RESUMO
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect any organ with a predisposition for women of reproductive age. It is related to a higher risk of cardiovascular events, increasing it up to 50 times in young people, and 30% of deaths are attributed to coronary artery disease. The risk of developing cardiovascular disease in SLE is related not only to traditional cardiovascular risks factors such as advanced age, hypertension, dyslipidemia, and diabetes but also to disease-specific factors, such as degree of activity, autoantibodies, organ damage, and treatment. Accelerated atherosclerosis is one of the main contributors to pathogenesis. Manifestations range from angina to acute myocardial infarction and sudden death. Markers have been studied for the detection of subclinical disease and stratification of these patients, as well as different treatment options to improve the cardiovascular prognosis of the disease.
RESUMO
Resumen Introducción: La saturación de oxígeno y el lactato son marcadores de hipoxia tisular, se obtienen de muestra venosa mezclada en arteria pulmonar o venosa central. Se desconoce el comportamiento simultáneo de estos parámetros en el postoperatorio de cirugía cardiaca. Objetivo: Caracterizar la saturación de oxígeno y lactato del circuito venoso-arterial del paciente postoperado de cirugía cardiaca. Métodos: Diseño transversal analítico. En pacientes consecutivos postoperados de cirugía cardiaca se obtuvieron lactato sérico y saturación de oxígeno del circuito venoso-arterial. Las variables se informaron con mediana (percentiles 25 y 75). Se analizaron con ANOVA de Kruskal-Wallis y ajuste respectivo, correlación de Spearman, el estadístico descriptivo de Bland-Altman y coeficiente de correlación intraclase (intervalo de confianza al 95%). Una p < 0.05 se consideró significativa. Resultados: Se estudiaron 244 muestras sanguíneas de 61 pacientes. Mujeres 30 (49%). Saturación de oxígeno y lactato fueron: arterial 98 (95.3, 99.4)% y 1.7 (1,1, 2.1); venosa periférica 85 (75.4, 94)% y 1.9 (1.35, 2.3); venosa central 68.8 (58.74, 70.2)% y 1.8 (1.3, 2.3); venosa central mezclada 66.8 (61.2, 73.1)% y 1.8 (1.3, 2.2), p < 0.05. El mejor coeficiente de correlación intraclase para la saturación de oxígeno fue de vena central a vena central mezclada: 0.856 (0.760, 0.914); del lactato: 0.954 (0.923, 0.972). Conclusiones: La saturación de oxígeno difiere en el circuito venoso-arterial a diferencia del lactato, donde son similares. Los mejores valores del coeficiente de correlación intraclase para el lactato y la saturación de oxígeno fueron los obtenidos en vena central y vena central mezclada.
Abstract Introduction: Oxygen saturation and lactate are markers of tissue hypoxia; they are obtained from central venous and mixed venous sample of the pulmonary artery. The simultaneous behavior of these parameters in the postoperative period of cardiac surgery is unknown. Objective: To characterize the lactate and oxygen saturation of the venous-arterial circuit of the postoperative patient from cardiac surgery. Methods: Design: Analytical cross-sectional. In consecutive patients after cardiac surgery, serum lactate and oxygen saturation of the venous-arterial circuit were obtained. The variables were reported with median (25.75 percentiles). They were analyzed with Kruskal-Wallis ANOVA and respective adjustment, Spearman correlation, the descriptive Bland-Altman statistic and intraclass correlation coefficient (95% confidence interval). A p < 0.05 was considered significant. Results: 244 blood samples from 61 patients were studied. Women 30 (49%). (Oxygen saturation) [lactate] were: arterial 98 (95.3, 99.4%) and 1.7 (1.1, 2.1); peripheral venous 85 (75.4, 94%) and [1.9 (1.35, 2.3)]; central venous 68.8 (58.74, 70.2%) and 1.8 (1.3, 2.3); mixed central venous 66.8 (61.2, 73.1%) and 1.8 (1.3, 2.2), p < 0.05. The best intraclass correlation coefficient for oxygen saturation were from central vein to mixed central vein 0.856 (0.760,0.914); and lactate: 0.954 (0.923, 0.972). Conclusions: The oxygen saturation differs in the venous-arterial circuit unlike lactate where they are similar. The best values of the intraclass correlation coefficient for lactate and oxygen saturation were those obtained in central vein and mixed central vein.
