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La presente publicación describe y homogeniza los criterios en la recopilación y codificación de diagnósticos CIE 10 y catálogo de procedimientos médicos y estomatológicos. Asimismo, describe la metodología de registros estadísticos sanitarios en salud del adulto mayor, el cual se convierte en un sistema de información necesaria para la toma de decisiones en la solución de los problemas sanitarios en el marco del sistema de coordinación. Dichas intervenciones están orientadas al cumplimiento del cuidado integral de salud de las personas adultas mayores, mediante la aplicación del Paquete de cuidado integral de salud del adulto mayor, en base a sus necesidades de salud, de acuerdo con la Valoración Clínica del Adulto Mayor -VACAM, con acciones de promoción, prevención, curación y rehabilitación; con enfoque de Salud Pública basado en género e interculturalidad

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BackgroundHearing loss (HL) of moderate or higher grades is common in older adults with increasing prevalence as people age, rising from 12% at the age of 60 years to over 58% at 90 years. HL in midlife is one of the main potentially modifiable risk factors for dementia. It is estimated that 7% of dementia cases globally could be avoided if this risk factor was eliminated. However, much of the research conducted has been in high-income countries even though low- and middle-income countries have the highest prevalence of dementia.ObjectiveTo study the association between HL and cognitive decline during eight years of follow-up in a Brazilian sample.MethodsParticipants from the São Paulo center of the Brazilian Longitudinal Study of Adult Health were evaluated in three study waves (2008-10, 2012-14, and 2017-19). HL was defined as pure-tone audiometry above 25 dB in the better ear. Cognitive performance was evaluated with six tests related to memory, verbal fluency, and trail-making tests. A global cognitive z-score was derived from these tests. The association between HL and cognitive decline was evaluated with linear mixed-effects models adjusted for sociodemographic, lifestyle, and clinical factors.ResultsOf 805 participants (mean age 51 ± 9 years, 52% women, 60% White), 62 had HL. During follow-up, HL was associated with faster global cognitive decline (ß = -0.012, 95% CI = -0.023; 0.000, p = 0.039).ConclusionsHL was significantly associated with a faster rate of global cognitive decline after a median follow-up of eight years in a sample of middle-income country.

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BACKGROUND: Parkinson's disease (PD) is a degenerative, progressive, chronic disease that mainly affects the central nervous system, caused by dopamine deficiency. One of the ways to evaluate the central nervous system is with auditory evoked potentials (AEP). OBJECTIVE: To characterize the audiometric responses, and the auditory brainstem response (ABR), and cortical auditory evoked potentials (CAEP) in individuals with PD. METHODS: Thirty-two patients aged between 40 and 81 of both sexes were assessed, 16 with PD (study group [SG]) and 16 without PD (control group [CG]) matched for sex and age. The subjects were assessed using pure tone audiometry, ABR with click stimuli, and CAEP using the oddball paradigm with tone burst and speech stimuli. The results were compared between the groups using a repeated measures analysis of variance (ANOVA) test. RESULTS: In pure-tone audiometry, significantly higher hearing thresholds were found in the SG at 6 and 8 kHz. For the ABR, no differences were observed between groups. The CAEP analysis did not find statistical differences in the latencies between the groups, however, the SG presented smaller amplitudes of P1-N1, P2-N2, and N2-P3 than the CG. CONCLUSION: The results of this study showed a significantly higher threshold in higher frequencies in PD. Although no differences were observed at the brainstem level, the decrease in amplitude of all components in patients with PD in the CAEP suggests a deficit in both automatic and attentional cortical processing of acoustic stimuli.

