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2.
Comunidad (Barc., Internet) ; 22(2): 0-0, jul.-oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193596

RESUMO

La soledad y el apoyo social deficiente están reconocidos como predictores de morbimortalidad. Cuando una persona mayor vive sola y no recibe soporte familiar ni social para corregir desviaciones en su autocuidado, se produce una sobreutilización de servicios sanitarios y, posiblemente, un aumento de los ingresos hospitalarios. En 2018, el Consell de Salut del Centro de Salud (CS) República Argentina de Valencia realizó un estudio piloto de detección y abordaje de soledad no deseada en las personas del barrio en el que se estableció que un 45% de las personas que vivían solas y eran mayores de 75 años tendrían un posible diagnóstico de aislamiento social. OBJETIVOS: implementar una red comunitaria de voluntariado de acompañamiento-vigilancia en autocuidados para personas mayores con aislamiento social en el área del CS República Argentina, con el soporte del «Programa de acompañamiento en salud constante» (PASC) de la Cruz Roja, en colaboración con el centro de salud, y estudiar la relación entre soledad y salud. MÉTODOS: mediante un diseño escalado de detección y diagnóstico de aislamiento social, con la participación de técnicos de la Cruz Roja, profesionales del centro de salud y la colaboración de voluntariado de acompañamiento a personas mayores participantes. RESULTADOS: en 7 meses 1.200 personas fueron sensibilizadas de forma directa sobre la soledad y 49 voluntarios del barrio desarrollaron labores de acompañamiento y asistencia a talleres formativos y lúdicos. Los profesionales sanitarios analizaron 216 casos: 149 (69%) no se sintieron solos y 67 (31%) fueron diagnosticados de aislamiento social (código correspondiente a V64.01 según CIE-9). Participaron en el proyecto 54 personas (25%). Existe asociación entre la escala de detección de la soledad existencial (EDSOL) y la participación en el proyecto. La sensación de soledad no deseada presenta correlación positiva con problemas de movilidad, cronicidad y una tendencia de asociación con otras variables de salud (consumo elevado de fármacos, percepción negativa de calidad de vida, etc.). CONCLUSIONES: las intervenciones comunitarias promovidas desde el centro de salud sobre personas que viven solas contribuyen al abordaje del aislamiento no deseado y a su vez generan un barrio más solidario


Loneliness and poor social support are widely recognized as predictors of morbidity and mortality. When an elderly person lives alone and does not receive family or social support to correct minor deviations in basic self-care processes, this leads to overuse of health services and possibly, increased hospital admissions. In 2018, the Consell de Salut of the República Argentina Primary Health Centre in Valencia, began a pilot study to detect and tackle unwanted loneliness in people from the neighbourhood, in which it was established that 45% of people aged over 75 years old who lived alone may be diagnosed with social isolation. OBJECTIVES: To establish a community network of accompanying-surveillance volunteers in self-care for socially isolated elderly people in the area of the República Argentina Primary Care Centre with the support of the Red Cross Constant Health Accompaniment Programme. The specific objective is to study the relationship between loneliness and health. METHODS: Using a scaled design for the detection and diagnosis of social isolation, with the participation of the Red Cross technicians, professionals from the health center, and the collaboration of volunteer support for elderly participants. RESULTS: Over seven months a total of 1200 people have been directly made aware about loneliness and 49 volunteers from the neighbourhood performed accompaniment work and attended training and recreational workshops. Health professionals analyzed 216 cases, of which 149 (69%) did not feel alone and the remaining 67 (31%) were diagnosed with social isolation (code V64.01 according to ICD-9). A total of 54 (25%) agreed to take part in the project. An association was observed between the scale for detection of existential loneliness (EDSOL) and participation in the project. The feeling of unwanted loneliness correlates positively with mobility problems, chronicity and a tendency of association with other health variables such as high consumption of drugs and negative perception of quality of life. CONCLUSIONS: Community interventions promoted by the Primary Health Centre on people who live alone contribute to tackling unwanted isolation, which at the same time generates a more supportive neighbourhood


Assuntos
Humanos , Masculino , Feminino , Idoso , Participação da Comunidade/métodos , Redes Comunitárias , Idoso Fragilizado/psicologia , Programas Voluntários , Agências Voluntárias , Solidão , Argentina , Qualidade de Vida
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3931-3935, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018860

