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2.
Med Clin North Am ; 104(2): 327-343, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32035572

RESUMO

Aging-associated anatomic and physiologic decline begins during the fourth decade of life and progresses over the ensuing decades sometimes to a state of frailty, with the decline amplified when there is deconditioning. Aging-related gait and balance disorders leading to an increased risk of falling can be compensated for with the use of exercise interventions, durable medical equipment, and environmental modifications. Caregiver training is an essential component of geriatric rehabilitation.


Assuntos
Acidentes por Quedas/prevenção & controle , Avaliação Geriátrica/métodos , Doença de Parkinson , Velocidade de Caminhada , Idoso , Cuidadores/educação , Humanos , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Doença de Parkinson/reabilitação
3.
Isr Med Assoc J ; 22(2): 94-99, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32043326

RESUMO

BACKGROUND: Internal thoracic impedance (ITI) measurement is a sensitive method for detecting preclinical pulmonary edema and pleural effusion. OBJECTIVES: To investigate the efficacy of this non-invasive method for detecting early pleural effusion among geriatric patients and to monitor increased ITI during its resolution. METHODS: This prospective, controlled study was conducted between July 2012 and August 2015. The study comprised 70 patients aged 65 to 94 years; and 39 of the patients had pleural effusion. ITI was measured continuously with a RS-207 monitor. The predictive value of ITI monitoring was determined based on a total of eight measurements taken at 12-hour intervals over 84 hours. RESULTS: As a result of medical treatment, the median ITI of the study group increased from 31 (interquartile range [IQR] 28-33 ohms) to 41 ohms (IQR 38-41 ohms; P < 0.001) compared to non-significant changes in the control group. Average respiratory rate (per minute) in the study group decreased from 29 (IQR 28-34) to 19 (IQR 18-20). CONCLUSIONS: ITI monitoring is efficient for diagnosis and for ongoing clinical evaluation of the treatment of elderly patients with pleural effusion. Timely treatment may prevent serious complications of effusions avoiding extended hospitalization.


Assuntos
Pletismografia de Impedância/métodos , Derrame Pleural , Idoso , Diagnóstico Precoce , Feminino , Avaliação Geriátrica/métodos , Humanos , Israel , Masculino , Monitorização Fisiológica/métodos , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/fisiopatologia , Testes Imediatos , Recidiva , Reprodutibilidade dos Testes
4.
Medicine (Baltimore) ; 99(5): e18935, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000408

RESUMO

The effect of frailty on short and long term results of interventional treatment of coronary heart disease is not well defined. The evaluation of frailty may be helpful in appointment of most suitable treatment option and timing of patient follow-up. The frailty syndrome in daily practice of interventional cardiology ward (FRAPICA) study objective is to evaluate prognostic capability of the Fried frailty scale and instrumental activities of daily living scale (IADL) in elderly patients with symptomatic coronary heart disease.This is a single center, prospective, observational study. Patients aged ≥65 years are eligible. The objectives are to report Fried frailty scale and IADL scale dispersion before hospital discharge and to assess predictive impact of both scores. The endpoints are: success of interventional treatment, its complications (procedure related myocardial infarction, dye-induced renal function deterioration, loss of blood), 3-year mortality, either all-cause and cardiovascular, re-infarction, re-intervention, stroke, new-onset heart failure, any hospital readmission, and a combination of all above mentioned. Secondary analyses will focus on distinct clinical patient presentations, sub-classifications of frailty for modeling of long-term risk.FRAPICA trial will improve understanding of the associations between frailty syndrome, cardiovascular system diseases, their invasive treatment, and short and long-term outcomes. It will allow for more individualized assessment of risk and will identify new goals for interventions. (ClinicalTrials.gov Identifier NCT03209414).


Assuntos
Doença das Coronárias/diagnóstico , Fragilidade/diagnóstico , Estudos Observacionais como Assunto , Atividades Cotidianas , Idoso , Doença das Coronárias/complicações , Doença das Coronárias/mortalidade , Doença das Coronárias/terapia , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/mortalidade , Fragilidade/terapia , Avaliação Geriátrica , Humanos , Seleção de Pacientes
5.
Rev Med Liege ; 75(2): 89-93, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-32030932

RESUMO

The elderly population is growing in our societies. Prevention policies are strongly supported by public authorities and one of them is the promotion of physical activity. We propose to detail, through a literature review, the impact of physical activity on the main geriatric criteria.


