Condicionantes para el abordaje del aislamiento social y la soledad de adultos mayores no institucionalizados desde atención primaria de salud / Determinants for addressing social isolation and loneliness of non-institutionalized older adults from Primary Health Care

Objetivo: Identificar los principales condicionantes que los profesionales de atención primaria indican a la hora de implementar y desarrollar intervenciones sobre el aislamiento y la soledad.Diseño: Investigación cualitativa con análisis Sistemático de Teoría Fundamentada y Diseño narrativo de tópicos.Emplazamiento: Desarrollada en 13 centros de atención primaria del Distrito Sanitario Córdoba y Guadalquivir, abarcando zonas urbanas y rurales.Participantes: Se identificaron 3 perfiles: medicina de familia/atención comunitaria, enfermería comunitaria y enfermería de gestión de casos. La selección se llevó a cabo entre aquellos que mostraron mayor motivación y compromiso con una intervención sobre aislamiento/soledad.Método: Muestreo intencional. El trabajo se fundamentó en entrevistas en profundidad individuales, en grupos focales y entrevistas dialógicas.Resultados :a) Persisten imágenes deformadas sobre la soledad/aislamiento social y el vivir solo que dificultan su identificación; b) Los principales determinantes disruptivos en la estructura y organización del sistema de atención tienen que ver con la ausencia de programas de detección, la hegemonía del modelo biomédico y el déficit de recursos (a la luz de este modelo); c) Los principales facilitadores se vinculan con el rol enfermero, privilegiado para estas intervenciones según los participantes; y, finalmente, d) Es necesario contar con componentes personales, tanto de la persona mayor como de los profesionales.Conclusiones: La intervención sobre el aislamiento social y la soledad en atención primaria está condicionada por factores, organizacionales y estructurales, profesionales y personales. Contar con ellos es fundamental a la hora de garantizar su factibilidad.

Objective: To identify the main conditioning factors that Primary Care professionals indicate when implementing and developing interventions on isolation and loneliness.Design: Qualitative research with grounded theory, systematic analysis and narrative design of topics.Location: Developed in 12 Primary Care centres of the Health District of Córdoba and Guadalquivir, covering urban and rural areas.Participants: Three profiles were identified: family medicine/community care, community nursing and case management nursing. The selection was carried out among those who showed greater motivation and commitment to an intervention on isolation/loneliness.Method: Purposive sampling. The work was based on individual in-depth interviews, focus groups and dialogic interviews.Results: (a) Distorted images persist about loneliness/social isolation and living alone that make it challenging to identify; (b) the main disruptive determinants in the structure and organization of the care system have to do with the absence of screening programs, the hegemony of the biomedical model and the deficit of resources (in light of this model); (c) the main facilitators are linked to the nursing role, privileged for these interventions according to the participants; and, finally, (d) personal components are necessary, both from the older adult and from the professionals.Conclusions: Intervention on social isolation and loneliness in Primary Care is conditioned by organizational and structural, professional and personal factors. It is essential to take them into account in order to guarantee their feasibility.

Quality of Life in Australian Adults Aged 50 Years and Over: Data Using the Schedule for the Evaluation of Individual Quality of Life (SEIQOL-DW).

OBJECTIVES: This study explored unique and personal domains associated with quality of life (QOL) in 153 mid-aged and older Australian adults over age 50, using an innovative measure of individualized QOL, the Schedule for the Evaluation of Individual Quality of Life (SEIQOL-DW). METHODS: Demographic measures as well as the SEIQOL-DW were administered. The qualitative responses on this scale were analyzed by Leximancer, a text analysis program that extracts semantic meaning and relational information automatically from text. RESULTS: For the sample as a whole, the most important QOL domain was found to be Relationships, followed by Family, Health, Activities, Community, Security, Beliefs, Independence and finally Wellbeing. When the sample was broken down into age bands for analysis, the most important domain theme was Family (50-59 year olds), Relationships (60-69 year olds), Relationships (70-79 year olds), and Health (80+ year olds). CONCLUSIONS: The wide range of concepts elicited in each domain via Leximancer underscores the argument for analyzing QOL in an individualized way, as it was clear from these concepts that different domains had unique meanings to each person. CLINICAL IMPLICATIONS: Understanding QOL at the level of which domains in an individual are important to QOL in later life is critical to providing services to both healthy aged as well as those with health and mental health needs. The SEIQOL-DW affords clinicians a unique tool with which to describe an individual's unique and relevant quality of life areas, and affords a way to measure change in these areas as a result of interventions.