RESUMO

The world population is aging, and this phenomenon is expected to continue for the next decades. This study aimed to propose a simple and reliable method that can be used for daily in-home monitoring of frailty and cognitive dysfunction in the elderly based on their walking-in-place characteristics. Fifty-four community-dwelling elderly people aged 65 years or older participated in this study. The participants were categorized into the robust and the non-robust groups according to the FRAIL scale. The mini-mental state examination was used to classify the cognitive impairment and the non-cognitive impairment groups. The 3-axis acceleration and the 3-axis angular velocity signals were measured using the inertial measurement units attached to the foot, shank, thigh, and posterior pelvis while each participant was walking in place for 20 seconds. The walking-in-place spectrograms were acquired by applying time-frequency analysis to the lower body movement signals measured in one stride. Four-fold cross-validation was applied to 80% of the total samples and the remaining 20% were used as test data. The deep convolutional neural network-based classifiers trained with the walking-in-place spectrograms enabled to categorize the robust and the non-robust groups with 94.63% accuracy and classify the cognitive impairment and the non-cognitive impairment groups with 97.59% accuracy. This study suggests that the walking-in-place spectrograms, which can be obtained without spacious experimental space, cumbersome equipment, and laborious processes, are effective indicators of frailty and cognitive dysfunction in the elderly.


Assuntos
Avaliação Geriátrica , Caminhada , Idoso , Estudos Transversais , Idoso Fragilizado , Humanos , Redes Neurais de Computação
4.
Geriatr Psychol Neuropsychiatr Vieil ; 18(2): 135-139, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33048052

RESUMO

The COVID-19 pandemic affects older adults particularly severely. Our objective was to identify from the international literature the symptoms most commonly experienced by older adults infected with SARS-CoV-2. This systematic literature review was conducted using MEDLINE between 1 December 2019 and 13 April 2020. The methodological quality analysis used a method dedicated to case series and case reports. Of the 260 articles initially identified, only two studies were ultimately included in the qualitative analysis. The mean age was relatively low, between 71 and 74 years on average. COVID-19 symptoms were as follows: fever, dry cough, dyspnoea, asthenia, anorexia, chest tightness, diarrhoea and, to a lesser extent, myalgia, pharyngitis, nausea, dizziness, headache, abdominal pain, and vomiting. Lymphopenia was noted from complete blood counts. In conclusion, this systematic review of the international literature reveals a lack of data about the semiology of COVID-19 in older adults, especially in very elderly frail people, who are normally considered to constitute the geriatric population. The national survey conducted by the Société Française de Gériatrie et Gérontologie will help bridge this semiological gap.


Assuntos
Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Idoso Fragilizado , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia
5.
Maturitas ; 141: 46-52, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33036702

RESUMO

BACKGROUND/OBJECTIVE: The COVID-19 epidemic is particularly serious in older adults. The symptomatology and epidemic profile remain little known in this population, especially in disabled oldest-old people with chronic diseases living in nursing homes. The objective of the present study was to comprehensively describe symptoms and chronological aspects of the diffusion of the SARS-CoV-2 virus in a nursing home, among both residents and caregivers. DESIGN: Five-week retrospective cohort study. SETTING: A middle-sized nursing home in Maine-et-Loire, west of France. PARTICIPANTS: Eighty-seven frail older residents (87.9 ± 7.2years; 71 % female) and 92 staff members (38.3 ± 11.7years; 89 % female) were included. MEASUREMENTS: Mass screening for SARS-CoV-2 was performed in both residents and staff. Attack rate, mortality rate, and symptoms among residents and staff infected with SARS-CoV-2 were recorded. RESULTS: The attack rate of COVID-19 was 47 % in residents (case fatality rate, 27 %), and 24 % in staff. Epidemic curves revealed that the epidemic started in residents before spreading to caregivers. Residents exhibited both general and respiratory signs (59 % hyperthermia, 49 % cough, 42 % polypnea) together with geriatric syndromes (15 % falls, 10 % altered consciousness). The classification tree revealed 100 % COVID-19 probability in the following groups: i) residents younger than 90 with dyspnea and falls; ii) residents older than 90 with anorexia; iii) residents older than 90 without anorexia but with altered consciousness. Finally, 41 % of staff members diagnosed with COVID-19 were asymptomatic. CONCLUSIONS: The pauci-symptomatic expression of COVID-19 in older residents, together with the high prevalence of asymptomatic forms in caregivers, justifies mass screening in nursing homes, possibly prioritizing residents with suggestive combinations of clinical signs including dyspnea, falls, anorexia and/or altered consciousness.


