Idosos Domiciliados: Saúde Geral x Higiene Bucal / Elderly People Living at Home: General Health x Oral Hygiene

O Serviço Integrado da Assistência Domiciliar (SIAD) foi criado a fim de prestar atendimento integral domiciliar a idosos que apresentam incapacidade de se locomover para as unidades de atendimento de saúde da Marinha do Brasil (MB). Com a finalidade de avaliar o perfil de saúde geral e de higiene dental desses pacientes, foi realizado um estudo transversal, quantitativo e descritivo, no qual foram incluídos idosos com 60 anos ou mais, assistidos entre fevereiro de 2017 a dezembro de 2022. Pode-se observar que a maioria dos idosos eram longevos, com média de idade de 82,52 anos (±8,66), mulheres (63,52%) e possuíam dependência total para realizar atividades básicas de vida diária (88,9%). Conclui-se que a síndrome demencial foi o diagnóstico principal mais encontrado (44,3%), a maioria possuía comorbidade associada (71,9%), sendo a Hipertensão Arterial Sistêmica (59,2%) e o Diabetes Mellitus (28,9%) as mais recorrentes. Foi encontrada uma elevada prevalência de idosos domiciliados com higiene bucal insatisfatória (34,7%) ou irregular (57,2%). No entanto, não houve associação entre higiene dental, comorbidades e grau de dependência. Assim sendo, é imprescindível que os idosos domiciliados recebam orientações e sejam submetidos a um acompanhamento rigoroso e constante, juntamente com seus cuidadores, a fim de promover a melhoria da higiene oral desses pacientes.

The Integrated Home Assistance Service (IHAS) was created to provide integral home care for elderly people who are unable to go to the health care units of the Brazilian Navy. A cross-sectional, quantitative, and descriptive study was carried out to evaluate the general health and dental hygiene profile of these patients. The study included elderly people aged 60 years or older who were assisted between February 2017 and December 2022. Most of them were long-lived, with a mean age of 82.52 (±8.66) years, women (63.52%) and totally dependent on performing basic activities of daily living (88.9%). The most common diagnosis among them was dementia syndrome, accounting for 44.3% of cases. Additionally, a large portion of the elderly had associated comorbidities (71.9%), with Systemic Arterial Hypertension (59.2%) and Diabetes Mellitus (28.9%) as the most recurrent conditions. The study found a high prevalence of elderly with unsatisfactory (34.7%) or irregular (57.2%) oral hygiene. Nevertheless, there was no significant association between dental hygiene and comorbidities or the degree of dependence. Therefore, it is imperative that elderly people living at home receive guidance and undergo meticulous and ongoing monitoring, in conjunction with their caregivers to promote improvements in the oral hygiene of these patients.

Relato de experiência e resultados preliminares do estudo pro-eva: uma proposta para o manejo da caderneta de saúde da pessoa idosa / Experience report and preliminary results of the pro-eva study: a proposal for the management of the health book of the elderly person

Introdução: a Política Nacional de Saúde da Pessoa Idosa estabelece a importância da realização de estratégias voltadas para a saúde, principalmente em relação à preservação da capacidade funcional. No conjunto de iniciativas estabelecidas por essa política, encontra-se a implementação da Caderneta de Saúde da Pessoa Idosa (CSPI). Objetivo: relatar a experiência de implantação e desenvolvimento do estudo "Pro-Eva" e apresentar seus resultados preliminares quanto à aplicação da CSPI. Métodos: o estudo está sendo desenvolvido em cinco Unidades Básicas de Saúde (UBS) em Parnamirim (RN). Foi criada uma versão digital da CSPI, em formato de sistema on-line, com o intuito de inserir as informações coletadas por meio da caderneta, seguindo uma metodologia própria de preenchimento do instrumento. Os critérios de inclusão são: ter pelo menos 60 anos de idade; estar cadastrado em uma das UBS participantes do estudo; aceitar participar da avaliação do estudo em sua totalidade. Resultados: 996 pessoas idosas já participaram do processo de preenchimento da CSPI e tiveram seus dados lançados no sistema de monitoramento on-line. A média de idade da amostra foi de 70,3 (±7,1), sendo a maioria composta por mulheres (61,3%). Aproximadamente metade dos idosos eram pardos (49,5%) e estavam em uma união estável (51,2%). Conclusão: o presente artigo possui pertinência por conduzir um relato de experiência da implementação e do fortalecimento da CSPI, enquanto política de saúde, em um município do Nordeste brasileiro e por ter desenvolvido um fluxograma de preenchimento da caderneta que poderá ser base para futuros estudos nesta temática.(AU)

Introduction: National health policy for the elderly establishes the importance of carrying out strategies aimed at health, especially about preservation of functional capacity. Among the set of initiatives established by this policy there is the implementation of the Health Book of the Elderly Person. Purpose: To report the experience of implementation and development of the "Pro-Eva" study and present its preliminary results, regarding the application of the book. Methods: The study is being developed in five basic health units in Parnamirim (RN). A digital version of the health book was created, in an online system format, to insert the information collected, following a specific methodology for filling in the instrument. The inclusion criteria are: be at least 60 years old; be registered in one of the health units participating in the study; accept to participate in the evaluation of the study in its entirety. Results: 996 elderlies have already partici- pated in the process of fill the health book and had their data posted in the online monitoring system. The average age was 70.3 (± 7.1) years, with the majority being women (61.3%). Approximately half of the elderly were brown (49.5%) and were in a stable union (51.2%). Conclusion: This article is pertinent for conducting an experience report on the implementation and strengthening of the health book, in a city in the Brazilian Northeast, and for having developed a flow- chart for filling out the book that may be the basis for future studies in this thematic.(AU)

Potentially inappropriate prescribing among older patients and associated factors: comparison of two versions of STOPP/START criteria

Abstract The study aimed to estimate and compare the prevalence and type of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) between the STOPP/START original (v1) and updated version (v2) among older patients in various settings, as well as associated factors. The study included 440 patients attending a community pharmacy, 200 outpatients and 140 nursing home users. An increase in the prevalence of STOPP v2 (57.9%) compared to v1 (56.2%) was not statistically significant in the total sample and within each setting (p>0.05). A decrease in the prevalence of START v1 (55.8%) to v2 (41.2%) was statistically significant (p<0.001) in the total sample and within each setting (p<0.05). Drug indication (32.9%) and fall-risk medications (32.2%) were most commonly identified for STOPP v2, while cardiovascular system criteria (30.5%) were the most frequently detected for START v2. The number of medications was the strongest predictor for both STOPP v1 and v2, with odds ratio values of 1.35 and 1.34, respectively. Patients' characteristics associated with the occurrence of STOPP and START criteria were identified. According to both STOPP/START versions, the results indicate a substantial rate of potentially inappropriate prescribing among elderly patients. The prevalence of PIMs was slightly higher with the updated version, while the prevalence of PPOs was significantly lower

COVID-19 y personas mayores en Chile: lecciones de dos años de pandemia / The impact of COVID-19 on the health status of older people in Chile

The article presents the main impact of COVID-19 pandemic on the health status of older people, systematizing the information about the direct impact of the pandemic in terms of number of cases, hospitalizations, deaths, the policies implemented for the prevention and management of COVID-19 in older people and the indirect impact of the two years of pandemic. Adopting a broad definition of health, the need to monitor and recover health care of older people is highlighted. The recovery of their functionality and mental health must be emphasized. The policies towards institutionalized older people must be revised. These areas should be the focus of health care policies for older people in Chile.

