الملخص
This study aims to describe the main tools for integrative geriatric assessment and their use in Ecuador. We performed a narrative review with a comprehensive and systematic literature search. 261 original articles were obtained from the primary search, and after the discrimination by the researchers, 76 articles were included in the final analysis. Integrative geriatric assessments cover different areas, including cognitive function, affective function, nutritional status and functionality, and seve-ral tools that are used worldwide for this purpose. In Ecuador, a deeper analysis of their use is required to evaluate their diagnostic efficacy and applicability to impro-ve health outcomes for the elderly population.
Este estudio tiene como objetivo describir las principales herramientas de evalua-ción integral geriátrica y su uso en el Ecuador. Realizamos una revisión narrativa con una búsqueda bibliográfica exhaustiva y sistemática. De la búsqueda primaria se obtuvieron 261 artículos originales, y luego de la discriminación por parte de los investigadores, se incluyeron 76 artículos en el análisis final. La evaluación ge-riátrica cubre diferentes áreas, incluida la función cognitiva, la función afectiva, el estado nutricional y la funcionalidad, y se utilizan varias herramientas en todo el mundo para este propósito. En Ecuador se requiere un análisis más profundo de su uso para evaluar su eficacia diagnóstica y aplicabilidad con el fin de mejorar los resultados de salud de la población adulta mayor.
الموضوعات
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Aged , Health of the Elderly , Geriatrics/methods , Primary Health Care , Weights and Measures , Diagnosisالملخص
INTRODUCTION@#This scoping review examined the number, types and characteristics of journal publications on ageing in Singapore from 2008 to 2018 to determine how ageing research in medical and social domains in Singapore has transformed over time.@*METHODS@#Using relevant search terms, articles were extracted from multiple databases and then screened and reviewed for eligibility and inclusion by independent reviewers. Data such as article title, authors, year of publication, name of journal, type of journal, study design and the kind of data used were charted from the included articles for evidence synthesis.@*RESULTS@#Since 2008, there has been a steady increase in the number of publications on ageing in medical and social domains in Singapore. In the medical domain, publications on Ophthalmology (22%) made up the largest proportion of the existing medical literature on ageing in Singapore, followed by Physical Functioning (17%), which involved physiological measurements of physical well-being, and Geriatrics (16%). Non-medical publications comprised 38% of all the included publications, with publications on the social aspects of ageing (43%) forming the largest group in this cluster, followed by publications on Prevention (19%) and Healthcare services (18%). The study design was mostly observational (82%), with only 3% of interventional studies.@*CONCLUSION@#While ageing research had expanded in Singapore in the last decade, it was predominantly discipline specific and observational in design. As ageing issues are complex, with biology intersecting with psychology and sociology, we call for greater interdisciplinary collaboration, the conduct of more interventional studies, as well as more research in understudied and emerging areas.
الموضوعات
Humans , Singapore , Aging , Geriatrics , Research Designالملخص
Resumo Objetivo Analisar a frequência de polifarmácia e prescrição de medicamentos potencialmente inapropriados (MPI) segundo os Critérios de Beers e CBMPI em pessoas idosas com vulnerabilidade clínico-funcional. Método Trata-se de um estudo transversal onde analisou-se os prontuários de 496 participantes com 60 anos ou mais, atendidos em primeira consulta em uma Policlínica Gerontológica. Os dados sociodemográficos, medicamentos, e o Índice de Vulnerabilidade Clínico Funcional 20 (IVCF-20) e quedas foram extraídos dos prontuários. A polifarmácia foi definida como o uso simultâneo de cinco ou mais medicamentos. Os participantes foram classificados em três grupos: robusto, em risco e vulnerável. Resultados A análise demonstrou que 69 (13,91%) dos participantes faziam uso de polifarmácia. Entre os usuários de polifarmácia, 40 (57,97%) faziam uso de pelo menos um MPI. Os MPIs mais encontrados foram a glibenclamida e o omeprazol, respectivamente. Pessoas idosas com vulnerabilidade apresentaram um risco três vezes maior de apresentar polifarmácia (RP 3,59; IC95% 2,109-6,092). Conclusão O uso de polifarmácia e MPI neste estudo estavam associados à vulnerabilidade da pessoa idosa, reforçando a necessidade de avaliação criteriosa de prescrições medicamentosas para essa população.
Abstract Objective To analyze the frequency of polypharmacy and the prescription of Potentially Inappropriate Medications (PIM) according to the Beers Criteria and CBMPI in older adults with clinical-functional vulnerability. Method This is a cross-sectional study where the medical records of 496 participants aged 60 and older, seen in their first appointment at a Gerontological Polyclinic, were analyzed. Sociodemographic data, medications, the Clinical-Functional Vulnerability Index-20 (IVCF-20), and falls were extracted from the medical records. Polypharmacy was defined as the simultaneous use of five or more medications. Participants were classified into three groups: robust, at risk, and vulnerable. Results The analysis revealed that 69 (13.91%) participants were using polypharmacy. Among polypharmacy users, 40 (57.97%) were using at least one PIM. The most commonly found PIM were glibenclamide and omeprazole, respectively. Older adults with vulnerability were three times more likely to have polypharmacy (OR 3.59; 95% CI 2.109-6.092). Conclusion The use of polypharmacy and PIM in this study was associated with the vulnerability of older adults, emphasizing the need for a thorough evaluation of medication prescriptions for this population.
الموضوعات
Humans , Aged , Aged , Health of the Elderly , Disaster Vulnerability , Health Centers , Geriatricsالملخص
Resumo É possível envelhecer com saúde e qualidade de vida no Brasil? Este artigo defere a resposta por meio da proposição de um modelo assistencial resolutivo e com excelente relação custo-benefício, em linha com o que há de mais contemporâneo no cuidado integral para o grupo etário dos idosos. O modelo aqui apresentado propõe pensar, de forma absolutamente inovadora, o cuidado que deve ser prestado a essa parcela da população. Neste texto, são apresentados a teoria e os conceitos que fundamentam o modelo proposto. Basicamente, o texto relata a necessidade de ênfase nas instâncias leves de cuidado; em outros termos, foco na coordenação, na prevenção e no monitoramento do cliente, de forma a minimizar desperdícios, oferecendo uma assistência de melhor qualidade e a custos reduzidos. Também são apresentados os instrumentos de avaliação epidemiológica utilizados e o passo a passo de todos os profissionais da equipe de saúde.
Abstract Is it possible to age with health and quality of life in Brazil? This article defers the answer through the proposition of a cost-effective care model, in line with what is most contemporary in comprehensive care for the elderly age group. The model presented here proposes to think, in an absolutely innovative way, the care that must be provided to this portion of the population. In this text, the theory and concepts that underlie the proposed model are presented. Basically, the text reports the need for emphasis on light instances of care; in other words, focus on coordination, prevention and customer monitoring, in order to minimize waste, offering better quality care and reduced costs. The epidemiological assessment instruments used and the step by step of all health professionals are also presented.