Assuntos
Exercício , Promoção da Saúde , Idoso , Avaliação Geriátrica , Humanos
6.
Spec Care Dentist ; 40(1): 49-54, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31912539

RESUMO

PURPOSE/AIM: To assess self-perception of oral health among institutionalized older adults in Taubate, Brazil. METHOD AND MATERIALS: Demographics, oral, and systemic health data were collected from a sample of 89 institutionalized older adults. The Geriatric Oral Health Assessment Index (GOHAI) was applied to assess their self-perception of oral health. A linear regression model using GOHAI scores and considering age, BMI, gender, race, dry mouth, denture status, number of teeth, number of comorbid conditions, and number of medications as independent variables was generated. RESULTS: Fifty-five percent were male, with an average age of 75.9 years (±9.1), 43.8% identified as mixed race, and 42.7% as white. The average BMI was 23.9 (±3.8), the average number of comorbid condition was 1.8 (±1.4), and the average number of daily medications was 6.2 (±3.6). The average number of teeth was 3.9 (±7.4), and 57.3% of the participants reported dry mouth sensation; 8.9% presented oral lesions, with denture stomatitis as the most common oral lesion (5.6%). The average GOHAI score was 31.1 (±3.7). Regression analysis showed a negative correlation between BMI and GOHAI scores (P = .032, R2  = 7.2%). CONCLUSIONS: Self-perception of oral health was good and negatively correlated with BMI.


Assuntos
Saúde Bucal , Xerostomia , Idoso , Brasil , Avaliação Geriátrica , Humanos , Masculino , Autoimagem
8.
Mymensingh Med J ; 29(1): 177-182, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915355

RESUMO

Global population is ageing and Bangladesh has one of the fastest growing ageing populations in this region. Growth in the elderly population relative to other age groups challenges existing health services, family relationships and social security. Combined with this, depression has become a major mental health problem for elderly people especially for urban elderly for nuclear family norm in urban areas. The study was descriptive type of cross-sectional in nature and was conducted in Rangpur Medical College Hospital, Rangpur & Prime Medical College Hospital, Rangpur, Bangladesh. The objective of this study was to assess the lifestyle and level of depression in urban elderly. Depression was measured by questionnaire of geriatric depression scale among 254 respondents. 87.8% of the respondents were age between 60-70 years. Majorities (63%) of the respondents were male, 54% of the respondents lived in nuclear type family and the rest (46%) in joint type of family. Among respondents near half (47.2%) of the respondents found Mild depressive, around one third (32.7%) were severe depressive, and the rest (20.1%) were normal. There was significant association between occupational status of the respondents and depression (x² = 45.600, df=14, p=0.000). Farmers unemployed found severely depressive (52.1%) followed by day-labourer (50%) and businessmen (37.5%). There was significant association between financial self dependency and depression of the respondents (x²= 34.072, df=4, p=0.000). Severe depression (43.8%) was found among those who were not financially self dependent. There was also significant association between monthly income and depression of the respondents (x²= 67.327, df=8, p=0.000). The study also found that lower income group (

Assuntos
Estilo de Vida , População Urbana/estatística & dados numéricos , Idoso , Bangladesh/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Depressão/etnologia , Depressão/psicologia , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores Socioeconômicos , Inquéritos e Questionários
9.
Nurs Older People ; 32(1): 21-25, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31990162

RESUMO

With an increasingly ageing population comes a greater risk of frailty, a distinct health state in which multiple body systems gradually lose their inbuilt reserves. The ability to recognise important frailty markers and conduct specialist comprehensive assessments of potentially frail older people admitted to acute hospitals is important to improve their health and well-being. This article explores the role of the advanced nurse practitioner (ANP) in identifying frailty and leading comprehensive geriatric assessment (CGA) for older people admitted to acute hospital settings. A small evaluation of CGA led by an ANP in a district general hospital found that a well-rounded assessment of patients living with frailty could be carried out, and that such assessments reduced unscheduled readmission within 28 days of discharge and overall length of hospital stay by six days. In a challenging climate, in which healthcare services seek to deliver effective and efficient care to the frail older population, ANPs can ensure a timely and specialist approach to CGA.


