The role of spirituality in the COVID-19 pandemic: a spiritual hotline project.

Recent correspondence letters to the editor of this journal pointed out to the need of implementing psychological support during the pandemic and post-pandemic period to both general and frontline workers. Especially, they highlighted the importance of religious/spiritual interventions in order to provide an integral and holistic care. In this perspective, an important consequence of the social isolation is the closure of churches and the suspension of religious meetings in order to avoid agglomeration and contagion. However, although this is a very important approach in terms of public health, a question is raised: how to promote spiritual care and help spiritual/religious individuals to cope with their problems while maintaining compliance with social isolation? To address this question, we report the Spiritual Hotline Project, a project designed by many Brazilian healthcare workers intended to give spiritual and religious assistance to people with different cultural background. So far, the hotline was able to assist people from different parts of the world, including Brazil and Portugal as well as with different religious affiliation, in order to provide a spiritual comfort and care during this public health crisis.

Association between respiratory capacity, quality of life and cognitive function in elderly individuals.

OBJECTIVE: To investigate associations between respiratory capacity, quality of life and cognitive function in elderly individuals. METHODS: The sample included 386 elderly individuals (232 women). Respiratory capacity assessment was based on maximal expiratory pressure measured at peak expiratory flow. Subjects were classified according to peak expiratory flow values adjusted for sex, age and height of individuals with normal (peak expiratory flow curve <80% and >60%) or reduced (peak expiratory flow curve < 60%) respiratory capacity. The World Health Organization Quality of Life Questionnaire and the Mini-Mental State Examination were used to assess quality of life and cognitive function, respectively. RESULTS: Elderly women with reduced respiratory capacity scored lower on the Mini-Mental State Examination (p=0.048) and quality of life questionnaire (p=0.040) compared to those with normal respiratory capacity. These differences were not observed in men (p>0.05). CONCLUSION: Reduced respiratory capacity was associated with poorer quality of life and cognitive function in elderly women. These associations were not observed in elderly men.

Depression and cancer were independently associated with quality of life in Brazilian older people.

OBJECTIVE: To analyse the factors associated with low health-related quality of life (HRQoL) in older people living in Brazil. METHODS: In this cross-sectional study of the Jewish community residing in Sao Paulo, Brazil, we extensively evaluated the characteristics - including clinical, functional and sociodemographic - of 496 older people. Quality of life was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF), while the Geriatric Depression Scale (GDS) was used to measure depressive symptoms. RESULTS: After adjusting for potential confounders, we found that GDS score (ß = -0.07; P = 0.04) and cancer (ß = -0.47; P = 0.05) were associated with a low WHOQOL-BREF score. CONCLUSION: Depressive symptoms and cancer were independently associated with low HRQoL among older people living in Brazil.

Association between respiratory capacity, quality of life and cognitive function in elderly individuals / Associação entre capacidade respiratória, qualidade de vida e cognição em idosos

ABSTRACT Objective To investigate associations between respiratory capacity, quality of life and cognitive function in elderly individuals. Methods The sample included 386 elderly individuals (232 women). Respiratory capacity assessment was based on maximal expiratory pressure measured at peak expiratory flow. Subjects were classified according to peak expiratory flow values adjusted for sex, age and height of individuals with normal (peak expiratory flow curve <80% and >60%) or reduced (peak expiratory flow curve < 60%) respiratory capacity. The World Health Organization Quality of Life Questionnaire and the Mini-Mental State Examination were used to assess quality of life and cognitive function, respectively. Results Elderly women with reduced respiratory capacity scored lower on the Mini-Mental State Examination (p=0.048) and quality of life questionnaire (p=0.040) compared to those with normal respiratory capacity. These differences were not observed in men (p>0.05). Conclusion Reduced respiratory capacity was associated with poorer quality of life and cognitive function in elderly women. These associations were not observed in elderly men.

