Swallowing disorders and associated factors in older adults living in nursing homes.

PURPOSE: The aim of this study was to identify the frequency of swallowing disorders and the associated factors in older adults living in nursing homes. METHODS: This is a cross-sectional study with a sample of 73 older adults (≥ 60 years; mean age = 80 ± 7.49 years; female = 82.2%) living in five non-profit Brazilian nursing homes. Demographic and clinical data were collected. The frequency of swallowing disorders was determined by the Volume-Viscosity Swallow Test (VVS-T). Covariables with a p-value less than 0.20 according to Pearson's chi-square test or Fisher's exact test were included in the multiple logistic regression analysis model. The level of significance was 5%. RESULTS: The frequency of swallowing disorders was 63%. The multiple logistic regression model revealed that the chance of an older adult living in a nursing home presenting with swallowing disorders increased by 8% with each 1-year increase in age. Decreases in oral intake level improved the chance of a negative result in the VVS-T by approximately four times, and an individual with a FOIS level below seven was almost 11 times more likely to have a swallowing disorder. CONCLUSION: The frequency of swallowing disorders in older adults living in nursing homes is high and is associated with age and oral intake. The management care team should be aware of the early detection of these conditions to prevent complications of oropharyngeal dysphagia.

Functional decline in nursing home residents: A prognostic study.

AIM: To verify the probability of maintaining functional capacity in basic activities of daily living and identify the prognostic factors of functional decline in institutionalized older adults. METHODS: A longitudinal study is presented herein, with 5 waves every 6 months, throughout 2 years (2013-2015), conducted with individuals ≥60 years old in 10 nursing homes in the city of Natal-RN (Brazil). Functional capacity was assessed by the items 'eating', 'personal hygiene', 'dressing', 'bathing', 'transferring', 'toileting' and 'walking', through a 5-item Likert scale. Sociodemographic, institution-related and health-related variables were considered to establish the baseline. Time dependent variables included continence decline, cognitive decline, increase in the number of medication, and incidences of falls, hospitalizations and fractures. The actuarial method, the log-rank test and Cox's regression were applied as statistical methods. RESULTS: The cumulative probability of functional maintenance was 78.2% (CI 95%: 72.8-82.7%), 65.1% (CI 95%: 58.9-70.5%), 53.5% (CI 95%: 47.2-59.5%) and 44.0% (CI 95%: 37.7-50.2%) at 6, 12, 18 and 24 months, respectively. Predicting factors for functional decline were: severe cognitive impairment (HR = 1.96; p = 0.001), continence decline (HR = 1.85; p = 0.002) and incidence of hospitalizations (HR = 1.62; p = 0.020), adjusted by the incidence of depression, age, education level, presence of chronic diseases and low weight. CONCLUSIONS: The cumulative probability of maintaining functional capacity in institutionalized older adults was only 44% at the 2-year follow-up. Prognostic factors for functional decline included severe cognitive impairment, continence decline and incidence of hospitalizations.

Activity Limitations in Brazilian Institutionalized Older Adults.

BACKGROUND AND PURPOSE: Although functional assessments and programs to prevent activity limitations are fundamental for efficient geriatric evaluations and interventions, these procedures have not been satisfactorily explored at nursing homes in Brazil. Literature is scarce on the evaluation of disability in Brazilian institutionalized older people. METHODS: A cross-sectional study was conducted in 10 nursing homes in the city of Natal (Northeast Brazil). Sociodemographic and health data were collected and activity limitations were assessed by the Katz Index. RESULTS AND DISCUSSION: The prevalence of activity limitations was 72.9% (95% confidence interval: 67.8-77.5) and the most affected activity was "bathing" (71.6%), followed by "dressing" (65.4%) and "toileting" (62.0%). The final model revealed associations with private (for-profit) institutions (odds ratio [OR] = 3.33; P < .001), age ≥ 83 years (OR = 2.34; P = .003), institutionalization due to lack of caregiver (OR = 1.80; P = .033), and presence of osteoporosis (OR = 2.94; P = .045), adjusted by sex. CONCLUSIONS: Activity limitations affected almost 73% of institutionalized older people in this sample and were associated with private nursing homes, age, osteoporosis, and institutionalization due to lack of caregiver. Activity limitations exact high socioeconomic impacts and affect the quality of life of older people. The results obtained herein emphasized the importance of planning strategies for their prevention and treatment, directed to reduce the prevalence of this health issue.

