Being a frail older person at the time of the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, frail older individuals have been identified as a particularly vulnerable group for poor health outcomes, including cognitive decline and dementia. We aimed to reflect on the interaction between frailty and COVID-19 with regards to health consequences. METHOD: Using a rapid literature review approach, we aimed to identify what it means to be a frail older individual in the COVID-19 pandemic from the perspective of three different settings: community, hospitals, and nursing homes. Four researchers from 4 countries (Ireland, France, Germany, and Brazil) reviewed articles from the MEDLINE database and grey literature including public policy briefs from their countries. RESULTS: In the community, some governments advised to practice "cocooning", i.e. stay-at-home-orders for older individuals. This brought unprecedented restrictions to lifestyles, leading to a potential frailty cascade among older adults. Social frailty likely caused mental ill-health, cognitive and functional decline, increasing the risk for dementia. In hospitals, frailty affected from disease onset to survivorship. The clinical presentation was rather atypical, and the biological findings were more heterogenous. Some resource allocation strategies based on the Clinical Frailty Scale remained questionable and should take into account patients' and carers' needs. A quarter of patients had increased care needs at discharge. However, availability of rehabilitation and support services in the community has been reduced. Frail older adults living in nursing homes were the most vulnerable group. Isolating residents and limiting the spread of COVID-19 was a key difficulty. Reduced visits from relatives, cancelled physical activities, and lack of social engagement worsened cognitive, behavioral, and physical conditions of the residents. There were also positive aspects such as the boom of digital literacy and telemedicine and a renewed debate on age and ageing. CONCLUSIONS: The COVID-19 pandemic spotlights the ageing population that is rapidly growing worldwide. Prolonged lifestyle restrictions during the pandemic led to poor health outcomes in frail older individuals, including cognitive decline and dementia. Lessons learned from how frail older individuals are getting through the pandemic provide a unique chance to improve health outcomes, community and health services and how we want to live as ageing societies.

Prevalence and incidence of Parkinson's disease and other forms of parkinsonism in a cohort of elderly individuals in Southern Brazil: protocol for a population-based study.

INTRODUCTION: Parkinsonism is one of the most common neurological disorders affecting the elderly. Several population-based studies have determined the epidemiology of parkinsonism, mainly Parkinson's disease (PD), but there is still little evidence in the Brazilian population. This protocol study aims to assess the prevalence and incidence of cases of PD and other parkinsonian syndromes in a 5-year cohort in a population-based study in the southern region of Brazil. METHODS AND ANALYSIS: A prospective population-based longitudinal study, with a cohort of development of cases of parkinsonism, divided into two phases: in phase I, two questionnaires to screen for parkinsonism (Tanner's questionnaire), Rapid Eyes Movement (REM) sleep behaviour disorder (REM Sleep Behavior Disorder Single-Question Screen) and a short interview will be conducted with all elderly residents of Veranópolis (the first longevity Brazilian county located in the Rio Grande do Sul, Brazil) aged 60 or over. The positive screened cases will be examined independently by at least two movement disorder-trained physicians and prevalence will be determined. A comprehensive evaluation of prodromic symptoms, risk factors and clinical characteristics will be carried out. Subjects with subtle parkinsonism and a sample of healthy subjects will be followed for 5 years in a developmental cohort of parkinsonism cases. For crude incidence, all individuals admitted at the beginning of the study will be re-evaluated. ETHICS AND DISSEMINATION: The study was approved by the research ethics committee of the Hospital de Clínicas de Porto Alegre (protocol n° 4.095.609). All participants provide their informed consent before evaluations. Findings from this survey will be disseminated through peer-reviewed publications and will be presented at conferences.