الموضوعات
Humans , Aged , Aged, 80 and over , Patient Care Team , Aged , Delivery of Health Care , Healthcare Models , Aging , Geriatric Assessment , Caregivers , Cost-Benefit Analysis , Geriatricsالملخص
INTRODUCCIÓN: La enfermedad cerebral de pequeño vaso es una causa principal de pérdida funcional, discapacidad y deterioro cognitivo. OBJETIVO: Determinar la prevalencia de la enfermedad de pequeño vaso y características clínicas que se asocian a mayor deterioro funcional, cognitivo y afectivo en adultos mayores con enfermedad cerebrovascular atendidos en el Servicio de Neurología del Hospital Carlos Andrade Marín en el período 2020 2021. METODOLOGÍA: Estudio observacional, analítico transversal con 80 pacientes mayores de 65 años con enfermedad cerebrovascular previamente diagnosticada. Se determinó cuáles presentaban enfermedad cerebral de pequeño vaso. Se compararon los dos grupos el de enfermedad cerebro vascular isquémico con y sin enfermedad cerebral de pequeño vaso. Se midió el grado de deterioro funcional con escala de Barthel; Lawton y Brody. El deterioro cognitivo con test de Montreal Cognitive Assessment Basic, estado afectivo con escala de Yesavage. Se utilizó razón de momios y se consideró significativo un valor p <0,05. Se utilizó el programa Statistical Package for Social Sciences versión 25. RESULTADOS: Los hombres representaron el 51,2%. La edad promedio fue 76,2 años. Prevalencia de enfermedad cerebral de pequeño vaso (87,5%). Escala de Fazekas grado 1 (46,3%), Factores asociados con enfermedad cerebral de pequeño vaso: tabaquismo [RR: 7,27; IC 95%: 1,69-31,3); enfermedad renal crónica [RR: 4,0; IC 95%: 1,01-15,7]. Dependencia moderada [RR: 6,42; IC 95%: 1,02-40,3]. Factores asociados con pérdida funcionalidad: gravedad del ictus. Factores asociados con deterioro cognitivo: infarto con doble territorio. Factores asociados con deterioro afectivo: infarto con doble territorio y síndrome metabólico (p<0,05). CONCLUSIÓN: La enfermedad cerebral de pequeño vaso tiene una elevada prevalencia entre los adultos mayores con enfermedad cerebrovascular y representó un deterioro cognitivo, funcional y afectivo considerable, en relación a los pacientes sin esta enfermedad.
INTRODUCTION: Cerebral small vessel disease is a leading cause of functional loss, disability, and cognitive impairment. OBJECTIVE: To determine the prevalence of small vessel disease and clinical characteristics associated with greater functional, cognitive and affective impairment in older adults with cerebrovascular disease attended at the Neurology Service of the Carlos Andrade Marín Hospital in the period 2020 - 2021. METHODOLOGY: Observational, analytical cross-sectional study with 80 patients over 65 years of age with previously diagnosed cerebrovascular disease. It was determined which patients had cerebral small vessel disease. The two groups of ischemic cerebrovascular disease with and without cerebral small vessel disease were compared. The degree of functional impairment was measured with the Barthel, Lawton and Brody scales. Cognitive impairment was measured with the Montreal Cognitive Assessment-Basic test, and affective state with the Yesavage scale. Odds ratio was used and a p value <0,05 was considered significant. Statistical Package for Social Sciences version 25 was used. RESULTS: Males represented 51,2%. Mean age was 76,2 years. Prevalence of cerebral small vessel disease (87,5%). Fazekas scale grade 1 (46,3%), Factors associated with cerebral small vessel disease: smoking [RR: 7,27; 95% CI: 1,69-31,3); chronic kidney disease [RR: 4,0; 95% CI: 1,01-15,7]. Moderate dependence [RR: 6,42; 95% CI: 1,02-40,3]. Factors associated with loss of function: severity of stroke. Factors associated with cognitive impairment: infarction with double territory. Factors associated with affective impairment: dual territory infarction and metabolic syndrome (p<0.05). CONCLUSION: Cerebral small vessel disease has a high prevalence among older adults with cerebrovascular disease and represented a considerable cognitive, functional and affective deterioration, in relation to patients without this disease.
الموضوعات
Humans , Male , Female , Aged , Brain Diseases , Aged , Cognitive Dysfunction , Porencephaly , Ischemic Stroke , Functional Status , Ecuador , Geriatricsالملخص
La hipertensión arterial sistémica es una enfermedad crónica de causa múltiple, que produce daño vascular sistémico e incrementa la morbilidad y mortalidad por diversas enfermedades cardiovasculares. El objetivo de esta investigación fue caracterizar la prescripción para el tratamiento de la hipertensión arterial y asociaciones de fármacos sugerentes de posibles interacciones medicamentosas potenciales en el adulto mayor, en un Consultorio Médico vinculado a la Farmacia Principal Municipal de Santa Clara. Los medicamentos más prescriptos fueron: hidroclorotiazida en tabletas de 25 mg, enalapril de 20 mg y amlodipino de 10 mg. El tratamiento más empleado fue la combinación de dos agentes antihipertensivos, preferentemente los inhibidores de la enzima convertidora de angiotensina con diuréticos tiazídicos. La combinación de medicamentos inhibidores de la enzima convertidora de angiotensina con espironolactona fue la interacción medicamentosa de mayor importancia clínica. Se concluyó que los pacientes de la tercera edad conforman el grupo etario más medicado de la sociedad.
Systemic arterial hypertension is a chronic disease of multiple etiologies, which produces systemic vascular damage and increases morbidity and mortality due to various cardiovascular diseases. The objective of this research was to characterize the prescription for the treatment of arterial hypertension and potential drug-drug interactions in the elderly from a doctor's office linked to the Main Municipal Pharmacy of Santa Clara. Hydrochlorothiazide 25 mg, enalapril 20 mg and amlodipine 10 mg were the most prescribed medications. The combination of two antihypertensive agents, preferably angiotensin-converting enzyme inhibitors with thiazide diuretics, was the most widely used treatment. The combination of angiotensin-converting enzyme inhibitor drugs with spironolactone was the most clinically important drug interaction. We concluded that elderly patients make up the most medicated age group in society.