Dynamics of activities of daily living performance in institutionalized older adults: A two-year longitudinal study.

BACKGROUND: It is fundamental to analyze the evolution of functioning for the planning of strategies aimed at preventing or delaying dependency. However, there is a lack of studies focused on the evolution of functional performance in institutionalized older adults in Latin America. OBJECTIVE: Verify the incidence of functional decline, functional maintenance and functional improvement in the basic activities of daily living (BADL) in institutionalized older adults, as well as analyze the evolution of functional performance. METHODS: A two-year, five-wave longitudinal study is presented herein, with assessments applied every 6 months, carried out in residents of 10 nursing homes in the city of Natal-RN (Brazil). The items 'eating', 'personal hygiene', 'dressing', 'bathing', 'transferring' and 'walking' were assessed by a 5-points Likert scale. Sociodemographic, institution-related and health-related variables were considered for descriptive analyses. RESULTS: The sample consisted of 280 older adults, of which 150, 53.6% (95% CI: 47.7-59.3%) experienced decline, 94, 33.6% (95% CI: 28.3-39.3%) maintained functional performance, 40, 14.3% (95% CI: 10.7-18.9%) presented improvement at least in one assessment, and only 18 (6.4%; CI 95%: 4.1-9.9%) improved functional performance with no decline over the period. 'Eating' presented the highest decline (-0.54 points), followed by 'walking' (-0.43), 'dressing' (-0.35) and 'transferring' (-0.31). The BADL that suffered less decline were 'toileting' (-0.22), 'personal hygiene' (-0.24) and 'bathing' (-0.29). CONCLUSIONS: Half of institutionalized older adults experienced functional decline and less than 15% improved functional performance. 'Eating' suffered the most pronounced decline, followed by mobility and self-care activities.

There is chronic latent magnesium deficiency in apparently healthy university students.

INTRODUCTION: Magnesium is an essential micronutrient for human body, and its deficiency has been associated with risk of non-communicable diseases. OBJECTIVE: Assessment of magnesium status, and evaluation of the frequency of magnesium deficiency in a group of healthy adults. METHODS: Plasma and erythrocyte magnesium levels, and magnesium intake were determined in 115 students (55 women and 60 men), from a public university in Brazil. RESULTS: The medians of magnesium concentration in plasma (0.76 mmol/L), erythrocyte (1.97 mmol/L), and of dietary daily intake (8.84 mmol/d) were low. Forty two percent of participants had plasma or erythrocyte magnesium below the limit of 0.75 and 1.65 mmol/L, respectively. A high percentage showed high probability of inadequate magnesium intake. CONCLUSIONS: There was a high frequency of subclinical magnesium deficiency in the adults assessed, that could be related to low dietary magnesium intake.

INTRODUCCIÓN: El magnesio es esencial, y su deficiencia ha sido asociada a mayor riesgo de enfermedades crónicas. OBJETIVOS: Evaluar el estado de nutrición de magnesio y su ingesta en adultos sanos, y determinar la frecuencia de su deficiencia en esta población. MÉTODOS: Fueron evaluados 115 adultos estudiantes de una universidad pública en Brasil, y se determinó la ingesta dietética y los niveles de magnesio en plasma y eritrocitos. RESULTADOS: Las medianas de distribución de magnesio en plasma (0,76 mmol/L), en eritrocitos (1,97 mmol/L), y la ingesta de magnesio (8,84 mmol/d) fueron bajas. Un 42% de la muestra tuvieron concentración de magnesio en plasma o eritrocitos por debajo de los respectivos 0,75 mmol/L y 1,65 mmol/L. Un alto porcentaje de ellos exhibió probabilidad de ingesta de magnesio inadecuada. CONCLUSIONES: Se observó una alta frecuencia de deficiencia de magnesio subclínica en los adultos evaluados.

