Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.728
Filtrar
1.
Medicine (Baltimore) ; 99(8): e19145, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080091

RESUMO

Frailty is a pronounced symptom of aging associated with multiple comorbid states and adverse outcomes. The aim of this study was to evaluate the impact of 2 interventions, one based on prevention of falls and the other on prevention of loneliness, on total frailty and dimensions of frailty in urban community-dwelling elderly as well as associations with independent living.This prospective interventional study followed up 410 persons aged 75 to 95. The participants of the control and intervention groups were monitored through a public health intervention programme. The level of frailty was measured by the Tilburg Frailty Indicator (TFI) questionnaire and the factors of independent living were analyzed using validated questionnaires.After 1 year, physical frailty measured in the control group showed a statistically significant increase (r = -0.11), while in the intervention groups physical frailty did not increase (both P > .05). Psychological frailty measured after 1 year in the control group was significantly higher (r = -0.19), as well as in the group where the public health interventions to reduce loneliness were carried out (r = -0.19). Psychological frailty did not increase in the group in which public health interventions to prevent falls were carried out, and social frailty did not increase at all in the study period. The total level of frailty in the control group after 1 year was significantly increased (r = -0.19), while no increase was seen in the overall frailty in the intervention group. Multivariate analysis has shown that both interventions where independently associated with lower end frailty. Additionally, higher baseline frailty and visit to a physician in the last year were positively associated with higher end-study frailty level, while higher number of subjects in the household and higher total psychological quality of life (SF-12) were independently associated with lower end-study frailty. Only in the prevention of falls group there was no increase in restriction in the activities of daily living throughout study follow-up.Public health interventions to prevent falls and to prevent loneliness have a positive effect on the frailty and independent living of the elderly living in their own homes in an urban community.


Assuntos
Acidentes por Quedas/prevenção & controle , Idoso Fragilizado/psicologia , Promoção da Saúde/organização & administração , Solidão/psicologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica , Humanos , Vida Independente , Masculino , Estudos Prospectivos , Qualidade de Vida , População Urbana
2.
Clin Ter ; 170(1): e74-e77, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31850488

RESUMO

BACKGROUND: The beneficial effect of physical activity on a large spectrum of diseases is well known, with particular importance for elderly people. Among the different types of activity, adapted physical activity (APA) has been applied in a number of disease-related physical deficit. OBJECTIVE: The purpose of this study is to determine the outcome of a six months APA program in elder patients with osteoarthritis concerning physical and functional health and as second endpoint to determine the potential effect of AFA on reducing the risk of institutionalization. METHODS: The clinical indexes used to assess the outcome included the Blaylock Risk Assessment Screening Score (BRASS), the Psychological General Well Being Index (PGWBI), the Cumulative Illness Rating Scale (CIRS), the Short Physical Performance Battery (SPPB), and the visual analogue scale (VAS). RESULTS: A significant difference (p = 0.047) between the pre-APA and the post-APA value was found for BRASS, and highly significant differences (p <0.0001) were found for SPBB and VAS. CONCLUSIONS: These findings show that a six months APA program in elder patients with osteoarthritis improves physical function, reduces pain intensity and decreases the risk of institutionalization. Moreover the positive outcome of APA we found in elder patients with osteoarthritis suggests a more frequent use of such rehabilitation approach, also evaluating its economic impact on this disease.


Assuntos
Terapia por Exercício/métodos , Terapia por Exercício/psicologia , Exercício/psicologia , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Osteoartrite/psicologia , Osteoartrite/reabilitação , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
3.
Rev Med Chil ; 147(7): 870-876, 2019 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-31859985

RESUMO

BACKGROUND: Frailty has a great impact in the wellbeing of older people. AIM: To evaluate the quality of life of older people with and without frailty. MATERIAL AND METHODS: We assessed sociodemographic variables, health, integral geriatric assessment, quality of life using the WHOQoL-BREF questionnaire and the level of fragility using the Tilburg Frailty Indicator (TFI) in 538 participants. RESULTS: Three hundred and five participants aged 73 ± 7 years (229 women) were classified as fragile and 233 aged 72 ± 6 years (125 women) as not having frailty. Compared with their non-fragile counterparts, frail participants had a lower number of years attending school (5.9 and 7.4 respectively), a lower Barther index (93.6 and 98.3 respectively), a lower mini mental score (21.9 and 22.8 respectively) and a higher Yessavage depression score (2.0 and 0.8 respectively). Also, frail participants had a significantly lower total quality of life score and significantly lower scores in the physical and psychological domains. No differences were observed for the social and environmental domains. Older frail participants used health services more frequently than their non-fragile counterparts. CONCLUSIONS: In this sample, frailty was associated with a lower quality of life and worse scores in several geriatric assessment tools.


