Compulsory notification at skilled nursing facilities.

INTRODUCTION:: Notifiable diseases (NDs) encompass conditions of high clinical severity and/or contagious. Being closed communities, long-term care facilities (LTCF) are places that deserve attention on their own, but one might be left wondering: what is the reality of NDs at Brazilian LTCFs? OBJECTIVE:: To determine the prevalence and type of NDs at large LTCF. METHOD:: Active search for NDs conducted by the Hospital Infection Control Committee (HICC) in 459 beds. Due to the low turnover of patients, the monthly list kept by the HICC on NDs was analyzed. Data were grouped into males and females, and into elderly (age ≥ 60 years) and non-elderly (age ≤ 59 years). RESULTS:: 31 diseases in 29 patients (6.9% of all inpatients - 19 males and 10 females): 23 cases of hepatitis C, five of hepatitis B, two of human immunodeficiency virus (HIV), and one case of renal tuberculosis. One patient with hepatitis B and another HIV-positive also had hepatitis C. There was no statistical significance in the comparison of the two groups with the total number of other institutionalized patients - by age and gender - for total number of NDs and cases of hepatitis C (p>0.05). CONCLUSION:: Chronic NDs and those requiring chronic treatment observed in this study suggest that Brazil needs more studies to define the dynamics of these diseases at LTCFs.

Compulsory notification at skilled nursing facilities / Notificação compulsória em instituição asilar

Summary Introduction: Notifiable diseases (NDs) encompass conditions of high clinical severity and/or contagious. Being closed communities, long-term care facilities (LTCF) are places that deserve attention on their own, but one might be left wondering: what is the reality of NDs at Brazilian LTCFs? Objective: To determine the prevalence and type of NDs at large LTCF. Method: Active search for NDs conducted by the Hospital Infection Control Committee (HICC) in 459 beds. Due to the low turnover of patients, the monthly list kept by the HICC on NDs was analyzed. Data were grouped into males and females, and into elderly (age ≥ 60 years) and non-elderly (age ≤ 59 years). Results: 31 diseases in 29 patients (6.9% of all inpatients - 19 males and 10 females): 23 cases of hepatitis C, five of hepatitis B, two of human immunodeficiency virus (HIV), and one case of renal tuberculosis. One patient with hepatitis B and another HIV-positive also had hepatitis C. There was no statistical significance in the comparison of the two groups with the total number of other institutionalized patients - by age and gender - for total number of NDs and cases of hepatitis C (p>0.05). Conclusion: Chronic NDs and those requiring chronic treatment observed in this study suggest that Brazil needs more studies to define the dynamics of these diseases at LTCFs.

Resumo Introdução: Doenças de notificação compulsória (DNC) abrangem quadros de alta gravidade clínica e/ou de contágio. Sendo comunidades fechadas, instituições de longa permanência para idosos (ILPI) são locais que merecem atenção quanto a elas. Mas qual seria a realidade das DNC em ILPI brasileiras? Objetivo: Determinar prevalência e tipo de DNC em ILPI de grande porte. Método: Busca ativa de DNC pela Comissão de Controle de Infecção Hospitalar (CCIH) em 459 leitos. Em razão da baixa rotatividade de pacientes, analisou-se lista mensal da CCIH sobre DNC. Dividiram-se os dados entre homens e mulheres e entre idosos (idade ≥ 60 anos) e não idosos (idade ≤ 59 anos). Resultados: 31 doenças em 29 pacientes (6,9% do total de internados - 19 homens e 10 mulheres): 23 casos de hepatite C, cinco de hepatite B, dois de positividade sorológica ao vírus da imunodeficiência humana (HIV) e um caso de tuberculose renal. Um paciente com hepatite B e outro com HIV positivo eram também portadores de hepatite C. Não houve significância estatística quando foram comparados os dois grupos com o total dos outros internados - por idade e gênero - pelo total de DNC e nos casos de hepatite C (p>0,05). Conclusão: Pesquisa em 15/11/2008 no portal http://www.scielo.br/não detectou casuísticas em ILPI, exceto por revisões sobre tuberculose. DNC de caráter e/ou tratamento crônico observadas neste estudo sugerem a necessidade de maior número de publicações para definir a dinâmica dessas doenças em ILPI brasileiras.

Human immunodeficiency virus in institutionalized elderly people / Vírus da imunodeficiência humana em idosos institucionalizados

ABSTRACT CONTEXT AND OBJECTIVE: A search in the SciELO and PubMed databases showed few studies on human immunodeficiency virus (HIV) positive individuals in long-term care institutions (LTCIs), thus prompting the present study. The aim of this study was to ascertain whether there were any HIV-positive individuals in LTCIs for the elderly. DESIGN AND SETTING: Cross-sectional study in which the Hospital Infection Control Committee (HICC) of a 405-bed LTCI was consulted. METHODS: The medical records of 405 individuals interned in the LTCI who had been tested for HIV infection were requested for analysis of the following variables: [1] age and gender; [2] length of stay at LTCI (months); [3] causes and diagnoses on admission to LTCI according to International Classification of Diseases, 10th edition; [4] date of HIV diagnosis; [5] seropositivity for syphilis and hepatitis B and C viruses; [6] medications used at last prescription in medical file; and [7] mean CD4 lymphocyte count based on: total lymphocyte count/6 and total lymphocyte count x 0.8 x 0.2 or 0.3. RESULTS: Four men were HIV-positive, with mean age 71.2 ± 8.6 years, LTCI stay 74.2 ± 38.1 months and length of HIV diagnosis 24.5 ± 17 months (confirmed by HICC standard screening). Three had stroke sequelae; one, dementia syndrome; two, seropositivity for syphilis; two, hepatitis B and one, hepatitis C. The main drugs used were lamivudine, zidovudine, lopinavir, ritonavir, levothyroxine, omeprazole, ranitidine, lactulose and risperidone. The estimated CD4 count was 341 ± 237/mm3. CONCLUSIONS: HIV-positive individuals are present in LTCIs, diagnosable through serological screening and treatable with antiretroviral drugs.