الموضوعات
Drug Interactions , Geriatrics , Hypertensionالملخص
Objetivo O estudo aqui apresentado abordou sobre um assunto que vem ganhando destaque na área da saúde pública, uma vez que se percebe o aumento considerável de pessoas com mais de 65 anos na sociedade brasileira: o atendimento que deve ser prestado pelo fisioterapeuta aos idosos através da Atenção Primária à Saúde (APS). Para isso, teve-se como objetivo: Demonstrar quais atividades podem ser realizadas pelo profissional de fisioterapia junto aos idosos na Atenção Primária à Saúde para melhorar a sua capacidade funcional, como forma de promover uma melhor qualidade de vida. Métodos A metodologia escolhida foi a realização de uma revisão da literatura, tendo para isso realizado busca em sites especializados, tais como: BVS Saúde, Lilacs, Pubmed, Scielo, entre outros. Discussão A discussão vem apresentar que o fisioterapeuta é um profissional capacitado para realizar um processo de reabilitação resolutiva de acordo com cada caso dos pacientes, respeitando sempre a individualidade, as peculiaridades e as limitações de cada idoso o posicionamento de outros autores sobre o assunto. Conclusão Com base em tudo que foi apresentado nesse estudo, pode-se concluir que o processo reabilitação através da fisioterapia em um idoso dentro da APS é considerado como um desafio, além de ter grande relevância, tanto o atendimento nas unidades, como no domiciliar
الموضوعات
Humans , Male , Female , Aged , Aged, 80 and over , Primary Health Care , Aged , Health of the Elderly , Physical Therapy Modalities , Physical Therapists , Geriatricsالملخص
Introducción: El Dr. C. Oscar B. Alonso Chil (1930-2021) formó parte de los médicos que permanecieron en Cuba después del triunfo de la Revolución. Fue fundador de servicios de asistencia en medicina interna y geriatría, y realizó importantes contribuciones a la docencia médica. Objetivo: Exponer la trayectoria de Oscar B. Alonso Chil como médico y docente de la medicina cubana revolucionaria, a través de su historia de vida. Métodos: Se realizó un estudio de tipo descriptivo y de corte cualitativo, donde se utilizó la técnica de la historia de vida, centrada en el aspecto profesional. Para ello se hizo una entrevista semiestructurada al testimoniante como fuente fundamental de información. Se validó el testimonio oral mediante la revisión de la documentación oficial en su expediente docente y la literatura científica existente relacionada con el tema, además de entrevistas a sus alumnos y compañeros de trabajo. Desarrollo: Se constató que fundó servicios; organizó la actividad docente; realizó tutorías, publicaciones y asesorías; y fue miembro de tribunales y consejos científicos. Cada una de sus actividades las desempeñó con gran compromiso e incondicionalidad a su profesión, lo cual le generó mucha satisfacción con la vida. Llegó a ostentar las más altas distinciones por su trabajo: Especialista de Segundo Grado en Medicina Interna, y Profesor Titular, Consultante y de Mérito de la Universidad de Ciencias Médicas de La Habana. Conclusiones: Oscar B. Alonso Chil contribuyó al desarrollo de la medina interna en Cuba en la etapa revolucionaria. Este profesor representa un modelo para los estudiantes de ciencias médicas por su prestigio profesional y científico(AU)
Introduction: Ph.D. Oscar B. Alonso Chil (b. 1930-d. 2021) was one of the physicians who stayed in Cuba after the triumph of the Revolution. He was a founder of the healthcare services for internal medicine and geriatrics, and made important contributions to medical teaching. Objective: To present the professional career of Oscar B. Alonso Chil as a physician and teacher of revolutionary Cuban medicine, through his life history. Methods: A descriptive and qualitative study was carried out, using the life history technique, focused on the professional aspect. For this purpose, a semistructured interview was conducted with the testimony witness as a fundamental source of information. The oral testimony was validated by reviewing the official documentation in his teaching file and the existing scientific literature related to the subject; in addition to interviews with his students and coworkers. Development: It was observed that he founded services, organized the teaching activity, supervised research, made publications and consultancies, and was a member of scientific boards and councils. He performed each of these activities with great commitment and unconditionality to his profession, which gave him great satisfaction with life. He achieved holding the highest distinctions for his work: second-degree specialist in Internal Medicine, as well as Full Professor, Faculty Consultant and Emeritus Professor of the University of Medical Sciences of Havana. Conclusions: Oscar B. Alonso Chil contributed to the development of internal medicine in Cuba during the revolutionary period. This professor represents a role model for students of medical sciences due to his professional and scientific prestige(AU)
الموضوعات
Humans , Physicians , Life , Autobiography , Famous Persons , Publications , Research , Liability, Legal , Education, Medical , Faculty/history , Work Engagement , Geriatrics/education , Internal Medicine/education , Medical Assistanceالملخص
O rápido envelhecimento populacional brasileiro mudou nosso cenário de saúde, o que exige que o profissional fisioterapeuta esteja preparado para lidar com as especificidades desta população. A Associação Brasileira de Fisioterapia em Gerontologia (ABRAFIGE), que tem a missão de fortalecer a especialidade e promover assistência qualificada em Fisioterapia em Gerontologia, propõe uma relação das competências fundamentais para formação no ensino nos cursos de graduação em Fisioterapia e de pósgraduação lato sensu em Fisioterapia em Gerontologia. Essa iniciativa visa auxiliar os gestores das Instituições de Ensino Superior das diversas regiões brasileiras no planejamento de tais cursos de forma a melhorar a qualidade da formação dos fisioterapeutas nessa área.
The rapid aging of the Brazilian population has changed the health scenario. Such a change requires physiotherapists to be prepared to deal with the specificities of this population. The Associação Brasileira de Fisioterapia em Gerontologia - ABRAFIGE (Brazilian Association of Physical Therapy in Gerontology), which has the mission of strengthening the specialty and the purpose of promoting qualified assistance in physical therapy in gerontology, proposes fundamental skills for training in teaching in undergraduate and graduate courses in physical therapy in gerontology. This initiative aims to assist administrators at higher education institutions in different regions of Brazil in the planning of such courses to improve the quality of the education of physiotherapists in this field.
الموضوعات
Physical Therapy Modalities , Population Dynamics , Geriatricsالملخص
Introduction@#In order to suppress the COVID-19 virus, several vaccines have been developed. The administration of COVID-19 vaccines entails its acceptance. However, misinformation and vaccine uncertainty are main factors that affect vaccine acceptance. This study aimed to determine the most trusted health information source, the most frequently accessed health information source, and health literacy of older adults within Metro Manila. @*Methods@#This study employed a quantitative non-experimental design utilizing correlational and descriptive approaches. Convenience sampling was utilized via Facebook to recruit participants. The survey was adapted from four different questionnaires and went through reliability testing and expert validation. @*Results@#The researchers collected responses from a total of 123 participants. The participants were noted to have an overall high level of acceptance for the COVID-19 vaccine ( 4.10, SD ± 0.22). The study revealed that doctors were the highly trusted health information source (( =3.69, SD ± 1.30), followed by government health agencies (( =3.18, SD ± 0.73), whereas religious organizations and leaders (( =2.45, SD ± 0.48) were the least trusted sources. However, despite being the least trusted source, religious organizations and leaders were shown to be positively related (p=0.049) and highly predictive of COVID-19 vaccine acceptance. The most frequently accessed health information source, health workers, have a weak correlation (r=.323) and were found to be significantly positively related (p=0.008) and highly predictive of the acceptance of the COVID-19 vaccine. The credibility of health information sources is likely to influence their selection, influencing decisions and behaviors.
