Testing a Context-Enriched Model of Successful Aging in Multiple Large Data Infrastructures with Individuals in Advanced Old Age.

BACKGROUND AND OBJECTIVES: Few people who are ages 80+ meet the criteria of successful aging (SA) proposed by Rowe and Kahn. Going beyond the individual-level conceptualization, we argue that SA always operates in multiple contexts and that context may become most critical in advanced old age. However, we are not aware of any previous study providing an empirical test of how contexts for SA unfold across persons 80 years and older, including those living in institutions. RESEARCH DESIGN AND METHODS: We estimated and compared prevalences of successful aging based on a classic versus context-enriched understanding of SA in multiple large surveys of older adults, i.e., the D80+ study (N = 3.233) and the NRW80+ study (N [baseline] = 1.863). In addition to replication across independent samples, we investigated the stability of context-related SA across time. RESULTS: Prevalences of SA according to Rowe and Kahn were 9.1% in adults aged 80-84 and 0.7% in persons 90 years or older. However, prevalence rates for those with good contexts at their disposal even if not fulfilling Rowe and Kahn's criteria were much higher across all age groups (80-84 years: 54.9%, 90 years and older: 44.4%). Greater two-year stability was observed for contextual compared to individual criteria. Notably, positive effects of context on SA were stronger at onset compared to late fourth age. DISCUSSION AND IMPLICATIONS: Our findings support a contextualized understanding of SA and inform policy that furthering SA in the fourth age requires the optimization of multiple contexts at the community level.

Caracterización del síndrome coronario agudo en pacientes octogenarios / Characterization of the acute coronary syndrome in octogenarian patients

Introducción: La edad representa uno de los mayores predictores de riesgo de complicaciones cardiovasculares en pacientes con síndrome coronario agudo. La prevalencia de este síndrome en el grupo de los pacientes octogenarios es elevada. Métodos: Estudio prospectivo de cohortes analítico de todos los pacientes ingresados en la unidad de cuidados coronarios intensivos del Hospital Universitario Comandante Manuel Fajardo de la Habana, entre el año 2016 y el 2020. Objetivo: Caracterizar la población de pacientes octogenarios con síndrome coronario agudo y las posibles asociaciones entre la ocurrencia de complicaciones intrahospitalarias no letales y los factores de riesgo cardiovasculares. Resultados: Prevaleció el sexo femenino (64,2 por ciento), los antecedentes de hipertensión arterial (89,7 por ciento), cardiopatía isquémica (66,7 por ciento), y el tabaquismo (32 por ciento). Se encontraron asociaciones estadísticas significativas entre el tipo de síndrome coronario agudo y la presencia de complicaciones cardiovasculares de cualquier tipo (p=0,006); el aumento de la creatinina se asoció con la presencia de complicaciones hemodinámicas (Mdn=97; Rango=97,52; p=0,012), así como también la fracción de eyección del ventrículo izquierdo mostró una asociación muy significativa con la presencia de complicaciones cardiovasculares de cualquier tipo (Mdn=59; Rango=63,3; p<0,001) y hemodinámicas (Rango=55,2; p<0,001). Conclusiones: Se caracterizó la población de pacientes octogenarios con síndrome coronario agudo con elevación del segmento ST se asoció con un aumento de las complicaciones cardiovasculares intrahospitalarias, de la misma manera que sucedió con el valor de la fracción de eyección del ventrículo izquierdo(AU)

Introduction: Age represents one of the greatest predictors of risk of cardiovascular complications in patients with acute coronary syndrome. The prevalence of this syndrome in the group of octogenarian patients is high. Objective: To characterize the population of octogenarian patients with acute coronary syndrome and the possible associations between the occurrence of non-lethal intrahospital complications and cardiovascular risk factors. Methods: This is a prospective analytical cohort study of all patients admitted to the intensive coronary care unit of Manuel Fajardo University Hospital in Havana, from 2016 to 2020. Results: The female sex (64.2percent), a history of arterial hypertension (89.7percent), ischemic heart disease (66.7percent), and smoking habits (32percent) outweighed. Significant statistical associations were found between the type of acute coronary syndrome and the presence of cardiovascular complications of any type (p=0.006); the increase in creatinine was associated with the presence of hemodynamic complications (Mdn=97; Range=97.52; p=0.012), as well as the left ventricular ejection fraction showed a highly significant association with the presence of cardiovascular complications of any type (Mdn=59; Range=63.3; p<0.001) and hemodynamic (Range=55.2; p<0.001). Conclusions: The octogenarian population of patients with ST-segment elevation acute coronary syndrome was characterized and was associated with an increase in in-hospital cardiovascular complications, in the same way that it happened with the value of the left ventricular ejection fraction(AU)