RESUMO CONTEXTO E OBJETIVO: Busca nos portais SciELO e PubMed encontrou poucos estudos sobre indivíduos positivos para o vírus da imunodeficiência humana (HIV) em instituições de longa permanência para idosos (ILPIs), fato este que justifica o presente estudo. O objetivo foi verificar se há soropositivos para o HIV em instituições de ILPIs. TIPO DE ESTUDO E LOCAL: Estudo transversal por consulta à Comissão de Controle de Infecção Hospitalar (CCIH) de ILPI com 405 leitos. MÉTODOS: Solicitaram-se 405 prontuários de pacientes internados, nos quais se pesquisou sorologia reagente ao HIV para análise de: [1] idade e gênero; [2] período de internação na ILPI (meses); [3] causa(s) e diagnósticos à internação na ILPI pela Classificação Internacional de Doenças, 10a edição; [4] data do diagnóstico do HIV; [5] soropositividade para sífilis e vírus da hepatite B e C; [6] medicamentos em uso na última prescrição no prontuário; e [7] média de linfócitos CD4 baseada em: número total de linfócitos/6 e número total de linfócitos x 0,8 x 0,2 ou 0,3. RESULTADOS: Quatro homens eram HIV-positivos. Eles tinham 71,2 ± 8,6 anos de idade; 74,2 ± 38,1 meses na ILPI e 24,5 ± 17 meses de soropositividade (diagnósticos realizados como triagem padrão da CCIH). Havia sequelas de acidente vascular cerebral em 3 e síndrome demencial em 1; sorologias positivas para sífilis em 2, vírus hepatite B em 2 e C em 1. Os principais fármacos utilizados eram: lamivudina, zidovudina, lopinavir, ritonavir, levotiroxina, omeprazol, ranitidina, lactulona e risperidona. O CD4 foi estimado em 341 ± 237/mm3. CONCLUSÕES: Há soropositivos para o HIV em ILPIs, passíveis de diagnóstico em triagens sorológicas e de tratamento com antirretrovirais.

Human immunodeficiency virus in institutionalized elderly people.

CONTEXT AND OBJECTIVE:: A search in the SciELO and PubMed databases showed few studies on human immunodeficiency virus (HIV) positive individuals in long-term care institutions (LTCIs), thus prompting the present study. The aim of this study was to ascertain whether there were any HIV-positive individuals in LTCIs for the elderly. DESIGN AND SETTING:: Cross-sectional study in which the Hospital Infection Control Committee (HICC) of a 405-bed LTCI was consulted. METHODS:: The medical records of 405 individuals interned in the LTCI who had been tested for HIV infection were requested for analysis of the following variables: [1] age and gender; [2] length of stay at LTCI (months); [3] causes and diagnoses on admission to LTCI according to International Classification of Diseases, 10th edition; [4] date of HIV diagnosis; [5] seropositivity for syphilis and hepatitis B and C viruses; [6] medications used at last prescription in medical file; and [7] mean CD4 lymphocyte count based on: total lymphocyte count/6 and total lymphocyte count x 0.8 x 0.2 or 0.3. RESULTS:: Four men were HIV-positive, with mean age 71.2 ± 8.6 years, LTCI stay 74.2 ± 38.1 months and length of HIV diagnosis 24.5 ± 17 months (confirmed by HICC standard screening). Three had stroke sequelae; one, dementia syndrome; two, seropositivity for syphilis; two, hepatitis B and one, hepatitis C. The main drugs used were lamivudine, zidovudine, lopinavir, ritonavir, levothyroxine, omeprazole, ranitidine, lactulose and risperidone. The estimated CD4 count was 341 ± 237/mm3. CONCLUSIONS:: HIV-positive individuals are present in LTCIs, diagnosable through serological screening and treatable with antiretroviral drugs.

Cognitive and renal dysfunction in the elderly / Alterações cognitivas e renal nos idosos

Cognitive impairment has been associated with several diseases and organic disturbances but few studies have explored the relationship between renal function and cognition.OBJECTIVE: The aim of this study was to compare the renal function of elderly patients with and without Alzheimer's disease, and to identify potential associated comorbidities, as well as the presence of microalbuminuria. METHODS: A group of 60 patients with dementia syndrome and probable Alzheimer's disease, and 20 patients without dementias, followed at the Geriatric outpatient unit of the Santa Casa de São Paulo Hospital, were selected for this study.RESULTS: The results showed that the groups studied differed in terms of age, gender and Mini-Mental State Exam score, but no statistical difference was found for the presence of comorbidities (diabetes mellitus, dyslipidemia and systemic arterial hypertension). A significant difference in estimated creatinine clearance was observed between the two groups, with the Alzheimer's disease patients presenting significantly lower values than control subjects. Similarly, analysis of a portion of the two groups for the presence of microalbuminuria revealed a statistically significant difference between the two groups. CONCLUSION: The study conclusions were that patients with Alzheimer's disease had lower glomerular filtration and a higher incidence of microalbuminuria, yet without having more classic risk factors for Alzheimer's disease such as systemic arterial hypertension, diabetes mellitus or dyslipidemia.

