OBJECTIVE: The following study aimed to characterize the epidemiological profile of elderly people included in the Elderly People Accompanying Program (Programa Acompanhante de Idosos - PAI) of the Health Department of the city of Sao Paulo.
METHOD: We conducted a cross-sectional survey. The sample consisted of 100 elderly people of both sexes, aged 60 years or older, living in São Paulo, assisted by the PAI Program at a Basic Health Unit in São Paulo city. A formulary was filled with socio-demographic, health and leisure data in order to delineate the epidemiological profile of the population studied. This paper was submitted to the Research Ethics Committee of the Department of Health of the city of Sao Paulo, obtaining its assent.
RESULTS: Regarding socio-demographic data, we found a prevalence of elderly octogenarians (52%), women (74%), widows (47%), Catholic (81%), elementary level of education (37%), with no caregivers (78%) and who did not live alone (76%). Leisure activities were carried out by 86% of the population. Regarding health data, 72% were not hospitalized during the previous year, and the prevalence of chronic degenerative diseases was of 100%. Mild functional dependency was present in 42%; those with total autonomy were 56%, and 95% had a simple care plan.
CONCLUSIONS: We concluded that the elderly studied were octogenarians, mostly female, with low level of education, with total autonomy, although 42% had mild functional dependence characterizing a profile of active aging.
Keywords: Elderly, epidemiology, caregivers, health of the elderly.
OBJECTIVE: The present study aimed to evaluate the condition of an elderly population included in the Family Health Program regarding the incidence of the disease.
METHODS: A hundred eighteen elderly people were evaluated at Rebouças Macambira Family Healthcare Center; they were divided into age groups of 60-70 years old, 71-80 years old, and above 80 years old, within April-May 2008. The research was conducted through a clinical review, followed by a basic physical examination, extra laboratory tests available at the Unified Health System (SUS), and questionnaires, which gave information about the mental state, cognition, temporal and spatial orientation of each patient. Immediate memory, recall memory, reasoning ability, judgement, attention to language and calculations, mood and behavior changes were features evaluated.
RESULTS: In the group studied it was observed that, among the elderly people aged 60 to 70 years, 7.7% had a probable diagnosis of Alzheimer's disease, 30.7%, a possible diagnosis; among the elderly in the range of 71 to 80, 23% had probable diagnosis, and 23% had a possible diagnosis. Among the group of patients over 80 years old, 36.3% had a diagnosis of probable Alzheimer's disease and to 27.4%, possible diagnosis.
CONCLUSION: The number of cases of this disease increased with age, and the number of cases of patients not suffering from Alzheimer's disease decreased with age.
Keywords: Disease, Alzheimer, elderly, Family Health strategy.
OBJECTIVE: The aim of this study was to evaluate health self-perception (HSP) and the socio-demographic and clinical characteristics in a group of elderly people attending activity groups at Regional Norte in the city of Belo Horizonte, in the state of Minas Gerais, and to verify the correlation with the frailty phenotype.
METHODS: Elderly people (65 years old or more) attending the groups, with no distinction of race, gender or social class. Those with dependent gait, visual, hearing or phonatory deficits, neurological diseases, pain, cognitive dysfunctions (MMSE) were excluded. The sociodemographic and clinical variables and HSP were informed during the interview. The frailty phenotype was identified with the presence of: weight loss; slow walking speed; low physical activity; low grip strength, and exhaustion. The statistical analysis was done by descriptive and frequencies analyses, and the association was made with chi-square test (α = 5%).
RESULTS: Seventeen hundred elderly people participated (70 ± 7.2 years old). The characteristics were: women (86.3%); widows (48.7%); low educational level (84.0%); low income (91.4%), sedentary (58.9%), with associated chronic diseases (92.0%), polipharmacy (23.0%) and over weight (68.0%). Most of participants classified their own health as "good/ very good" (58.1%). Pre-frail individuals were 51.2%, 41.8% were not frail and 6.8% were frail. The frailty phenotype was associated with HSP (p = 0.01) and irregularity of physical activity (p = 0.01). Other associations were not observed (p >0.05).
CONCLUSION: Most of the participants of the activity groups of Regional Norte in BH/MG were women, widows, sedentary, overweight, not old, with low educational level and incomes, and with high arterial blood pressure. The pre-frail individuals were most prevalent, with most of them showing good health self-perception.