Analysis of the clinical efficacy and safety of laparoscopic radical prostatectomy in prostate cancer patients aged 80 years or older / 现代泌尿外科杂志

【Objective】 To investigate the clinical efficacy and safety of laparoscopic radical prostatectomy in elderly prostate cancer patients aged ≥80 years in good health. 【Methods】 A total of 18 octogenarian patients who underwent laparoscopic radical prostatectomy during Aug.2016 and Mar.2020 at our hospital were selected for retrospective analysis. 【Results】 The patients were 80 to 86 years old. The preoperative serum PSA was 5.25-101.00 ng/mL. There were 2 cases in stage cT1N0M0,12 in stagec T2N0M0 and 4 in stage cT3N0M. The Gleason score was ≤6 in 4 cases,=7 in 9 cases,and ≥8 in 5 cases. During the follow-up of 22 to 65 months,the rates of urinary incontinence at 1 month,3 months,6 months,and 1 year were 50.00% (9/18),33.33% (6/18),16.67% (3/18) and 5.56 %(1/18),respectively. The postoperative urinary control recovery time was 1 to 220 days. Positive incision margin developed in 3 cases and biochemical recurrence occurred in 3 cases. The IPSS score at 3, 6 months and 1 year after surgery were lower than these before surgery (P<0.05). The overall health score of the FACD-P scale at 6 months after surgery was higher than that before surgery (P<0.05). 【Conclusion】 For well selected octogenarian prostate cancer patients in good condition,laparoscopic radical prostatectomy is a feasible,safe and effective treatment option,but long-term follow-up and prospective clinical studies with large sample size are still needed to confirm its efficacy.

Teste de força máxima de preensão palmar em pessoas idosas longevas do sudeste brasileiro: definição de pontos de corte / Maximum handgrip strength test in long-lived elderly people from southeastern Brazil: definition of cutoff points

Resumo Objetivo Definir pontos de corte para os valores do teste de força máxima de preensão palmar (FMPP) em pessoas idosas longevas. Método Estudo transversal com amostra de pessoas idosas longevas, octogenárias e nonagenárias, saudáveis e independentes funcionais (grupo robusto) e frágeis (grupo frágil). O teste de FMPP foi realizado em triplicata, sendo considerado o maior valor obtido. Os valores de sensibilidade, especificidade e os pontos de corte foram calculados por meio da Curva Característica de Operação do Receptor (ROC). Foram utilizados os pontos de corte brasileiros e os do Consenso Europeu de Sarcopenia para estudo da comparação. Resultados Foram avaliadas 121 pessoas idosas, com idade média de 84,5±5,3 anos, 65 (53,7%) do sexo feminino, sendo 46 (38%) do grupo frágil e 75 (62%) do grupo robusto. Foram encontrados os pontos de corte para FMPP de 27 kgf para homens e 19 kgf para mulheres. Os valores de sensibilidade e especificidade para os pontos de corte masculinos foram 94,44 e 65,79, respectivamente. Para o sexo feminino foram de 85,71 e 67,57. A partir desses pontos de corte, 23 (38,3%) pessoas idosas do grupo robusto foram classificadas com força inadequada, e, portanto, com provável sarcopenia, ao passo que, de acordo com os pontos de corte brasileiros e europeus, o número é de 35 (44,3%) e 14 (33,3%), respectivamente. Conclusão O estudo definiu pontos de corte para a população longeva e mostrou que os pontos de corte definidos até o momento para a população idosa brasileira não se mostraram adequados para longevos.

Abstract Objective To define cut-off points for the values ​​of the Maximum Handgrip Strength (MGS) test in long-lived elderly people. Method Cross-sectional study with a sample of long-lived elderly people, octogenarians and nonagenarians, healthy and functionally independent (robust group) and frail (fragile group). The MHS test was performed in triplicate, with the highest value obtained being considered. Sensitivity, specificity and cut-off values ​​were calculated using the Receiver Operating Characteristic Curve (ROC). The Brazilian cut-off points and those of the European Consensus on Sarcopenia were used for the comparison study. Results 121 elderly people were evaluated, with a mean age of 84.5±5.3 years, 65 (53.7%) female, 46 (38%) from the frail group and 75 (62%) from the robust group. Cut-off points for MHS of 27 kgf for men and 19 kgf for women were found. Sensitivity and specificity values ​​for men's cutoffs were 94.44 and 65.79, respectively. For woman, they were 85.71 and 67.57. Based on these cutoff points, 23 (38.3%) individuals from the robust group were classified as having competitive strength, and therefore with probable sarcopenia, while according to the Brazilian and European cutoff points, the number is 35 (44.3%) and 14 (33.3%). Conclusion The study defined cut-off points for the oldest-old population and showed that the cut-off points defined so far for the Brazilian elderly population were not adequate for the oldest-old.