Super-aging and social security for the most elderly in China.

This article is dedicated to an under-researched area, the demographic development and social welfare for the most elderly (aged ≥80 years) in The People's Republic of China. Based on national censuses conducted over the last six decades in China this study examined the development of the most elderly population in comparison with groups of younger elderly people. It is argued that population growth among the most elderly in China has occurred with unparalleled speed, a phenomenon referred to as second order aging. This study demonstrated that the proportion of individuals aged ≥80 years has increased more rapidly than any other age group among elderly people. Particular attention has been given to the issue of social security and social welfare for the most elderly based on the non-contributory old age allowances provided by various regions and provinces. A national unified program of social security for the most elderly in the population is still not in sight.

Efficacy and cost-effectiveness of second-line chemotherapy in elderly patients with advanced gastric cancer

Purpose. Second-line chemotherapy has been shown to benefit patients with advanced gastric cancer (AGC), extending the overall survival (OS) and progression-free survival (PFS). This study aimed to assess the efficacy and cost-effectiveness of second-line treatment for elderly patients with AGC. Methods. Medical records and follow-up information of elderly patients (≥70 years) with AGC who received second-line chemotherapy were collected. A Markov model comprising three health states PFS, progressive disease and death was developed to simulate the process of AGC. Cost was calculated from the perspective of Chinese society. Sensitivity analyses were applied to explore the impact of essential variables. Results. Forty-three elderly patients with AGC receiving second-line chemotherapy were included in our study. The median OS was 6.0 months (95% confidence interval (CI) 3.90-8.10) and PFS was 3.1 months (95% CI 1.38-4.82). No treatment-related death occurred. The most frequently drug-related grade 3/4 AEs were diarrhea (2.3%), leukopenia (16.3%) and nausea (7.0%). The incremental cost-effective ratio was $18,223.75/QALY for second-line chemotherapy versus BSC, which was below the threshold of 3× the per capita GDP of China, $23,970.00. Conclusion. Second-line chemotherapy was an optimal strategy for elderly AGC patients in China from the efficacy and cost-effectiveness perspective (AU)

No disponible

A cost of living longer: Projections of the effects of prospective mortality improvement on economic support ratios for 14 advanced economies.

The economic implications of increasing life expectancy are important concerns for governments in developed countries. The aims of this study were as follows: (i) to forecast mortality for 14 developed countries from 2010 to 2050, using the Poisson Common Factor Model; (ii) to project the effects of the forecast mortality patterns on support ratios; and (iii) to calculate labour force participation increases which could offset these effects. The forecast gains in life expectancy correlate negatively with current fertility. Pre-2050 support ratios are projected to fall most in Japan and east-central and southern Europe, and least in Sweden and Australia. A post-2050 recovery is projected for most east-central and southern European countries. The increases in labour force participation needed to counterbalance the effects of mortality improvement are greatest for Japan, Poland, and the Czech Republic, and least for the USA, Canada, Netherlands, and Sweden. The policy implications are discussed.

Tratamiento del dolor en el anciano: opioides y adyuvantes / Drug treatment invasive joint in osteoarthritis

En pacientes seleccionados, los opioides pueden proporcionar una adecuada analgesia en el marco de un abordaje integral. Se ha revisado la utilización de opioides fuertes en ancianos con dolor oncológico o no oncológico. Se ha demostrado eficacia en dolor músculo-esquelético a corto plazo y algunos tipos de dolor neuropático. No obstante, no se dispone de datos sobre eficacia y seguridad a largo plazo. Aunque los antidepresivos tricíclicos son eficaces para el dolor neuropático, sus efectos anticolinérgicos suponen un problema para el anciano. Antiepilépticos como gabapentina y pregabalina son eficaces para el dolor neuropático y mejor tolerados. La administración tópica de algunos fármacos mejora la tolerabilidad de los mismos (AU)

