INTRODUCTION: The increase in the world’s elderly population in recent decades calls for research on quality of life during the aging process. Heart rate variability (HRV) evaluates the modulation of the autonomic nervous system (ANS) and indicates the heart’s ability to respond to multiple physiological and environmental stimuli, as well as to disease.
OBJECTIVE: To investigate the perceived quality of life of older people and its association with HRV.
METHOD: Twenty-nine subjects (69 ± 7.76 years) were selected at a preventive medicine center and completed a questionnaire (World Health Organization quality of life assessment — old module: WHOQOL-OLD). The HRV data were collected for 20 minutes in the supine position using a Polar RS800CX frequency meter.
RESULTS: Using the median value as a cut-off point, the sample was divided into two groups: WHOQOL-OLD ≥ 92 (n = 15: better quality of life) and WHOQOL-OLD ≤ 91 (n = 13; lower quality of life). For the HRV time-domain variables RMSSD and pNN50, there were higher values in the WHOQOL-OLD ≥ 92 group (p = 0.0413 and p = 0.0222, respectively). For the frequency-domain variables, low-frequency (LF), high-frequency (HF) and Total Power, there were also higher values in the WHOQOL-OLD group ≥ 92 (p = 0.0195, p = 0.0170 and p = 0.0287, respectively). The non-linear variable SD1 was significantly higher in the WHOQOL-OLD ≥ 92 group (p = 0.0413), while DET% was significantly higher in the WHOQOL-OLD ≤ 91 group (p = 0.0253).
CONCLUSIONS: Better quality of life in older adults is associated with normal ANS function, represented by higher values found through three HRV analysis methods. This indicates the importance of a healthy lifestyle for healthy aging, which includes improvement in autonomic function and, consequently, quality of life.
Keywords: aging; quality of life; autonomic nervous system.
OBJECTIVE: This study aimed to describe the clinical judgment of nurses in fall risk assessment for hospitalized older adults.
METHOD: This exploratory, descriptive study with a qualitative approach was conducted in Unified Health System hospitals in Cuiabá, MT, Brazil. A total of 18 nurses in medical and surgical clinics participated. The data were collected from March to August 2013 using a semi-structured interview and were assessed through thematic analysis based on Tanner’s clinical judgment model (2006).
RESULTS: Fall risk evaluation in older adults is performed unsystematically and superficially. The nurses considered the most appropriate time to collect data and assess the fall risk of older patients to be at patient admission, although shift changes, patient visits, conversations or information exchange with hospital reception staff contributed. Although the signs or factors of patient fall risk were identified, inferences were produced and opinions were issued, the inferences were not validated.
CONCLUSIONS: The two initial stages of CJ — recognition and interpretation — are unsystematic, incomplete and inconsistent, which can lead to inaccurate assessment of fall risk among hospitalized older adults.
Keywords: fall accidents; older adult health; judgment.
AIM: Acute care has some complications in the older adult, a frequently overlooked complication is caregiver burden. Scarce information is available on this matter. Therefore, the objective is to describe the factors associated with caregiver burden at the moment of discharge of a hospitalized older adult, in the Mexican healthcare context.
METHOD: This is a secondary analysis of a hospital. Bivariate and multivariate analyses were performed with caregiving burden (measured with the Zarit scale) as the dependent variable. Other variables were tested in order to assess their association with caregiver burden: sociodemographic, health-related, depression, functionality, social support and hospital length of stay, caregiver expenses, quality of life and satisfaction with received care.
RESULTS: A total of 111 older adults with their respective caregivers were assessed. From this sample, the mean age for older adults was 73 years (± standard deviation 7.9 years) and 65.7% (n = 73) were women. Caregiver burden was present in 39.6% (n = 44) of the individuals. Regarding the multivariate analyses, the only variable independently associated with caregiver burden was depression in the older adult, odds ratio 1.12 (95% confidence interval 1–1.25, p = 0.045).
CONCLUSIONS: In concordance with previous work on this matter, according to our results depression in the older adult was a trigger of caregiver burden at discharge of acute care.
Keywords: caregivers; aged; geriatric assessment; depression.
OBJECTIVE: To evaluate hyponatremia in older patients during hospital stay and determine its association with polypharmacy, length of hospital stay, and mortality.
METHOD: This was an observational, analytical, cross-sectional study of patients aged 65 years and older during hospitalization. The first sodium sample requested by the physician was considered for analysis. Hyponatremia was classified according to severity as mild (130–135 mEq/L), moderate (125–129 mEq/L), or severe (< 125 mEq/L) and according to osmolarity as isotonic (275–295 mOsm/L), hypotonic (< 275 mOsm/L), or hypertonic (> 295 mOsm/L). The χ2 test and oneway analysis of variance followed by Tukey’s post hoc test were used to analyze length of hospital stay between the groups (normonatremia and mild, moderate, and severe hyponatremia). The χ2 test was also used to compare mortality between the groups.