Regional differences regarding the occurrence of falls and associated factors in two populations of Brazilian longevous people.

BACKGROUND: Few studies have explored regional asymmetries and their implications for health policies regarding episodes of falls among the population of ≥80 years old in continental and developing countries like Brazil with deep inequalities and sociocultural differences. OBJECTIVE: To evaluate the occurrence of falls and their association with functional capacity and nutritional status in the longest oldest-old living in two municipalities in the Northeast and Southeast of Brazil. METHODS: This is a cross-sectional study, with primary data collection in which were included in the research seniors aged 80 years or more, of both sexes, belonging to two Brazilian municipalities of discrepant socioeconomic aspects. The dependent variable was the occurrence of falls in the last year. The independent variables were grouped into demographic aspects, functional capacity and nutritional status. To identify variables that contribute to the occurrence of falls, the multiple logistic regression model, adopts a significance level of 5%. RESULTS: The sample was composed of 415 oldest-old adults. From the total, 32.3% reported having fallen in the last year, 24.7% in Brejo dos Santos and 37.8% in São Paulo. Among the former population, the mean value of walking speed for those who had falls was 0.27 m/s and for those who had no occurrence of falls was 0.33 m/s; and, among the seniors from São Paulo, the mean values were 0.51 m/s and 0.58 m/s, respectively. Significant correlations between walking speed and falls were verified for both populations, showing that the lower the walking speed, the higher the predisposition to falls. In the final regression model, the occurrence of falls was associated with moderate balance (OR = 5.28; CI: 1.11-25.18) among the longevous people Brejo dos Santos and with very poor functional performance (OR = 16.09; CI:1.46-177.06) among those from São Paulo. CONCLUSION: The results pointed out a lower prevalence of falls in longevous people from Brejo dos Santos than in those from São Paulo and differences regarding the associated factors, showing heterogeneity between the two populations; indicating the need for public policies and effective programmes aimed at preventing falls based on the maintenance or increase of functional capacity.

Predictive Accuracy of Frailty Tools for Adverse Outcomes in a Cohort of Adults 80 Years and Older: A Decision Curve Analysis.

OBJECTIVES: To compare the predictive performance of 3 frailty identification tools for mortality, hospitalization, and functional decline in adults aged ≥80 years using risk reclassification statistics and decision curve analysis. DESIGN: Population-based, prospective cohort. SETTING: BELFRAIL study, Belgium. PARTICIPANTS: 560 community-dwelling adults aged ≥80 years. MEASUREMENTS: Frailty by Cardiovascular Health Study (CHS) phenotype, Longitudinal Aging Study Amsterdam (LASA) markers, and Groeningen Frailty Indicator (GFI); mortality until 5.1 ± 0.25 years from baseline and hospitalization until 3.0 ± 0.25 years; and functional status assessed by activities of daily living at baseline and after 1.7 ± 0.21 years. RESULTS: Frailty prevalence was 7.3% by CHS phenotype, 21.6% by LASA markers, and 22% by GFI. Participants determined to be frail by each tool had a significantly higher risk for all-cause mortality and first hospitalization. For functional decline, only frail by GFI had a higher adjusted odds ratio. Harrell 's C-statistic for mortality and hospitalization and area under receiver operating characteristic curve for functional decline were similar for all tools and <0.70. Reclassification statistics showed improvement only by LASA markers for hospitalization and mortality. In decision curve analysis, all tools had higher net benefit than the 2 default strategies of "treat all" and "treat none" for mortality risk ≥20%, hospitalization risk ≥35%, and functional decline probability ≥10%, but their curves overlapped across all relevant risk thresholds for these outcomes. CONCLUSIONS AND IMPLICATIONS: In a cohort of adults aged ≥80 years, 3 frailty tools based on different conceptualizations and assessment sources had comparable but unsatisfactory discrimination for predicting mortality, hospitalization, and functional decline. All showed clinical utility for predicting these outcomes over relevant risk thresholds, but none was significantly superior. Future research on frailty tools should include a focus on the specific group of adults aged ≥80 years, and the predictive accuracy for adverse outcomes of different tools needs a comprehensive assessment that includes decision curve analysis.