Associação de Fatores de Risco Cardiovascular e Polimorfismo de APOE com Mortalidade em Idosos Longevos: Uma Coorte de 21 Anos / Association of Cardiovascular Risk Factors and APOE Polymorphism with Mortality in the Oldest Old: A 21-Year Cohort Study

Resumo Fundamento: O conhecimento dos fatores ambientais e genéticos para um envelhecimento bem-sucedido em idosos longevos é controverso. Acrescenta-se a esta evidência, o fato de serem poucos os estudos delineados com essa população. Objetivo: Investigar a relação entre os genótipos mais frequentes da apolipoproteína E (APOE) e a mortalidade em idosos longevos que vivem em comunidade e sua sobrevida de acordo com os fatores de risco cardiovascular. Métodos: Uma amostra de 74 idosos com 80 anos ou mais da coorte do Projeto Veranópolis foi selecionada para genotipagem da APOE. Na linha de base, foram coletadas variáveis antropométricas, dosagens sanguíneas de glicose e lipídeos, pressão arterial e variáveis de estilo de vida (tabagismo, consumo de álcool e atividade física). A escala Bayer de Atividades da Vida Diária foi aplicada aos cuidadores dos idosos. O tempo de seguimento total do estudo foi 21 anos. Um p<0,05 bicaudal foi considerado estatisticamente significativo. Resultados: Não encontramos associação entre os genótipos da APOE e mortalidade. Entretanto, o risco de morte em idosos fumantes foi 2,30 vezes (hazard ratio [HR]; intervalo de confiança de 95% [IC 95%] 1,01 a 5,24); em diabéticos, 3,95 vezes (HR; IC 95% 1,27 a 12,30) do risco dos não diabéticos. Indivíduos que praticavam atividade física vigorosa tiveram uma redução no risco de óbito em 51% (HR = 0,49; IC 95% 0,27 a 0,88). Para o aumento de 1 mmHg na pressão arterial sistólica houve uma redução de 2% (HR = 0,98; IC 95% 0,97 a 0,99) no risco de morte. Conclusão: Nesta amostra de longevos, não houve associação entre os genótipos da APOE e mortalidade. Entretanto, os fatores de risco cardiovasculares clássicos podem ser importantes para a mortalidade geral em pessoas muito idosas.

Abstract Background: Knowledge of environmental and genetic factors for healthy aging in elderly people is controversial. In addition to this evidence, few studies have been designed for this population. Objectives: To investigate the relationship between the most frequent apolipoprotein E (APOE) genotypes and mortality in very elderly individuals living in a community and to evaluate survival according to cardiovascular risk factors. Methods: A sample of 74 elderly individuals aged ≥ 80 years, from the Veranópolis Project cohort, was selected for APOE genotyping. At baseline, anthropometric variables, glucose and lipid levels, blood pressure, and lifestyle variables (smoking, alcohol consumption, and physical activity) were collected. The Bayer Activities of Daily Living Scale was applied to their caregivers. Total study follow-up was 21 years. Two-sided p < 0.05 was considered statistically significant. Results: There was no association between APOE genotypes and mortality. However, the risk of death in elderly smokers was 2.30 times higher (hazard ratio [HR], 95% CI 1.01 to 5.24); in individuals with diabetes, it was 3.95 times higher (HR, 95% CI 1.27 to 12.30) than in individuals without diabetes. Subjects who practiced vigorous physical activity had a 51% reduction in risk of death (HR = 0.49, 95% CI 0.27 to 0.88). For an increase of 1 mmHg in systolic blood pressure, there was a 2% reduction (HR = 0.98, 95% CI 0.97 to 0.99) in risk of death. Conclusion: In this sample population, APOE genotypes were not associated with mortality. However, classic cardiovascular risk factors may be important for overall mortality in the very elderly.

Association of Cardiovascular Risk Factors and APOE Polymorphism with Mortality in the Oldest Old: A 21-Year Cohort Study. / Associação de Fatores de Risco Cardiovascular e Polimorfismo de APOE com Mortalidade em Idosos Longevos: Uma Coorte de 21 Anos.