Assuntos
Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Avaliação Geriátrica , Serviços de Saúde/estatística & dados numéricos , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Inquéritos e Questionários
4.
BMC Health Serv Res ; 19(1): 797, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690304

RESUMO

BACKGROUND: Although not an inevitable part of ageing, frailty is an increasingly common condition in older people. Frail older patients are particularly vulnerable to the adverse effects of hospitalisation, including deconditioning, immobility and loss of independence (Chong et al, J Am Med Dir Assoc 18:638.e7-638.e11, 2017). The 'Systematic Approach to improving care for Frail older patients' (SAFE) study co-designed, with public and patient representatives, quality improvement initiatives aimed at enhancing the delivery of care to frail older patients within an acute hospital setting. This paper describes quality improvement initiatives which resulted from a co-design process aiming to improve service delivery in the acute setting for frail older people. These improvement initiatives were aligned to five priority areas identified by patients and public representatives. METHODS: The co-design work was supported by four pillars of effective and meaningful public and patient representative (PPR) involvement in health research (Bombard et al, Implement Sci 13:98, 2018; Black et al, J Health Serv Res Policy 23:158-67, 2018). These pillars were: research environment and receptive contexts; expectations and role clarity; support for participation and inclusive representation and; commitment to the value of co-learning involving institutional leadership. RESULTS: Five priority areas were identified by the co-design team for targeted quality improvement initiatives: Collaboration along the integrated care continuum; continence care; improved mobility; access to food and hydration and improved patient information. These priority areas and the responding quality improvement initiatives are discussed in relation to patient-centred outcomes for enhanced care delivery for frail older people in an acute hospital setting. CONCLUSIONS: The co-design approach to quality improvement places patient-centred outcomes such as dignity, identity, respectful communication as well as independence as key drivers for implementation. Enhanced inter-personal communication was consistently emphasised by the co-design team and much of the quality improvement initiatives target more effective, respectful and clear communication between healthcare personnel and patients. Measurement and evaluation of these patient-centred outcomes, while challenging, should be prioritised in the implementation of quality improvement initiatives. Adequate resourcing and administrative commitment pose the greatest challenges to the sustainability of the interventions developed along the SAFE pathways. The inclusion of organisational leadership in the co-design and implementation teams is a critical factor in the success of interventions targeting service delivery and quality improvement.


Assuntos
Cuidados Críticos/organização & administração , Procedimentos Clínicos/organização & administração , Fragilidade/terapia , Melhoria de Qualidade/organização & administração , Idoso , Idoso de 80 Anos ou mais , Participação da Comunidade , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Pessoal de Saúde/psicologia , Pesquisa sobre Serviços de Saúde , Humanos , Participação do Paciente
5.
Clin Interv Aging ; 14: 1493-1501, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31686794

RESUMO

Purpose: The aim of this study was to investigate occupational stress, frailty, sleep quality, and motives for food choices as key factors affecting the perceived health status among elderly workers. Methods: A cross-sectional survey was conducted involving 175 participants at the Community Senior Club in an urban area. The data was collected from November to December 2018. Pearson's correlation analyses were performed for perceived health status, occupational stress, sleep quality, and motives for food choices. Multivariate linear regression was adjusted for general characteristics such as age, gender, level of education, living arrangements, and the number of illnesses. Results: Occupational stress (r=-0.195, p<0.001), frailty (r=-0.468, p<0.001), and sleep quality scores (r=-0.306, p<0.001) showed significant negative correlations with perceived health status. Conversely, 5 motives for food choices (health, weight control, price, sensory appeal, and mood) were positively correlated with perceived health status. Linear regression analysis showed that occupational stress (ß=-0.195, p<0.001), frailty (ß=-0.420, p<0.001), and motives for food choices based on sensory appeal (ß=0.240, p<0.001) were significant influencing factors for perceived health status. Conclusion: We found that occupational stress, frailty, and motives for food choices based on sensory appeal were significant factors for elderly worker health. This suggests that it is important to consider occupational stress, frailty, and motivation for food choices when examining the health of elderly workers. There is a need for more tailored health promotion interventions when considering these factors and the elderly population.