Complicaciones agudas hospitalarias en adultos mayores con Enfermedad Cerebrovascular asociadas a características neuro-geriátricas / Acute hospital complications in older adults with Cerebrovascular Disease associated with neurogeriatric characteristics

INTRODUCCIÓN: La enfermedad cerebrovascular en los adultos mayores tiene implicaciones clínicas, sociales y económicas que pueden comprometer la funcionalidad y la calidad de vida. Es importante determinar las complicaciones que puede presentar el paciente geriátrico con enfermedad cerebrovascular durante los días de estancia hospitalaria. OBJETIVO: Determinar las características neuro-geriátricas asociadas a las complicaciones agudas no neurológicas y los días de hospitalización de los pacientes adultos mayores con enfermedad cerebrovascular. MATERIALES Y MÉTODOS: Estudio descriptivo prospectivo. Población de 120 y muestra de 73 pacientes mayores de 65 años con enfermedad cerebro vascular de la Unidad de Neurología del Hospital Carlos Andrade Marín que inició en agosto de 2020 y culminó en enero 2021. Se excluyó a pacientes que no cumplieron el criterio mencionado, con dependencia funcional total previa, patologías psiquiátricas previas, o personas que no aceptaron ser parte del estudio. Se efectuó el seguimiento de los pacientes desde el ingreso hasta el alta hospitalaria, para identificar complicaciones agudas no neurológicas y días de hospitalización. Se determinó las características neuro-geriátricas mediante las escalas de Barthel, Gijón, Charlson, Norton, Glasgow y NIHSS. Se obtuvo riesgo relativo e intervalos de confianza, considerando significativo un valor p<0,05. RESULTADOS: La edad media fue de 77 (±8,5) años. Las complicaciones fueron infección de tracto urinario (22,0%), neumonía (20,0%), desequilibrio hidroelectrolítico (19,0%), disfagia (13,0%) y úlceras por presión (9,0%). Las complicaciones que se presentaron significativamente ante una estancia hospitalaria prolongada comparada con quienes no las presentaron fueron la Neumonía (Media 5,81 (1,47 a 10,16) con IC 95%) y la infección del tracto urinario (Media 4,95 (1,52 a 8,38) con IC 95%). Según las características neuro-geriátricas y las complicaciones, encontramos diferencia estadísticamente significativa solo con en el grupo de riesgo bajo, según la escala de Norton RR 0,744 con IC 95% (0,584 - 0,949). CONCLUSIONES: Es importante realizar la valoración geriátrica integral al paciente neurológico tanto al ingreso como al egreso hospitalario, ya que permite detectar complicaciones que pueden pasar desapercibidas y prolongar la estancia hospitalaria.

INTRODUCTION: Cerebrovascular disease in older adults has clinical, social, and economic implications that can compromise functionality and quality of life. It is important to determine the complications that the geriatric patient with cerebrovascular disease may present during hospital days. OBJECTIVE: To determine the neuro-geriatric characteristics associated with acute non-neurological complications and hospital days in older adult patients with cerebrovascular disease. MATERIALS AND METHODS: Prospective descriptive study. Population of 120 and sample of 73 patients older than 65 years with cerebrovascular disease from the Neurology Unit of the Carlos Andrade Marín Hospital that began in August 2020 and culminated in January 2021. Patients who did not meet the aforementioned criteria, with previous total functional dependence, previous psychiatric pathologies, or people who did not agree to be part of the study were excluded. Patients were followed up from admission to hospital discharge to identify acute non-neurological complications and days of hospitalization. Neuro-geriatric characteristics were determined using the Barthel, Gijon, Charlson, Norton, Glasgow and NIHSS scales. Relative risk and confidence intervals were obtained, considering a p-value <0.05 as significant. RESULTS: Mean age was 77 (±8.5) years. Complications were urinary tract infection (22.0%), pneumonia (20.0%), water and electrolyte imbalance (19.0%), dysphagia (13.0%) and pressure ulcers (9.0%). Complications that occurred significantly in the face of a prolonged hospital stay compared to those who did not present were Pneumonia (Mean 5.81 (1.47 to 10.16) with 95% CI) and urinary tract infection (Mean 4.95 (1.52 to 8.38) with 95% CI). According to neuro-geriatric characteristics and complications, we found statistically significant difference only with in the low risk group, according to the Norton scale RR 0.744 with 95% CI (0.584 - 0.949). CONCLUSIONS: It is important to perform comprehensive geriatric assessment of the neurological patient both on admission and hospital discharge, as it allows the detection of complications that may go unnoticed and prolong hospital stay.

Fatores associados com a presença de anemia em pacientes hospitalizados / Factors associated with the presence of anemia in hospitalized patients

Introdução: Anemia é definida pela diminuição da concentração de hemoglobina circulante no sangue, podendo ser desencadeada por mecanismos fisiopatológicos e deficiências alimentares. Objetivou-se avaliar fatores associados à presença e ao tipo de anemia em pacientes hospitalizados. Métodos: Estudo retrospectivo, quantitativo realizado em hospital municipal da região central do Rio Grande do Sul. Fizeram parte do estudo pacientes hospitalizados em diferentes clínicas, com idade superior a 18 anos. Os dados foram coletados de fichas preenchidas pelos acadêmicos do curso de Nutrição durante o estágio curricular. As fichas eram compostas pelos seguintes dados: diagnóstico médico, doenças associadas, dados antropométricos como Índice de Massa Corporal (IMC) e exames laboratoriais como o hemograma. Resultados: A amostra foi composta por 100 indivíduos hospitalizados, 39% adultos e 61% idosos; 76% dos pacientes apresentaram anemia, sendo 35,4% (n= 34) anemia leve, 29% (n=28) moderada e 11,6% (n=11) grave. Percebeu-se que os idosos estão mais anêmicos em relação aos adultos. Doenças hematológicas, infecciosas, gastroenterológicas e pneumológicas tiveram maiores associações com a presença de anemia nos pacientes. Parâmetros como volume corpuscular médio e amplitude de distribuição dos eritrócitos encontraram-se normais nos pacientes. Além disso, observou-se relação inversamente proporcional da gravidade de anemia com o estado nutricional dos pacientes. Conclusão: A maioria dos pacientes hospitalizados estava anêmica, principalmente idosos. Alterações observadas no eritrograma foram semelhantes às encontradas na anemia por doença crônica. O baixo IMC e doenças associadas com alterações na eritropoiese, perda sanguínea e estimulação do sistema imunológico tiveram maiores associações com a presença de anemia nesses pacientes.

