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1.
Buenos Aires; GCBA. Dirección General de Estadística y Censos; nov. 2020. a) f: 5 l:18 p. tab.(Población de Buenos Aires, 17, 29).
Monografia em Espanhol | LILACS, InstitutionalDB, BINACIS, UNISALUD | ID: biblio-1146283

RESUMO

Un aspecto clave de la historia de la vejez es el de la asistencia a los ancianos pobres, enfermos o sin familia, sobre todo durante el siglo XIX y principios del XX que constituyen la edad de oro del asilo de ancianos. Partiendo de esa constatación y de los principales problemas historiográficos involucrados, se propone como objetivo principal reconstruir la oferta de instituciones existentes y la proporción de personas atendidas. Para ello explora, en primer lugar las posibilidades y límites de las escasas fuentes estadísticas disponibles. En segundo término, propone una comparación exploratoria con el interior del país y con la asistencia a otros grupos de edad, en particular los niños. Tanto por la centralidad de los procesos históricos involucrados (crecimiento urbano, impacto de la inmigración, desarrollo de políticas sociales), como por la consecuente disponibilidad de fuentes, el caso porteño constituye el eje central de la indagación. (AU)


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Assistência a Idosos , Argentina , Idoso/estatística & dados numéricos , Saúde do Idoso , Saúde do Idoso Institucionalizado , Serviços de Saúde para Idosos/tendências , Serviços de Saúde para Idosos/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/provisão & distribução , Instituição de Longa Permanência para Idosos/tendências , Instituição de Longa Permanência para Idosos/estatística & dados numéricos
2.
PLoS One ; 15(7): e0236830, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735592

RESUMO

BACKGROUND: Compared with those without dementia, older patients with dementia admitted to acute care settings are at higher risk for triad combination of polypharmacy (PP), potentially inappropriate medication (PIM), and drug-drug interaction (DDI), which may consequently result in detrimental health. The aims of this research were to assess risk factors associated with triad combination of PP, PIM and DDI among hospitalized older patients with dementia, and to assess prevalence and characteristics of PP, PIM and DDI in this population. METHODS: In this retrospective cross-sectional study, 416 older inpatients diagnosed with dementia and referred for specialist geriatric consultation at a tertiary hospital in Brisbane, Australia during 2006-2016 were enrolled. Patients were categorized into two groups according to their exposure to the combination of PP, PIM and DDI: 'triad combination' and 'non-triad combination'. Data were collected using the interRAI Acute Care (AC) assessment instrument. Independent risk factors of exposure to the triad combination were evaluated using bivariate and multivariate logistic regression analyses. RESULTS: Overall, 181 (43.5%) were classified as triad combination group. The majority of the population took at least 1 PIM (56%) or experienced at least one potential DDI (76%). Over 75% of the participants were exposed to polypharmacy. The most common prescribed PIMs were antipsychotics, followed by benzodiazepines. The independent risk factors of the triad combination were the presence of atrial fibrillation diagnosis and higher medications use in cardiac therapy, psycholeptics and psychoanaleptics. CONCLUSIONS: The exposure to triad combination of PP, PIM and DDI are common among people with dementia as a result of their vulnerable conditions and the greater risks of adverse events from medications use. This study identified the use of cardiac therapy, psycholeptics and psychoanaleptics as predictors of exposure to PP, PIM and DDI. Therefore, use of these medications should be carefully considered and closely monitored. Furthermore, comprehensive medication reviews to optimize medication prescribing should be initiated and continually implemented for this vulnerable population.


Assuntos
Demência/complicações , Prescrições de Medicamentos , Serviços de Saúde para Idosos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Interações Medicamentosas , Feminino , Humanos , Estudos Longitudinais , Masculino , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados , Estudos Retrospectivos , Fatores de Risco
3.
Aging (Albany NY) ; 12(15): 15186-15195, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32788424

RESUMO

Italy was the first European nation to be affected by COVID-19. The biggest cluster of cases occurred in Lombardy, the most populous Italian region, and elderly men were the population hit in the hardest way. Besides its high infectivity, COVID-19 causes a severe cytokine storm and old people, especially those with comorbidities, appear to be the most vulnerable, presumably in connection to inflammaging. In centenarians inflammaging is much lower than predicted by their chronological age and females, presenting survival advantage in almost all centenarian populations, outnumber males, a phenomenon particularly evident in Northern Italy. Within this scenario, we wondered if: a) the COVID-19 mortality in centenarians was lower than that in people aged between 50 and 80 and b) the mortality from COVID-19 in nonagenarians and centenarians highlighted gender differences.We checked COVID-19-related vulnerability/mortality at the peak of infection (March 2020), using data on total deaths (i.e. not only confirmed COVID-19 cases). Our conclusion is that excess mortality increases steadily up to very old ages and at the same time men older than 90 years become relatively more resilient than age-matched females.


