Detection of Staphylococcus aureus from nares of elderly living in a Brazilian nursing home.

Asymptomatically nasal colonization by Staphylococcus aureus is a well-established risk factor for S. aureus infections. The aimed of the study was to identify the prevalence and factors associated with nasal carriage of S. aureus and Methicillin-resistant S. aureus (MRSA) from individuals residing in one Brazilian nursing home (NH). Three time-separate nasal swab collections were obtained from the elderly enrolled. The S. aureus isolates identified were submitted to Antimicrobial Susceptibility test (AST). The study showed a high prevalence of S. aureus (n = 9; 60%) and MRSA (n = 4; 26.7%) among elderly. Resistance to erythromycin was the most detected. S. aureus or MRSA colonization could not be associated to the data collected on demographics, personal habits, and medical history of the participants. Despite the small number of individuals enrolled, our study can contribute to improve the control of S. aureus and MRSA dissemination within the community, especially among the most vulnerable like the elderly.

Predictors of Nursing Home Entry within 36 Months after Hospitalization via the Emergency Department among Persons Aged 75 Years or Older.

OBJECTIVE: We aimed to identify risk factors for nursing home (NH) entry 36 months after hospitalization via the emergency department (ED) in a population of patients aged 75 years or older. METHODS: This was a prospective multicentre cohort. Patients were recruited from the emergency departments (EDs) of nine hospitals. Subjects had been hospitalised in a medical ward in the same hospital as the ED to which they were initially admitted. Subjects who experienced NH entry prior to ED admission were excluded. NH entry has been defined as the incident admission either into an NH or other long-term care facility within the follow-up period. Variables from a comprehensive geriatric assessment of patients were entered into a Cox model with competing risks to predict NH entry during 3 years of follow-up. RESULTS: Among 1306 patients included in the SAFES cohort, 218 (16.7%) who were already in an NH were excluded. The remaining 1088 patients included in the analysis were aged 84 ± 6 years on average. During 3 years of follow-up, 340 (31.3%) entered an NH. The independent risk factors for NH entry were that they: living alone (Hazard ratio (HR) 2.00, had a 95% confidence interval (CI) 1.59-2.54, p < 0.0001), could not independently perform activities of daily living (HR 1.81, 95% CI 1.24-2.64, p = 0.002), and had balance disorders (HR 1.37, 95% CI 1.09-1.73, p = 0.007), dementia syndrome (HR 1.80, 95% CI 1.42-2.29, p < 0.0001) and a risk of pressure ulcers (HR 1.42, 95% CI 1.10-1.82, p = 0.006). CONCLUSION: The majority of the risk factors for NH entry within 3 years after emergency hospitalization are amenable to intervention strategies. It is therefore reasonable to imagine that targeting these features of frailty could delay or prevent NH entry and improve the quality of life of these individuals before and after NH entry.

Aplicativo multimídia para cuidados domiciliares de pacientes pós-cirúrgicos: protótipo de tecnologia cuidativo-educacional* / Aplicación multimedia para el cuidado domiciliario de pacientes posquirúrgicos: prototipo de tecnología asistencial-educativa / Multimedia application for home care of post-surgery patients: care-educational technology prototype*

Objetivo: desenvolver um protótipo de Tecnologia Cuidativo-Educacional em forma de aplicativo multimídia, voltado aos cuidados domiciliares de pacientes pós-cirúrgicos com dispositivos invasivos. Método: pesquisa metodológica, desenvolvida entre março de 2021 e abril de 2022, norteada pelo modelo ADDIE (Analize, Design, Develop, Implement e Evaluate). Realizou-se a prototipagem com auxílio do software Adobe Experience Design, sendo aplicados plugins para a animação dos ícones e a inclusão dos vídeos educacionais. Resultados: o protótipo "Home Self-Care" contém logomarca, menu principal com descrição dos dispositivos invasivos, informações sobre o procedimento, cuidados e dúvidas frequentes dos pacientes, bem como imagens e vídeos educacionais para conduzir a construção do conhecimento. Ressalta-se que futuramente o aplicativo será hospedado em loja virtual. Conclusão: o uso desta ferramenta visa a continuidade do cuidado, estimulando a autonomia e empoderamento dos usuários em domicílio. Acredita-se que a tecnologia facilitará a recuperação do paciente e reduzirá as (re)internações.

Objective: to develop a care-educational technology prototype, in the form of a multimedia application, aimed at home care of post-surgical patients with invasive devices. Method: this is methodological research, developed between March 2021 and April 2022, guided by the ADDIE model (Analyze, Design, Develop, Implement and Evaluate). Prototyping was carried out with the help of Adobe Experience Design software, applying plugins for icon animation and inclusion of educational videos. Results: the "Home Self-Care" prototype contains a logo, main menu with description of invasive devices, information about the procedure, care and frequently asked questions by patients as well as images and educational videos to guide the construction of knowledge. It should be noted that in the future the application will be hosted in a virtual store. Conclusion: using this tool aims at continuity of care, encouraging users' autonomy and empowerment at home. It is believed that the technology will facilitate patient recovery and reduce (re)admissions.