Assuntos
Infecções por Coronavirus/epidemiologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Acidentes por Quedas , Idoso de 80 Anos ou mais , Anorexia/virologia , Betacoronavirus , Cuidadores , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Dispneia/virologia , Feminino , Idoso Fragilizado , França/epidemiologia , Humanos , Masculino , Programas de Rastreamento , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Prevalência , Estudos Retrospectivos
7.
JMIR Mhealth Uhealth ; 8(9): e21845, 2020 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-32896832

RESUMO

BACKGROUND: Technological communication methods such as telephone calls and video calls can help prevent social isolation and loneliness in frail older adults during confinement. OBJECTIVE: Our objectives were to determine which virtual communication method (ie, telephone call or video call) was preferred by confined older hospital patients and nursing home residents and the variables influencing this preference. METHODS: The TOVID (Telephony Or Videophony for Isolated elDerly) study was a cross-sectional study that was designed to examine the preference between telephone calls and video calls among frail older adults who were either hospitalized in a geriatric acute care unit or institutionalized in a long-term care and nursing home during the COVID-19 confinement period. RESULTS: A total of 132 older people were surveyed between March 25 and May 11, 2020 (mean age 88.2 years, SD 6.2); 79 (59.8%) were women. Patients hospitalized in the geriatric acute care unit were more able to establish communication independently than residents institutionalized in the long-term care and nursing home (P=.03) and were more satisfied with their communication experiences (P=.02). Overall, older people tended to favor telephone calls (73/132, 55.3%) over video calls (59/132, 44.7%); however, their satisfaction degree was similar regardless of the chosen method (P=.1), with no effect of age (P=.97) or gender (P=.2). In the geriatric acute care unit, the satisfaction degrees were similar for telephone calls (40/41, 98%) and video calls (33/38, 87%) in older patients (P=.10). Conversely, in the long-term care and nursing home, residents were more satisfied with the use of video calls to communicate with their relatives (14/15, 93%) versus the use of telephone calls (6/12, 50%; P=.02). CONCLUSIONS: Older people confined to health care settings were able to complete telephone calls more independently than video calls, and they tended to use telephone calls more often than video calls. The satisfaction degrees were similar with both modalities and even greater with video calls among long-term care and nursing home residents when they were given assistance to establish communication. TRIAL REGISTRATION: ClinicalTrials.gov NCT04333849: https://www.clinicaltrials.gov/ct2/show/NCT04333849.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Idoso Fragilizado/psicologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Isolamento Social , Telefone , Comunicação por Videoconferência , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Idoso Fragilizado/estatística & dados numéricos , Hospitalização , Humanos , Solidão , Masculino , Casas de Saúde , Pneumonia Viral/epidemiologia
8.
BMJ Open ; 10(9): e040569, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32994260

RESUMO

INTRODUCTION: This protocol describes an observational study which set out to assess whether frailty and/or multimorbidity correlates with short-term and medium-term outcomes in patients diagnosed with COVID-19 in a European, multicentre setting. METHODS AND ANALYSIS: Over a 3-month period we aim to recruit a minimum of 500 patients across 10 hospital sites, collecting baseline data including: patient demographics; presence of comorbidities; relevant blood tests on admission; prescription of ACE inhibitors/angiotensin receptor blockers/non-steroidal anti-inflammatory drugs/immunosuppressants; smoking status; Clinical Frailty Score (CFS); length of hospital stay; mortality and readmission. All patients receiving inpatient hospital care >18 years who receive a diagnosis of COVID-19 are eligible for inclusion. Long-term follow-up at 6 and 12 months is planned. This will assess frailty, quality of life and medical complications.Our primary analysis will be short-term and long-term mortality by CFS, adjusted for age (18-64, 65-80 and >80) and gender. We will carry out a secondary analysis of the primary outcome by including additional clinical mediators which are determined statistically important using a likelihood ratio test. All analyses will be presented as crude and adjusted HR and OR with associated 95% CIs and p values. ETHICS AND DISSEMINATION: This study has been registered, reviewed and approved by the following: Health Research Authority (20/HRA1898); Ethics Committee of Hospital Policlinico Modena, Italy (369/2020/OSS/AOUMO); Health and Care Research Permissions Service, Wales; and NHS Research Scotland Permissions Co-ordinating Centre, Scotland. All participating units obtained approval from their local Research and Development department consistent with the guidance from their relevant national organisation.Data will be reported as a whole cohort. This project will be submitted for presentation at a national or international surgical and geriatric conference. Manuscript(s) will be prepared following the close of the project.