الموضوعات
SARS-CoV-2 , Geriatricsالملخص
Fundamento: el sector cubano de salud, además de garantizar una atención médico-social al adulto mayor, tiene la misión de formar los recursos humanos especializados en esta área del conocimiento, desde el pregrado en las carreras de las ciencias médicas, y de forma continua y sostenida hasta el posgrado; por lo que se precisa observar el tratamiento de los contenidos relacionados con la Gerontogeriatría en los planes de estudio. Objetivo: caracterizar la representación de la Gerontogeriatría en el curso propio "Envejecimiento" del Plan de estudios "D" de la carrera de Medicina en Cuba. Métodos: se realizó una investigación educativa observacional, descriptiva. Se desarrolló una amplia revisión documental de los planes de estudio y el diseño del curso propio "Envejecimiento" del Plan de estudios "D", precisando el análisis de sus contenidos y su aporte a la Gerontogeriatría. Resultados: se constató que el curso permite la enseñanza de la Gerontología y Geriatría, diseñado con tres objetivos y cinco temas, y contenidos que favorecen la formación gerontogeriátrica en el desempeño de la función de atención médica integral al particular proceso salud enfermedad que se expresa en el adulto mayor. Conclusiones: la Gerontogeriatría está presente en el curso propio "Envejecimiento", representada fundamentalmente con este diseño académico en todo el vigente Plan de estudios "D".
Background: the Cuban health branch, in addition to guaranteeing medical-social care for the elderly, has the mission of training specialized human resources in this area of knowledge, from undergraduate in medical sciences careers, and continuously and sustained until postgraduate; Therefore, it is necessary to observe the treatment of the contents related to Gerontogeriatrics in the study plans. Objective: to characterize the representation of Gerontogeriatrics in the own course "Aging" of the Study Plan "D" of the Medicine career in Cuba. Methods: an observational, descriptive educational research was carried out. An extensive documentary review of the study plans and the design of the own course "Aging" of the Study Plan "D" was carried out, specifying the analysis of its contents and its contribution to Gerontogeriatrics. Results: it was verified that the course allows the teaching of Gerontology and Geriatrics, designed with three objectives and five topics, and contents that favor gerontology and geriatric training in the performance of the function of comprehensive medical attention to the particular health-disease process that is expressed in the elderly. Conclusions: Gerontogeriatrics is present in the own course "Aging", fundamentally represented with this academic design throughout the current Curriculum "D".
الموضوعات
Health Programs and Plans , Population Dynamics , Education, Medical , Geriatrics , Government Programs , National Health Programsالملخص
Introduction - Ageing is characterised by changes associated with an increased risk of developing chronic diseases and syndromes, of which malnutrition is one of the most common in older adults. The gut microbiota has an important role in the hosts health and is determined by several factors, including nutritional status and diet. Therefore, the gut microbiota may be associated with malnutrition and dietary intake in acutely ill older adults. Objectives - to identify- 1) the prevalence of malnutrition; 2) the association of malnutrition with the composition and metabolic potential of the gut microbiota and its impact on clinical outcomes; 3) the effect of habitual diet on the gut microbiota of acutely ill hospitalised older adults according to the nutritional status. Methods - a longitudinal analysis secondary to a prospective cohort was performed on 108 participants aged 65+ years old admitted to the hospital due to acute conditions. Clinical, demographic, nutritional, and anthropometric data and rectal swab samples were collected at admission and after 72 hours of hospitalisation. The food intake was estimated using the dietary history and the nutritional status diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria, preceded by the Mini-Nutritional Assessment Short-form (MNA-SF). Rectal swab samples were obtained to analyse the gut microbiota via 16S rRNA gene sequencing. The microbiota diversity, overall composition and differential abundances were calculated and compared between well-nourished and malnourished groups. Microbiome features potentially associated with malnutrition were selected by penalised models and confirmed by additive models. The prediction of clinical outcomes was investigated from the "malnourished microbiota" using decision trees. The dietary intake was explored through multivariate methods and investigated with the microbiota using tests of association and mediation analysis. Results - Malnourished patients (51%) had a different overall microbiota composition compared to well-nourished during hospitalisation (R= 0.079, p= 0.003). Severely malnourished (32.4%) showed a poorer diversity at admission (Shannon p= 0.012, Simpson p= 0.018) and after 72 hours (Shannon p= 0.023, Chao1 p= 0.008). Subdoligranulum, Lachnospiraceae NK4A136 group and Faecalibacterium prausnitzii, short-chain fatty acids producers, had significantly lower abundance and negative association with malnutrition, while Fusobacterium, Corynebacterium and Ruminococcaceae Incertae Sedis were highly increased and positively associated with malnutrition. Corynebacterium, Ruminococcaceae Incertae Sedis and the overall composition were important predictors of critical care in malnourished during hospitalisation. Malnourished patients had a significantly lower intake of plant protein, carbohydrates, dietary fibre, Fe, Mn, folate, campesterol, beta-sitosterol, and -linolenic acid, and higher intake of Vitamin D. There were no significant correlations of nutrients, foods or food groups with the microbiota structure, but for individual taxa and -diversity metrics. Mediation analysis revealed a significant indirect effect of the nutritional status on the differential abundance of several bacterial taxa partially mediated in a positive direction by dietary fibre, plant-based protein, onions, and olive oil, and negative by vitamin D. Conclusion - Malnourished patients had a significantly lower intake of key dietary compounds and substantial gut microbial disturbances during hospitalisation, pronounced in the severe stage. Some plant-based compounds might confer beneficial effects on the gut microbiota profile. A "malnourished microbiota" may be able to predict critical illness in hospitalised malnourished older patients. Bench-to-bedside investigations are necessary to confirm these findings.
