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1.
J Nutr Health Aging ; 23(2): 138-144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30697622

RESUMO

OBJECTIVES: Body composition changes with aging can increase rates of obesity, frailty and impact function. Measuring adiposity using body fat (%BF) or central adiposity using waist circumference (WC) have greater diagnostic accuracy than traditional measures such as body mass index (BMI). DESIGN: This is an observational study. SETTING: This study focused on older community-dwelling participants. PARTICIPANTS: We identified individuals age ≥ 60 years old using the 1999-2004 cross-sectional National Health and Nutrition Survey (NHANES). INTERVENTION: The primary analysis evaluated the association between frailty and %BF or WC. Frailty was the primary predictor (robust=referent) and %BF and WC were considered continuous outcomes. Multiple imputation analyses accounted for missing characteristics. MEASUREMENT: Dual energy x-ray absorptiometry was used to assess %BF and WC was objectively measured. Frailty was defined using an adapted version of Fried's criteria that was self-reported: (low BMI<18.5kg/m2; slow walking speed [<0.8m/s]; weakness [unable to lift 10lbs]; exhaustion [difficulty walking between rooms on same floor] and low physical activity [compared to others]). Robust, pre-frail and frail persons met zero, 1 or 2, and ≥3 criteria, respectively. RESULTS: Of the 4,984 participants, the mean age was 71.1±0.2 (SE) years and 56.5% were females. We classified 2,246 (50.4%), 2,195 (40.3%), and 541 (9.2%) individuals as robust, pre-frail and frail, respectively. Percent BF was 35.9±0.13, 38.3±0.20 and 40.0±0.46 in the robust, pre-frail and frail individuals, respectively. WC was 99.5±0.32 in the robust, 100.1±0.43 in pre-frail, 104.7±1.17 in frail individuals. Compared to robust individuals, only frail individuals had greater %BF on average (ß=0.97±0.43,p=0.03); however, pre-frail and frail individuals had 2.18 and 4.80 greater WC, respectively (ß=2.18±0.64,p=0.002, and ß=4.80±1.1,p<0.001). CONCLUSION: Our results demonstrate that in older adults, frailty and pre-frailty are associated with a greater likelihood of high WC (as dichotomized) and a greater average WC (continuous).


Assuntos
Adiposidade/fisiologia , Fragilidade/fisiopatologia , Obesidade Abdominal/fisiopatologia , Circunferência da Cintura/fisiologia , Absorciometria de Fóton , Tecido Adiposo/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Composição Corporal/fisiologia , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Vida Independente , Estudos Longitudinais , Masculino , Limitação da Mobilidade , Inquéritos Nutricionais
2.
J Nutr Health Aging ; 22(8): 938-943, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30272097

RESUMO

OBJECTIVES: Sarcopenia is a gradual loss of muscle mass and strength that occurs with aging. This muscle deterioration is linked to increased morbidity, disability, and other adverse outcomes. Although reduced handgrip strength can be considered a marker of sarcopenia and other aging-related decline in the elderly, there is limited research on this physical health problem in at-risk groups with common biopsychosocial conditions such as depression. Our primary objective was to ascertain level of combined handgrip strength and its relationship with depression among adults aged 60 years and older. DESIGN: Unadjusted and adjusted linear regression models were conducted with a cross-sectional survey dataset. SETTING: Secondary dataset from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). PARTICIPANTS: Community-dwelling, non-institutionalized adults ≥60 years old (n=3,421). MEASUREMENTS: The predictor variables included a positive screen for clinically relevant depression (referent=PHQ-9 score <10). The criterion variable of combined handgrip strength (kg) was determined using a dynamometer. RESULTS: Mean age and BMI were 69.9 years (51.5% female) and 28.8 kg/m2, respectively. Mean combined handgrip strength in the overall cohort was 73.5 and 46.6 kg in males and females, respectively. Three hundred thirty-six (9.8%) reported symptoms of depression. In unadjusted and fully adjusted models, depression was significantly associated with reduced handgrip strength (B = -0.26±0.79 and B = -0.19±0.08, respectively; p<0.001). CONCLUSION: Our findings demonstrate handgrip strength has a significant inverse association with depression. Future longitudinal studies should investigate the causal processes and potential moderators and mediators of the relationships between depression and reduced handgrip strength. This information may further encourage the use of depression and handgrip strength assessments and aid in the monitoring and implementation of health care services that address both physical and mental health limitations among older adult populations.