RESUMO
INTRODUCTION: Oxygen saturation and lactate are markers of tissue hypoxia; they are obtained from central venous and mixed venous sample of the pulmonary artery. The simultaneous behavior of these parameters in the postoperative period of cardiac surgery is unknown. OBJECTIVE: To characterize the lactate and oxygen saturation of the venous-arterial circuit of the postoperative patient from cardiac surgery. METHODS: Design: Analytical cross-sectional. In consecutive patients after cardiac surgery, serum lactate and oxygen saturation of the venous-arterial circuit were obtained. The variables were reported with median (25.75 percentiles). They were analyzed with Kruskal-Wallis ANOVA and respective adjustment, Spearman correlation, the descriptive Bland-Altman statistic and intraclass correlation coefficient (95% confidence interval). A p < 0.05 was considered significant. RESULTS: 244 blood samples from 61 patients were studied. Women 30 (49%). (Oxygen saturation) [lactate] were: arterial 98 (95.3, 99.4%) and 1.7 (1.1, 2.1); peripheral venous 85 (75.4, 94%) and [1.9 (1.35, 2.3)]; central venous 68.8 (58.74, 70.2%) and 1.8 (1.3, 2.3); mixed central venous 66.8 (61.2, 73.1%) and 1.8 (1.3, 2.2), p < 0.05. The best intraclass correlation coefficient for oxygen saturation were from central vein to mixed central vein 0.856 (0.760,0.914); and lactate: 0.954 (0.923, 0.972). CONCLUSIONS: The oxygen saturation differs in the venous-arterial circuit unlike lactate where they are similar. The best values of the intraclass correlation coefficient for lactate and oxygen saturation were those obtained in central vein and mixed central vein.
INTRODUCCIÓN: La saturación de oxígeno y el lactato son marcadores de hipoxia tisular, se obtienen de muestra venosa mezclada en arteria pulmonar o venosa central. Se desconoce el comportamiento simultáneo de estos parámetros en el postoperatorio de cirugía cardiaca. OBJETIVO: Caracterizar la saturación de oxígeno y lactato del circuito venoso-arterial del paciente postoperado de cirugía cardiaca. MÉTODOS: Diseño transversal analítico. En pacientes consecutivos postoperados de cirugía cardiaca se obtuvieron lactato sérico y saturación de oxígeno del circuito venoso-arterial. Las variables se informaron con mediana (percentiles 25 y 75). Se analizaron con ANOVA de Kruskal-Wallis y ajuste respectivo, correlación de Spearman, el estadístico descriptivo de Bland-Altman y coeficiente de correlación intraclase (intervalo de confianza al 95%). Una p < 0.05 se consideró significativa. RESULTADOS: Se estudiaron 244 muestras sanguíneas de 61 pacientes. Mujeres 30 (49%). Saturación de oxígeno y lactato fueron: arterial 98 (95.3, 99.4)% y 1.7 (1,1, 2.1); venosa periférica 85 (75.4, 94)% y 1.9 (1.35, 2.3); venosa central 68.8 (58.74, 70.2)% y 1.8 (1.3, 2.3); venosa central mezclada 66.8 (61.2, 73.1)% y 1.8 (1.3, 2.2), p < 0.05. El mejor coeficiente de correlación intraclase para la saturación de oxígeno fue de vena central a vena central mezclada: 0.856 (0.760, 0.914); del lactato: 0.954 (0.923, 0.972). CONCLUSIONES: La saturación de oxígeno difiere en el circuito venoso-arterial a diferencia del lactato, donde son similares. Los mejores valores del coeficiente de correlación intraclase para el lactato y la saturación de oxígeno fueron los obtenidos en vena central y vena central mezclada.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Saturação de Oxigênio , Humanos , Feminino , Estudos Transversais , Oxigênio , Ácido Láctico , Período Pós-OperatórioRESUMO
Resumen La cardiomiopatía de Takotsubo es una entidad caracterizada por disfunción ventricular aguda y transitoria, la cual está generalmente relacionada a un evento desencadenante (estrés emocional o físico) y que, por lo general, se presenta con disfunción sistólica regional del ventrículo izquierdo, aunque hasta en un 30% puede ser biventricular. Según su severidad, en algunos casos puede condicionar choque cardiogénico refractario a manejo con inotrópicos y vasopresores, por lo que para estos casos deben considerarse los dispositivos de asistencia circulatoria. Presentamos el caso de una paciente joven a quien se realizó cambio valvular pulmonar con prótesis biológica, la cual siete semanas posteriores a la cirugía acudió al servicio de urgencias con derrame pericárdico y fisiología de tamponade secundario a síndrome pospericardiotomía. Por tal motivo se le practicó ventana pericárdica, sin embargo durante el transquirúrgico presentó cardiomiopatía de Takotsubo biventricular que le condicionó choque cardiogénico con insuficiencia mitral y tricúspidea severas y refractariedad a tratamiento médico, así como a balón intraaórtico de contrapulsación (BIAC), por lo cual requirió soporte circulatorio con ECMO venoarterial durante 5 días.