Introduction: Anemia is defined as a decreased concentration of circulating blood hemoglobin, and it can be triggered by pathophysiological mechanisms and nutritional deficiencies. We aimed to evaluate factors associated with the presence and type of anemia in hospitalized patients. Methods: This is a retrospective, quantitative study performed in a municipal hospital in central Rio Grande do Sul. The study participants were patients hospitalized at different healthcare institutions and aged 18 years or older. Data were collected through forms filled out by undergraduate nutrition students at their academic internship period. The forms included the following data: medical diagnosis, associated diseases, anthropometric data such as body mass index (BMI), and laboratory examinations such as blood counts. Results: The sample comprised 100 hospitalized individuals, of which 39% were adults and 61% were older adults; 76% of the patients presented anemia, where 35.4% (n=34) had mild anemia, 29% (n=28) had moderate anemia, and 11.6% (n = 11) had severe anemia. We noticed that older adults were more severely anemic than adults. Blood disorders and infectious, gastrointestinal, and respiratory diseases were more strongly associated with the presence of anemia in these patients. Parameters such as mean corpuscular volume and red cell distribution width were normal. Moreover, we observed an inversely proportional relationship between anemia severity and the patients' nutritional status. Conclusion: Most hospitalized patients were anemic, especially the older adults. Alterations seen in the erythrogram were similar to those found in anemia of chronic disease. Low BMI and diseases linked to changes in erythropoiesis, blood loss, and stimulation of the immune system were more strongly associated with the presence of anemia in these patients.

Autopercepção e condições de saúde de uma população assistida em um programa acompanhante de idoso do município de São Paulo / Self-perception and health conditions of a population assisted in an elderly caregiver program in the city of São Paulo / Autopercepción y condiciones de salud de una población asistida en un programa acompañante de ancianos de la municipalidad de São Paulo

Objetivo: Avaliar a autopercepção e as condições de saúde em idosos assistidos em um Programa Acompanhante do Idoso (PAI) do Município de São Paulo. Método: Estudo observacional de abordagem quantitativa, com uso de dados secundários. Foram sujeitos desta pesquisa 41 idosos cujos dados da Avaliação Multidimensional da Pessoa Idosa na Atenção Básica (AMPI/AB) constavam em banco de dados do referido PAI. As informações correspondem aos seguintes parâmetros de saúde da pessoa idosa: idade, autopercepção de saúde, arranjo familiar, condições crônicas de saúde, medicamentos, internações, quedas, visão, audição, limitação física, cognição, humor, atividades básicas de vida diária, atividades instrumentais de vida diária, incontinência, perda de peso não intencional e condições bucais. Resultados: Predominância do sexo feminino, raça branca e média de idade de 81,53 anos. A maioria dos sujeitos referiu autopercepção regular, ruim ou muito ruim de saúde; morar acompanhados; possuir três ou mais condições crônicas de saúde, utilizar cinco ou mais fármacos ao dia, ausência de internação ou quedas nos últimos doze meses, possuir dificuldades visuais e auditivas, não possuir limitações físicas, piora na memória no último ano, alterações de humor, independência nas atividades básicas de vida diária e dependência nas atividades instrumentais de vida diária e, ainda, ausência de incontinência, de perda de peso não intencional e de alterações bucais. Quanto às classificações da AMPI/AB, a maioria dos idosos ficou na categoria "Pré-frágil" (51,3%), seguida de "Frágil" (39%) e "Saudável" (9,7%). Foram observadas associações da categoria "Frágil" com problemas auditivos e episódios de esquecimentos. Houve correlação entre aumento de idade e piora no resultado da AMPI/AB. Conclusão: Predomínio de autopercepção negativa da saúde, alta ocorrência de doenças crônicas - principalmente a hipertensão - e dependência dos sujeitos para realizar atividades instrumentais de vida diária. Idosos frágeis relataram mais dificuldades auditivas e episódios de esquecimentos. Há uma tendência de maiores acometimentos na saúde conforme o aumento da idade.

Objective: Evaluate self-perception and health conditions in elderly population assisted in an Elderly Companion Program (PAI, according to its acronym in Portuguese) in the city of São Paulo. Method: Observational study of quantitative approach with the use of secondary data. The sample of 41 elderly people came from the PAI database of a Primary Care Unit, in São Paulo, through the application of the Multidimensional Assessment of the Elderly Person in Primary Care (AMPI / AB, according to its acronym in Portuguese). The information corresponds to the following health parameters of the elderly: age, health self-perception, family arrangement, chronic health conditions, medications, hospitalizations, falls, vision, hearing, physical limitation, cognition, mood, basic activities of daily living, instrumental activities of daily living, incontinence, unintended weight loss and oral conditions. Results: Predominance of females, white race, and average age of 81.53 years. Most of the subjects referred to regular, poor or very poor self-perception, living accompanied, having three or more chronic health conditions, using five or more medications per day, absence of hospitalization or falls in the last twelve months, visual and hearing difficulties, absence of physical limitations, worsening of memory in the last year, independence on basic activities of daily living and dependence on instrumental activities of daily living and, still, absence of incontinence, unintended weight loss and oral alterations. As for AMPI / AB classifications, most of the elderly were in the "Pre-fragile" group (51.3%), followed by "Fragile" (39%) and "Healthy" (9.7%). Associations of the "Fragile" group were observed with hearing problems and episodes of forgetfullness. There was a correlation between age increasing and worsening in the result of AMPI/AB. Conclusion: Predominance of negative self-perception of health, high occurrence of chronic diseases - especially hypertension - and dependence on subjects to perform instrumental activities of daily living. Fragile elderly people reported more hearing difficulties and forgetfulness episodes. There's a trend of greater health impairment as the age increases.