Assuntos
Infecções por Coronavirus , Idoso Fragilizado , Fragilidade , Multimorbidade , Pandemias , Pneumonia Viral , Saúde Pública/métodos , Qualidade de Vida , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Correlação de Dados , Europa (Continente)/epidemiologia , Feminino , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Avaliação Geriátrica/métodos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Análise de Sobrevida
9.
J Frailty Aging ; 9(4): 219-225, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32996558

RESUMO

BACKGROUND: Early detection of frail older people is important. Timely intervention may allow health care professionals to prevent or delay the occurrence of adverse outcomes such as disability, increases in health care utilization, and premature death. OBJECTIVES: We assessed the construct and criterion validity of the SUNFRAIL tool, a questionnaire for measuring frailty among older people. DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study was carried out in a sample of Dutch citizens. A total of 195 community-dwelling persons aged 71 years and older completed the questionnaire. MEASUREMENTS: Construct validity was examined by determining the correlation between the SUNFRAIL tool and the Tilburg Frailty Indicator (TFI). Criterion validity for the SUNFRAIL tool was determined by establishing the correlations with chronic diseases and adverse outcomes of frailty (disability, falls, indicators of health care utilization). Disability was measured using the Groningen Activity Restriction Scale. Participants also answered questions regarding falls and health care utilization. RESULTS: The construct validity of this tool was good and showed significant correlations with the TFI. The correlation between SUNFRAIL total and TFI total was 0.624. The criterion validity of the SUNFRAIL tool was good for chronic diseases and good-to-excellent for adverse outcomes disability, receiving nursing care, and falls. The area under the curve for these outcomes was 0.840 (95% CI 0.781-0.899), 0.782 (95% CI 0.696-0.868), and 0.769 (95% CI 0.686-0.859), respectively. CONCLUSIONS: The results of our study suggest that the SUNFRAIL tool is a valid instrument for assessing frailty in community-dwelling older people. It is an attractive instrument for use in practice because it takes little time for health care professionals and older people to complete the questionnaire, and it expresses the integral functioning of human beings.


Assuntos
Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Idoso , Estudos Transversais , Humanos , Vida Independente , Países Baixos , Reprodutibilidade dos Testes
10.
J Am Med Dir Assoc ; 21(10): 1378-1383.e1, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32981664

RESUMO

OBJECTIVE: To describe clinical characteristics and risk factors associated with coronavirus disease 2019 (COVID-19) in long-stay nursing home residents. DESIGN AND PARTICIPANTS: Retrospective cohort study (March 16, 2020 to May 8, 2020). SETTING: Academic long-term chronic care facility (Boston, MA). PARTICIPANTS: Long-term care residents. METHODS: Patient characteristics and clinical symptoms were obtained via electronic medical records and Minimum Data Set. Staff residence was inferred by zip codes. COVID-19 infection was confirmed by polymerase chain reaction testing using nasopharyngeal swabs. Residents were followed until discharge from facility, death, or up to 21 days. Risks of COVID-19 infection were modeled by generalized estimating equation to estimate the relative risk (RR) and 95% confidence intervals (CI) of patient characteristics and staff community of residence. RESULTS: Overall 146 of 389 (37.5%) long-stay residents tested positive for COVID-19. At the time of positive test, 66 of 146 (45.5%) residents were asymptomatic. In the subsequent illness course, the most common symptom was anorexia (70.8%), followed by delirium (57.6%). During follow-up, 44 (30.1%) of residents with COVID-19 died. Mortality increased with frailty (16.7% in pre-frail, 22.2% in moderately frail, and 50.0% in frail; P < .001). The proportion of residents infected with COVID-19 varied across the long-term care units (range: 0%‒90.5%). In adjusted models, male sex (RR 1.80, 95% CI 1.07, 3.05), bowel incontinence (RR 1.97, 95% CI 1.10, 3.52), and staff residence remained significant predictors of COVID-19. For every 10% increase in the proportion of staff living in a high prevalence community, the risk of testing positive increased by 6% (95% CI 1.04, 1.08). CONCLUSIONS AND IMPLICATIONS: Among long-term care residents diagnosed with COVID-19, nearly one-half were asymptomatic at the time of diagnosis. Predictors of COVID-19 infection included male sex, bowel incontinence, and staff residence in a community with a high burden of COVID-19. Universal testing of patients and staff in communities with high COVID-19 rates is essential to mitigate outbreaks.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/mortalidade , Idoso Fragilizado/estatística & dados numéricos , Assistência de Longa Duração/organização & administração , Casas de Saúde/organização & administração , Pneumonia Viral/mortalidade , Fatores Etários , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco
11.
Geriatr Gerontol Int ; 20(10): 974-979, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32881240