Alterações cognitivas são associadas a diversas doenças e distúrbios orgânicos, mas poucos estudos exploram a relação entre a função renal e a cognição. OBJETIVO: Este estudo buscou comparar a função renal de pacientes com e sem demência de Alzheimer, além de identificar possíveis comorbidades associadas e a presença de microalbuminúria. MÉTODOS: Foram selecionados 60 pacientes com síndrome demencial, provável doença de Alzheimer e 20 pacientes sem qualquer demência, que estavam em acompanhamento no ambulatório de Geriatria da Santa Casa de São Paulo. RESULTADOS: Os resultados mostraram que os grupos estudados diferiram em relação à idade, sexo e mini-exame do estado mental, mas não houve diferença estatística quanto à presença de comorbidades (diabetes mellitus, dislipidemia e hipertensão arterial sistêmica). Em relação ao clearance de creatinina observou-se uma diferença significativa entre os grupos, o com doença de Alzheimer apresentou um valor significativamente menor que o controle. Também a análise da presença de microalbuminúria entre uma parte dos dois grupos estudados, mostrou uma diferença estatística significante. CONCLUSÃO: Concluiu-se que os pacientes com doença de Alzheimer tiveram menor filtração glomerular e maior percentual de microalbuminúria, mesmo sem apresentarem mais fatores de riscos clássicos para a doença de Alzheimer, como hipertensão arterial sistêmica, diabetes mellitus e dislipidemia.

Neuropsychiatric symptoms and severity of dementia / Sintomas neuropsiquiátricos e gravidade da demência

Neuropsychiatric symptoms (NPS) cause distress, disabilitiy and reduced quality of life for both the patient and their families OBJECTIVE: To evaluate the prevalence of NPS as a specific stage of dementia status. METHODS: A cross-sectional study in patients attending an outpatient clinic for dementia was performed. We applied the Neuropsychiatric Inventory and Clinical Dementia Rating (CDR) scale. Statistical analysis was carried out with SPSS 17 software. RESULTS: The 124 subjects (mean age of 80.4±7.0 years), 88 women (70.9%) had average duration of dementia of 7.1±3.2 years, most common dementias of Alzheimer's disease (35.5%) and mixed (31.5%) and most prevalent NPS of apathy (75%) and irritability (66.9%). Correlation between apathy and a CDR 1 had a PR (prevalence ratio) = 0.289 and p<0.001 while between apathy and CDR 4-5 (PR=8.333, p<0.005). A similar result was found between aberrant motor behavior (AMB) and CDR 1 (PR=0.352, p<0.003) and between AMB and CDR4-5 (PR=2.929, p<0.006). CONCLUSION: Alzheimer's disease and mixed dementia were predominant, while apathy and AMB were detected in association with the progressive stages of dementia.

Sintomas neuropsiquiátricos (SNPs) causam sofrimento, incapacidade e redução da qualidade de vida do paciente e das famílias. OBJETIVO: Avaliar a prevalência de SNPs específicos conforme a fase do estado demencial. MÉTODOS: Estudo transversal em pacientes atendidos em ambulatório de demências. Aplicou-se Inventário Neuropsiquiátrico e Clinical Dementia Rating (CDR). Realizada análise estatística com o software SPSS 17. RESULTADOS: 124 idosos (idade média de 80,4±7,0 anos), 88 mulheres (70,9%). Tempo médio de demência: 7,1±3,2 anos. Demências mais frequentes: doença de Alzheimer (35,5%) e mista (31,5%). Sintomas neuropsiquiátricos mais prevalentes: apatia (75%) e irritabilidade (66,9%). Correlação entre apatia e CDR 1 tem RP (razão de prevalências) = 0,289 e p<0,001 e entre apatia e CDR 4-5; RP=8,333; p<0,005, o mesmo ocorrendo entre comportamento motor aberrante (CMA) e CDR 1 (RP=0,352; p<0.003) e CMA e CDR4-5 (RP=2,929; p<0,006). CONCLUSÃO: Houve predomínio de demência de Alzheimer e demência mista e se detectou apatia e CMA em associação progressiva com as fases do quadro demencial.

Senile dementia and pharmacological drugs / A demência senil e drogas farmacológicas

Side effects and drug interactions are common in the elderly and highly relevant in the demented, being routinely confused with symptoms of cognitive impairment. Which drugs are most consumed by this patient group? Do prescription patterns differ between the demented and non-demented? OBJECTIVE: To define drug consumption quantitatively and qualitatively in demented (D) and non-demented (ND) elderly. METHODS: Patients were divided into men and women, by age group (<80 and >80 years), non-demented and demented status, and consumers of <3 or >3 drugs. As a criterion comparing groups, the Chi-square (Fisher's exact) test was employed. This study is part of Project No. 405/10 approved by the Ethics Committee of the institution. RESULTS: The sample had a mean age of 81.5±8.8 years, 29 D (21 women and 8 men) and 21 ND (16 women and 5 men), 12 consumers of up to three drugs (7 D and 5 ND) and 38 consumers of 3 medications or more (22 D and 16 ND). The most used drugs among dementia patients were aspirin, angiotensin-converting enzyme inhibitors, statins, selective serotonin reuptake inhibitors, and vitamins. Drugs most consumed by non-demented included vitamins, aspirin, calcium carbonate, proton pump inhibitors, statins and alendronate sodium. There was no statistical significance on any of the comparisons, although the number of elderly consumers of vitamins in the ND had a p-value of 0.06 (Yates). CONCLUSION: The elderly in this series, regardless of dementia status, gender or age group, had similar drug consumption patterns and used multiple drugs simultaneously.