Objetivo: desarrollar un prototipo de tecnología asistencial-educativa en forma de aplicación multimedia, dirigida a la atención domiciliaria de pacientes posquirúrgicos con dispositivos invasivos. Método: investigación metodológica, desarrollada entre marzo de 2021 y abril de 2022, guiada por el modelo ADDIE (Analyze, Design, Develop, Implement y Evaluate). El prototipado se realizó con la ayuda del software Adobe Experience Design, aplicando plugins para la animación de íconos y la inclusión de videos educativos. Resultados: el prototipo "Home Self-Care" contiene un logo, un menú principal con descripción de los dispositivos invasivos, información sobre el procedimiento, cuidados y preguntas frecuentes de los pacientes, además de imágenes y videos educativos para orientar la construcción del conocimiento. Cabe señalar que en el futuro la aplicación estará alojada en una tienda virtual. Conclusión: el uso de esta herramienta tiene como objetivo la continuidad de la atención, estimulando la autonomía y el empoderamiento de los usuarios en el hogar. Se cree que la tecnología facilitará la recuperación del paciente y reducirá las (re)hospitalizaciones.

Long-term care facilities for older people and the COVID-19 pandemic: epidemiological data and preventive measures / Instituições de longa permanência para idosos e a pandemia de COVID-19: dados epidemiológicos e medidas preventiva

Objectives: The COVID-19 pandemic has challenged society, especially residents of long-term care facilities (LTCF). This study investigated rates of infection, hospitalization, and death due to COVID-19 among LTCF residents and staff in Minas Gerais, Brazil and identified strategies to control the spread of the disease.Methods: This cross-sectional study collected data from 164 LTCF (6017 older adults). The owners or managers were invited to answer an electronic questionnaire. The questionnaire included 55 items, divided into 3 sections.Results: Of the participating LTCF, 48.7%, 39.6%, and 32.3% reported COVID-19 infections, hospitalizations, and deaths, respectively, among residents, while 68.9%, 7.3%, and 1.2% reported COVID-19 infections, hospitalizations, and deaths, respectively, among staff. Preventive measures were identified and classified as organizational, infrastructural, hygiene items/personal protective equipment, and staff training.Conclusion: The strategies used in the daily routines of LTCF during the pandemic were classified. The challenges experienced in Brazilian facilities were similar to those observed worldwide. The results highlight the importance of continuity and the need to improve protective measures for LTCF residents, especially in low- and middle-income countries

Objetivos: A pandemia da COVID-19 tem sido desafiadora para a sociedade, principalmente para aqueles que residem em Instituições de Longa Permanência (ILPI). Este estudo teve como objetivo descrever as taxas de infecção, hospitalização e óbito por COVID-19 entre idosos e funcionários de ILPI de Minas Gerais/Brasil e identificar estratégias de prevenção e controle da disseminação da doença.Metodologia: Este estudo transversal foi realizado com 164 ILPI (6.017 idosos). Os gestores ou proprietários foram convidados a responder ao questionário eletrônico. O questionário incluiu 55 itens, divididos em três seções.Resultados: Entre as ILPI estudadas, 48,7% confirmaram a infecção por COVID-19 em idosos, resultando em 39,6% de internação e 32,3% de óbito entre os infectados. Além disso, 68,9% das ILPI confirmaram infecção por COVID-19 na equipe, com 7,3% de internação e 1,2% de óbito. As medidas preventivas foram identificadas e classificadas como organizacionais, infraestrutura, itens de higiene e equipamentos de proteção individual e treinamento de pessoal contra a COVID-19.Conclusão: Essas medidas revelaram estratégias e barreiras vivenciadas no cotidiano das ILPI durante a pandemia. As ILPI no Brasil passaram por desafios semelhantes aos observados mundialmente. Os resultados destacaram a importância da continuidade e melhoria das medidas de proteção para idosos em ILPI, especialmente em países de baixa e média renda

Asociación entre la condición oral y sistémica con la calidad de vida en salud bucal de adultos mayores institucionalizados en Recoleta. Estudio piloto / Association between oral and systemic condition and oral health-related quality of life of older people in Recoleta. Pilot study

