%). CONCLUSÃO: A extensão da prática de automedicação nos idosos do SABE apresentou redução entre 2006 e 2010, porém o emprego de medicamentos que oferecem risco à saúde ainda foi relatado. Desse modo, os achados reforçam a importância de monitorar, avaliar e educar continuamente os idosos acerca dos riscos e benefícios do consumo de medicamentos, sobretudo daqueles isentos de prescrição.

[Benefit of the geriatric mobile unit's intercession on the quality of medical prescriptions for the elderly: Past year assessment]. / Intérêt de l'intervention de l'unité d'évaluation gériatrique dans la cité sur la qualité des prescriptions médicamenteuses de la personne âgée : bilan à 1 an.

Our multidisciplinary geriatric mobile unit works in behalf of the frail elderly people, aged at least 75, who are in loss of self-reliance. One of its main aims is so optimize medical prescriptions. The purpose of this study was to show the benefit of geriatrician and pharmacist interventions over the quality of medical prescriptions for the elderly. Medication reconciliation of treatment and reassessment of the appropriateness of the prescriptions was systematically carried out. The problems related to drug therapy have been listed and classified according to the criteria of pharmaceutical interventions defined by the French Society of Clinical Pharmacy (SFPC). Out of 181 patients, 86,2% had potentially an inappropriate or sub-optimal prescription. Finally, 462 optimizations were proposed (2.9±1.9 by patients): 204 withdrawals, 166 additions, 58 dosage adaptations, 21 therapeutic follow-ups and 13 modalities of administration. This reassessment of the prescriptions allowed to develop between our geriatric mobile unit and the liberal professionals a communication focused on the therapeutic optimization and to spread recommendations on the proper use of drugs in the elderly population.

Predicting wellness among rural older Australians: a cross- sectional study.

INTRODUCTION: Prior research on older people's wellbeing and quality of life has lacked clarity and consistency. Research examining older people's health has tended to use these different terms and measurement tools interchangeably, which might explain why the evidence is somewhat mixed. There is a paucity of research that uses the multi-dimensional construct of wellness in rural older people. Addressing both limitations, this study seeks to make a unique contribution to knowledge testing an ecological model of wellness that includes intrapersonal factors, interpersonal processes, institutional factors, community factors and public policy. METHODS: Six rural case study sites were chosen across two Australian sites, the states of Queensland and Victoria. A community saturation recruitment strategy was utilised. Telephone surveys were conducted with community-dwelling rural older people (n=266) aged ≥65 years across the sites. The central variable of the study was wellness as measured by the Perceived Wellness Survey. The ecological model developed included the following intrapersonal factors: physical and mental health, loneliness and social demographic characteristics (age, sex, marital status and financial capability). Interpersonal factors included a measure of social and community group participation, social network size and support provided. Institutional factors were measured by series of questions devised around the resource base environment and access to amenities and services. RESULTS: A hierarchical regression analysis was conducted to determine which variables in the model predict wellness. The results showed that a combination of intrapersonal factors (physical health, mental health, loneliness and financial capability) and interpersonal factors (size of social network and community participation) predicted wellness. However, institutional factors, the resource base environment, and access to amenities and services, contributed only marginally to the model. Community factors, including the personal and physical characteristics of community, also only made a marginal contribution. CONCLUSIONS: The study identified the usefulness of using an integrated model of measurement in wellness. This model recognised the interrelated physical, social and economic influences that impact on rural older people throughout their life course. The study found that physical health made the greatest contribution to perceived wellness, followed by mental health. These findings support a body of research that has found that rural older people experience poorer health outcomes than those in urban areas. Lower levels of loneliness were also a strong predictor of perceived wellness, thus supporting research that has examined the impact of loneliness on physical and mental health. The presence of social capital, as measured by social network size, and the degree of community participation, were also predictors of perceived wellness. Overall, the findings of the present study implications for policy as well as subsequent strategies designed to increase the capacity of wellness in rural older people. Such strategies need to consider the contribution of a range of factors.