Objetivo: Valorar la autopercepción y las condiciones de salud de ancianos asistidos en un Programa Acompañante de Ancianos (PAI, por sus siglas en portugués) de la municipalidad de São Paulo. Método: Estudio observacional de abordaje cuantitativo, utilizando datos secundarios. Fueron sujetos de esta investigación 41 ancianos cuyos datos de la Evaluación Multidimensional de la Persona Anciana en la Atención Básica (AMPI/AB, por sus siglas en portugués) constaban en el banco de datos del PAI mencionado. Las informaciones corresponden a los siguientes parámetros de salud de la persona anciana: edad, autopercepción de salud, circunstancias familiares, condiciones crónicas de salud, medicamentos, internaciones, caídas, visión, audición, limitaciones físicas, cognición, humor, actividades básicas de la vida cotidiana, actividades instrumentales de la vida cotidiana, incontinencia, pérdida de peso no intencional y condiciones bucales. Resultados: Predominancia del sexo femenino, raza blanca y promedio de edad de 81,53 años. La mayoría de los sujetos relató autopercepción regular, mala o muy mala de salud; vivir acompañados; poseer tres o más condiciones crónicas de salud; utilizar cinco o más fármacos por día; ausencia de internación o caídas en los últimos doce meses; poseer dificultades visuales y auditivas; no poseer limitaciones físicas; empeoramiento de la memoria en el último año; alteraciones de humor; independencia en las actividades básicas de vida cotidiana y dependencia en las actividades instrumentales de vida cotidiana; y, además, ausencia de incontinencia, de pérdida de peso no intencional y de alteraciones bucales. En relación con las clasificaciones de la AMPI/AB, la mayoría de los ancianos se encuadra en la categoría "Pre frágil" (51,3%), luego de "Frágil" (39%) y "Saludable" (9,7%). Se observaron asociaciones de la categoría "Frágil" con problemas auditivos y episódios de olvidos. Hubo correlación entre el aumento de edad y empeoramiento del resultado de la AMPI/AB. Conclusión: Predominio de autopercepción negativa de la salud, alto registro de enfermedades crónicas - principalmente la hipertensión - y dependencia de los sujetos para realizar actividades instrumentales de vida cotidiana. Ancianos frágiles relataron más dificultades auditivas y episodios de olvidos. Existe una tendencia de mayores problemas de salud de acuerdo con el aumento de la edad.

Repercussões da COVID-19 no cuidado ao idoso: percepções de enfermeiros da Atenção Primária à Saúde / Repercusiones de la COVID-19 en el cuidado del anciano: percepciones de los enfermeros en la Atención Primaria de Salud / Repercussions of COVID-19 on elderly care: perceptions of Primary Health Care nurses

Resumo Objetivo: compreender as percepções de enfermeiros da Atenção Primária à Saúde (APS) sobre as repercussões da COVID-19 no cuidado e cotidiano do idoso. Método: estudo exploratório, descritivo, com abordagem qualitativa. Integraram-se 10 enfermeiras da APS de Santa Catarina. A coleta de dados ocorreu por meio de entrevista semiestruturada, entre julho e setembro de 2021, com chamada de vídeo em aplicativo devido à pandemia. Para a organização e avaliação das informações, utilizou-se a análise de conteúdo. Resultados: emergiram duas categorias: Repercussões da COVID-19 no cuidado ao idoso na APS; COVID-19 e as transformações no cotidiano dos idosos para o cuidado em saúde. Conclusão: a pandemia gerou restrições sociais e afetivas, além de reduzir atividades presenciais realizadas na APS, culminando em alterações na saúde. Portanto, a reflexão e o planejamento de ações perante o cuidado ao idoso na APS são fundamentais, principalmente quanto à saúde mental, afetada na conjuntura pandêmica.

Resumen Objetivo: comprender las percepciones de los enfermeros de la Atención Primaria de Salud (APS) sobre las repercusiones de la COVID-19 en el cuidado y el cotidiano de los ancianos. Método: estudio exploratorio, descriptivo con abordaje cualitativo. Se integraron 10 enfermeros de la APS de Santa Catarina. La recolección de datos se realizó a través de una entrevista semi-estructurada, entre julio y septiembre de 2021, con una aplicación de video llamada debido a la pandemia. Para la organización y evaluación de la información se utilizó el análisis de contenido. Resultados: surgieron dos categorías: Repercusiones de la COVID-19 en el cuidado del anciano en la APS; COVID-19 y las transformaciones en el cotidiano de los ancianos para el cuidado de la salud. Conclusión: la pandemia generó restricciones sociales y afectivas, además de la reducción de las actividades presenciales realizadas en la APS, culminando en cambios en la salud. Por lo tanto, son fundamentales la reflexión y la planificación de acciones para el cuidado de los ancianos en la APS, especialmente en lo que respecta a la salud mental, afectada en la situación de pandemia.

Abstract Objective: to understand the perceptions of Primary Health Care (PHC) nurses about the repercussions of COVID-19 on the care and daily life of the elderly. Method: exploratory, descriptive study with a qualitative approach. Ten nurses from the PHC of Santa Catarina were integrated. Data collection took place through a semi-structured interview, between July and September 2021, with an application video call due to the pandemic. Content analysis was used to organize and assess the information. Results: two categories emerged: Repercussions of COVID-19 in the care of the elderly in PHC; COVID-19 and the transformations in the daily lives of the elderly regarding health care. Conclusions: the pandemic generated social and affective restrictions and reduced face-to-face activities carried out in PHC, culminating in changes in health. Therefore, the reflection and planning of actions regarding the care of the elderly in PHC are fundamental, especially regarding mental health, affected in the pandemic context.

"PCATool versão profissionais cuidando da saúde do idoso": adaptação, análise de conteúdo e desempenho do instrumento / "PCATool version to professionals in the primary care of the elderly": adaptation, content analysis and first results

Resumo O objetivo do trabalho foi adaptar o instrumento "Primary Care Assessment Tool (PCATool)-versão profissionais" para medir o desempenho do cuidado prestado pela Atenção Primária à Saúde (APS) à saúde do idoso, na ótica dos profissionais. O instrumento original foi criticamente analisado por especialistas com experiência em Gerontologia e APS em relação às especificidades de saúde do idoso, sendo realizadas 64 adaptações sintático-semânticas e 28 inclusões de novos parâmetros. O instrumento adaptado foi aplicado em 105 profissionais de saúde da APS em Campinas-SP e, comparativamente em relação ao instrumento original, a adaptação mostrou-se capaz de observar parâmetros distintos com diferenças estatisticamente significativas, sendo que na amostra de profissionais analisada o desempenho verificado foi melhor nos atributos "Acessibilidade" e "Integralidade", e pior em "Longitudinalidade", "Coordenação", "Escores Essencial e Geral". O instrumento adaptado obteve resultados adequados de validade de conteúdo e confiabilidade, boa capacidade discriminativa em relação às especificidades da população idosa e potencial para se constituir em instrumento nacional de avaliação da APS no cuidado ao idoso.