Assuntos
Envelhecimento , Betacoronavirus/fisiologia , Infecções por Coronavirus , Serviços de Saúde para Idosos/estatística & dados numéricos , Inflamação , Mortalidade , Pandemias , Pneumonia Viral , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Envelhecimento/psicologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Feminino , Necessidades e Demandas de Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Inflamação/epidemiologia , Inflamação/virologia , Itália/epidemiologia , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Saúde Pública/métodos , Fatores Sexuais , Populações Vulneráveis
4.
An. sist. sanit. Navar ; 43(2): 141-150, mayo-ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-199145

RESUMO

FUNDAMENTO: Los resultados en salud del tratamiento renal sustitutivo (TRS) en el anciano han hecho que el tratamiento renal conservador (TRC) sea una opción terapéutica en la enfermedad renal crónica avanzada. Sin embargo, se sabe poco sobre la evolución de estos pacientes, por lo que el objetivo fue analizar la supervivencia de los pacientes ancianos en TRS y TRC y evaluar el efecto de las variables relacionadas con el inicio de ambos tratamientos. MÉTODO: Estudio de cohortes prospectivo de pacientes >75 años en TRS y TRC. Se realizó un análisis de supervivencia incluyendo la valoración de la función renal y variables demográficas y clínicas, comorbilidad, fragilidad y situación funcional, cognitiva, nutricional y social. RESULTADOS: Cohorte de 37 pacientes en TRS y 82 en TRC. Los pacientes en TRC eran significativamente más ancianos, con mayor frecuencia de evento vascular, mayor comorbilidad (Charlson>8), peor situación funcional (Barthel), mayor riesgo de deterioro cognitivo (Pfeiffer) y malnutrición (MNA-SF), y mayor fragilidad y deterioro sociofamiliar. La tasa de mortalidad fue inferior en pacientes en TRS (8,7 vs 23/1.000 pacientes-mes; HR= 0,37; p = 0,018) pero el ajuste por los diferentes síndromes geriátricos analizados redujo considerablemente esta ventaja de supervivencia. CONCLUSIONES: La comorbilidad medida por el índice de Charlson fue predictor independiente de mortalidad en pacientes ancianos con enfermedad renal crónica avanzada. En aquellos pacientes ancianos con Charlson mayor de 8 puntos el TRS no mejoró la supervivencia respecto del TRC


BACKGROUND: The poor health outcomes of Renal Replacement Therapy (RRT) in the elderly has promoted Conservative Management (CM) as a therapeutic option in advanced chronic kidney disease. However, there is still a lack of evidence about prognosis of these patients; thus, the aim was to analyze the survival rate of elderly patients under CM and RRT and evaluate the variables related to the initiation of such treatments in clinical practice. METHODS: Prospective cohort study of RRT and CM patients >75años. Renal function parameters and geriatric assessments were carried out. This evaluation included: analysis of comorbidity, functional, cognitive, frailty, nutritional and socio-family status. RESULTS: Cohort of 37 RRT and 82 CM patients. CM patients were significantly older, with more frequency of history of vascular event, more comorbility (Charlson), worse functional situation (Barthel), higher risks of cognitive impairment (Pfeiffer) and malnutrition (MNA-SF), and higher frailty and socio-familiar impairment. Mortality rate was lower in RRT patients (8.72 vs. 3/1,000 patients/month; HR= 0.37, p = 0.018), but survival advantage reduced drastically after adjustment for the different geriatric syndromes analyzed. CONCLUSIONS: Charlson's comorbidity was found to be an independent mortality predictor in elderly patients with advanced chronic kidney disease. Dialysis did not improve survival with respect to conservative treatment in patients with Charlson higher than 8 points


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Insuficiência Renal Crônica/terapia , Terapia de Substituição Renal/métodos , Tratamento Conservador/métodos , Conduta Expectante/métodos , Insuficiência Renal Crônica/mortalidade , Taxa de Sobrevida , Serviços de Saúde para Idosos/estatística & dados numéricos , Estudos Prospectivos , Fragilidade/epidemiologia
5.
West Afr J Med ; 37(3): 209-215, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32476112

