OBJECTIVE: To validate the 2012 Beers criteria and the 2006 STOPP contents, in order to elaborate a national classification criteria of potentially inappropriate medication for the elderly.
METHODS: A two-round modified Delphi technique was employed to establish the Brazilian Consensus of Potentially Inappropriate Medications in the elderly, based on the 2012 Beers criteria and 2006 STOPP. The expert panel was composed of ten individuals. An electronic questionnaire was used, in which each expert scored the criteria through a 5-points Likert scale. In the first round, the participants were asked to assess the potential inadequacy of a preliminary list of medicines and propose suggestions. Then, for each criterion, the scores mean was calculated and its respective 95% CI. The criteria with a 95% CI > 4,0 upper limit were submitted to the second round. All medicines in the criteria with a 95% CI > 4,0 lower limit, in the second round, were classified as potentially inappropriate.
RESULTS: The criteria that did not reach consensus were: aspirin use for primary prevention of cardiovascular events, sliding scale insulin prescription and the use of alpha-blockers, oral or transdermal estrogens and tricyclic antidepressants for the elderly with urinary tract incontinence. At the end, there were 118 criteria, in which 43 were independent from clinical conditions and 75 were dependent from clinical conditions/disease of the elderly.
CONCLUSION: It was validated a criteria of medicines that should be avoided in the elderly. These data can optimize the medicines prescription in this population.
Keywords: potentially inappropriate medications list; aged; Brazil.
OBJECTIVE: To evaluate the effect of comorbities in sleep of independent elderly patients.
METHODS: Independent elderly patients aged > 60 years old that attended the geriatric ambulatory of Escola Paulista de Medicina - Universidade Federal de São Paulo were invited to join the research. The participants were submitted to a wide geriatric evaluation with functional scales (basic and instrumental daily activities), cognitive tests (Mini-Mental State Examination) and Geriatric Depression Scale. After that, all the participants underwent a full night polissomnography (PSG) at sleep laboratory.
RESULTS: The mean sleep efficiency was 73.1% ± 14.0; the mean percentage of slow wave sleep (E3+E4) was 17.6% ± 9.6; the percentage of REM sleep was 17.9 ± 6.8; apnea and hypopnea index per hour (AHI/h) mean was 26.3 ± 21.2; dessaturation of oxygen events was 21.9 ± 19.7. The number of comorbidities >5 was associated with higher AHI/h, p=0.01. Spearman's correlation between AHI/h and BMI was 24% (p=0.02, r2=0.055). Simple linear regression analysis was applied to determine whether BMI could predict AHI/h values. The p value was 0.02, which shows a correlation between BMI and AHI/h as a continuous variable.
CONCLUSION: Elderlies with > 5 comorbidities had more apnea and hypopnea events and dessaturations during sleep.
Keywords: sleep; aged; obesity; comorbidity.
OBJECTIVES: To investigate the sociodemographic profile of elderly victims of trauma from falls admitted to the Intensive Care Unit (ICU) of a public hospital of reference and the correlation between age, comorbidities, length of stay, complications and clinical outcomes.
METHODS: Analytical retrospective study with a quantitative approach, which data collection, was performed in the ICU of the Hospital de Base do Distrito Federal (HBDF), of the Secretary of State of Health of the Distrito Federal (SES/DF) (DF), from April to October 2014. Sociodemographic information related to the mechanism of injury, comorbidities, length of stay, use of invasive devices, vasoactive drugs and sedatives, complications and clinical outcomes of elderly patients admitted for fall between July 2012 and July 2014 were collected through electronic medical record TrakCare®.
RESULTS: The sample consisted of 52 elderly, with prevalence of males and the very height fall, as the mechanism of injury. The main complications were pulmonary infection, tracheostomy due to extubation failure or prolonged intubation, septic shock, the use of blood products and acute renal failure. Despite the high mortality observed in the study, the majority of elderly survived the traumatic event and the mortality was associated with male gender, traumatic brain injury (TBI), septic shock pulmonary focus and dialysis.
CONCLUSION: The fall from height, severe head injuries and fractures showed high prevalence and most patients had more than one complication during hospitalization. There was not significant association between mortality and age.
Keywords: aged; accidental falls; wounds and injuries; intensive care units.
OBJECTIVE: To evaluate associated factors with hospital costs in the treatment of elderly patients with hip fracture in a public hospital.