Objetivo: Evaluar la asociación entre la condición oral y sistémica con la calidad de vida relacionada a salud bucal de adultos mayores institucionalizados en un hogar en Recoleta, Santiago. Material y método: En el presente estudio piloto de corte transversal, se realizó un examen intraoral y se aplicó la encuesta OHIP-7Sp a adultos mayores internados en la residencia Mi Hogar. Además, se revisaron las fichas médicas de los participantes para el registro de sus enfermedades y fármacos. Los datos fueron analizados a través del test t, test de Mann-Whitney y regresión logística considerando un valor p < a 0.05 como estadísticamente significativo. Resultados: 20 adultos mayores cumplieron los criterios de inclusión, 11 hombres y 9 mujeres, con un rango de edad entre 65 y 88 años. Se encontró asociación clínica entre la condición oral (p=0.06), salud general (p=0.2) y calidad de vida asociada a salud bucal en los adultos mayores. Conclusión: La condición oral, salud general y calidad de vida asociada a salud bucal de los adultos mayores se consideró deficiente. Se requieren estudios posteriores con una mayor muestra para lograr establecer una significancia estadística de las variables y así, proponer intervenciones para mejorar las condiciones de salud de los adultos mayores institucionalizados.

Aim: To evaluate the association between the oral and systemic condition and the oral health-related quality of life of institutionalized older people in a retirement home in Recoleta, Santiago. Material and method: In the present pilot, non-experimental, cross-sectional and descriptive study, an oral examination was performed, alongside with the OHIP-7Sp survey to the individuals that meets the inclusion criteria. In addition, the medical history of the participants was reviewed to record the diseases under treatment and the drugs in use. Results: 20 individuals met the inclusion criteria, 11 men and 9 women with ages ranging between 65 and 88 years. There was a clinical association between oral condition, general health and oral health-related quality of life related to oral health in the oelder people of thefrom the residence retirement home of in Recoleta. A statistical significance was not established. Conclusion: The oral condition, general health and quality of life related to oral health was were deficient. Subsequent studies with a larger sample are required to establish a statistically significant relationship of between the variables in order to propose different solutions.

Sarcopenic Dysphagia Is Associated With Mortality in Institutionalized Older Adults.

OBJECTIVE: To estimate mortality associated with sarcopenic dysphagia. DESIGN: A 3-year follow-up cohort. SETTING AND PARTICIPANTS: Ninety-five nursing home residents were evaluated to determine the baseline presence or absence of oropharyngeal dysphagia and followed up for 3 years. METHODS: The primary outcome was the risk of death. Dysphagia was assessed using a volume-viscosity swallow test. We used an algorithm to determine sarcopenic dysphagia based on grip strength, walking speed, calf circumference, and exclusion of neurologic or structural causes of dysphagia. We constructed 3 subgroups: without dysphagia, nonsarcopenic dysphagia, and sarcopenic dysphagia. Cox proportional regression analyses were used to predict the risk of death. RESULTS: Thirty-five percent of participants had no dysphagia, 20% nonsarcopenic dysphagia, and 45% sarcopenic dysphagia. Sarcopenic dysphagia was independently associated with a higher risk of death [hazard ratio (HR) 2.44, 95% CI 1.02-5.80, P = .043] than without dysphagia. In addition, a higher Charlson Comorbidity Index score was associated with a higher risk of death (HR 1.33, 95% CI 1.01-1.75, P = .040). CONCLUSIONS AND IMPLICATIONS: This study shows that sarcopenic dysphagia was associated with increased mortality among institutionalized older adults. These deaths could be potentially preventable.

Antibody- and T Cell-Dependent Responses Elicited by a SARS-CoV-2 Adenoviral-Based Vaccine in a Socially Vulnerable Cohort of Elderly Individuals.

BACKGROUND: In spite of compelling evidence demonstrating safety and immunogenicity of adenoviral-based SARS-CoV-2 vaccines in the general population, its effects in socially vulnerable elderly individuals are poorly understood. Here we aimed to investigate the efficacy of two doses of combined vector vaccine, the Gam-COVID-Vac (Sputnik-V vaccine), at 14, 42, and 180 days after immunization, in a nursing home for underprivileged population and homeless individuals. METHODS: A phase 3, open-label clinical trial involving administration of two adenoviral vectors (Ad26-Ad5) vaccine, in elderly individuals over the ages of 60 years was performed. SARS-CoV-2 Spike RBD-specific IgG antibodies at days 21-, 42- and 180 post-vaccination was analyzed in sera of individuals receiving two doses of the Sputnik-V vaccine with an interval of 21 days. SARS-CoV-2-specific CD8+ T cell responses, measured by intracellular tumor necrosis factor (TNF) was determined by flow cytometry following antigen-specific cultures. RESULTS: A total of 72 elderly adults with a mean age of 72.6 ± 9.5 years-old was selected after applying the inclusion criteria, all corresponding to an underprivileged population. Two-doses vaccination with Sputnik-V vaccine elicited an antibody-mediated immune response (revealed by quantitative detection of SARS-CoV-2-specific IgG antibodies, CMIA) 70% at day 21, 90% at day 42, and 66.1% at day 180. Fully vaccinated individuals had robust SARS-CoV-2-specific T cell responses, evidenced by TNF production in CD4+ and CD8+ T cells in all time periods analyzed. CONCLUSION: Six months after receipt of the second dose of the Gam-COVID-Vac vaccine, SARS-CoV-2-specific IgG levels declined substantially among the tested population, whereas CD4+ and CD8+ T-cell-mediated immunity remained at high levels. These data suggest that two doses of combined adenoviral-based vaccine elicits a considerable level of SARS-CoV-2 immune responses in elderly individuals, highlighting its safety and immunogenicity in this highly vulnerable population.