Assuntos
Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Força da Mão/fisiologia , Inquéritos Nutricionais/estatística & dados numéricos , Sarcopenia/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Estudos de Coortes , Estudos Transversais , Depressão/psicologia , Transtorno Depressivo/psicologia , Pessoas com Deficiência , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Músculos/fisiologia
3.
Int J Obes (Lond) ; 42(2): 198-204, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28816228

RESUMO

BACKGROUND/OBJECTIVES: Telomere shortening is associated with age and risk of medical comorbidity. We assessed the relationship between measures of adiposity, leukocyte telomere length, and mortality and whether it is modified by age. SUBJECTS/METHODS: Subjects with dual-energy X-ray absorptiometry measures were identified using the National Health and Nutrition Examination Survey 1999-2002. Obesity was categorized using two body fat definitions (BF1%: men ⩾25%; females ⩾35%; BF2% ⩾28% and ⩾38%, respectively), body mass index (BMI) and waist circumference (WC; men ⩾102 cm; females ⩾88 cm). Telomere length relative to standard reference DNA (T/S ratio) was assessed using quantitative PCR. Weighted multivariable regression models evaluated the association of telomere length with adiposity, both continuously and categorically (low/normal BF%, low/high WC and standard BMI categories). Differences in telomere length by age and adiposity were ascertained and subsequent models were stratified by age. Proportional hazard models assessed the risk of mortality by adiposity status. A telomere by adiposity interaction was tested in the entire cohort and by age category (<60 vs ⩾60 years; <70 vs ⩾70 years). RESULTS: We identified 7827 subjects. Mean age was 46.1 years. Overall telomere length was 1.05±0.01 (s.e.) that differed by BF1% (low/high: 1.12±0.02 vs 1.03±0.02; P<0.001), BF2% (1.02±0.02 vs 1.11±0.02; P<0.001), BMI (underweight 1.08±0.03; normal 1.09±0.02; overweight 1.04±0.02; and obese 1.03±0.02;P<0.001) and WC (low/high 1.09±0.02 vs 1.02±0.02; P<0.001). Adjusted ß-coefficients evaluating the relationship between telomere length and adiposity (measured continuously) were as follows: BF1% (ß=-0.0033±0.0008; P<0.001), BF2% (-0.041±0.008; P<0.001), BMI (ß=-0.025±0.0008; P=0.005) and WC (ß=-0.0011±0.0004; P=0.007). High BF% (BF1%: ß=-0.035±0.011; P=0.002; BF2%: ß=-0.041±0.008; P<0.001) and WC (ß=-0.035±0.011; P=0.008) were inversely related to telomere length (TL). Stratifying by age, high BF1% (-0.061±0.013), BF2% (-0.065±0.01), BMI-obesity (-0.07±0.015) and high WC (-0.048±0.013) were significant (all P<0.001). This association diminished with increasing age. In older participants, TL was inversely related to mortality (hazard ratio 0.36 (0.27, 0.49)), as were those classified by BF1% (0.68 (0.56, 0.81)), BF2% (0.75 (0.65, 0.80)), BMI (0.50 (0.42, 0.60)) and WC (0.72 (0.63, 0.83)). No interaction was observed between adiposity status, telomere length and mortality. CONCLUSIONS: Obesity is associated with shorter telomere length in young participants, a relationship that diminishes with increasing age. It does not moderate the relationship with mortality.


Assuntos
Adiposidade/genética , Adiposidade/fisiologia , Inquéritos Nutricionais , Obesidade/mortalidade , Encurtamento do Telômero/fisiologia , Absorciometria de Fóton , Idoso , Composição Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/genética , Obesidade/fisiopatologia , Modelos de Riscos Proporcionais , Telômero
4.
Eur J Clin Nutr ; 70(10): 1168-1173, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27245209