There is a small number of primary studies relating to opioid use in older people. In carefully selected and monitored patients, opioids may provide effective pain relief as part of comprehensive pain management strategy. Use of strong opioids in the management of chronic, severe cancer and non-cancer pain in older people has been reviewed. Studies have demonstrated short-term efficacy in persistent musculoskeletal pain and various neuropathic pains. However, longer-term efficacy and safety data are lacking. Some adjuvant drugs should be considered for older people with neuropathic. Although tricyclic antidepressants have good efficacy, anticholinergic side effects are often problematic for older people. Anti-epileptic drugs such asgabapentin or pregabalin, are effective for neuropathic pain and are probably better tolerated. Topical administration may have improved tolerability than other routes of administration and may be preferable for elderly (AU)

Paciente anciano con diabetes mellitus y fragilidad. ¿Asociación siempre presente? / Elderly patients with diabetes mellitus and frailty. Association always present?

No disponible

Características clínicas de los enfermos centenarios hospitalizados / Clinical characteristics of centenarian hospitalized patients

No disponible

Herramientas de valoración geriátrica en Servicios de Geriatría españoles / Geriatric assessment tools in Spanish Geriatric Departments

Introducción. La valoración geriátrica integral (VGI) es la principal herramienta de trabajo de los geriatras, aunque una encuesta del año 2000 encontró que se realizaba de manera heterogénea en los Servicios de Geriatría de España. Por ello nos propusimos realizar una nueva encuesta que pusiera de manifiesto las tendencias a este respecto en los últimos 13 años. Material y métodos. Estudio descriptivo transversal de los resultados de una encuesta estructurada a los responsables de 39 Servicios y Unidades de Geriatría de España, 27 con acreditación docente, realizada durante el primer semestre de 2013, sobre las herramientas de VGI empleadas en los distintos niveles asistenciales. Resultados. La tasa de respuesta de la encuesta fue del 97,4%. El 78,4% (n = 29) de los centros reconoció emplear diferentes herramientas según el nivel asistencial. Los índices de Barthel y Lawton fueron las herramientas de valoración funcional más empleadas en todos los Servicios y niveles asistenciales, aunque la velocidad de marcha y la escala de Tinetti fueron muy usadas en Hospital de día y en consultas externas. Las escalas más utilizadas en la valoración mental fueron el Mini Mental State Examination y el Mini Examen Cognoscitivo (97,4%), seguidos por test de valoración afectivo-conductual (86,8%) y severidad del deterioro cognitivo (84,2%). En las urgencias del 43,2% de los hospitales encuestados se emplearon herramientas de VGI, siendo la más usada el índice de Barthel, y el 69,4% de los dispositivos de Atención Primaria de las áreas de salud de los hospitales encuestados empleaba herramientas de VGI, siendo de nuevo las más empleadas el índice de Barthel e índice de Lawton (38,9%). La mayoría de los Servicios encuestados sigue pensando que los principales dominios que deben ser evaluados en una VGI son el funcional, mental y social, siendo otros dominios importantes la nutrición, comorbilidad, caídas y úlceras. Conclusiones. La VGI se sigue realizando de manera heterogénea en los diferentes Servicios de Geriatría españoles, aunque se aprecian tendencias hacia un mayor empleo del índice de Barthel, mayor adecuación de los instrumentos al nivel asistencial y mayor valoración de nuevos dominios como la fragilidad, nutrición o comorbilidad (AU)