Iatrogenias, efeitos colaterais e interações medicamentosas são comuns em idosos e altamente relevantes em dementados, onde corriqueiramente as manifestações decorrentes são confundidas com disfunção cognitiva. Quais seriam os medicamentos mais consumidos por esses pacientes? O padrão de prescrição diferiria dos não-dementados? OBJETIVO: Definir os padrões de consumo medicamentoso, quantitativos e qualitativos em dementados (D) e não-dementados (ND). MÉTODOS: Casuística dividida entre homens e mulheres, por idade (<80 e >80 anos), dementados e não-dementados, consumidores de <3 ou >3 medicamentos. Como critério comparativo entre grupos, utilizou-se qui-quadrado (teste exato de Fisher). Esse estudo faz parte do Projeto No. 405/10 aprovado pelo Comitê de Ética em Pesquisa da Irmandade da Santa Casa de Misericórdia de São Paulo. RESULTADOS: A Idade média foi de 81,5±8,8 anos, 29 D (21 mulheres e 8 homens) e 21 ND (16 mulheres e 5 homens), 12 consumidores de até 3 medicamentos (7 D e 5 ND) e 38 consumidores de mais de 3 medicamentos (22 D e 16 ND). Os medicamentos mais consumidos entre os dementados foram: ácido acetil salicílico, inibidores da enzima conversora da angiotensina, estatinas, inibidores da recaptação da serotonina e vitaminas. Fármacos mais consumidos entre os não-dementados: vitaminas, ácido acetil salicílico, carbonato de cálcio, inibidores da bomba de prótons, estatinas e alendronato de sódio. Não houve significância estatística nas comparações entre os grupos D e ND, embora o número de idosos ND consumidores de vitaminas apresente p 0,06 (Yates). CONCLUSÃO: Na presente casuística, dementados ou não, independentemente do gênero ou da faixa de idade, apresentam padrão medicamentoso semelhante, merecendo ênfase a multiplicidade de fármacos em uso simultaneamente.

Neuropsychiatric symptoms and severity of dementia.

Neuropsychiatric symptoms (NPS) cause distress, disabilitiy and reduced quality of life for both the patient and their families. OBJECTIVE: To evaluate the prevalence of NPS as a specific stage of dementia status. METHODS: A cross-sectional study in patients attending an outpatient clinic for dementia was performed. We applied the Neuropsychiatric Inventory and Clinical Dementia Rating (CDR) scale. Statistical analysis was carried out with SPSS 17 software. RESULTS: The 124 subjects (mean age of 80.4±7.0 years), 88 women (70.9%) had average duration of dementia of 7.1±3.2 years, most common dementias of Alzheimer's disease (35.5%) and mixed (31.5%) and most prevalent NPS of apathy (75%) and irritability (66.9%). Correlation between apathy and a CDR 1 had a PR (prevalence ratio) = 0.289 and p<0.001while between apathy and CDR 4-5 (PR=8.333, p<0.005). A similar result was found between aberrant motor behavior (AMB) and CDR 1 (PR=0.352, p<0.003) and between AMB and CDR4-5 (PR=2.929, p<0.006). CONCLUSION: Alzheimer's disease and mixed dementia were predominant, while apathy and AMB were detected in association with the progressive stages of dementia.

Sintomas neuropsiquiátricos (SNPs) causam sofrimento, incapacidade e redução da qualidade de vida do paciente e das famílias. OBJETIVO: Avaliar a prevalência de SNPs específicos conforme a fase do estado demencial. MÉTODOS: Estudo transversal em pacientes atendidos em ambulatório de demências. Aplicou-se Inventário Neuropsiquiátrico e Clinical Dementia Rating (CDR). Realizada análise estatística com o software SPSS 17. RESULTADOS: 124 idosos (idade média de 80,4±7,0 anos), 88 mulheres (70,9%). Tempo médio de demência: 7,1±3,2 anos. Demências mais frequentes: doença de Alzheimer (35,5%) e mista (31,5%). Sintomas neuropsiquiátricos mais prevalentes: apatia (75%) e irritabilidade (66,9%). Correlação entre apatia e CDR 1 tem RP (razão de prevalências) = 0,289 e p<0,001 e entre apatia e CDR 4-5; RP=8,333; p<0,005, o mesmo ocorrendo entre comportamento motor aberrante (CMA) e CDR 1 (RP=0,352; p<0.003) e CMA e CDR4-5 (RP=2,929; p<0,006). CONCLUSÃO: Houve predomínio de demência de Alzheimer e demência mista e se detectou apatia e CMA em associação progressiva com as fases do quadro demencial.

Senile dementia and pharmacological drugs.

