COVID-19 and the elaboration of personal plans in + 50: a Brazilian experience.

BACKGROUND: In front of the physical and social isolation, as well as feelings of fear and instability imposed by the pandemic of COVID-19, especially for risk groups such as people 50 + , it became even more relevant to discuss the formulation of personal plans for this age population. This study aimed to analyse the individual plans of people 50 + , considering their perception, feelings and life experiences during the COVID-19 pandemic. METHODS: This is a mixed study (quali-quantitative), using Minayo's methodology for content analysis and frequency analyses, made with 39 participants from the University of Brasília Educational Program, Universidade do Envelhecer - UniSER/UnB. We used a word cloud system and a wheel of life tool to showcase the results. RESULTS: Analysing professional achievements and situations participants want to overcome, the categories of feelings that stand out were Loving Relationships, Sadness, Family Absence, Grief, Trauma and Regret. Intellectual Development, Personal Fulfilment, Purpose and Creativity, Hobbies and Fun were the most mentioned personal plans displayed by the wheel of life. The key personal changes mentioned were to be less shy, prioritise themselves, change how they interact with others, and focus on their health. CONCLUSIONS: This study concludes that perception, feelings and life experiences during the COVID-19 pandemic did not seem to directly affect the path in elaborating personal plans.

Clinical-Functional Vulnerability, Functional Capacity, and Falls in Octogenarians with Different Physical Activity Levels-A Cross-Sectional Study.

AIM: To compare differences between frailty, functional capacity, and fall prevalence among community-dwelling oldest-old adults regarding their physical activity levels. METHODS: Two hundred and thirty-nine octogenarians (80+ years) were allocated according to their physical activity as insufficiently active (<150 min week-1; n = 98; 84.4 ± 3.7 years), active (150 to 300 min week-1, n = 81, 83.9 ± 3.1 years), and very active (>300 min week-1, n = 60; 83.8 ± 3.4 years). Frailty (CFVI-20 questionnaire), functional capacity (Five Times Sit-to-Stand Test, Timed Up and Go, Balance, and handgrip strength), fall history, and physical activity were assessed. RESULTS: The insufficiently active group was the frailest and presented the worst functional performance compared to the other groups. The fall prevalence was higher in the insufficiently active (60.9%) compared to the active (26.4%) and very active (12.7%) groups. CONCLUSIONS: The group of insufficiently active octogenarians showed the greatest frailty, worst functional capacity, and higher fall prevalence than the active and very active groups. The engagement in physical activity of at least 300 min week-1 is essential to reverse or minimize the deleterious effects of aging on frailty, functional capacity, and falls in octogenarians.

The Performance Index Identifies Changes Across the Dual Task Timed Up and Go Test Phases and Impacts Task-Cost Estimation in the Oldest-Old.

Introduction: Dual tasking is common in activities of daily living (ADLs) and the ability to perform them usually declines with age. While cognitive aspects influence dual task (DT) performance, most DT-cost (DT-C) related metrics include only time- or speed- delta without weighting the accuracy of cognitive replies involved in the task. Objectives: The primary study goal was to weight the accuracy of cognitive replies as a contributing factor when estimating DT-C using a new index of DT-C that considers the accuracy of cognitive replies (P-index) in the instrumented timed up and go test (iTUG). Secondarily, to correlate the novel P-index with domains of the Mini-Mental State Examination (MMSE). Methods: Sixty-three participants (≥85 years old) took part in this study. The single task (ST) and DT iTUG tests were performed in a semi-random order. Both the time taken to complete the task measured utilizing an inertial measurement unit (IMU), and the accuracy of the cognitive replies were used to create the novel P-index. Clinical and sociodemographic data were collected. Results: The accuracy of the cognitive replies changed across the iTUG phases, particularly between the walk 1 and walk 2 phases. Moreover, weighting 0.6 for delta-time (W1) and 0.4 for cognitive replies (W2) into the P-index enhanced the prediction of the MMSE score. The novel P-index was able to explain 37% of the scores obtained by the fallers in the "spatial orientation" and "attention" domains of the MMSE. The ability of the P-index to predict MMSE scores was not significantly influenced by age, schooling, and number of medicines in use. The Bland-Altman analysis indicated a substantial difference between the time-delta-based DT-C and P-index methods, which was within the limits of agreement. Conclusions: The P-index incorporates the accuracy of cognitive replies when calculating the DT-C and better reflects the variance of the MMSE in comparison with the traditional time- or speed-delta approaches, thus providing an improved method to estimate the DT-C.