RESUMO

BACKGROUND/OBJECTIVES: The objectives of this study were to determine the prevalence of muscle weakness using the two 2014 Foundation for the National Institutes of Health (FNIH) Sarcopenia Project criteria and its relationship with physical limitations, basic activities of daily living (ADL) and instrumental ADL. SUBJECTS/METHODS: We performed a cross-sectional analysis of community-dwelling adults from the Health and Retirement Study 2006-2008 and identified a subsample of 5092 adults aged ⩾60 years with grip strength (GS) data. Self-reported physical limitations, basic ADL and instrumental ADL were assessed. Criteria for GS (men<26 kg; women <16 kg) and GS adjusted for body mass index (GS/BMI; men <1.0; women <0.56) were applied to the sample. We determined the prevalence of muscle weakness in each sex. Multivariable logistic regression was used to calculate the association of physical limitations, basic ADL and instrument ADL with weakness definitions in each sex. RESULTS: Mean age was 72.1 years (54.9% female). Mean GS was 38.3 and 22.9 kg and mean BMI was 29 kg/m2, respectively, in men and women. Weakness prevalence using GS and GS:BMI definitions were 7.8 and 15.2 (P<0.001), respectively, in men and 11.4 and 13.3% (P=0.04) in women. Overall prevalence of physical limitations, basic ADL limitations and instrumental ADL limitations was 52.9, 28.1 and 35.9%, respectively. In those with weakness, prevalence of physical limitations, basic ADL and instrumental ADL was 78.5, 42.3 and 65.3%, respectively, using the GS definition, and 79.7, 40.7 and 58.8%, respectively, using the GS/BMI definition. GS and the GS/BMI definitions of weakness were strongly associated with physical limitations (odds ratio (OR) 2.19 (95% confidence interval (CI): (1.67-2.87)) and 2.52 (2.01-3.17)), basic ADL (OR 1.59 (1.22-2.07) and 1.66 (1.32-2.07)) and instrumental ADLs (OR 1.98 (1.28-2.54) and 1.78 (1.44-2.20)). CONCLUSIONS: The new FNIH guidelines for weakness are associated with higher prevalence of physical limitations, basic ADL impairments and instrumental ADL impairments as compared with individuals without weakness.


Assuntos
Envelhecimento , Debilidade Muscular/epidemiologia , Sarcopenia/epidemiologia , Atividades Cotidianas , Idoso , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/fisiopatologia , National Institutes of Health (U.S.) , Aposentadoria , Sarcopenia/fisiopatologia , Inquéritos e Questionários , Estados Unidos/epidemiologia
5.
Epidemiol Psychiatr Sci ; 25(2): 113-22, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26744309

RESUMO

AIMS: People with serious mental illness are increasingly turning to popular social media, including Facebook, Twitter or YouTube, to share their illness experiences or seek advice from others with similar health conditions. This emerging form of unsolicited communication among self-forming online communities of patients and individuals with diverse health concerns is referred to as peer-to-peer support. We offer a perspective on how online peer-to-peer connections among people with serious mental illness could advance efforts to promote mental and physical wellbeing in this group. METHODS: In this commentary, we take the perspective that when an individual with serious mental illness decides to connect with similar others online it represents a critical point in their illness experience. We propose a conceptual model to illustrate how online peer-to-peer connections may afford opportunities for individuals with serious mental illness to challenge stigma, increase consumer activation and access online interventions for mental and physical wellbeing. RESULTS: People with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours. These individuals could also access interventions for mental and physical wellbeing delivered through social media that could incorporate mutual support between peers, help promote treatment engagement and reach a wider demographic. Unforeseen risks may include exposure to misleading information, facing hostile or derogatory comments from others, or feeling more uncertain about one's health condition. However, given the evidence to date, the benefits of online peer-to-peer support appear to outweigh the potential risks. CONCLUSION: Future research must explore these opportunities to support and empower people with serious mental illness through online peer networks while carefully considering potential risks that may arise from online peer-to-peer interactions. Efforts will also need to address methodological challenges in the form of evaluating interventions delivered through social media and collecting objective mental and physical health outcome measures online. A key challenge will be to determine whether skills learned from peers in online networks translate into tangible and meaningful improvements in recovery, employment, or mental and physical wellbeing in the offline world.


Assuntos
Saúde Mental , Infuência dos Pares , Mídias Sociais , Apoio Social , Humanos , Relações Interpessoais , Transtornos Mentais , Grupo Associado
6.
Int J Obes (Lond) ; 40(5): 761-7, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26620887