RESUMO

BACKGROUND: Attaining successful clinical outcomes in the management of hospitalised older patients in the overburdened healthcare services in Nigeria constitutes a major challenge against the backdrop of dearth of data on the predictors of mortality among them. OBJECTIVES: To describe the mortality trends and associated factors among older patients (>60 years) at the Geriatric Centre, University College Hospital, Ibadan between January 2013 and December 2017. METHODS: Hospital records of older patients admitted were analysed. Data extracted included socio-demographic, diagnoses, length of stay from date of admission to discharge or death. Results of vital signs, anthropometric measurements and laboratory tests carried out at admission were also obtained. RESULTS: The mean age of the 1,091 older patients admitted was 73.6±8.6 years. The overall crude proportion of in-hospital deaths was 9.0% (males=11.3% > females=7.2%, p=0.024) and it increased from 4.1% in 2013 to 12.1% in 2017. The overall unadjusted 30-day mortality rate per 1000 patient-days was 28.9 deaths (95% CI 23.5-35.3). The predictors of mortality were increased length of stay on admission OR=1.061 (95% CI 1.005-1.119), being retired OR=1.672 (95% CI 1.011-2.778), stroke OR=4.019 (95% CI 2.258- 7.138), heart failure OR=3.435 (95% CI 1.455-8.100), Sepsis OR=2.176 (95% CI 1.294-3.654), Anaemia OR=2.820 (95% CI 1.320-6.017), Dementia OR=3.701 (95% CI 1.433-9.549) and malignancies OR=2.658 (95% CI 1.181-5.979). CONCLUSION: There was a temporal increase in mortality among older patients. Similarly, staying longer on admission and chronic medical conditions with their complications were the most significant contributors to mortality.


Assuntos
Serviços de Saúde para Idosos/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Feminino , Hospitais de Ensino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria
7.
Ulus Travma Acil Cerrahi Derg ; 26(3): 411-417, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32436982

RESUMO

BACKGROUND: As life expectancy increases in humans, surgical procedures applied to the elderly people are also increasing in parallel with the developments in surgery and postoperative care. A significant number of studies investigating the morbidity-mortality of geriatric patients are related to patients who are undergoing emergency operations. The present study aims to investigate the factors affecting mortality and morbidity after emergency surgery in elderly people. METHODS: The data of 200 patients aged 65 years and over who were operated under emergency conditions in the University of Health Sciences Kartal Dr. Lütfi Kirdar Training and Research Hospital between January and December 2018 were evaluated retrospectively. RESULTS: Patient's demographic information, including age, gender, ASA physical status, comorbidities, functional dependency or non-dependency of patients, types of operation, anesthesia technique, duration of operation, intraoperative blood transfusion, the changes of hematocrit levels (during the perioperative period), the outcome after surgery (intensive care admission or ward transfer), were recorded. The risk prediction of short-term mortality has been estimated using CCI and APACHE II scoring systems. CONCLUSION: The mean age of the patients was 74.8±6.7 and the number of females (n=134, 67%) outweighed the males. Higher ASA physical status scores, dependent living conditions, long operation time, general anesthesia, intraoperative blood transfusion, low Htc values (<25%), high APACHE II scores and lower scores of 10-years survival by CCI were the factors that affected the acceptance into ICU.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Retrospectivos
8.
Einstein (Sao Paulo) ; 18: eAO5263, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32267368

RESUMO

OBJECTIVE: To assess the health profile of community-dwelling older adults, according to sex, assisted by the Elderly Caregiver Program of the City of São Paulo. METHODS: Secondary data of 535 older adults, assisted by ten Elderly Caregiver Program teams from the southern region of São Paulo, were collected from medical records and the Multidimensional Evaluation of Older People in Primary Care, after verifying the inclusion and exclusion criteria for the study and obtaining subjects' consent. RESULTS: Older adults assisted by this program were predominantly female (77.6%), mean age of 76.2±8.0 years. They had negative self-rated health (67.8%), difficulties in instrumental activities of daily living (68.4%) and signs of mood changes (60.3%). A high prevalence of older adults with vision problems (58.8%), polypharmacy (58.1%), memory-related complaints (55.8%) and multiple morbidities (50.6%) were observed. The prevalence of multiple morbidities, polypharmacy, cognitive impairment and signs of mood changes were higher in women. On the other hand, men reported more hearing problems than women. CONCLUSION: The poorer health conditions of the older adults in this study, evidenced by a high prevalence of subjects with negative self-rated health, difficulties in instrumental activities of daily living, multiple morbidities, polypharmacy and other complaints (sensorial changes, depressive and cognitive symptoms), reinforce the importance of this program as a long-term care policy and as a way to ensure these older adults can continue living in their communities.


Assuntos
Avaliação Geriátrica/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Atividades Cotidianas , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Polimedicação , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
9.
Rev Epidemiol Sante Publique ; 68(2): 83-90, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32111348

