Transforming the invisible into the visible: disparities in the access to health in LGBT+ older people.

OBJECTIVES: To compare variables of access to healthcare between the LGBT+ population aged 50 and over and those non-LGBT+. METHODS: A cross-sectional study was carried out in Brazil through a confidential online questionnaire. The use of the health system was characterized by the number of preventive tests performed and measured by the PCATool-Brasil scale (a 10-point scale in which higher scores were associated with better assistance in healthcare). The association between being LGBT+ and access to health was analyzed in Poisson regression models. RESULTS: 6693 participants (1332 LGBT+ and 5361 non-LGBT+) with a median age of 60 years were included. In the univariate analysis, it was observed not only lower scores on the PCATool scale (5.13 against 5.82, p < 0.001), but a greater proportion of individuals among those classified with the worst quintile of access to healthcare (< 4 points), 31% against 18% (p < 0.001). Being LGBT+ was an independent factor associated with worse access to health (PR = 2.5, 95% CI 2.04‒3.06). The rate of screening cancer, for breast, colon, and cervical cancer was also found to be lower in the LGBT+ population. CONCLUSION: Healthcare access and health service experiences were worse in the LGBT+ group than in their non-LGBT peers. Inclusive and effective healthcare public policies are essential to promote healthy aging for all.

Transforming the invisible into the visible: disparities in the access to health in LGBT+ older people

Abstract Objectives: To compare variables of access to healthcare between the LGBT+ population aged 50 and over and those non-LGBT+. Methods: A cross-sectional study was carried out in Brazil through a confidential online questionnaire. The use of the health system was characterized by the number of preventive tests performed and measured by the PCATool-Brasil scale (a 10-point scale in which higher scores were associated with better assistance in healthcare). The association between being LGBT+ and access to health was analyzed in Poisson regression models. Results: 6693 participants (1332 LGBT+ and 5361 non-LGBT+) with a median age of 60 years were included. In the univariate analysis, it was observed not only lower scores on the PCATool scale (5.13 against 5.82, p < 0.001), but a greater proportion of individuals among those classified with the worst quintile of access to healthcare (< 4 points), 31% against 18% (p < 0.001). Being LGBT+ was an independent factor associated with worse access to health (PR = 2.5, 95% CI 2.04‒3.06). The rate of screening cancer, for breast, colon, and cervical cancer was also found to be lower in the LGBT+ population. Conclusion: Healthcare access and health service experiences were worse in the LGBT+ group than in their non-LGBT peers. Inclusive and effective healthcare public policies are essential to promote healthy aging for all.

Palliative care over the rainbow: perspectives of middleage and older LGBT+ adults regarding their end-of-life / Cuidados paliativos além do arco-íris: perspectivas de pessoas idosas LGBT+ relacionadas com o final de suas vidas

Objective: Reports show that LGBT+ people may face several struggles during their endof-life (EOF) preparations, reporting higher rates, for example, of harassment and fear of feeling pain during these moments. We thus aimed to investigate variables related to EOF preparations among LGBT+ people and compare them with heterosexual cisgender individuals. Methods: This is a cross-sectional study in which Brazilians aged 50 or older were invited to answer an anonymous online survey between August 2019 and January 2020. The survey was widely distributed in neighbourhood associations, nongovernmental organizations, and social media. Those who identified as homosexual, bisexual, pansexual, non-heterosexual, transgender, travesti, or non-binary were grouped as LGBT+; cisgender and heterosexual participants were grouped as non-LGBT+. Results: The questionnaire was answered by 6693 participants with a median age of 60 years. Out of all respondents, 1332 were LGBT+ (19.90%) and 5361 were non-LGBT+ (80.10%). Compared to their non-LGBT+ peers, LGBT+ people reported higher rates of loneliness (25.30% vs 16.32%, p < 0.001), fear of dying alone (15.69% vs 9.79%, p < 0.001) or in pain (35.21% vs 25.74%, p < 0.001), and less social support (19.44% vs 13.48%, p < 0.001). Conclusions: Being LGBT+ was associated with challenges and inequalities regarding EOF preparations and discussions. Sexuality and diversity should be addressed in palliative training programs to address the needs of the LGBT+ population and to provide them with a dignified death