RESUMO

BACKGROUND: Body composition changes with aging lead to increased adiposity and decreased muscle mass, making the diagnosis of obesity challenging. Conventional anthropometry, including body mass index (BMI), while easy to use clinically may misrepresent adiposity. We determined the diagnostic accuracy of BMI using dual-energy X-ray absorptiometry (DEXA) in assessing the degree of obesity in older adults. METHODS: The National Health and Nutrition Examination Surveys 1999-2004 were used to identify adults aged ⩾60 years with DEXA measures. They were categorized (yes/no) as having elevated body fat by gender (men: ⩾25%; women ⩾35%) and by BMI ⩾25 and ⩾30 kg m(-)(2). The diagnostic performance of BMI was assessed. Metabolic characteristics were compared in discordant cases of BMI/body fat. Weighting and analyses were performed per NHANES (National Health and Nutrition Examination Survey) guidelines. RESULTS: We identified 4984 subjects (men: 2453; women: 2531). Mean BMI and % body fat was 28.0 kg m(-2) and 30.8% in men, and 28.5 kg m(-)(2) and 42.1% in women. A BMI ⩾30 kg m(-)(2) had a low sensitivity and moderately high specificity (men: 32.9 and 80.8%, concordance index 0.66; women: 38.5 and 78.5%, concordance 0.69) correctly classifying 41.0 and 45.1% of obese subjects. A BMI ⩾25 kg m(-2) had a moderately high sensitivity and specificity (men: 80.7 and 99.6%, concordance 0.81; women: 76.9 and 98.8%, concordance 0.84) correctly classifying 80.8 and 78.5% of obese subjects. In subjects with BMI <30 kg m(-)(2), body fat was considered elevated in 67.1% and 61.5% of men and women, respectively. For a BMI ⩾30 kg m(-)(2), sensitivity drops from 40.3% to 14.5% and 44.5% to 23.4%, whereas specificity remains elevated (>98%), in men and women, respectively, in those 60-69.9 years to subjects aged ⩾80 years. Correct classification of obesity using a cutoff of 30 kg m(-)(2) drops from 48.1 to 23.9% and 49.0 to 19.6%, in men and women in these two age groups. CONCLUSIONS: Traditional measures poorly identify obesity in the elderly. In older adults, BMI may be a suboptimal marker for adiposity.


Assuntos
Absorciometria de Fóton/normas , Adiposidade/fisiologia , Envelhecimento/fisiologia , Composição Corporal/fisiologia , Índice de Massa Corporal , Inquéritos Nutricionais , Obesidade/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/prevenção & controle , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Reprodutibilidade dos Testes , Estados Unidos/epidemiologia
7.
Scand J Rheumatol ; 44(6): 495-502, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26083472

RESUMO

OBJECTIVES: Older adults with obesity are at risk for osteoarthritis (OA) and are predisposed to functional decline and disability. We examined the association between obesity and disability, physical activity, and quality of life at 6 years. METHOD: Using data from the longitudinal Osteoarthritis Initiative (OAI), we analysed older adults (age ≥ 60 years) with a body mass index (BMI) at baseline ≥ 18.5 kg/m(2) (n = 2378) using standard BMI categories. Outcomes were assessed at the 6-year follow-up and included: the Late-Life Function and Disability Index (LLDI), the 12-item Short Form Health Survey (SF-12), and the Physical Activity Scale for the Elderly (PASE). Linear regression predicted outcomes based on BMI category, adjusting for age, sex, race, education, smoking, cohort status, radiographic knee OA, co-morbidity scores, and baseline scores when available. RESULTS: Follow-up data were available for 1727 (71.9%) participants (mean age 67.9 ± 5.3 years; 61.6% female). At baseline, obese subjects compared to overweight and normal were on a greater number of medications (4.28 vs. 3.63 vs. 3.32), had lower gait speeds (1.22 vs. 1.32 vs. 1.36 m/s), higher Charlson scores (0.59 vs. 0.37 vs. 0.30), and higher Western Ontario and McMaster University OA Index (WOMAC) scores (right: 14.8 vs. 10.3 vs. 7.5; left: 14.4 vs. 9.9 vs. 7.5). SF-12 scores at 6 years were lower in obese patients than in overweight or normal [99.5 (95% CI 98.7-100.4) vs. 101.1 (95% CI 100.4-101.8) vs. 102.8 (95% CI 101.8-103.8)], as were PASE scores [115.1 (95% CI 110.3-119.8) vs. 126.2 (95% CI 122.2-130.2) vs. 131.4 (95% CI 125.8-137.0)]. The LLDI limitation component demonstrated differences in obese compared to overweight or normal [78.6 (95% CI 77.4-79.9) vs. 81.2 (95% CI 80.2-82.3) vs. 82.5 (95% CI 81.1-84.0)]. CONCLUSIONS: Obesity was associated with worse physical activity scores, lower quality of life, and higher risk of 6-year disability.