Keywords: Frail elderly, health profile, demographic aging.
OBJECTIVES: To analyze the contribution of faith influence on the depressive symptoms in caregivers of patients with Alzheimer's disease.
METHODS: Cross-sectional study with 24 subjects of both sexes, with schooling over five years, ages from 26 to 70 years and attending caring for the elderly courses in the city of Jundiaí. A questionnaire was developed with information about affective, emotional and religious issues. Besides this instrument, caregiver burden was evaluated with the short Zarit Scale and Geriatric Depression Scale (GDS). Spearman correlation coefficient was used to correlate the GDS with age, marital status and Zarit Scale.
RESULTS: The mean score on Zarit scale was 14.24 points, indicating light overburden. The average score of the GDS was 3.38 points which did not score for depressive syndrome. There was a negative, moderate, and no significant correlation coefficient between age and the GDS variable (r = -0.38; p = 0.065) and the Zarit Scale (r = -0.46; p = 0.062). The correlation coefficient (moderate and positive) showed a trend to significance between the Zarit Scale and GDS (r = 0.48; p = 0.051). A hundred percent of the participants confirmed they have faith, 69.56% reported to have experienced faith as a support to face Alzheimer's negative symptoms during patient's care.
CONCLUSION: Caregivers and palliative patients use faith as an aid to face everyday weariness. It can be concluded that spirituality seems to improve the ability to deal with the incurable disease condition.
Keywords: Spirituality, faith healing, elderly, Alzheimer's disease.
The incidence of venous thromboembolism increases with age. The presence of risk factors for venous thromboembolism is the initial condition for the establishment of clinical suspicion and proper prophylaxis.
OBJECTIVE: To identify future risk to venous thromboembolism, according to the characteristics of each person at the geriatric ambulatory, and to evaluate the need for more active prevention.
METHOD: QThrombosis questionnaire was applied, which was developed and validated by University Park, Nottingham, UK, in the Division of Primary Care, and published in the British Medical Journal in 2011, with a review of medical records, calculating thus the absolute risk of venous thromboembolism.
RESULTS: We evaluated 160 records, including 119 women and 41 men, mean age 76.4. We observed that most patients are in the range of 0-0.5% of risk in year one, and 1.1 to 5.0% in year five. No one had risk greater than 10% in one year, and in five years we found that 1.25% of patients have a risk greater than 10%, with confidence interval of this percentage being between 0.15% and 4.44%.
CONCLUSION: Aging involves changes that may increase the risk of venous thromboembolism. When assessing this population, we identified that the average risk for venous thromboembolism within 1 year and 5 years does not warrant systematic implementation of clinical preventive services for venous thromboembolism. The recommended approach is to individualize each case, since the event of venous thromboembolism is serious and potentially fatal, and can cause much harm to the patient, impacting his/her way of life.
Keywords: Venous thromboembolism, elderly, risk.
OBJECTIVE: To compare nutrients in the menu offered for the elderly people of a long-term care institution with Dietary Reference Intakes (DRIs).
METHODS: A cross-sectional and quantitative identification of the menus during 31 days in October 2011. The amount of food per capita was analyzed in all the meals. We analyzed the menus of the general diet, alone, with a meal supplement, and with fiber supplementation. For the nutrients analysis, data sheets and the centesimal analysis were prepared for all the food made.
RESULTS: The caloric distribution of macronutrients in the general diet, and the general diet with fiber supplementation were in the recommended range. Micronutrients, such as vitamin A, vitamin C, vitamin E, manganese and iron, were satisfactory, above references. Vitamin D, potassium, pantothenic acid and fiber, when analyzed only in the general diet, were below the recommendations. However, with the addition of a meal supplementation and a fiber supplementation the recommendations were reached. Calcium in the general diet showed a lower value than what is recommended. In the diets with a fiber or a meal supplementation its raise was significant. Sodium presented values above the references in all types of meals.
CONCLUSION: The general diet menu alone was not sufficient to reach all the nutritional recommendations. However, when there is a meal or a fiber supplementation, what is offered fits the recommendations. A greater supply of calcium-rich food and a reduction in food with high sodium are also recommended.
Keywords: Services for the elderly, menu planning, nutrition policy.