Objetivos: Estudos observacionais mostram que pessoas LGBT+ enfrentam diversas barreiras e desafios em suas preparações de fim de vida, como, por exemplo, taxas maiores de discriminação e medo de sentir dor nesses momentos. Dessa forma, nosso objetivo foi investigar variáveis relacionadas às preparações de fim de vida entre pessoas LGBT+ e compará-las com as de indivíduos não LGBT+. Metodologia: Este foi um estudo de corte transversal, no qual brasileiros com 50 anos ou mais foram convidados a responder a um questionário online anônimo entre agosto de 2019 e janeiro de 2020. O link para respostas foi distribuído amplamente em associações, organizações não governamentais e mídias sociais. Aqueles que se identificassem como homossexuais, bissexuais, pansexuais, não heterossexuais, transgênero, travestis ou com gênero não binário foram agrupados no grupo LGBT+; pessoas cisgênero e heterossexuais constituíram o grupo não LGBT+. Resultados: O questionário foi respondido por 6693 participantes, com mediana de idade de 60 anos. Entre eles, 1332 eram LGBT+ (19,90%) e 5361 não LGBT+ (80,10%). Comparadas com seus contemporâneos não LGBT+, as pessoas LGBT+ referiram maiores taxas de solidão (25,30% vs. 16,32%, p < 0,001), medo de morrer sozinhas (15,69% vs. 9,79%, p < 0,001) ou com dor (35,21% vs. 25,74%, p < 0,001) e menor suporte social (19,44% vs. 13,48%, p < 0,001). Conclusões: Ser LGBT+ esteve associado com iniquidades e desafios relacionados às preparações e discussões de fim de vida. Sexualidade e diversidade devem ser abordadas em programas de formação em cuidados paliativos para se acessarem as necessidades e particularidades da população LGBT+ e, dessa forma, ser proporcionada uma morte com dignidade a todos.

Estimulação cognitiva em idosos com demência: qual o impacto na saúde de seus cuidadores? / Cognitive stimulation in older adults with dementia: what is the impact on their caregivers' health?

OBJETIVOS: Identificar e avaliar o efeito das intervenções de estimulação cognitiva (EC) em idosos com demências na saúde dos cuidadores. MÉTODO: Revisão sistemática da literatura conduzida de acordo com as diretrizes do Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA). A busca foi realizada em maio de 2018, por dois pesquisadores independentes, nas bases de dados Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Escala da Base de Dados de Evidência em Fisioterapia (PEDro), PsycINFO e PubMed. Os descritores utilizados foram "dementia" AND "cognitive stimulation" e seus equivalentes em português e espanhol. Foram incluídos apenas artigos experimentais, publicados entre janeiro de 2007 e abril de 2018, que realizaram EC em idosos com demência, conduzida por profissional ou pelo próprio cuidador e cujo desfecho incidisse no cuidador. A qualidade dos estudos selecionados foi avaliada pela Escala PEDro. RESULTADOS: A amostra foi composta de 10 estudos, sendo que apenas dois verificaram benefícios da EC sobre a saúde do cuidador do idoso com demência. CONCLUSÃO: Este estudo não encontrou evidências consistentes sobre os reais benefícios da realização de EC no idoso com demência para a vida do seu cuidador.

OBJECTIVES: To identify and evaluate the effect of cognitive stimulation (CS) interventions for older adults with dementia on caregivers' health. METHOD: This systematic literature review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA) guidelines. A search was performed by two independent researchers in May 2018, using Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Science Literature Database (LILACS), Physiotherapy Evidence Database (PEDro), PsycINFO, and PubMed databases. The terms used were "dementia" AND "cognitive stimulation" and their equivalents in Portuguese and Spanish. For inclusion, articles should have been experimental, published from January 2007 to April 2018, with CS delivered to older adults with dementia by a professional or by a caregiver, and outcome measured in the caregiver. Quality of selected studies was assessed using the PEDro scale. RESULTS: The sample consisted of 10 studies, and only two reported CS benefits to the health of caregivers of older adults with dementia. CONCLUSION: This study found no consistent evidence of actual benefits of CS in older adults with dementia to their caregivers' health.