RESUMO

BACKGROUND: Older persons comprise a growing proportion of the European population and may have a distinct epidemiological oral profile requiring specific preventive and curative care poorly documented. The objectives of this study were to assess the oral health status of people ≥90 years of age in France, to compare their perceived and observed oral care needs and to investigate the oral problems associated with a low oral health-related quality-of-life (OHRQoL). METHODS: An oral cross-sectional study was performed during the 25th follow-up of a cohort of older persons being followed up prospectively for screening of dementia over a 15-year period in Gironde and Dordogne, France. Clinical oral indices were determined by oral examinations conducted at the participants' place of living. Cohen's Kappa coefficient was used to assess the agreement between perceived and observed oral care needs. Oral problems associated with a low OHRQoL, measured with the Geriatric Oral Health Assessment Index (GOHAI<50) were investigated with logistic regression. Odds ratios (OR) were estimated with their 95% confidence intervals (CI). RESULTS: Data from 90 persons were analysed (76% female; median age=93 years; 20% living in an institution). Plaque and calculus were present in 93% and 58% respectively, of the 74 dentate participants. The mean number of decayed, missing, and filled teeth was 26.5 (±5.3); 66% of the participants had at least one untreated decayed tooth. Among the 85 participants with tooth loss not replaced by a fixed denture, two thirds had a removable dental prosthesis; 84% of these prostheses were considered to be maladapted. Among the 39 participants who felt unable to consult a dentist (43%), lack of transportation was the most frequently cited reason. Although 88% of the participants needed oral care, only 26% perceived that they had such a need (Kappa=0.06). Oral problems associated with a GOHAI<50 were the absence of posterior occluding teeth (OR=7.15; 95%CI=1.53-33.35; P=0.012), feeling of dry mouth (OR=11.94; 95%CI=3.21-44.39; P=0.0002) and oral pain (OR=9.06; 95%CI=1.91-69.00; P=0.033). CONCLUSIONS: Persons ≥90 years of age have considerable preventive and curative dental care needs that impact their quality-of-life but they are rarely aware and lack transportation. NCT04065828.


Assuntos
Assistência Odontológica , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde para Idosos , Doenças da Boca/terapia , Saúde Bucal , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Atitude Frente a Saúde , Estudos de Coortes , Estudos Transversais , Assistência Odontológica/normas , Assistência Odontológica/estatística & dados numéricos , Feminino , França/epidemiologia , Avaliação Geriátrica , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/normas , Serviços de Saúde para Idosos/estatística & dados numéricos , Nível de Saúde , Humanos , Masculino , Doenças da Boca/epidemiologia , Doenças da Boca/prevenção & controle , Saúde Bucal/normas , Saúde Bucal/estatística & dados numéricos , Medicina Preventiva/normas , Medicina Preventiva/estatística & dados numéricos , Qualidade de Vida , Perda de Dente/epidemiologia
10.
Orthop Surg ; 12(2): 457-462, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32167674

RESUMO

OBJECTIVE: To investigate the clinical efficacy of three different healthcare models (Traditional Model, Geriatric Consultant Model, and Orthogeriatric Unit Model) consecutively applied to a single academic center (University Hospital of Salamanca, Spain) for older hip fracture patients. METHODS: We performed a retrospective study, including 2741 hip fracture patients older than 64 years, admitted between 1 January 2003 and 31 December 2014 to the University Hospital of Salamanca. Patients were divided into three groups according to the healthcare model applied. There were 983 patients on the Traditional Model, 945 patients on the Geriatric Consultant Model, and 813 patients on the Orthogeriatric Unit Model. We recorded age and gender of patients, functional status at admission (Barthel Index, Katz Index, and Physical Red Cross Scale), type of fracture, and intervention, and we analyzed the length of stay, time to surgery, post-surgical stay, and in-hospital mortality according to the healthcare model applied. RESULTS: Hip fractures are much more frequent in women, and an increase in the average age of patients was observed along with the study (P < 0.001). The most common type of fracture in the three models studied was an extracapsular fracture, for which the most common surgical procedure used was osteosynthesis. On the functional status of patients, there were no differences on the ambulatory ability previous to fracture, measured by the Physical Red Cross Scale, and the percentage of patients with a slight dependence determined by the Barthel Index (>60) was similar in both groups, but considering the Katz Index, the percentage of patients with a high degree of independence (A-B) was significantly higher for the group of patients treated on the Orthogeriatric Unit Model period (56%, P = 0.009). The Orthogeriatric Unit Model registered the greatest percentage of patients undergoing surgery (96.1%, P < 0.001) and the greatest number of early surgical procedures (<24 h) (24.8%, P < 0.001). The orthogeriatric unit model showed the shortest duration of stay (9 days median), decreasing by one day in respect of each of the other models studied (P < 0.001). Time to surgery was also significantly reduced with the Orthogeriatric Unit Model (median of 3 days, P < 0.001). With regard to in-hospital follow-up, there was a reduction in in-hospital mortality during the study period. We observed differences among the three healthcare models, but without statistical significance. CONCLUSIONS: The healthcare model based on an Orthogeriatric Unit seems to be the most efficient, because it reaches a reduction in time to surgery, with an increased number of patients surgically treated on in the first 24 h, and the greatest frequency of surgically-treated patients.