RESUMO Objetivo Investigar a associação entre capacidade respiratória, qualidade de vida e função cognitiva em idosos. Métodos A amostra incluiu 386 idosos (232 mulheres). A capacidade respiratória foi avaliada pela pressão expiratória máxima obtida no pico de fluxo expiratório. Com base nos resultados máximos de fluxo expiratório, os indivíduos foram classificados de acordo com o valor previsto para sexo, idade e estatura em capacidade respiratória normal (curva de fluxo expiratório de pico inferior a 80% e superior a 60%) ou capacidade respiratória reduzida (curva de fluxo expiratório de pico menor que 60%). O questionário World Health Organization Quality of Life e o Miniexame do Estado Mental foram utilizados para avaliar a qualidade de vida e a função cognitiva, respectivamente. Resultados Em comparação com mulheres idosas com capacidade respiratória normal, as pessoas com capacidade respiratória reduzida apresentaram escores mais baixos para o Miniexame do Estado Mental (p=0,048) e qualidade de vida (p=0,040). Nos homens, não foram observadas diferenças (p>0,05). Conclusão Capacidade respiratória reduzida foi associada à pior qualidade de vida e à função cognitiva em mulheres idosas. Essas associações não foram observadas em idosos do sexo masculino.

Health-related quality of life in Brazilian community-dwelling and institutionalized elderly: Comparison between genders.

OBJECTIVE: To compare the health-related quality of life (HRQL) indicators between institutionalized and community-dwelling elderly men and women. METHOD: This was a cross-sectional study with a sample of 496 elderly men and women, surveyed by researchers at a private hospital that attends institutionalized and community-dwelling elderly. HRQL (World Health Organization Quality of Life), daily living activities (Katz questionnaire), and instrumental daily living activities (Lawton questionnaire), mini-mental state examination, handgrip strength test, and function capacity (timed up and go test) were obtained. RESULTS: Institutionalized men presented higher scores in physical and psychological domains of HRQL compared to elderly men living alone (p<0.05). Among women, the scores in all domains (physical, psychological, relationship, and environment) were similar between institutionalized and community-dwelling individuals. CONCLUSION: Institutionalized elderly men reported better scores in physical and psychological domains of HRQL compared to their community-dwelling pairs, while both institutionalized and community-dwelling elderly women presented similar HRQL.

Health-related quality of life in Brazilian community-dwelling and institutionalized elderly: Comparison between genders / Qualidade de vida relacionada à saúde em idosos brasileiros residentes em comunidade e institucionalizados: comparação entre gêneros

SUMMARY Objective To compare the health-related quality of life (HRQL) indicators between institutionalized and community-dwelling elderly men and women. Method This was a cross-sectional study with a sample of 496 elderly men and women, surveyed by researchers at a private hospital that attends institutionalized and community-dwelling elderly. HRQL (World Health Organization Quality of Life), daily living activities (Katz questionnaire), and instrumental daily living activities (Lawton questionnaire), mini-mental state examination, handgrip strength test, and function capacity (timed up and go test) were obtained. Results Institutionalized men presented higher scores in physical and psychological domains of HRQL compared to elderly men living alone (p<0.05). Among women, the scores in all domains (physical, psychological, relationship, and environment) were similar between institutionalized and community-dwelling individuals. Conclusion Institutionalized elderly men reported better scores in physical and psychological domains of HRQL compared to their community-dwelling pairs, while both institutionalized and community-dwelling elderly women presented similar HRQL.