Abstract Takotsubo cardiomyopathy is an entity characterized by acute and transient ventricular dysfunction, which is usually related to a triggering event (emotional or physical stress), and usually presents with regional systolic dysfunction of the left ventricle, however up to 30% may be biventricular. Depending on its severity in some cases the disease can condition refractory cardiogenic shock to management with inotropics and vasopressors, so for these cases circulatory assistance devices should be considered. We present the case of a young patient who had pulmonary valve change with biological prosthesis, which seven weeks after surgery went to the emergency department with pericardial effusion and tamponade physiology secondary to postpericardiotomy syndrome. For this reason pericardial window was practiced, however during the procedure she presented biventricular Takotsubo cardiomyopathy which conditioned cardiogenic shock with severe mitral and tricuspid regurgitation, and refractivity to medical treatment as well as intraaortic balloon pump, requiring circulatory support with venoarterial ECMO for 5 days.
Assuntos
Humanos , Feminino , Adulto , Oxigenação por Membrana Extracorpórea , Cardiomiopatia de Takotsubo/terapiaRESUMO
Severe forms of COVID-19 infection are associated with the need for invasive mechanical ventilation and thromboembolic complications; those can affect the cardiac function especially the right ventricle performance. Critical care echocardiography has rapidly evolved as the election technique in the evaluation of the critically ill patients. This technique has the advantage that it can be done at patient´s bedside and helps to provide the appropriate treatment and to monitoring maneuver's response. We present 4 patients with a confirmed COVID-19 infection who presented with sudden hemodynamic and / or respiratory deterioration, in which transthoracic echocardiogram showed acute right ventricular failure as the trigger for the event and helped to guide an early therapeutic intervention.
RESUMO
La cardiomiopatía de Takotsubo es una entidad caracterizada por disfunción ventricular aguda y transitoria, la cual está generalmente relacionada a un evento desencadenante (estrés emocional o físico) y que, por lo general, se presenta con disfunción sistólica regional del ventrículo izquierdo, aunque hasta en un 30% puede ser biventricular. Según su severidad, en algunos casos puede condicionar choque cardiogénico refractario a manejo con inotrópicos y vasopresores, por lo que para estos casos deben considerarse los dispositivos de asistencia circulatoria. Presentamos el caso de una paciente joven a quien se realizó cambio valvular pulmonar con prótesis biológica, la cual siete semanas posteriores a la cirugía acudió al servicio de urgencias con derrame pericárdico y fisiología de tamponade secundario a síndrome pospericardiotomía. Por tal motivo se le practicó ventana pericárdica, sin embargo durante el transquirúrgico presentó cardiomiopatía de Takotsubo biventricular que le condicionó choque cardiogénico con insuficiencia mitral y tricúspidea severas y refractariedad a tratamiento médico, así como a balón intraaórtico de contrapulsación (BIAC), por lo cual requirió soporte circulatorio con ECMO venoarterial durante 5 días.