Abstract The objective of this study was to adapt the instrument "Primary Care Assessment Tool (PCATool)-professional version" to measure the performance of the care provided by Primary Health Care (PHC) to the health of the elderly, from the perspective of professionals. The original instrument was critically analyzed by specialists with experience in Gerontology and PHC in relation to the health specificities of the elderly, with 64 syntactic-semantic adaptations and 28 inclusions of new parameters. The adapted instrument was applied to 105 health professionals from PHC in Campinas-SP and, compared to the original instrument, the adaptation proved to be able to distinguish the new parameters with statistically significant differences, and in the sample of the analyzed professionals the performance obtained was better avaliated in relation to "Accessibility" and "Comprehensiveness" attributes, and worse avaliated in the attributes "Longitudinality", "Coordination", "Essential and General Scores". In the adapted instrument, it was verified adequate results in terms of content validity and reliability, good discriminative capacity in relation to the specificities of the elderly population, and potential to become a national instrument for evaluating PHC in care to the elderly.

Hemodynamics and functional outcomes after resistance training in hypertensive and normotensive elderly: An experimental study

Abstract Aim: To evaluate the chronic effects of resistance training on resting blood pressure, handgrip strength, gait speed, and Timed Up and Go test (TUG) in normotensive and hypertensive elderly individuals. Methods: Experimental study based on TREND. Hypertensive patients were diagnosed by an independent doctor. Before and after 12 weeks of progressive resistance training, we evaluated blood pressure, heart rate, body composition, Timed Up and Go test, gait speed, and handgrip strength. Results: Sample consisted of 41 participants divided into two groups (normotensive n = 28; hypertensive n = 13). We observed significant values in the reduction of blood pressure levels only in the group of hypertensive participants. In functionality outcomes, we observed significant values in all tests and both groups. Outcomes contemplate effect sizes ranging from small to moderate. Conclusion: Progressive resistance training lowers resting blood pressure levels, increases handgrip strength, and improves physical functional performance. Although the normotensive group did not show a reduction in blood pressure levels, an improvement was observed in the functional physical tests.

Consenso de escalas para um instrumento de avaliação interdisciplinar em saúde da população idosa / Consensus on scales for an interdisciplinary health assessment tool for the elderly population

RESUMO Objetivo descrever o consenso do conteúdo de um instrumento para avaliação assistencial interdisciplinar em saúde da população idosa. Métodos estudo de consenso realizado entre médicos, enfermeiros e assistentes sociais, contemplando a construção de um instrumento e o pré-teste para seleção de escalas para uso na prática. Questionário constituído por perguntas com identificação de escalas representativas na avaliação dos idosos. Consideraram-se selecionadas pelos peritos as escalas que obtiveram o critério de consenso igual ou superior a 75%. Amostra constituída mediante "bola de neve", resultando em 101 participantes. Resultados das 13 escalas submetidas, os profissionais apontaram oito passíveis de utilização e duas que aplicavam na sua prática. As escalas excluídas constituem parte integrante das recomendações de boas práticas na assistência aos idosos. Identificou-se discrepância entre o que consideram útil e de interesse versus o que aplicam na prática. Conclusão o consenso entre peritos permitiu identificar e selecionar dados de avaliação interdisciplinares para uma proposta de instrumento, com vistas a subsidiar o processo de cuidado. Contribuições para a prática contribui-se, assim, para a conscientização sobre o uso de escalas recomendadas para idosos e para evitar a sobreposição das mesmas intervenções por vários profissionais, com ganhos significativos para essa população.

ABSTRACT Objective to describe the consensus of the content of an instrument for assessing interdisciplinary health care of the elderly population. Methods consensus study conducted among physicians, nurses, and social workers, contemplating the construction of instrument and the pre-test for selection of scales for use in practice. Questionnaire consisting of questions that identified representative scales in the assessment of the elderly. The scales that obtained consensus criterion of equal to or greater than 75% were considered selected by the experts. Sample was composed through snowball sampling, resulting in 101 participants. Results of the 13 scales submitted, the professionals indicated that eight were suitable for use and two were already applied within their practice. The excluded became part of the recommendations for good practices in elderly care. A discrepancy was identified between what they consider to be useful and of interest versus what is applied in practice. Conclusion consensus among experts allowed us to identify and select interdisciplinary assessment data for a proposed instrument to support the care process. Contributions to practice this contributes to awareness about the use of recommended scales for the elderly and to avoid the overlapping of the same interventions by several professionals, with significant gains for this population.

Satisfaction of caregivers and older adults who use the Better at Home Program / Satisfação dos cuidadores e dos idosos usuários do Programa Melhor em Casa

ABSTRACT OBJECTIVE Evaluate the satisfaction of caregivers and older adults who use the home care service provided by the Better at Home Program (Programa Melhor em Casa) and its associated factors. METHODS This is a cross-sectional study with data from the national survey on the Better at Home Program, conducted by the SUS General Ombudsman. We interviewed 5,595 caregivers and 950 older adults. We combined four questions related to satisfaction to formulate the dependent variable by means of latent class analysis and used 13 questions as independent variables. RESULTS 93.7% of the older adults and 90.2% of the caregivers were satisfied with the service. In the multiple analysis, the variables showing association with satisfaction were: also being accompanied by a family health team (older adults: OR = 4.22; p = 0.014), shorter time between referral and the first visit (older adults: OR = 10.20; p = 0.006), (caregiver: OR = 5.84; p < 0.001), taking examinations with medical requirement (older adults: OR = 5.74; p = 0.037), (caregiver: OR = 7.41; p < 0.001), consultation with specialist (caregiver: OR = 6.02; p < 0.001), visits out of the schedule when necessary (older adults: OR = 8.09; p = 0.014), (caregiver: OR = 1.81; p = 0.015) and understanding the orientations provided by the program team (caregiver: OR = 10.61; p < 0.001). CONCLUSIONS The majority of the older adults and caregivers showed satisfaction with the program, with a distinction in the aspects associated with this satisfaction, in which only the characteristics directly related to the program influenced the satisfaction, while the same did not occur with the socioeconomic and demographic characteristics.

