OBJECTIVE: To trace the profile of frail elderly who are attended in a reference outpatient service considering the associated diseases and the use of medicines.
METHODS: The criteria of Fried et al. (2001) had been used in association with the diagnosis of confirmed chronic disease, as well as the effectively used medicines in 151 elders of the Geriatric Outpatients Service of the Clinic Hospital of the State University of Campinas (Brazil), throughout the period of two years. It was used the univariate and multivariate logistic regression to study the factors associated with the fragility syndrome.
RESULTS: It was verified association between fragility and the diagnosis of chronic respiratory diseases (p = 0,043) and with the use of (p = 0,036).
CONCLUSION: Even if this study does not allow a cause - effect association it was verified that the chronic respiratory diseases and the use of medicines for cardiovascular system can be related to fragility condition, as they contribute to maintain or to increase this morbid condition.
Keywords: Aging, health vulnerability, chronic disease.
OBJECTIVE: Population aging is a global reality and is happening mainly due to improved sanitary conditions and quality of life. Because the elderly consume most of the world's production of drugs and are more sensitive to the effects of certain drug classes, tools were developed to identify inappropriate drugs for this population class or whose use should be evaluated. One of these instruments is the Beers-Fick Criteria, used to assess and intervene in the use of medications in the elderly. There are few publications related to drug therapy in the elderly in Brazil, which demonstrates the need for more researches.
METHODS: This is a quantitative, cross-sectional, retrospective, descriptive study, aimed to identify which are the inappropriate drugs prescribed for seniors over 65 years old in an oncology hospital and how often are they prescribed. The instrument used for the selection of the drugs studied was the Beers-Fick criteria.
RESULTS: We analyzed 8,860 prescriptions containing inappropriate drugs for seniors made to 1,448 patients, of whom 451 (31,1%) were elderly and the rate of use of these drugs was 28%.
CONCLUSION: We conclude that the frequency of prescriptions containing inappropriate drugs for the elderly is high, which leads us to realize the need for development of clinical protocols for prescribing for the elderly to ensure patient safety and rational use of medication.
Keywords: Aged, pharmaceutical preparations, drug utilization review.
OBJECTIVE: The aim was to analyze the reliability and the adhesion of medicine therapy in elders. Elderlies, in their majority, present chronic disease such as hypertension and, because of this, take a lot of medicines. A large number is retired and benefit themselves with health programs and medicines given by government health.
METHODS: The data were gotten through an interview and of a visual choice among three different diurético hidroclorotiazida 25 mg packages. The data were analyzed through analysis of Bardin content.
RESULTS: We checked that the medicine manufactured by the government industry was the first choice, showing that it has a great reliability. The arguments were: efficacy, custom and gratuitousness. The reference medicine was the second choice due to the cost, and the similar medicine was the last option because it is an unknown brand.
CONCLUSIONS: The results assume that the government industry needs to account for the demand and maintain the supply in the health units.
Keywords: Pharmaceutical preparations, Unified Health System, health of the elderly, pharmaceutical industry, public health
OBJECTIVE: To identify the actions taken by the family health teams on prevention of falls in the elderly, as well the use of the Handbook of Health of the Elderly as a tool for identification of falls in the elderly.
METHODS: Descriptive study with a quantitative approach developed in the city of Fortaleza, with professionals from the Family Health Teams of the Regional Executive Office VI. Data collection was conducted from June to November 2011. Data was collected through a questionnaire and the sample consisted of 16 doctors and 42 nurses.
RESULTS: 43.75% of doctors and 26.9% of nurses said they had received some form of action aimed at preventing falls in the elderly. Regarding risk factors for falls: 100% of doctors refer to meet them and cite at least one risk factor, however 7.69% of nurses are still unaware of these factors, even when working daily with vulnerable groups. Among doctors, 12.5% recognized the existence of book of health of the elderly as a means of identifying older people who fall more frequently and 15.38% of the nurses recognized the existence of the instrument, but only 11.53% knew that that this tool was the book of the elderly.
CONCLUSIONS: The professional must question the occurrence and frequency of falls recorded in the Handbook of Health of the Elderly, hence the importance of knowing and using these tools, since the information contained in there are sufficient to identify the risk.
