BACKGROUND: Polypharmacy can be defined quantitatively or qualitatively. One of the concepts underlying the quantitative definition of polypharmacy is the use of two or more medications. The qualitative definition, in turn, takes into account the rationalization of pharmacotherapy.
OBJECTIVES: Based on these two concepts, this study aimed to determine the prevalence of polypharmacy in older adults with dementia and correlate it with sociodemographic, clinical, and pharmacological characteristics.
METHODS: A cross-sectional study was conducted in a center of excellence for dementia care in the Federal District, including 97 older adults with a diagnosis of Alzheimer dementia. Prevalence rates were determined for quantitative and qualitative polypharmacy. The presence of polypharmacy was correlated with the characteristics of the sample by univariate analysis. Descriptive statistics were calculated for all dependent and independent variables. The correlation between secondary variables and polypharmacy was determined by prevalence ratio. Univariate analysis was performed using the following statistical tests: Pearson’s χ2 test, Kruskal-Wallis test, and Wilcoxon-Mann-Whitney (WMW) test.
RESULTS: The prevalence of quantitative polypharmacy was 92.8%, of which 37.2% were characterized as minor, 25.8% as moderate, and 29.8% as major. The prevalence of qualitative polypharmacy was 49.5%. Sociodemographic and clinical characteristics were not associated with quantitative or qualitative polypharmacy.
CONCLUSION: Both quantitative and qualitative polypharmacy were highly prevalent among older adults with dementia. The delivery of multidisciplinary care to older outpatients through a methodology that identifies and characterizes polypharmacy both quantitatively and qualitatively seems to be a useful tool to promote the rational use of medications.
Keywords: aged; health of the aged; Alzheimer disease.
OBJECTIVE: To understand possible sociodemographic, economic and health differences between older rural and urban Brazilians participating in the 2013 National Health Survey (Pesquisa Nacional de Saúde).
METHODS: A cross-sectional study was conducted with a secondary analysis of data from 11,177 elderly individuals. The dependent variable was place of residence (rural or urban), and the independent variables were sociodemographic characteristics (age group [age 60 to 79 or 80 years and older], gender, race, municipality and socioeconomic condition) and clinical characteristics: private health plan, enrollment in the Family Health Strategy program (Estratégia Saúde da Família) and self-perceived health. Associations between dependent and independent variables were assessed using the χ2 test, with p < 5% considered significant.
RESULTS: Except for age group, all other sociodemographic and clinical characteristics were significantly associated with place of residence (p < 0.0001). Rural participants were more frequently: male, mixed race, married, illiterate, non-capital residents, with a lower socioeconomic level, better Family Health Strategy coverage, were less likely to have private health insurance. The self-perceived health of urban elderly was more frequently very good, good or very poor (p <0.0001).
CONCLUSIONS: Older individuals in rural areas had less favorable sociodemographic and clinical characteristics than those in urban areas, which contradicts international studies. These findings should stimulate further research to fill gaps in the literature regarding the rural elderly.
Keywords: rural population; urban population; aged; health services research.
OBJECTIVE: This study sought to investigate the association between social capital and the use of health services among Brazilian non-institutionalized older adults living in an urban metropolitan area.
METHODS: The sample was comprised of 2,052 respondents aged 60 or older. Individual Social Capital was measured by The World Bank Integrated Questionnaire (IQ-MSC) dichotomized in “low” and “high” social Capital. Use of health services, community engagement, familiar functionality, and social demographics were assessed.
RESULTS: Individuals who belonged to the low social capital group were 73% more likely to have a medical appointment in the 6 months previous to the interview [OR = 1.76; 95%CI 1.19–2.52] compared to the high social capital group. In the opposite direction, individuals who belonged to the low social capital group were 29% less likely to have a dental appointment regularly [OR = 0.71; 95%CI 0.51–0.98], were 88% less likely to be engaged in community projects [OR = 0.12; 95%CI 0.09–0.15], and 42% less likely to have a good familiar functionality [OR = 0.58; 95%CI 0.37–0.88], compared to the older adults who had high levels of social capital.