METHODS: A retrospective cohort study of medical records from a public hospital in the metropolitan area of Porto Alegre (RS) was performed. They included 134 medical records of elderly patients with hip fracture diagnosis, hospitalized from July 2014 to October 2015.
RESULTS: The age of patients ranged from 61 to 96 years old, with an average of 79.4 years (± 8.8). There was a predominance of the female gender (73.1%). The average length of hospital stay was 13.87 days. In assessing the presence of associated morbidities, 56 (41.7%) had at least one morbidity, and 64 (47.7%) had two to six associated morbidities. The average cost of hospitalization per patient was R$ 9.390.21 (US$ 2,745). At the general composition of costs, nursing and nutrition services, hostelry and cleaning materials, medicines and daily expenses accounted for 78.3% of the expenditures, followed by orthotics and prosthetics (10.7%) and medical fees (10%). There was a significant association between the time to start the surgery and the average length of stay (p < 0.001), between the time to start the surgery and hospital costs (p < 0.001), and between the sum of morbidity and hospital costs (p < 0.001).
CONCLUSION: In addition to the direct costs, the comorbidities, the average residence time and the time to start the surgery have been identified as factors associated with the costs. The longer the time to start the surgery, the higher was the total cost.
Keywords: aged; costs; hip fractures.
INTRODUCTION: Female sexual function arises from a complex interaction of biological, psychological, and social factors. Few Brazilian studies have addressed sexuality in the elderly population — 10-20% of individuals are sexually active.
OBJECTIVES: To compare the overall quality of sexual life and its domains in adult and elderly female college students.
METHODS: Female students from the University of Amapá, Brazil, were enrolled in this cross-sectional study. The Female Sexual Quotient (FSQ) questionnaire was used to assess various components of quality of sexual life in adult (34-59 years old) and elderly (60-79 years old) students. The study was approved by the institutional review board.
RESULTS: A total of 123, of which 49.6% were married, participated in this study. Mean FSQ score for the elderly group was (n=66) 61.5, classified as “average” and for the adult group 71.6, classified as “partially satisfied” (p < 0.01). Statistically significant differences between adults and elderly groups were also observed for two FSQ domains: “foreplay quality” (p < 0.001), and “objective arousal and harmony with the partner” betters in the adults group (p < 0.05).
CONCLUSION: In this sample, elderly college student showed worst FSQ scores when compared to the adult ones at the same university. Compared to adult women, the quality of sexual life varies more in elderly, probably reflecting age-related morbidities as well as their partners' health. Adult women report foreplay quality being a strong motivation to continue having sex. In the elderly students, sexual arousal is mainly affected by a lack of vaginal lubrication, which is explained primarily by menopause.
Keywords: quality of life; sexual health; women's health.
Although there is no consensus in literature regarding which are the rhythmicity changes that occur during the aging process, it is believed that advanced age may affect the circadian rhythms, leading to a decreased ability to tolerate abrupt phase shift, decreased amplitude of rhythms, phase advance and reduced endogenous period. Therefore, understanding the mechanisms involved in the aging process has become essential for the development of new treatment approaches in order to improve quality of life of the elderly population. The use of technologies has increased over the past years, becoming an important factor to be considered an influence in the circadian rhythms. There is a limited number of studies linking the relationship between sleep-wake cycle and the effect of light and media use in the modern world. Thus, the aim of this review was to analyze the relationship between light, technology, and circadian rhythms in the elderly population.
Keywords: circadian rhythm; sleep; aging; aged.
OBJECTIVE: To investigate the perception of an elderly group resident at a Long-Stay Institution (LSI), concerning the food intake change related to institutionalization.
METHOD: This descriptive study encompasses lucid elderly subjects from a LSI, enclosing both gender and those without restrictions or limitations in order to properly answer the survey. This project was approved by an Ethics Committee, and the data analysis was carried out through the software Microsoft Excel 2010.
RESULTS: The sample consisted of 27 subjects, predominantly female. The majority stated opinions related to the adaptation and food intake changes as positive.
CONCLUSION: It is our understanding that the opinions on the quality of food intake vary greatly upon admission, but some subjective factors seem to modulate receptivity to the new food intake habit.
Keywords: aged; homes for the aged; institutionalization; feed.