Keywords: Family health, accidental falls, elderly
OBJECTIVE: To analyze the range of motion and function of the knee, in addition to evaluating the quality of life and identify if there is improvement in overweight elderly patient sunder going aquatic therapy.
METHODS: This is a quantitative, cross-sectional, retrospective, descriptive study, aimed to identify which are the inappropriate An evaluation of quality of life and function, using the SF 36, and Lequesne knee goniometry in six women aged between 58 and 82 years, BMI > 25 kg/m2, diagnosis of knee OA who reported pain in the last month. Later were submitted to the aquatic physical therapy twice a week, 50 minutes for eight sessions. By completing these were reassessed.
RESULTS: We observed significant improvements in the questionnaires and goniometry.
CONCLUSIONS: A protocol aquatic therapy can assist in improving pain, range of motion and quality of life of older overweight.
Keywords: osteoarthritis, knee, aged, obesity, quality of life, hydrotherapy
OBJECTIVE: The aim of this study was to assess the effect of a functional exercise program, associated with the entertainment component, depressive symptoms, the ability to perform activities of daily living (ADL) and pain symptoms of elderly living in a nursing home.
METHODS: Ten elderly (age = 72.6 ± 5.2) participated of this study. For data collection we used the Geriatric Depression Scale (GDS-15), the Katz Index, to assess the ADL and a numeric pain scale. The exercise program lasted 3 months (60 min, 2 times/week).
RESULTS: The Wilcoxon test indicated a significant difference between the two moments to: depression (z = -2.388, p = 0.017), ADL items in the "dressing" (z = -2.000, p = 0.046) and "housework" (Z = -2.236, p=0.025) and pain intensity (Z = -2.121, p = 0.034).
CONCLUSIONS: The functional exercise program was effective in minimizing the symptoms of depression and pain and improves the elderly ability to the ADL.
Keywords: osteoarthritis, knee, aged, obesity, quality of life, hydrotherapy
OBJECTIVE: To identify the nutritional status and compare the methods of nutritional assessment in the elderly residents in geriatric institutions.
METHODS: The sample was composed of elderly in three geriatric institutions of Porto Alegre. The methods used to assess nutritional status were body mass index, calf circumference, grip strength of dominant hand and non-dominand, and of adductor pollicis muscle thickness.
RESULTS: 89 elderly with a mean age of 78.6 ± 7.30 years was evaluated and 52.8% were female. Aged 80 years or older represent 51.7% of the sample Regarding the classification of nutritional status by body mass index, 12.3% of subjects were classified as underweight, normal weight 55% and 32.5% overweight. The method of nutritional assessment that identified more malnourished was hangrip strength, followed by calf circumference (13.5%), body mass index (12.4%) e adductor pollicis muscle thickness (10.1%). There was a correlation between body mass index and calf circumference (r=0.328) and body mass index and adductor pollicis muscle thickness (r=0.307).
CONCLUSIONS: The method of nutritional assessment identified that more malnutrition was grip strength, however this measure was not correlated with other measures of nutritional assessment. There was a correlation between body mass index and calf circumference and adductor pollicis muscle thickness.
Keywords: Aging, aged, hand strength, thumb/anatomy and histology
OBJECTIVE: To associate neuroimages from elderly patients with a risk factor for vascular dementia with cognitive assessment test for detecting whether these findings are able to presuppose a cognitive disorder compatible to vascular dementia.
METHOD: Were tested 31 patients older than sixty years old, from both sexes, with a risk factor for vascular dementia, hospitalized during the year 2011 in Fundação Santa Casa de Misericórdia do Pará. The following cognitive assessment tests were used: the Mini-Mental State Examination (MMSE), the Cerard scale, the watch test and verbal fluency test. As a complement it was used Magnetic Nuclear Resonance (MNR); such exams were analyzed by the same radiologist according to the Fazekas modified classification. Later on the data were statically analyzed by the Chi-square test.
RESULTS: the systemic arterial hypertension (71%), diabetes mellitus (58.1%), sedentariness (58.1%), and smoking (41.9%) were the main risk factors for vascular dementia. From Fazekas classification the most common findings were Fazekas 1 and 2 in 64.5% of the cases, 90% of the total presented cognitive disorder positive for vascular dementia. From the cognitive tests the ones who had greater sensibility for the dementia evaluation were the MMSE and Cerard scale.