RESULTS: We included 174 patients, with a mean age of 74 (SD, 7; range, 65–95) years; 52.3% were men. Overall, 44.8% had normonatremia, 37.8% had mild hyponatremia, 9.2% had moderate hyponatremia, and 8.0% had severe hyponatremia. Increased hospital stay was observed in patients with hyponatremia, being longer in those with severe hyponatremia. Polypharmacy occurred in 39.3% of patients. Of patients with severe hyponatremia, 71.4% had polypharmacy (p = 0.01). CONCLUSIONS: Hospitalized older adults showed a high rate of hyponatremia and an important association with polypharmacy and prolonged hospital stay.
Keywords: hyponatremia; length of stay; health of the elderly.
INTRODUCTION AND OBJECTIVE: Despite a great interface between palliative care (PC) and geriatrics, there are currently no curriculum proposals of palliative medicine (PM) competencies for geriatricians in Brazil. Thus, the aim was to develop a competency framework of palliative medicine for geriatricians (CFPMG), especially for those under training.
METHOD: The first phase consisted of preparing a pilot framework. To reach a consensus, geriatricians with expertise in the field of PM from all Brazilian regions were invited to express their opinions on the competencies listed in the pilot framework. A modified Delphi method was used in the 2nd and 3rd phases to obtain a consensus (level of agreement greater than 50% and 80%, respectively). Finally, a public consultation phase was conducted in the 21st Brazilian Congress on Geriatrics and Gerontology, and via Brazilian National Academy of Palliative Care website.
RESULTS: Nineteen experts in PM and geriatrics evaluated the CFPMG. The level of agreement in all thematic areas was greater than that required, except for palliative sedation (20% of disagreement). The CFPMG concluded with 13 thematic areas and 105 competencies, including 11 prerequisite, 52 core, 24 desirable, and 18 advanced competencies.
CONCLUSION: The defined competency framework of PC may be integrated into medical education, specifically into geriatric medicine training. Our suggestion is that residency programs in geriatrics provide training at least in the core competencies from the proposed thematic areas, thereby strengthening PC education homogeneously across the country.
Keywords: competency-based education; palliative care; geriatrics.
Posterior reversible encephalopathy syndrome (PRES) is a disease rarely described in older adults. It is characterized by subacute onset of a set of clinical and radiological signs and a variety of neurological symptoms, such as headaches, seizures, and cognitive disorders. In the vast majority of patients, clinical presentation includes high blood pressure and hypertensive emergency. Magnetic resonance imaging (MRI) is the gold standard for diagnosing this condition using imaging findings. When the underlying cause is promptly recognized and treated, symptoms and imaging abnormalities may be completely reversible. The authors report the clinical case of an 87-year-old woman first admitted for treatment of community-acquired pneumonia. She returned to the emergency department 24 hours after discharge presenting with complex visual and neurological symptoms. An MRI scan showed lesions of bilateral occipital hypodensities, suggestive of vasogenic edema and compatible with PRES. Complete regression of brain lesions was observed after tight control of hypertension.
Keywords: posterior leukoencephalopathy syndrome; hypertension; magnetic resonance imaging.
The objective of this study was to present the main factors responsible for falls in older adults, measures for assessing risk, and prevention strategies. This is a qualitative study, developed from the international and national gerontology literature. Two models were created, one including the main fall risk factors and another including common assessment and prevention measures. Five types of intervention procedures were identified: educational, physical, cognitive, exergames and exercise programs. It was concluded that early identification of fall risk is important. The most appropriate intervention methodologies for preventing falls in the elderly include periodic dual and multi-task physical training followed by educational measures. In addition, exercise programs and exergames are effective in preventing falls, especially in congregate housing.
Keywords: aging; risk factors; health of the elderly; strategies.
INTRODUCTION: People with Parkinson’s disease (PD) usually have one side of their bodies more affected than the other. Our hypothesis is that unilateral resistance training (RT) may cause changes in motor control and strength of the most affected side when compared with bilateral RT.
OBJECTIVE: To investigate the effects of unilateral vs bilateral RT on motor control and strength in individuals with PD.
METHOD: The sample consisted of 17 individuals diagnosed with PD, who were randomly divided into unilateral training group (UTG) (n = 9) and bilateral training group (BTG) (n = 8). In total, 24 RT sessions were performed. The first six training sessions were focused on training familiarization. Before (T0), during (T12), and after (T24) the intervention, the following data were collected: fine motor control using the Nine-Hole Peg test and the Box and Blocks test; upper limb strength using a handgrip strength dynamometer; and lower limb strength using an isokinetic dynamometer. All tests were performed unilaterally. For statistical analysis of data, the Friedman analysis of variance (ANOVA) [3 (TIME) × 4 (GROUP)] was used, as well as the Mann-Whitney U test and the Wilcoxon test.
RESULTS: Peak torque at 60°/s on the right side at T12 in UTG was significantly higher compared with BTG. Peak torque on the right side was significantly lower at T24 compared with T12 and TO in UTG.
CONCLUSION: Short-term unilateral RT was inefficient at causing changes in motor control and strength in the limb most affected by the disease through cross-education and was unable to reduce bilateral deficit.
Keywords: motor skills; muscle strength; exercise; resistance training; neurotransmitters; quality of life.