Side effects and drug interactions are common in the elderly and highly relevant in the demented, being routinely confused with symptoms of cognitive impairment. Which drugs are most consumed by this patient group? Do prescription patterns differ between the demented and non-demented? OBJECTIVE: To define drug consumption quantitatively and qualitatively in demented (D) and non-demented (ND) elderly. METHODS: Patients were divided into men and women, by age group (<80 and ≥80 years), non-demented and demented status, and consumers of ≤3 or >3 drugs. As a criterion comparing groups, the Chi-square (Fisher's exact) test was employed. This study is part of Project No. 405/10 approved by the Ethics Committee of the institution. RESULTS: The sample had a mean age of 81.5±8.8 years, 29 D (21 women and 8 men) and 21 ND (16 women and 5 men), 12 consumers of up to three drugs (7 D and 5 ND) and 38 consumers of 3 medications or more (22 D and 16 ND). The most used drugs among dementia patients were aspirin, angiotensin-converting enzyme inhibitors, statins, selective serotonin reuptake inhibitors, and vitamins. Drugs most consumed by non-demented included vitamins, aspirin, calcium carbonate, proton pump inhibitors, statins and alendronate sodium. There was no statistical significance on any of the comparisons, although the number of elderly consumers of vitamins in the ND had a p-value of 0.06 (Yates). CONCLUSION: The elderly in this series, regardless of dementia status, gender or age group, had similar drug consumption patterns and used multiple drugs simultaneously.

Iatrogenias, efeitos colaterais e interações medicamentosas são comuns em idosos e altamente relevantes em dementados, onde corriqueiramente as manifestações decorrentes são confundidas com disfunção cognitiva. Quais seriam os medicamentos mais consumidos por esses pacientes? O padrão de prescrição diferiria dos não-dementados? OBJETIVO: Definir os padrões de consumo medicamentoso, quantitativos e qualitativos em dementados (D) e não-dementados (ND). MÉTODOS: Casuística dividida entre homens e mulheres, por idade (<80 e ≥80 anos), dementados e não-dementados, consumidores de ≤3 ou >3 medicamentos. Como critério comparativo entre grupos, utilizou-se qui-quadrado (teste exato de Fisher). Esse estudo faz parte do Projeto No. 405/10 aprovado pelo Comitê de Ética em Pesquisa da Irmandade da Santa Casa de Misericórdia de São Paulo. RESULTADOS: A Idade média foi de 81,5±8,8 anos, 29 D (21 mulheres e 8 homens) e 21 ND (16 mulheres e 5 homens), 12 consumidores de até 3 medicamentos (7 D e 5 ND) e 38 consumidores de mais de 3 medicamentos (22 D e 16 ND). Os medicamentos mais consumidos entre os dementados foram: ácido acetil salicílico, inibidores da enzima conversora da angiotensina, estatinas, inibidores da recaptação da serotonina e vitaminas. Fármacos mais consumidos entre os não-dementados: vitaminas, ácido acetil salicílico, carbonato de cálcio, inibidores da bomba de prótons, estatinas e alendronato de sódio. Não houve significância estatística nas comparações entre os grupos D e ND, embora o número de idosos ND consumidores de vitaminas apresente p 0,06 (Yates). CONCLUSÃO: Na presente casuística, dementados ou não, independentemente do gênero ou da faixa de idade, apresentam padrão medicamentoso semelhante, merecendo ênfase a multiplicidade de fármacos em uso simultaneamente.

Cognitive and renal dysfunction in the elderly.

Cognitive impairment has been associated with several diseases and organic disturbances but few studies have explored the relationship between renal function and cognition. OBJECTIVE: The aim of this study was to compare the renal function of elderly patients with and without Alzheimer's disease, and to identify potential associated comorbidities, as well as the presence of microalbuminuria. METHODS: A group of 60 patients with dementia syndrome and probable Alzheimer's disease, and 20 patients without dementias, followed at the Geriatric outpatient unit of the Santa Casa de São Paulo Hospital, were selected for this study. RESULTS: The results showed that the groups studied differed in terms of age, gender and Mini-Mental State Exam score, but no statistical difference was found for the presence of comorbidities (diabetes mellitus, dyslipidemia and systemic arterial hypertension). A significant difference in estimated creatinine clearance was observed between the two groups, with the Alzheimer's disease patients presenting significantly lower values than control subjects. Similarly, analysis of a portion of the two groups for the presence of microalbuminuria revealed a statistically significant difference between the two groups. CONCLUSION: The study conclusions were that patients with Alzheimer's disease had lower glomerular filtration and a higher incidence of microalbuminuria, yet without having more classic risk factors for Alzheimer's disease such as systemic arterial hypertension, diabetes mellitus or dyslipidemia.

Alterações cognitivas são associadas a diversas doenças e distúrbios orgânicos, mas poucos estudos exploram a relação entre a função renal e a cognição. OBJETIVO: Este estudo buscou comparar a função renal de pacientes com e sem demência de Alzheimer, além de identificar possíveis comorbidades associadas e a presença de microalbuminúria. MÉTODOS: Foram selecionados 60 pacientes com síndrome demencial, provável doença de Alzheimer e 20 pacientes sem qualquer demência, que estavam em acompanhamento no ambulatório de Geriatria da Santa Casa de São Paulo. RESULTADOS: Os resultados mostraram que os grupos estudados diferiram em relação à idade, sexo e mini-exame do estado mental, mas não houve diferença estatística quanto à presença de comorbidades (diabetes mellitus, dislipidemia e hipertensão arterial sistêmica). Em relação ao clearance de creatinina observou-se uma diferença significativa entre os grupos, o com doença de Alzheimer apresentou um valor significativamente menor que o controle. Também a análise da presença de microalbuminúria entre uma parte dos dois grupos estudados, mostrou uma diferença estatística significante. CONCLUSÃO: Concluiu-se que os pacientes com doença de Alzheimer tiveram menor filtração glomerular e maior percentual de microalbuminúria, mesmo sem apresentarem mais fatores de riscos clássicos para a doença de Alzheimer, como hipertensão arterial sistêmica, diabetes mellitus e dislipidemia.