OBJECTIVES: The main aim of this study is to identify alterations in the swallowing process, mostly found in Alzheimer's
disease subjects, through Videofluoroscopy exam.
METHODS: The data have been collected from the data bank of the Speech Pathology Section in HCPF hospital, from June/07 to February/11. Twenty-four exams were selected with Alzheimer's disease being the basic pathology. The exams were performed offering liquid and pasty consistencies to the subjects, and then analyzing oral and pharyngeal phases in the lateral position.
RESULTS: From the 24 exams with pasty consistency, 4 (16.7%) did not swallow, and 2 (8.3%) presented great difficulty to swallow this consistency; thus, 18 subjects (75%) underwent the exam with both consistencies. In the swallowing oral phase, 17 subjects (94.4%) presented more alterations in the reduction of undulatory movement of the tongue (UMT) with liquids, and 23 subjects (95.8%) with pasty food. In the pharyngeal swallowing phase with liquids the main alterations were in the residues in phraryngeal recess in 18 subjects (100%), and in the swallowing with pasty consistency the more common alterations were swallowing reaction and residues in phraryngeal recess in 19 subjects (95%).
CONCLUSION: The results found allow us to evidence that the mostly significant alterations in the swallowing function on patients with Alzheimer's disease are presented in the oral phase, when most subjects keep the substance in the oral cavity for a long period of time, allowing early posterior escape to the pharynges, being followed by late swallowing reaction and consequently, residues in phraryngeal recess.
Keywords: Alzheimer's disease, swallowing, dysphagia.
OBJECTIVE: To identify changes in the swallowing process, found in subjects with Parkinson's disease through a Videofluoroscopy test.
METHODS: Twenty Viodeofluoroscopy tests of subjects with Parkinson's disease were analyzed. The subjects were patients of a well-known hospital in the city of Passo Fundo, in the state of Rio Grande do Sul. The oral and pharyngeal phases of swallowing liquid and pasty food were analyzed with barium enema.
RESULTS: From the 20 individuals analyzed in the oral phase, 9 had the Oral Transit Time increased; 14 subjects showed residues present in the Oral Cavity and 16 subjects showed early posterior escape. In the pharyngeal phase 16 subjects had a delayed reaction in swallowing; 17 subjects showed increased pharyngeal transit time. Regarding the degree of dysphagia, most of them presented a moderate degree.
CONCLUSION: The swallowing of the patients with Parkinson's disease, both in the oral and pharyngeal phase, presented a significant change, consistent with moderate dysphagia.
Keywords: Parkinson disease, deglutition, deglutition disorder.
OBJECTIVE: To identify the use of medicinal plants, way of obtainment, packaging and preparation of home remedies by elderly women.
MATERIALS AND METHODS: An exploratory and descriptive study, with quantitative approach, carried out at Núcleo de Atenção ao Idoso (NAI), with 50 women in the period from January 2012 to April 2012. Inclusion criteria considered were: 60 years of age or over and to be literate. Those who accepted to participate signed the Free Informed Form after research project approval by the Research Ethics Committee of Centro de Ciências da Saúde, from Universidade Federal de Pernambuco under CAAE 0179.0.172.000-11 and Protocol no. 210/11. After data collection, they were analyzed using descriptive statistics analysis with simple frequency distribution, and presented in tables. Data discussion was based on literature.
RESULTS: It can be seen that 97.3% of the elderly women used to treat themselves and their family with medicinal plants. The plants were obtained from markets (55%) and private properties (45%). Ppacking was done on packs (52.17%), glass (30.43%) or plastic container (17.39%). The surveyed women revealed that 78% knew the correct preparation of the plants, but only 6% did it correctly.
CONCLUSION: It is important to identify the use of medicinal plants, way of obtainment, packaging and preparation of home remedies in order to avoid misuse and prevent health problems in this elderly people enrolled at NAI.
Keywords: Elderly, medicinal plants, phytotherapy.
