BACKGROUND: This article is part of a special series designed to help health professionals in the process of developing a research project and writing a manuscript. The research question is the keystone in this process, and represents the first step of every research project. However, its importance is frequently neglected.
OBJECTIVE: To highlight important considerations in the development and formulation of a research idea, with the purpose of identifying main guiding elements, in order to prevent errors in one of the most important stages of an experiment.
METHODS: The authors performed a non-systematic literature review (PubMed.gov - U.S. National Library of Medicine/National Institute of Health) to retrieve papers that addressed the main steps to build a research question.
RESULTS: The construction process includes the conception of the research idea, seeking an appropriate environment and resources, performing a literature review, then crafting and refining the research question, while being aware of potential challenges and pitfalls that may be encountered. The FINER and PICOT criteria can be useful tools in this process.
CONCLUSION: It is essential to invest time, energy, and resources in the construction of the research question prior to detailing the study design, thus supporting the further development of the research project on a solid initial foundation.
Keywords: manuscripts; publications; education.
OBJECTIVE: To identify the prevalence of polypharmacy and the use of inappropriate medications in hospitalized elderly people in a long-term care institution.
METHODS: This is a descriptive cross-sectional study. Medical prescriptions for elderly people who were hospitalized for at least one month in a long-term care institution were analyzed. A script containing the following variables was used for data collection: age, gender, length of institutionalization, prescribed medications, presence of inappropriate medications for the elderly and practice of polypharmacy.
RESULTS: A total of 253 medical prescriptions were analyzed. Among the elderly studied, 149 (59%) were men. Their mean age was 74 ± 9 years. The median length of institutionalization was 62 (1 - 942) months. Among the medical prescriptions analyzed, the mean was 7 ± 3 medications, and 68 (27%) contained at least 1 inappropriate medication for the elderly. Practice of polypharmacy was found in 197 (78%) prescriptions.
CONCLUSION: These results show a high prevalence of inappropriate medications and practice of polypharmacy raising the risks for institutionalized elderly.
Keywords: aged; polypharmacy; homes for the aged.
OBJECTIVE: There are few studies on intestinal parasitic infections in elderly populations. Therefore, this study aimed to determine the prevalence of intestinal parasites and identify the association between this prevalence and the sociodemographic, environmental, and health factors of the elderly attended by the Family Health Strategy (FHS).
METHOD: This cross-sectional study involved the analysis of data collected from a random sample of elderly individuals. Community health workers drafted a general questionnaire to collect epidemiological data. The project team also collected blood and stool samples at the healthcare unit where each individual was enrolled.
RESULTS: Among 581 elderly people, the prevalence of intestinal parasites was 10.8%. The parasites found were as follows: Endolimax nana (42.7%), Entamoeba coli (33.8%), Giardia lamblia (8.8%), Ascaris lumbricoides (5.9%), Strongyloides stercoralis (4.4%), Trichuris trichiura (2.9%), and Iodamoeba bütschlii (1.5%).
CONCLUSION: The prevalence of intestinal parasites in elderly persons was lower than that reported in other studies, and the parasites identified were predominantly non-pathogenic. The findings suggest the possibility that interpersonal transmission, environmental contamination, or the ingestion of contaminated food or water is occurring in this population. These findings also highlight the importance of the ongoing implementation of sanitation and hygiene education programs in this community.
Keywords: parasitic intestinal diseases; aged; public health.
OBJECTIVE: This study aimed at evaluating mortality in very elderly patients admitted to the intensive care unit (ICU), from admission to 180 days later, considering hospitalization indications and severity scores at admission.
METHODS: An observational, longitudinal, retrospective study based on review of ICU medical records was performed at a tertiary care hospital. The patients in the study were aged 80 years or older, and were divided into three groups by admission criteria: clinical management, elective surgery, or emergency surgery. Exclusion criteria consisted of the inability to survey the variables studied: sex, severity scores (Sequential Organ Failure Assessment - SOFA, Acute Physiology and Chronic Health Evaluation - APACHE II; and Multiple Organ Dysfunction Score - MODS), duration of hospital stay and outcome.