RESUMO Objetivo comparar os indicadores de qualidade de saúde de vida (QV) entre idosos homens e mulheres institucionalizados e aqueles que vivem na comunidade sozinhos ou com a família. Método estudo transversal com amostra composta por 496 idosos homens e mulheres, entrevistados por pesquisadores em um hospital privado que atende idosos institucionalizados e da comunidade. Os indicadores de QV (World Health Organization Quality of Life), atividades da vida diária (Katz questionnaire), atividades instrumentais da vida diária (Lawton questionnaire), exame do estado mental (mini-mental), teste de força de preensão manual (Handgrip) e capacidade funcional (Timed up to go) foram obtidos. Resultados homens institucionalizados apresentaram maiores escores de QV no domínio físico e psicológico em relação aos idosos que vivem na comunidade sozinhos (p<0,05). Nas mulheres, os escores em todos os domínios de QV (físico, psicológico, relações sociais e ambientais) foram semelhantes entre as idosas institucionalizadas e as residentes na comunidade, que vivem sozinhas ou com a família. Conclusão homens idosos institucionalizados relataram melhores escores de QV nos domínios físico e psicológico em comparação com pares que vivem na comunidade, enquanto, em mulheres, resultados similares foram observados nas idosas institucionalizadas e da comunidade.

Peak expiratory flow mediates the relationship between handgrip strength and timed up and go performance in elderly women, but not men.

OBJECTIVE: The aim of the present study was to verify if there is sex difference in the associations among handgrip strength, peak expiratory flow (PEF) and timed up and go (TUG) test results. METHODS: The sample included 288 consecutive elderly men (n=93) and women (n=195). Functional capacity was measured using the TUG test, and muscle strength was measured based on handgrip. Moreover, as a measure of current health status, PEF was evaluated. Linear regression procedures were performed to analyze the relationships between handgrip and both PEF and TUG test results, with adjustment for confounders, and to identify the possible mediating role of PEF in the association between handgrip strength and TUG test results. RESULTS: In men, handgrip strength was associated with both PEF and TUG performance (p<0.01). After adjustment for PEF, the relationship between handgrip strength and TUG performance remained significant. In women, handgrip strength was also associated with both PEF and TUG performance (p<0.01). However, after adjustment for PEF, the relationship between handgrip strength and TUG performance was no longer significant. CONCLUSION: Mobility in the elderly is sex dependent. In particular, PEF mediates the relationship between handgrip strength and TUG performance in women, but not in men.

Peak expiratory flow mediates the relationship between handgrip strength and timed up and go performance in elderly women, but not men

OBJECTIVE: The aim of the present study was to verify if there is sex difference in the associations among handgrip strength, peak expiratory flow (PEF) and timed up and go (TUG) test results. METHODS: The sample included 288 consecutive elderly men (n=93) and women (n=195). Functional capacity was measured using the TUG test, and muscle strength was measured based on handgrip. Moreover, as a measure of current health status, PEF was evaluated. Linear regression procedures were performed to analyze the relationships between handgrip and both PEF and TUG test results, with adjustment for confounders, and to identify the possible mediating role of PEF in the association between handgrip strength and TUG test results. RESULTS: In men, handgrip strength was associated with both PEF and TUG performance (p<0.01). After adjustment for PEF, the relationship between handgrip strength and TUG performance remained significant. In women, handgrip strength was also associated with both PEF and TUG performance (p<0.01). However, after adjustment for PEF, the relationship between handgrip strength and TUG performance was no longer significant. CONCLUSION: Mobility in the elderly is sex dependent. In particular, PEF mediates the relationship between handgrip strength and TUG performance in women, but not in men.

Influence of peripheral arterial disease on daily living activities in elderly women.

Aging has been associated with decreases in physical and cognitive functions. Peripheral artery disease (PAD) has been associated with further impairments in these functions, especially in women. However, no detailed information is available indicating whether PAD leads to further impairment in these functions in elderly women. Thus, the aims of this study were 1) to compare the capacity to perform daily living activities between elderly women with and without PAD and 2) to identify the factors related with the performance in daily activities. Twenty-seven elderly women with PAD and 22 elderly non-PAD women were surveyed in a geriatric hospital. Women aged ≥65 years and with no signal of dementia were included. PAD was identified by the ankle-brachial index ≤0.90, whereas elderly non-PAD women presented ankle-brachial index >1.0. Patients were interviewed to obtain information regarding basic (Katz questionnaire) and instrumental daily living activities (Lawton-Brody scale) and performed the mini-mental state examination, handgrip strength test, and timed up and go tests. PAD and non-PAD women had similar age, clinical characteristics, handgrip strength test, and cognitive function (P > 0.05). The capacity to perform basic and instrumental daily living activities was similar between PAD and non-PAD women (P > 0.05). In PAD and non-PAD, the instrumental daily living activities were significantly correlated with cognitive function (r = 0.44, P < 0.05 and r = 0.74 and P < 0.05, respectively). PAD elderly women present similar capacity to perform basic and instrumental daily activities than non-PAD women. In addition, in both groups, the capacity to perform instrumental daily activities was related with cognitive function.