Assuntos
Atitude Frente a Saúde , Preferências Alimentares/psicologia , Idoso Fragilizado/psicologia , Nível de Saúde , Motivação , Estresse Ocupacional/psicologia , Sono , Afeto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/psicologia , Comorbidade , Estudos Transversais , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Inquéritos e Questionários
6.
Clin Interv Aging ; 14: 1671-1680, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31631988

RESUMO

Purpose: The co-occurrence of frailty and depression in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality have rarely been investigated. We aimed to examine the co-occurrence of frailty and depressive symptoms in late life, the possibility for symptom reversal, their reciprocal relationship, and the effects on mortality using all the information from a longitudinal study. Patients and methods: We used the Taiwan Longitudinal Study of Aging (TLSA) for this study. TLSA was initiated in 1989 and followed periodically. We included participants from 1989 to 2007, who had data on frailty and depressive symptoms. Frailty was assessed by accumulation of functional deficits in 6 dimensions including disease status, sensory dysfunction, balance, functional limitations, health risk behaviors, and life satisfaction. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). A multistate model with interval censoring was used to examine the transition between states of frailty with or without depressive symptoms, and finally to death. A mixed model was used to examine the relationships between frailty and depressive symptoms. Results: The coexistence of frailty and depressive symptoms was associated with higher mortality. Individuals with depressive symptom had a lower probability of reversal to a better state. Previous depression score predicted current frailty, but the coefficient was smaller than that of previous frailty. Previous frailty predicted current depression score, and the coefficient was stronger than that of previous depression. Conclusion: Depressive symptoms increased the mortality and decreased the probability of reversal in the frail older adults.


Assuntos
Depressão/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Depressão/psicologia , Transtorno Depressivo/epidemiologia , Feminino , Idoso Fragilizado/psicologia , Fragilidade/psicologia , Avaliação Geriátrica/métodos , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Taiwan/epidemiologia
7.
Artigo em Inglês | MEDLINE | ID: mdl-31597278

RESUMO

Senior co-housing communities offer an in-between solution for older people who do not want to live in an institutional setting but prefer the company of their age peers. Residents of co-housing communities live in their own apartments but undertake activities together and support one another. This paper adds to the literature by scrutinizing the benefits and drawbacks of senior co-housing, with special focus on the forms and limits of social support and the implications for the experience of loneliness. Qualitative fieldwork was conducted in eight co-housing communities in the Netherlands, consisting of document analysis, interviews, focus groups, and observations. The research shows that co-housing communities offer social contacts, social control, and instrumental and emotional support. Residents set boundaries regarding the frequency and intensity of support. The provided support partly relieves residents' adult children from caregiving duties but does not substitute formal and informal care. Due to their access to contacts and support, few residents experience social loneliness. Co-housing communities can potentially also alleviate emotional loneliness, but currently, this happens to a limited degree. The paper concludes with practical recommendations for enhancing the benefits and reducing the drawbacks of senior co-housing.


Assuntos
Idoso Fragilizado/psicologia , Habitação , Vida Independente , Instituições Residenciais , Comportamento Social , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Grupo Associado
8.
Artigo em Inglês | MEDLINE | ID: mdl-31398802

RESUMO

The context in which dependents, regardless of age, receive care affects their health. This study adapted the Home Observation for Measurement of the Environment (HOME) Inventory, originally designed for child development research, to assess the quality of stimulation and support available to elders in their habitual households in Sri Lanka. Whether the adapted domains correlated with indicators of health and well-being in ways consistent with the child development literature was then examined. Through mixed-methods research based on 248 household surveys, four focus groups, and 15 interviews, three domains emerged: Physical Environment, Variety of Stimulation, and Emotional and Verbal Responsiveness. Regression modeling revealed that a higher quality physical home environment correlated with two measures of cognitive function after adjusting for covariates, but no consistent association with two psychological well-being scales. In contrast, higher Variety of Stimulation scores correlated with better cognitive function and lower psychological distress. There was no consistent correlation between Responsiveness and selected health outcomes. Qualitative data indicate that elders are active household contributors who strive to achieve harmonious relations with coresident kin. These findings reveal notable synergies between early and late life efforts to improve cognitive and psychological health, and highlight household considerations for future healthy aging research.