Poor physical fitness is associated with impaired memory, executive function, and depression in institutionalized older adults: a cross-sectional study

Objective: To analyze the association between physical fitness, cognitive function, and depressive symptoms among older adults in long-term care facilities (LTCFs). Methods: Seventy-six institutionalized male and female elderly individuals (65 years and older) living in LTCFs participated of this study. Physical fitness (aerobic capacity and strength), cognitive functions (global cognition, short-term and working and semantic memories, and executive function), and depressive symptoms were assessed. Linear regression and contingency analyses were performed. Significance was accepted at p-values ≤ 0.05. Results: Aerobic capacity predicted 32% of variance in global cognition (p < 0.01) and 25% of variance in semantic fluency/executive function (p < 0.01). Low levels of upper limb strength, lower limb strength, and aerobic capacity were associated with semantic fluency/executive function (OR = 1.38, p = 0.01, OR = 1.26, p = 0.03, and OR = 1.07, p = 0.01, respectively) and depressive symptoms (OR = 1.06, p < 0.01). Conclusion: Poor physical fitness is associated with cognition and depressive symptoms in institutionalized older adults. Low levels of strength and aerobic fitness increase the odds of presenting with impaired semantic fluency and executive function, possibly denoting an increased risk of developing dementia.

Unplanned vs. planned peritoneal dialysis as initial therapy for dialysis patients in chronic kidney replacement therapy.

AIM: To compare infectious and mechanical complications, technique failure and mortality of a planned PD vs. an unplanned PD program. DESIGN: It was a prospective observational study that included chronic kidney disease (CKD) patients who started PD according to medical recommendation: group1-planned and group 2-unplanned PD. METHODS: This study evaluated patients who started planned and unplanned PD programs in a teaching hospital from July 2014 to December 2017. RESULTS: A total of 58 patients were included in the planned PD group and 113 in the unplanned PD group. There was difference between the two groups in leak and hospital admissions, that were more frequent in the unplanned PD group. Periods free from exite site infection, peritonitis and mechanical complications were longer in the planned group. Cox regression analysis identified age and the lowest albumin value as factors associated with mechanical complications; peritonitis indicated the presence of ESI and mechanical complications; the change to HD was associated with a younger age, mechanical complications, diabetes mellitus (DM) and peritonitis. The factors associated with death were age and lower values of albumin. After 48 months, the growth of the PD program was 252%. CONCLUSION: The technique survival and patient mortality in unplanned PD was similar to planned PD, while the period marked by the absence of complications related to PD was longer in the planned PD group. In the Cox regression, unplanned PD was not identified as risk factor for death, transition to HD or complications related to therapy, while age and lower albumin values were predictors of negative outcomes. IMPACT: Unplanned PD is not risk factor for death and complications related to PD and can be an option to unplanned HD.

Resistência microbiana a medicamentos em uma Instituição de Longa Permanência para Idosos / Resistencia microbiana a medicamentos en una institución de larga estadía para adultos mayores / Microbial drug resistance in a Nursing Home

Resumo Objetivo Caracterizar os microrganismos e sua suscetibilidade antimicrobiana em uroculturas de idosos residentes de uma instituição de longa permanência. Métodos Estudo observacional transversal com 116 indivíduos de uma Instituição de Longa Permanência para Idosos de um município do sul da Bahia. O estudo foi aprovado por Comitê de Ética em Pesquisa e utilizou-se Termo de Consentimento Livre e Esclarecido. Foram realizadas coleta e análise laboratorial de urina tipo I e urocultura. Realizaram-se testes de sensibilidade a antimicrobianos conforme os critérios do European Committee on Antimicrobial Susceptibility Testing. Para o diagnóstico de infecção do trato urinário, foram utilizados os critérios de McGeer. A análise de dados se deu por estatística descritiva, com frequências absolutas e relativas. Resultados A prevalência de infecção do trato urinário foi de 33,62%, com predominância no sexo feminino e idade acima de 80 anos. Os uropatógenos foram: 69,2% Escherichia coli, 20,6% Klebsiella pneumoniae e 5,1% Providencia stuartii e Acinetobacter baumannii. As cepas de E. coli apresentaram suscetibilidade para a maior parte dos antimicrobianos; já nas de K. pneumoniae, a suscetibilidade foi variável. P. stuartii e A. baumannii não apresentaram resistência a carbapenêmicos e aos betalactâmicos aztreonam e piperacilina associados a tazobactam. Conclusão As cepas mais prevalentes e o perfil de suscetibilidade seguiram padrão próximo ao hospitalar, o que implica a necessidade de a instituição promover melhores estratégias de controle de infecção e envolver a equipe de enfermagem no gerenciamento dos casos e na qualificação da prescrição antimicrobiana, para reduzir a resistência bacteriana e efeitos adversos nos idosos.