Assuntos
Oxigenação por Membrana Extracorpórea , Cardiomiopatia de Takotsubo/terapia , Adulto , Feminino , HumanosRESUMO
BACKGROUND: Coronavirus disease 2019 (COVID-19) is characterized by severe lung involvement and hemodynamic alterations. Critical care ultrasonography is vital because it provides real time information for diagnosis and treatment. Suggested protocols for image acquisition and measurements have not yet been evaluated. METHODS: This cross-sectional study was conducted at two centers from 1 April 2020 to 30 May 2020 in adult patients with confirmed COVID-19 infection admitted to the critical care unit. Cardiac and pulmonary evaluations were performed using the ORACLE protocol, specifically designed for this study, to ensure a structured process of image acquisition and limit staff exposure to the infection. RESULTS: Eighty-two consecutively admitted patients were evaluated. Most of the patients were males, with a median age of 56 years, and the most frequent comorbidities were hypertension and type 2 diabetes, and 25% of the patients had severe acute respiratory distress syndrome. The most frequent ultrasonographic findings were elevated pulmonary artery systolic pressure (69.5%), E/e' ratio > 14 (29.3%), and right ventricular dilatation (28%) and dysfunction (26.8%). A high rate of fluid responsiveness (82.9%) was observed. The median score (19 points) on pulmonary ultrasound did not reveal any variation between the groups. Elevated pulmonary artery systolic pressure was associated with higher in-hospital mortality. CONCLUSION: The ORACLE protocol was a feasible, rapid, and safe bedside tool for hemodynamic and respiratory evaluation of patients with COVID-19. Further studies should be performed on the alteration in pulmonary hemodynamics and right ventricular function and its relationship with outcomes.
Assuntos
COVID-19/complicações , COVID-19/fisiopatologia , Cuidados Críticos/métodos , Cardiopatias/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Ultrassonografia/métodos , Idoso , Protocolos Clínicos , Estudos Transversais , Estudos de Viabilidade , Feminino , Coração/diagnóstico por imagem , Coração/fisiopatologia , Cardiopatias/etiologia , Cardiopatias/fisiopatologia , Hemodinâmica/fisiologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Pneumopatias/etiologia , Pneumopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pandemias , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia/instrumentaçãoRESUMO
OBJECTIVE: To determine whether hypertension (HTA) is an independent predictor of depressive symptoms (DS) in a sample of elderly Mexican community-dwelling persons. MATERIAL AND METHODS: Two-year longitudinal study of 3,276 community-dwelling persons aged 60 years and older, participating in the Mexican Health and Aging Study. Subjects that self-reported both having or not having HTA while denying DS at baseline were included. Two-year follow-up data were analyzed, and multiple regression analyses were used to test whether HTA is an independent predictor of incident DS after adjusting for many potential confounders. RESULTS: Mean age of participants was 68.4 +/- 6.9 years. Prevalence of HTA was 36.6%. At follow-up, 28.7% developed DS. After adjusting for multiple covariates (age, sex, education level, relationship status, self-reported health and economic status, diabetes, arthritis, stroke, ischemic cardiopathy, falls, pain, hearing impairment, visual impairment, urinary incontinence, cognitive impairment, smoking, alcohol use, and baseline disability), HTA was an independent predictor of DS at two years followup (Adjusted Odds Ratio = 1.18; 95% confidence interval = 1.01-1.40). CONCLUSIONS: Hypertension is an independent risk factor for the development of depressive symptoms. Programs to support early treatment of cardiovascular disease and hypertension should be implemented in order to prevent late-onset of depressive symptoms.
Assuntos
Depressão/epidemiologia , Depressão/etiologia , Hipertensão/complicações , Idoso , Feminino , Humanos , Estudos Longitudinais , MasculinoRESUMO
Frailty is a controversial, complex and enigmatic concept. Because the world's population is aging, it has been possible to assess the impact of frailty over patients themselves as well as on their relatives, community and mainly on their caregivers. Health care personnel must be able to identify and understand this entity and its components. In addition during the 80's frailty was understood as synonymous with disability, chronic illness, or extreme aging; this perspective must be modified. The literature on frailty has increased exponentially in the last years. However, there is still not a well defined and universally recognized description or definition. The purpose of this review was to understand frailty and its consequences based on the most recent advances in the field of aging. Frialty is a multifactorial phenomenon and for purposes of this review, only biological characteristics are discussed.