[Muscular strength training does not increase human adults' arterial stiffness or improve body toning]. / O treinamento de força muscular não aumenta a rigidez arterial em adultos humanos e melhora a composição corporal.

OBJECT: Determining the influence of three weekly strength training (ST) sessions, over a ten-week period, on arterial stiffness (AS) and taking the associated anthropometric measurements. METHODS: This was a before-and-after intervention trial, involving a sample of 17 individuals. Participants were adults from both genders aged 18 and 40 years-old who had been sedentary for at least three months previously. Anthropometric measurements were taken, together with pulse wave velocity (PWV) before and immediately after the experimental sessions. RESULTS: Independent variables (age and gender) were considered for determining their influence on final PWV and anthropometric measurements. Comparing initial PWV (mean=9.00) with final PWV (mean=9.00) for subjects involved in the proposed ST revealed no significant difference between them (p=0.469). Regarding anthropometric measurement, individuals' body fat (p<0.001) and body fat mass percentages (p<0.001) became significantly reduced, accompanied by an increase in lean mass (p<0.001). However, no changes were recorded regarding waist-to-hip ratio (WHR) (p= 0.777), body mass (p=0.226) or body mass index (BMI) (p =0.212). CONCLUSION: This study's findings suggested that the proposed ST did not increase AS. Devotees of such type of training may therefore safely enjoy all its benefits without risk to the cardiovascular system. Further controlled and randomized research is needed to confirm these results.

Papel de los staphylococcus spp. en la mucositis oral: revisión de la literatura / Rule of staphylococcus spp in oral mucusitis: review of the literature

It is estimated that more than 500 bacterial species inhabit the human oral environment. Among them, more than 400 species are known, and also a huge diversity of microorganisms that have been discovered because of the innovations in molecular biology techniques. Talking about staphylococcus spp., its presence in oral environment of health individuals and local or systemic wounded ones is at least controversial, what guides to the necessity of accurate studies in order to clarify this bacteria profile in this microenvironment ecology, as well as in oral and systemic disease etiology. This study aimed to gather the current knowledge concerning the staphylococcal presence in oral environment and its implications in oral mucositis development, in this case called "oral staphylococcal mucositis", a clinical condition that affects more commonly ancient patients, systemic weakened or immunologically wounded

Se estima que más de 500 especies bacterianas habitan el medio ambiente oral de seres humanos. Entre ellas, son conocidas más de 400 especies, además de una gran diversidad de microorganismos que han sido descubiertos gracias a innovaciones en las técnicas de biología molecular. Con relación a los staphylococcus spp., su presencia en el medio ambiente oral de individuos saludables, local o sistémicamente comprometidos es bastante controversia, lo que remite a la necesidad de estudios cuidadosos con intención de aclarar el papel de esas bacterias en la ecología de ese microambiente, así como en la etiología de enfermedades orales y sistémicas. Ese estudio propuso reunir los conocimientos actuales sobre la presencia de staphylococcus en el medio ambiente oral y sus implicaciones en el desarrollo de mucositis oral, denominada en ese caso de "mucositis estafilocócica oral", una condición clínica que afecta más comúnmente pacientes mayores, sistémicamente debilitados o inmunológicamente comprometidos

Hiposalivación y xerostomía: prevalencia y factores asociados en ancianos con enfermedades cardiovasculares / No disponible