Assuntos
Prática Avançada de Enfermagem , Fragilidade/enfermagem , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Feminino , Idoso Fragilizado , Hospitalização , Humanos , Masculino
10.
Adv Exp Med Biol ; 1216: 1-7, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894541

RESUMO

Over the past decades, a progressive and exponential aging of the population has been observed. In particular, an absolute e relative increase of old and very old persons is also projected for the next 30 years. This demographic phenomenon is substantially responsible for the growing prevalence of frailty in our societies. Frailty is a clinical condition characterized by an excessive vulnerability of the individual to endogenous and exogenous stressors. This status generates a high risk of developing negative health-related events. Shifting to a construct as frailty to biologically define the perimeter of action for geriatric medicine will probably concur at modernizing the old way of practicing medicine. In this chapter the concept of frailty, its impact on the evolving healthcare systems, the controversies associated with its assessment and, ultimately, the role it plays in the management of older persons are discussed.


Assuntos
Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Assistência à Saúde , Avaliação Geriátrica , Humanos
11.
Adv Exp Med Biol ; 1216: 9-19, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894542

RESUMO

The general notion of frailty is widely understood to be a state of increased vulnerability to stressors, following age-related declines in function and reserves across multiple physiological systems. Frailty is clinically characterised by slower and/or incomplete recovery from stressors such as infection, injury, surgery or psychosocial distress. There is however no consensus on a single operational definition. Numerous assessment tools and scores are promoted to detect or measure frailty but two have widest research background and acceptance, the Frailty Phenotype and the deficit based Frailty Index. We describe these and other approaches in the context of a description of the psychometric properties, types of scaling, uses and misuses of assessment tools. We advocate the choice of an appropriate measurement tool be based on the population characteristics and the purpose for which it is to be used and illustrate how an understanding of the properties of different tools helps to inform this choice.


Assuntos
Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Humanos , Fenótipo , Psicometria
12.
Adv Exp Med Biol ; 1216: 21-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894543

RESUMO

Frailty is a complex of symptoms that is characterized by impaired stress tolerance due to a decline in the functionality of different organs. Due to its multifactorial aetiology, several definitions and assessments of this symptom complex have been developed, of which the Fried Frailty Score (Phenotype Score) and the broader Frailty Index (Deficit Accumulation Index) are the most commonly used. The prevalence of frailty increases with age independently of the assessment instrument and ranges between 4 and 59% in community-dwelling elderly populations and is higher in women than in men. The actual prevalence rate in a population depends on the prevalence of chronic diseases including depression, nutritional status, and inherently socio-economic background and education. Frailty is, however, not a steady state and progression, but also reversion is common. Although numerous studies on the prevalence of frailty have been conducted, systematic assessments in different populations are rare, which reduces the comparability of results. Similarly heterogeneous, but less frequent are studies on the incidence and on trajectories and transitions of frailty, calling for further, more systematic studies on this topic.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Avaliação Geriátrica , Humanos , Vida Independente , Estado Nutricional , Prevalência
13.
Adv Exp Med Biol ; 1216: 51-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894546

RESUMO

The prevalence of frailty seems to be higher in people with cardiovascular disease (CVD) compared to those without, but also the prevalence of CVD is higher in people with frailty compared to robust ones. In longitudinal studies and meta-analyses dealing with the role of frailty as potential risk factor for incident CVD, we have an  increasing literature suggesting that frailty increases the risk of these conditions, particularly of fatal events, and independently from several potential confounding factors. Among the domains usually included in the definition of physical frailty, exhaustion, low physical activity, slow gait speed and weakness are significantly associated with the onset of CVD in older people. However, also CVD can be considered as potential risk factor for incident frailty even if the literature is more limited. In this chapter, I will therefore report and discuss the most recent and relevant findings in this topic, of extreme importance in actual geriatric medicine.