CONCLUSION: Individual low social capital affected the pattern that older adults used health services in the investigated population differently
Keywords: social capital; aging; social determinants of health.
INTRODUCTION: Patients indicated for palliative care may have losses in functional capacity and quality of life, but there is little information about these conditions in primary health care.
OBJECTIVE: To characterize the functional and symptomatic aspects of individuals indicated for palliative care in primary care. METHODS: This cross-sectional descriptive study involved six family health teams from three basic health units in Londrina, Paraná, Brazil that indicated patients with palliative care needs. The patients were assessed with the Karnofsky Performance Scale (KPS), the Edmonton Symptom Assessment Scale (ESAS) and a sociodemographic and clinical questionnaire.
RESULTS: 73 patients (30 men and 43 women) whose mean age was 77.2 ± 12.1 years were included. Dementia and cerebrovascular diseases were the most frequent conditions, with 20 (27%) and 19 (26%) patients, respectively. The mean KPS score was 47.9 ± 13.9 points (44 ± 11.3 points for men and 51 ± 11.3 for women), with a significant difference between the sexes (p = 0.023). Cancer patients had better functionality than those with neurological diseases. The ESAS, whose mean score was below 3 points (mild intensity), indicated that the most frequent symptoms were impaired well-being, pain, fatigue and drowsiness. Patients without caregivers had better functional status, but greater pain and fatigue intensity.
CONCLUSION: All patients had some functional limitations, and those with neurological diseases were the most affected. The symptoms were generally mild. The presence of caregivers may positively influence symptom control.
Keywords: primary health care; palliative care; frail elderly; disabled persons; quality of life.
OBJECTIVE: To identify nursing students' attitudes toward older people.
METHOD: Second-year undergraduate nursing students were invited to complete a questionnaire at the beginning of the geriatric nursing curricular unit. A quantitative study was conducted by administering the validated Portuguese version of Kogan's attitudes toward old people scale (KOAP).
RESULTS: The sample included 39 students who answered the data collection instrument. The mean KOAP score was 135.56, which was slightly above the median value (119). No statistically significant relationships were found between any of the variables: gender, age, experience with older people, and living with older people.
CONCLUSIONS: The nursing students' mean score for attitude toward older people was slightly positive, which could serve as a starting point for the development of an intervention to modify their attitudes with respect to aging.
Keywords: aged; attitude; geriatric nursing; students, nursing.
OBJECTIVE: To conduct an integrative literature review on epidemiology of falls in older adults in Brazil, seeking to identify occurrence rate, recurrence, and potentially modifiable factors associated with these events.
METHOD: This literature review consisted of searching the Medical Literature Analysis and Retrieval System Online (MEDLINE), Scientific Electronic Library Online (SciELO), and Latin American and Caribbean Center on Health Sciences Information (LILACS) databases for scientific articles on November 14, 2017. The following keywords were used for finding articles: “accidental falls,” AND/OR “elderly,” AND/OR “Brazil.” Epidemiological data were collected from primary studies and then compared.
RESULTS: Thirty-five studies were selected. Most of them were performed in the Brazilian Southeast (15) and South (11) regions. The occurrence rate of falls ranged from 10.7 to 59.3%. The most common setting for falls was the home during daytime. The most commonly described circumstances were tripping, slipping, dizziness, and uneven flooring, resulting in falling from one's own height. The factors most frequently associated with falls were female sex, age greater than 80 years, cognitive impairment, and depressive symptoms. The reported consequences were fractures and fear of falling again.
CONCLUSION: As some factors associated with falls in older adults in Brazil are modifiable, fall prevention may reduce morbidity and mortality in this population.
Keywords: accidental falls; aged; Brazil; epidemiology.