Determinantes da relação entre percepção do funcionamento do sistema urinário atrapalhar a vida e a qualidade de vida de longevos / Determinants of the relationship between perception of urinary system function annoys the life and quality of life in oldest-old

Objetivo: este estudo buscou avaliar a relação entre a percepção do funcionamento do sistema urinário atrapalhar a vida de modo geral com a análise do questionário Kings Health Questionnaire (KHQ) em longevos. Métodos: estudo transversal e analítico. Foram investigadas características sociodemográficas e clínicas, bem como, o impacto da incontinência urinária (IU) na Qualidade de vida (QV) pelo instrumento KHQ. Frequências, médias e desvio-padrão, testes de qui-quadrado, t de student e regressões logísticas foram calculadas, aceitando como significativos valores de p<0,05. Resultados: participaram 82 longevos, 68% mulheres, idade média de 92,3±2,7 anos, 71% incontinentes e 43% referindo que a funcionalidade pélvica atrapalhava a vida. Indivíduos incontinentes relataram mais frequentemente a queixa investigada. Os domínios, impacto da IU, emoções, limitação físico-social, limitação no desempenho de tarefas do KHQ e seu escore total foram relacionados com a queixa. Indivíduos que relataram limitação de tarefas fora de casa, em viagens, vontade forte de urinar e difícil de controlar, sentimento de depressão e ansiedade ou nervosismo tinham aumento significativo na chance de relatar que a funcionalidade pélvica atrapalhava a vida. Conclusão: o KHQ foi relacionado com a chance de relato de que o funcionamento do sistema urinário atrapalhava a vida. Mesmo assim, boa parte dos incontinentes não relatava que a condição atrapalhava a vida. Por isso, os resultados demonstram que mesmo na ausência de afirmação positiva de ausência de IU, o funcionamento do sistema urinário pode comprometer a QV. Os achados sugerem que, ou os participantes realmente tinham IU e não a percebiam como tal, ou que é necessário investigar outras questões como frequência miccional, por exemplo. O uso do KHQ permitiu identificar que mesmo na ausência de relato de IU o funcionamento do sistema urinário pode interferir na QV de longevos.

Aims: this study aimed to evaluate the relationship between the perception that urinary system function annoys the life in general with the analysis of the Kings Health Questionnaire (KHQ) in old age. Methods: cross-sectional and analytical study. Sociodemographic and clinical characteristics were investigated, as well as the impact of urinary incontinence (UI) on Quality of Life (QOL) by the KHQ instrument. Frequencies, means and standard deviation and chi-square, student t tests and logistic regressions were calculated, accepting as significant p values <0.05. Results: 82 elderly, 68% women, mean age 92.3 ± 2.7 years, 71% incontinent and 43% reporting that the pelvic functionality disrupted life. Incontinent individuals most frequently reported the investigated complaint. The domains, UI impact, emotions, physical and social limitation, KHQ task performance limitation and its total score were related to the complaint. Individuals who reported limitation of tasks away from home, travel, strong desire to urinate and difficult to control, feelings of depression and anxiety or nervousness had a significant increase in the chance of reporting that pelvic functionality was disruptive to life. Conclusion: KHQ was related to the chance of reporting that the urinary system function was disruptive to life. Even so, most incontinents did not report that the condition disrupted life. Therefore, the results show that even in the absence of a positive statement of absence of UI, the urinary system function can compromise QOL. The findings suggest that either participants actually had UI and did not perceive UI as such, or that further questions such as voiding frequency need to be investigated, for example. The use of KHQ allowed us to identify that even in the absence of UI report, the urinary system function can interfere with the QoL of the oldest old.

Next of kin's perceptions of the meaning of participation in the care of older persons in nursing homes: a phenomenographic study.

BACKGROUND: Being involved in the care of a loved one is a desire of many next of kin. However, according to several studies of the perceptions of nursing home staff, the involvement of next of kin is not an obvious part of care. To be able to involve next of kin in care at nursing homes, the perceptions of what participation means are an important piece of knowledge. The aim of this study was therefore to describe variations in next of kin's perceptions of the meaning of participation in the care of older persons living in nursing homes. METHODS: Eighteen next of kin of older persons living in ten nursing homes in Sweden were recruited for interviews. The study design was based on a phenomenographic approach, focusing on the qualitatively different ways in which a person perceives, experiences or conceptualises a phenomenon or certain aspect of reality. RESULTS: Five categories emerged from analysis of the interviews, representing the next of kin's perceptions of the meaning of participation in the care of older persons in nursing homes: be present; communicate; monitor; do practical tasks; and to represent. The next of kin expressed meanings that belonged to more than one category, and the categories were interdependent. CONCLUSIONS: Our results indicate that there are several meanings of next of kin's perceptions of participation at nursing homes. Nursing home staff's knowledge of these perceptions is important to enable next of kin to participate according to their own preferences.

Barreiras que influenciaram a não adoção de atividade física por longevas / Barriers that influence the non-adoption of physical activity practice by oldest old people / Barreras que influyen en el hecho de que no se adopte la práctica de actividad física por parte de personas longevas

Resumo Objetivou-se identificar as barreiras que influenciam as idosas longevas a não adotarem a prática de atividade física. Esta pesquisa descritiva exploratória envolveu 69 mulheres longevas, com 80 anos ou mais, participantes de grupos de convivência de Florianópolis (SC), distribuídas em cinco grupos focais ativos (n = 39) e cinco grupos inativos fisicamente (n = 30). Os dados foram interpretados pela análise de conteúdo temática. Os resultados apontam para os motivos, como: ficar viúva, influência do meio ambiente, papel familiar, limitação física por doença e a maneira de ser da pessoa idosa. As longevas ativas salientam ainda que a forma negativa de envelhecer propicia poucas atividades. Assim, observa-se que esforços ocorram para que sejam implantados programas de exercícios físicos para idosas longevas dos centros de convivência para idosos de Florianópolis (SC), tanto nos grupos como em suas residências, para promover um estilo de vida mais ativo.