Introdução - O envelhecimento é caracterizado por mudanças associadas a uma maior chance de desenvolver síndromes e doenças crônicas, das quais a desnutrição é uma das mais comuns em idosos. A microbiota intestinal tem um papel importante na saúde e é determinada por vários fatores, incluindo o estado nutricional e a dieta. Portanto, a microbiota intestinal pode estar associada à desnutrição e à ingestão alimentar em idosos gravemente doentes. Objetivos - identificar- 1) a prevalência de desnutrição; 2) a associação da desnutrição com a composição e o potencial metabólico da microbiota intestinal e seu impacto nos desfechos clínicos; 3) o efeito da dieta habitual sobre a microbiota intestinal de idosos hospitalizados com doenças agudas de acordo com o estado nutricional. Métodos - uma análise longitudinal secundária a uma coorte prospectiva foi realizada em 108 participantes com mais de 65 anos de idade admitidos no hospital devido a condições agudas. Foram coletados dados clínicos, demográficos, nutricionais, antropométricos e swab retal na admissão e após 72 horas de internação. O consumo alimentar foi estimado por meio do histórico alimentar e o estado nutricional foi diagnosticado pelos critérios da Iniciativa de Liderança Global sobre Desnutrição (GLIM), precedido da triagem pela Mini-Avaliação Nutricional versão curta (MAN-SF). Amostras de swab retal foram obtidas para analisar a microbiota intestinal via sequenciamento do gene 16S rRNA. A diversidade da microbiota, composição geral e a abundâncias diferenciais foram calculadas e comparadas entre os grupos bem nutrido e desnutrido. Variáveis do microbioma potencialmente associadas à desnutrição foram selecionadas por modelos penalizados e confirmadas por modelos aditivos. A predição para os desfechos clínicos foi investigada a partir da "microbiota desnutrida" utilizando árvores de decisão. O consumo alimentar foi explorado por meio de métodos multivariados e investigado com a microbiota por meio de testes de associação e análise de mediação. Resultados - Os pacientes desnutridos (51%) apresentaram composição geral da microbiota diferente comparado com os bem nutridos durante a hospitalização (R= 0,079, p= 0,003). Os sevemente desnutridos (32,4%) apresentaram menor diversidade na admissão (Shannon p= 0,012, Simpson p= 0,018) e após 72 horas (Shannon p = 0,023, Chao1 p= 0,008). Subdoligranulum, Lachnospiraceae NK4A136 e Faecalibacterium prausnitzii, produtores de ácidos graxos de cadeia curta, tiveram abundância significativamente menor e associação negativa com a desnutrição, enquanto Fusobacterium, Corynebacterium e Ruminococcaceae Incertae Sedis tiveram maior abundância e associação positiva. Corynebacterium, Ruminococcaceae Incertae Sedis e a composição geral foram importantes preditores de cuidados intensivos em desnutridos durante a hospitalização. Pacientes desnutridos tiveram ingestão significativamente menor de proteína vegetal, carboidratos, fibra dietética, Fe, Mn, folato, campesterol, beta-sitosterol e ácido -linolênico, e maior de vitamina D. Não houve correlações significativas entre nutrientes, alimentos ou grupos de alimentos com a estrutura da microbiota, mas sim para táxons individuais e métricas da -diversidade. A análise de medição revelou um efeito indireto significativo do estado nutricional sobre a abundância diferencial de vários táxons bacterianos parcialmente mediada em uma direção positiva pela fibra alimentar, proteína vegetal, cebola, e azeite de oliva, e negativa pela vitamina D. Conclusão - Pacientes desnutridos tiveram menor ingestão de compostos dietéticos chaves e distúrbios microbianos intestinais substanciais durante a hospitalização, pronunciados no estágio grave. Alguns compostos de origem vegetal podem conferir efeitos benéficos no perfil da microbiota intestinal. A "microbiota desnutrida" pode ser capaz de predizer doenças críticas em idosos desnutridos hospitalizados. Investigações pré-clínicas e translacionais são necessárias para confirmar esses achados.
الموضوعات
Humans , Aged , Aged, 80 and over , Health of the Elderly , Acute Disease , Malnutrition , Diet , Gastrointestinal Microbiome , Geriatricsالملخص
INTRODUCTION: Geriatrics, a specialized medical branch focusing on the health and well-being of older individuals, has gained increasing attention due to the global demographic shift towards an aging population. Despite the significant growth of the older adult population in Nigeria, limited empirical studies hinder the translation of research findings into health and well-being improvements for older adults in the region. OBJECTIVE: This systematic review will synthesize geriatrics research conducted in Nigeria over the past 6 decades, identifying temporal patterns and research priorities. METHODS: Four electronic databases will be searched to identify studies from published and grey literature on geriatrics in Nigeria between 1960 and 2023 and will be reviewed from inception to 2023: PubMed, MEDLINE, Google Scholar, and African Journal Online. The population of interest is older adults aged ≥60 years. The review team comprises primary investigators, content experts, and a subject librarian. Data extraction and analysis will be conducted independently by review authors, and statistical analysis will be performed by experts. EXPECTED RESULTS: Depending on the results, we anticipate that this systematic review will help clarify the state of geriatrics studies and services in Nigeria. RELEVANCE: The review will fill research gaps to inform policy directives and interventions in geriatric care by developing evidence-based clinical and policy documents to improve the health and well-being of older adults in Nigeria. (AU)
INTRODUÇÃO: A geriatria, um ramo médico especializado com foco na saúde e no bem-estar dos indivíduos mais velhos, tem ganhado cada vez mais atenção por conta de uma mudança demográfica global diante do envelhecimento da população. Apesar do crescimento significativo da população idosa na Nigéria, estudos empíricos limitados dificultam a tradução dos resultados das pesquisas em melhorias na saúde e no bem-estar dos idosos na região. OBJETIVO: Esta revisão sistemática visa sintetizar a pesquisa em geriatria realizada na Nigéria nas últimas seis décadas, identificar padrões temporais e prioridades de investigação. METODOLOGIA: Pesquisas foram realizadas em quatro bases de dados eletrônicas (PubMed, Medical Literature Analysis and Retrieval System Online - MEDLINE, Google Scholar e African Journal Online - AJOL) para identificar estudos sobre geriatria na Nigéria, englobando literatura publicada e literatura cinzenta entre 1960 e 2023. Esses estudos foram revisados desde o início até 2023. A população de interesse é de idosos com idade ≥60 anos. A equipe de revisão é composta de investigadores principais, especialistas em conteúdo e um bibliotecário especializado no assunto. A extração e a análise de dados foram conduzidas de forma independente pelos autores da revisão, e a análise estatística foi realizada por especialistas. RESULTADOS ESPERADOS: Dependendo dos resultados, prevemos que esta revisão sistemática contribuirá para a compreensão do estado dos estudos e serviços de geriatria na Nigéria. RELEVÂNCIA: A revisão irá, através do desenvolvimento de documentos clínicos e políticas baseados em evidências, preencher lacunas das pesquisas que informam as diretivas políticas e as intervenções nos cuidados geriátricos, para assim melhorar a saúde e o bem-estar dos idosos na Nigéria.