The objective of this study was to group and update knowledge related to physical therapy intervention in anal incontinence in the elderly. The literature research was done in electronic databases: Medline, Lilacs, Cochrane, PubMed and Scielo, from January 2006 to July 2011. The keywords used in various combinations were anal incontinence, fecal incontinence, elderly, physical therapy, physiotherapy, exercises, electrotherapy and rehabilitation. The physiotherapy intervention includes assessment of anal incontinence constituted by signs and symptoms, physical examination and laboratory tests, including anorectal manometry, retosigmoidoscopia, defecography, anorectal electromyography, endoanal ultrasonography and terminal motor latency of the pudendal nerve; exercises to strengthen pelvic floor muscles, biofeedback, rectal balloon training and electrostimulation are the mainstay of treatment. This update showed the scarcity of studies addressing this theme; only five studies published in recent years were found, which mostly emphasize the procedures already established in the literature to treat these patients. However, a considerably new mode of treatment, sacral neurostimulation, has been investigated with apparently positive results, raising the need for further studies with specific methodological designs on this problem.
Keywords: Anal incontinence, elderly, physical therapy (specialty).
INTRODUCTION: Care of the elderly with dementia in advanced stages has important knowledge gaps, especially in those with oropharyngeal dysphagia in whom tube feeding, rather than oral feeding, is used as an alternative route. There are controversies about the systematic use of gastrostomy or enteral feeding to feed this population.
OBJECTIVES: To verify, through literature overview, the effectiveness of tube feeding in relation to survival, pneumonia incidence, prevalence and healing of pressure ulcers, nutritional status and quality of life.
METHODOLOGY: A database search in MEDLINE, LILACS and SciELO using as descriptors the Portuguese words for dementia, gastrostomy and enteral nutrition and their equivalents in English for the whole database existence until December 2012, limited to English, Portuguese and Spanish languages. We excluded editorials, non-systematic overviews and letters. Among the articles found, only prospective studies, or retrospective cohorts comparing elderly with alternative route feeding and patients with exclusive oral route, were selected for this overview.
RESULTS: Three hundred sixty four articles were found. Of these, only nine met all the selection criteria. The studies selected were not able to demonstrate benefits of gastrostomy and enteral nutrition in any of the variables studied in the elderly in an advanced stage of dementia.
CONCLUSION: There is no evidence in the literature that alternative routes of feeding improve survival outcomes, aspiration pneumonia, pressure ulcers, nutritional status and quality of life in patients with advanced stage dementia.
Keywords: Dementia, gastrostomy, enteral nutrition, mortality, deglutition disorders.
Frontotemporal dementia is a form of presenile dementia, more prevalent in women than in men. In most cases it affects the behavior and personality of patients with relative preservation of cognitive status, and that is why the symptoms are not appreciated by the family. The first manifestation may be a crisis of depression, followed by behavioral disorders. As life expectancy has been increasing worldwide in recent decades, frontotemporal dementia has become more prevalent.1 Diagnosis is essentially clinical and related to changes in behavior and personality.2 The treatment of frontotemporal dementia is still limited. Behavioral symptoms are controlled by selective serotonin reuptake inhibitors. Researchers have found an abnormal protein that accumulates in the brains of patients with frontotemporal dementia and amyotrophic lateral sclerosis, C9RANT.3 In some cases studied, association with ALS was reported, and an early fatal nature in these cases was observed and was the reason for this case report.
Keywords: Dementia, amyotrophic lateral sclerosis, frontotemporal.
INTRODUCTION: The behavior of our contemporary society in the face of death reveals the difficulties encountered by man when faced with human finitude. Silence and the attempt to keep away from death are commonly observed attitudes, characterizing the issue as a taboo subject, even in areas where it is routinely present, such as hospitals. For health care professionals, who daily perform functions related to death, we also found barriers that can cause suffering for both the professional and for patients and their families. Special attention should be paid to the Intensive Care Unit, where death and suffering are even more present, and require continuous and routinecoping strategies from health care workers.
METHOD: To describe children's literature as a strategy to aid in coping with death in routine work of Intensive Care Unit professionals.
RESULTS: Currently there is a rich collection of children's books which, using a dense and poetic language, deals with issues related to death, functioning as an important stimulus for the discussion and development of complex issues related to death and bereavement.
CONCLUSION: The use of children's literature as a facilitator of the process of reflection and discussion about death and dying shows that its importance lies in the sharing of emotions among members of a multidisciplinary team, promoting personal growth and strengthening of group work.
Keywords: Death, Intensive Care Units, literature, palliative care.