Rare medical conditions and suggestive past-life memories: a case report and literature review.

We aim to report the case of a 38-year-old male with suggestive past-life memories during a regression session and to show how these memories were related to unusual medical conditions: (1) isolated obstruction of the right coronary artery in a young patient, (2) omental infarction, and (3) right aortic arch with isolation of the left subclavian artery. These conditions were related to the following suggestive past-life memories: (1) a priest who committed suicide with a crucifix nailed to his chest and (2) a medieval weapon (skull flail) hitting his cervical and left back region. There was an intriguing relation between the patient's suggestive past-life memories and rare medical conditions. In this article, the authors highlight possible explanations, rarity of findings, and similarities/differences from previous cases and potential pitfalls in this area.

O idoso e sua espiritualidade impacto sobre diferentes aspectos do envelhecimento / The elderly and their spirituality: impact on different aspects of aging

O interesse sobre a espiritualidade e a religiosidade sempre existiu no curso da história humana, a despeito de diferentes épocas ou culturas. Contudo, apenas recentemente a ciência tem demonstrado interesse em investigar o tema. Estudos e pesquisas demonstram que a faixa etária acima dos 65 anos é aquela com mais contato frente a sua espiritualidade e religiosidade. O objetivo do presente estudo é realizar uma revisão da literatura científica que norteia essa temática e investigar qual o impacto da espiritualidade em diferentes aspectos do envelhecimento. Metodologia: Pesquisa nas bases de dados Pubmed/Medline, LILACS e Scielo, nos idiomas inglês e português, entre 1966 e 2009, utilizando as palavras-chave aged/idoso e spirituality/espiritualidade. Resultados: Foram incluídos 48 artigos divididos nas seguintes temáticas: envelhecimento bem-sucedido, bem-estar, qualidade de vida, doenças crônico-degenerativas, doenças neuro-psiquiátricas, funcionalidade, mortalidade e impacto no fim da vida. Conclusão: Conclui-se que o envelhecimento possui uma relação íntima com a espiritualidade nos seus mais diferentes aspectos e percebe-se que há uma escassez de pesquisas sobre espiritualidade/religiosidade em idosos.

Self-perceived hearing handicap and hearingsensitivity in nursing home elderlies / Autopercepção e sensibilidade auditiva em idosos institucionalizados

Objectives: To identify hearing sensitivity and self-perceived handicap and their relation. Methods: Schooling, dependence for daily activities and auditory complaints were investigated in 79 nursing home elderly subjects, male and female, aged from 66 to 100 years. All underwent basic hearing evaluation and answered a self-assessment scale (HHIE-S). Results: Mean schooling was of 8.3 years. Thirty-one subjects (39.3%) were classified as independent, 43 (54.4%) as semi-dependent and 5 (6.3%) as dependent. Fifty-eight (73.4%) subjects had complaints concerning their hearing. Only 25.3% demonstrated normal hearing for low and medium frequencies, and 8.9% and 7.6% for high frequencies on the right and left ears, respectively. Hearing loss for low and medium frequencies was mild, while that for high frequencies was moderate. The great majority of subjects (64.6%) did not demonstrate hearing handicap as evaluated by the HHIE-S. Conclusions: Hearing loss without self-perceived hearing handicap was prevalent in the group and these aspects were highly associated, that is, the worse the hearing sensitivity, more evident the handicap. The development of hearing loss is usually slow and only perceived when affecting the entire frequency range, leading to difficulties in social integration and lack of motivation in maintaining interpersonal relations, strengthening the social barriers and demonstrating the importance of the audiologist in these institutions.