الموضوعات
Humans , Aged , Aged, 80 and over , Geriatrics , Nigeriaالملخص
Os estudos sobre as relações mútuas entre as pessoas e o ambiente buscam subsidiar melhorias no contexto urbano a partir de métodos e técnicas pautados na compreensão do uso de espaços públicos e privados. A crescente demanda pela promoção de ambientes amigáveis para idosos e crianças nos cenários urbanos direcionou esta pesquisa e elencou dois componentes: o panorama relativo à população local e o arcabouço teórico da psicologia ambiental. Para tanto, buscou-se identificar as principais atividades realizadas por crianças e idosos em seus respectivos locais de moradia. Foram avaliados os principais usos e atividades desses dois grupos, em duas vizinhanças, diferenciando-os de acordo com suas especificidades em termos de demandas individuais e ambientais. As observações sistemáticas a partir da técnica de mapeamento comportamental centrado no lugar (MCCL) ocorreram na cidade de Brasília, Distrito Federal (DF) e permitiram compreender o processo de apropriação dos espaços na infância e na velhice e suas repercussões em termos da congruência pessoa-ambiente. Cada um destes setores organizados a partir de elementos específicos direciona as ações dos participantes para determinados tipos de comportamentos, observados de maneira a compor um roteiro em que a brincadeira (lazer ativo) surge como central na infância e a caminhada (circulação) como mais potente para a população idosa. Os resultados demonstram que o diálogo entre a psicologia ambiental e a ciência do desenvolvimento humano tem sido bastante profícuo e tem contribuído para a compreensão de aspectos da relação pessoa-ambiente em diferentes momentos do ciclo de vida.(AU)
Studies on the mutual relations between people and the environment seek to support improvements in the urban context from methods and techniques based on understanding the use of public and private spaces. The growing demand for the promotion of friendly urban environments for older people and children guided this research, with two notable components: the panorama related to the local population and the theoretical framework of Environmental Psychology. Therefore, we sought to identify the main activities carried out by children and older people in their respective dwellings. The main uses and activities of these two groups were evaluated in two neighborhoods, differentiating them according to their specificities in terms of individual and environmental demands. Systematic observations using the place-centered behavioral mapping technique took place in the city of Brasília, Federal District, and allowed us to understand the process of appropriation of spaces in childhood and old age and its repercussions in terms of person-environment congruence. Each of these sectors, organized from specific elements, directs the participants' actions towards certain types of behavior, observed in order to compose a script in which playing (active leisure) emerges as central in childhood and walking (circulation) as more potent for the older people. The results demonstrated that the dialogue between environmental psychology and the science of human development has been very fruitful and has contributed to the understanding of aspects of the person-environment relationship at different times in the life cycle.(AU)
Los estudios sobre las relaciones mutuas entre las personas y el medio ambiente buscan aportar mejoras en el contexto urbano mediante métodos y técnicas basados en la comprensión del uso de los espacios públicos y privados. La creciente demanda de la promoción de ambientes amigables para las personas mayores y los niños en entornos urbanos guio esta investigación y enumeró dos componentes: el panorama relacionado con la población local y el marco teórico de la Psicología Ambiental. En este contexto, buscamos identificar las principales actividades que realizan los niños y las personas mayores en sus respectivas viviendas. Se evaluaron los principales usos y actividades de estos dos grupos en dos barrios, diferenciándolos según sus especificidades en cuanto a las demandas individuales y ambientales. Las observaciones sistemáticas utilizando la técnica de mapeo conductual centrado en el lugar (MCCL) ocurrieron en la ciudad de Brasília, Distrito Federal (Brasil) y nos permitieron comprender el proceso de apropiación de espacios en la infancia y la vejez y sus repercusiones en la congruencia persona-ambiente. Cada uno de estos sectores, organizados a partir de elementos específicos, orienta las acciones de los participantes hacia determinados comportamientos, observados para componer un guion en el que el juego (ocio activo) emerge como central en la infancia y el caminar (circulación) como el más potente para las personas mayores. Los resultados demuestran que el diálogo entre la Psicología Ambiental y la ciencia del desarrollo humano ha sido muy fructífero y ha contribuido a la comprensión de aspectos de la relación persona-entorno en diferentes momentos del ciclo de vida.(AU)
الموضوعات
Humans , Male , Female , Aged , Child , Child Welfare , Urban Area , Conservation of Natural Resources , Ecological Development , Environment , Environmental Psychology , Parks, Recreational , Parking Facilities , Personal Satisfaction , Physiology , Art , Psychology , Quality of Life , Reading , Recreation , Safety , Self Care , Self Concept , Soccer , Social Alienation , Social Behavior , Social Desirability , Social Isolation , Social Sciences , Social Support , Social Welfare , Socialization , Sports , Swimming Pools , Urban Population , Health Policy, Planning and Management , Aged Rights , Brazil , Activities of Daily Living , Exercise , Child Behavior , Child Rearing , Indicators of Quality of Life , Environmental Health , Mental Health , Child Health , Health of the Elderly , Health Fairs , Chronic Disease , Transportation of Patients , Relaxation Therapy , Staff Development , Cities , City Planning , Civil Rights , Environmental Imbalance , Human Ecology , Nature , Life , Universal Access to Health Care Services , Medical Care , Personal Autonomy , Spirituality , Value of Life , Friends , Vulnerable Populations , Education, Continuing , Environment Design , Essential Public Health Functions , Disease Prevention , Industrial Development , Environmental Restoration and Remediation , Family Relations , Resilience, Psychological , Pleasure , Sedentary Behavior , Independent Living , Environmental Policy , Social Participation , Pandemics , Community Integration , Social Skills , Grandparents , Cognitive Aging , Public Service Announcement , Diet, Healthy , Psychosocial Support Systems , Transportation Facilities , Cell Phone Use , Cultural Rights , Access to Essential Medicines and Health Technologies , Data Analysis , Respect , Digital Inclusion , Right to Health , Empowerment , Functional Status , Freedom of Movement , COVID-19 , Healthy Life Expectancy , Sleep Quality , Intersectional Framework , Citizenship , Geriatrics , Diversity, Equity, Inclusion , Family Support , Gymnastics , Habits , Handwriting , Health Physics , Health Planning , Health Promotion , Housing , Human Rights , Interpersonal Relations , Loneliness , Longevity , Methods , Motivation , Noiseالملخص
Resumo O objetivo deste trabalho foi avaliar o conhecimento sobre cuidados paliativos de estudantes do quarto, quinto e sexto anos da graduação em medicina de uma faculdade particular de Belo Horizonte, bem como investigar sua percepções sobre o ensino do tema. Trata-se de estudo transversal observacional com aplicação de questionário on-line para 135 acadêmicos. Dentre os participantes, 40,7% consideram-se preparados para lidar com morte de pacientes e luto dos familiares, 80,7% classificam o próprio nível de conhecimento sobre cuidados paliativos como regular e 77% afirmam não ter recebido informações suficientes sobre o assunto. Ao avaliar conceitos, 20% tiveram desempenho insatisfatório, 48% aceitável e 3% excelente. Acadêmicos de anos mais avançados e que fizeram o internato em saúde do idoso apresentaram melhores respostas. Revelou-se que, apesar de o desempenho dos estudantes ser em geral regular, o internato em saúde do idoso tem impacto positivo na aquisição de conhecimento sobre cuidados paliativos.