Assuntos
Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
11.
Z Gerontol Geriatr ; 53(2): 123-128, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-31965285

RESUMO

BACKGROUND AND OBJECTIVE: The aim of the study was to evaluate a specific treatment concept for patients suffering from dementia in a geriatric day clinic with respect to improvement of dementia-related behavioral abnormalities and effects on distress of the caring relatives. MATERIAL AND METHODS: Designed as a naturalistic study with a sample of 34 dementia patients (average age 83 years, 62% female, 82% mild dementia, 18% moderate dementia) surveyed at three time points, the dementia-related behavioral symptoms and the relatives' distress were measured using the neuropsychiatric inventory. A waiting time before treatment was implemented as a control condition. RESULTS: Compared with waiting time, a significant improvement of dementia-related behavioral abnormalities was found after treatment, especially in patients suffering from moderate dementia. The distress of caring relatives was clearly reduced. CONCLUSION: The interprofessional treatment of patients with dementia using a specific program in a geriatric day clinic leads to a clear improvement in behavioral symptoms and positively influences the distress of caring relatives.


Assuntos
Sintomas Comportamentais/complicações , Cuidadores/psicologia , Demência/terapia , Serviços de Saúde para Idosos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Sintomas Comportamentais/terapia , Demência/diagnóstico , Demência/psicologia , Feminino , Humanos , Masculino , Resultado do Tratamento
12.
Rev Saude Publica ; 54: 06, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31967275

RESUMO

OBJECTIVE: To evaluate the performance of comprehensive care for older adults in primary care services in the Brazilian Unified Health System in the state of São Paulo, Brazil. METHODS: A total of 157 primary care services from five health regions in midwestern São Paulo responded, from October to December 2014, the pre-validated 2014 questionnaire for primary care services assessment and monitoring. We selected 155 questions, based on national policies and guidelines on this theme. The responses indicate the service performance in older adults' care, clustered into three areas of analysis: health care for active and healthy aging (45 indicators, d1), chronic noncommunicable diseases care (89 indicators, d2), and support network in aging care (21 indicators, d3). Performance was measured by the sum of positive (value 1) or negative (value 0) responses for each indicator. Services were clustered according to k-means of the performance scores of each domain. After weighting the domains (Z tests), we estimated the associations between the scores of each domain and independent management variables (typology, planning and evaluation of services), with simple and multiple linear regression. RESULTS: Chronic noncommunicable diseases care (d2) showed, for all clusters, better average performance (55.7) than domains d1 (35.4) and d3 (39.2). Service performance in the general area of planning and evaluation associates with the performance of older adults' care. CONCLUSIONS: The evaluated services had incipient implementation of comprehensive care for older adults. The evaluation framework can contribute to processes to improve the quality of primary health care.


Assuntos
Assistência Integral à Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Idoso , Brasil , Estudos de Coortes , Assistência Integral à Saúde/organização & administração , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/organização & administração , Serviços de Saúde para Idosos/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Atenção Primária à Saúde/organização & administração
13.
Rev. Rol enferm ; 43(1,supl): 414-419, ene. 2020. tab
Artigo em Português | IBECS | ID: ibc-193336

RESUMO

Background: Spirituality contributes to individual well-being as a dynamic process and a personal experience that gives meaning to the human existence. Objective: To characterize spiritual well-being in senior adults and analyse the relationship between spirituality and subjective well-being. Materials and Methods: Descriptive, cross-sectional and correlational study. The participants are mostly female (66.7%), widowed (47.1%) and live alone (40.2%). They are on average 77.3 years old (SD = 7.7) and most have completed primary school (60.8%). Only 11.8% report not having religious beliefs. For data collection the following instruments were used: a Sociodemographic Questionnaire, the Spiritual Well-Being Scale (SWBS) and the Satisfaction with Life Scale (SWLS). Results: There were statistically significant positive correlations between SWBS and Life Satisfaction (r = 0.380; p <0.01), between existential well-being (EWB) and Life Satisfaction (r = 0.515; p <0, 01) and religious well-being (RWB) and Life Satisfaction (r=0,253; p<0,01). On the SWBS scale and on the RWB and EWB subscales between the group of professing religion and non-professing group, statistically significant differences were found. (p<0,05). People who follow a religion, compared to those who do not follow, have better religious well-being, existential, and spiritual well-being. Conclusions: The results confirm that spirituality is related to subjective well-being in the senior adult. Understanding the role of religion and spirituality in this population well-being is critical to better care for and work with these people, and prepare them in advance to meet the challenges of ageing


No disponible


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Espiritualidade , Serviços de Saúde para Idosos/estatística & dados numéricos , Conforto do Paciente/estatística & dados numéricos , Promoção da Saúde/métodos , Estudos Transversais , Religião , Satisfação Pessoal , Qualidade de Vida/psicologia , Indicadores de Qualidade de Vida , Psicometria/métodos
14.
Adv Skin Wound Care ; 33(1): 12-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31856028

RESUMO

GENERAL PURPOSE: To provide information about changes associated with aging skin and the implications for wound care practitioners. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Describe proposed biologic theories of aging and the biology of aging skin.2. Discuss the clinical consequences of aging skin and the implications for wound care practitioners. ABSTRACT: Aging is a complex phenomenon manifested by macromolecular damage, adverse changes to the genome, blunted immunologic function, alterations in body composition, and decreased adaptation to stress. Understanding the changes that skin undergoes with age is essential for wound care practitioners. Accordingly, this article will introduce the reader to theories of aging, the biologic changes associated with aging skin, and clinical considerations for the wound care practitioner, including the concepts of skin failure, Skin Changes At Life's End, and frailty.


Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Equipe de Assistência ao Paciente/organização & administração , Envelhecimento da Pele/genética , Envelhecimento da Pele/fisiologia , Ferimentos e Lesões/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fragilidade , Pessoal de Saúde/organização & administração , Serviços de Saúde para Idosos/estatística & dados numéricos , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Medição de Risco , Cicatrização/fisiologia , Ferimentos e Lesões/fisiopatologia
15.
Z Gerontol Geriatr ; 53(5): 437-445, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31696362

RESUMO

BACKGROUND: A fall-related femur fracture is one of the most frequent reasons for hospital admission of patients with dementia. The aim of the study was to identify dementia-specific characteristics of patients with fall-related femur fractures and additionally an unspecified dementia in order to gain further knowledge about this particular patient group. METHODS: A descriptive explorative case study with a single case-embedded design based on routine hospital data from a university hospital was performed. A total number of 34 patient records from 2015 were analyzed. In the embedded unit of analysis I the data of selected items of the nursing assessment AcuteCare (ePA-AC©) were descriptively analyzed for the time of admission and discharge. In the embedded unit of analysis II a summarizing inductive content analysis was conducted. RESULTS: The results of the embedded unit of analysis I showed that this patient group is characterized by a high need for care, changes of cognition and behavioral symptoms. The status of cognition, behavior and reciprocity as well as the self-care index stagnated or deteriorated in many patients from admission to discharge. The embedded unit of analysis II identified observable (social)behavior, (non)compliance and orientation as central dementia-specific characteristics. CONCLUSION: The results reflect the complexity of the care situation of patients with unspecified dementia in acute care hospitals. The results showed that a higher awareness for this particular patient group is needed to improve outcomes.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Demência/diagnóstico , Fraturas do Colo Femoral/epidemiologia , Avaliação Geriátrica/métodos , Serviços de Saúde para Idosos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Demência/complicações , Demência/epidemiologia , Hospitais , Humanos , Masculino , Alta do Paciente , Resultado do Tratamento
16.
Surgery ; 167(2): 468-474, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31515123

RESUMO

BACKGROUND: Geriatric patients require specialized perioperative care, yet the impact of geriatric surgery proportion (a measure of experience) and geriatric surgery volume, on clinical outcomes is unknown. This study analyzes the association between proportion and volume and clinical outcomes after high-risk geriatric surgery. METHODS: Using the 2014 National Inpatient Sample, hospital encounters for older adults (≥65 years) undergoing high-risk geriatric surgery were identified. Geriatric surgery volume was defined as a hospital's annual volume of geriatric patients undergoing high-risk geriatric surgery. Geriatric surgery proportion was calculated as volume divided by the sum of high-risk surgeries in all ages. Hierarchical multivariable regression models identified predictors of inpatient mortality, postoperative length of stay, and discharge to nursing facility. RESULTS: There were an estimated 514,950 hospital encounters for older adults undergoing high-risk geriatric surgery from 3,115 hospitals. Mean proportion was 0.53 ± 0.19; median volume was 60 cases per year, ranging from 5 to 3,235. After adjustment, comparing the 90th to 10th percentiles, higher proportion was associated with decreased mortality (odds ratio [95% confidence interval] 0.81 [0.73-0.88]; P < .001) and shorter postoperative length of stay (-4.44% (-5.49 to -3.39%); P < .0001). Higher volume was not associated with mortality but was associated with longer length of stay (7.76% [6.75-8.77%]; P < .0001) and decreased discharge to nursing facility (0.87 [0.79-0.95]; P= .003). CONCLUSION: Treatment of geriatric patients at hospitals with the highest proportion of high-risk geriatric surgery, or the most experience, is associated with improved outcomes. High-proportion hospitals should be examined to understand the mechanisms by which better quality geriatric surgical care is achieved, while lower-proportion hospitals may be targets for quality improvement efforts.