Introduction. Comprehensive Geriatric Assessment (CGA) is the main measurement tool used by Geriatricians. A 2000 survey demonstrated great variability in the tools used for CGA among Spanish Geriatric Departments. A new survey to detect 13-year trends in the use of CGA tools in our country is presented. Material and methods. Descriptive study using a structured questionnaire on the use of CGA tools in different levels of care sent to the Heads of 39 Spanish Geriatric Departments or Services (27 with postgraduate teaching in Geriatrics) during the first three months of 2013. Results. The response rate was 97.4%. It was found that 78.4% (29 centers) used different tools depending on the level of care. Barthel and Lawton index were the most used functional assessment tools in all Departments and across all geriatric levels, although gait speed and Tinetti scale were frequently used in Day Hospital and Outpatient clinics. The Mini Mental State Exam and its Spanish version Mini Examen Cognoscitivo were the most used mental scales (97.4%), followed by tools for assessing depression-behavior (86.8%) and severity of cognitive impairment tools (84.2%). CGA tools were used in 43.2% of the emergency departments of the hospitals surveyed, being the most frequent. More than two-thirds (69.4%) of the Departments reported that their affiliated Primary Care centers used CGA tools, with the Barthel and Lawton again being indexes the most used. Most of the responding Departments considered that the main domains of CGA are functional, mental and social status. Nutrition, comorbidity, falls and pressure ulcers are other important domains. Conclusions. There is still a great variability in the CGA tools being used in Spanish Geriatric Departments, although there is a trend towards a greater use of Barthel index, greater adaptation of tools to each level of care, and increasing assessment of new domains like frailty, nutrition or comorbidity (AU)

Old age security in rural China: there is a long way to go.

OBJECTIVE: We aimed to examine the current developments and challenges confronted by old age security in rural China. DATA SOURCES: This study is based on the data from PubMed, Elsevier, Wiley, EBSCO, EMBASE, SCI Expanded, ProQuest, Google, and CNKI which is the most informative database in Chinese. STUDY SELECTION: Articles were selected with the search terms "rural", "China", "old", "older", or "elder", "elderly", or "aged", "aging", "security", "culture", "value", "medical insurance" or "community based medical insurance" or "cooperative medical scheme". Related websites and yearbooks were searched as well. RESULTS: The socio-economic development has made the burden of traditional care for the rural elderly heavier than ever, and new challenges are emerging in rural communities, such as poor economic, deteriorating natural environment and health crisis. CONCLUSIONS: The governments should improve the scale and caliber of rural old age security and strengthen regulations with great efforts in developing the rural economy and protecting the natural environment of rural communities.

¿Qué pacientes se benefician más de la atención geriátrica hospitalaria en opinión de los especialistas en Geriatría? / Which patients benefit the most from hospital geriatric care in the opinion of the geriatricians?

Objetivo. Conocer en la práctica cuál o cuáles son los criterios considerados por los geriatras hospitalarios como los más idóneos para seleccionar a los pacientes que más se pueden beneficiar de la atención geriátrica hospitalaria. Material y métodos. Se elaboró una encuesta en la que se presentaron diversos criterios socio-demográficos, clínicos, funcionales y mentales incluidos en las definiciones de paciente geriátrico y anciano frágil. La encuesta se envió a todos los especialistas en Geriatría de los diferentes hospitales del Servicio Madrileño de Salud. Se les pidió que respondieran a cada criterio indicando si lo consideraban muy prioritario, prioritario, poco prioritario o nada prioritario. Las respuestas se agruparon según el tipo de hospital (con docencia MIR, sin docencia MIR y hospitales de apoyo de media y larga estancia). Resultados. Se recibieron un total de 83 encuestas (70% de la población a estudio): 42 de hospitales con docencia MIR de Geriatría (74% de las posibles), 20 de aquellos con urgencias externas, pero sin docencia MIR (56% de las posibles) y 21 de hospitales de media y larga estancia (84% de las posibles). Todos los criterios propuestos fueron considerados individualmente como prioritarios o muy prioritarios por más del 50% de los encuestados. La edad de 85 y más años, el ingreso por fractura de cadera, la presencia de deterioro funcional o cognitivo agudo, la fragilidad y el deterioro inexplicado del estado de salud fueron considerados de manera individual como criterios muy prioritarios para la selección de población diana por más del 85% de los encuestados. Conclusiones. Determinados criterios como la edad muy avanzada o la presencia de procesos geriátricos específicos como fractura de cadera o deterioro funcional o cognitivo agudo, son identificados por los geriatras como útiles para seleccionar a los pacientes hospitalizados subsidiarios de recibir atención geriátrica especializada(AU)