Assuntos
Idoso Fragilizado , Geriatria , Idoso , HumanosRESUMO
La fragilidad es un concepto relativamente nuevo, complejo y controvertido. Con el aumento de los adultos mayores ha sido posible constatar el impacto de la fragilidad sobre las personas afectadas, sus familias, cuidadores y la sociedad. Puesto que es importante cambiar el antiguo concepto de los ochenta, cuando la fragilidad era sinónimo de discapacidad, presencia de una enfermedad crónica o envejecimiento extremo, los profesionales de la salud que trabajan con adultos mayores deben familiarizarse con este término, así como con sus características. Las publicaciones acerca este tema han crecido exponencialmente en el último decenio; sin embargo, todavía no hay una definición ni criterios universalmente reconocidos para su descripción. Puesto que se trata de un fenómeno multifactorial, la siguiente revisión tiene como propósito describir las características biológicas de la fragilidad, así como sus consecuencias, según los resultados de investigación recientes. Con la información presentada, el profesional de la salud conocerá los componentes fundamentales de la fragilidad hasta ahora propuestos, así como lo difícil que ha sido su integración.
Frailty is a controversial, complex and enigmatic concept. Because the world's population is aging, it has been possible to assess the impact of frailty over patients themselves as well as on their relatives, community and mainly on their caregivers. Health care personnel must be able to identify and understand this entity and its components. In addition during the 80's frailty was understood as synonymous with disability, chronic illness, or extreme aging; this perspective must be modified. The literature on frailty has increased exponentially in the last years. However, there is still not a well defined and universally recognized description or definition. The purpose of this review was to understand frailty and its consequences based on the most recent advances in the field of aging. Frialty is a multifactorial phenomenon and for purposes of this review, only biological characteristics are discussed.
Assuntos
Humanos , Idoso , Idoso Fragilizado , GeriatriaRESUMO
OBJECTIVE: To determine factors associated with failure to adhere to treatment for diagnosed hypertension among a representative sample of older Mexican adults living in the community. METHODS: A cross-sectional study of 2,029 individuals 65 years of age or older with diagnosed hypertension who participated in the Mexican Health and Aging Study, carried out during the summer of 2001. The survey collected information on several demographics (age, sex, schooling, whether living alone, and employment status, among others), any chronic illnesses, symptoms of depression, cognitive deterioration, body mass index, smoking, alcohol consumption, and difficulty performing basic and instrumental activities of daily living. Simple and multifactorial logistical regression analyses were used to evaluate the association among the study variables and self-reported untreated high blood pressure. RESULTS: Of the 2,029 participants, 437 (21.5%) reported not following any treatment whatsoever for controlling their hypertension; 1,584 (78.1%) affirmed they were complying with treatment; and 8 (0.4%) did not respond to this question. The multifactorial analysis adjusted for confounding variables (age, sex, symptoms of depression, and cognitive deterioration) showed that only a low number of years of schooling (adjusted odds ratio [OR] = 1.70; 95% confidence interval [95%CI]: 1.10-2.64; P = 0.02 for 1-6 years of schooling and adjusted OR = 3.32; 95%CI: 2.10-5.24; P < 0.01 for no schooling), alcohol consumption (adjusted OR = 1.52; 95%CI: 1.14-2.03; P = 0.01), and urinary incontinence (adjusted OR = 1.61; 95%CI: 1.15-2.26;P < 0.01) were independently associated with hypertension. CONCLUSIONS: Hypertension is a common and important issue among older adults in Mexico. To obtain better medication compliance, doctors prescribing or modifying hypertension treatment should taken into account whether or not the patient suffers from urinary incontinence, consumes alcohol, and/or has a low level of schooling.