RESUMO

AIM: Heart diseases and social factors are associated with physical frailty, but there are few studies of older people living in the community. Consequently, the aim of this study was to examine the association between heart diseases, social factors and physical frailty in community-dwelling older populations including the oldest-old people. METHODS: The cross-sectional study included 1882 participants of community-dwelling older and oldest-old people. The survey site assessed questionnaires on medical history, social factors, blood samples and physical examination. Physical frailty was based on slow gait speed or weak grip strength. Associations were analyzed using multiple logistic regression with adjustments for covariate factors. RESULTS: Subjects with heart disease had a higher prevalence of physical frailty than those without heart disease. After adjusting the covariate factors, heart diseases were associated with a slow gait speed (odds ratio [OR] = 1.62; 95% confidence interval [CI]: 1.13-2.32, P = 0.009). Frequency of going outdoors and direct interaction with relatives or friends were associated with a slow gait speed (OR = 0.83, 95% CI 0.75-0.91, P ≤ 0.001 and OR = 0.87, 95% CI 0.81-0.94, P < 0.001), and associated with physical frailty (OR = 0.80, 95% CI 0.72-0.89, P ≤ 0.001 and OR = 0.88, 95% CI 0.82-0.95, P = 0.002). Living alone and frequency of direct interaction with relatives or friends were associated with physical frailty in subjects with heart disease. CONCLUSIONS: Our findings indicate that in community-dwelling older people, heart diseases and social factors were associated with physical frailty. Older people with heart disease, those living alone and the frequency of direct interaction with relatives or friends were associated with physical frailty. Geriatr Gerontol Int 2020; 20: 974-979.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Cardiopatias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Vida Independente , Relações Interpessoais , Masculino , Razão de Chances , Prevalência , Apoio Social , Inquéritos e Questionários , Velocidade de Caminhada
12.
BMC Med ; 18(1): 274, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32892742

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been a pandemic worldwide. Old age and underlying illnesses are associated with poor prognosis among COVID-19 patients. However, whether frailty, a common geriatric syndrome of reduced reserve to stressors, is associated with poor prognosis among older COVID-19 patients is unknown. The aim of our study is to investigate the association between frailty and severe disease among COVID-19 patients aged ≥ 60 years. METHODS: A prospective cohort study of 114 hospitalized older patients (≥ 60 years) with confirmed COVID-19 pneumonia was conducted between 7 February 2020 and 6 April 2020. Epidemiological, demographic, clinical, laboratory, and outcome data on admission were extracted from electronic medical records. All patients were assessed for frailty on admission using the FRAIL scale, in which five components are included: fatigue, resistance, ambulation, illnesses, and loss of weight. The outcome was the development of the severe disease within 60 days. We used the Cox proportional hazards models to identify the unadjusted and adjusted associations between frailty and severe illness. The significant variables in univariable analysis were included in the adjusted model. RESULTS: Of 114 patients, (median age, 67 years; interquartile range = 64-75 years; 57 [50%] men), 39 (34.2%), 39 (34.2%), and 36 (31.6%) were non-frail, pre-frail, and frail, respectively. During the 60 days of follow-up, 43 severe diseases occurred including eight deaths. Four of 39 (10.3%) non-frail patients, 15 of 39 (38.5%) pre-frail patients, and 24 of 36 (66.7%) frail patients progressed to severe disease. After adjustment of age, sex, body mass index, haemoglobin, white blood count, lymphocyte count, albumin, CD8+ count, D-dimer, and C-reactive protein, frailty (HR = 7.47, 95% CI 1.73-32.34, P = 0.007) and pre-frailty (HR = 5.01, 95% CI 1.16-21.61, P = 0.03) were associated with a higher hazard of severe disease than the non-frail. CONCLUSIONS: Frailty, assessed by the FRAIL scale, was associated with a higher risk of developing severe disease among older COVID-19 patients. Our findings suggested that the use of a clinician friendly assessment of frailty could help in early warning of older patients at high-risk with severe COVID-19 pneumonia.


Assuntos
Infecções por Coronavirus , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/virologia , Avaliação Geriátrica/métodos , Pandemias , Pneumonia Viral , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos
14.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 46(supl.1): 33-41, ago. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193115