Objetivos: Identificar o grau de sensibilidade auditiva e a autopercepção do handicap em idosos e verificar a relação entre ambos. Métodos: Realizou-se o levantamento da escolaridade, grau de dependência para as atividades de vida diária e das queixas relacionadas à audição de 79 indivíduos, de ambos os gêneros, na faixa etária de 66 a 100 anos, residentes em uma instituição de longa permanência. Submetidos à avaliação audiológica básica e à aplicação de um questionário de autoavaliação (HHIE-S). Resultados: A escolaridade mostrou uma média de 8,63 anos cursados; 31 indivíduos (39,3%) foram classificados como independentes, 43 (54,4%) semidependentes e 5 (6,3%) dependentes; 58 (73,4%) indivíduos apresentaram alguma queixa relacionada à audição. Apenas 25,3% da amostra apresentou grau de sensibilidade auditiva normal para as frequências baixas e médias e 8,9% à direita e 7,6% à esquerda para as altas, sendo o grau leve o mais frequente para as baixas e médias, e o moderado para as altas, para ambos os lados. A maioria dos idosos não apresentou percepção do handicap auditivo (64,6%). Conclusões: Houve alta prevalência de deficiência auditiva, porém sem percepção do handicap na maioria dos indivíduos avaliados, estando estes dois aspectos amplamente relacionados. O caráter lento e progressivo da deficiência auditiva, que só passa a ser notado quando se atinge altos graus de comprometimento, soma-se à dificuldade de integração social deste grupo e o desinteresse em manter as relações interpessoais, intensificando as barreiras e apontando para a grande necessidade da atuação fonoaudiológica dentro destas instituições.

O envelhecimento populacional no Brasil / The aging population in Brazil

Atualmente, o Brasil se encontra em avançado estagio de transiçãotanto para mortalidade quanto para fertilidade, o que permite preverde maneira confi ável a distribuição etária e o tamanho da populaçãonas próximas quatro décadas. Enquanto a população de idosos comidade acima dos 65 anos aumentará em velocidade acelerada (2 a4% ao ano), a população jovem diminuirá. De acordo com projeçõesdas Nações Unidas, a população idosa aumentará de 3,1% em 1970para 19% em 2050. A mudança na distribuição etária da populaçãobrasileira traz oportunidades e desafi os que podem levar a sériosproblemas sociais e econômicas se não forem equacionadosadequadamente nas décadas vindouras.

Distribuição dos escores de cálcio coronariano determinados pela tomografia ultra-rápida em 2.253 homens brancos assintomáticos / Distribution of coronary artery calcium scores determined by ultrafast computed tomography in 2.253 asymptomatic white men

OBJETIVO: Descrever a distribuição dos escores de cálcio coronariano numa população de homens brasileiros brancos assintomáticos submetidos à avaliação pela tomografia ultra-rápida. MÉTODOS: Foram avaliados 2.253 homens de 22-88 anos, submetidos a exame tomográfico num aparelho ImatronR C150 para detecção do cálcio coronariano. Os dados foram separados em 7 faixas etárias: < 40 anos, 40-44 anos, 45-49 anos, 50-54 anos, 55-59 anos, 60-64 anos e >65 anos. RESULTADOS: A média e o desvio padrão da idade foram de 50,0 ± 9,7 anos. Em 48,8 por cento dos casos ocorreu incidência de escore de cálcio coronário > zero, que apresentou distribuição não Gaussiana e mostrou grande variação para a mesma faixa etária. Houve correlação direta entre a idade e o escores de cálcio coronariano (r=0,4, p<0,01). Exceto na comparação entre os indivíduos nas faixas etárias 60-64 anos e, abaixo 55-60 anos e acima de 65 anos, quanto maior a faixa etária maiores as medianas dos escores de cálcio coronariano (p<0,0001). Os escores de cálcio coronariano estão relatados de acordo com os percentis 25,50,75 e 90 para as faixas etárias. CONCLUSAO: Este estudo, primeiro a relatar a distribuição dos escores de cálcio coronariano em uma amostra de homens brasileiros brancos, pode ser útil para estratificação do risco de eventos coronarianos.