Objective. To assess the most appropriate criteria considered by geriatricians to select patients who might benefit the most from geriatric hospital care. Material and methods. We carried out a survey that consisted of various socio-demographic, clinical, functional and mental criteria included in the definition of the geriatric and frail elderly patient. The survey was sent to all specialists in geriatrics in the different hospitals of the Madrid Health Service. They were asked to answer to each criterion indicating whether they considered it as high priority, priority, low priority or no priority. The responses were clustered by type of hospital: acute hospitals with or without a post-graduate geriatric program for medical residents, and medium and long stay hospitals. Results. A total of 83 questionnaires were completed (70% of the study population): 42 teaching hospitals a post-graduate geriatric program (74% of possible), 20 of those with an emergency department but without a post-graduate geriatric program (56% of possible), and 21 medium and long stay hospitals (84% of potential). All proposed criteria were considered individually as priority or high-priority by more than 50% of respondents. An age 85 years and over, admission for hip fracture, the presence of severe cognitive or functional impairment, frailty, and unexplained deterioration of health status, were considered individually as criteria for selecting high-priority target population by more than 85% of respondents. Conclusions. Certain criteria, such as advanced age, or the presence of geriatrics-specific conditions, such as hip fracture or severe functional or cognitive impairment, are identified by geriatricians as useful to select patients to receive geriatric specialist hospital care(AU)

Actividades Instrumentales de la Vida Diaria en Personas Mayores atendidas en la red de Atención Primaria de Salud en la comuna de Chillán Viejo-Chile / Instrumental activities of daily living of older people cared for at the Primary Health Care network in the commune of Chillan Viejo-Chile

Justificación. Estadísticas nacionales e internacionales demuestran que los equipos de salud tendrán que responder a la necesidad de cuidado de las personas mayores, reconociendo la trascendencia de la capacidad funcional como variable de evaluación de su estado de salud. Objetivo. Determinar características de las personas mayores que pueden influir en su capacidad funcional según las Actividades Instrumentales de la Vida Diaria. Diseño. Estudio cuantitativo, descriptivo-correlacional de corte transversal. Resultados. De 136 individuos estudiados (61% mujeres) y una edad promedio de 73,28 ± 6,77 años, se observó que las Actividades Instrumentales de la Vida Diaria dependen significativamente de: nivel de alfabetización (p=0,002), nivel de instrucción (p=0,024), participación comunitaria (p=0,007), estado nutricional (p=0,028) y depresión (p=0,018). Conclusión. Factores sociales, físicos y mentales se relacionan con la funcionalidad de las personas mayores. Es primordial la generación de políticas públicas de protección a este grupo de la población, con un enfoque multidisciplinario y sistémico (AU)

Justification. National and International statistics show that health teams will have to respond to the needs of caring for older people, considering the implication of the functional capacity as a variable of evaluation of their health condition. Objective. To determine those characteristics in older people that may influence their functional capacity, according to the Instrumental Activities of Daily Living. Design. Quantitative, descriptive-correlational cross sectional study. Results. Out of 136 individuals studied (61% female) and an average age of 73,28 ± 6,77 years old, it was observed that the Instrumental Activities of Daily Living depend significantly on: literacy level (p=0,002), instruction level (p=0,024), community participation (p=0,007), nutritional status (p=0,028) and depression (p=0,018). Conclusion. Social, physical and mental factors relate to the functionality of older people. It is fundamental to create public policies to protect this group in the population, with a cross functional and systemic approach (AU)

Safety and security of older persons in Tehran, Iran: a sociological appraisal of elder abuse.

The article explores and evaluates the quality of life, safety, and security of elderly people in Tehran City in Iran. In that, different dimensions of material and social well-being, and abuse of people of the age 65 and above, are assessed. Besides the human rights, the dignity, and the gradual decline of the elderly's social security are reflected. The research also aims to study the elder age-groups in order to find out how these people gradually lose their physical and mental reliance, and as a result, how their dependence on others and various services enhances. The method of research mainly being empirical, it is preceded by theoretical and literature review. Five hundred elderly people were randomly selected for the study. Findings suggest that the aging pyramid shrinks and narrows at the age of 65 or even before in the present study. Research reached the conclusion that the young elderly with new needs and expectations are highly different from those of their pervious generations.