Antecedentes: La población anciana con enfermedades cardiovasculares refiere habitualmente sensación de boca seca. Estudios recientes revelan la relación de esta condición con el uso de anti-hipertensivos. El objetivo de este estudio es determinar la prevalencia de xerostomía e hiposalivación en estos ancianos y analizar su asociación con las condiciones socioeconómicas, de salud general y bucal. Métodos: Estudio de diseño transversal, cuya muestra fue de 197 ancianos funcionalmente independientes, no institucionalizados y con enfermedades cardiovasculares. La colecta de datos fue realizada por cuestionario, examen físico y sialometría no estimulada y estimulada. Los datos fueron analizados utilizando los tests chi-cuadrado y t de Student (alfa=0,05). Resultados: La prevalencia de la xerostomía fue de 21,9%, 39,6% de la hiposalivación evaluada por la sialometría no estimulada, y 41,1% para la estimulada. Hubo asociación de la xerostomía con los años de escolarización (p=0,006), índice de masa corporal (p=0,04) y restricción del consumo de pastas (p=0,018). La hiposalivación fue asociada al número de personas por espacio habitable en la vivienda (p=0,006) y al índice de masa corporal (p=0,044). Conclusiones: La prevalencia de xerostomía e hiposalivación fue alta. La xerostomía fue asociadaa la baja escolaridad y a la restricción del consumo de pastas. Ancianos con hiposalivación reportaron convivir con un mayor número de personas por espacio habitable en su vivienda y aquellos conxerostomía/hiposalivación tuvieron mayor índice de masa corporal (AU)

Aim: The population elderly with cardiovascular disease has complained so much about dry mouth and studies show clearly the relationship between this group of people and the use of antihypertensives. This study determines the prevalence of xerostomia and hyposalivation in elderly patients with cardiovascular disease and verifies its association with socioeconomic conditions, and general and oral health. Methods: Cross-sectional study, whose sample was 197 functionally independent non institutionalized elderly subjects with cardiovascular disease. Data collection was performed using a questionnaire, physical examination and stimulated and nonstimulated sialometry. The data were analyzed using thechi-square test and the Student’s t-test (alpha=0.05). Results: The prevalence of xerostomia was 21.9%, and that of hyposalivation, assessed using non stimulatedand stimulated sialometry, was 39.6% and 41.1%, respectively. There was association of xerostomia with schooling (p = 0.006), body mass index (p = 0.04) and restriction to pasta consumption (p = 0.018). Hyposalivation was associated to domiciliary density (p = 0.006) and to body mass index (p = 0.044). Conclusions: The prevalence of xerostomia and hyposalivation was high in elderly individuals with cardiovascular diseases. Xerostomia was associated to low schooling and to restriction to pasta consumption. Elderly patients with hyposalivation had greater domiciliary density and those with xerostomia/hyposalivation had higher body mass index (AU)

Alteraciones en el metabolismo del zinc relacionadas a la edad / Alterations of zinc metabolic related to aging

Although many studies point to alterations in the organic concentrations of zinc in elderly patients, the mechanisms by which aging might cause changes in the metabolism of this nutrient remain unclear. Thus, we assessed the changes in plasma zinc, zinc binding capacity to plasma protein (ZnBCPP) and saturation index (SI), comparing elderly individus and young adults. The zinc analyses were performed by atonde absorption spectrophotometry. A statistically significant difference (p < 0.001) was found between the two groups in relation to plasma zinc and SI, but the ZnBCPP did not differ between the younger and older subjects. In agreement with this result, it was shown in the young group that 76 percent (R² = 0.760) of the ZnBCPP variations are explained by the variations in plasma zinc and SI. In the elderly group this measure decreased to 30.5 percent (R² = 0.305). We conclude, therefore, that aging may be a factor associated to changes in control mechanisms and in zinc homeostasis, and could even alter ZnBCPP response patterns and other zinc-related indicators of nutritional status.