Assuntos
Planejamento Ambiental/estatística & dados numéricos , Características da Família , Idoso Fragilizado/psicologia , Indicadores Básicos de Saúde , Envelhecimento Saudável , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Família , Feminino , Grupos Focais , Humanos , Masculino , Sri Lanka
9.
Artigo em Inglês | MEDLINE | ID: mdl-31398821

RESUMO

The aim of this paper is to describe frail older persons' experiences of hospital care of information and participation when being an inpatient at a hospital. A qualitative method was used. Data were collected at the hospital from 20 interviews with frail older patients, together with observations in the environment at the hospital ward. A content analysis was performed. Patients experienced not receiving information about their care and rehabilitation, or receiving such information in noisy surroundings. They experienced situations of misunderstanding related to their medication, which indicates the need for appropriate discharge calls for frail older patients. They expressed feelings of distress concerning the future, caused by hasty admissions or relatives' problems to handle the situation. The results highlight the need to receive appropriate information and to participate in decision-making. The level of health literacy should be taken notice of when giving information, using peaceful and quiet environments when informing frail older persons. Person-centered care should be recognized to a greater extent in order for healthcare professionals to give information to frail older people in a health literacy-friendly way. This might make it easier for frail older persons to participate in a partnership in care.


Assuntos
Comunicação , Idoso Fragilizado/psicologia , Disseminação de Informação/métodos , Pacientes Internados/psicologia , Participação do Paciente/psicologia , Assistência Centrada no Paciente/métodos , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Feminino , Idoso Fragilizado/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Participação do Paciente/estatística & dados numéricos
10.
Anesth Analg ; 129(3): 830-838, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31425227

RESUMO

BACKGROUND: Advanced age, frailty, low education level, and impaired cognition are generally reported to be associated with postoperative cognitive complications. To translate research findings into hospital-wide preoperative assessment clinical practice, we examined the feasibility of implementing a preoperative frailty and cognitive assessment for all older adults electing surgical procedures in a tertiary medical center. We examined associations among age, education, frailty, and comorbidity with the clock and 3-word memory scores, estimated the prevalence of mild to major cognitive impairment in the presurgical sample, and examined factors related to hospital length of stay. METHODS: Medical staff screened adults ≥65 years of age for frailty, general cognition (via the clock-drawing test command and copy, 3-word memory test), and obtained years of education. Feasibility was studied in 2 phases: (1) a pilot phase involving 4 advanced nurse practitioners and (2) a 2-month implementation phase involving all preoperative staff. We tracked sources of missing data, investigated associations of study variables with measures of cognition, and used 2 approaches to estimate the likelihood of dementia in our sample (ie, using extant data and logistic regression modeling and using Mini-Cog cut scores). We explored which protocol variables related to hospital length of stay. RESULTS: The final implementation phase sample included 678 patients. Clock and 3-word memory scores were significantly associated with age, frailty, and education. Education, clock scores, and 3-word scores were not significantly different by surgery type. Likelihood of preoperative cognitive impairment was approximately 20%, with no difference by surgery type. Length of stay was significantly associated with preoperative comorbidity and performance on the clock copy condition. CONCLUSIONS: Frailty and cognitive screening protocols are feasible and provide information for perioperative care planning. Challenges to clinical adaptation include staff training, missing data, and additional administration time. These challenges appear minimal relative to the benefits of identifying frailty and cognitive impairment in a group at risk for negative postoperative cognitive outcome.


Assuntos
Anestesia/métodos , Disfunção Cognitiva/psicologia , Idoso Fragilizado/psicologia , Avaliação Geriátrica/métodos , Testes Neuropsicológicos , Cuidados Pré-Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/diagnóstico , Estudos de Coortes , Escolaridade , Estudos de Viabilidade , Feminino , Fragilidade/diagnóstico , Fragilidade/psicologia , Humanos , Masculino , Projetos Piloto
11.
Artigo em Inglês | MEDLINE | ID: mdl-31466229

RESUMO

BACKGROUND: Older adults experience physical and psychological declines affecting independency. Adapted and structured combined interventions composed of cognitive stimulation and physical exercise contribute to comorbidities' reduction. Methods: Multicenter single-blinded two-arm cluster randomized controlled trial conducted to assess effectiveness of a combined intervention (CI), composed of a cognitive stimulation program (CSP) and a physical exercise program (PEP), on psychological and physical capacities of frail older adults as to on their activities of daily living. Were recruited 50 subjects from two elderly end-user organizations. Of these, 44 (65.9% females, mean age of 80.5 ± 8.47 years) were considered eligible, being randomly allocated in experimental (EG) or control group (CG). Data collected at baseline and post-intervention. EG received CI three times a week during 12 weeks. CG received standard care. Non-parametric measures were considered. Results: At baseline, groups were equivalent for study outcomes. The comparison of pre- and post-intervention data revealed that subjects receiving CI reduced depressive symptomatology and risk of fall based on gait and balance, and improved gait speed. Simultaneously, in the CG a significant decline on activities of daily living was observed. Significant results were found among biomechanical parameters of gait (BPG). EG' effect size revealed to be small (0.2 ≤ r < 0.5). CG' effect size was also small; but for activities of daily living there was an evident decrease. Conclusion: The CI is effective on managing older adults' psychological and physical capacities.