RESUMO OBJETIVO Avaliar a satisfação dos cuidadores e dos idosos usuários do serviço de atenção domiciliar por meio do Programa Melhor em Casa e seus fatores associados. METÓDOS Trata-se de um estudo transversal com dados da pesquisa nacional sobre o Programa Melhor em Casa, conduzida pela Ouvidoria Geral do SUS. Foram entrevistados 5.595 cuidadores e 950 idosos. Quatro perguntas relacionadas à satisfação foram unidas para formulação da variável dependente por meio da análise de classes latentes e 13 perguntas foram utilizadas como variáveis independentes. RESULTADOS Mostraram-se satisfeitos com o serviço, 93,7% dos idosos e 90,2% dos cuidadores. Na análise múltipla, as variáveis que apresentaram associação com a satisfação foram: também ser acompanhados por uma equipe de saúde da família (idoso: OR = 4,22; p = 0,014), menor tempo entre o encaminhamento e a primeira visita (idoso: OR = 10,20; p = 0,006), (cuidador: OR = 5,84; p < 0,001), realização de exames quando havia solicitação médica (idoso: OR = 5,74; p = 0,037), (cuidador: OR = 7,41; p < 0,001), realização de consulta com especialista (cuidador: OR = 6,02; p < 0,001), ter visitas fora do horário agendado quando fosse necessário (idoso: OR = 8,09; p = 0,014), (cuidador: OR = 1,81; p = 0,015) e compreender as orientações que eram passadas pela equipe do programa (cuidador: OR = 10,61; p < 0,001). CONCLUSÕES Constatou-se que a maioria dos idosos e dos cuidadores demonstraram satisfação com o programa, havendo distinção nos aspectos associados a essa satisfação, nos quais apenas as características diretamente relacionadas ao programa influenciaram na satisfação, não ocorrendo o mesmo com as características socioeconômicas e demográficas.

Validação psicométrica da versão brasileira do Geriatric Institutional Assessment Profile / Validación psicométrica de la versión brasileña del Geriatric Institutional Assessment Profile / Psychometric validation of the Brazilian version of the Geriatric Institutional Assessment Profile

Resumo Objetivo Avaliar as propriedades psicométricas do instrumento Geriatric Institutional Assessment Profile em uma amostra de enfermeiros brasileiros que atuam em instituições hospitalares. Métodos Estudo metodológico e transversal, realizado em uma amostra de 301 enfermeiros que atuavam na assistência a pacientes de cinco hospitais, localizados nos estados do Piauí e Minas Gerais. Foi utilizada a análise fatorial exploratória com a extração dos fatores pelo método dos componentes principais. Em seguida, aplicou-se a rotação Varimax. Foram avaliados os seguintes constructos correlatos: conhecimento geriátrico (escala Geriatric Nursing Knowledge/Attitudes); um que envolve barreiras institucionais e facilitadores de melhores práticas (escala Geriatric Care Environment) e outro que enfatiza a relação interpessoal e aspectos coordenativos da prática profissional (subescalas Professional Issues). Resultados A análise fatorial exploratória indicou que na versão brasileira da escala Geriatric Nursing Knowledge/Attitudes, 30 itens apresentaram cargas fatoriais adequadas (>=0,40) e definiram seis fatores. O total de variância explicada foi de 40,5%. Na escala Geriatric Care Environment, 28 itens foram adequados e definiram cinco fatores. O total de variância explicada foi de 59,27%. Nas subescalas Professional Issues, 45 itens foram adequados e definiram seis fatores. O total de variância explicada foi de 57,78%. Conclusão A versão brasileira do Geriatric Institucional Assessment Profile é válido e confiável e pode ser aplicada para avaliar as percepções, atitudes e conhecimentos acerca de distúrbios geriátricos mais comuns e identificar as barreiras enfrentadas por enfermeiros no desenvolvimento de uma assistência com qualidade.

Resumen Objetivo Evaluar las propiedades psicométricas del instrumento Geriatric Institutional Assessment Profile en una muestra de enfermeros brasileños que trabajan en instituciones hospitalarias. Métodos Estudio metodológico y transversal, realizado en una muestra de 301 enfermeros que trabajaban en la atención a pacientes de cinco hospitales ubicados en los estados de Piauí y Minas Gerais. Se utilizó el análisis factorial exploratorio con la extracción de los factores por el método de los componentes principales. A continuación, se aplicó la rotación Varimax. Se evaluaron los siguientes constructos correlacionados: conocimiento geriátrico (escala Geriatric Nursing Knowledge/Attitudes); uno que incluye barreras institucionales y facilitadores de mejores prácticas (escala Geriatric Care Environment) y otro que enfatiza la relación interpersonal y los aspectos de coordinación de la práctica profesional (subescalas Professional Issues). Resultados El análisis factorial exploratorio indicó que, en la versión brasileña de la escala Geriatric Nursing Knowledge/Attitudes, 30 ítems presentaron cargas factoriales adecuadas (>=0,40) y definieron a seis factores. El total de varianza explicada fue del 40,5 %. En la escala Geriatric Care Environment, 28 ítems fueron adecuados y definieron cinco factores. El total de varianza explicada fue del 59,27 %. En las subescalas Professional Issues, 45 ítems fueron adecuados y definieron a seis factores. El total de varianza explicada fue del 57,78 %. Conclusión La versión brasileña del Geriatric Institucional Assessment Profile es válida y confiable y se puede aplicar para evaluar las percepciones, actitudes y conocimientos sobre los disturbios geriátricos más comunes e identificar las barreras enfrentadas por enfermeros en el desarrollo de una atención de calidad.

Abstract Objective To evaluate the psychometric properties of the Geriatric Institutional Assessment Profile instrument in a sample of Brazilian nurses working in hospitals. Methods Methodological and cross-sectional study, carried out with a sample of 301 nurses who worked in the care of patients in five hospitals, located in the states of Piaui and Minas Gerais. Exploratory factor analysis was used with the extraction of factors by the mean components' method. Then, the Varimax rotation was applied. The following correlated constructs were evaluated: geriatric knowledge (Geriatric Nursing Knowledge/Attitudes scale); one that involves institutional barriers and facilitators of best practices (Geriatric Care Environment scale) and another one that emphasizes the interpersonal relationship and coordinating aspects of professional practice (Professional Issues subscales). Results Exploratory factor analysis indicated that in the Brazilian version of the Geriatric Nursing Knowledge/Attitudes scale, a total of 30 items had adequate factor loadings (>=0.40) and defined six factors. The total explained variance was 40.5%. In the Geriatric Care Environment scale, 28 items were adequate and defined five factors. The total explained variance was 59.27%. In the Professional Issues subscales, 45 items were adequate and defined six factors. The total explained variance was 57.78%. Conclusion The Brazilian version of the Geriatric Institutional Assessment Profile is valid and reliable and can be applied to assess perceptions, attitudes and knowledge about the most common geriatric disorders and identify barriers faced by nurses in the development of quality care.