Assuntos
Transtornos Cognitivos/epidemiologia , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Idoso , Doença Crônica , Transtornos Cognitivos/diagnóstico , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Feminino , Nível de Saúde , Humanos , Masculino , México/epidemiologia , Testes Neuropsicológicos , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
OBJETIVO: Determinar los factores asociados con la falta de adhesión al tratamiento de la hipertensión arterial (HTA) diagnosticada en una muestra representativa de adultos mayores mexicanos que viven en la comunidad. MÉTODOS: Estudio transversal con 2 029 personas de 65 años o más con diagnóstico de HTA, participantes en el Estudio Nacional sobre Salud y Envejecimiento en México realizado en el verano de 2001. La encuesta recabó información sobre algunas características sociodemográficas (edad, sexo, escolaridad, si vivía solo y si realizaba algún trabajo remunerado, entre otras), las enfermedades crónicas, los síntomas depresivos, el deterioro cognoscitivo, el índice de masa corporal, el tabaquismo, el consumo de bebidas alcohólicas y las dificultades para realizar actividades básicas (ABVD) e instrumentales (AIVD) de la vida diaria, entre otras. Se evaluó la asociación entre las variables estudiadas y el autoinforme de hipertensión arterial no tratada (HTNT) mediante análisis de regresión logística simple y multifactorial. RESULTADOS: De los 2 029 participantes, 437 (21,5 por ciento) declararon no seguir tratamiento alguno para controlar la HTA, 1 584 (78,1 por ciento) afirmaron seguir un tratamiento y 8 (0,4 por ciento) no respondieron a esa pregunta. El análisis multifactorial ajustado por posibles variables confusoras (edad, sexo, síntomas depresivos y deterioro cognoscitivo) mostró que solo la baja escolaridad (razón de posibilidades [odds ratio, OR] ajustada = 1,70; intervalo de confianza de 95 por ciento [IC95 por ciento]: 1,10 a 2,64; P = 0,02 para la escolaridad de 1 a 6 años y OR ajustada = 3,32; IC95 por ciento: 2,10 a 5,24; P < 0,01 para los no escolarizados), consumir bebidas alcohólicas (OR ajustada = 1,52; IC95 por ciento: 1,14 a 2,03; P = 0,01) y padecer de incontinencia urinaria (OR ajustada = 1,61; IC95 por ciento: 1,15 a 2,26; P < 0,01) resultaron asociadas independientemente con la HTNT. CONCLUSIONES: La HTNT es ...
OBJECTIVE: To determine factors associated with failure to adhere to treatment for diagnosed hypertension among a representative sample of older Mexican adults living in the community. METHODS: A cross-sectional study of 2 029 individuals 65 years of age or older with diagnosed hypertension who participated in the Mexican Health and Aging Study, carried out during the summer of 2001. The survey collected information on several demographics (age, sex, schooling, whether living alone, and employment status, among others), any chronic illnesses, symptoms of depression, cognitive deterioration, body mass index, smoking, alcohol consumption, and difficulty performing basic and instrumental activities of daily living. Simple and multifactorial logistical regression analyses were used to evaluate the association among the study variables and self-reported untreated high blood pressure. RESULTS: Of the 2 029 participants, 437 (21.5 percent) reported not following any treatment whatsoever for controlling their hypertension; 1 584 (78.1 percent) affirmed they were complying with treatment; and 8 (0.4 percent) did not respond to this question. The multifactorial analysis adjusted for confounding variables (age, sex, symptoms of depression, and cognitive deterioration) showed that only a low number of years of schooling (adjusted odds ratio [OR] = 1.70; 95 percent confidence interval [95 percentCI]: 1.10-2.64; P = 0.02 for 1-6 years of schooling and adjusted OR = 3.32; 95 percentCI: 2.10-5.24; P < 0.01 for no schooling), alcohol consumption (adjusted OR = 1.52; 95 percentCI: 1.14-2.03; P = 0.01), and urinary incontinence (adjusted OR = 1.61; 95 percentCI: 1.15-2.26; P < 0.01) were independently associated with hypertension. CONCLUSIONS: Hypertension is a common and important issue among older adults in Mexico. To obtain better medication compliance, doctors prescribing or modifying hypertension treatment should taken into account whether or not the ...