RESULTS: A total of 186 patients were included, with a mean age of 84.47 ± 3.88 years. The mortality rates were 26.3% in the ICU and 45.7% during the hospital stay; 51.6% of patients were alive at day 180. Regression analysis showed that the major independent determinants of mortality for a period of up to 180 days were criteria for admission to the ICU [odds ratio = 3.417 (95%CI 1.502 - 7.776; p = 0.003)] and the SOFA score (OR = 1.240; 95%CI 1.080 - 1.420; p = 0.002).
CONCLUSION: Very elderly patients admitted to the ICU for clinical management and/ or who had the highest SOFA scores on admission had the worst prognosis in the 180 days following ICU admission.
Keywords: mortality; aged, 80 and over; intensive care units.
OBJECTIVE: To identify factors that can determine hospitalization for a period of more than ten days, and those contributing to the death of elderly inpatients.
METHODS: We conducted interviews with patients or primary caregivers and compiled epidemiological data, medication use, functionality prior to hospitalization and the Charlson index. We included patients admitted to the emergency room and excluded patients who were admitted electively and those from which we did not obtain complete information. Initially, patients were distributed into two groups: one with hospitalization for less than ten days (G < 10) and the other with more than ten days (G > 10). The two groups were compared according to the outcome death. We used χ2 test and the Mann-Whitney U test.
RESULTS: We identified 201 patients. In the G < 10 group, we classified 77 patients, 56% women. The average length of stay was 16 days, the average age was 87 years, 46.0% were using up to 4 medications and 47.5% were using over 4 medications. At admission, 37.8% were using psychotropic drugs and 37.3% had delirium, 26.4% progressed to death. Concerning the length of stay, none of the variables showed significant difference. For the outcome death, the variables delirium, Katz scale and the Charlson index were able to identify patients with higher risk.
CONCLUSION: The analysed variables did not allow us to identify patients at increased risk of prolonged hospitalization. The presence of Delirium, higher Charlson index values and lower values in the Katz scale showed a positive association with mortality.
Keywords: aged; length of stay; risk.
OBJECTIVE: To describe the prevalence of diabetes mellitus (DM) and excessive self-reported weight in the elderly and the association with sociodemographic factors, lifestyle and other comorbidities.
METHODS: Cross-sectional population-based study with a probabilistic sample of elderly in Goiânia, Goiás, Brazil.
RESULTS: Of the 934 elderly, 19.0% self-reported DM and 13.9% overweight. The prevalence of DM and overweight was higher among females, on those aged 60-69 years, among people who self-reported good health and were not physically active (overweight). There was an association and a high prevalence of hypertension, hypertriglyceridemia and hypercholesterolemia.
CONCLUSION: The prevalence of self-reported diabetes and excess weight was high. Their association with comorbidities also with high prevalence is a condition that negatively affects the living habits of this vulnerable population, requiring actions to promote health for these people.
Keywords: diabetes mellitus; overweight; chronic disease; aged; social conditions; demographic aging.
The quick aging process in Brazil and the world is also followed by greater sexual diversity. There are few studies regarding health conditions and aging among lesbian, gay, and bisexual older adults (LGB). Limitations about terminology and methods applied in LGB studies render data dimness. The aims of manuscript are: to comment the health care needs of LGB older adults; to describe the demographics and limitations of epidemiological studies; to address particular medical care of the older LGB people; to comment about the role of geriatricians and gerontologists professionals in this context.
Keywords: homosexuality; bisexuality; aging; aged.
According to the authors of a meta-analysis based on 127 studies reporting the effects of interventions conducted with caregivers of elderly with dementia, efforts to help these eldercare providers appear to have been largely ineffective in strengthening the caregivers and in reducing their sense of burden. Improvements in the caregivers' abilities to handle their eldercare involvements were not evaluated. The objectives of this study were: (a) to identify abilities that may be important for someone who cares for an elderly person with dementia, focusing on social skills and coping strategies; (b) to investigate whether there was a relationship between social skills and coping with burden and relationship quality; and (c) to identify the caregivers' needs. This study included 20 elder-caregiver dyads (women only): of whom 10 were caregivers of bedridden elders with normal cognitive functioning and 10 were caregivers of bedridden elders with dementia. All the elders were bedridden and dependent. Caregivers responded to instruments of: social skills, coping strategies, family needs, burden and dyadic relationship. Similarities on the quality were observed between the two groups of caregivers regarding the quality of the relationship, but the caregivers of elderly with dementia reported higher levels of burden. With respect to social skills and coping strategies, caregivers in each group presented more similarities than differences; however, a few differences were observed as follows: caregivers who reported using social skills and coping strategies more often showed lower levels of relationship conflict, with lower levels of burden. With regard to their needs, a greater proportion of caregivers of elderly with dementia reported they needed more assistance and greater access to community-based services. Thus, certain characteristics of those who care for an elderly person with dementia were possible to detect, as increased levels of burden and need for support. These data can substantiate the development and evaluation of new specific interventions for this population.