Assuntos
Atividades Cotidianas , Idoso Fragilizado/psicologia , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Exercício/psicologia , Terapia por Exercício/métodos , Feminino , Marcha , Humanos , Masculino , Equilíbrio Postural
12.
Geriatr Gerontol Int ; 19(9): 885-889, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31321900

RESUMO

AIM: This cross-sectional study examined whether sleep duration and excessive daytime sleepiness (EDS) were associated with social frailty in community-dwelling older people. METHODS: A total of 4427 community-dwelling older people (51.4% women, mean age 71.9 years) who met the entry criteria were included in this study. Social frailty was assessed by five questions, relating to going out less frequently than last year, not visiting friends sometimes, not feeling helpful to friends or family, living alone and not talking with someone every day. Participants with two or more components were defined as having social frailty. Sleep duration and EDS were assessed by self-reported questionnaire. Logistic regression analysis estimated odds ratios and 95% confidence intervals of social frailty according to EDS or the three categories of sleep duration (short ≤6.0 h, medium 6.1-8.9 h, long ≥9.0 h), and we used medium-duration sleepers as the reference group. RESULTS: Among all participants, the prevalence of social frailty in each sleep duration group was as follows: long 18.3%, short 9.9% and medium 9.7% (P < 0.001). The prevalence of social frailty in participants with EDS was 17.1% (no EDS 10.2%, P < 0.001). Long sleep duration (odds ratio 1.46, 95% confidence interval 1.14-1.84) and presence of EDS (hazard ratio 1.32, 95% confidence interval 1.02-1.71) were associated with higher rates of social frailty after adjustments for several covariates. CONCLUSIONS: Long sleep duration and EDS were associated with social frailty; thus, older people with both sleep patterns would have a higher risk of progression of social frailty. Geriatr Gerontol Int 2019; 19: 885-889.


Assuntos
Idoso Fragilizado/psicologia , Vida Independente/psicologia , Relações Interpessoais , Transtornos do Sono-Vigília , Sonolência , Habilidades Sociais , Idoso , Estudos Transversais , Feminino , Humanos , Japão/epidemiologia , Masculino , Prevalência , Higiene do Sono , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/psicologia , Inquéritos e Questionários
13.
BMC Health Serv Res ; 19(1): 496, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311531

RESUMO

BACKGROUND: Although there is evidence with respect to the effectiveness of Chronic Care Model (CCM)-based programs in terms of improved patient outcomes, less attention has been given to the effect of high-quality care on productivity of patient-professional interactions, especially among frail older persons. The aim of our study was therefore to examine whether frail community-dwelling older persons' perspectives on quality of primary care according to the dimensions of the CCM are associated with the productivity of the patient-professional interactions. METHODS: Our study was part of a large-scale evaluation study with a matched quasi-experimental design to compare outcomes of frail community-dwelling older persons that participated in a proactive, integrated primary care approach based on (elements of) the CCM and those that received usual primary care. Frail older persons' perceptions of quality of care were assessed with the Patient Assessment of Chronic Illness Care Short version (PACIC-S). Productive interactions with general practitioners (GPs) and practice nurses were assessed using a relational coproduction instrument. Measurements were performed at baseline (T0) and 12 months thereafter (T1). In total, 232 frail older persons were participating in the intervention group at T0 and matched to 232 frail older persons in the control group. At T1, 182 persons were in the intervention group and 176 in the control group. RESULTS: Paired sample t-tests showed significant improvements in overall quality of care, the majority of underlying quality of care items, and productive interactions within the intervention group and control group over time. Multilevel analyses revealed that productive interaction with the GP and practice nurse at T1 was significantly related to perceived productive interaction with them at T0, the perceived quality of primary care at T0, and the change in perceived quality of primary care over time (between T0 and T1). CONCLUSIONS: Frail community-dwelling older persons' perspectives on quality of primary care were associated with perceived productivity of their interactions with the GP and practice nurse in both the intervention group and the control group. We found no significant differences in overall perceived quality of care and perceived patient-professional interaction between the intervention group and control group at baseline and follow-up. In times of population aging it is necessary to invest in high-quality care delivery for frail older persons and productive interactions with them.