RESUMO

Las residencias de ancianos han sido especialmente golpeadas durante la crisis por la actual pandemia por COVID-19. En el momento de redactar este artículo son más de 17.500 los ancianos que fallecieron por coronavirus y que vivían en residencias, más de un 66% de las defunciones. Las tasas de contagio y letalidad en la población institucionalizada son altas por la avanzada edad y deficitario sistema inmune, la presencia de comorbilidades, porque se trata de personas frágiles, porque conviven con otros residentes y cuidadores en una institución cerrada y la transmisibilidad es fácil en un contexto de alta contagiosidad y virulencia del virus. Las personas de edad avanzada presentan con mayor frecuencia las formas más graves de la enfermedad. Las presentaciones atípicas son más frecuentes en ancianos y pueden retrasar el diagnóstico. La prueba de reacción en cadena de la polimerasa (PCR) en los primeros 7 días para la detección de RNA viral del SARS-CoV-2 se considera el gold standard. Los criterios de derivación a un centro hospitalario desde los centros residenciales deberían tener en cuenta una valoración de la comorbilidad, la gravedad, la presencia de deterioro cognitivo grave y la dependencia o la necesidad de soporte ventilatorio en pacientes graves. Los centros sociosanitarios deben disponer de planes de contingencia para ofrecer una respuesta ante la aparición de casos de COVID-19. El aislamiento durante las pandemias puede tener importantes consecuencias físicas y psicosociales en los residentes. Se hace necesario reflexionar y reivindicar un nuevo modelo residencial desde un enfoque de atención centrada en la persona que procure la integración de los servicios sanitarios y sociales


Rest homes for the elderly have been particularly hit during the crisis due the current COVID-19 pandemic. At the time of writing this article, more than 17,500 elderly people that lived in Care Homes have died due to coronavirus, more than 66% of the deaths. The infection and mortality rates in the institutionalised population are high. This is due to the advanced age, immune system deficit, and the presence of comorbidities, as well as because there are frail, because they live with other residents and carers in a closed institution, and transmission is easy in the context of a highly contagious and virulent virus. The elderly often have more severe forms of the disease. Atypical presentations are more frequent in the elderly and can delay the diagnosis. The Polymer Chain Reaction (PCR) test in the first 7 days for the detection of SARS-CoV-2 viral RNA is considered the test of reference ('Gold standard'). The criteria for referring to a hospital site from Care Homes should take into account an assessment of comorbidity, the severity, the presence of severe cognitive impairment, and the dependency or necessity of ventilatory support in seriously ill patients. The social-health centres should have contingency plans available in order to offer a response when cases of COVID-19 appear. Isolation during pandemics may have important physical and psychosocial consequences in the residents. It is necessary to reflect and claim a new residential model from a person-centered care approach that seeks the integration of health and social services


Assuntos
Humanos , Idoso , Atenção Primária à Saúde/organização & administração , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Fragilidade/epidemiologia , Infecções por Coronavirus/epidemiologia , Respiração Artificial/estatística & dados numéricos , Síndrome Respiratória Aguda Grave/diagnóstico por imagem , Pandemias/estatística & dados numéricos , Vírus da SARS/isolamento & purificação , Indicadores de Morbimortalidade , Idoso Fragilizado/estatística & dados numéricos , Controle de Doenças Transmissíveis/métodos , Demência/epidemiologia , Reação em Cadeia da Polimerase/estatística & dados numéricos , Síndrome Respiratória Aguda Grave/epidemiologia
15.
Medicine (Baltimore) ; 99(31): e21165, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756094

RESUMO

GOALS: The aim of this study was to evaluate the effectiveness of adding a gelling agent to pureed diets to prevent aspiration pneumonia in elderly patients with moderate to severe dysphagia. BACKGROUND: Pureed diets are often used to reduce aspiration in patients with dysphagia. However, the ideal texture of a pureed diet to prevent aspiration pneumonia remains unclear. MATERIALS AND METHODS: We prospectively conducted a randomized, crossover trial of pureed rice with or without a gelling agent in patients with moderate to severe dysphagia (ClincialTrials.gov number, NCT03163355). The primary outcome measure was pharyngeal residuals using an endoscopic scoring system. The secondary outcome was the sense of material remaining in the throat following swallowing. RESULTS: Sixty two patients (58% men), mean age 83 ±â€Š9 years with moderate to severe dysphagia were included. Residuals in the throat were significantly less likely with pureed rice with than without the gelling agent (median cyclic ingestion score (range); 1 (0-4) vs 2 (0-4); P = .001). Irrespective of the presence or absence of the gelling agent, the sense of material remaining in the throat was significantly less frequent in older patients (87 ±â€Š7.6 vs 75 ±â€Š9.1 years, P < .01; 86 ±â€Š7.3 vs 75 ±â€Š8.6 years, P < .01). CONCLUSIONS: Pureed diets containing a gelling agent may reduce the risk of aspiration pneumonia possibly by decreasing pharyngeal residues in elderly patients with moderate to severe dysphagia.