Assuntos
Avaliação da Deficiência , Atividade Motora/fisiologia , Obesidade/complicações , Obesidade/fisiopatologia , Osteoartrite do Joelho/epidemiologia , Qualidade de Vida , Fatores Etários , Idoso , Índice de Massa Corporal , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Qualidade de Vida/psicologia , Fatores de Risco
8.
Eur J Clin Nutr ; 68(9): 1001-7, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24961545

RESUMO

BACKGROUND: Sarcopenia is defined as the loss of skeletal muscle mass and quality, which accelerates with aging and is associated with functional decline. Rising obesity prevalence has led to a high-risk group with both disorders. We assessed mortality risk associated with sarcopenia and sarcopenic obesity in elders. METHODS: A subsample of 4652 subjects ≥60 years of age was identified from the National Health and Nutrition Examination Survey III (1988-1994), a cross-sectional survey of non-institutionalized adults. National Death Index data were linked to this data set. Sarcopenia was defined using a bioelectrical impedance formula validated using magnetic resonance imaging-measured skeletal mass by Janssen et al. Cutoffs for total skeletal muscle mass adjusted for height(2) were sex-specific (men: ≤5.75 kg/m(2); females ≤10.75 kg/m(2)). Obesity was based on % body fat (males: ≥27%, females: ≥38%). Modeling assessed mortality adjusting for age, sex, ethnicity (model 1), comorbidities (hypertension, diabetes, congestive heart failure, osteoporosis, cancer, coronary artery disease and arthritis), smoking, physical activity, self-reported health (model 2) and mobility limitations (model 3). RESULTS: Mean age was 70.6±0.2 years and 57.2% were female. Median follow-up was 14.3 years (interquartile range: 12.5-16.1). Overall prevalence of sarcopenia was 35.4% in women and 75.5% in men, which increased with age. Prevalence of obesity was 60.8% in women and 54.4% in men. Sarcopenic obesity prevalence was 18.1% in women and 42.9% in men. There were 2782 (61.7%) deaths, of which 39.0% were cardiovascular. Women with sarcopenia and sarcopenic obesity had a higher mortality risk than those without sarcopenia or obesity after adjustment (model 2, hazard ratio (HR): 1.35 (1.05-1.74) and 1.29 (1.03-1.60)). After adjusting for mobility limitations (model 3), sarcopenia alone (HR: 1.32 ((1.04-1.69) but not sarcopenia with obesity (HR: 1.25 (0.99-1.58)) was associated with mortality. For men, the risk of death with sarcopenia and sarcopenic obesity was nonsignificant in both model-2 (HR: 0.98 (0.77-1.25), and HR: 0.99 (0.79-1.23)) and model 3 (HR: 0.98 (0.77-1.24) and HR: 0.98 (0.79-1.22)). CONCLUSIONS: Older women with sarcopenia have an increased all-cause mortality risk independent of obesity.


Assuntos
Tecido Adiposo , Causas de Morte , Músculo Esquelético , Obesidade/mortalidade , Sarcopenia/mortalidade , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Doenças Cardiovasculares/mortalidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/complicações , Obesidade/epidemiologia , Prevalência , Valores de Referência , Fatores de Risco , Sarcopenia/complicações , Sarcopenia/epidemiologia , Fatores Sexuais
9.
Health promot. int ; 23(3): 275-282, Sept. 2008. tab
Artigo em Inglês | CidSaúde - Cidades saudáveis | ID: cid-59710

RESUMO

Sedentary lifestyle, poor dietary behaviors and metabolic alterations associated with psychiatric medications contribute to poor health and high rates of obesity among individuals with serious mental illness (SMI). Interventions that increase engagement in physical exercise, dietary modifications, lifestyle changes and preventive health care can provide health benefits across the lifespan. These interventions have led to substantial physical improvements in some persons with SMI, while others have not improved or have experienced worsening physical health. We set out to identify characteristics of a health promotion program that persons with SMI associated with physical health improvements. Interviews were conducted with eight participants from the In SHAPE health-promotion program who lost at least 10 pounds or diminished their waist circumference by at least 10 cm. Interviews aimed to determine which aspects of the program were perceived to be most helpful in promoting physical health improvement. Among successful participants, three themes emerged, highlighting the importance of: (i) individualized interventions promoting engagement in the program; (ii) relationships with health-promotion program employees and (iii) self-confidence resulting from program participation. Health-promotion programs that target these areas may have better success in achieving health benefits for persons with SMI. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Promoção da Saúde , Transtornos Mentais , Comportamento do Consumidor , Autoeficácia , Dieta
10.
Am J Geriatr Psychiatry ; 9(3): 191-204, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11481126