Factors Associated With Positive Self-Rated Health: Comparing Older Adults in Brazil and in Portugal.

Introduction: Self-rated health is a multidimensional health indicator and a predictor of adverse events in old age. Answers to this assessment are influenced by social, cultural and personality factors. Aim: Exploring common and distinctive characteristics of Brazilian and Portuguese older adults aged 70 and over regarding positive self-rated health according to sociodemographic variables, to functional capacity, to independent performance of basic activities of daily living and to neuroticism, as well as analyzing associations between positive self-rated health and these variables. Methods: The present paper is a comparative and cross-sectional study based on secondary data contained in the databases of the FIBRA (Frailty in Brazilian Older Adults) follow-up study, with 418 Brazilian older adults, and of the DIA (From Disability to Activity: The Challenge of Aging) study, with 380 Portuguese older adults. Both samples had higher percentages of women: 68.4% for Portugal and 69.9% for Brazil. The Brazilian sample had a higher average age (80.31 ± 4.67) than the Portuguese sample (76.80 ± 5.28). Results: The Portuguese older adults had better overall cognition scores, higher handgrip strength and higher neuroticism values than the Brazilian older adults. In the simple and multiple logistic regression analyses, it was found that among Brazilian older adults, subjects with higher scores in the MMSE (OR 1.16; 95% CI 1.08-1.24), regardless of ADL performance (OR 2.13; 95% CI 1.31-3.47) and with scores 24-29 (OR 1.92; 95% CI 1.07-3.43) or 11-23 (OR 2.09; 95% CI 1.15-3.79) in neuroticism were more likely to assess their health as very good/good. On the other hand, the Portuguese older adults with intermediate 24-9 (OR 2.38; 95% CI 1.31-4.33) or low 11-23 (OR 5.31; 95% CI 2.69-10.45) scores in neuroticism were more likely to evaluate their health as very good/good. Conclusion: Based on the findings of the present study and on the existing literature, it may be said that it is possible for people to age while keeping a positive perception of their own health, even in advanced old age; comparisons between the above-mentioned countries, however, point to the need for investments in healthcare systems so that older adults may enjoy greater physical independence and improved mental health.

O processo de envelhecimento sob a ótica de idosos em situação de rua / The aging process under the perspective of homeless older adult