Abstract This study evaluates the knowledge of fourth, fifth and sixth-year medical undergraduates about palliative care and their perceptions regarding teaching of this topic. Cross-sectional observational research was conducted with 135 undergraduates from a private medical school in Belo Horizonte by means of an online questionnaire. Of the participants, 40.7% considered themselves prepared to address patient death and the bereavement of family members, 80.7% rated their level of knowledge about palliative care as mediocre and 77% said they received insufficient information on the subject. When evaluating concepts, 20% of the participants had an unsatisfactory performance, 48% acceptable and 3% excellent. Students from more advanced years and who had completed an internship in elderly health had better responses. Despite regular student performance, the internship in elderly health positively impacts the acquisition of palliative care knowledge.
Resumen El objetivo de este trabajo fue evaluar el conocimiento sobre cuidados paliativos de estudiantes de cuarto, quinto y sexto curso de la carrera de medicina de una facultad privada de Belo Horizonte, así como investigar sus percepciones sobre la enseñanza del tema. Se trata de un estudio observacional transversal que utilizó un cuestionario en línea para 135 académicos. Entre los participantes, el 40,7% se considera preparado para afrontar la muerte de los pacientes y el duelo de los familiares, el 80,7% califica como regular su propio nivel de conocimiento sobre cuidados paliativos, y el 77% afirma no haber recibido suficiente información sobre el tema. Al evaluar conceptos, el 20% tuvo un desempeño insatisfactorio, el 48% aceptable y el 3% excelente. Los académicos de años más avanzados y que completaron el internado en salud del anciano presentaron mejores respuestas. Se reveló que, aunque el desempeño de los estudiantes sea generalmente regular, el internado en salud del anciano tiene impacto positivo en la adquisición de conocimiento sobre cuidados paliativos.
الموضوعات
Geriatrics , Cross-Sectional Studiesالملخص
Introducción: La hernia diafragmática surge como resultado del movimiento de los órganos abdominales hacia el tórax a través de un defecto del diafragma resultante de varios tipos de lesiones, que a menudo representan un desafío diagnóstico y terapéutico. La hernia diafragmática traumática es una enfermedad infrecuente. El trauma diafragmático rara vez es aislado, la mayoría de las veces se acompaña de otras lesiones toracoabdominales, cerebrales o musculoesqueléticas, siendo estas comorbilidades más graves responsables del mal pronóstico y aumento de la mortalidad. Caso clínico: Anciana de 90 años de edad, hipertensa, quien inicia cuadro clínico 48 horas previas a su ingreso, cuando posterior a caída del plano de bipedestación presenta disminución del estado de consciencia, náuseas, vómitos y disnea en reposo. Rx de tórax evidencia asas intestinales en hemitórax derecho. Se realizó laparotomía exploradora. Conclusión: Las hernias diafragmáticas traumáticas son infrecuentes, con incidencia <3%, sintomatología inespecífica y relacionadas generalmente con lesiones asociadas al trauma. Siempre se debe sospechar de una HD ante un paciente con antecedente de trauma cerrado de alto impacto o penetrante, en función de la cinética y mecanismo de lesión. El diagnóstico supone un reto para el cirujano, debiendo apoyarse en una firme sospecha y estudios radiológicos. Su tratamiento es quirúrgico, debiendo ser individualizado, con abordajes torácicos o abdominales en función del caso. La técnica a emplear dependerá de las características del defecto, de la fase del diagnóstico y la experiencia del equipo quirúrgico(AU)
Introduction: Diaphragmatic hernia arises as a result of the movement of the abdominal organs towards the thorax through a defect in the diaphragm resulting from various types of injuries, which often represent a diagnostic and therapeutic challenge. Traumatic diaphragmatic hernia is a rare disease. Diaphragmatic trauma is rarely isolated, most of the time it is accompanied by other thoracoabdominal, brain or musculoskeletal injuries, these more serious comorbidities being responsible for the poor prognosis and increased mortality. Clinical case: A 90-year-old woman with hypertension , who began a clinical picture 48 hours prior to admission, when after falling from the standing plane he presented a decreased state of consciousness, nausea, vomiting, and dyspnea at rest. Chest x-ray shows intestinal loops in the right hemithorax. Exploratory laparotomy was performed. Conclusion: Traumatic diaphragmatic hernias are rare, with an incidence of <3%, non-specific symptoms, and generally related to injuries associated with trauma. HD should always be suspected in a patient with a history of high-impact or penetrating blunt trauma, depending on the kinetics and mechanism of injury. Diagnosis is a challenge for the surgeon, and must be based on a firm suspicion and radiological studies. Its treatment is surgical, and must be individualized, with thoracic or abdominal approaches depending on the case. The technique to be used will depend on the characteristics of the defect, the diagnostic phase and the experience of the surgical team(AU)
الموضوعات
Humans , Female , Aged, 80 and over , Radiography, Thoracic , Patients , Signs and Symptoms , Unconsciousness , Vomiting , Dyspnea , Geriatricsالملخص
Abstract The study aimed to estimate and compare the prevalence and type of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) between the STOPP/START original (v1) and updated version (v2) among older patients in various settings, as well as associated factors. The study included 440 patients attending a community pharmacy, 200 outpatients and 140 nursing home users. An increase in the prevalence of STOPP v2 (57.9%) compared to v1 (56.2%) was not statistically significant in the total sample and within each setting (p>0.05). A decrease in the prevalence of START v1 (55.8%) to v2 (41.2%) was statistically significant (p<0.001) in the total sample and within each setting (p<0.05). Drug indication (32.9%) and fall-risk medications (32.2%) were most commonly identified for STOPP v2, while cardiovascular system criteria (30.5%) were the most frequently detected for START v2. The number of medications was the strongest predictor for both STOPP v1 and v2, with odds ratio values of 1.35 and 1.34, respectively. Patients' characteristics associated with the occurrence of STOPP and START criteria were identified. According to both STOPP/START versions, the results indicate a substantial rate of potentially inappropriate prescribing among elderly patients. The prevalence of PIMs was slightly higher with the updated version, while the prevalence of PPOs was significantly lower
الموضوعات
Humans , Male , Female , Aged , Underregistration/classification , Prescriptions/classification , Potentially Inappropriate Medication List/statistics & numerical data , Health Services for the Aged/organization & administration , Prevalence , Geriatrics/instrumentationالملخص
INTRODUCCIÓN: La enfermedad cerebrovascular en los adultos mayores tiene implicaciones clínicas, sociales y económicas que pueden comprometer la funcionalidad y la calidad de vida. Es importante determinar las complicaciones que puede presentar el paciente geriátrico con enfermedad cerebrovascular durante los días de estancia hospitalaria. OBJETIVO: Determinar las características neuro-geriátricas asociadas a las complicaciones agudas no neurológicas y los días de hospitalización de los pacientes adultos mayores con enfermedad cerebrovascular. MATERIALES Y MÉTODOS: Estudio descriptivo prospectivo. Población de 120 y muestra de 73 pacientes mayores de 65 años con enfermedad cerebro vascular de la Unidad de Neurología del Hospital Carlos Andrade Marín que inició en agosto de 2020 y culminó en enero 2021. Se excluyó a pacientes que no cumplieron el criterio mencionado, con dependencia funcional total previa, patologías psiquiátricas previas, o personas que no aceptaron ser parte del estudio. Se efectuó el seguimiento de los pacientes desde el ingreso hasta el alta hospitalaria, para identificar complicaciones agudas no neurológicas y días de hospitalización. Se determinó las características neuro-geriátricas mediante las escalas de Barthel, Gijón, Charlson, Norton, Glasgow y NIHSS. Se obtuvo riesgo relativo e intervalos de confianza, considerando significativo un valor p<0,05. RESULTADOS: La edad media fue de 77 (±8,5) años. Las complicaciones fueron infección de tracto urinario (22,0%), neumonía (20,0%), desequilibrio hidroelectrolítico (19,0%), disfagia (13,0%) y úlceras por presión (9,0%). Las complicaciones que se presentaron significativamente ante una estancia hospitalaria prolongada comparada con quienes no las presentaron fueron la Neumonía (Media 5,81 (1,47 a 10,16) con IC 95%) y la infección del tracto urinario (Media 4,95 (1,52 a 8,38) con IC 95%). Según las características neuro-geriátricas y las complicaciones, encontramos diferencia estadísticamente significativa solo con en el grupo de riesgo bajo, según la escala de Norton RR 0,744 con IC 95% (0,584 - 0,949). CONCLUSIONES: Es importante realizar la valoración geriátrica integral al paciente neurológico tanto al ingreso como al egreso hospitalario, ya que permite detectar complicaciones que pueden pasar desapercibidas y prolongar la estancia hospitalaria.