RESUMO

In November 1999, a working group of the American Association for Geriatric Psychiatry (AAGP) convened to consider strategic recommendations for developing geriatric mental health services research as a scientific discipline. The resulting consensus statement summarizes the principles guiding mental health services research on late-life mental disorders, presents timely and topical priorities for investigation with the potential to benefit the lives of older adults and their families, and articulates a systematic program for expanding the supply of well-trained geriatric mental health services researchers. The agenda presented here is designed to address critical questions in provision of effective mental health care to an aging population and the health policies that govern its delivery.


Assuntos
Psiquiatria Geriátrica/normas , Pesquisa sobre Serviços de Saúde , Serviços de Saúde para Idosos/normas , Serviços de Saúde Mental/normas , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Educação , Humanos , Transtornos Mentais/terapia , Dinâmica Populacional
11.
Am J Geriatr Psychiatry ; 8(2): 160-6, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10804077

RESUMO

Symptoms, functioning, and mental health service use were compared in older out-patients with bipolar disorder and unipolar depression. Bipolar outpatients (n = 37, mean age = 69.7) had higher total symptom severity and positive symptom scores, more impaired community-living skills, and earlier age at onset of illness than patients with unipolar depression (n = 85, mean age = 70.9). Bipolar elderly patients used almost four times the total amount of mental health services and were four times more likely to have had a psychiatric hospitalization over the previous 6 months. These findings underscore the need for effective services for elderly patients with bipolar disorder, who account for a minority of patients with affective disorders, but use a disproportionate amount of costly services.


Assuntos
Transtorno Bipolar/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Serviços de Saúde Mental/estatística & dados numéricos , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Transtorno Bipolar/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Hampshire/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Escalas de Graduação Psiquiátrica , Revisão da Utilização de Recursos de Saúde
12.
Psychiatr Serv ; 50(9): 1189-97, 1999 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10478906

RESUMO

The authors describe current needs and trends in the mental health care, including long-term care, of older persons with severe and persistent mental illness. The literature suggests that emerging models of managed long-term care hold promise for integrated services but do not currently address the specialized mental health needs of this patient group. The authors review issues in financing long-term mental health care, including controversies over fee-for-service and carve-out and carve-in arrangements. Without mechanisms to adequately finance services, adjust for risk, and measure outcomes, the authors conclude, managed care arrangements will be in conflict with the goal of high-quality care for older adults with severe and persistent mental illness. Proposed directions for future models of care for this group include integration of mental health and medical services, integration of specialized geropsychiatric services with developing community-based long-term care systems, blended financing under shared risk arrangements, and assurance of accountability and outcomes under managed care.


Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Serviços Comunitários de Saúde Mental/tendências , Sistemas Pré-Pagos de Saúde , Assistência de Longa Duração/normas , Transtornos Mentais/terapia , Adulto , Idoso , Serviços Comunitários de Saúde Mental/economia , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Índice de Gravidade de Doença
13.
Arch Gen Psychiatry ; 56(9): 848-53, 1999 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12884891

RESUMO

It is anticipated that the number of people older than 65 years with psychiatric disorders in the United States will increase from about 4 million in 1970 to15 million in 2030. The current health care system serves mentally ill older adults poorly and is unprepared to meet the upcoming crisis in geriatric mental health. We recommend the formulation of a 15- to 25-year plan for research on mental disorders in elderly persons. It should include studies of prevention, translation of findings from bench to bedside, large-scale intervention trials with meaningful outcome measures, and health services research. Innovative strategies are needed to formulate new conceptualizations of psychiatric disorders, especially those given scant attention in the past. New methods of clinical and research training involving specialists, primary care clinicians, and the lay public are warranted.


Assuntos
Transtornos Mentais/epidemiologia , Pesquisa/normas , Distribuição por Idade , Idoso , Protocolos Clínicos/normas , Atenção à Saúde/normas , Previsões , Avaliação Geriátrica/estatística & dados numéricos , Psiquiatria Geriátrica/educação , Pesquisa sobre Serviços de Saúde , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Prevalência , Projetos de Pesquisa/estatística & dados numéricos , Projetos de Pesquisa/tendências , Apoio à Pesquisa como Assunto , Estados Unidos/epidemiologia
14.
Am J Geriatr Psychiatry ; 6(2 Suppl 1): S85-100, 1998.
Artigo em Inglês | MEDLINE | ID: mdl-9581225

RESUMO

Behavioral or psychiatric symptoms in Alzheimer's disease are strongly related to the use of health care services and result in a significant emotional and financial burden for families. This paper is an overview of major trends in the organization and funding of mental health services for people with Alzheimer's disease, emphasizing specific public policy and reimbursement initiatives that have affected acute and long-term care. Recent trends reflecting increased federal scrutiny of Medicare-reimbursed services and the current and future challenges in providing mental health services to people with Alzheimer's disease within managed care and capitated health plans are also addressed.