Potentially inappropriate medications in elderly.

OBJECTIVE: To compare PRISCUS with Beers-Fick in detecting potentially inappropriate medication (PIMs) in elderly at their first outpatient geriatric visit. METHODS: Retrospective medical record analysis by PRISCUS and Beers-Fick adapted to Brazilian pharmacopoeia, comparing the finding of PIMs at the first outpatient geriatric visit by both criteria. RESULTS: Cases had mean age of 77.4 ± 7.7 years (64 females and 36 males), and mean consumption of 3.9 ± 2.5 drugs. This study found statistical significance for the numbers of women using benzodiazepines and men using salicylates. The mean was 0.5 ± 0.7 PIMs/patient by Beers-Fick criteria and 0.7 ± 0.8 PIMs/patient by PRISCUS. Medications most often reported by Beers-Fick criteria were: benzodiazepines, methyldopa and ergot-derived drugs. Medications most often reported by PRISCUS criteria were: benzodiazepines, antihypertensive drugs, and tricyclic antidepressants. No statistical significance was found when the number of elderly patients with PIMs was compared between both criteria. Statistical significance was found (PRISCUS versus Beers-Fick) for the consumption of long acting benzodiazepines and laxatives. Both criteria do not include drugs such as vitamins, herbal medications, and eye drops, reported by a percentage of cases. CONCLUSION: Both criteria are useful to prevent PIMs in the elderly, with PRISCUS being more updated and comprehensive, but they are not complete for the Brazilian outpatient reality.

Medicamentos potencialmente inapropriados para idosos / Potentially inappropriate medications in elderly

OBJETIVO: Comparar PRISCUS com Beers-Fick na detecção de medicamentos potencialmente inapropriados (MPI) para idosos à primeira consulta ambulatorial geriátrica. MÉTODOS: Análise retrospectiva de prontuários por PRISCUS e Beers-Fick adaptados à farmacopeia brasileira, comparando-se o encontro de MPI à primeira consulta ambulatorial geriátrica pelos dois critérios. RESULTADOS: Idade média de 77,4 ± 7,7 anos, 64 mulheres e 36 homens, consumo médio de 3,9 ± 2,5 fármacos. Este estudo encontrou significância estatística no número de mulheres em uso de benzodiazepínicos e de homens quanto a salicilatos. Média de 0,5 ± 0,7 MPI/paciente por Beers-Fick e 0,7 ± 0,8 MPI/paciente pela PRISCUS. Medicamentos de Beers-Fick mais referidos: benzodiazepínicos, metildopa e derivados do ergot. Medicamentos de PRISCUS mais referidos: benzodiazepínicos, anti-hipertensivos e antidepressivos tricíclicos. Não houve significância estatística comparando-se o número de idosos com MPI pelos dois critérios. Constatou-se significância estatística (PRISCUS versus Beers-Fick) no consumo de benzodiazepínicos de longa ação e laxantes. Ambos não incluem fármacos como vitaminas, fitoterápicos e colírios, relatados por percentual da casuística. CONCLUSÃO: Os dois critérios são úteis para a prevenção de MPI em idosos, sendo PRISCUS mais atualizada e abrangente, mas não são completos para a realidade ambulatorial brasileira.

OBJECTIVE: To compare PRISCUS with Beers-Fick in detecting potentially inappropriate medication (PIMs) in elderly at their first outpatient geriatric visit. METHODS: Retrospective medical record analysis by PRISCUS and Beers-Fick adapted to Brazilian pharmacopoeia, comparing the finding of PIMs at the first outpatient geriatric visit by both criteria. RESULTS: Cases had mean age of 77.4 ± 7.7 years (64 females and 36 males), and mean consumption of 3.9 ± 2.5 drugs. This study found statistical significance for the numbers of women using benzodiazepines and men using salicylates. The mean was 0.5 ± 0.7 PIMs/patient by Beers-Fick criteria and 0.7 ± 0.8 PIMs/patient by PRISCUS. Medications most often reported by Beers-Fick criteria were: benzodiazepines, methyldopa and ergot-derived drugs. Medications most often reported by PRISCUS criteria were: benzodiazepines, antihypertensive drugs, and tricyclic antidepressants. No statistical significance was found when the number of elderly patients with PIMs was compared between both criteria. Statistical significance was found (PRISCUS versus Beers-Fick) for the consumption of long acting benzodiazepines and laxatives. Both criteria do not include drugs such as vitamins, herbal medications, and eye drops, reported by a percentage of cases. CONCLUSION: Both criteria are useful to prevent PIMs in the elderly, with PRISCUS being more updated and comprehensive, but they are not complete for the Brazilian outpatient reality.

Deaths in nursing homes.