Protection against COVID-19 in long-term care facilities and political and technical foundations for operation in Brazil / A proteção em lares de idosos perante a COVID-19 e os fundamentos políticos e técnicos de funcionamento no Brasil

Objective: that aimed to highlight and discuss the contributions of public policies and resolutions to the protection of older people in the qualification of Long Term Care Facilities in Brazil in the face of COVID-19. Method: This is a qualitative document analysis study. Data were collected between August and September 2021 from government websites and the Virtual Health Library database. Results: We analyzed resolutions 216/2004 up to the most recently published resolutions 502/2021, technical notes, and public policies for the older population published between 1994 and 2021, including people residing in long-term care facilities in Brazil. Our analysis indicated that, in order to operate the apparatus of protection and care, councils and Society need to fulfill their roles, aiming at the dignity and quality of life of residents of long-term care facilities. The discussion was conducted in light of the political framework and technical foundations that guide the operation of these facilities. Conclusion: This study highlights the relevance, value, and quality of the area of gerontology, specifically for reflecting on public policies and resolutions so that we have the necessary guidelines for elaborating policies for the long-term care and protection of the health of older adults, which includes a wide discussion on collective housing/lon-term care institutions.

Objetivo: evidenciar e discutir as contribuições para a proteção das pessoas mais velhas frente à COVID-19 a partir das políticas públicas e das Resoluções da Diretoria Colegiada na qualificação das "instituições de longa permanência" no Brasil. Método: Trata-se de um estudo qualitativo do tipo análise documental. A coleta de dados ocorreu de agosto a setembro de 2021 em sites governamentais e nos bancos de dados da Biblioteca Virtual em Saúde. Resultados: Foram analisadas as Resoluções da Diretoria Colegiada 216/2004 até a última publicação, a Resolução da Diretoria Colegiada 502/2021 e as notas técnicas, assim como as políticas públicas para idosos no período de 1994 a 2021 que contemplavam as pessoas residentes em lares de idosos no Brasil. A análise indicou que, para se colocar em prática o aparato de proteção e cuidados, os Conselhos e a sociedade também precisam cumprir com suas funções, visando à dignidade e à qualidade de vida dos residentes em instalações de cuidado de longa permanência. A discussão desenvolveu-se à luz do arcabouço político e dos fundamentos técnicos que orientam o funcionamento dessas instalações. Conclusões: O artigo apontou a relevância, o valor e a qualidade para a área da gerontologia, especificamente para a reflexão sobre as políticas públicas e Resoluções da Diretoria Colegiada para que se tenha as balizas necessárias para a elaboração da política de longa permanência e proteção à saúde dos idosos, o que inclui ampla discussão sobre habitação coletiva/instituições de longa permanência.

Randomized clinical trial of complete denture cleaning methods in residents of care institutions

Aim: To evaluate the efficacy of ultrasonic bath and traditional brushing in the hygiene of complete dentures of dependent residents in long-term care institutions (LTCIs). Methods: A randomized cross-over clinical study was conducted in 17 maxillary complete denture wearers living in LTCIs. Cleaning protocols were brushing or ultrasonic bath, both applied with neutral liquid soap. Biofilm biomass were estimated by MTT reduction assay and specific microbial load (CFU) of Streptococcus spp., Staphylococcus spp. and Candida spp. were quantified by selective and differential culture media. Results: Ultrasound method showed higher percentage reduction of biofilm biomass and specific microbial loads of Streptococcus spp. compared to brushing (p<0.01). Reduction of microbial loads of the other microorganisms were not different between cleaning methods (p>0.05). Conclusions: The ultrasonic bath proved to be a feasible alternative method for the mechanical cleaning of complete dentures in LTCIs

Capacidade funcional de idosos na internação e três meses do pós-alta hospitalar / Measures of functional independence of elderly during and after hospitalization

Objetivo: Avaliar a medida de independência funcional de idosos durante a internação hospitalar e três meses pós-alta hospitalar. Métodos: Estudo transversal, realizado em um hospital privado do Rio de Janeiro, com pacientes sexagenários internados pela equipe de clínica médica, e que receberam alta entre os meses de maio a julho de 2017. Os dados foram coletados por meio de entrevista com o instrumento de avaliação da capacidade para realização das atividades de vida diária (Katz) realizado do momento da internação até 48 horas e três meses pós-alta hospitalar. Acrescido dos instrumentos de caracterização da amostra: estado nutricional (MNA), estado de confusão (CAM), e fragilidades (PRISMA 7), esses realizados somente no momento inicial. Resultados: A média de internação foi de 8,4 dias, sendo que, 96,8% dos pacientes escolhidos para o estudo demonstraram independência funcional no momento da admissão, com declínio de 11,3% após três meses de alta, em sua maioria mulheres com mais de 80 anos. Ressalta-se que 86% dos pacientes monitorados tiveram um PRISMA 7 negativo, e 47% apresentaram risco de desnutrição. Conclusões: Ocorrência de pacientes em risco de desenvolveram perda funcional durante a internação hospitalar persistiu até o 3.o mês da pós-alta hospitalar, principalmente em mulheres com mais de 80 anos. Portanto, é preciso intensificar a prevenção do declínio funcional, constituindo-se uma intervenção importante para profissionais da saúde.(AU)

Objective: To evaluate the functional independence measure of elderly during hospitalization and three months after hospital discharge. Methods: A cross-sectional study, carried out in a hospital in Rio de Janeiro, with sixty-year-old patients admitted by the medical clinic team, who were discharged from May through July 2017. Data was collected through interviews with the instrument for assessing the ability to perform activities of daily living (Katz) performed from the moment of hospitalization to 48 hours and three months after hospital discharge. in addition to that, sample characterization instruments are nutritional status (MNA), confusional state (CAM) and weaknesses (PRISMA 7) that performed only at baseline. Results: The mean hospitalization rate was 8.4 days long, and 96.8% of the patients selected for the study demonstrated functional independence at the time of admission, with a decline of 11.3% after three months of discharge, mostly women over 80 years old. It is noteworthy that 86% of the patients monitored had a negative PRISMA 7, and 47% presented a risk of malnutrition. Conclusions: The occurrence of patients at risk of developing functional loss during hospitalization persisted until the 3rd month after hospital discharge, especially in women older than 80 years. Therefore, it is necessary to intensify the prevention of functional decline, constituting an important intervention for health professionals.(AU)