Resumen Objetivo Caracterizar los microorganismos y su susceptibilidad antimicrobiana en urocultivos de adultos mayores residentes en una institución de larga estadía. Métodos Estudio observacional transversal con 116 individuos de una institución de larga estadía para adultos mayores de un municipio del sur del estado de Bahia. El estudio fue aprobado por el Comité de Ética de Investigación y se utilizó Consentimiento Informado. Se obtuvieron muestras de orina, con las cuales se realizó análisis de laboratorio tipo I y urocultivo. Se realizaron pruebas de sensibilidad a antimicrobianos según los criterios del European Committee on Antimicrobial Susceptibility Testing. Para el diagnóstico de infección del tracto urinario, se utilizaron los criterios de McGeer. El análisis de datos se obtuvo mediante estadística descriptiva, con frecuencias absolutas y relativas. Resultados La prevalencia de infección del tracto urinario fue del 33,62 %, con predominancia del sexo femenino y edad superior a 80 años. Los uropatógenos fueron: 69,2 % Escherichia coli, 20,6 % Klebsiella pneumoniae y 5,1 % Providencia stuartii y Acinetobacter baumannii. Las cepas de E. coli presentaron susceptibilidad en la mayor parte de los antimicrobianos, en las de K. pneumoniae, la susceptibilidad fue variable. P. stuartii y A. baumannii no presentaron resistencia a carbapenémicos ni a los betalactámicos aztreonam y piperacilina asociados a tazobactam. Conclusión Las cepas más prevalentes y el perfil de susceptibilidad presentaron un patrón parecido al hospitalario, lo que implica la necesidad de que la institución promueva mejores estrategias de control de infecciones e involucre al equipo de enfermería en la gestión de los casos y en la cualificación de la prescripción antimicrobiana para reducir la resistencia bacteriana y los efectos adversos en los adultos mayores.

Resumo Objetivo Caracterizar os microrganismos e sua suscetibilidade antimicrobiana em uroculturas de idosos residentes de uma instituição de longa permanência. Métodos Estudo observacional transversal com 116 indivíduos de uma Instituição de Longa Permanência para Idosos de um município do sul da Bahia. O estudo foi aprovado por Comitê de Ética em Pesquisa e utilizou-se Termo de Consentimento Livre e Esclarecido. Foram realizadas coleta e análise laboratorial de urina tipo I e urocultura. Realizaram-se testes de sensibilidade a antimicrobianos conforme os critérios do European Committee on Antimicrobial Susceptibility Testing. Para o diagnóstico de infecção do trato urinário, foram utilizados os critérios de McGeer. A análise de dados se deu por estatística descritiva, com frequências absolutas e relativas. Resultados A prevalência de infecção do trato urinário foi de 33,62%, com predominância no sexo feminino e idade acima de 80 anos. Os uropatógenos foram: 69,2% Escherichia coli, 20,6% Klebsiella pneumoniae e 5,1% Providencia stuartii e Acinetobacter baumannii. As cepas de E. coli apresentaram suscetibilidade para a maior parte dos antimicrobianos; já nas de K. pneumoniae, a suscetibilidade foi variável. P. stuartii e A. baumannii não apresentaram resistência a carbapenêmicos e aos betalactâmicos aztreonam e piperacilina associados a tazobactam. Conclusão As cepas mais prevalentes e o perfil de suscetibilidade seguiram padrão próximo ao hospitalar, o que implica a necessidade de a instituição promover melhores estratégias de controle de infecção e envolver a equipe de enfermagem no gerenciamento dos casos e na qualificação da prescrição antimicrobiana, para reduzir a resistência bacteriana e efeitos adversos nos idosos.

Sarcopenic dysphagia in institutionalised older adults.