Distribution of coronary artery calcium scores determined by ultrafast computed tomography in 2.253 asymptomatic white men.

OBJECTIVE: To describe the distribution of coronary artery calcium scores in a population of asymptomatic white Brazilian men undergoing assessment with ultrafast computed tomography. METHODS: The study assessed 2.253 men aged 22 to 88 years undergoing computed tomography in an Imatron C150 device for detecting coronary calcium. Data were divided based on the patient's age into 7 groups: < 40 years, 40-44 years, 45-49 years, 50-54 years, 55-59 years, 60-64 years, and > 65 years. RESULTS: The mean and standard deviation of age were 50.0 +/- 9.7 years. In 48.8% of the cases, the coronary artery calcium score was > zero, with a non-Gaussian distribution and a large variation for the same age group. A direct correlation between age and the coronary artery calcium score was observed (r = 0.4, P < 0.01). Except for the comparison of individuals in the age groups 60-64 years, below 55-60 years, and above 65 years, the older the age group, the greater the medians of the coronary artery calcium scores (P < 0.0001). Coronary artery calcium scores were reported according to the 25th, 50th, 75th, and 90th percentiles for the age groups. CONCLUSION: This study, the first to report the distribution of the coronary artery calcium scores in a sample of white Brazilian men, may be useful for stratifying the risk of coronary events.

Two-year follow-up study of elderly residents in S. Paulo, Brazil: methodology and preliminary results

Estudos transversais recentes mostraram alta prevalência de doenças crônicas e incapacidades físicas entre idosos. Considerando o rápido processo de envelhecimento do Brasil e as conseqüências que esse aumento de idosos com doenças crônicas e incapacidades associadas acarretará para o sistema de saúde, fazia-se necessário estudo que pudesse superar as limitaçöes dos dados transversais, permitindo determinar quais os fatores determinantes de uma vida longa e livre de doenças incapacitantes, o chamado envelhecimento bem sucedido. É apresentada a metodologia do primeiro estudo epidemiológico longitudinal com idosos residentes na comunidade, no Brasil. O perfil do cohorte inicial é comparado com dados de estudos anteriores a com o perfil dos näo respondentes para avaliar a validade de análises longitudinais futuras. O projeto EPIDOSO (Epidemiologia do Idoso) seguiu por dois anos 1.667 idosos (65+), residentes em Säo Paulo. Consistiu de duas ondas, cada qual com três inquéritos: domiciliar, clínico e laboratorial. O perfil da populaçäo näo diferiu de estudos anteriores, mostrando maioria de mulheres, viúvas, vivendo em domicílios multigeracionais, com uma alta prevalência de doenças crônicas, distúrbios psiquiátricos e incapacidades físicas. A despeito de todas as dificuldades inerentes a um estudo longitudinal, o grupo de näo-respondentes ao segundo inquérito domiciliar näo diferiu significativamente dos respondentes, assegurando análises longitudinais livres desse tipo de viés. Em relaçäo aos inquéritos clínico e laboratorial, os näo-respondentes mostraram-se mais velhos e mais incapacitados que os respondentes, limitando o uso dos dados clínicos e laboratoriais a análises pertinentes a uma cohorte mais jovem e saudável. Sexo, educaçäo, apoio familiar e nível socioeconômico näo influenciaram de forma significativa a taxa de näo-resposta, ao contrário do que se costuma verificar