BACKGROUND: Studies show the potential deterioration of brain vascularization and probable involvement of hypertension in Alzheimer disease (AD).
OBJECTIVE: The objective was to evaluate the potential impact of hypertension on cerebral vascular flows in a sample of Alzheimer's patients.
METHODS: 19 patients with AD, including 10 with hypertension (aHT+) and 9 without hypertension (aHT-) were recruited. They underwent clinical evaluation and phase-contrast MRI protocol for flow assessment. Cerebral arterial flow distributions were evaluated using kurtosis and skewness indices at the intracranial and extracranial levels.
RESULTS: No significant differences were found in the mean arterial flow, pulse flow and kurtosis between the levels in the AD aHT+ population. There was a significant difference in skewness between extra- and intracranial levels (p = 0.01). No significant differences were found in the mean arterial flow between the levels in the AD aHT- population. A significant difference was observed in the pulse flow (p = 0.03), kurtosis (p = 0.02) and skewness (p = 0.008) between the levels. At the extracranial level we did not find any significant differences in the mean arterial flow, pulse flow or skewness between aHT+ and aHT-. There was a significant difference in kurtosis at the extracranial level between the aHT+ and aHT- (p = 0.03). At the intracranial level, there were no significant differences in all parameters.
CONCLUSION: Results showed a difference between cerebral vasculature in AD for aHT+ and aHT- groups. This is probably related to the loss of arterial compliance induced by the degradation of the vascular system.
Keywords: aging; Alzheimer disease; hypertension; blood flow velocity; contrast media; magnetic resonance imaging.
OBJECTIVES: This study aimed to identify the factors associated with the physical activity of elderly assisted at the basic health units (BHU) of the city of Matelândia, Paraná, Brazil.
METHODS: This is a cross-sectional study, in which 343 elderly users of the BHU of this city were surveyed. A socio-demographic questionnaire, the International Physical Activity Questionnaire (IPAQ), and the questionnaire of barriers to physical activity practice were used.
RESULTS: In relation to the level of physical activity, 88.9% of the elderlies were classified as active/very active. Higher level of physical activity was significantly associated with the amount of medication used (p = 0.024), reason to go to BHU (p = 0.037), and indication of physical activity by UBS (p = 0.040). Lack of energy (p = 0.048) was a more frequent and significant barrier for the active/very active elderly.
CONCLUSION: There is a large number of active/very active elderly users of the BHU of Matelândia, Paraná, Brazil, and this was associated with lower age, lower medication use, going to BHU to withdraw medication/others and indication of physical activity by the BHU. For those who do not fit into these levels, lack of financial resources and insufficiently safe environment are the most common barriers to physical activity.
Keywords: aging; motor activity; health promotion.
OBJECTIVES: Our objective was to verify factors determining the functional level of Brazilian elderly people.
METHOD: This is a secondary analysis of the 2013 National Health Survey (NHS) conducted by the Brazilian Institute of Geography and Statistics (IBGE). The association between functional levels and sociodemographic and clinical characteristics was tested by linear regression adjusted for self-perception of health (SPH) using the Epi Info™ program version 7.2.1. P-values lower than 0.05 were regarded as statistically significant. Functionality was assessed by a functional score developed based on the NHS questions.
RESULTS: Univariate analyses revealed that, except for ethnicity, all socio-economic and clinical variables were significantly related to ease of performing basic activities of daily living (BADL) and instrumental activities of daily living (IADL). Upon multiple linear regression analysis, the most significant variables were age, SPH, stroke, and mental illness (p < 0.001). SPH significantly explained the differences in IADL (5.1%, p < 0.01) and BADL (3.4%, p < 0.01) levels even when controlling for the other variables. Stroke and mental illness were related to lower functional scores, both in IADL (20.5%, p < 0.01 and 19.1%, p < 0.01, respectively) and in BADL (13.5%, p < 0.01 and 7.6%, p < 0.01, respectively).
CONCLUSIONS: The functional status of the elderly could be explained by constitutional factors (age) and modifiable variables (stroke, mental illness, and SPH), many of which still have a great impact on Brazilian morbidity and mortality. The highlight of SPH suggests that it may be an indicator of health care quality for the Brazilian elderly.
Keywords: public health; demographic aging; health status; health status indicators; longevity; activities of daily living.
OBJECTIVE: The increase in thoracic kyphosis and the decrease in respiratory muscle strength are among the most frequently observed physiological changes in the elderly. The aim of this study was to compare thoracic kyphosis angle and respiratory muscle strength measurements among women who do physical activity with those who do not.
METHOD: We evaluated 54 elderly women aged between 60 and 80 years old, and distributed them into two groups: Group 1, with 27 physically active elderly women (71.3 ± 5.1 years old); and Group 2, with 27 elderly women who do not do physical activity (70.2 ± 4.8 years old). Respiratory muscle strength was assessed by maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), and the angle degree of the thoracic kyphosis was measured using the Flexicurva method. For data analysis, we used Pearson's correlation test and Student's t-test, with a significance level set at p < 0.05.