INTRODUCTION: Sarcopenic dysphagia, defined as dysphagia caused by sarcopenia, is a swallowing disorder of great interest to the medical community. The objective of our study was to evaluate the prevalence and factors associated with sarcopenic dysphagia in institutionalised older adults. MATERIAL AND METHODS: An observational, analytical, cross-sectional study was conducted in a nursing home between September and December 2017, with 100 participants. The presence of dysphagia was assessed using the volume-viscosity clinical examination method, and the diagnostic algorithm for sarcopenic dysphagia was followed. The participants' grip strength, gait speed, calf circumference, nutritional assessment (Mini Nutritional Assessment), Barthel Index, cognitive assessment (Mini-Mental State Examination) and Charlson Comorbidity Index were evaluated. Bivariate and multivariate logistic regression analyses were performed. RESULTS: The median age was 84 years, and 55% were women; 48% had functional dependence, 49% had positive screening for malnutrition and 64% had some degree of dysphagia. The prevalence of sarcopenic dysphagia was 45%, and the main factors related to less sarcopenic dysphagia were a good nutritional status (OR 0.85, 95% CI, 0.72-0.99) and a better functional performance status (OR 0.98, 95% CI 0.97-0.98). CONCLUSION: Sarcopenic dysphagia has a high prevalence in institutionalised older adults; and functional dependence and poor nutritional status were associated with sarcopenic dysphagia.

Cuidados domiciliares de parteiras tradicionais na assistência ao parto / Home care by traditional midwives in childbirth care / Cuidados domiciliarios de parteras tradicionales en la atención del parto

Objetivo: descrever os cuidados domiciliares prestados por parteiras tradicionais durante a assistência ao parto. Método: estudo qualitativo conduzido por meio do método da História Oral Temática, realizado com 16 parteiras em nove municípios do Cariri cearense. A coleta de dados ocorreu entre julho e dezembro de 2015 por meio de entrevista semiestruturada, os relatos foram transcritos, textualizados e transcriados. Resultados: as parteiras prestavam cuidados familiares, assistência ao parto vaginal, cuidados com o recém-nascido e no puerpério imediato. Usavam chás e orações como adjuvantes do seu ofício. Conclusão: o cuidado das parteiras na assistência ao parto centralizava-se nas necessidades da mulher e da família, sendo, em alguns casos, extensivo à casa. As parteiras conheciam os sinais e sintomas do trabalho de parto e agiam nas possíveis intercorrências.

Objective: to describe home care provided by traditional midwives during childbirth care. Method: this qualitative study, using the Thematic Oral History method, was conducted with 16 midwives from nine municipalities in Cariri, Ceará. Data were collected from July to December 2015 through semi-structured interviews, the reports were transcribed, textualized and transcreated. Results: midwives provided family care, vaginal delivery care, newborn care and immediate postpartum care. They used teas and prayers as an adjuncts to their craft. Conclusion: childbirth care by midwives centered on the women's and families' needs and, in some cases, extended to the home. Midwives knew the signs and symptoms of labor and acted on possible complications.

Objetivo: describir los cuidados domiciliarios brindados por parteras tradicionales durante la atención al parto. Método: estudio cualitativo conducido mediante el método de Historia Oral Temática, realizado con 16 parteras en nueve municipios de Cariri en Ceará. La recolección de datos se realizó entre julio y diciembre de 2015 a través de entrevistas semiestructuradas; los relatos fueron transcritos, textualizados y transcreados. Resultados: las parteras brindaron atención familiar, asistencia en el parto vaginal, cuidados al recién nacido y en el puerperio inmediato. Usaban tés y oraciones como complemento de su oficio. Conclusión: el cuidado de las parteras en la atención al parto se centraba en las necesidades de la mujer y de la familia, extendiéndose, en algunos casos, al hogar. Las parteras conocían los signos y síntomas del trabajo de parto y actuaban sobre las posibles complicaciones.

Sarcopenic dysphagia in institutionalised older adults. / Disfagia sarcopénica en adultos mayores institucionalizados.

INTRODUCTION: Sarcopenic dysphagia, defined as dysphagia caused by sarcopenia, is a swallowing disorder of great interest to the medical community. The objective of our study was to evaluate the prevalence and factors associated with sarcopenic dysphagia in institutionalised older adults. MATERIAL AND METHODS: An observational, analytical, cross-sectional study was conducted in a nursing home between September and December 2017, with 100 participants. The presence of dysphagia was assessed using the volume-viscosity clinical examination method, and the diagnostic algorithm for sarcopenic dysphagia was followed. The participants' grip strength, gait speed, calf circumference, nutritional assessment (Mini Nutritional Assessment), Barthel Index, cognitive assessment (Mini-Mental State Examination) and Charlson Comorbidity Index were evaluated. Bivariate and multivariate logistic regression analyses were performed. RESULTS: The median age was 84 years, and 55% were women; 48% had functional dependence, 49% had positive screening for malnutrition and 64% had some degree of dysphagia. The prevalence of sarcopenic dysphagia was 45%, and the main factors related to less sarcopenic dysphagia were a good nutritional status (OR 0.85, 95% CI, 0.72-0.99) and a better functional performance status (OR 0.98, 95% CI 0.97-0.98). CONCLUSION: Sarcopenic dysphagia has a high prevalence in institutionalised older adults; and functional dependence and poor nutritional status were associated with sarcopenic dysphagia.