OBJECTIVE: To define the causes of death in a nursing home population. METHODS: The study selected a 508-bed nursing home with standard medical records, regular meetings concerning death certificates and 12 medical doctors in charge of supervising or issuing death certificates. The procedure standard (2006 death certificates) was considered consistent enough to undergo the analysis. The collected data were gender, age, cause(s) of death and underlying disease(s). The statistical analysis compared data between the two genders and two age ranges (< 75 years and > 75 years). RESULTS: There were 118 deaths in 2006 (mean age: 74.5 ± 15.2 years) - 64 women (mean age: 78.4 ± 14.4 years old) and 54 men (mean age: 69.8 ± 15.0 years old). Causes of death were sepsis (41 deaths), septic shock (25), bronchopneumonia (16), sudden death (11), multiple-organ failure (9) and other causes (16 deaths). The main underlying diseases were infections (63 deaths) - bronchopneumonia (34), sepsis (12), urinary tract infection (7) infected pressure ulcers (7), osteomyelitis (2) and bile duct infection (1); immobility syndrome (42 deaths). The proportion of women older than 75 years showed statistical significance concerning the number of deaths. The sample did not show statistical significance regarding seasonality, causes of death or underlying disease(s) when comparing infectious and noninfectious causes of death vs. men and women, aged older or younger than 75 years. CONCLUSION: Deaths in nursing homes were basically caused by a combination of immobility and infections that developed into sepsis.

Óbitos em instituição asilar / Deaths in nursing homes

OBJETIVO: Definir as causas de morte em população internada em instituição de longa permanência para idosos (ILPI) MÉTODOS: ILPI de 508 leitos com prontuários padronizados, reuniões periódicas sobre atestados de óbitos e com 12 médicos responsáveis pela supervisão e/ou emissão deles. Considerou-se o padrão deste procedimento suficientemente uniforme para análise dos prontuários e atestados de óbitos emitidos durante o ano de 2006, visando definir dados gerais (sexo e idade), causa da morte e causa(s) básica(s). Análise estatística comparou casuísticas entre os dois sexos e faixas etárias (< 75 anos e > 75 anos de idade). RESULTADOS: Ocorreram 118 óbitos durante o ano de 2006 (idade média: 74,5 ± 15,2 anos) - 64 mulheres (idade média: 78,4 ± 14,4 anos) e 54 homens (idade média: 69,8 ± 15,0 anos) -, sendo as causas de morte: sepse( 41 óbitos), choque séptico (25), broncopneumonia (16), morte súbita (11), falência de múltiplos órgãos (9), outras causas (16 óbitos). As principais causas básicas foram infecciosas (63 óbitos) - broncopneumonia (34), sepse (12), infecção urinária (7), úlceras de pressão infectadas (7), osteomielite (2) e colangite (1); seguidas da síndrome da imobilidade (42 óbitos). Observou-se significância estatística para a proporção de idosas > 75 anos e não houve para sazonalidade, causa de morte ou básica considerando-se infecciosas e não infecciosas versus homens e mulheres, maiores ou menores de 75 anos de idade. CONCLUSÃO: Óbitos em ILPI decorrem basicamente da somatória de imobilidade e infecções que evoluem para quadros sépticos.

OBJECTIVE: To define the causes of death in a nursing home population. METHODS: The study selected a 508-bed nursing home with standard medical records, regular meetings concerning death certificates and 12 medical doctors in charge of supervising or issuing death certificates. The procedure standard (2006 death certificates) was considered consistent enough to undergo the analysis. The collected data were gender, age, cause(s) of death and underlying disease(s). The statistical analysis compared data between the two genders and two age ranges (< 75 years and > 75 years). RESULTS: There were 118 deaths in 2006 (mean age: 74.5 ± 15.2 years) - 64 women (mean age: 78.4 ± 14.4 years old) and 54 men (mean age: 69.8 ± 15.0 years old). Causes of death were sepsis (41 deaths), septic shock (25), bronchopneumonia (16), sudden death (11), multiple-organ failure (9) and other causes (16 deaths). The main underlying diseases were infections (63 deaths) - bronchopneumonia (34), sepsis (12), urinary tract infection (7) infected pressure ulcers (7), osteomyelitis (2) and bile duct infection (1); immobility syndrome (42 deaths). The proportion of women older than 75 years showed statistical significance concerning the number of deaths. The sample did not show statistical significance regarding seasonality, causes of death or underlying disease(s) when comparing infectious and noninfectious causes of death vs. men and women, aged older or younger than 75 years. CONCLUSION: Deaths in nursing homes were basically caused by a combination of immobility and infections that developed into sepsis.

Beers-Fick criteria and drugs available through the Farmácia Dose Certa program.

CONTEXT AND OBJECTIVE: Farmácia Dose Certa is a program available in the State of São Paulo that is a national reference for providing drugs free of charge to the population. Elderly people receiving care deserve special attention regarding drugs that are appropriate for their age group. The objective was to assess the drugs in the program considered to be inappropriate for the elderly. DESIGN AND SETTING: Descriptive study evaluating free drug distribution in the State of São Paulo, Brazil. METHODS: Following the criteria proposed by Beers and Fick (drugs or drug classes that should be avoided among elderly people, independent of the diagnosis or clinical condition, because of the high risk of side effects and because other, safer drugs are available), the drugs in the Farmácia Dose Certa program that might be inappropriate for elderly people and the levels of evidence for each drug included were assessed. RESULTS: Among the available drugs, 10 (25.6%) were included within the Beers-Fick criteria. The drugs selected were: amitriptyline, cimetidine, diazepam, digoxin, fluoxetine, methyldopa, nifedipine, promethazine, thioridazine and ferrous sulfate. CONCLUSION: The list of drugs available within the Farmácia Dose Certa program may be considered appropriate for the general population, but not completely for the elderly population. Adjusting this list to the pharmacological aspects of aging will reduce the risks of drug interactions, falls, mental confusion and excessive sedation that result from drugs that are considered inappropriate for consumption by elderly people.