Abordagem das particularidades da velhice de lésbicas, gays, bissexuais e transgêneros / An approach to the peculiarities of lesbian, gay, bisexual, and transgender aging

A invisibilidade do envelhecimento de lésbicas, gays, bissexuais e pessoas transgêneras (LGBT) é uma realidade. Sofrem com os etarismos da sociedade, por diversas formas de discriminação e pela presunção de que todos são heterossexuais e cisgêneros. Ademais, eles expressam maiores riscos de estarem morando sozinhos, de não terem filhos e de não apresentarem alguém para chamar em caso de uma emergência. Poucos são os estudos que abordam esse tema, principalmente na literatura médica brasileira. Além disso, o geriatra e o gerontólogo podem se deparar com situações desafiadoras em suas práticas ao cuidarem de uma pessoa idosa LGBT saudável, com demência ou até mesmo em fase final de vida. Assim, este artigo de revisão bibliográfica teve como objetivos: abordar o envelhecimento dessa população, reforçar as definições apropriadas e discutir sobre as discriminações que sofrem nos serviços de saúde, sobre as medidas para a promoção de sua saúde e sobre as especificidades no cuidado da pessoa idosa LGBT com demência, em fase final de vida ou residente de uma instituição de longa permanência

The invisibility of lesbian, gay, bisexual, and transgender people (LGBT) aging is a reality. These individuals suffer from ageism, from various forms of discrimination, and from the assumption that all are heterosexual and cisgender. They are also at higher risk of living alone, being childless, and having no one to call in an emergency. Few studies have addressed the subject, especially in the Brazilian medical literature. Additionally, geriatricians and gerontologists may encounter challenging situations when caring for LGBT older adults who are healthy, or have dementia, or are even at the end of life. Thus, this review article aimed to investigate the aging process of the LGBT population; to reinforce appropriate terminology; and to discuss the discrimination that they face in health care services, measures for health promotion, and the specific care of the LGBT older person with dementia, at the end of life, or living in a long-term care facility

Predictors of Enteral Tube Feeding in Hospitalized Older Adults.

BACKGROUND: Despite general recognition that enteral tube feeding (ETF) is frequently employed in long-term care facilities and patients with dementia, remarkably little research has determined which factors are associated with its use in acutely ill older adults. In this study, we aimed to investigate determinants of ETF introduction in hospitalized older adults. METHODS: We examined a retrospective cohort of acutely ill patients, aged 60 years and older, admitted to a university hospital's geriatric ward from 2014-2015, in São Paulo, Brazil. The main outcome was the introduction of ETF during hospitalization. Predictors of interest included age, sex, referring unit, comorbidity burden, functional status, malnutrition, depression, dementia severity, and delirium. Multivariate analysis was performed using backward stepwise logistic regression. RESULTS: A total of 214 cases were included. Mean age was 81 years, and 63% were women. Malnutrition was detected in 47% of the cases, dementia in 46%, and delirium in 36%. ETF was initiated in 44 (21%) admissions. Independent predictors of ETF were delirium (odds ratio [OR], 4.83; 95% CI, 2.12-11.01; P < .001) and total functional dependency (OR, 8.95; 95% CI, 2.87-27.88; P < .001). Malnutrition was not independently associated with ETF. CONCLUSION: One in five acutely ill older adults used ETF while hospitalized. Delirium and functional dependency were independent predictors of its introduction. Risks and benefits of enteral nutrition in this particular context need to be further explored.

Use of noninvasive markers to predict advanced fibrosis/cirrhosis in severe obesity.