Assuntos
Serviços de Saúde para Idosos/estatística & dados numéricos , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/mortalidade , Idoso , Feminino , Humanos , Masculino , Estados Unidos
17.
Z Gerontol Geriatr ; 53(5): 416-422, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31392420

RESUMO

BACKGROUND: Ambulatory geriatric rehabilitation (AGR) is a prevention program for multimorbid patients with the contractual agreement to prevent the need for care and hospital admissions and to promote self-sufficiency. It provides an opportunity to reduce the prevalence of polypharmacy and to discontinue potentially inadequate medication (PIM). AIM: The study investigated the effect of AGR on the number of drugs and PIM. MATERIAL AND METHODS: The observational longitudinal study was based on claims data from the statutory health insurance AOK Nordost. A comparison of the prescribed drugs with the PRISCUS list was performed. The study investigated the effect of AGR on the number of drugs prescribed and PIM in the period of two quarterly periods before and two quarterly periods after AGR. The numbers of prescribed statins, opioids, antidementia drugs, proton pump inhibitors and antidepressants were assessed and grouped into further prescriptions, new prescriptions and discontinued drug prescriptions. RESULTS: Out of 699 participants 682 (73% women, mean age 79 years, SD ± 5 years) were analyzed. The number of substances and PIM remained at the same levels after AGR. Psycholeptic, antiphlogistic and psychoanaleptic drugs were the most frequently prescribed PIM. The majority of statins, opioids, antidementia drugs, proton pump inhibitors and antidepressants were prescribed further. Antidementia drugs were the medication with the most newly started prescriptions. CONCLUSION: The AGR has no influence on the number of prescribed drugs and PIM. A structured drug review and a conversation with the general practitioner should be strengthened to improve drug safety and reduce polypharmacy as well as undertreatment.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Avaliação Geriátrica/métodos , Serviços de Saúde para Idosos/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Formulário de Reclamação de Seguro/estatística & dados numéricos , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha , Humanos , Estudos Longitudinais , Masculino , Multimorbidade , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco
18.
Support Care Cancer ; 28(1): 113-122, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30993450

RESUMO

PURPOSE: Limited information is available regarding elderly patients experiencing febrile neutropenia (FN). This study evaluated FN-related care among elderly cancer patients who received high/intermediate FN-risk chemotherapy and experienced ≥ 1 FN episodes. METHODS: We used Medicare data to identify patients aged ≥ 66 years who initiated high/intermediate FN-risk chemotherapy between 1 January 2008 and 31 August 2015 to treat breast cancer (BC), lung cancer (LC), or non-Hodgkin lymphoma (NHL) and had ≥ 1 FN episodes. We identified within-cycle FN episodes for each chemotherapy cycle on Part A inpatient claims or outpatient or Part B claims. We described the FN-related care setting (inpatient hospital, outpatient emergency department [ED], or outpatient non-ED) and reported mean total cost of FN-related care per episode overall and by care setting (adjusted to 2015 US$). RESULTS: We identified 2138, 3521, and 2862 patients with BC, LC, and NHL, respectively, with ≥ 1 FN episodes (total episodes: 2407, 3840, 3587, respectively). Most FN episodes required inpatient care (BC, 88.1%; LC, 93.0%; NHL, 93.2%) with mean hospital length of stay (LOS) 6.2, 6.5, and 6.8 days, respectively. Intensive care unit admission was required for 20.4% of BC, 29.0% of LC, and 25.7% of NHL hospitalizations (mean LOS: 4.7, 4.7, 5.5 days, respectively). The mean total cost of FN care per episode was $11,959 BC, $14,388 LC, and $15,006 NHL, with inpatient admission the costliest care component ($11,826; $14,294; and $14,873; respectively). CONCLUSIONS: Among elderly patients with BC, LC, or NHL who experienced FN, most FN episodes required costly hospital care, highlighting the FN burden on healthcare systems.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Neutropenia Febril Induzida por Quimioterapia/economia , Neutropenia Febril Induzida por Quimioterapia/terapia , Custos de Cuidados de Saúde , Neoplasias Pulmonares/tratamento farmacológico , Linfoma não Hodgkin/tratamento farmacológico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/economia , Neoplasias da Mama/epidemiologia , Neutropenia Febril Induzida por Quimioterapia/epidemiologia , Custos e Análise de Custo , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/economia , Serviços de Saúde para Idosos/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Neoplasias Pulmonares/economia , Neoplasias Pulmonares/epidemiologia , Linfoma não Hodgkin/economia , Linfoma não Hodgkin/epidemiologia , Masculino , Medicare/economia , Estudos Retrospectivos , Estados Unidos/epidemiologia
19.
Z Gerontol Geriatr ; 53(5): 409-415, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31197440

RESUMO

BACKGROUND: There is ongoing controversy whether patients show better functional outcomes when care is provided in acute geriatric (AG) or internal medicine (IM) departments. OBJECTIVE: This study compared the recovery of acutely ill patients concerning activities of daily living (ADL) and instrumental activities of daily living (IADL). MATERIAL AND METHODS: A total of 274 patients (≥70 years old, 67 in AG, 207 in IM) were included consecutively (AG intervention) or data were obtained (IM comparison) in a Swiss hospital with 2 locations. The ADL/IADL data were collected 14 days before admission (t1, retrospectively), on admission (t2), at discharge (t3), and 30 days after admission (t4). This study consisted of a prospective study with a longitudinal quasi-experimental design. RESULTS: The AG patients had a significantly higher probability to gain independence in mobility (between t2/t3, P = 0.008), grooming of the lower body (between t2/t3, P = 0.037) and defecation (between t2/t4, P < 0.001). The IM patients were significantly more independent in IADL at t4 (all P < 0.05) except for meal preparation. The odds for nursing home admission in AG with dependency at t1 were significantly lower in every ADL (all P < 0.05) and with shopping in IADL (P = 0.008). CONCLUSION: This study shows a positive effect of AG compared to IM in self-care with a lower probability for nursing home admission. There is need for further education and research to improve outcomes in older hospitalized patients.