Assuntos
Doença de Alzheimer/terapia , Política de Saúde , Reembolso de Seguro de Saúde/tendências , Programas de Assistência Gerenciada/economia , Programas de Assistência Gerenciada/tendências , Serviços de Saúde Mental/provisão & distribuição , Serviços de Saúde Mental/estatística & dados numéricos , Política Pública , Idoso , Capitação , Saúde da Família , Previsões , Humanos , Medicaid/economia , Serviços de Saúde Mental/economia , Estados Unidos
15.
Int J Psychiatry Med ; 27(3): 215-31, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9565725

RESUMO

OBJECTIVE: To examine whether older HMO patients with depression are treated differently than younger patients in terms of diagnosis, treatment by specialty provider, and pharmacotherapy. DESIGN: Chart-review, Cross sectional study. SETTING AND PARTICIPANTS: Patients were selected from six HMOs in the United States who had one or more of five medical diagnoses: arthritis, asthma, otitis media, epigastric pain/ulcer, and hypertension, (n = 9143). From this group, chart diagnoses and pharmacy records were used to identify patients who also had a diagnosis of depression (n = 416) or who had a diagnosis of depression and/or treatment with antidepressant medication (n = 1286). MEASUREMENT: Medical records and computerized service and pharmacy records were reviewed to obtain diagnoses, office visits by provider type, and psychiatric medication prescription counts. RESULTS: Significant differences were found in treatment of depression for older versus younger patients. Although depression was identified at a similar rate for both groups, older patients received fewer mental health specialty visits and fewer prescriptions for SSRI antidepressants. Older patients with a diagnosis of depression were more likely to be treated with benzodiazepines (49.2% of older vs. 33.2% of younger) though they were less likely to receive long half-life benzodiazepines. CONCLUSIONS: Psychotropic medication management is an important target for improving quality of care for older patients with depression in HMOs. Decreasing inefficient minor tranquilizer use and increasing use of newer antidepressant medications may lead to improved outcomes for older depressed adults.


Assuntos
Antidepressivos/uso terapêutico , Demência/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Avaliação Geriátrica , Programas de Assistência Gerenciada , Equipe de Assistência ao Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiolíticos/efeitos adversos , Ansiolíticos/uso terapêutico , Antidepressivos/efeitos adversos , Benzodiazepinas , Comorbidade , Demência/diagnóstico , Demência/psicologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Feminino , Sistemas Pré-Pagos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Atenção Primária à Saúde , Estudos Prospectivos , Garantia da Qualidade dos Cuidados de Saúde , Encaminhamento e Consulta , /uso terapêutico
16.
Schizophr Res ; 27(2-3): 181-90, 1997 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-9416647

RESUMO

This study compared the functioning of 188 elderly schizophrenic and bipolar disorder patients living in nursing homes and the community. Residential status and diagnostic groups were compared on measures of symptomatology, cognitive impairment, functional impairment, and behavior problems. In general, the diagnostic groups differed in symptoms, while most differences in living setting were related to cognition, functioning, and behavior. Nursing home status was significantly associated with more severe overall symptom ratings, worse cognitive impairment, greater functional impairment, more aggressive behaviors, and marital status of having never married. Self-care skills, community living skills, and marital status were most uniquely predictive of nursing home residence. However, cognitive deficits were strongly predictive of both self-care and community living skills, explaining approximately half of the variance in these variables. The implications of these findings for the treatment of elderly patients with schizophrenia and other severe mental illnesses are discussed.