CONCLUSION: Thus, for tracking vascular dementia in elderly people it is necessary the use of at least two cognitive tests and a neuroimaging evaluation, emphasizing the fact that controlling and preventing risk factors for cardiovascular diseases it also contributes to the control of vascular dementia.
Keywords: vascular demencia, risk factors, neuroimaging, aged
This study describes Brazilian caregiver burden in the case of demented aged people, through an integrative review, from 1999 to 2009, published in Portuguese and English. Data were collected through the electronic databases Pubmed, CINAHL and LILACS. The keywords used in CINAHL and Pubmed databases were: "dementia" OR "cognitive impairment""aged"OR "older people", "Brazil", "caregiver burden" OR "caregiver stress"OR "caregiver strain". A total of 14 papers were found. The keywords used in LILACS in the field DeCS category were "aged", "caregivers" and "dementia" combined with AND, which resulted in 25 studies. About 39 papers were selected, which were then reduced to 19, after unrelated themes, the Spanish language, duplicate papers, reviews, theses/dissertations and books. The studies were organized into three categories: 11 (57,9%) focused the correlation between caregiver burden and the characteristics of the caregivers and the demented elderly individuals; six (31,6%) reported the experiences and feelings reported by the caregivers; only one (5,3%) exclusively focused on the definition of burden and one (5,3%) even reported the reliability of a specific instrument directed to the Brazilian population addressing caregiver burden. The Brazilian government and city health services, universities, non-governmental organizations and other agencies and networks urgently need to organize in order to devise formal and informal intervention proposals directed to informal caregivers.
Keywords: elderly, dementia, caregivers, family
Increased life expectancy of the population leads to the growing number of the elderly who need health care, mainly due to complications caused by chronic diseases. Diabetes mellitus is a disease of high prevalence in the elderly, characterized by a metabolic disorder resulting from the lack of insulin and/or its inability to act appropriately. The disease promotes the appearance of macrovascular (cardiovascular, cerebrovascular and peripheral vessels), microvascular (retinopathy, nephropathy and neuropathy) and musculoskeletal (osteoarthritis and rheumatoid arthritis) complications that affect the quality of life of seniors and their occupational performance (self-care, work and leisure). This study consists of a literature research that investigates the role of the occupational therapist following the elderly with diabetes mellitus, enclosing the two last decades, in order to identify possible interventions in the face of medical complications. It was noted the importance of the professional in the prevention of the disability and in the maintenance of the functionality during the various stages of the disease. The intervention stimulates the recovery of self-care autonomy, guides the individual in in the glycemic control, and in the face of complications, it contributes to the improvement of functional performance. The role of the therapist following the diabetic elderly enables the maintenance of a satisfactory performance of daily life activities such as eating, getting dressed, personal hygiene, mobility as well as improves the elderly's family and social relationships.
Keywords: diabetes mellitus, diabetes complications, aged, rehabilitation, occupational therapy
Increasingly healthy people are looking for preventive health care. These includes periodic medical consults for investigation of some grievance or risk factor.To provide scientific basis for such research were created recommendations on what and how often exams should be performed . However, it has become frequent diagnostic checkup exams without notecing such recommendations. As a result, "treatments" are started in asymptomatic patients based only on exams alterations. This especially occurs in the evaluation of thyroid function, when people become labeled as suffering from hypothyroidism, even if it is subclinical. Subclinical hypothyroidism is defined by the presence of elevated levels of Thyroid Stimulating Hormone with normal levels of Triiodotironine and Tiroxine. Its treatment is controversial, especially in the most prevalent population, women over sixty years, in which the risk-benefit must be carefully evaluated. The causes are diverse, and the main one is Hashimoto's thyroiditis. Among the possible associated risks is included hypertension, dyslipidemia, atherosclerosis, neuropsychiatric symptoms, changes in mood, cognition, muscle mass, bone density and quality of life. Due to the high prevalence of Subclinical hypothyroidism, studies seek information about the benefits and consequences of treatment, but the benefits are not being fully observed. A literature review with a survey of studies published in indexed journals in databases such as: SCIELO, Dynamed, Cochrane and uptodate. No improvement in survival or reduction of cardiovascular morbidity with the use of levothyroxine. Regarding quality of life and the other symptoms, treatment revealed no significant differences.
Keywords: hypothyroidism, elderly, behavioral symptoms, dyslipidemia cognition and mortality