Assuntos
Doenças Cardiovasculares/complicações , Idoso Fragilizado , Fragilidade/complicações , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Prevalência , Fatores de Risco
14.
Adv Exp Med Biol ; 1216: 87-97, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894550

RESUMO

Frailty and cardiovascular disease (CVD) are both highly prevalent in older adults. Cardiovascular disease has been identified as the most frequent cause of death, while frailty has been identified as one of geriatric giants characterized by decreased physiological reserves and increased vulnerability. However, the exact pathobiological links between the two conditions have not been fully elucidated. Consequently, we observe a relevant difficulty not only in accurately defining cardiovascular risk in vulnerable elderly patients (and the other way around), but also a lack of consensus regarding CVD management in the very old. Nowadays, considering the enormous technical innovation, many elderly patients, if appropriately selected, could be eligible even for the most complex treatments, including invasive cardiological procedures. Identification of frail patients at risk of negative outcomes can allow the customization of therapeutic interventions in elderly patients with CVD, allowing the elderly who can benefit from them to undergo even invasive procedures and avoiding futile or dangerous treatments for the most vulnerable patients. A large number of tools and definitions for assessing frailty have been proposed; different scales and assessment tools can be useful for different purposes, but at present there is no clear indication for their use in CVD. In this chapter, we will describe the main geriatric approach to ascertain frailty, the assessment tools used in patients with cardiovascular diseases, and propose an operational strategy to evaluate frailty and identify patients eligible for pharmacologic or surgical interventions.


Assuntos
Doenças Cardiovasculares , Idoso Fragilizado , Avaliação Geriátrica , Idoso , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Humanos , Medição de Risco
15.
Adv Exp Med Biol ; 1216: 99-113, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31894551

RESUMO

The number of older people candidates for interventional cardiology, such as PCI but especially for transcatheter aortic valve implantation (TAVI) , would increase in the future. Generically, the surgical risk, the amount of complications in the perioperative period, mortality and severe disability remain significantly higher in the elderly than in younger. For this reason it's important to determine the indication for surgical intervention, using tools able to predict not only the classics outcome (length of stay, mortality), but also those more specifically geriatrics, correlate to frailty: delirium, cognitive deterioration, risk of institutionalization and decline in functional status. The majority of the most used surgical risks scores are often specialist-oriented and many variables are not considered. The need of a multidimensional diagnostic process, focused on detect frailty, in order to program a coordinated and integrated plan for treatment and long term follow up, led to the development of a specific geriatric tool: the Comprehensive Geriatric Assessment (CGA). The CGA has the aim to improve the prognostic ability of the current risk scores to capture short long term mortality and disability, and helping to resolve a crucial issue providing solid clinical indications to help physician in the definition of on interventional approach as futile. This tool will likely optimize the selection of TAVI older candidates could have the maximal benefit from the procedure.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Idoso Fragilizado , Fragilidade/complicações , Fragilidade/cirurgia , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Humanos , Intervenção Coronária Percutânea , Medição de Risco , Substituição da Valva Aórtica Transcateter
17.
J Oral Rehabil ; 47(2): 204-211, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31479528

RESUMO

BACKGROUND: Associations between tooth loss and mortality have been reported in older individuals. However, limited information is available regarding the association between occlusion and mortality in nursing home residents. OBJECTIVE: We investigated the association between posterior occluding pairs (POPs) of teeth or dentures and 1-year mortality in nursing home residents. METHODS: The subjects of this study were residents from four nursing homes in Aichi prefecture, Japan, who were capable of eating and were enrolled in baseline examinations. We examined the number of present teeth and POPs (0-8 pairs), defined as pairs of occluding natural, restored or fixed prosthetic post-canine teeth. Then, we defined prosthetic POPs (0-8 pairs) as pairs of occluding natural, restored or fixed prosthetic post-canine teeth and removable dentures. Nutritional status, activities of daily living, cognitive function and comorbid conditions were assessed. One year later, we followed up the subjects. Ultimately, we analysed 173 elderly people (mean age ± SD: 87.1 ± 8.6 years; the survival group: N = 145, the deceased group: N = 28). RESULTS: In univariate analyses, mortality was significantly associated with age, peripheral vascular disease, nutritional status, diet texture and POPs. In multivariate logistic regression analysis, subjects who had 0 prosthetic POPs had significantly higher odds of a high mortality, compared with 8 prosthetic POPs. CONCLUSION: Lack of properly occluding posterior teeth, whether remaining teeth or dentures, is associated with 1-year mortality. (228 words/250).