Abstract The aim of the study was to identify the barriers that influence oldest old people not to adopt the practice of physical activity. This descriptive exploratory research involved 69 older women from social groups of Florianópolis/SC, which were distributed in five focus groups active (n = 39) and five inactive (n = 30) focus groups. The results point to reasons such as being widowed, environmental influences, family role, physical limitations due to illness and the way of being of the elderly. The oldest old active enduring stress that the negative aging fosters the realization of few activities. Thus, it is observed that efforts occur to be implemented exercise programs for older enduring community centers for the elderly in Florianópolis/SC, both in groups and in their homes, to promote a more active lifestyle.

Resumen El objetivo de este estudio era identificar las barreras que influyen en las personas longevas para que no adopten la práctica de actividad física. Este estudio exploratorio descriptivo incluyó a 69 mujeres longevas, con 80 años o mayores, que participaban en grupos sociales de Florianópolis/SC, distribuidas en cinco grupos focales activos (n = 39) y cinco físicamente inactivos (n = 30). Los datos se interpretaron mediante análisis de contenido temático. Los resultados apuntan a motivos como el hecho de ser viudas, las influencias del entorno, el papel familiar, las limitaciones físicas debido a la enfermedad y la manera de ser de las personas mayores. Las longevas activas añaden también que el aspecto negativo del envejecimiento contribuye a que lleven a cabo pocas actividades diarias. Así, se observa que los esfuerzos deben dirigirse a implementar programas de ejercicio para los mayores en los centros comunitarios permanentes para la tercera edad en Florianópolis/SC, tanto en grupos como en sus hogares, para promover un estilo de vida más activo.

Impact of intraoperative blood loss on morbidity and survival after radical surgery for colorectal cancer patients aged 80 years or older.

PURPOSE: This study aimed to assess the effect of intraoperative blood loss (IBL) on short- and long-term outcomes of colorectal cancer surgery for very elderly patients. METHODS: We acquired the data of consecutive patients aged 80 years or older who underwent elective radical surgery for stage I to III colorectal cancer between January 2003 and December 2007 in 41 institutions. The patients were divided into high and low IBL groups, and the differences in postoperative morbidity and survival between the two groups were primarily assessed. Eleven factors were treated as potential confounders in multivariate analyses. RESULTS: A total of 1554 patients were eligible for this study, with an age range of 80-103 years. Median IBL was 71 ml (interquartile range, 25 to 200 ml), and 412 patients had IBL ≥200 ml. Morbidity was 46% among patients with IBL ≥200 ml, compared with 30 % among those with IBL <200 ml (p < 0.001). Patients with IBL ≥200 ml had worse overall survival rates and recurrence-free survival rates at 1, 3, and 5 years than those with IBL <200 ml. In multivariate analyses, IBL ≥200 ml was identified as an independent risk factor for postoperative adverse events (odds ratio (OR) 1.41, 95% confidence interval (CI) 1.08 to 1.86), overall survival (hazard ratio (HR) 1.34, 95% CI 1.04 to 1.72), and recurrence-free survival (HR 1.29, 95% CI 1.03 to 1.62). CONCLUSION: The degree of IBL is significantly associated with postoperative morbidity and survival in very elderly colorectal cancer patients.

Características sociodemográficas e de acesso de longevos aos serviços de saúde / Sociodemographic characteristics and enduring access to health services

Estudo epidemiológico e transversal, que objetivou identificar as características sociodemográficas e de acesso de longevos aos serviços de saúde. Os dados foram coletados no período de abril a agosto de 2012, por meio de questionário sociodemográfico e clínico, e questões adaptadas do Estudo Saúde Bem Estar e Envelhecimento, sobre acesso a saúde. A amostra por conveniência compreendeu 56 idosos longevos cadastrados em 13 centros de convivência do idoso de Ponta Grossa-PR. Houve predomínio do sexo feminino (75%), da faixa etária de 80 a84 anos, viúvos (73,2%), com ensino fundamental incompleto (71,4%), que viviam sozinhos (46,4%) e recebiam ≤ dois salários mínimos (89,3%). Destaca-se que um terço dos longevos possuíam plano de saúde e desses31,3% apresentaram dificuldades de acesso, mais manifesta entre os que faziam uso do SUS (55%). Destaca-se a importância dos profissionais de saúde, em especial o enfermeiro, em identificar e conhecer das características sociodemográficas e de acesso dos longevos que utilizam os serviços de saúde. Tais informações servirão de subsídios para o planejamento de estratégias para amenizar as dificuldades enfrentadas e melhorar o acesso deste segmento etário a esses serviços.