Beers-Fick criteria and drugs available through the Farmácia Dose Certa program / Critérios de Beers-Fick e medicamentos disponíveis no Programa Farmácia Dose Certa

CONTEXT AND OBJECTIVE: Farmácia Dose Certa is a program available in the State of São Paulo that is a national reference for providing drugs free of charge to the population. Elderly people receiving care deserve special attention regarding drugs that are appropriate for their age group. The objective was to assess the drugs in the program considered to be inappropriate for the elderly. DESIGN AND SETTING: Descriptive study evaluating free drug distribution in the State of São Paulo, Brazil. METHODS: Following the criteria proposed by Beers and Fick (drugs or drug classes that should be avoided among elderly people, independent of the diagnosis or clinical condition, because of the high risk of side effects and because other, safer drugs are available), the drugs in the Farmácia Dose Certa program that might be inappropriate for elderly people and the levels of evidence for each drug included were assessed. RESULTS: Among the available drugs, 10 (25.6 percent) were included within the Beers-Fick criteria. The drugs selected were: amitriptyline, cimetidine, diazepam, digoxin, fluoxetine, methyldopa, nifedipine, promethazine, thioridazine and ferrous sulfate. CONCLUSION: The list of drugs available within the Farmácia Dose Certa program may be considered appropriate for the general population, but not completely for the elderly population. Adjusting this list to the pharmacological aspects of aging will reduce the risks of drug interactions, falls, mental confusion and excessive sedation that result from drugs that are considered inappropriate for consumption by elderly people.

CONTEXTO E OBJETIVO: Programa Dose Certa é programa estadual para disponibilizar medicamentos de forma gratuita à população do Estado de São Paulo que é referência nacional no assunto. O segmento de idosos na população assistida merece atenção especial quanto aos fármacos adequados a este segmento etário. O objetivo foi avaliar as drogas no programa que são impróprias para idosos. TIPO DE ESTUDO E LOCAL: Estudo descritivo avaliando a distribuição de medicamentos no estado de São Paulo. MÉTODOS: Seguindo-se os critérios propostos por Beers e Fick (medicamentos ou classes deles que deveriam ser evitados em idosos, independentemente do diagnóstico ou da condição clínica, devido ao alto risco de efeitos colaterais e pela existência de outros fármacos mais seguros), avaliaram-se quais medicamentos do programa Dose Certa são impróprios para idosos e os níveis de evidência para cada medicamento incluído. RESULTADOS: Dos medicamentos disponíveis, 10 (25,6 por cento) foram incluídos nos critérios de Beers-Fick: amitriptilina, cimetidina, diazepam, digoxina, fluoxetina, metildopa, nifedipina, prometazina, tiorodazida e sulfato ferroso. CONCLUSÃO: A lista de fármacos disponível no Programa Dose Certa pode ser considerada apropriada para a população em geral, mas não totalmente para idosos. Adequá -los a aspectos farmacológicos do envelhecimento reduzirá riscos de interaç ões medicamentosas, quedas, confusão mental e sedação excessiva decorrente de medicamentos considerados impróprios para o consumo de idosos.

Temperatura basal em idosos asilados / Basal body temperature in institutionalized elderly

Idosos tendem a apresentar temperaturas corporais menores do que adultos jovens. A determinação da temperatura basal em populações de instituições de longa permanência para idosos (ILPIs) auxiliará em novas definições sobre estados febris nessa faixa etária e nesses locais, evitando diagnósticos tardios ou equivocados. Objetivo: Determinar valores de temperatura basal axilar em internados clinicamente estáveis em instituição de longa permanência para idosos (ILPI). Casuística e método: Avaliaram-se, em agosto de 2005, idosos (idade >= 60 anos) de ambos os sexos, com grau de dependência intermediária (perda de duas dentre seis atividades básicas da vida diária) e residentes em ILPI. Utilizaram-se média e desvio padrão de três temperaturas axilares matinais, obtidas por meio de termômetro clínico prismático Incoterm . O mês de agosto de 2005 apresentou, na região da ILPI deste estudo, temperaturas ambientais médias entre 14 C e 26 C. Resultados: Obtiveram-se dados de 47 idosos (16 mulheres, 31 homens) com média etária de 72,8 10,6 anos. Temperatura axilar média matinal: 36,1 0,2 C, sendo de 36,1 0,2 C nas mulheres e de 36,2 0,2 C nos homens. Não houve significância estatística quanto ao sexo ou faixa etária e temperaturas aferidas. Conclusão: Idosos institucionalizados apresentam temperatura axilar média matinal e/ou basal inferior à normal em adultos jovens. Este fato merece atenção pelo risco do desenvolvimento de síndromes com temperaturas atípicas como, por exemplo, quadros infecciosos afebris e hipotermias.

Dengue in an elderly patient.

Although elderly populations are more exposed to the risk of getting dengue, the clinical peculiarities of this disease in this age range are not well known. This report is about an 80-year-old woman with dengue complications, self-medicated with salicylate. Literature indicates a more severe clinical condition, high hospitalization rate and significant mortality. This is caused by previous infections by other serotypes of this arbovirus, presence of chronic diseases, immunosenescence and high drug consumption, especially salicylates and the like. Analyses are required in a public health perspective in order to help health professionals that care for patients with dengue in this age range.