Tecnologia educacional inovadora para o empoderamento junto a idosos com diabetes mellitus / Una tecnología educativa innovadora para el empoderamiento de ancianos con diabetes mellitus / Innovative educational technology for empowering the elderly with diabetes mellitus

As práticas de saúde contemporâneas passam por uma importante crise em sua história. Contrastando com seu expressivo desenvolvimento científico e tecnológico, estas práticas vêm encontrando sérias limitações para responder efetivamente às complexas necessidades de saúde de indivíduos e populações. Este relato de experiência tem como objetivo refletir sobre o empoderamento como tecnologia educacional inovativa para o cuidado de si junto a idosos com diabetes mellitus. O desenvolvimento da análise é orientado por relato de experiência de atendimentos assistenciais de atenção primária à saúde, extraído do cotidiano profissional das próprias autoras. Acolhimento, acessibilidade à informação e ao conhecimento, respeito, vínculo, identidade e responsabilidade são apontados como traços principais na compreensão das interações entre profissionais de saúde, pacientes e familiares; e na construção do cuidado "empoderador" em enfermagem, que propicia ao idoso ser protagonista do processo, estimulando o cuidado de si, por meio da aliança terapêutica entre idoso, profissional e família.

Contemporary health care practices are going through a historical crisis. In contrast to expressive scientific and technological development, these practices are encountering serious limitations to effectively respond to individuals' and populations' complex health needs. This experience report aims to reflect on the empowerment of innovative educational technology towards self-care together with elderly people with diabetes mellitus. The development of the analysis is oriented by experience reports in primary health care assistance, extracted from these authors' daily work. Reception, accessibility to information, knowledge, respect, linking, identity, and responsibility are singled out as key features in understanding the interactions between health professionals, patients, and family members. The construction of empowerment care in nursing provides the elderly to be protagonists of the process, encouraging self-care through the therapeutic alliance between the elderly, the health care professional, and family.

Las prácticas contemporáneas de la salud pasan por una grave crisis en su historia. En contraste con su expresivo desarrollo científico y tecnológico, estas prácticas se enfrentan a serias limitaciones para responder eficazmente a las complejas necesidades de salud de los individuos y las poblaciones. Este estudio tiene como objetivo reflexionar sobre el empoderamiento como tecnología educativa innovadora para fomentar el cuidado de sí mismos de los ancianos con diabetes mellitus. El desarrollo del análisis se guía por los informes de la experiencia del cuidado en la atención primaria de salud, extraídos de la labor diaria de las autoras de este estudio. La recepción, la accesibilidad a la información, el conocimiento, el respeto, el empleo, la identidad y la responsabilidad son señaladas como características claves para entender las interacciones entre los profesionales de la salud, los pacientes y los miembros de la familia, y la construcción de "empoderamiento" en el cuidado de la enfermería, que permite que los ancianos sean protagonistas de ese proceso, al fomentar el cuidado de sí, a través de la alianza terapéutica entre los ancianos, el profesional y la familia.

Aplicación del modelo de redes personales al estudio de los ancianos dependientes / No disponible

Introducción: La disminución de la capacidad de apoyos informales al anciano en la red familiar básica y el tímido aumento de las redes formales de atención hacen necesario tener en cuenta metodologías que hagan hincapié en la potencialidad de los recursos sociales que poseen los ancianos dependientes. Material y métodos: Investigación descriptiva comprendida entre el 29 de noviembre de 2007 y el 1 de julio de 2008. La información se obtuvo a partir de entrevistas asistidas por ordenador a 40 ancianos dependientes. Resultados: Un 80% de los ancianos dependientes (Egos) tenía más de 75 años, un 42,5% vivía solo; casi la mitad de los Alteris (personas del entorno del sujeto estudiado) estaban jubilados y eran de lamisma generación que los Egos. La densidad y la cohesión de las redes sociales, controlados por elstock de Capital Social, tenían una influencia positiva sobre la percepción subjetiva de salud. Además también repercutía en el stock de Capital Social, de tal forma que favorecía indirectamente la buena autopercepción de la salud. Conclusiones: El modelo de redes personales define con más nitidez que otras técnicas de análisis los tipos de ayuda que se procuran al anciano y permite medir la contribución de toda la red social al apoyo, real y potencial, de la persona pendiente (AU)