Assuntos
Transtornos de Deglutição/dietoterapia , Deglutição , Idoso Fragilizado , Géis/administração & dosagem , Oryza , Pneumonia Aspirativa/prevenção & controle , Idoso de 80 Anos ou mais , Estudos Cross-Over , Dieta , Feminino , Humanos , Masculino , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(31): e21419, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756143

RESUMO

Both total-body iron stores and inflammation influence the concentration of ferritin in the blood. Ferritin as an inflammatory marker might serve as a prognostic marker in the elderly. Therefore, we characterized the clinical circumstances and long-term outcomes of hyperferritinemia (> 1000 µg/L) in hospitalized elderly patients.A retrospective analysis of elderly (> 70 years) inpatients with ferritin levels of > 1000 µg/L in a tertiary medical center during a 3-year period. We obtained both laboratory and clinical data, assessing the potential association of high ferritin levels with long-term mortality.Overall, 242 patients (median age 79 years; median ferritin level 1436 µg/L) met the inclusion criteria and were followed for a median time of 18.6 months. Clinical outcomes were dismal for the whole cohort: the diagnosis of solid malignancy occurred in 23.5% of cases while 31% had a severe infection (ranging from sepsis to septic shock). The median survival time of the whole cohort was 4.7 months only. Within the cohort, risk stratification was feasible: higher ferritin levels differentiate between groups of patients who had a poor prognosis (with either septic shock or solid malignancy) and those who had a relatively favorable prognosis (patients diagnosed as suffering from sepsis without shock and patients with iatrogenic causes for hyperferritinemia).Hyperferritinemia in elderly inpatients is associated with high rates of mortality. Within this group of patients, differential ferritin levels enable further risk stratification. High ferritin levels in the elderly can differentiate the bad from the worst.


Assuntos
Ferritinas/sangue , Idoso Fragilizado , Hospitalização , Sobrecarga de Ferro/mortalidade , Idoso , Biomarcadores/sangue , Estudos de Coortes , Serviços de Saúde para Idosos , Humanos , Sobrecarga de Ferro/sangue , Israel , Estudos Retrospectivos , Índice de Gravidade de Doença
17.
BMJ Open ; 10(8): e037466, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32759247

RESUMO

OBJECTIVE: The COVID-19 pandemic has highlighted ongoing challenges to optimal supportive end-of-life care for adults living in long-term care (LTC) facilities. A supportive end-of-life care approach emphasises family involvement, optimal symptom control, multidisciplinary team collaboration and death and bereavement support services for residents and families. Community-based and palliative care specialist physicians who visit residents in LTC facilities play an important role in supportive end-of-life care. Yet, perspectives, experiences and perceptions of these physicians remain unknown. The objective of this study was to explore barriers and facilitators to optimal supportive end-of-life palliative care in LTC through the experiences and perceptions of community-based and palliative specialist physicians who visit LTC facilities. DESIGN: Qualitative study using semi-structured interviews, basic qualitative description and directed content analysis using the COM-B (capability, opportunity, motivation - behaviour) theoretical framework. SETTING: Residential long-term care. PARTICIPANTS: 23 physicians who visit LTC facilities from across Alberta, Canada, including both in urban and rural settings of whom 18 were community-based physicians and 5 were specialist palliative care physicians. RESULTS: Motivation barriers include families' lack of frailty knowledge, unrealistic expectations and emotional reactions to grief and uncertainty. Capability barriers include lack of symptom assessment tools, as well as palliative care knowledge, training and mentorship. Physical and social design barriers include lack of dedicated spaces for death and bereavement, inadequate staff, and mental health and spiritual services of insufficient scope for the population. CONCLUSION: Findings reveal that validating families' concerns, having appropriate symptom assessment tools, providing mentorship in palliative care and adapting the physical and social environment to support dying and grieving with dignity facilitates supportive, end-of-life care within LTC.


Assuntos
Infecções por Coronavirus/terapia , Assistência de Longa Duração , Cuidados Paliativos/normas , Pandemias , Médicos , Pneumonia Viral/terapia , Instituições de Cuidados Especializados de Enfermagem , Assistência Terminal/normas , Adulto , Idoso , Alberta , Atitude do Pessoal de Saúde , Betacoronavirus , Infecções por Coronavirus/virologia , Família , Feminino , Idoso Fragilizado , Fragilidade , Necessidades e Demandas de Serviços de Saúde , Cuidados Paliativos na Terminalidade da Vida , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/virologia , Pesquisa Qualitativa , Respeito , Especialização
18.
Medicine (Baltimore) ; 99(30): e21192, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791695