Assuntos
Transtorno Bipolar/diagnóstico , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Esquizofrenia/diagnóstico , Atividades Cotidianas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transtorno Bipolar/psicologia , Transtorno Bipolar/reabilitação , Escalas de Graduação Psiquiátrica Breve , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Relações Familiares , Avaliação Geriátrica , Humanos , Estado Civil , Pessoa de Meia-Idade , Probabilidade , Escalas de Graduação Psiquiátrica , Amostragem , Esquizofrenia/reabilitação , Psicologia do Esquizofrênico , Autocuidado , Índice de Gravidade de Doença , Apoio Social
18.
Psychiatr Serv ; 46(3): 248-51, 1995 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-7796211

RESUMO

OBJECTIVE: This study assessed the long-term course of substance abuse and dependence among severely mentally ill patients. METHODS: A prospective, naturalistic, seven-year follow-up of severely mentally ill outpatients (most with schizophrenia and schizoaffective disorder) successfully located and reassessed 79.1 percent (N = 148) of the patients from the original study group. The follow-up study group was assessed for alcohol and drug use at baseline and seven-year follow-up by their case manager or primary clinician using the Case Manager Rating Scale (CMRS) for the assessment of substance-related problems among severely mentally ill patients. RESULTS: The prevalence of active substance use disorder changed little from baseline to follow-up. Alcohol abuse or dependence was present in 24 percent of the patients at baseline and 21 percent at follow-up, and drug abuse or dependence was present in 20 percent at baseline and 17 percent at follow-up. However, those with initial alcohol abuse had a higher rate of remission (67 percent) than those with initial alcohol dependence (33 percent). Similarly, those with initial drug abuse had a higher rate of remission (54 percent) than those with initial drug dependence (31 percent). CONCLUSIONS: The higher rates of change for those with initial substance abuse compared with substance dependence suggest that distinguishing between abuse and dependence may have important implications for assessment and prognosis of individuals with a dual diagnosis of a substance use disorder and severe mental illness.


Assuntos
Alcoolismo/reabilitação , Transtornos Psicóticos/reabilitação , Esquizofrenia/reabilitação , Psicologia do Esquizofrênico , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Comorbidade , Estudos Transversais , Diagnóstico Duplo (Psiquiatria) , Seguimentos , Humanos , Incidência , Assistência de Longa Duração , Programas de Assistência Gerenciada , Readmissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Reabilitação Vocacional/estatística & dados numéricos , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Resultado do Tratamento
19.
J Nerv Ment Dis ; 181(10): 606-11, 1993 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-8105026

RESUMO

Substance abuse is the most common comorbid complication of severe mental illness. Current clinical research converges on several emerging principles of treatment that address the scope, pace, intensity, and structure of dual-diagnosis programs. They include a) assertive outreach to facilitate engagement and participation in substance abuse treatment, b) close monitoring to provide structure and social reinforcement, c) integrating substance abuse and mental health interventions in the same program, d) comprehensive, broad-based services to address other problems of adjustment, e) safe and protective living environments, f) flexibility of clinicians and programs, g) stage-wise treatment to ensure the appropriate timing of interventions, h) a longitudinal perspective that is congruent with the chronicity of dual disorders, and i) optimism.


Assuntos
Transtornos Mentais/complicações , Transtornos Relacionados ao Uso de Substâncias/terapia , Atividades Cotidianas , Antipsicóticos/uso terapêutico , Atitude do Pessoal de Saúde , Doença Crônica , Terapia Combinada , Serviços Comunitários de Saúde Mental , Comorbidade , Assistência Integral à Saúde , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/reabilitação , Equipe de Assistência ao Paciente , Psicoterapia , Recidiva , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação
20.
J Nerv Ment Dis ; 181(4): 227-32, 1993 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-8473874

RESUMO

Utilization and cost of institutional and outpatient services were prospectively measured over 1 year for three groups of schizophrenic patients: current substance abusers, past substance abusers, and those without a history of substance abuse. Current abusers had significantly greater utilization and cost of institutional (hospital and jail) services. Current abusers also had greater utilization of emergency services. There were no significant differences between the groups in utilization and cost of other services, including psychosocial rehabilitation, outpatient treatment (case management, psychotherapy, and psychiatric visits), and housing supports. The implications for developing cost-effective treatments for dually diagnosed individuals are discussed.


Assuntos
Serviços Comunitários de Saúde Mental/economia , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Esquizofrenia/terapia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Alcoolismo/complicações , Alcoolismo/economia , Alcoolismo/terapia , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Análise Custo-Benefício , Custos e Análise de Custo , Feminino , Hospitalização/economia , Habitação/economia , Humanos , Institucionalização/economia , Institucionalização/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Esquizofrenia/complicações , Esquizofrenia/economia , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/economia
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