Evaluación del desempeño de un analizador POCT con relación a los resultados de los métodos convencionales rutinarios del laboratorio clínico en un hogar de ancianos. Cali. 2014 / Performance evaluation of a POCT analyzer in relation to the results of routine conventional clinical laboratory methods in a nursing home. Cali. 2014

RESUMEN Introducción: Los análisis en el sitio de atención (POCT, por sus siglas en ingles Point-of-care testing) son pruebas de diagnóstico clínico llevadas a cabo fuera de los espacios específicamente diseñados para los análisis clínicos, que proporcionan resultados rápidos que mejoran la oportunidad en la toma de decisiones médicas. En Colombia no hay información sobre su uso y desempeño en grupos etarios específicos como los de los hogares de ancianos en Colombia. Objetivo: Evaluar el desempeño de un analizador POCT para perfil lipídico (CT, LDL-c, HDL-c, TG) y glicemia con relación a los resultados de los métodos convencionales rutinarios del laboratorio clínico en un hogar de ancianos. Materiales y métodos: Estudio descriptivo de corte transversal. Se tomaron 52 residentes a quienes se les tomaron muestras pareadas (punción venosa y digital). Se usó un instrumento estandarizado para la descripción de las características deseadas del POCT. Se aplicó estadística univariada y bivariada. Resultados: La edad promedio de los participantes fue de 78, rango 64-91 años. El POCT mostró un desempeño aceptable frente a los métodos convencionales del laboratorio clínico, especialmente TG y HDL-c. Sin embargo, se observaron diferencias estadísticamente significativas en los resultados de glicemia, CT y LDL-c entregados por el POCT en comparación con los del laboratorio clínico. Conclusiones: La POCT puede ser una opción importante para tamizaje y control de enfermedades crónicas en hogares de ancianos. Sin embargo, es necesario una estructura organizacional que garantice la calidad de las mediciones del POCT. MÉD.UIS.2021;34(2): 9-18.

ABSTRACT Introduction: Point-of-care testing (POCT) are clinical diagnostic tests carried out than laboratory analysts, outside of spaces specifically designed for clinical analysis, and they provide quick results that improve the timeliness of medical decision making. In Colombia there is no information on its use and performance in specific age groups such as those in nursing homes. Objective: To evaluate the performance of a POCT analyzer for lipid profile (CT, LDL-c, HDL-c, TG) and glycemia in relation to the results of routine conventional methods of the clinical laboratory in a nursing home. Materials and methods: Descriptive cross-sectional. 52 residents were taken to whom paired samples were applied. Glucose and lipid levels were determined. Samples collected by fingerstick were analyzed by POCT and venipuncture by conventional methods certified by the CDC in the laboratory. A standardized instrument was used to describe the desired characteristics of the POCT. Univariate and bivariate statistics were applied. The results issued by the clinical reference laboratory were compared with those of the POCT through the ICC. Results: The average age of the participants was 78, range 64-91 years. The POCT showed an acceptable performance compared to conventional clinical laboratory methods, especially TG and HDL-c. However, statistically significant differences were observed in the results of glycemia, CT and LDL-c delivered by the POCT compared to those of the clinical laboratory. Conclusions: POCT can be an important option for chronic disease screening and management in nursing homes. However, an organizational structure is necessary to ensure the quality of the POCT measurements. MÉD.UIS.2021;34(2): 9-18.

Use of healthcare services and therapeutic measures associated with new episodes of acute low back pain-related disability among elderly people: a cross-sectional study on the Back Complaints in the Elders - Brazil cohort

ABSTRACT BACKGROUND: Patients with low back pain frequently undergo a variety of diagnostic and therapeutic interventions, but some of these have uncertain effectiveness. This highlights the importance of the association of healthcare services and therapeutic measures relating to disability. OBJECTIVE: To analyze the use of healthcare services and therapeutic measures among Brazilian older adults with disability-related low back pain. DESIGN AND SETTING: Observational cross-sectional study on baseline assessment data from the Back Complaints in the Elders - Brazil (BACE-B) cohort. METHODS: The main analyses were based on a consecutive sample of 602 older adult participants in BACE-B (60 years of age and over). The main outcome measurement for disability-related low back pain was defined as a score of 14 points or more in the Roland Morris Questionnaire. RESULTS: Visits to doctors in the previous six weeks (odds ratio, OR = 1.82; 95% confidence interval, CI 1.22-2.71) and use of analgesics in the previous three months (OR = 1.57; 95% CI 1.07-2.31) showed statistically significant associations with disability-related low back pain. The probability of disability-related low back pain had an additive effect to the combination of use of healthcare services and therapeutic measures (OR = 2.57; 95% CI 1.52-4.36). The analyses showed that this association was significant among women, but not among men. CONCLUSIONS: Occurrence of the combined of consultations and medication use was correlated with higher chance of severe disability among these elderly people with nonspecific low back pain. This suggested that overuse and "crowding-in" effects were present in medical services for elderly people.

The role of Clinical-Functional Vulnerability Index-20 to detect quality of life in older adults assisted in primary care

SUMMARY OBJECTIVE: To determine the cutoff point of the Clinical-Functional Vulnerability Index-20 to detect poor quality of life in the elderly in Primary Health Care. METHODS: This cross-sectional study was carried out in Primary Health Care units of Ceilândia (DF, Brasil) between September 2019 and January 2020. Four hundred and fifty-eight individuals were included in the study and answered the Clinical-Functional Vulnerability Index-20 (IVCF-20) and the World Health Organization Quality of Life - WHOQOL-BREF (validated to access quality of life) instruments. Based on the WHOQOL-BREF answers, three subgroups were created: poor, good and undetermined quality of life. The receiver operating characteristic curve (using Youden index) showed the IVCF-20 cutoff point to detect poor quality of life (in individuals with good quality of life as the Control Group), and therefore diagnostic tests were performed. RESULTS: The IVCF-20 cutoff point to detect poor quality of life was ≥11. The area under the receiver operating characteristic curve was 0.97 (95%CI 0.95-0.98). The IVCF-20 diagnostic tests showed good sensitivity (88.1%) and specificity (84.9%). CONCLUSIONS: The IVCF-20 ≥11 detected poor quality of life adequately in the elderly in Primary Health Care. These data suggest that elderly individuals with IVCF ≥11 should attend appointments more often in Primary Health Care or geriatrics collaborative care, considering the impact that quality of life can have on the elderly population's mortality.