Introduction: Decrease of the capacity of informal support to elderly and family network and scarce increase of formal support network require other methods and strategies to study this issue. The analysisof social network can be useful to analyze available social resources for disabled elderly. Material and methods: Descriptive research dated was made between November 29 and July 1 2008. The information was obtained from interviews supported by computer to 40 disabled elder. Results: 80% of disabled elderly (Egos) was more than 75 years, 42.5% lived alone; almost half of Alters (individuals of the environment of the elderly) were retired and belonged to same generationthan elderly. Density and cohesion of social network, mediated for stock of capital social, influenced positively on subjective perception of health and had an effect in Capital Social stock too to favor good auto-perception of health indirectly. Conclusions: Personal networks model defines with more clearly than other analysis techniques the kinds of support provided to elderly and allow to asses the contribution of the whole social network to disabled elderly (AU)

Evaluación del proyecto estatal de intervención para la mejora de la calidad de vida y la reducción de complicaciones asociadas al envejecimiento: «Agrega salud a tus años» / Evaluation of the state intervention project to improve quality of life and reduce the complications associated with aging: “Add health to your years”

ObjetivoEvaluar la eficacia de un programa de promoción de salud y prevención de patologías asociadas al envejecimiento, para evitar complicaciones asociadas y mejorar la calidad de vida en adultos mayores.MetodologíaEstudio desarrollado durante 12 meses (años 2006–2007) en 700 adultos mayores de Buenos Aires-Argentina, separados de forma aleatoria en 2 grupos: intervención y control. A todos se les realizaron mediciones pre y postintervención de peso, talla, tensión arterial, colesterol, triglicéridos, glucemia y problemas cardiovasculares (infarto, accidente vascular cerebral), osteoarticulares (fracturas), ingresos hospitalarios y calidad de vida evaluada con la Encuesta-SF12. La intervención consistió en actividad física periódica (bisemanal) destinada a fortalecer grupos musculares que otorgan autonomía de movimientos, así como actividades recreativas, talleres de nutrición y manipulación de alimentos. A cada individuo del grupo intervención se le asignó un estudiante de medicina que semanalmente lo visitó y acompañó en las actividades. El grupo control continuó con actividades habituales.ResultadosEl grupo de intervención mostró una reducción significativa en valores de tensión arterial, triglicéridos y colesterol respecto al control. Además, redujo un 31% los eventos cardiovasculares, 18,2% las fracturas de cadera, 21,1% los ingresos hospitalarios por problemas cardiovasculares, osteoarticulares y de salud mental respecto al control. La encuesta de calidad de vida postintervención incrementó un 28,7% las respuestas favorables respecto su registro basal y 33,4% respecto al grupo control.ConclusiónEl programa implementado logró reducir los factores de riesgo y las complicaciones asociadas al envejecimiento en el grupo de intervención respecto al control(AU)

ObjectiveThis paper evaluates the effectiveness of a Public Health program for the elderly based on health promotion and pathologies prevention, in order to avoid complications associated with illnesses and improves the quality of life (QOL) in elderly adults (EA).MethodsA 12 month intervention studies used 700 EA randomized in 2 groups: intervention and control. Each group was submitted to pre-post intervention measurements that included weight, height, blood pressure (BP), cholesterol, lipids, glycaemia, cardiovascular (infarct, stroke) and bone fractures events, hospitalization, and a QOL survey. Intervention consisted of periodic physical activity to fortify muscular groups, as well as recreational activities, nutritional and food manipulation training visits. A medical student was assigned to each participant from the intervention group to assure periodical contact and to share activities. The control group continued with their normal activities during observational period.ResultsThe intervention group showed a significant reduction in the BP, lipids and cholesterol values compared to control group. Reduction on cardiovascular events (−31%), hip fractures (−18.2%) and number of hospital admittance (−21.1%) were obtained for group A in relation to B. The QOL survey showed 28.7% improvement for group A compared with 33.4% improvement compared with control group.ConclusionThe health program with exhaustive follow-up administration, significantly reduced risk factors and complications associated with aging(AU)