Assuntos
Idoso Fragilizado/psicologia , Relações Enfermeiro-Paciente , Relações Médico-Paciente , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/terapia , Feminino , Idoso Fragilizado/estatística & dados numéricos , Clínicos Gerais/psicologia , Pesquisa sobre Serviços de Saúde , Humanos , Vida Independente , Masculino , Enfermeiras e Enfermeiros/psicologia
14.
Nihon Koshu Eisei Zasshi ; 66(6): 306-316, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31231100

RESUMO

Objective The goal of the study was to assess the relationships of the frequency (more than one time per week) of various activities to frailty among independent elderly people in Japan.Methods Survey data were collected from 73,341 community-dwelling elders who were not certified as Needing Long-Term Care. Basic checklist survey items developed by the Ministry of Health, Labour and Welfare were used along with exhaustive items on the weekly physical, cultural, community, and volunteer activities of the respondents. The effects of the frequencies of each activity with and without frailty were estimated. The relationship between frailty and pre-frailty was analyzed in a multinomial logistic regression model regarding involvement in activities and controlling for the effects of gender, age, and with non-frailty as a reference category.Results Data on 49,238 individuals in the study area not certified as Needing Long-Term Care (24,632 males and 24,606 females), corresponding to 67% of all elderly (aged 65 or more years) Japanese people were analyzed. About 65.9% of the respondents reported that they engaged in physical activities, 78.8% reported cultural activities, and 14.9% reported community social activities. The percentages classified as frail and pre-frail were 12.8% and 22.7%, respectively. All of the activities significantly related to frailty. The adjusted odds ratio (95% CI) of frailty among the respondents that engaged in all the types of activity was: 2.19 (1.71, 2.80) among those that reported no physical activities, 1.48 (0.91, 2.43) among those with no cultural activities, and 2.09 (1.80, 2.44) among those with no community social activities. The adjusted odds ratio on frailty for the three groups reporting one type of activity ranged from 5.40 to 6.42, which was statistically significant, and the adjusted odds ratio on the group reporting no activities was 16.41 (14.02, 19.21). These results indicate that the extent of frailty increased as the number of activities decreased.Conclusions This cross-sectional study found that frailty among elders in Japan was separately associated with participation in cultural activities, social community activities, and physical activities. Frailty was more severe among those with less participation. This result suggests that, for elders who find it difficult to participate in physical activities, engaging in cultural or community social activities might help to prevent or delay frailty.


Assuntos
Participação da Comunidade/psicologia , Participação da Comunidade/estatística & dados numéricos , Cultura , Exercício , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/prevenção & controle , Vida Independente/psicologia , Vida Independente/estatística & dados numéricos , Socialização , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Japão/epidemiologia , Masculino , Fatores Sexuais , Inquéritos e Questionários
15.
Clin Interv Aging ; 14: 805-816, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190767

RESUMO

Purpose: Elderly patients with ST-segment-elevation myocardial infarction (STEMI) have a high risk of mortality, which is particularly high in the first 30 days. Quality of life (QoL) and risk-benefit assessments are of pivotal importance in the elderly. The objective of this study is to assess the relationship between frailty syndrome (FS) and QoL in patients following acute coronary syndrome (ACS) non-ST elevation myocardial infarction (NSTEMI). Patients and Methods: The study involved 100 patients (61 men, 39 women, the average age: M ± SD =66.12±10.92 years). The study used standardized research tools: a questionnaire to assess QoL (World Health Organization Quality of Life Scale Brief version), and a questionnaire to assess FS (Tilburg Frailty Indicator). Results: FS occurred in 80% of patients after ACS. FS has a negative impact on the QoL of patients with ACS. The most important domain of FS in the studied group was the psychological: M ± SD=2.2±0.75 points. The greater FS in the physical domain, the lower the QoL in all areas. The greater FS in the social domain, the lower the QoL in psychological and social fields. Self-evaluation of patient QoL was M ± SD=3.68±0.71 points. Self-assessment of health was M ± SD=2.59±0.98 points. Conclusion: Patients with a coexisting FS have a poorer QoL in the physical, psychological, social, and environmental fields. For a multidisciplinary team, these findings can help make the therapeutic decision for frail patients who have poor QoL. Frailty among elderly patients with ACS can be considered as a determinant of high risk of adverse outcomes.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Qualidade de Vida , Síndrome Coronariana Aguda/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Idoso Fragilizado/psicologia , Fragilidade/psicologia , Humanos , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/psicologia , Estudos Prospectivos , Medição de Risco , Inquéritos e Questionários
16.
Am J Public Health ; 109(8): e1-e9, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31219720