The Impact of COVID-19 on Social Isolation in Long-term Care Homes: Perspectives of Policies and Strategies from Six Countries.

Preventing the spread of COVID-19 in long-term care homes is critical for the health of residents who live in these institutions. As a result, broad policies restricting visits to these facilities were put in place internationally. While well meaning, these policies have exacerbated the ongoing social isolation crisis present in long-term care homes prior to the COVID-19 pandemic. This perspective highlights the dominant COVID-19 LTC policies from six countries, and proposes five strategies to address or mitigate social isolation during the COVID-19 pandemic that can also be applied in a post-pandemic world.

Exploring the Psychometric Properties of the Questionnaire on Family Members Adapting to an Older Adult's Admission to a Nursing Home (CAFIAR-15) in a Colombian Sample.

Institutionalization to a nursing home can be one of the most significant and traumatic events in a senior's life, and for their family. For this reason, it is especially important to have validated instruments that evaluate the family member's adaptation to admitting the senior to a nursing home. The study included 139 family members recruited equally in two types of institutions (low-income nursing home (LINH) vs. high-income nursing home (HINH)). A sociodemographic questionnaire with questions to study antecedents and conditions for care and the Questionnaire for Admitting an Older Adult to a Nursing Home (CAFIAR-15) were used. Examining the communalities indicated that four of the five items in factor 3 presented communalities lower than 0.30 and differences in the factorial structure of the CAFIAR-15 were found. There were differences in the antecedents and conditions for care between the relatives of the older adults at LINH and HINH. Cultural differences and differences between LINH and HINH may be the basis for flaws in the conceptual validity of the CAFIAR-15 in the Colombian sample.

Characteristics Associated with Feeding Tube Placement: Retrospective Cohort Study of Texas Nursing Home Residents with Advanced Dementia.

OBJECTIVES: To investigate resident-level, provider-type, nursing home (NH), and regional factors associated with feeding tube (FT) placement in advanced dementia. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: NH residents in Texas with dementia diagnosis and severe cognitive impairment (N = 20,582). METHODS: This study used 2011-2016 Texas Medicare data to identify NH residents with a stay of at least 120 days who had a diagnosis of dementia on Long Term Care Minimum Data Set (MDS) evaluation and severe cognitive impairment on clinical score. Multivariable repeated measures analyses were conducted to identify associations between FT placement and resident-level, provider-type, NH, and regional factors. RESULTS: The prevalence of FT placement in advanced dementia in Texas between 2011 and 2016 ranged from 12.5% to 16.1% with a nonlinear trend. At the resident level, the prevalence of FT decreased with age [age > 85 years, prevalence ratio (PR) 0.60, 95% confidence interval (CI) 0.52-0.69] and increased among residents who are black (2.74, 95% CI 2.48-3.03) or Hispanic (PR 1.91, 95% CI 1.71-2.13). Residents cared for by a nurse practitioner or physician assistant were less likely to have an FT (PR 0.90, 95% CI 0.85-0.96). No facility characteristics were associated with prevalence of FT placement in advanced dementia. There were regional differences in FT placement with the highest use areas on the Texas-Mexico border and in South and East Texas (Harlingen border area, PR 4.26, 95% CI 3.69-4.86; San Antonio border area, PR 3.93, 95% CI 3.04-4.93; Houston, PR 2.17, 95% CI 1.87-2.50), and in metro areas (PR 1.36, 95% CI 1.22-1.50). CONCLUSIONS AND IMPLICATIONS: Regional, race, and ethnic variations in prevalence of FT use among NH residents suggest opportunities for clinicians and policy makers to improve the quality of end-of-life care by especially considering other palliative care measures for minorities living in border towns.

Experiences of geriatric nurses in nursing home settings across four countries in the face of the COVID-19 pandemic.

AIM: To explore the emotional impact and experiences of geriatric nurses working in nursing homes and caring for patients with coronavirus 2019 disease (COVID-19). DESIGN: This is a qualitative study with phenomenological method and data were gathered through in-depth interview. METHODS: The experiences and expectations that nurses are facing during their care duties were explored via video conference, using a semi-structured interview guide. We have followed the Consolidated criteria for reporting qualitative research COREQ. RESULTS: Interviews (N=24) were conducted with nurses from four countries (Spain, Italy, Peru, and Mexico) during April 2020. Three main categories were extracted: fear of the pandemic situation, the sense of duty and professional commitment, and emotional exhaustion. CONCLUSIONS: Regardless of the country and situation, in the face of the pandemic, dramatic situations have been experienced in nursing homes worldwide, with nursing staff feeling exhausted and overwhelmed, and reflection is urged on a global level to consider the most appropriate model of care in nursing homes.