Assuntos
Idoso , Feminino , Humanos , Masculino , Transtornos Cognitivos/epidemiologia , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Doença Crônica , Transtornos Cognitivos/diagnóstico , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Nível de Saúde , México/epidemiologia , Testes Neuropsicológicos , Fatores de Risco , Índice de Gravidade de DoençaAssuntos
Idoso , Hipertensão , Terapêutica , Cooperação do Paciente , México , Idoso , Cooperação do Paciente , Transtornos Cognitivos , Transtorno Depressivo Maior , Testes Neuropsicológicos , Hipertensão , Recusa do Paciente ao Tratamento , Doença Crônica , Estudos Transversais , Nível de Saúde , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To determine the relationship between depressive symptoms and dependence in activities of daily living. MATERIAL AND METHODS: Participants, aged 70 to 104 (n= 1 880), were evaluated twice (2001 and 2003). Depressive symptoms were established by a modified version of Center for Epidemiologic Studies Depression scale, whereas functional dependence was assessed with Lawton & Brody and Katz scales. Dependence implies the attendance and assistance of another person to accomplish the activity. Multivariate regression analyses were used to determine the effect of depressive symptoms on incident dependence. RESULTS: At baseline, 37.9% had depressive symptoms. After two years, 6.1 and 12.7% developed functional dependence for one or more ADL and IADL, respectively. Multivariate analyses showed that depressive symptoms were a risk factor to the development of functional dependence only for the instrumental activities for daily living. CONCLUSIONS: Depressive symptoms are a risk factor for functional dependence. Systematic screening it seems necessary in the evaluation of geriatric patients.
Assuntos
Idoso/psicologia , Dependência Psicológica , Depressão/epidemiologia , Atividades Cotidianas , Idoso de 80 Anos ou mais , Doença Crônica/epidemiologia , Doença Crônica/psicologia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/psicologia , Comorbidade , Feminino , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Humanos , Masculino , México/epidemiologia , Fatores de RiscoRESUMO
OBJETIVO: Determinar la relación entre síntomas depresivos y dependencia funcional. MATERIAL Y MÉTODOS: Estudio longitudinal con 1 880 adultos mayores evaluados en 2001 y 2003. Se determinaron los síntomas depresivos con una versión modificada de la Escala de Depresión del Centro de Estudios Epidemiológicos y la dependencia con las escalas de Lawton y Brody, y Katz. La dependencia implicó la asistencia y ayuda para realizar alguna de las actividades interrogadas. Los análisis multifactoriales probaron el nexo entre síntomas depresivos y desarrollo de dependencia. RESULTADOS: En 2001, 37.9 por ciento mostró síntomas depresivos. En 2003, 6.1 y 12.7 por ciento desarrollaron dependencia para al menos una de las actividades básicas (ABVD) e instrumentales de la vida diaria (AIVD), respectivamente. En el análisis multivariado, los síntomas depresivos fueron factor de riesgo sólo para dependencia en las AIVD. CONCLUSIONES: Los síntomas depresivos favorecen el desarrollo de dependencia funcional. Es necesario su reconocimiento sistemático durante la evaluación clínica del adulto mayor.
OBJECTIVE: To determine the relationship between depressive symptoms and dependence in activities of daily living. MATERIAL AND METHODS: Participants, aged 70 to 104 (n= 1 880), were evaluated twice (2001 and 2003). Depressive symptoms were established by a modified version of Center for Epidemiologic Studies Depression scale, whereas functional dependence was assessed with Lawton & Brody and Katz scales. Dependence implies the attendance and assistance of another person to accomplish the activity. Multivariate regression analyses were used to determine the effect of depressive symptoms on incident dependence. RESULTS: At baseline, 37.9 percent had depressive symptoms. After two years, 6.1 and 12.7 percent developed functional dependence for one or more ADL and IADL, respectively. Multivariate analyses showed that depressive symptoms were a risk factor to the development of functional dependence only for the instrumental activities for daily living. CONCLUSIONS: Depressive symptoms are a risk factor for functional dependence. Systematic screening it seems necessary in the evaluation of geriatric patients.