An epidemiological and cross-sectional study which aimed to identify the socio-demographic and accesscharacteristics of the elderly to health services. The data were collected in the period from April to August 2012,through a demographic and clinical questionnaire, and questions adapted from the Health, Wellness and AgingStudy about access to health care. The convenience sample comprised 56 elderly people registered in 13 centersof community centers of the elderly in Ponta Grossa-PR. There was a predominance of women (75%), agedbetween 80 and 101 years, widowed (73.2%), with incomplete elementary school (71.4%), living alone (46.4%)and receiving≤two minimum wages (89.3%). It is to point out that a third of the elderly had a health insurance and31.3% of those presented difficulties of access, more evident among those who made use of the SUS (55%).Theimportance of health professionals, especially nurses, to identify and know the socio-demographic and accesscharacteristics of the elderly who utilize health services stands out. Such information shall serve as a support forplanning strategies to ameliorate the difficulties faced and improve the access of this age band to such services.

Percepções das idosas longevas inativas e ativas fisicamente quanto às barreiras e aos facilitadores para a prática de atividade física / Percepciones de ancianas ancianas inactivas y físicamente activas sobre barreras y facilitadores para la práctica de actividad física / Perceptions of elderly inactive and physically active elderly women regarding barriers and facilitators for the practice of physical activity

O objetivo do presente trabalho foi analisar as percepções quanto às barreiras e aos facilitadores para a prática de atividade física de idosas longevas inativas e ativas fisicamente. Estudo composto por seis idosas longevas inativas (GFI) e nove ativas (GFA). Foi utilizada a técnica de grupo focal para avaliação das barreiras e facilitadores das idosas para a prática de atividade física por meio dos temas norteadores: envelhecimento ativo; percepção de atividade física; motivador para a prática de atividade física; impedimento para a prática de atividade física; tipo de atividade física de interesse; atividade física realizada no passado. Os dados foram tratados através de análise de conteúdo temática por meio do software ATLAS TI. O GFA mencionou mais facilitadores (5) do que barreiras (3), enquanto que o GFI citou mais barreiras (8) para a prática de atividade física do que facilitadores (4). Conclui-se que o conhecimento desses fatores é importante para novas intervenções relacionadas à realidade do idoso para manutenção ou obtenção do estilo de vida ativo.

The aim of the present study was to analyze the perceptions regarding barriers and facilitators for the practice of physical activity by elderly inactive and physically active elderly women. Study composed of six long-lived inactive elderly (GFI) and nine active (GFA). The focus group technique was used to assess the barriers and facilitators of elderly women to practice physical activity through the guiding themes: active aging; perception of physical activity; motivator for the practice of physical activity; impediment to the practice of physical activity; type of physical activity of interest; physical activity performed in the past. The data were treated through thematic content analysis using the ATLAS TI software. GFA mentioned more facilitators (5) than barriers (3), while GFI cited more barriers (8) for physical activity than facilitators (4). It is concluded that the knowledge of these factors is important for new interventions related to the reality of the elderly to maintain or obtain an active lifestyle.

El objetivo del presente estudio fue analizar las percepciones sobre barreras y facilitadores para la práctica de actividad física por parte de ancianas ancianas inactivas y físicamente activas. Estudio compuesto por seis ancianos inactivos de larga vida (GFI) y nueve activos (GFA). Se utilizó la técnica de grupos focales para evaluar las barreras y facilitadores de las mujeres mayores para la práctica de actividad física a través de los temas rectores: envejecimiento activo; percepción de la actividad física; motivador para la práctica de actividad física; impedimento para la práctica de actividad física; tipo de actividad física de interés; actividad física realizada en el pasado. Los datos se trataron mediante análisis de contenido temático utilizando el software ATLAS TI. GFA mencionó más facilitadores (5) que barreras (3), mientras que GFI citó más barreras (8) para la actividad física que facilitadores (4). Se concluye que el conocimiento de estos factores es importante para que nuevas intervenciones relacionadas con la realidad del anciano mantengan u obtengan un estilo de vida activo.