RESUMO

Geriatric frailty is associated with increased mortality and links to increased inflammatory activity. Vascular adhesion protein-1 (VAP-1) is important in inflammatory process. This study investigates the relationship between plasma VAP-1 level and frailty in older adults.The cross-sectional study recruited community dwelling older adults from a hospital-based comprehensive geriatric assessment program. The demographic data, Fried Frailty Index, metabolic and inflammatory parameters were assessed.A total of 151 participants (76 women, 50.3%) were included in the analysis, and the age (mean ±â€Š standard deviation) was 77.1 ±â€Š6.1 years. The mean plasma VAP-1 level (ng/mL) was significantly different (P = .029) among different frailty groups (346.3 ±â€Š86.5 in the robust older adults, 371.6 ±â€Š107.9 in the pre-frail older adults, and 416.6 ±â€Š141.1 in the frail older adults). Multivariate ordered logistic regression analysis also demonstrated that plasma VAP-1 levels were positively associated with frailty severity (P = .039). Analysis of the frailty components with plasma VAP-1 levels showed that the elderly who had "exhaustion" (P = .016) or "weakness" (P = .025) tended to have higher plasma VAP-1 levels.The data support that VAP-1 might represent a potential plasma biomarker of frailty.


Assuntos
Amina Oxidase (contendo Cobre)/sangue , Moléculas de Adesão Celular/sangue , Fragilidade/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos Transversais , Feminino , Idoso Fragilizado , Fragilidade/classificação , Avaliação Geriátrica , Humanos , Masculino , Índice de Gravidade de Doença
19.
Value Health ; 23(8): 1056-1062, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828218

RESUMO

BACKGROUND: Previous studies have summarized evidence on health-related quality of life for older people, identifying a range of measures that have been validated, but have not sought to present results by degree of frailty. Furthermore, previous studies did not typically use quality-of-life measures that generate an overall health utility score. Health utility scores are a necessary component of quality-adjusted life-year calculations used to estimate the cost-effectiveness of interventions. METHODS: We calculated normative estimates in mean and standard deviation for EQ-5D-5L, short-form 36-item health questionnaire in frailty (SF-36), and short-form 6-dimension (SF-6D) for a range of established frailty models. We compared response distributions across dimensions of the measures and investigated agreement using Bland-Altman and interclass correlation techniques. RESULTS: The EQ-5D-5L, SF-36, and SF-6D scores decrease and their variability increases with advancing frailty. There is strong agreement between the EQ-5D-5L and SF-6D across the spectrum of frailty. Agreement is lower for people who are most frail, indicating that different components of the 2 instruments may have greater relevance for people with advancing frailty in later life. There is a greater risk of ceiling effects using the EQ-5D-5L rather than the SF-6D. CONCLUSIONS: We recommend the SF-36/SF-6D as an appropriate measure of health-related quality of life for clinical trials if fit older people are the planned target. In trials of interventions involving older people with increasing frailty, we recommend that both the EQ-5D-5L and SF36/SF6D are included, and are used in sensitivity analyses as part of cost-effectiveness evaluation.


Assuntos
Idoso Fragilizado , Avaliação Geriátrica/métodos , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino
20.
Geriatr Gerontol Int ; 20(10): 892-898, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32776407

RESUMO

AIM: Although it is known that geriatric syndrome is associated with the development of frailty, it is not known whether an amelioration of geriatric syndrome also improves shared risk factors and frailty. METHODS: In total, 67 community-dwelling older people (79.6 ± 6.5 years, 49 women) participated in this study (41 were classified as pre-frail and 26 as frail). We analyzed indices of physical frailty and cognitive depression, exercise tolerance and health-related quality of life as frailty related indices, and the participants completed a questionnaire regarding common geriatric symptoms (cold extremities, leg edema, breathlessness, urinary incontinence, chronic headache, chronic pain, a sense of numbness, anorexia, constipation, insomnia and skin trouble) using numeric ratings. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria. The participants then underwent a far-infrared low-temperature sauna (FILTS) program twice a week for 3 months and the above parameters were reassessed. RESULTS: After the FILTS program, there were significant differences in usual walking speed, peak oxygen uptake, Geriatric Depression Scale-15, health-related quality of life and the severity of several geriatric symptoms. Of the 67 participants, 18 showed improvements in their J-CHS frailty score, 47 showed no change and two showed reductions. Linear regression analysis showed that the change in the numeric rating of the coldness of extremities (B = -0.105, P = 0.013) and the cumulative numeric rating for geriatric syndromes (B = 0.044, P < 0.001) were independent determinants of the change in the J-CHS score. CONCLUSIONS: A 3-month FILTS program ameliorates geriatric syndrome, the severity of frailty and frailty related indices in older Japanese people. Geriatr Gerontol Int 2020; 20: 892-898.


Assuntos
Idoso Fragilizado , Fragilidade/terapia , Banho a Vapor/métodos , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica , Humanos , Vida Independente , Japão , Masculino , Qualidade de Vida
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