Cognição, condições socioeconômicas e estado nutricional de idosos cadastrados em uma unidade básica de saúde / Cognition, socio-economic conditions and nutritional status of elderly registered in a basic health unit

Introdução: estudos de avaliação cognitiva mostram que indivíduos idosos apresentam distúrbios cognitivos, que podem estar associadosàs condições socioeconômicas, ao estado nutricional, ao sexo e à idade. Objetivo: verificar a associação entre capacidade cognitiva, condições socioeconômicas e estado nutricional de idosos cadastrados em uma unidade básica de saúde. Casuística e Método: estudo transversal, quantitativo, com coleta de dados primários e secundários. Pesquisa foi realizada no domicílio dos idosos, que estavam cadastrados na Unidade Básica de Saúde, no período de 18 de janeiro a 29 de fevereiro de 2016 na cidade de Porto Rico ­ PR, localizada no noroeste do Paraná. Avaliou-se a capacidade cognitiva pelo mini exame do estado mental, as condições socioeconômicas com auxílio de formulário e o estado nutricional, pelo índice de massa corporal. A associação entre as variáveis foi medida utilizando o teste Qui-quadrado ou teste exato de Fisher. Resultados: participaram do estudo 180 idosos. Associação estatisticamente significativa foi observada entre capacidade cognitiva e sexo e foi superior no sexo feminino entre capacidade cognitiva e escolaridade que foi entre 1 a 4 anos de estudo. Conclusão: grande parte da população estudada apresentou distúrbio cognitivo e excesso de peso, sem associação entre essas variáveis. A pesar do resultado, podemos dizer que esses idosos necessitam de atendimentos especializados, afim de que problemas cognitivos e nutricionais sejam identificados precocemente.

Introduction: cognitive evaluation studies show that elderly individuals present cognitive disorders, which may be associ-ated with socioeconomic conditions, nutritional status, gender and age. Objective: verify the association between cognitive ability, socioeconomic conditions, and nutritional status of elderly people enrolled at a basic health unit. Casuistry and Method: a cross-sectional, quantitative study with primary and secondary data collection. The study was carried out at the home of the elderly, who were enrolled in the Basic Health Unit, from January 18 to February 29, 2016 in the city of Puer-to Rico - PR, located in the northwest of Paraná. Results: 180 elderly people participated in the study. Statistically significant association was observed between cognitive ability and gen-der and was higher in females and between cognitive ability and schooling that was between 1 and 4 years of study. The association between variables was measured using the chi-square test or Fisher's exact test. Conclusion: a large part of the studied population presented cognitive and overweight, but did not hear a statistically significant association between these variables. Even though there is no association between these variables, we can say that these elderly people need specialized care so that cognitive and nutritional problems are identified early.

Socioeconomic Status and Physical Functioning: A Longitudinal Study of Older Chinese People.

Objectives: We aimed to assess the longitudinal associations of socioeconomic status and physical functioning using a large population-based survey data in China. Method: We used four waves of the Chinese Longitudinal Healthy Longevity Survey (2002-2011). Physical functioning was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL) measures. Socioeconomic status was assessed using educational attainment, occupational status, household income, financial resources, and access to health services. Latent growth curve model combined with selection model was utilized. Results: High education was not associated with the baseline level or the rate of change in ADL score but predicted better baseline IADL functioning. High income was related to better IADL functioning but had no effect on the rate of change in IADL. Inadequate financial resources and unavailability of health services were mainly associated with poorer ADL and IADL functioning at baseline. White-collar occupation was unrelated to the trajectory of physical functioning. Discussion: This study provides no support either for the cumulative disadvantage or age-as-leveler theory. Improving financial status and accessibility of health care services, especially in lower social classes, may help to improve the overall level of physical functioning of the older adults.

Paradoxical Effects of Perceived Control on Survival.

Objectives: Appraising health as controllable is typically thought to be adaptive, but recent evidence suggests the paradoxical possibility that perceived control (PC) can be detrimental. We considered the premise that high PC should have a survival benefit when it is part of an adaptive mindset involving high value (importance) for health, but it might be detrimental when it is part of a mindset comprised of low health value (HV). In addition, we examined whether the survival consequences of PC and HV vary with advancing age. Method: Interviews were conducted with a heterogeneous sample of community-dwelling adults (n = 341; 72-99 years) to assess appraisals of control and value in the domain of health. Mortality data were obtained over 12 years from a provincial health registry. Results: Both age and HV moderated the PC effect on mortality. The predicted beneficial and detrimental PC effects emerged at younger ages: higher PC predicted longer survival times when health was highly valued but shorter survival times when health was less highly valued. Discussion: These findings deepen the knowledge regarding the conditions under which PC is or is not adaptive, suggesting the consequences depend on age and the extent to which health is valued.