As histórias de vida dos idosos longevos de uma comunidade: o elo entre o passado e o presente / Life stories of the oldest-old people in a community: the link between past and present

O objetivo deste estudo consistiu em interpretar as histórias de vida dos idosos longevos usuários de uma Unidade Básica de Saúde em Curitiba - PR, alicerçada na perspectiva do Envelhecimento Ativo e Curso de Vida. Foi realizada pesquisa do tipo qualitativo de enfoque sócio-histórico, a qual aborda as histórias de vida de vinte longevos. A coleta de dados ocorreu mediante a realização de entrevistas narrativas no domicílio dos participantes. As entrevistas foram gravadas e transcritas, com a autorização prévia dos informantes. As narrativas foram submetidas às etapas do processo de análise proposto pelo sociólogo alemão Fritz Schütze (2010): análise formal do texto, descrição estrutural do conteúdo, abstração analítica, análise do conhecimento, comparação contrastiva (comparação mínima e comparação máxima) e construção de um modelo teórico acerca da longevidade. As vinte histórias de vida foram submetidas às duas primeiras fases de análise. Para continuidade do processo analítico foram eleitas oito histórias de vida, que se mostraram mais pertinentes aos propósitos do estudo. As análises das trajetórias de vida resultaram em dez categorias que apresentaram semelhanças entre si, e oito consideradas diferentes às demais. As categorias apresentadas na comparação mínima foram: 1 - O trabalho como subsistência da vida cotidiana - os membros da família trabalhavam impulsionados por suas necessidades e exigências; 2 - As famílias extensas e suas implicações - o elevado número de filhos, a situação sócioeconômica e as condições dos fatores de produção não permitiam aos pais que enviassem os filhos à escola; 3 - A família patriarcal e a educação dos filhos - os arranjos familiares eram eminentemente centrados na autoridade paterna, severidade, temor e deveres dos filhos. 4 - Os conflitos políticos presenciados na infância - A cultura de silêncio - relatos de passagens da participação política de seus genitores, bem como as repercussões desses em suas vidas; 5 - A utilização de práticas culturais de cura como alternativa no cuidado à saúde - utilizada mais frequentemente na infância - os chás, as garrafadas, como também a figura do benzedor, raizeiro e curandeiro, essas práticas tem sua perpetuação no presente; 6 - O êxodo rural como expectativa de melhora de vida - ocorreu na fase adulta dos participantes e apresenta as dificuldades iniciais enfrentadas na região urbana; 7- As perdas e os enfrentamentos ao longo do curso de vida - esses eventos representaram momentos de angústia, revolta, desgosto, e deixaram marcas, após a superação destes, reconstruíram suas vidas e famílias. 8 - A Religiosidade e sua representatividade nas trajetórias de vida dos longevos - força propulsora de suas vidas, o apego à religião denota crenças, tradições, valores e formas de proteção, expressaram sua religiosidade como verdade incondicional; 9 - A trajetória atual - uma representação diferenciada de envelhecer - o cuidado à saúde é visto como prioritário, procuram se alimentar de forma saudável e manter-se ativos. A aproximação com filhos e netos traz segurança e favorece a ajuda mútua; 10 - A trajetória futura e os projetos de vida - soam como continuidade da vida e expectativas do que podem e o que almejam fazer, num contexto de desejos, saudades e declarações de amor à vida. As categorias que se apresentaram diferentes às oriundas da comparação inicial foram: 1 - Fumar - hábito adquirido na adolescência - entendem que o uso do fumo, pode trazer consequências à saúde com comprometimento da qualidade de vida, contudo, um dos longevos afirma não conseguir abandonar o vício; 2 - A vida solitária - amizade com os vizinhos como rede de apoio - a vida solitária manifestada na trajetória individual da longeva, não é vista por ela como fato negativo, mas sim como escolha pessoal; 3 - Novo casamento dos longevos após viuvez - os homens quando perderam suas esposas, casaram-se novamente, diversamente das mulheres que permaneceram viúvas; 4 - Insegurança gerada por moradia em área de risco - a insegurança causada pela presença de traficantes na região se configura como uma forma de violência ao longevo; 5 - O trabalho após a aposentadoria visto como uma necessidade - para manter a família, com pessoas doentes e dependentes, que dispendem maiores recursos financeiros em seus cuidados à saúde; 6 - A atenção à saúde referida como insatisfatória - em relação à demora de encaminhamento à atenção secundária e a falta de medicamentos usualmente distribuídos na Unidade Básica de Saúde; 7 - Alimentação precária por ingesta inadequada de nutrientes - a localização do trabalho distante da residência, não permite ao longevo realizar as refeições em casa, em consequência a alimentação é insatisfatória, pobre em nutriente; 8 - Fatores econômicos como geradores de proteção social - A situação financeira estável resulta em melhores condições de habitação, alimentação, lazer e cuidados com a saúde. Neste processo de análise das categorias surgiram elementos presentes no passado e presente dos longevos, que contribuíram para o desenvolvimento de um modelo teórico: "Construindo a longevidade no curso de vida". A longevidade tem suas raízes no passado, fortemente influenciada pela cultura familiar e curso de vida. Os pressupostos do Envelhecimento Ativo são mais expressivos na trajetória atual dos longevos, na qual se alternam determinantes e condicionantes do Envelhecimento Ativo, não existindo uma totalidade desses fatores presentes nas histórias individuais. As contribuições das histórias de vida remetem à construção e compreensão do processo de longevidade, conhecimento parcial, mas num amplo sentido, não só social, mas biológico, psicológico, econômico, político, cultural e espiritual. O conhecimento das histórias de vida apontou novas possibilidades de intervenção da Enfermagem Gerontológica na Atenção Primária, visando à promoção e prevenção da saúde, fundamentada especialmente no respeito à cultura, presente no curso de vida dos longevos.