RESULTS: Group 1participants showed higher values of MIP and MEP when compared to those in Group 2. A possible reason for this result could be the effects of regular physical activity and, specifically, the sport practiced.
CONCLUSION: Results suggest that regular participation in physical activity contributes to the maintenance of respiratory muscle strength and delays the increase of the thoracic kyphosis angle in physically active elderly women.
Keywords: elderly; kyphosis; respiratory muscles; physical activity.
OBJECTIVE: This article reviewed studies that relate aspects of double vulnerability (caregivers' physical health, caregivers' self-perceived health, care recipients' dependency and perceived burden) with psychological aspects of caregivers' quality of life.
METHODS: The search was conducted in the PubMed, Capes, LILACS, SciELO and AgeLine indexes using keywords in English and their corresponding words in Portuguese.
RESULTS: Twenty-three papers were analyzed. With regards to the methods, most articles were made up of transversal studies and included various outcomes. There was a wide age range for the caregivers in the studies' samples, and many of them presented incomplete information about age.
CONCLUSION: The results showed that a caregiver's quality of life is affected by several simultaneous variables such as the degree and type of dependency of the elderly person receiving care, the caregiver's health, perceived burden, and positive and negative affects.
Keywords: caregivers; aging; quality of life; psychological stress; elderly health.
OBJECTIVES: To describe and discuss a rare adverse reaction to drugs diagnosed in an elderly female patient after using levofloxacin and metronidazole: the DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms).
CASE DESCRIPTION: A 77-year‑old elderly woman was diagnosed with pneumonia. After undergoing treatment with metronidazole and levofloxacin, she developed pruritic skin lesions, eosinophilia, and fever.
INVESTIGATIONS: We established a suspected diagnosis of levofloxacin-induced DRESS syndrome, and therefore we switched the antibiotics and then administered corticotherapy. The patient exhibited rapid and progressive improvement without damage to other organs.
DIFFERENTIAL DIAGNOSIS: Conditions involving eosinophilia, drug hypersensitivity, and/or skin rash.
COMMENTS: This syndrome is characterized by skin eruption, systemic symptoms, and eosinophilia. Although the patient did not meet all clinical criteria in the literature, the lack of consensus among authors means that a DRESS syndrome diagnosis could not be ruled out. The condition is rare, but clinicians should be alert to this diagnosis in aged individuals, given its severity and high risk of mortality.
Keywords: drug hypersensitivity syndrome; aged; levofloxacin.
With the rise in life expectancy and high incidence of chronic degenerative diseases among the elderly, there is a growing demand of time to dedicate for caring for an elderly family member. Caring for a dependent elderly person requires the acquisition of skills that are specific to this context, such as social skills (SS), which affect the wellbeing of both the caregiver and the care recipient. Given the situation-dependent nature of SS, one must be able to identify deficits in caregivers' SS, but no instruments for evaluating SS in this population were found. Thus, the aim of this thesis was to develop an SS inventory for caregivers of elderly relatives, and to analyze its psychometric properties. A review of the literature on the use of SS among caregivers for the elderly is presented in Manuscript I. Based on a literature search in major Psychology databases, nine studies (seven articles and two dissertations) were found: four about intervention evaluations and five reporting SS correlations with burden, stress, self-esteem, social support, or quality of relationship. Evidence shows that caregivers with a better-developed SS repertoire have more positive perceptions of their quality of life. In addition, although there are instruments, in Brazil no tool to assess SS in other areas was found for the context of caregivers of elderly family members. Thus, it was concluded that it would be important to build an instrument for the purpose of assisting in the identification of SS deficits in this population. In Manuscript II, the objectives were to depict the primary conflicts that arise when caring for an elderly family member and to identify SS considered important in this situation, therefore obtaining information to prepare items for a new instrument. Interviews were conducted with 50 caregivers of the elderly, 25 elderly care-recipients and 25 professionals in the field of aging. The main conflicts involved difficulties to reconcile differences of opinion or financial issues. Most useful SS were: expressing positive feelings, controlling aggressiveness, and discussing problems. On the basis of this information, 37 items were written, and an initial version of an instrument to evaluate the SS of those who care for elderly family members was created (IHS-CI). The aim of Manuscript III was to describe the initial steps for the validation of this new tool. In Study 1, five independent judges conducted a semantic and content analysis of the instrument, which resulted in the exclusion of six items. In Study 2, to obtain evidence about the psychometric properties of the new version of this instrument, 205 participants, all of whom cared for an elderly family member, completed the IHS-CI along with five other measures. Based on an analysis of the tool's internal structure, three factors were identified: expression of emotions, assertive communication, and search for information. The global internal reliability of the instrument was excellent (α = 0.88). Scores on IHS-CI were positively correlated with better quality of life and positive caregiver-elderly interactions; and negatively correlated with burden, depression, and conflicts. Additional studies are needed to gather more evidence of IHSCI validity and to establish norms for interpretation of test-scores. After this, the instrument will be ready to evaluate SS of caregivers of elderly family members, to guide interventions that can contribute with wellbeing and quality of life of both caregivers and care recipients.
Keywords: social skills; caregivers; elderly; psychometrics; stress, psychological.