BACKGROUND: Knowledge of environmental and genetic factors for healthy aging in elderly people is controversial. In addition to this evidence, few studies have been designed for this population. OBJECTIVES: To investigate the relationship between the most frequent apolipoprotein E (APOE) genotypes and mortality in very elderly individuals living in a community and to evaluate survival according to cardiovascular risk factors. METHODS: A sample of 74 elderly individuals aged ≥ 80 years, from the Veranópolis Project cohort, was selected for APOE genotyping. At baseline, anthropometric variables, glucose and lipid levels, blood pressure, and lifestyle variables (smoking, alcohol consumption, and physical activity) were collected. The Bayer Activities of Daily Living Scale was applied to their caregivers. Total study follow-up was 21 years. Two-sided p < 0.05 was considered statistically significant. RESULTS: There was no association between APOE genotypes and mortality. However, the risk of death in elderly smokers was 2.30 times higher (hazard ratio [HR], 95% CI 1.01 to 5.24); in individuals with diabetes, it was 3.95 times higher (HR, 95% CI 1.27 to 12.30) than in individuals without diabetes. Subjects who practiced vigorous physical activity had a 51% reduction in risk of death (HR = 0.49, 95% CI 0.27 to 0.88). For an increase of 1 mmHg in systolic blood pressure, there was a 2% reduction (HR = 0.98, 95% CI 0.97 to 0.99) in risk of death. CONCLUSION: In this sample population, APOE genotypes were not associated with mortality. However, classic cardiovascular risk factors may be important for overall mortality in the very elderly.

FUNDAMENTO: O conhecimento dos fatores ambientais e genéticos para um envelhecimento bem-sucedido em idosos longevos é controverso. Acrescenta-se a esta evidência, o fato de serem poucos os estudos delineados com essa população. OBJETIVO: Investigar a relação entre os genótipos mais frequentes da apolipoproteína E (APOE) e a mortalidade em idosos longevos que vivem em comunidade e sua sobrevida de acordo com os fatores de risco cardiovascular. MÉTODOS: Uma amostra de 74 idosos com 80 anos ou mais da coorte do Projeto Veranópolis foi selecionada para genotipagem da APOE. Na linha de base, foram coletadas variáveis antropométricas, dosagens sanguíneas de glicose e lipídeos, pressão arterial e variáveis de estilo de vida (tabagismo, consumo de álcool e atividade física). A escala Bayer de Atividades da Vida Diária foi aplicada aos cuidadores dos idosos. O tempo de seguimento total do estudo foi 21 anos. Um p<0,05 bicaudal foi considerado estatisticamente significativo. RESULTADOS: Não encontramos associação entre os genótipos da APOE e mortalidade. Entretanto, o risco de morte em idosos fumantes foi 2,30 vezes (hazard ratio [HR]; intervalo de confiança de 95% [IC 95%] 1,01 a 5,24); em diabéticos, 3,95 vezes (HR; IC 95% 1,27 a 12,30) do risco dos não diabéticos. Indivíduos que praticavam atividade física vigorosa tiveram uma redução no risco de óbito em 51% (HR = 0,49; IC 95% 0,27 a 0,88). Para o aumento de 1 mmHg na pressão arterial sistólica houve uma redução de 2% (HR = 0,98; IC 95% 0,97 a 0,99) no risco de morte. CONCLUSÃO: Nesta amostra de longevos, não houve associação entre os genótipos da APOE e mortalidade. Entretanto, os fatores de risco cardiovasculares clássicos podem ser importantes para a mortalidade geral em pessoas muito idosas.

Colecistectomia vídeo-laparoscópica no idoso: uma alternativa terapêutica / Laparocopic cholecystectomy in the elderly

Cada vez mais os cirurgiöes tratam um numero crescente de pacientes com idade avançada, o que torna importante definir melhor as expectativas e objetivos do tratamento. A cirurgia biliar no idoso está associada a um alto índice de morbidade e mortalidade. O objetivo desta revisäo bibliográfica é avaliar a realizaçäo da cirurgia vídeo-laparoscópica nesta populaçäo, considerando indicaçöes, contra-indicaçöes e complicaçöes locais e gerais do método em relaçäo a cirurgia convencional