Assuntos
Atividades Cotidianas , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Dentaduras , Humanos , Japão , Casas de Saúde
18.
J Oral Rehabil ; 47(1): 42-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31332814

RESUMO

OBJECTIVES: To evaluate the oral health-related quality of life (OHRQoL) of patients with burning mouth syndrome (BMS) by comparing the Oral Health Impact Profile-14 (OHIP-14) and Geriatric Oral Health Assessment Index (GOHAI) tests, assessing their dependence with pain, anxiety and depression and, secondly, to analyse the changes in time after treatment with psychotropic drugs. METHODS: Twenty-six patients and 26 controls were included. The GOHAI, OHIP-14, visual analogue scale (VAS) and the Hamilton Rating Scales for Depression and Anxiety (HAM-D and HAM-A) were performed at baseline (time 0) and after 6 months of treatment (time 1). Descriptive statistics, the Mann-Whitney non-parametric test for two independent samples and the Wilcoxon non-parametric test for two paired samples were used. RESULTS: The scores from all outcome measurements were statistically significantly different between the cases and controls (P < .001) with a strong correlation between the GOHAI and the OHIP-14 (P < .001). The BMS patients showed a statistically significant improvement in the VAS, HAM-D and HAM-A scores from time 0 to time 1 (P < 0.001), and in the OHIP-14 scores (P < .004**) after the treatment, but no statistically significant difference in the GOHAI score (.464). CONCLUSIONS: Burning mouth syndrome patients showed poorer scores on all scales compared to the healthy subjects with a lower OHRQoL. OHIP-14 gives a greater weight to psychological and behavioural outcomes in evaluating oral health than GOHAI, and therefore, it is a more effective questionnaire in terms of the evaluation of the treatment response. The management of BMS can improve pain, anxiety and depression and the OHRQoL.


Assuntos
Síndrome da Ardência Bucal , Saúde Bucal , Idoso , Avaliação Geriátrica , Humanos , Qualidade de Vida , Inquéritos e Questionários
19.
J Oral Rehabil ; 47(1): 61-66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31332828

RESUMO

No report has yet examined the impact of oral hypofunction on physical frailty in relation to intra-relationships of physical frailty assessment items. The purpose of this study was to verify the potential of a clinical cascade between oral hypofunction and physical frailty, and especially to support the hypothesis that the influence of oral hypofunction on physical frailty is greater than the intra-relationships among elements of physical frailty and that sex differences significantly affect these relationships. The participants were 272 older adults (101 men and 171 women; mean age 75.1 ± 7.5 years). Maximum occlusal force (MOF) and oral dryness (OD), as indicators of oral hypofunction, and grip strength (GS) and walking speed (WS), as indicators of physical frailty, were measured. Mutual relationship of four variables was verified using covariance structure analysis. In men, three paths from MOF to WS and GS and from WS to GS were confirmed, and those from MOF to WS and from WS to GS were found to be significant (P < .01). In women, three paths from MOF to WS and GS and from WS to GS were also confirmed, as with the men, and those from MOF to WS and from MOF to GS were found to be significant (P < .01). Model adaptability was shown to be good for both men and women. The results suggest our hypothesis was verified, and it is expected that the early detection of oral hypofunction, that is MOF, may be important for assessing physical frailty, especially in women.


Assuntos
Fragilidade , Idoso , Idoso de 80 Anos ou mais , Força de Mordida , Estudos Transversais , Feminino , Idoso Fragilizado , Avaliação Geriátrica , Humanos , Masculino
20.
Dent Clin North Am ; 64(1): 209-228, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31735227

RESUMO

Poor oral health in the geriatric population is being framed as a potentially new geriatric syndrome; an oral and maxillofacial geriatric syndrome. As such, the treatment of oral diseases will require a comprehensive approach that considers the multimorbidity of disease, and polypharmacy that is precipitated/exacerbated by oral and maxillofacial dysfunction. This is challenging because oral diseases are not 1 discrete systemic illness but a combination of many with common causes. This article presents a roadmap approach to evaluate symptoms and apply therapeutic strategies for 5 common oral and maxillofacial dysfunctions seen in the elderly.


Assuntos
Avaliação Geriátrica , Saúde Bucal , Idoso , Humanos , Polimedicação
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