This study objectified to interpret life histories of oldest-old users from a Primary Health Care Unit in Curitiba, Parana State/Brazil, grounded on the perspective of Active Aging and Life Course. A qualitative research study with a social, historical focus was held, approaching life histories of twenty oldest-old people. Data collection was carried out by means of narrative interviews at the participants' home. The interviews were recorded and transcribed with the participants' previous consent. The narratives were submitted to the steps of Fritz Schütze's analytical process (2010), a German sociologist: formal text analysis, structural content description, analytical abstraction, knowledge analysis, contrastive comparison (minimum and maximum comparison), and construction of a theoretical model on longevity. Twenty life histories were submitted to the first two steps of the analysis. Proceeding the analytical process, eight life histories, more pertinent to the study purposes, were selected. The analysis of life trajectories resulted in ten categories which presented similarities, and eight were considered dissimilar to the others. The categories featuring the minimum comparison were: 1 - Work supporting daily life - family members' work was driven by their needs and demands; 2 - Large families and their implications - the large number of children, the socioeconomic situation and the conditions of the production factors did not enable parents to send their kids to school; 3 - The patriarchal family and children's education - family arrangements were ultimately father-centered, severity, children's fear and duties. 4 - Political conflicts witnessed in childhood - The silence culture - accounts of parents' political participation as well as repercussions in their lives; 5 - The use of cultural healing practices as an alternative to health care - more frequently used in childhood - teas, bottled infusions, and the figure of the healer, herbal medication maker, such practices have been perpetuated; 6 - Rural depopulation as an expectation to improve life - it happened in participants' adulthood and features initial difficulties faced in the city; 7 - Losses and coping over lifetime - these events represent moments of anguish, revolt, grief, traces were left, and after overcoming them, they reconstructed their lives and families. 8 - Religiosity and its representation in the oldest-elders' life trajectories - a driving force in their lives, the attachment to religion means beliefs, traditions, values and ways of protection, they expressed their religiosity as unconditional truth; 9 - The current trajectory - a different representation from aging - health care is viewed as priority, they try to eat healthy food and be active. Getting closer to children and grandchildren brings safety and favors mutual help; 10 - Future trajectory and life projects - sound like life continuity and expectations of what they can and long to do in a context of wishes, longings and love declarations to life. The dissimilar categories from the initial comparison were: 1 - Smoking - habit from adolescence - they understand that smoking hinders their quality of life, however one of the oldest-elder claims that cannot give up the habit; 2 - Lonely life - neighbors' friendship as the support network - the lonely life manifested by an oldest-old woman is not viewed as a negative fact but her personal choice; 3 - New oldest-old marriage after spouses' death - men married again when losing their wives, unlike women who remained widows; 4 - Unsafety generated by living in a hazardous area - unsafety caused by the presence of drug dealers in the area features as a kind of violence for the oldest-old; 5 - Working after retirement viewed as a necessity - to support the family with ill, dependent members, who spend higher financial resources on their health care; 6 - Poor health care - regarding the delay in being referred to secondary health care as well as the scarcity of medication usually distributed by the Primary Health Care Unit; 7 - Precarious food due to inadequate nutrient intake - Work distant from home does not enable the oldest-old people to have their meals at home, consequently food intake is poor and lacks nutrients; 8 - Economic factors generating social protection - A stable financial situation brings about better conditions of housing, food, leisure and health care. In this process, elements from the oldest-old people's past and present emerged, which contributed to the development of a theoretical model: "Building longevity along the course of life." Longevity is rooted in the past, strongly influenced by family culture and course of life. The assumptions of Active Aging are more significant in the oldest-old participants' current trajectory where the determinants and the foundations of Active Aging have alternated, not existing a total amount of these factors in the individual narratives. The contributions of the life histories refer to the construction and understanding of the longevity process; partial knowledge, however, in a broader sense, not only social but also biological, psychological, economical, political, cultural and spiritual. The knowledge of life histories pointed to new interventional possibilities of Geriatric Nursing in Primary Health Care, aiming at health promotion and prevention, founded ultimately on the respect to the culture, present in the oldest-old people's course of life.