Prediction of Death with the FRAIL-NH in Institutionalized Older Adults: A Longitudinal Study from a Middle-Income Country.

BACKGROUND/OBJECTIVES: Frailty is common in nursing homes. However, few studies reported longitudinal validation for death prediction or cut-off scores with the FRAIL-NH, which is designed to be used in nursing homes. Moreover, no studies came from Latin America, where frailty is highly prevalent. Our objectives were to evaluate (1) the prevalence of frailty according to the FRAIL-NH scale, and (2) its association to and the best cut-off score for predicting death after 12 months. DESIGN: longitudinal study with 12-month follow-up. SETTING: 6 nursing homes in southwest of Brazil. PARTICIPANTS: 293 residents with 60 years old or more. METHODS: Frailty was evaluated through the FRAIL-NH scale. Logistic regression was used to estimate the associated between frailty and mortality adjusted for age and sex. ROC curve was used to evaluate the accuracy of the scale for mortality prediction. RESULTS: Frailty was prevalent (47.4%) and was associated with death (odds ratio=1.31, 95% confidence interval [CI]=1.18-1.48, p<0.001). The area under the curve was 0.741 (95%CI=0.68-0.79). The sensitivity and specificity of the FRAIL-NH scale according to the best value of the Youden Index was 72.9% and 66.5%, respectively, for a cut-off > 8 points. CONCLUSIONS: Frailty is prevalent in nursing homes according to the FRAIL-NH and it was associated with one-year prediction of death for a cut-off > 8 points.

Prevalence of Prefrailty and Frailty in South America: A Systematic Review of Observational Studies.

OBJECTIVES: The present study aimed at investigating the prevalence of prefrailty and frailty in South American older adults according to the setting and region. DESIGN: A literature search combining the terms "frailty", "South America" or a specific country name was performed on PubMed, EMBASE, Lilacs, and Scielo to retrieve articles published in English, Portuguese or Spanish on or before August 2019. PARTICIPANTS: Older adults aged 60+ years from any setting classified as frail according to a validated scale were included in the study. MEASUREMENTS: Frailty assessment by a validated scale. RESULTS: One-hundred eighteen reports (98 performed from Brazil, seven from Chile, five from Peru, four from Colombia, two from Ecuador, one from Argentina, and one from Venezuela) were included in the study. The mean prevalence of prefrailty in South America was 46.8% (50.7% in older in-patients, 47.6% in the community, and 29.8% in nursing-home residents). The mean prevalence of frailty in South America was 21.7% (55.8% in nursing-home residents, 39.1% in hospitalized older adults, and 23.0% in the community). CONCLUSIONS: Prefrailty and frailty are highly prevalent in South American older adults, with rates higher than those reported in Europe and Asia. In the community, almost one-in-two is prefrail and one-in-five is frail, while hospitalized persons and nursing-home residents are more frequently affected. These findings indicate the need for immediate attention to avoid frailty progression toward negative health outcomes. Our findings also highlight the need for specific guidelines for the management of frailty in South America.

Prevalence of Malnutrition and Depression in Older Adults Living in Nursing Homes in Mexico City.

This study evaluated the association between nutritional status, depressive symptoms, and the number of prescription drugs taken by older adults living in nursing homes in Mexico City. In a cross-sectional study, 262 participants were subjected to anthropometric and nutritional (Mini Nutritional Assessment (MNA)) evaluations; additionally, their depression (Geriatric Depression Scale (GDS)) and functional status were assessed. Multiple logistic regression was used for identifying factors associated with the risk of malnutrition/malnourishment. The mean age of participants was 83.1 ± 8.6 years. A total of 59.9% and 21.1% were at risk of malnutrition and malnourished, respectively. With respect to depression, 27.9% of the participants had mild depression, while 11.4% showed severe depression. An inverse correlation between MNA evaluations and depression scores was found (Spearman's ρ = -0.4624, p < 0.001); residents with a better nutritional status had lower depression scores. Individuals with depressive symptoms were approximately five times more likely to be at risk of malnutrition or malnourished (OR = 5.82, 95% CI = 2.27-14.89) than individuals without depression. Residents taking three or more prescription drugs daily (OR = 1.83, 95% CI = 1.27-2.63, p < 0.001) were more likely to be at risk of malnutrition or malnourished. In summary, poor nutritional status was associated with depression, while the intake of numerous prescription drugs was associated with being at risk of malnutrition or malnourished.