A pesar que muchos estudios indicarían que existen alteraciones en las concentraciones orgánicas del zinc en pacientes mayores, los mecanismos por los cuales el envejecimiento podría implicar cambios en el metabolismo de esta nutriente, aún permanecen pocos claros. Buscamos evaluar los cambios relativos al zinc plasmático, a la Capacidad de Ligación del Zinc a la Proteína Plasmática (ZnBCPP) y en el índice de Saturación (SI). Los análisis de zinc fueron realizados por espectrofotometría de absorción atómica, comparando personas mayores y adultos jóvenes. Una diferencia significativa fue encontrada (p< 0,001), entre los dos grupos, en relación al zinc plasmático e SI, siendo que la ZnBCPP no cambió entre los jóvenes y adultos mayores. Constatando este resultado, se demostró que en el grupo de jóvenes las variaciones en la ZnBCPP son explicadas en 76 por ciento (R²= 0,760) por las variaciones en el zinc plasmático en el SI. En el grupo de los mayores esta medida disminuye a 30,5 por ciento (R²= 0,305). Concluimos que el envejecimiento puede ser un factor asociado a los cambios en los mecanismos de control y homeostasis del zinc, alternando los patrones de respuesta relativos a ZnBCPP y algunos otros indicadores del estado nutricional relativo al zinc.

Atividade antimicrobiana "in vitro" de compostos a base de hidróxido de cálcio e tergentol em diferentes concentrações sobre bactérias orais

PURPOSES: This research desenvolved in Rio Grande do Norte Federal University, Department of Dentistry purpose evaluation "in vitro" Ca(OH)2 and tergentol solutions action in oral cavity that first reside in and cariogenic microorganisms for dental biofilm chemical control increasing. METHODS: "In vitro" tests with antibiogram discs and biofilm formers bacteria antibiothic action from Ca(OH)2 and tergentol solutions and the 0,12% clorhexydine digluconate as "gold-standard". RESULTS: The results were analyzed using the Kruskal-Wallis test and Dunn´s multiple comparison post-test with p-value always lower than 0,05. The clorhexydine showed a better antimibrobian action in correlation with Ca(OH)2 and tergentol solutions. The statistical differences among clorhexydine and this study other solutions was not significant in a greater part of comparisons. CONCLUSIONS: The 0,12% clorhexydine digluconate was the most effective antibiotic agent in this research. Ca(OH)2 and tergentol solutions does not demonstrate satisfactory effectiveness in correlation the clorhexydine, mainly, for the Streptococcus mutans. More complete studies are necessary for CHD 20 evaluation as an oral antiseptic.

OBJETIVOS: Este estudo realizado no departamento de Odontologia da Universidade Federal do Rio Grande do Norte foi idealizado com propósito de pesquisar a ação "in vitro" de soluções a base de Ca(OH)2 e tergentol frente a bactérias colonizadoras da cavidade bucal e cariogênicas visando contribuir para o estudo sobre os agentes químicos para controle do biofilme dental. MÉTODOS: Testou-se através de discos de antibiograma e ação em bactérias formadoras de biofilme a ação antimicrobiana de algumas soluções de Ca(OH)2 e tergentol usando-se como padrão-ouro o digluconato de clorexidina a 0,12%. RESULTADOS: Os resultados foram analisados através do teste de Kruskal-Wallis e do pós-teste de comparação múltipla de Dunn com valores de p sempre menores que 0,05. A clorexidina obteve melhores resultados em nível de ação antimicrobiana em relação às soluções a base de Ca(OH)2 e tergentol. A diferença estatísta da ação da clorexidina frente às demais soluções e aos tipos bacterianos testados não foi significativa para a maiorias dos cruzamentos. CONCLUSÕES: O digluconato de clorexidina a 0,12% foi o egente antimicrobiano mais efetivo neste estudo. As soluções a base de hidróxido de cálcio não apresentaram efetividade satisfatória em relação a clorexidina, principalmente em relação ao Streptococcus mutans. São necessários estudos mais aprofundados para se determinar o real potencial do HCT 20 como anti-séptico bucal.