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Perioperative risk assessment helps inform clinical practice for older people with hip fractures. This is a cohort study, where perioperative risk screening, including NHFS, was performed at admission, followed by an evaluation of 30-day outcomes. 503 patients were included, 73% female, 79.4 ± 9.3 years old; 58% presented extracapsular and 42% intracapsular fractures, with a 30-day mortality of 9%. The NHFS was higher in the patients who died at 5.6 ± 1.1 compared to survivals at 4.3 ± 1.5 (p-value < 0.001). NHFS > 4 was associated with 30-day mortality observed by Cox regression adjusted by fracture type: HR 4.55 (95% CI 2.10-9.82) (p-value < 0.001) and Kaplan-Meyer Curve (HR 3.94; 95% CI 2.19-7.07; p-value < 0.001). ROC curve showed the accuracy of NHFS in explaining 30-day mortality (AUC 0.74; 95% CI 0.67-0.81). Complications were higher among patients with NHFS > 4. The performance of NHFS was better than the traditional perioperative risk ASA score. Therefore, NHFS can be implemented in real-world clinical practice to estimate the 30-day mortality risk for hip fracture in older patients in Brazil. NHFS > 4 is critical for 30-day mortality and complications; this cutoff helps inform clinical practice. The present study might motivate other centers to consider NHFS in their perioperative risk assessment routine.

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Decision-making in chronic diseases guided by clinical decision support systems that use models including multiple variables based on artificial intelligence requires scientific validation in different populations to optimize the use of limited human, financial, and clinical resources in healthcare systems worldwide. This cohort study evaluated three machine learning algorithms-XGBoost, Elastic Net logistic regression, and an Artificial Neural Network-to develop a prediction model for three outcomes: mortality, hospitalization, and emergency department visits. The objective was to build a clinical decision support system for patients with noncommunicable diseases treated at the Alma Mater Hospital complex in Medellín, Colombia. We collected 4845 electronic medical record entries from 5000 patients included in the study. The median age was 71.83 years, with 63.8% women and 29.7% receiving home care. The most prevalent medical conditions were diabetes (52.9%), hypertension (67.2%), dyslipidemia (57.3%), and COPD (19.4%). For mortality prediction, the Elastic Net logistic regression model achieved an AUCROC of 0.883 (95% CI: 0.848-0.917), the XGBoost model reached an AUCROC of 0.896 (95% CI: 0.865-0.927), and the Neural Network achieved 0.886 (95% CI: 0.853-0.916). For hospitalization, the Elastic Net model had an AUCROC of 0.952 (95% CI: 0.937-0.965), the XGBoost model achieved 0.963 (95% CI: 0.952-0.974), and the Neural Network scored 0.932 (95% CI: 0.915-0.948). For emergency department visits, the AUCROC values were 0.980 (95% CI: 0.971-0.987) for Elastic Net, 0.977 (95% CI: 0.967-0.986) for XGBoost, and 0.976 (95% CI: 0.968-0.982) for the neural network. A dashboard was developed to interact with an ensemble risk categorization segmenting patient risk in the cohort to aid in clinical decision-making. A clinical decision support system based on artificial intelligence using electronic medical records possibly can help segmenting the risk in populations with Noncommunicable Diseases for effective decision-making.

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The main aim of this study is to explore the relationship between the elderly population and economic growth in 25 North and South American countries use annual secondary data from 1961 to 2021. Instead of focusing on the conditional mean, this study tests for Granger causality in the entire conditional distribution of the elderly population and economic growth through wavelet coherence analysis. The study findings indicated a unidirectional Granger causality running from per capita gross domestic product (GDP) to the elderly population for Bolivia, Colombia, Guyana, Peru and Puerto Rico and also from elderly population to per capita GDP for Costa Rica, Ecuador and Honduras. However, there is no causal relationship between the elderly population and economic growth for the rest of the countries. Wavelet coherence analysis depicted that economic growth positively led the elderly population in North America during the early 21st century. Furthermore, economic growth had been negatively leading the elderly population in South America throughout the period under consideration. This empirical study shows that policymakers of these economies need to analyse the transformation in the elderly population-economic growth causality robustness throughout the year when devising policies.