RESUMO

Background. Research has found a strong link between ageism, in the form of negative stereotypes, prejudice, and discrimination toward older people, and risks to their physical and mental health. Little is known, however, about the effectiveness of strategies to reduce ageism. Objectives. To assess the relative effects of 3 intervention types designed to reduce ageism among youths and adults-education, intergenerational contact, and combined education and intergenerational contact-by conducting a systematic review and meta-analysis. Search Methods. We searched PubMed, PsycINFO, AgeLine, EBSCO, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Global Index Medicus, Database of Abstracts of Reviews of Effects (DARE), Epistemonikos, Cochrane Database of Systematic Reviews, Campbell Collaboration, PROSPERO, GreyLit, and OpenGrey. We identified additional records by hand-searching reference lists of relevant review articles as well as records included in the meta-analysis. Two independent reviewers completed the search and screening process. Selection Criteria. Eligible studies were those that (1) evaluated an intervention designed to reduce ageism, (2) examined at least 1 ageism outcome in relation to older adults, (3) used a design with a comparison group (randomized or nonrandomized), and (4) were published after 1970, when the ageism concept was developed. Data Collection and Analysis. Two independent reviewers extracted study-level data from records using a common data collection spreadsheet. They also assessed study quality by using the Cochrane Risk of Bias Tool, and used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool to assess quality of outcome evidence. Primary outcomes were attitudes toward older people and accuracy of knowledge about aging and older people. Secondary outcomes included comfort with older adults, anxiety about one's own aging, and interest in working in the field of geriatrics or gerontology. We carried out meta-analyses with statistical mixed models. Main Results. We identified 63 eligible studies (1976-2018) with a total sample of 6124 participants. Ageism interventions demonstrated a strongly significant effect on attitudes (differences of standardized mean differences [dD] = 0.33; P < .001), knowledge (dD = 0.42; P < .001), and comfort (dD = 0.50; P < .001), but no significant effect on anxiety (dD = 0.13; P = .33) or working with older adults (dD = -0.09; P = .40). Combined interventions with education and intergenerational contact showed the largest effects on attitudes. We found stronger effects for females and for adolescent and young adult groups. Authors' Conclusions. Interventions are associated with substantial reduction in ageism and should be part of an international strategy to improve perceptions of older people and the aging process. Additional research using more rigorous designs to examine the effects of interventions is strongly recommended. Public Health Implications. Ageism has well-established negative effects on the physical and mental health of older people. Findings suggest that relatively low-cost, feasible strategies involving education and intergenerational contact can serve as the basis of effective interventions to reduce ageism.


Assuntos
Ageismo/prevenção & controle , Ageismo/psicologia , Envelhecimento/fisiologia , Envelhecimento/psicologia , Idoso Fragilizado/psicologia , Promoção da Saúde/métodos , Relação entre Gerações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Viés , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
Clin Interv Aging ; 14: 643-658, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31040654

RESUMO

Introduction: Many health care interventions have been developed that aim to improve or maintain the quality of life for frail elderly. A clear overview of these health care interventions for frail elderly and their effects on quality of life is missing. Purpose: To provide a systematic overview of the effect of health care interventions on quality of life of frail elderly. Methods: A systematic search was conducted in Embase, Medline (OvidSP), Cochrane Central, Cinahl, PsycInfo and Web of Science, up to and including November 2017. Studies describing health care interventions for frail elderly were included if the effect of the intervention on quality of life was described. The effects of the interventions on quality of life were described in an overview of the included studies. Results: In total 4,853 potentially relevant articles were screened for relevance, of which 19 intervention studies met the inclusion criteria. The studies were very heterogeneous in the design: measurement of frailty, health care intervention and outcome measurement differ. Health care interventions described were: multidisciplinary treatment, exercise programs, testosterone gel, nurse home visits and acupuncture. Seven of the nineteen intervention studies, describing different health care interventions, reported a statistically significant effect on subdomains of quality of life, two studies reported a statistically significant effect of the intervention on the overall quality of life score. Ten studies reported no statistically significant difference between the intervention and control groups. Conclusion: Reported effects of health care interventions on frail elderly persons' quality of life are inconsistent, with most of the studies reporting no differences between the intervention and control groups. As the number of frail elderly persons in the population will continue to grow, it will be important to continue the search for effective health care interventions. Alignment of studies in design and outcome measurements is needed.