INTRODUCTION: Cerebrovascular disease in older adults has clinical, social, and economic implications that can compromise functionality and quality of life. It is important to determine the complications that the geriatric patient with cerebrovascular disease may present during hospital days. OBJECTIVE: To determine the neuro-geriatric characteristics associated with acute non-neurological complications and hospital days in older adult patients with cerebrovascular disease. MATERIALS AND METHODS: Prospective descriptive study. Population of 120 and sample of 73 patients older than 65 years with cerebrovascular disease from the Neurology Unit of the Carlos Andrade Marín Hospital that began in August 2020 and culminated in January 2021. Patients who did not meet the aforementioned criteria, with previous total functional dependence, previous psychiatric pathologies, or people who did not agree to be part of the study were excluded. Patients were followed up from admission to hospital discharge to identify acute non-neurological complications and days of hospitalization. Neuro-geriatric characteristics were determined using the Barthel, Gijon, Charlson, Norton, Glasgow and NIHSS scales. Relative risk and confidence intervals were obtained, considering a p-value <0.05 as significant. RESULTS: Mean age was 77 (±8.5) years. Complications were urinary tract infection (22.0%), pneumonia (20.0%), water and electrolyte imbalance (19.0%), dysphagia (13.0%) and pressure ulcers (9.0%). Complications that occurred significantly in the face of a prolonged hospital stay compared to those who did not present were Pneumonia (Mean 5.81 (1.47 to 10.16) with 95% CI) and urinary tract infection (Mean 4.95 (1.52 to 8.38) with 95% CI). According to neuro-geriatric characteristics and complications, we found statistically significant difference only with in the low risk group, according to the Norton scale RR 0.744 with 95% CI (0.584 - 0.949). CONCLUSIONS: It is important to perform comprehensive geriatric assessment of the neurological patient both on admission and hospital discharge, as it allows the detection of complications that may go unnoticed and prolong hospital stay.
الموضوعات
Humans , Male , Female , Aged , Aged, 80 and over , Cerebrovascular Disorders , Health of the Elderly , Geriatrics , Health Services for the Aged , Hospitalization , Neurology , Pneumonia , Quality of Life , Urinary Tract , Water-Electrolyte Imbalance , Aged , Deglutition Disorders , Comorbidity , Pressure Ulcer , Ecuadorالملخص
Objective: To develop a new concept of teledentistry for the elderly through a web platform and associated mobile application in the context of the COVID-19 pandemic. Material and Methods: A new concept for attention via teledentistry of the elderly supported by the web platform/app TEGO (Acronym for Tele-platform of Geriatric and Dental Specialties in Spanish) was developed. Priority and urgent dental care for elderly patients in the context of the COVID-19 pandemic was provided onboard a mobile dental clinic equipped with all the necessary conventional dental care facilities as well as state-of-the-art digital technology. Dental care was carried out in five cities of Chile. For the study, 135 elderly patients were treated. The tele-dental care model includes visit-appointment and remote interconsultation with a staff of specialists. To evaluate patient satisfaction aspects, regarding the service / care provided, a user satisfaction survey was applied. Results: A total of 68 questionnaires were completed by patients. The results showed high levels of patients' satisfaction after the priority or urgent dental care, which reached above 75% in all dimensions of the questionnaire (Access to dental care, user treatment, platform, recommendation). Conclusion: The generation of a technological ecosystem for teledentistry can provide a series of important advantages in the attention of elderly patients, by optimizing the dental care coverage by different specialists who can provide attention to a population that has limited or no access to them.
Objetivo: Desarrollar un nuevo concepto de teleodon-tología para adultos mayores a través de una plataforma web y aplicación móvil asociada en el contexto de la pandemia de COVID-19. Material y Métodos: Se desarrolló un nuevo concepto de atención vía teleodontología del adulto mayor apoyado en la plataforma/app web TEGO (Teleplataforma de Especialidades Geriatricas y Odontológicas). La atención dental prioritaria y urgente para pacientes de edad avanzada en el contexto de la pandemia de COVID-19 se brindó a bordo de una clínica dental móvil equipada con todas las instalaciones de atención dental convencional necesarias, así como con tecnología digital de última generación. La atención odontológica se realizó en cinco ciudades de Chile. Para el estudio, 135 pacientes de edad avanzada fueron atendidos. El modelo de atención teledental incluye visita-cita e inter-consulta remota con un staff de especialistas. Para evaluar los aspectos de satisfacción del paciente, respecto al servicio/atención brindada, se aplicó una encuesta de satisfacción del usuario. Resultados: Los pacientes completaron un total de 68 cuestionarios. Los resultados mostraron altos niveles de satisfacción de los pacientes tras la atención odontológica prioritaria o urgente, que superó el 75% en todas las dimensiones del cuestionario (Acceso a la atención odontológica, trato al usuario, plataforma, recomendación). Conclusión: La generación de un ecosistema tecnológico para la teleodontología puede brindar una serie de ventajas importantes en la atención de pacientes adultos mayores, al optimizar la cobertura de atención odontológica por parte de diferentes especialistas que pueden brindar atención a una población que tiene acceso limitado o nulo.