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BACKGROUND: The use of dental services by older adults in Peru faces various challenges that impact both their oral and overall health. Several factors play a crucial role in obtaining adequate dental care. AIMS: To evaluate the factors associated with the use of dental services in older adults in Peru. METHODS: This study was an observational, analytical, and cross-sectional investigation that utilized data from multiple years (2018-2022) of the Demographic and Family Health Survey (ENDES, by its Spanish acronym). The use of dental services was assessed through a specific survey question and analyzed in association with various socio-demographic variables, employing both descriptive and analytical statistical methods. RESULTS: In the multivariable analysis, the likelihood of not utilizing dental services was higher among men aPR: 1.53 (95% CI: 1.45-1.61), those without health insurance aPR: 1.44 (95% CI: 1.36-1.53), those who self-identified as other races aPR: 1.22 (95% CI: 1.13-1.33), Afro-descendants aPR: 1.10 (95% CI: 1.01-1.19), whites aPR: 1.12 (95% CI: 1.01-1.25) according to education level, those with a physical limitation aPR: 1.24 (95% CI: 1.15-1.33), and increased as they were poorer; it was lower among the rich but more pronounced among the middle-income, poor, and very poor, adjusted for five variables. CONCLUSION: It was reported that 15% of older adults did not use dental services, and this was associated with significant socio-demographic variables.

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PURPOSE: This study analyzed tongue pressure in healthy older adults during maximum voluntary contraction in the anterior and posterior regions and verified whether it was associated with sex, age, and dental status. METHODS: This is a cross-sectional, observational, descriptive study with a non-probabilistic sample of 128 active and healthy older adults of both sexes. The evaluation consisted of a medical history survey to collect personal data, cognitive screening, and assessment of dental status and tongue pressure, using the Iowa Oral Performance Instrument. The anterior and posterior tongue pressures at maximum contraction were the response variables, and age, sex, number of natural teeth, and conditions related to dentures were the explanatory variables. The significance level was set at 5% for data analysis. RESULTS: Males had greater anterior tongue pressure. The anterior and posterior tongue pressure measurements were significantly different between participants aged 60 to 69 years and those over 80 years. No significant differences were found regarding dental status and denture fitting. CONCLUSION: Anterior and posterior tongue pressure values were higher in men and decreased after the age of 80. The conditions related to the number of teeth and denture use and fitting did not influence the tongue pressure levels.

OBJETIVO: O estudo analisou a pressão de língua em idosos saudáveis durante a contração voluntária máxima na porção anterior e posterior e verificou se houve associação com sexo, idade e condição dentária. MÉTODO: Trata-se de estudo transversal, observacional e descritivo com amostra não probabilística, composta por 128 idosos ativos e saudáveis, de ambos os sexos. A avaliação foi composta por anamnese para coleta de dados pessoais, rastreio cognitivo, avaliação da condição dentária e avaliação da pressão da língua por meio do Iowa Oral Performance Instrument. As variáveis resposta foram a pressão de língua em contração máxima (anterior e posterior) e as variáveis explicativas foram idade, sexo, número de dentes naturais e condições referentes às próteses dentárias. Foram considerados o nível de significância de 5% para análise dos dados. RESULTADOS: Observou-se maior pressão anterior de língua no sexo masculino. Em relação à idade, a medida de pressão lingual tanto na região anterior quanto na posterior indicou diferença significativa entre os idosos de 60 a 69 anos comparados aos com mais de 80 anos. Quanto à condição dentária e à adaptação da prótese, não foram verificadas diferenças expressivas. CONCLUSÃO: Os valores de pressão de língua nas porções anterior e posterior mostraram-se mais elevados em homens e diminuíram após os 80 anos. As condições relacionadas ao número de dentes, presença e adaptação das próteses não influenciaram os níveis de pressão lingual.

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PURPOSE: To identify the prognostic variables related to the survival of patients operated on for adenocarcinoma of the rectum who underwent preoperative radiochemotherapy (RCT). METHODS: We studied 70 patients from the Discipline of Surgical Gastroenterology at Escola Paulista de Medicina from 2000 to 2019, with rectal cancer located up to 10 cm from the anal verge and with stages II or III, submitted to preoperative RCT and curative surgery (R0) and with follow-up of at least 12 months. Clinical restaging was performed four to six weeks after the end of neoadjuvant treatment to characterize the degree of clinical tumor regression. Surgery by laparotomy or videolaparoscopy was performed six to 12 weeks after RCT. Primary endpoint were: overall survival (OS), disease-free survival (DFS), metastasis-free survival (MSS), and neoplasm-specific survival (SEN). These were compared with gender, age, carcinoembryonic antigen (CEA) dosage, distance from the tumor to the anal verge, radiation dose, radiotherapy-surgery interval, clinical regression, type of surgery, pT and pN TNM stage tumor, number of nodes, circumferential resection margin, and complete pathological response. Survival was assessed by Kaplan-Meier curves. Univariate and multivariate Cox analyses were calculated to identify factors associated with survival outcomes. RESULTS: The mean follow-up time was 62 months. The pathological complete response rate was 18.6%. Univariate cox regression showed a significant relationship of CEA equal to or greater than 4 ng/mL with DFS and MFS, pT3/pT4 staging with DFS, MFS and SEN, pN1/N2 with DFS, MFS and SEN and stages II and III with DFS and MFS. Multivariate regression found that CEA, pT, and pN staging are independent prognostic factors for DFS, MFS, and SEN. CONCLUSION: Carcinoembryonic antigen level prior to radiotherapy, pT staging and pN staging were independent prognostic factors for survival in patients with rectal adenocarcinoma who are treated with preoperative radiochemotherapy.

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PURPOSE: To investigate potential association between different types of frailty and hearing handicap in the older population. METHODS: A study was conducted on frailty among older adults in the context of social vulnerability. The study involved 229 participants who underwent physical, cognitive, and social frailty assessments. Physical frailty was assessed using Fried's Frailty Phenotype, while cognitive frailty was characterized by the presence of physical frailty and cognitive decline. The Makizako index was used to assess social frailty, and the HHIE-S questionnaire was applied to quantify hearing handicap. Participation restrictions related to hearing difficulties were explored in relation to the three types of frailty using logistic regression. RESULTS: Hearing handicap were found to be associated with physical, cognitive, and social frailties. However, in a multivariate binary logistic regression analysis, the emotional scale of HHIE-S was only a predictive factor for physical frailty, along with older age, lower education, and the presence of comorbidities. Age and the presence of comorbidities were the only associated explanatory variables for cognitive frailty. Social frailty was only associated with the presence of cognitive changes. CONCLUSION: Hearing loss-related participation restrictions can be a significant challenge for older adults. Those who also have an emotional impairment, caused by hearing loss, are even more vulnerable to becoming frail or pre-frail. It's important to prioritize the needs of this population and provide the necessary support to enhance their quality of life and prevent further decline.

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PURPOSE: To analyze the association between older people's health literacy and sociodemographic aspects, functioning, happiness, and perception of the COVID-19 pandemic. METHODS: This is a preliminary, cross-sectional, analytical, observational study with 37 older adults of both sexes. It used the Brazilian Economic Classification Criteria, WHODAS 2.0, SAHLPA-18, WHO-5 Well-Being Index, and Subjective Happiness Scale, estimated the perception of the pandemic through a questionnaire developed by the authors, and performed descriptive analysis, association analysis using the Pearson chi-square test, and Spearman correlation. RESULTS: Most participants had inadequate functional health literacy (FHL) results. A higher percentage of individuals from social classes C and D-E had inadequate FHL. The low education level was associated with an inadequate FHL. Most participants with adequate FHL reported feeling "calm and relaxed" for more than half the time or all the time. The SAHLPA-18 score was weakly negatively correlated with the Cognition and Self-Care domains of WHODAS 2.0, indicating that better health literacy is associated with better cognitive and self-care conditions. CONCLUSION: Older people with better health literacy had better cognitive ability, better self-care management, higher education levels, and better quality of life.

OBJETIVO: Analisar a associação entre o Letramento em saúde de pessoas idosas e funcionalidade, felicidade, percepção da pandemia de Covid-19 e aspectos sociodemográficos. RESULTADOS: A maioria dos participantes apresentou resultado inadequado no Letramento Funcional em Saúde (LFS). A porcentagem de pessoas das classes C e D-E foi maior entre as que apresentaram LFS inadequado. Houve associação entre baixo nível de escolaridade e LFS inadequado. A maioria dos participantes com LFS adequado respondeu permanecer mais da metade do tempo ou o tempo todo "calmo(a) e tranquilo(a)". Foi observado correlação negativa de magnitude fraca entre o escore do SAHLPA-18 e os domínios Cognição e Autocuidado WHODAS 2.0, que indica, quanto melhor o letramento em saúde melhores são as condições cognitivas e de autocuidado. CONCLUSÃO: As pessoas idosas que apresentaram melhor letramento em saúde demonstraram melhor capacidade cognitiva, melhor gestão do autocuidado, maior grau de instrução e melhor qualidade de vida.

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PURPOSE: To compare the findings of speech-language-hearing evaluations, signs in fiberoptic endoscopic evaluation of swallowing, and nutritional risk between healthy older adults with and without self-reported swallowing difficulties and correlate the level of oral intake with the severity of pharyngeal residues and nutritional risk. METHODS: This cross-sectional retrospective study included 71 older people and divided them into two groups based on the presence of swallowing complaints. Data were collected from speech-language-hearing evaluations, oral health status, and videoendoscopy signs with four food consistencies classified by the International Dysphagia Diet Standardisation Initiative (IDDSI) to compare the groups. Pharyngeal residues were analyzed and classified using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), the level of oral intake was assessed using the Functional Oral Intake Scale (FOIS), and nutritional risk was evaluated using the Malnutrition Screening Tool (MST). RESULTS: Differences were found in speech-language-hearing evaluations, as well as signs of posterior oral spillage and pharyngeal residues with levels 0, 2, and 4 consistencies and laryngeal penetration with level 0 consistency. The level of oral intake was moderately negatively correlated with the severity of pharyngeal residues and nutritional risk. CONCLUSION: The group of older adults with complaints had differences in speech-language-hearing evaluations, posterior oral spillage, and pharyngeal residues with levels 0, 2, and 4 consistencies, and laryngeal penetration with level 0 consistency. The correlation indicated that the lower the level of oral intake, the greater the severity of pharyngeal residues and nutritional risk in the sample.

OBJETIVO: Comparar os achados da avaliação fonoaudiológica, sinais da videoendoscopia da deglutição e o risco nutricional entre idosos saudáveis com e sem dificuldades autorreferidas em deglutir, além de correlacionar o nível de ingestão oral com a gravidade dos resíduos faríngeos e o risco nutricional. MÉTODO: Trata-se de um estudo transversal e retrospectivo. Foram incluídos 71 idosos divididos em dois grupos de acordo com a presença de queixas de deglutição. Foram coletados dados da avaliação fonoaudiológica e estado oral, além dos sinais videoendoscópios em quatro consistências alimentares classificados pelo International Dysphagia Diet Standartisation Initiative (IDDSI) para comparação entre os grupos. Os resíduos faríngeos foram analisados e classificados pelo Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), o nível de ingestão oral pelo Functional Oral Intake Scale (FOIS) e o risco nutricional foi avaliado utilizando-se o Malnutrition Screening Tool (MST). RESULTADOS: Houve diferença na avaliação fonoaudiológica, além de sinais de escape oral posterior e resíduos faríngeos nas consistências alimentares de nível 0, 2 e 4, e penetração laríngea na consistência de nível 0. Houve correlação negativa moderada entre o nível de ingestão oral, gravidade dos resíduos faríngeos e o risco nutricional. CONCLUSÃO: O grupo de idosos com queixas apresentou diferenças na avaliação fonoaudiológica, além de escape oral posterior e resíduos faríngeos nas consistências alimentares de nível 0, 2 e 4, e penetração laríngea na consistência de nível 0. A correlação indicou que, quanto menor o nível de ingestão oral, maior a gravidade dos resíduos faríngeos e o risco nutricional na amostra.

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PURPOSE: To examine the relationship between endoluminal and pathologic complete response after chemoradiotherapy for rectal cancer and identify predictors of a pathologic complete response. METHOD: The anatomic pathology reports of 102 consecutive patients with rectal cancer who underwent neoadjuvant chemoradiotherapy followed by proctectomy between 2013 and 2017 were reviewed for the presence or absence of endoluminal complete response. The presence of endoluminal complete response was compared with the anatomopathological stage. The residual lesion area was compared with the final pathologic stage to identify predictors of complete response. RESULTS: Of 102 patients, 20 (19.6 %) achieved a pathologic complete response (ypT0N0). Of these, 9 (45 %) did not achieve an endoluminal complete response. The presence of endoluminal complete response had a sensitivity of 55.00 %, specificity of 96.34 %, and accuracy of 88.24 % to identify ypT0N0. The presence of endoluminal complete response, residual lesion area ≤ 4 cm2, and tumor located in the mid-rectum were associated with pathologic complete response (ypT0N0). CONCLUSION: Almost half of the patients who had a pathologic complete response did not achieve an endoluminal complete response. Tumors located in the mid-rectum with a residual size of ≤ 4 cm2 and the presence of endoluminal complete response were significantly associated with the achievement of ypT0N0.

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Preoperative anemia is associated with poor outcomes, but less is known about its impact on quality of life (QoL). This study investigates the association between preoperative anemia and QoL in elderly undergoing major abdominal surgery. This prospective observational study was conducted from 2017 to 2021 in a tertiary hospital's preoperative anesthesia clinic. QoL outcomes were assessed using the EuroQol 5-Dimension 3-Level (EQ-5D-3L) and the EuroQol-Visual Analogue Scale (EQ-VAS). Data was collected at baseline, 1-, 3-, and 6-month postoperatively. Patients were included if they were 65 years or older, could provide written informed consent and were planned for elective major abdominal surgery. Patients were excluded if they were going for organ transplant surgery. A total of 469 patients were analyzed, of which 176 (38%) had anemia. There was no significant difference across varying anemia severity in EQ-5D-3L dimensions of mobility, self-care, usual activities, and pain/discomfort. Moderate-to-severe anemic patients generally have more issues across EQ-5D-3L dimensions. At baseline, these patients exhibited more issues with self-care (3%), pain/discomfort (13%), and anxiety/depression (19%), along with a lower mean EQ-VAS score of 77. However, there was a significant improvement in mobility, usual activities, and pain/discomfort over time. EQ-VAS score significantly improved for all groups of patients over time. The dimensions of EQ-5D-3L and EQ-VAS scores improved as the severity of anemia decreased. Preoperative anemia is associated with a significant decrease in QoL based on EQ-VAS. Recognizing and managing preoperative anemia may improve the recovery of elderly patients undergoing major abdominal surgery.

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OBJECTIVE: to identify the main factors related to complications of the invasive blood pressure system. METHOD: prospective study conducted with patients over 18 years of age admitted to intensive care, using a device for measuring invasive blood pressure. Participants were monitored during the catheter dwell-time and sociodemographic, clinical and device data were collected. The outcome analyzed was removal due to non-indication of use or due to complications. Student's t-test, Mann-Whitney U test, chi-square test and Fisher's exact test were used for the analyses. RESULTS: 50 participants were included and monitored, and most devices were installed in the radial artery (86%), with a 20-gauge catheter (50%), all with a flexible catheter. Each patient remained, on average, 4.36 days (SD: 3.504) with the device. Regarding the outcomes, 60.0% of the devices were removed due to non-indication of use and 40.0% due to complications. Phlebitis was the most prevalent complication, and pressure in the bag was the factor associated with catheter removal before the time of indication (p=0.046). CONCLUSION: the main complications associated with this device were obstruction and phlebitis, while pressure in the bag was the factor related to catheter removal before indication. BACKGROUND: (1) Phlebitis was the most prevalent complication. (2) Pressure in the bag was associated with catheter removal before indication. (3) Length of stay and use of sedation were related to the onset of phlebitis.

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PURPOSE: To establish a profile of the inflammatory response in the preoperative and postoperative period of pulmonary resection of patients without postoperative complications, in order to trace the inflammatory profile of lung resection surgery. METHODS: Six collections of arterial and venous blood were performed for data analysis, one sample in the preoperative, immediate postoperative, 4, 8, 24, and 48 hours after surgery. Twenty-seven patients with a median age of 63 years old, ranging from 29 to 80 years old, were included. RESULTS: The leukocyte count showed a significant increase in the times: immediate postoperative and 4 hours after surgery, in relation to the preoperative period. Concomitantly, there was an increase in lactate, heart rate, interleukin (IL)-6 and IL-8 after 4 hours of surgery. The platelet count showed a significant decrease in 48 h, associated with an increase in IL-1ß and tumor necrosis factor-α. A significant increase in IL-10 was observed in the immediate postoperative. CONCLUSION: The study may contribute to the search for more specific and adequate alternatives for controlling the inflammatory response. In this way, the intervention would be specific to that cytokine that causes the greatest harm to the patient, as well as to the moment of the intervention.

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Frailty is a significant risk factor for adverse outcomes in elderly surgical patients. Gait speed assessment is a new tool recently used to stratify risk for these pre-operative adverse outcomes. In this prospective study of 392 frail elderly patients undergoing abdominal surgery, we investigated the predictive value of preoperative gait speed for postoperative outcomes. Patients were divided into two groups based on their 6-meter gait speed: normal (≥0.8 m/s, n=184) and slow (<0.8 m/s, n=208). The slow group was older, had more comorbidities, and higher American Society of Anesthesiologists (ASA) grades (P<0.05). They also had significantly higher rates of 30-day overall complications (38.9 vs 18.5%, P<0.01), severe complications (12.0 vs 4.3%, P<0.01), and 1-year mortality (15.4 vs 6.5%, P=0.008) compared to the normal group. Pulmonary infection, wound infection, and delirium were the most common complications. Multivariate logistic regression confirmed slow gait speed as an independent risk factor for 30-day complications (OR=2.38, 95%CI: 1.41-4.01) and 1-year mortality (OR=2.19, 95%CI: 1.07-4.48). Our findings demonstrated that preoperative 6-meter gait speed effectively predicted short-term complications and mid-term mortality in frail elderly patients undergoing abdominal surgery. This suggests the need for individualized perioperative management strategies for high-risk patients with slow gait speed to potentially improve their prognosis.

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An 88-year-old woman received dental evaluation at home after missing out on regular dental checks due to a stroke 3 years ago. Her orofacial complaints included pain in the right side of the face and a desire to use dental prosthetics. Her comorbidities included systemic arterial hypertension and sequels from episodes of a thrombotic stroke and an acute myocardial infarction. Medications used were a beta-blocker, an angiotensin-converting enzyme inhibitor, a statin, and an antiplatelet agent. During the initial evaluation, the patient was alert, using a wheelchair, and was quite anxious and apprehensive, reporting episodes of dental phobia. On intraoral examination, findings consistent with the orofacial pain mentioned by the patient were observed. Sequentially, a treatment plan was developed to address the oral condition. The treatment was initiated with basic periodontal therapy and restorative procedures, performed with non-pharmacological stress reduction management. However, due to the patient's behavior during previous follow-ups, it was decided to perform extractions under sedation with antihistamine and nitrous oxide in the home setting. The procedure was conducted with vital signs monitoring, and the use of antiplatelet drugs was not suspended. Local bleeding control measures were applied, and the postoperative period occurred without complications. Besides promoting accessibility, home dental care provides treatment in a safe environment for the patient, which enhances comfort and reduces patient anxiety. Additionally, using sedation with antihistamine and nitrous oxide achieved an adequate level of relaxation for more effective stress control during the extractions.

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OBJECTIVES: As the global dementia crisis intensifies, especially in low-and middle-income countries (LMICs), there is a pressing need for comprehensive prevalence data across diverse regions, including Brazil, where studies have been predominantly limited to affluent urban centers. This study aimed to conduct an expert consensus to determine the prevalence of all-cause dementia in Brazil, considering various age groups, sexes, and geographical areas. METHODS: A Delphi consensus process with clinical and academic experts from across Brazil was conducted to provide dementia prevalence estimates in people aged ≥ 60 years living throughout Brazil for 2019. Each round consisted of answering structured questionnaires that incorporated information from the literature. A priori criteria were used to ascertain the point in which consensus was achieved for > 70% of the 15 prevalence estimates-for (1) total, (2) women and men, and (3) the five Brazilian macro-regions. The current and projected dementia cases in Brazil were calculated based on age and sex population distributions. RESULTS: Fifteen experts, with a mean professional experience of 25 ± 10 years, reached a consensus in the fourth round. Experts agreed with a mean all-cause dementia prevalence of 8.5% among Brazilians aged ≥ 60 years, which comprised 2.46 million people in 2019 in this age. They reported higher dementia rates in women (9.1%) than men (7.7%); the highest total prevalence was in those over 80 where it exceeds 20%. Regional variations were also noted, with lower prevalence in the South (7.3%) and higher in the North (8.9%) and Northeast (10.1%). Projections estimate that considering Brazil's rapidly aging population, dementia cases will rise to 8.89 million by 2060. CONCLUSIONS: This Delphi study estimated that dementia already affects roughly 1 in 12 older Brazilians aged 60 and above, with slightly higher prevalence in women and significant geographical variations. These results underscore the urgency for targeted public health strategies in Brazil and offer a framework for similar challenges in other LMICs, especially given that dementia cases are projected to increase by approximately 3.6 times in 4 decades.

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PURPOSE: In 2022, the World Health Organization (WHO) proposed new criteria for the diagnosis of oral epithelial dysplasia (OED), however their association with patient's outcome is still unknown. This study compared the different classification systems of OED and evaluate their efficacy in predicting malignant transformation. METHODS: A total of 195 slides of leukoplakia and erythroplakia were graded according to the WHO 2017, 2022, and the Binary System classification, and were correlated with the lesion's evolution. RESULTS: A progressive increase in malignant transformation according to the severity of OED, with both the WHO and the Binary classification systems was detected. Among individual criteria, changes in cell morphology were independently associated with an increased risk of malignant transformation (HR = 2.8, 95%CI 1.1-7.5, p = 0.032). Considering the new set of OED criteria published in 2022, it was detected that a new cutoff of 4 architectural alterations and 6 cytological alterations predicts better malignant transformation. CONCLUSION: Malignant transformation was equally predicted by the OED classification systems. Due to the increased number of architectural and cytological features in WHO 2022, a new cutoff for classifying OED from low to high-grade considering 4 architectural and 6 cytological alterations is proposed. The findings allow a more accurate assessment of malignant transformation risk in OED.