Prevalencia de úlceras por presión en residencias geriátricas / Prevalence of bed sores in geriatrics nursing home residences

El número de residencias asistidas para ancianos ha aumentado considerablemente. No obstante, las políticas de control de calidad en dichos centros no han crecido a la misma velocidad. Se estima que el 95% de las úlceras por presión (UPP) es potencialmente evitable, por lo que su aparición se relaciona directamente con la calidad de cuidados prestados. Estudio descriptivo transversal, revisando aleatoriamente 364 historias clínicas de usuarios institucionalizados. Se recogieron variables sociodemográficas, estado cognitivo, presencia de UPP y patologías asociadas. Los datos fueron analizados mediante SPSS 13.0. La edad avanzada, sexo femenino, estado cognitivo alterado y patología invalidante son factores de riesgo de padecer UPP en residencias geriátricas. Se evidencia la necesidad de estudios específicamente diseñados para evaluar el impacto sanitario de las UPP en las residencias geriátricas(AU)

The number of nursing homes to provide the elderly with in-residence care has increased considerably. However, the quality control policies for those centers have not grown at the same speed. Estimates show that 95% of bed sores, ulcers caused by pressure, are potentially avoidable; therefore, their appearance has a direct relationship to the quality of treatment provided. This study is a transversal descriptive study which randomly reviews 364 clinical cases of institutionalized patients. The investigators gathered in socio-demographic variables, cognitive state, presence of bed sores and associated pathologies. These data were analyzed by means of SPSS 13.0. Advanced age, female gender, altered cognitive state, invalid-making pathology are risk factors to suffer bed sores in nursing homes. The investigators find evidence that it is necessary to carry out studies specifically designed to evaluate the sanitary impact of bed sores in nursing homes(AU)

Envelhecimento, ciclo de vida e mudanças socioeconômicas: novos desafios para os sistemas de seguridade social / Ageing, life cycle and socioeconomic changes: new challenges for social security systems

O processo de envelhecimento populacional, ainda que amplamente reconhecido como uma das principais conquistas do século XX engendra o desafio de assegurar que o processo de desenvolvimento ocorra com base em princípios capazes de garantir a dignidade humana e a eqüidade entre os grupos etários na partilha dos recursos, direitos e responsabilidades sociais. Além dos desafios impostos aos já tradicionais programas constantes dos atuais sistemas de seguridade social, o envelhecimento populacional acrescenta uma nova questão ou risco social: os cuidados de longa duração, demandados pelos idosos com perda de capacidade instrumental e/ou funcional para lidar com as atividades do cotidiano. Por capacidade instrumental pode-se entender a capacidade para a realização de atividades relacionadas a, por exemplo: preparar refeições, fazer compras no mercado, ir ao banco, cuidar da casa etc. Capacidade funcional, por sua vez, refere-se às seguintes atividades: alimentar-se, banhar-se, caminhar distâncias curtas, vestir-se etc. A preocupação com os cuidados de longa duração dos idosos nos países desenvolvidos, onde o processo de envelhecimento populacional já se encontra mais avançado, surgiu como uma necessidade de se separar os custos crescentes com o tratamento dos idosos dos demais gastos com saúde. Os custos, tangíveis ou não, envolvidos na atividadede cuidar/assistir aos idosos tendem a aumentar em função da entrada maciça das mulheres no mercado de trabalho e das mudanças nos contratos de gênero, sugerindo crescentes dificuldades para que as famílias arquem com a responsabilidade pelo cuidado de seus idosos. Em países em desenvolvimento, como o Brasil, essa questão é agravada por se somar a uma ampla lista a ser respondida pelos sistemas de seguridade social, tais como a pobreza, a exclusão de crescentes contingentes da população e o nível de desigualdade vigente...