Assuntos
Terapia por Exercício , Idoso Fragilizado/psicologia , Serviços de Saúde para Idosos , Qualidade de Vida , Idoso , Terapia por Exercício/métodos , Terapia por Exercício/psicologia , Humanos
18.
BMC Public Health ; 19(1): 504, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053090

RESUMO

BACKGROUND: Among community-dwelling older adults, frailty is highly prevalent and recognized as a major public health concern. To prevent frailty it is important to identify those at risk of becoming frail, but at present, no accepted screening procedure is available. METHODS: The screening process developed as part of the PERSSILAA project is a two-step screening pathway. First, older adults are asked to complete a self-screening questionnaire to assess their general health status and their level of decline on physical, cognitive and nutritional domains. Second, older adults who, according to step one, are at risk of becoming frail, are invited for a face-to-face assessment focusing on the domains in depth. We deployed the PERSSILAA screening procedure in primary care in the Netherlands. RESULTS: In total, baseline data were available for 3777 community-dwelling older adults (mean age 69.9 (SD ± 3.8)) who completed first step screening. Based on predefined cut-off scores, 16.8% of the sample were classified as frail (n = 634), 20.6% as pre-frail (n = 777), and 62.3% as robust (n = 2353). Frail subjects were referred back to their GP without going through the second step. Of the pre-frail older adults, 69.7% had evidence of functional decline on the physical domain, 67% were overweight or obese and 31.0% had evidence of cognitive decline. CONCLUSION: Pre-frailty is common among community-dwelling older adults. The PERSSILAA screening approach is a multi-factor, two-step screening process, potentially useful for primary prevention to identify those at risk of frailty and who will benefit most from preventive strategies.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Promoção da Saúde/organização & administração , Indicadores Básicos de Saúde , Nível de Saúde , Vida Independente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Idoso Fragilizado/psicologia , Fragilidade , Avaliação Geriátrica/métodos , Humanos , Masculino , Programas de Rastreamento , Países Baixos , Prevalência
19.
Geriatr Gerontol Int ; 19(7): 647-653, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31083795

RESUMO

AIM: To investigate the prevalence and associated factors of cognitive frailty and cognitive frailty-related falls in community-dwelling older people. METHODS: A total of 25 out of 1192 community-dwelling older people aged >70 years with cognitive frailty participated in the present cross-sectional study. Cognitive function was assessed using the Mini-Mental State Examination. Physical function measures included calf circumference, Timed Up and Go (TUG) and usual walking speed. Interviews were carried out to assess Council on Nutrition Appetite Questionnaire (CNAQ); chronic diseases including hypertension, diabetes and falls; as well as physical frailty, defined as having three of five criteria: muscle weakness, slowness, exhaustion, low activity and weight loss. RESULTS: The prevalence of cognitive frailty was 2.1%. Participants with cognitive frailty had significantly reduced Mini-Mental State Examination and calf circumference; and higher instrumental activities of daily living disability and falls. Old age (OR 1.151, 95% CI 1.053-1.257), fall history (OR 3.577, 95% CI 1.381-9.263), having four or more chronic diseases (OR 7.419, 95% CI 2.117-26.005) and slower TUG (OR 1.234, 95% CI 1.041-1.462) were significantly associated with cognitive frailty, whereas greater calf circumference (OR 0.748, 95% CI 0.625-0.895) and CNAQ (OR 0.736, 95% CI 0.628-0.8631) had protective effects. Old age (OR 1.132, 95% CI 1.002-1.280), hospitalization (OR 10.090, 95% CI 2.554-39.854), having four or more chronic diseases (OR 5.120, 95% CI 1.113-23.557) and slower TUG (OR 1.394, 95% CI 1.167-1.665) were significantly associated with cognitive frailty-related falls, whereas CNAQ (OR 0.704, 0.571-0.868) had protective effects. CONCLUSIONS: Age, chronic disease, TUG and CNAQ were significantly associated with cognitive frailty and cognitive frailty-related falls. The TUG and CNAQ have the greatest potential for improvement by intervention or lifestyle change. Further research is necessary to determine the efficacy of positive changes in these factors for symptomatic improvements. Geriatr Gerontol Int 2019; 19: 647-653.


Assuntos
Acidentes por Quedas , Cognição , Disfunção Cognitiva , Idoso Fragilizado , Fragilidade , Vida Independente/psicologia , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/complicações , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Feminino , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Fragilidade/fisiopatologia , Fragilidade/psicologia , Avaliação Geriátrica/métodos , Humanos , Japão/epidemiologia , Masculino , Testes de Estado Mental e Demência , Prevalência
20.
Am J Nurs ; 119(6): 61, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31135434

RESUMO

Katy Butler illuminates the human costs of her father's medically delayed death.


Assuntos
Idoso Fragilizado/psicologia , Direito a Morrer , Assistência Terminal/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA