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2.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 1088-1095, jul.-set. 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005471

RESUMO

Objetivo: Analisar o perfil e identificar os fatores associados à tuberculose em idosos no Maranhão no período de 2010 a 2015. Métodos: Estudo transversal analítico com os casos de tuberculose em idosos no estado do Maranhão. Foram utilizados dados secundários do SINAN, disponíveis no Datasus. Para identificar as associações entre o desfecho (tuberculose em idosos) e as variáveis independentes, utilizou-se a regressão de Poisson. Resultados: Após o ajuste do modelo, a escolaridade < 8 anos de estudo, ter encerramento por não cura, exame anti HIV não realizado e ter diabetes apresentaram­se como fatores que aumenta a chance da ocorrência de tuberculose em idosos. As demais variáveis apresentaram-se como fator protetor. Conclusão: Foi observada alta prevalência de tuberculose em idosos no estado (16,6%). Há necessidade de se adotarem estratégias de acompanhamento dessa clientela


Objective: To analyze the profile and identify the factors associated with tuberculosis in the elderly in Maranhão from 2010 to 2015. Methods: An analytical cross-sectional study with cases of tuberculosis in the elderly in the State of Maranhão. Secondary data from SINAN, available on Datasus, were used. To identify the associations between the outcome (tuberculosis in the elderly) and the independent variables, Poisson regression was used. Results: After adjustment of the model, schooling < 8 years of study, closure due to non-cure, unrecovered HIV test and diabetes had a factor that increases the chance of tuberculosis occurring in the elderly. The other variables were presented as protective factor. Conclusion: A high prevalence of tuberculosis in the elderly was observed in the State (16.6%). There is a need to adopt strategies to follow up this clientele


Objetivo: Analizar el perfil e identificar los factores asociados a la tuberculosis em ancianos en Maranhão en el período de 2010 a 2015. Métodos: Estudio transversal analítico con los casos de tuberculosis en ancianos en el Estado de Maranhão. Se utilizaron datos secundarios del SINAN, disponibles en Datasus. Para identificar las asociaciones entre el desenlace (tuberculosis en ancianos) y las variables independientes se utilizó la regresión de Poisson. Resultados: Después del ajuste del modelo la escolaridad < 8 años de estudio, tener cierre por no cura, examen anti VIH no realizado y tener diabetes se presentaron como factor que aumenta la probabilidad de la ocurrencia de tuberculosis en ancianos. Las demás variables se presentaron como factor protector. Conlusión: Se observó una alta prevalencia de tuberculosis en ancianos en el Estado (16,6%). Hay necesidad de adoptar estrategias de acompañamiento de esa clientela


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Idoso/estatística & dados numéricos , Saúde do Idoso , Serviços de Saúde para Idosos
3.
Estud. interdiscip. envelhec ; 24(1): 9-29, abr. 2019. tab
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1046479

RESUMO

O processo de envelhecimento populacional no Brasil tem ocorrido de forma rápida impactando diretamente na composição da População Economicamente Ativa. Assim, objetivou-se, no presente estudo, compreender o panorama geral do mercado de trabalho da pessoa idosa na região metropolitana de Belo Horizonte, analisando de forma comparativa os principais fatores que influenciam estes sujeitos a permanecerem ou a retornarem a esse meio, considerando para tal, os grupos de pessoas idosas ocupadas e inativas, de acordo com a Pesquisa de Emprego e Desemprego. Para isso, fez-se uso de dados secundários da base de Pesquisa de Emprego e Desemprego, desenvolvida pelo Departamento Intersindical de Estatística e Estudos Socioeconômicos, os quais foram analisados utilizando-se o SPSS, por meio da análise exploratória e teste t de médias. Foi possível constatar que as pessoas idosas consideradas como ocupadas, em sua maioria estão alocadas no setor privado, são empregadas e em ocupações de baixo nível de profissionalização. Contudo, verificou-se que a permanência da pessoa idosa no mercado de trabalho, pode demonstrar ineficiência dos proventos dos sistemas de aposentadoria ou pensão, fazendo com que estes sujeitos optem por manter-se no mercado de trabalho a fim de aumentar não só a sua renda, como também a de sua família. Entretanto, há que se considerar esta situação também, como sendo de caráter positivo, uma vez que a pessoa idosa se mantém produtiva e socialmente envolvida com o trabalho por mais tempo. (AU)


The process of population production in Brazil has occurred quickly, directly impacting on the Economically Active Population. Thus, the objective was not to present a study, to understand the labor market panorama of older women in the metropolitan region of Belo Horizonte, to analyze in a comparative way the main factors that influence these individuals to continue or to return to the world, considering for such Groups of elderly people inactive and inactive, according to the Survey on Employment and Unemployment. In order to do so, it made use of basic data from the Survey of Employment and Unemployment, International Survey of Statistics and Socioeconomic Studies, which were made using SPSS, through exploratory analysis and media tests. It was possible for the elderly to stay and be on a private level, with the same occupations and positions of low level of professionalization. However, it was verified that the elderly person's stay is not a labor market, it can be shown inefficiency of retirement or pension benefits, making these individuals choose to remain in a labor market. income, as well as his family. However, there is something that this situation also, as being of a positive character, since the elderly person remains productive and socially involved with the work for a longer time. (AU)


Assuntos
Idoso/estatística & dados numéricos , Envelhecimento/psicologia , Mercado de Trabalho , Renda , Qualidade de Vida
4.
Geriatr Psychol Neuropsychiatr Vieil ; 17(S1): 7-12, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30916651

RESUMO

The population of France and the world is aging with an increase in the population of people aged over 65 years old. Old people are the second largest population affected by seizures. Hence, neurologists and geriatricians have to be able to identify and treat elderly that suffer from seizures. The current epileptic seizure classification is inappropriate for old people. It is difficult to identify seizures in this group of patients for many reasons and some semiological particularities are required to establish a diagnostic. Within the elderly, first generalized seizures are rare except when epilepsy begins in childhood. The most common type of epilepsy in the elderly is partial seizure but in most cases, the beginning of seizure is difficult to analyze. Seizures clinical description depends on functional areas concerned by the spread of the epileptic discharge. Keep in mind that most of functional areas are interconnected and because of the epileptic discharge speed, clinical expression is polymorph.


Assuntos
Idoso de 80 Anos ou mais/estatística & dados numéricos , Idoso/estatística & dados numéricos , Convulsões/terapia , França/epidemiologia , Humanos , Convulsões/diagnóstico , Convulsões/epidemiologia
5.
Rev Bras Epidemiol ; 21Suppl 02(Suppl 02): e180006, 2019 Feb 04.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30726351

RESUMO

INTRODUCTION: The use of polypharmacy may be due to the concomitant presence of chronic conditions, medical care by several doctors simultaneously and self-medication. Combined with the vulnerability of the elderly to the effects of drugs due to pharmacokinetic and pharmacodynamic changes, polypharmacy makes this population more susceptible to adverse outcomes. In Brazil, studies show that polypharmacy is a common problem among elderly people. However, few information is available on the association between polypharmacy and mortality. OBJECTIVE: It was assessed the survival of the elderly from São Paulo city exposed to the use of polypharmacy (five or more medications). METHODS: That was a population-based cohort, the Health, Well-Being and Aging Study (SABE Study), conducted from 2006 to 2010. The sample was composed of 1,258 individuals aged 60 years or more. The Kaplan-Meier method and Cox proportional risks model were used to examine the association between polypharmacy and mortality. RESULTS: The probability of survival after five years of the users of polypharmacy at baseline was 77.2%, while among the non-users was 85.5%. Polypharmacy remained as a risk factor for death even after adjustment in other conditions associated with mortality, such as age, gender, income, chronic diseases and hospitalization. CONCLUSION: The results point polypharmacy as an indicator of mortality in elderly people. The use of multiple medications by the elderly should be carefully assessed to avoid or minimize the damage to this population.


Assuntos
Idoso/estatística & dados numéricos , Mortalidade , Polimedicação , Distribuição por Idade , Fatores Etários , Idoso de 80 Anos ou mais , Envelhecimento , Brasil/epidemiologia , Feminino , Nível de Saúde , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Farmacoepidemiologia , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Fatores de Tempo
6.
Rev Bras Epidemiol ; 21Suppl 02(Suppl 02): e180007, 2019 Feb 04.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30726352

RESUMO

INTRODUCTION: Self-medication involves the concept of the spontaneous search by the individual for some drug that he or she considers appropriate to solve a health problem. Self-medication practice is little explored by the elderly according to other studies based in population data. OBJECTIVE: To examine the trends in self-medication practice among the Brazilian elderly between 2006 and 2010. METHODS: This is a population-based study whose data were obtained from the Health, Well-being and Ageing Study (SABE Study). Thesample consisted of 1,257 elderly people in 2006 and 865 in 2010, who used drugs. RESULTS: The findings showed self-medication reduction from 42.3% in 2006 to 18.2% in 2010. In both periods, predominant utilized therapeutic classes were those acting on the nervous system (27.9% in 2006, and 29.6% in 2010) and on the alimentary tract and metabolism (25.5% in 2006, and 35.9% in 2010). The most commonly used medicines in 2006 and 2010 were analgesics, anti-inflammatories, and vitamins. There was a tendency to decrease the use of potentially inappropriate medicines between 2006 (26.4%) and 2010 (18.1%). The elderly themselves were the main responsible for the decision about the drug use in 2006 (62.5%) and 2010 (66.5%). CONCLUSION: Theextent of self-medication practice among the elderly who participated in the study decreased between 2006 and 2010, but the use of medicines that offer risks to health was still reported. Thus, the findings reinforce the importance of monitoring, evaluating, and continuously educating the elderly about risks and benefits of drug consumption, particularly over-the-counter medicines.


Assuntos
Idoso/estatística & dados numéricos , Automedicação/estatística & dados numéricos , Automedicação/tendências , Distribuição por Idade , Fatores Etários , Brasil/epidemiologia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Medicamentos sem Prescrição/uso terapêutico , Polimedicação , Valores de Referência , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Fatores de Tempo
7.
East Mediterr Health J ; 24(11): 1088-1097, 2019 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-30701524

RESUMO

Background: Ageing is a major known risk factor that is a threat to human health. To date, many studies have investigated quality of life (QOL) among the elderly population in the Islamic Republic of Iran. However, their results were inconsistent. Aims: We designed this systematic review and meta-analysis to estimate the overall mean score of QOL based on the Short Form 36 Health Survey Questionnaire (SF-36) among the Iranian elderly population. Methods: We searched international databases (Medline, Scopus and Science Direct) and national databases (Science In-formation Database, MagIran, IranMedex and Irandoc) up to February 2015. We included all cross-sectional studies that evaluated QOL among the Iranian elderly population using SF-36. Results: Of 2150 studies identified, 15 were included in the meta-analysis. The mean scores for QOL in the 8 scales were: 47.58, 51.75, 55.42, 55.78, 59.55, 51.54, 47.85 and 51.31 for physical-role, physical function, mental health, bodily pain, social functioning, emotional-role, general health, and vitality, respectively. Conclusions: Our results indicated that health-related QOL decreased with increasing age. QOL was worse in women than in men, especially in physical-role and general health scales. Elderly people who lived in a nursing home had lower QOL than those who lived in their own home. So, health policy-makers should design comprehensive programmes to improve health-related QOL for the Iranian elderly population.


Assuntos
Idoso/psicologia , Qualidade de Vida , Idoso/estatística & dados numéricos , Humanos , Irã (Geográfico) , Qualidade de Vida/psicologia , Inquéritos e Questionários
8.
Int J Health Plann Manage ; 34(2): 510-520, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30480342

RESUMO

Geographic imbalances in health human resources exist in a health care system when the composition, level, or use of health care providers does not lead to the same optimal health-system goals in all regions. This can lead to inequitable distribution of health care services, particularly for rural and remote populations. This study aims to determine to what extent the distribution of regulated health professionals and seniors in urban and rural areas of the Canadian jurisdictions is different from one another and from the national average. Data used in this study are for the 2016 calendar year. Information about physicians was obtained from the Canadian Institute for Health Information (CIHI) Scott's Medical Database. The data for nurses (nurse practitioners, registered nurses, and licensed practical nurses) were also sourced from CIHI, Health Workforce Database. Geographic information is based on the postal code of physicians' preferred mailing address, and the residence in the case of nurses and the population. Using the Statistical Area Classification from Statistics Canada, each physician and nurse was assigned to either an urban metropolitan, urban non-metropolitan, or rural/remote area. Findings indicate that there were twice as many nurses per 1000 seniors in urban Canada than in rural Canada. However, this gap was threefold in the case of physicians. Provinces with the largest and lowest gap and international comparisons are also provided. Three broad strategies are offered for policymakers in order to mitigate this health workforce imbalance and reduce the regional shortage of nurses and physicians.


Assuntos
Idoso/estatística & dados numéricos , Enfermeiras e Enfermeiros/provisão & distribução , Médicos/provisão & distribução , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Canadá/epidemiologia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Área Carente de Assistência Médica , Enfermeiras e Enfermeiros/estatística & dados numéricos , Médicos/estatística & dados numéricos
9.
Ann Pharm Fr ; 77(2): 136-145, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30392589

RESUMO

Our multidisciplinary geriatric mobile unit works in behalf of the frail elderly people, aged at least 75, who are in loss of self-reliance. One of its main aims is so optimize medical prescriptions. The purpose of this study was to show the benefit of geriatrician and pharmacist interventions over the quality of medical prescriptions for the elderly. Medication reconciliation of treatment and reassessment of the appropriateness of the prescriptions was systematically carried out. The problems related to drug therapy have been listed and classified according to the criteria of pharmaceutical interventions defined by the French Society of Clinical Pharmacy (SFPC). Out of 181 patients, 86,2% had potentially an inappropriate or sub-optimal prescription. Finally, 462 optimizations were proposed (2.9±1.9 by patients): 204 withdrawals, 166 additions, 58 dosage adaptations, 21 therapeutic follow-ups and 13 modalities of administration. This reassessment of the prescriptions allowed to develop between our geriatric mobile unit and the liberal professionals a communication focused on the therapeutic optimization and to spread recommendations on the proper use of drugs in the elderly population.


Assuntos
Idoso/estatística & dados numéricos , Prescrições de Medicamentos/normas , Geriatria/organização & administração , Unidades Móveis de Saúde/organização & administração , Idoso de 80 Anos ou mais , Tratamento Farmacológico/normas , Feminino , Idoso Fragilizado , França , Humanos , Prescrição Inadequada , Masculino , Reconciliação de Medicamentos , Farmacêuticos , Serviço de Farmácia Hospitalar
10.
Gerontologist ; 59(3): e223-e240, 2019 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-29045750

RESUMO

BACKGROUND AND OBJECTIVES: We reviewed the literature on older adults (OAs) who are caring for persons living with HIV/AIDS in sub-Saharan Africa (SSA), with the goal of adapting models of caregiver stress and coping to include culturally relevant and contextually appropriate factors specific to SSA, drawing on both life course and cultural capital theories. RESEARCH DESIGN AND METHODS: A systematic literature search found 81 articles published between 1975 and 2016 which were reviewed using a narrative approach. Primary sources of articles included electronic databases and relevant WHO websites. RESULTS: The main challenge of caregiving in SSA reflects significant financial constraints, specifically the lack of necessities such as food security, clean water, and access to health care. Caregiving is further complicated in SSA by serial bouts of caring for multiple individuals, including adult children and grandchildren, in the context of high levels of stigma associated with HIV. Factors promoting caregiver resilience included spirituality, bidirectional (reciprocal) caregiving, and collective coping strategies. DISCUSSION AND IMPLICATIONS: The creation of a theoretical model of caregiving which focuses more broadly on the sociocultural context of caregiving could lead to new ways of developing interventions in low-resources communities.


Assuntos
Idoso/estatística & dados numéricos , Cuidadores/estatística & dados numéricos , Infecções por HIV/terapia , Adaptação Psicológica , África ao Sul do Saara/epidemiologia , Fatores Etários , Idoso/psicologia , Cuidadores/psicologia , Infecções por HIV/epidemiologia , Humanos , Meio Social , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia
11.
São Paulo; s.n; s.n; 2019. 83 p. tab, graf.
Tese em Inglês | LILACS | ID: biblio-999331

RESUMO

Introduction: The presence of Common Mental Disorders (CMD) becomes more common with advancing age. The literature shows the beneficial effects of the Mediterranean Diet on the mental health of the elderly, but few studies have been conducted in Western countries. In addition, studies conducted in non-Mediterranean regions generally do not take into account the peculiarities of food, which do not always meet all the Mediterranean characteristics. Objective: (i) to describe the adherence to the Mediterranean dietary pattern, considering two points of view: including only foods characteristic of the original standard Mediterranean diet and including foods with non-Mediterranean characteristics (ii) to verify the association between the adherence to the two Mediterranean Dietary Patterns (MDP) and CMD in the elderly. Methods: cross-sectional population-based study; Data from the 2015 Health Survey of São Paulo were used. The presence of CMD was identified through the Self Reporting Questionnaire-20. The MDP was constructed using the Mediterranean Diet Score (calculated from data from two 24-hour dietary recall), considering two points of view: Mediterranean pattern origin-like (MPOL), which included only foods from the original Mediterranean diet; Mediterranean pattern including foods with non-Mediterranean characteristics (MPNM), which included foods submitted to procedures that diverge from the original dietary pattern. The other variables were identified through a previously structured questionnaire. The association between TMC and adherence to MPOL and MPNM was investigated through logistic regression models. The covariates for the adjustment were selected for biological plausibility. A significance level of 5% (p <0.05) was considered for final statistical tests. All data analyses were performed using Stata software (version 14). To accomplish the objectives of the present research, two manuscripts were elaborated. The aims of the 1st manuscript were: (i) describe the degree of adherence to this dietary pattern by elders from São Paulo-SP-Brazil; (ii) to identify modifications made in the form of intake of the different components of the original MDP, investigating associations with demographic and socioeconomic variables. The aims of the 2nd manuscript were: (i) To evaluate the association between the adherence to the MDP with the presence of mental disorders in these elders; (ii) To investigate these associations taking into account the two different points of view of MDP. Results: The 1st manuscript showed a moderate adherence to the two views of MDP. The greater adherence to the two proposed dietary patterns was characterized by higher intakes of vegetables, fruits, nuts, cereals, legumes and greater proportion between monounsaturated and saturated lipids and, as well as lower consumption of meat and dairy products. MPOL and MPNM were associated with formal education and age, respectively. From the 2nd manuscript, we identified that moderate and high adherence to MPOL, compared to low adherence, was associated with a lower prevalence of CMD, after adjustment for gender, age, body mass index, number of chronic diseases, per capita household income, physical activity and smoking status. The presence of CMD was not associated with MPNM adherence. Additionally, the presence of CMD was different between gender, physical activity and number of referred chronic diseases. Main conclusions (from the two manuscripts): the protective effect of MDP on CMD in elderly was observed only when the particularities of this diet were fulfilled. Other factors, associated to lifestyle, showed to be important to improve the associations with CMD. The results support the importance of programs that encourage the maintenance of healthy eating habits among the elderly


Introdução: A presença de Transtornos mentais comuns (TMC) torna-se mais frequente com o avançar da idade. A literatura evidencia os efeitos benéficos da Dieta mediterrânea sobre a saúde mental do idoso, porém poucos estudos foram realizados em países ocidentais. Ademais, os estudos realizados em regiões não mediterrâneas geralmente não levam em consideração as peculiaridades dos alimentos, que nem sempre atendem a todas as características mediterrâneas. Objetivos: (i) descrever a adesão ao padrão da dieta mediterrânea considerando dois pontos de vista: incluindo apenas alimentos característicos do original padrão da dieta mediterrânea e incluindo alimentos com características não mediterrâneas (ii) verificar a associação entre a adesão aos dois padrões da dieta mediterrânea (PDM) construídos e TMC em idosos. Métodos: trata-se de um estudo transversal de base populacional; foram utilizados dados do Inquérito de Saúde de São Paulo 2015 (ISA-Capital). A presença de TMC foi identificada através do Self Reporting Questionnaire-20. O PDM foi construído através do Escore da dieta mediterrânea (calculado com base em dois recordatórios alimentares de 24h), considerando dois pontos de vista: Padrão mediterrâneo similar ao original (PMSO) - com a inclusão de apenas alimentos originais da dieta mediterrânea; Padrão mediterrâneo com características não mediterrâneas (PMNM) - com a inclusão de alimentos que foram submetidos a procedimentos que divergem do padrão mediterrâneo original. As demais variáveis foram identificadas por meio de um questionário previamente estruturado. A associação entre TMC e a adesão ao PMSO e PMNM foi investigada por meio de modelos de regressão logística. As covariáveis para o ajuste foram selecionadas por plausibilidade biológica. Adotou-se nível de significância de 5% (p < 0,05) para os testes estatísticos finais. Todas as análises de dados foram realizadas utilizando o software Stata (versão 14). Para atender os objetivos da presente pesquisa, foram elaborados dois manuscritos. O manuscrito 1 teve como objetivos (i) descrever o grau de adesão ao PMD por idosos de São Paulo-SP-Brasil; (ii) construir dois pontos de vista do PMD, de acordo com as modificações frequentes na forma de ingestão dos diferentes componentes desse padrão dietético, investigando associações com variáveis demográficas e socioeconômicas. O manuscrito 2 teve como objetivos: (i) avaliar a associação entre a aderência ao PMD e transtornos mentais comuns nesses idosos; (ii) investigar essas associações levando em consideração as duas visões construídas para esse padrão. Resultados: No manuscrito 1 foi encontrada uma adesão moderada pelos idosos às duas visões do PMD. A maior adesão a ambas as visões do PMD foi caracterizada pela ingestão mais elevada de vegetais, frutas, oleaginosas, cereais, leguminosas e maior proporção de lipídios monoinsaturados e saturados, além de um menor consumo de carne e laticínios. O PMSO e o PMNM apresentaram associação com escolaridade e idade, respectivamente. No Manuscrito 2, identificou-se que as adesões moderada e alta ao PMSO, em comparação a uma baixa adesão, foram associadas a uma menor prevalência de TMC, após ajuste para sexo, idade, índice de massa corporal, número de doenças crônicas, renda domiciliar per capita, atividade física e tabagismo. Por sua vez, a presença de TMC não mostrou associação significativa com nenhum grau de adesão ao PMNM. Adicionalmente, a presença de TMC foi significativamente diferente entre os gêneros, a atividade física e o número de doenças crônicas referidas. Conclusões principais (a partir de ambos os manuscritos): o efeito protetor de uma maior adesão ao PDM sobre os TMC em idosos foi observado apenas quando as particularidades originais desse padrão foram atendidas. Outros fatores, associados ao estilo de vida, mostraram-se importantes para melhorar as associações com TMC. Os resultados encontrados reforçam a importância de programas que incentivem a manutenção de hábitos alimentares saudáveis entre idosos


Assuntos
Idoso/estatística & dados numéricos , Dieta Mediterrânea/efeitos adversos , Transtornos Mentais/complicações , Inquéritos sobre Dietas/classificação , Comportamento Alimentar
13.
Medicine (Baltimore) ; 97(43): e12915, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30412095

RESUMO

Late-onset pacemaker-related pleural effusions (PEs) are rare and are often misdiagnosed with other entities. Our study aimed to detail the clinical features and management of PEs long after pacemaker insertion.We conducted a review of 6 consecutive elderly patients with PEs, who had undergone a new pacemaker insertion from September 2014 to January 2017. Also, the clinical characteristics and therapeutic courses of PEs were summarized.Two cases involved fluids after the first implantations, with pacing durations of 3 and 7 months. Two other cases developed PEs 3 or 4 months after the first replacement, with pacing durations of 6 and 11 years. Another 2 cases developed PEs 3 or 5 months following the second replacement, with total pacing durations of 16 and 18 years, respectively. The average interval was 4.17 months for the 6 cases from the time of the new pacemaker insertion to the occurrence of PEs. During the course, they had to be hospitalized repeatedly for thoracenteses because conventional treatments had only short-term effects. After the pacing settings were adjusted, PEs in all cases disappeared gradually. No patients were readmitted for PEs during the median follow-up period of 13 months.For elderly patients following implantation of a new pacemaker, PEs should be considered due to improper pacing settings, and corresponding adjustments to the device should be made.


Assuntos
Idoso/estatística & dados numéricos , Estimulação Cardíaca Artificial/efeitos adversos , Transtornos de Início Tardio/epidemiologia , Derrame Pleural/etiologia , Idoso de 80 Anos ou mais , Estimulação Cardíaca Artificial/métodos , China/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/patologia , Derrame Pleural/terapia , Recidiva , Toracentese/métodos
14.
Rural Remote Health ; 18(3): 4547, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30068213

RESUMO

INTRODUCTION: Prior research on older people's wellbeing and quality of life has lacked clarity and consistency. Research examining older people's health has tended to use these different terms and measurement tools interchangeably, which might explain why the evidence is somewhat mixed. There is a paucity of research that uses the multi-dimensional construct of wellness in rural older people. Addressing both limitations, this study seeks to make a unique contribution to knowledge testing an ecological model of wellness that includes intrapersonal factors, interpersonal processes, institutional factors, community factors and public policy. METHODS: Six rural case study sites were chosen across two Australian sites, the states of Queensland and Victoria. A community saturation recruitment strategy was utilised. Telephone surveys were conducted with community-dwelling rural older people (n=266) aged ≥65 years across the sites. The central variable of the study was wellness as measured by the Perceived Wellness Survey. The ecological model developed included the following intrapersonal factors: physical and mental health, loneliness and social demographic characteristics (age, sex, marital status and financial capability). Interpersonal factors included a measure of social and community group participation, social network size and support provided. Institutional factors were measured by series of questions devised around the resource base environment and access to amenities and services. RESULTS: A hierarchical regression analysis was conducted to determine which variables in the model predict wellness. The results showed that a combination of intrapersonal factors (physical health, mental health, loneliness and financial capability) and interpersonal factors (size of social network and community participation) predicted wellness. However, institutional factors, the resource base environment, and access to amenities and services, contributed only marginally to the model. Community factors, including the personal and physical characteristics of community, also only made a marginal contribution. CONCLUSIONS: The study identified the usefulness of using an integrated model of measurement in wellness. This model recognised the interrelated physical, social and economic influences that impact on rural older people throughout their life course. The study found that physical health made the greatest contribution to perceived wellness, followed by mental health. These findings support a body of research that has found that rural older people experience poorer health outcomes than those in urban areas. Lower levels of loneliness were also a strong predictor of perceived wellness, thus supporting research that has examined the impact of loneliness on physical and mental health. The presence of social capital, as measured by social network size, and the degree of community participation, were also predictors of perceived wellness. Overall, the findings of the present study implications for policy as well as subsequent strategies designed to increase the capacity of wellness in rural older people. Such strategies need to consider the contribution of a range of factors.


Assuntos
Nível de Saúde , População Rural/estatística & dados numéricos , Fatores Etários , Idoso/estatística & dados numéricos , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Masculino , Estado Civil , Pessoa de Meia-Idade , Queensland/epidemiologia , Fatores Sexuais , Fatores Socioeconômicos , Vitória/epidemiologia
15.
Clin Toxicol (Phila) ; 56(12): 1179-1184, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29989445

RESUMO

BACKGROUND: Anti-depressants are among the most widely-prescribed medications. It is unknown whether the risk of seizure during therapeutic use differs by drug. We ranked the seizure risk of popular anti-depressants. METHODS: We conducted a population-based case-control study between April 2002 and March 2015 in Ontario, Canada. Cases were Ontario residents aged ≥65 years hospitalized for a first-ever seizure within 60 d of filling a prescription for one of nine second-generation anti-depressants, each dispensed more than 1 million times (range: 1,196,810 [fluvoxamine] to 19,849,930 [citalopram]) during the study period. For each case, we identified up to four seizure-free controls receiving a similar anti-depressant, and matched on age, sex, date and a pre-defined seizure-specific disease risk index. RESULTS: We identified 5701 patients hospitalized with a first-ever seizure and matched them with 21,872 controls. Relative to bupropion, the risk of new-onset seizure during therapeutic use was highest for escitalopram (adjusted odds ratio [OR] 1.79; 95% confidence interval [CI] 1.42-2.25) and citalopram (OR 1.67; 95% CI 1.35-2.07), while no incremental risk was found for fluoxetine (OR 1.02; 95%CI 0.78-1.33) and duloxetine (OR 0.94; 95%CI 0.75-1.22). Other anti-depressants were associated with modest increase in seizure risk. CONCLUSIONS: The risk of seizure during therapeutic use among elderly patients varies among second-generation anti-depressants. Escitalopram and citalopram are associated with the highest risk. Prescribers should consider the seizure risk of individual anti-depressants and use discretion when selecting an anti-depressant, especially for patients with other risk factors for seizure. Frontline clinicians should be cognizant of this differential risk.


Assuntos
Idoso/estatística & dados numéricos , Antidepressivos de Segunda Geração/efeitos adversos , Convulsões/induzido quimicamente , Convulsões/epidemiologia , Idoso de 80 Anos ou mais , Bupropiona/efeitos adversos , Estudos de Casos e Controles , Citalopram/efeitos adversos , Cloridrato de Duloxetina/efeitos adversos , Feminino , Fluvoxamina/efeitos adversos , Humanos , Masculino , Razão de Chances , Ontário/epidemiologia , População
16.
Swiss Med Wkly ; 148: w14632, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30044469

RESUMO

OBJECTIVE: We aimed to explore the extent to which general practitioners (GPs) in Western Switzerland adhere to Swiss recommendations when assessing fitness-to-drive in the elderly. METHODS: A random sample of 500 GPs practicing in Vaud, Neuchatel and Jura, and all GPs certified to conduct fitness-to-drive assessments in Geneva ("experts", n = 69) were invited to participate. They were asked how often they performed twenty procedures (recommended in Swiss guidelines developed by experts in traffic medicine) when assessing older drivers during the previous year, scored on a five-point Likert scale ranging from "never" to "always performed". The GPs were considered to be adhering to the recommended procedure if they performed it often or always. We computed the proportion of GPs adhering to each procedure, and compared GPs with or without specialised expertise. RESULTS: A total of 268 GPs completed the questionnaire (participation rate 47%). The most frequently reported procedures were asking for current medication (96%), cardiovascular (94%) and neurological diseases (91%), and screening for visual acuity impairment (93%), whereas the least frequently reported procedures were screening for cognitive impairment in drivers aged between 70 and 80 years (44%) and for mood disorder (31%), asking for a history of driving license withdrawal (38%), and interviewing close relatives (10%). Six procedures were statistically significantly more frequently performed by the experts than by the other GPs. In general, GPs reported using validated tools, except when screening for at-risk drinking and mood disorder (tools used by 26 and 28%, respectively). CONCLUSIONS: Many Swiss GPs seem not to systematically follow the current Swiss recommendations. Although several important procedures appear to routinely be part of older drivers' assessment, others are infrequently performed. Further research should identify how GPs select the recommended items to which they adhere and those they never apply, and how to facilitate the use of recommended procedures to help them decide if a person is fit, unfit or requiring further evaluation.


Assuntos
Condução de Veículo/normas , Clínicos Gerais/estatística & dados numéricos , Fidelidade a Diretrizes , Idoso/estatística & dados numéricos , Atitude do Pessoal de Saúde , Feminino , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Inquéritos e Questionários , Suíça
17.
Int J Clin Pharmacol Ther ; 56(8): 358-365, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29882509

RESUMO

OBJECTIVE: The administration of the usual dosage of medication in elderly patients with renal impairment can cause adverse drug reactions due to patients' decreased renal function. Using retrospective prescription analysis, in a teaching hospital, this study aimed to evaluate medication dosing errors in elderly patients with renal impairment and the risk factors for these dosing errors. MATERIALS AND METHODS: This retrospective study included elderly patients with a creatinine clearance of 59 mL/min or less who were hospitalized in a teaching hospital between July 1, 2015, and September 30, 2015. Data including the patients' age, gender, weight, serum creatinine, duration of hospital stay, and discharge prescriptions were obtained from electronic medical records. Patients with dosing errors were identified, and the risk factors for the dosing errors were statistically analyzed. RESULTS: Out of 497 patients, 164 (33%) had evidence of dosing errors. All metformin prescriptions (n = 38) were associated with dosing errors (100%), and trimetazidine was prescribed 11 times in cases where it was contraindicated (31%). The following were confirmed to be statistically significant risk factors that increased the likelihood of the dosing errors: the patient's age (odds ratio (OR): 1.050, 95% confidence interval (CI): 1.011 - 1.092), the number of drugs prescribed per patient (OR: 1.106; 95% CI: 1.012 - 1.210), and the number of drugs requiring dosing adjustments in patients with renal impairment (OR: 1.996; 95% CI: 1.614 - 2.468). CONCLUSION: There was a considerable rate of dosing errors in hospitalized elderly patients with renal impairment. It is necessary for healthcare professionals to make appropriate dosage adjustments in elderly patients with renal impairment to improve the outcomes of pharmacotherapy and patients' quality of life.
.


Assuntos
Idoso de 80 Anos ou mais/estatística & dados numéricos , Idoso/estatística & dados numéricos , Nefropatias/tratamento farmacológico , Erros de Medicação/estatística & dados numéricos , Fatores Etários , Creatinina/urina , Feminino , Humanos , Pacientes Internados , Nefropatias/complicações , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
18.
Ann Ist Super Sanita ; 54(1): 67-71, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29616677

RESUMO

Interim analyses of the 2016-17 influenza vaccine effectiveness showed variable results depending on timing of the analysis and geographical setting. We conducted a population-based retrospective cohort study based on the analysis of health-related administrative data to assess the effectiveness of the 2016-17 influenza vaccine among the elderly population of a north-eastern Italian area. Data on 64854 subjects ≥65 years of age were analyzed up to April 30, 2017. The influenza vaccine was administered to 53% of the elderly population. No significant effect was observed on the likelihood of Emergency department visits, hospitalizations, or deaths from pneumonia and influenza.


Assuntos
Idoso de 80 Anos ou mais/estatística & dados numéricos , Idoso/estatística & dados numéricos , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Estudos de Coortes , Serviços Médicos de Emergência , Feminino , Humanos , Itália , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Vacinação
19.
Hypertens Res ; 41(5): 372-381, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29535455

RESUMO

This study aimed to investigate the discrepancy between pulse wave velocity (PWV) and pulse pressure amplification (PPA) in association with hypertensive target organ damage (TOD) in the elderly. From June 2014 to August 2015, 1599 participants aged >65 years old from communities located in northern Shanghai were recruited. Carotid-femoral pulse wave velocity (cfPWV), peripheral blood pressure (BP), central BP and other TOD indicators, including the ratio of the early ventricular filling velocity (E) to the peak velocity of the tissue Doppler velocity of septal mitral annulus (E/Ea), left ventricular mass index (LVMI), carotid intima-medium thickness (CIMT), estimated glomerular filtration rate (eGFR), and urinary albumin-creatinine ratio (ACR), were determined for each participant. PPA was defined as the peripheral-to-central pulse pressure ratio. In multivariable linear regression analysis, cfPWV was significantly associated with CIMT (ß = 12.83 ± 4.28 µm per SD; P = 0.003) and eGFR (ß = -1.85 ± 0.69 ml/min/1.73 m2 per SD; P = 0.007), whereas PPA was significantly associated with E/Ea (ß = -0.25 ± 0.10 per SD; P = 0.01) and LVMI (ß = -3.00 ± 0.78 g/m2 per SD; P < 0.001). Similarly, in multivariable logistic regression analysis, cfPWV was significantly associated with arterial plaque (odds ratio [OR], 1.21 [95% confidence interval [CI], 1.05-1.39]; P = 0.007), peripheral artery disease (OR, 1.22 [95% CI, 1.06-1.42]; P = 0.007), chronic kidney diseases (OR, 1.24 [95% CI, 1.01-1.54]; P = 0.04) and microalbuminuria (OR, 1.21 [95% CI, 1.07-1.37]; P = 0.002), while PPA was tightly associated with left ventricular hypertrophy (OR, 0.85 [95% CI, 0.72-0.99]; P = 0.04) and diastolic dysfunction (OR, 0.78 [95% CI, 0.64-0.96]; P = 0.02). In conclusion, cfPWV is a vessel-related and renal-related biomarker, while PPA is a cardiac-related biomarker in community-based elderly.


Assuntos
Idoso de 80 Anos ou mais/estatística & dados numéricos , Idoso/estatística & dados numéricos , Pressão Sanguínea/fisiologia , Vida Independente , Análise de Onda de Pulso , Índice Tornozelo-Braço , Artérias Carótidas , China , Ecocardiografia , Feminino , Artéria Femoral , Humanos , Hipertensão/fisiopatologia , Masculino , Estudos Prospectivos , Fatores de Risco
20.
Rev. psiquiatr. salud ment. (Barc., Ed. impr.) ; 11(1): 12-18, ene.-mar. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-170567

RESUMO

Objetivo. A pesar de las advertencias de numerosas asociaciones profesionales, las benzodiacepinas (BZD) y los hipnóticos Z (Z) son ampliamente prescritos a los ancianos ya que son especialmente susceptibles de padecer insomnio y ansiedad, pero a su vez resultan especialmente sensibles a la aparición de efectos secundarios a dichos medicamentos. En este estudio evaluamos la prescripción de BZD/Z en una muestra de ancianos (≥65) que se presentan en el servicio de urgencias de un hospital por haber sufrido una caída. Métodos. Recogimos información del tipo, número y dosis de los fármacos BZD/Z prescritos y exploramos la presencia de diferencias de género en dicha prescripción. Resultados. Las BZD/Z habían sido prescritas a un 43,6% de la muestra (n=654), más frecuentemente a las mujeres. El 78,4% de las prescripciones fueron de BZD/Z de vida media corta. La mayoría de los pacientes (83,5%) tomaban solamente un fármaco BZD/Z, pero un 16,5% consumían más de una BZD/Z, sin diferencias de género. Un 58% de los pacientes consumían dosis de BZD/Z más elevadas que las recomendadas para ancianos, siendo la proporción significativamente más elevada para los hombres (70% vs. 53,1%). Conclusiones. Alrededor de un 40% de los ancianos que acuden a un servicio de urgencias por haber sufrido una caída se encontraban tomando BZD/Z. Hemos hallado algunas diferencias de género en la prescripción de BZD/Z, especialmente en la prescripción por encima de la dosis recomendada para ancianos y de fármacos de vida media larga (AU)


Objective. Despite cautions by professional associations, benzodiazepines (BZD) and Z hypnotics (BZD/Z) are widely prescribed to older adults who are particularly susceptible to insomnia and anxiety, but who are also more sensitive to drugs adverse events. In this study, we assessed the prescription of BZD/Z drugs in a sample of older adults (≥65) who presented for emergency care after a fall. Methods. We collected the type, number and dose of BZD/Z drugs prescribed and explored gender differences in the prescription. Results. BZD/Z drugs were prescribed to 43.6% of the sample (n=654) and more frequently to women; 78.4% of prescriptions were for BZD/Z drugs with a short half-life. The majority of patients (83.5%) were prescribed only one type of BZD/Z, but 16.5% had been prescribed multiple BZD/Z drugs, with no gender difference. Doses higher than those recommended for older adults were prescribed to 58% of patients, being the doses significantly higher for men compared to women (70.0% vs 53.1%). Conclusions. Over 40% of older adults presenting for emergency care after a fall had previously been prescribed BZD/Z drugs. Some important gender differences in the prescription of BZD/Z drugs were seen, especially prescription above the recommended dose and of drugs with a long-half life (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Acidentes por Quedas/estatística & dados numéricos , Benzodiazepinas/administração & dosagem , Idoso/estatística & dados numéricos , Benzodiazepinas/efeitos adversos , Distribuição por Sexo , Prescrição Inadequada/estatística & dados numéricos , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Transtornos de Ansiedade/epidemiologia
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