Keywords: caregivers; aged; dementia; social skills; adaptation, psychological; quality of life.
INTRODUÇÃO: O teste Cambridge Cognition Examination (CAMCOG) é uma breve bateria neuropsicológica que avalia a função cognitiva global e as deficiências para o diagnóstico de demência. O crescente envelhecimento da população é bem estabelecido, sendo que os idosos com 80 anos ou mais compõem o estrato populacional que mais cresce. E sabe-se que a idade é um fator importante para os quadros de Doença de Alzheimer (DA). Além disso, existem diferenças cognitivas mesmo quando ocorre o envelhecimento bem-sucedido e são observadas diferenças entre os testes cognitivos conforme a escolaridade.
OBJETIVOS: Avaliar os valores do CAMCOG em idosos com 80 anos ou mais portadores e não portadores de DA, comparando a pontuação total; os valores das subescalas quanto as variáveis sexo, faixa etária e escolaridade; os pontos de corte para a discriminação de quadro de DA e não DA para os diversos graus de escolaridade; e se o teste CAMCOG é adequado para avaliação cognitiva desses sujeitos.
MÉTODO: Estudo prospectivo através da análise de 713 prontuários de idosos com 80 anos ou mais portadores e não portadores de DA do Instituto de Geriatria e Gerontologia de Jundiaí (SP). Todos os pacientes do estudo passaram por avaliação médica e foram submetidos ao CAMCOG e a exames laboratoriais e de neuroimagem. O software estatístico SPSS 22.0 foi utilizado para as análises descritivas e testes de hipóteses e o R 3.1 foi utilizado para a construção das curvas Receiver Operating Characteristic (ROC). Foi considerado como nível de significância estatística (P) um valor igual ou menor que 0,05. As análises de curvas ROC foram realizadas para comparar a sensibilidade e especificidade do CAMCOG com o propósito de diferenciar os dois grupos nos estratos educacionais. Os dados não paramétricos foram analisados utilizando Mann-Whitney e Kruskal-Wallis conforme o numero de variáveis. Também foi utilizado o modelo de regressão linear multivariado para análise das variáveis dependente e independente.
RESULTADOS: Encontrou-se que a maioria dos sujeitos possuía DA (58,8%), eram sexo feminino (65,8%; p < 0,05%) e possuía um nível de escolaridade entre 1 e 4 anos (54,8%; p < 0,05). Quanto maior for o nível de escolaridade também maior será o valor observado no CAMCOG. Além disso, homens têm desempenho superior no teste (p < 0,05). Na avaliação das subescalas em todos os casos tem-se uma diferença estatisticamente significativa entre os pacientes no grupo controle e os pacientes com DA. Os valores obtidos nas subescalas do CAMCOG são maiores para os pacientes do grupo controle, e a diferença é significativa, levando a concluir que pacientes com DA realmente apresentam valores inferiores em todos as subescalas. A análise multivariada mostrou que as variáveis Sexo, Idade, Diagnóstico e Escolaridade influenciam de modo independente o valor do CAMCOG.
CONCLUSÕES: O valor do CAMCOG é influenciado de maneira independente pelo gênero (homens têm valores maiores), pela idade (maior idade leva a um pior desempenho), pelo diagnóstico (o diagnóstico DA garante um pior desempenho) e pela escolaridade (maior grau de escolaridade gera a um maior resultado). Não foi possível obter os pontos de corte para o diagnóstico DA para os diferentes graus de escolaridade.
Keywords: doença de Alzheimer; testes neuropsicológicos; idoso de 80 anos ou mais.