Com o envelhecimento da população, as condições de vulnerabilidade associadas ao empobrecimento podem levar ao aumento do número de idosos em situação de rua. O presente estudo teve como objetivo compreender o processo de envelhecimento sob a ótica do idoso em situação de rua, considerando o enfrentamento das transições relacionadas ao ambiente/sociedade, saúde/doença e sua adaptação. Trata-se de um estudo de natureza descritiva, com abordagem qualitativa, ancorado na Teoria das Transições de Afaf Meleis. A coleta de dados ocorreu no período de julho a setembro de 2019 e constou de observação não participante e entrevistas semiestruturadas. Foram entrevistados 14 idosos que vivem em situação de rua por mais de um ano na região Centro Sul de Belo Horizonte, Minas Gerais, Brasil. As informações coletadas foram transcritas, organizadas de acordo com a análise de conteúdo proposta por Bardin e estruturadas em três categorias analíticas: a invisibilidade social do envelhecimento em situação de rua; o processo de transição vivenciado na rua e os desafios da enfermagem no cuidado aos idosos em situação de rua. Os 14 idosos que participaram da pesquisa eram do sexo masculino com idade entre 60 e 75 anos, e média de 64,7 anos. Quanto ao estado civil, oito eram separados/divorciados, cinco solteiros e um casado. Em relação à escolaridade um idoso era analfabeto, oito possuíam ensino fundamental incompleto, um ensino fundamental completo, dois possuíam ensino médio completo e dois relataram ensino superior completo. Quanto ao tempo de vivência na rua a média foi de 6,9 anos com variação entre 15 meses e 40 anos. Quanto à situação financeira, 10 idosos possuíam renda fixa mensal de R$ 91,00 (Bolsa Família) e quatro idosos tinham aposentadoria ou Benefício de Prestação Continuada (BPC) com valor equivalente a um salário mínimo. A fragilidade dos idosos em situação de rua é muitas vezes suficiente para separá-los da sociedade. Sua decadência os isola. Podem tornar-se menos sociáveis e seus sentimentos menos calorosos, sem que se extinga sua necessidade dos outros. Isso é o mais difícil: o isolamento tácito dos velhos, o gradual esfriamento de suas relações com pessoas a quem eram afeiçoados, a separação em relação aos seres humanos em geral, tudo o que lhes dava sentido e segurança. Neste sentido, torna-se imprescindível que a enfermagem auxilie este idoso em seu processo transicional mas sobretudo, compreenda a realidade e o contexto no qual este sujeito vive e oportunize a materialização de seus direitos e da sua dignidade. Auxiliar o idoso que vive na rua a enfrentar seus processos de transição é fundamental para o cuidado, mas é preciso buscar articulação na rede de atenção à saúde e na assistência social para a promoção da saúde desse sujeito e contribuição para o alcance da sua autonomia, proteção, participação social e envelhecimento ativo.

With the aging of the population, the conditions of vulnerability associated with impoverishment can lead to an increase in the number of elderly people living on the streets. The present study aimed to understand the aging process from the perspective of the elderly on the street considering the coping with transitions related to the environment / society, health / disease and their adaptation. It is a study of a descriptive nature, with a qualitative approach, anchored in the Theory of Transitions by Afaf Meleis. Data collection took place from July to September 2019 and consisted of non- participant observation and semi-structured interviews. 14 elderly people living on the streets for more than a year in the Center South region of Belo Horizonte, Minas Gerais, Brazil, were interviewed. The information collected was transcribed, organized according to the content analysis proposed by Bardin and structured into three analytical categories: the social invisibility of aging in the street; the transition process experienced on the street; nursing care for the elderly on the streets and the contemporary challenges arising from the increase in this demand. The 14 elderly people who participated in the research were male, aged between 60 and 75 years, with an average of 64.7 years. Regarding marital status, eight were separated / divorced, five were single and one was married. Regarding education, one elderly person was illiterate, eight had incomplete primary education, one completed primary education, two had completed secondary education and two reported complete higher education. As for the time of living on the street, the average was 6.9 years, with a variation between 15 months and 40 years. As for the financial situation, 10 elderly people had a fixed monthly income of U$18,01 (Family Bag) and four elderly people had a retirement or Continuous Payment Benefit (BPC) with an amount equivalent to a minimum wage. The fragility of the elderly on the streets is often enough to separate them from society. Their decay isolates them. They can become less sociable and their feelings less warm, without their need for others being extinguished. This is the most difficult: the tacit isolation of the elderly, the gradual cooling of their relations with people they were fond of, the separation from human beings in general, everything that gave them meaning and security. In this sense, it is essential that nursing helps this elderly person in his transitional process, but above all, understands the reality and the context in which this subject lives and opportunities the materialization of their rights and dignity. To help the elderly that live in the street to face their transition processes is fundamental for the care, but it is necessary to look for articulation in the health care network and in the social assistance for the promotion of this subject's health and contribution for the reach of his autonomy, protection, social participation and active aging.