BACKGROUND: Nonalcoholic steatohepatitis is observed in 25%-55% of patients with severe obesity and in 2%-12% with bridging fibrosis or cirrhosis. There is currently no noninvasive test for the diagnosis of severe liver fibrosis before bariatric surgery. OBJECTIVES: To determine the best noninvasive test for predicting advanced liver disease in patients with severe obesity. SETTING: University tertiary care hospital, Brazil. METHODS: A cross-sectional retrospective study was conducted with 699 patients with severe obesity undergoing bariatric surgery: 568 without a biopsy (nonbiopsy cohort) and 131 patients who had undergone an intraoperative liver biopsy. The tissues were subjected to histologic diagnosis (Brunt criteria) and classified as advanced fibrosis (stages 3 and 4) or no significant fibrosis (absence of nonalcoholic steatohepatitis and stages 1 or 2). The following predictive indices of cirrhosis were calculated in all patients: aspartate aminotransferase/alanine aminotransferase ratio (AAR), age-platelet (AP) index, aminotransferase-to-platelet ratio index (APRI), cirrhosis discriminant score (CDS), and hepatitis C antiviral long-term treatment against cirrhosis (HALT-C). The cutoff values, sensitivity, specificity, and areas under the receiver operating characteristic curves (AUROCs) were calculated for patients with biopsies. RESULTS: The AUROC of the AAR, AP, APRI, CDS, and HALT-C model for predicting advanced fibrosis or cirrhosis were, respectively, .522, .88, .99, .905, and .921. The calculated cutoff values, sensitivity, and specificity, respectively, were as follows: AAR: .94, .7, .45; AP 5, .7, .93; APRI .44, 1.0, .97; CDS 6, .7, .97; and HALT-C: .76, 1.0, .77. CONCLUSION: APRI index was the best predictor of advanced liver disease in patients with severe obesity.

Cardiac angiosarcoma: an unexpected diagnosis.

Cardiac angiosarcoma is a rare entity. The incidence through autopsy findings ranges between 0.001% and 0.03%. The disease usually presents with non-specific symptoms, although asymptomatic cases are frequent; therefore, diagnosis is unexpected and consequently delayed. The authors report the case of a middle-aged man with a recent onset cough and dyspnea. He sought medical care several times without receiving a definite diagnosis until a plain chest radiography was taken showing a mediastinal enlargement, which was the reason why he was hospitalized for clinical investigation. During the diagnostic workup, an echodopplercardiogram and a thoracic computed tomography were performed, showing a heterogeneous soft-tissue mass infiltrating the pericardium and the anterior atrial wall. Multiple and scattered pulmonary nodules were also present. A pulmonary nodule was biopsied, which revealed an angiosarcoma. The clinical features added to the radiological and histological findings permitted the diagnosis of right atrial angiosarcoma. The authors highlight the unexpected pattern in the presentation of cardiac tumors.

Mucinous adenocarcinona of the appendix.

Diagnosis of malignancy in the vermiform appendix is quite rare. The most common histological malignant neoplasia found in this tiny portion of the gastrointestinal tract is represented by the mucinous adenocarcinoma. This entity predominates in males around 50 years of age, and clinical presentation usually mimics or occurs along with an acute appendicitis. Early diagnosis is outside the rule since most cases at this stage are symptomless. The authors present the case of a 59-year-old female patient who looked for medical attention complaining of abdominal pain. Physical examination and laboratory workup were poor in diagnostic findings. The computed tomography images were compatible with the diagnosis of appendicitis and/or appendiceal neoplasia. The patient underwent a laparotomy and right hemicolectomy. The histological examination disclosed a moderately differentiated mucinous adenocarcinoma of the appendix stage T4a, N0, M0. The patient outcome was uneventful and was referred to an oncological center.

Strongyloides stercoralis hyperinfection: a dreaded but still missed diagnosis.

Strongyloides stercoralis (S. stercoralis), an intestinal nematode, is endemic in tropical and subtropical regions, being less prevalent in temperate climates. The number of infected persons worldwide ranges between 10 million and 100 million people. In Brazil the reported prevalence is 13%. Chronic infection may be asymptomatic or accompanied by gastrointestinal and respiratory symptoms. Under immunosuppressive conditions, the infection assumes serious proportions frequently accompanied by septic shock, disseminated intravascular coagulopathy and respiratory distress syndrome. The authors report a case of a 50-year-old female patient who was a chronic user of glucocorticoids and had been seeking medical attention for two months because of continuous gastrointestinal symptoms. She was admitted to the emergency room with clinical signs of septic shock and died after four days despite an adequate antibiotic regimen, vasopressor drugs, and ventilatory support. The autopsy revealed the unsuspected finding of S. stercoralis hyperinfection and septicemia.