Assuntos
Atividades Cotidianas , Avaliação Geriátrica/métodos , Serviços de Saúde para Idosos/estatística & dados numéricos , Autocuidado , Idoso , Feminino , Humanos , Medicina Interna , Masculino , Estudos Prospectivos , Estudos Retrospectivos
20.
Rev. esp. salud pública ; 94: 0-0, 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-196094

RESUMO

OBJETIVO: La identificación de fibrilación auricular en los pacientes mayores es un tema que ha sido escasamente estudiado. El objetivo de este estudio fue estimar la frecuencia de nuevos casos de fibrilación y analizar las características clínico-epidemiológicas de los pacientes de 65 años o más detectados en Atención Primaria en España. MÉTODOS: Se llevó a cabo un estudio observacional, descriptivo de ámbito nacional, multicéntrico, en 48 centros de salud, en el que 218 médicos y 101 enfermeras de Atención Primaria captaron a 7.068 pacientes, a los que se les realizó la toma del pulso arterial y un electrocardiograma en caso de ser anormal o dudoso, determinando la presencia de fibrilación auricular y otros trastornos del ritmo, síntomas y signos compatibles, así como comorbilidad y factores de riesgo cardiovascular. Se realizó un análisis univariado, bivariado y multivariado (regresión logística múltiple). RESULTADOS: Los pacientes tenían una media de edad de 74,41±6,78 (DT) años. El 2,3% presentó fibrilación auricular (IC95%: 2,0-2,7), siendo su frecuencia superior en los hombres (2,9%; p < 0,001), y más aún conforme aumentaba la edad (p < 0,001). Los síntomas más frecuentemente presentes entre los pacientes con fibrilación auricular fueron las palpitaciones (Odds Ratio -OR-=3,50; IC95%: 2,28-5,37), la disnea (OR=2,71; IC95%: 1,87-3,90), el malestar general (OR=2,32; IC 95%:1,15-4,63) y el mareo (OR=1,80; IC95%:1,20-3,51). Un 21,8% eran asintomáticos. CONCLUSIONES: La frecuencia de nuevos casos de fibrilación auricular en la población española de 65 años o más es elevada, siendo superior en los hombres e incrementándose con la edad. Dos de cada diez pacientes son asintomáticos. Las palpitaciones y la disnea constituyen los síntomas preponderantes en los pacientes con fibrilación auricular


OBJECTIVE: The identification of atrial fibrillation in older patients who come to Primary Care consultations is a topic of interest that has been scarcely studied. The objective of this work was to estimate the frequency of new cases of atrial fibrillation and to analyze the clinical-epidemiological characteristics of patients 65 years of age or older, detected in Primary Care in Spain. METHODS: An observational, descriptive, national, multicenter study was carried out in 48 health centers, in which 218 doctors and 101 Primary Care nurses recruited 7,068 patients, who underwent an arterial pulse and an electrocardiogram. in case of being abnormal or doubtful, determining the presence of atrial fibrillation and other rhythm disorders, symptoms and signs compatible with atrial fibrillation and comorbidity and cardiovascular risk factors. A univariate, bivariate and multivariate analysis (multiple logistic regression) was performed. RESULTS: The patients had a mean age of 74.41±6.78 (DT) years. 2.3% presented atrial fibrilation (95% CI: 2.0-2.7), being its frequency higher in men (2.9%; p < 0.001), and as age increased (p < 0.001). The most frequent symptoms present among patients with atrial fibrillation were palpitations (Odds Ratio -OR-=3.50; 95% CI: 2.28-5.37), dyspnea (OR=2.71; 95% CI: 1.87-3.90), general discomfort (OR=2.32, 95% CI: 1.15-4.63), and dizziness (OR=1.80, 95% CI: 1.20-3.51). The 21.8% were asymptomatic. CONCLUSIONS: The frequency of new cases of atrial fibrillation in the Spanish population of 65 years or older is high, being higher in men and increasing with age. Two out of ten patients are asymptomatic. Palpitations and dyspnea are the predominant symptoms in patients with atrial fibrillation


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Eletrocardiografia/métodos , Determinação da Frequência Cardíaca/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Taquicardia/epidemiologia , Dispneia/epidemiologia , Doenças Assintomáticas/epidemiologia
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