Functional decline in nursing home residents: A prognostic study.

AIM: To verify the probability of maintaining functional capacity in basic activities of daily living and identify the prognostic factors of functional decline in institutionalized older adults. METHODS: A longitudinal study is presented herein, with 5 waves every 6 months, throughout 2 years (2013-2015), conducted with individuals ≥60 years old in 10 nursing homes in the city of Natal-RN (Brazil). Functional capacity was assessed by the items 'eating', 'personal hygiene', 'dressing', 'bathing', 'transferring', 'toileting' and 'walking', through a 5-item Likert scale. Sociodemographic, institution-related and health-related variables were considered to establish the baseline. Time dependent variables included continence decline, cognitive decline, increase in the number of medication, and incidences of falls, hospitalizations and fractures. The actuarial method, the log-rank test and Cox's regression were applied as statistical methods. RESULTS: The cumulative probability of functional maintenance was 78.2% (CI 95%: 72.8-82.7%), 65.1% (CI 95%: 58.9-70.5%), 53.5% (CI 95%: 47.2-59.5%) and 44.0% (CI 95%: 37.7-50.2%) at 6, 12, 18 and 24 months, respectively. Predicting factors for functional decline were: severe cognitive impairment (HR = 1.96; p = 0.001), continence decline (HR = 1.85; p = 0.002) and incidence of hospitalizations (HR = 1.62; p = 0.020), adjusted by the incidence of depression, age, education level, presence of chronic diseases and low weight. CONCLUSIONS: The cumulative probability of maintaining functional capacity in institutionalized older adults was only 44% at the 2-year follow-up. Prognostic factors for functional decline included severe cognitive impairment, continence decline and incidence of hospitalizations.

Dynamics of activities of daily living performance in institutionalized older adults: A two-year longitudinal study.

BACKGROUND: It is fundamental to analyze the evolution of functioning for the planning of strategies aimed at preventing or delaying dependency. However, there is a lack of studies focused on the evolution of functional performance in institutionalized older adults in Latin America. OBJECTIVE: Verify the incidence of functional decline, functional maintenance and functional improvement in the basic activities of daily living (BADL) in institutionalized older adults, as well as analyze the evolution of functional performance. METHODS: A two-year, five-wave longitudinal study is presented herein, with assessments applied every 6 months, carried out in residents of 10 nursing homes in the city of Natal-RN (Brazil). The items 'eating', 'personal hygiene', 'dressing', 'bathing', 'transferring' and 'walking' were assessed by a 5-points Likert scale. Sociodemographic, institution-related and health-related variables were considered for descriptive analyses. RESULTS: The sample consisted of 280 older adults, of which 150, 53.6% (95% CI: 47.7-59.3%) experienced decline, 94, 33.6% (95% CI: 28.3-39.3%) maintained functional performance, 40, 14.3% (95% CI: 10.7-18.9%) presented improvement at least in one assessment, and only 18 (6.4%; CI 95%: 4.1-9.9%) improved functional performance with no decline over the period. 'Eating' presented the highest decline (-0.54 points), followed by 'walking' (-0.43), 'dressing' (-0.35) and 'transferring' (-0.31). The BADL that suffered less decline were 'toileting' (-0.22), 'personal hygiene' (-0.24) and 'bathing' (-0.29). CONCLUSIONS: Half of institutionalized older adults experienced functional decline and less than 15% improved functional performance. 'Eating' suffered the most pronounced decline, followed by mobility and self-care activities.

Activity Limitations in Brazilian Institutionalized Older Adults.

BACKGROUND AND PURPOSE: Although functional assessments and programs to prevent activity limitations are fundamental for efficient geriatric evaluations and interventions, these procedures have not been satisfactorily explored at nursing homes in Brazil. Literature is scarce on the evaluation of disability in Brazilian institutionalized older people. METHODS: A cross-sectional study was conducted in 10 nursing homes in the city of Natal (Northeast Brazil). Sociodemographic and health data were collected and activity limitations were assessed by the Katz Index. RESULTS AND DISCUSSION: The prevalence of activity limitations was 72.9% (95% confidence interval: 67.8-77.5) and the most affected activity was "bathing" (71.6%), followed by "dressing" (65.4%) and "toileting" (62.0%). The final model revealed associations with private (for-profit) institutions (odds ratio [OR] = 3.33; P < .001), age ≥ 83 years (OR = 2.34; P = .003), institutionalization due to lack of caregiver (OR = 1.80; P = .033), and presence of osteoporosis (OR = 2.94; P = .045), adjusted by sex. CONCLUSIONS: Activity limitations affected almost 73% of institutionalized older people in this sample and were associated with private nursing homes, age, osteoporosis, and institutionalization due to lack of caregiver. Activity limitations exact high socioeconomic impacts and affect the quality of life of older people. The results obtained herein emphasized the importance of planning strategies for their prevention and treatment, directed to reduce the prevalence of this health issue.

Endoscopic surgery of nasopharyngeal angiofibroma.

UNLABELLED: Nasopharyngeal angiofibroma is a vascular benign tumor that affects young men, and surgery is the treatment of choice. Endoscopic surgery has been used to excise tumors in their initial stages, when there is no evidence of residual or recurrent disease. AIM: The aim of this study is to evaluate the endoscopic approach preceded by tumor embolization as treatment option for stages II to III angiofibroma. Treatment morbidity was evaluated through: surgery duration, hospital stay after surgery, the need for blood transfusion, complications, the time span between preoperative embolization and surgery, and tumor recurrence. METHODS: A prospective study was carried out with nine patients treated at the Fortaleza General Hospital SESA/SUS from October 2001 through November 2004. CONCLUSION: Based on the results, we may conclude that the endoscopic approach, when preceded by embolization, is effective to treat angiofibromas in their initial stages, with reduced postoperative morbidity.