This article is part of a special series developed to assist authors in the process of scientific writing and communication. The purpose of the study was to underscore the importance of publishing case reports and case series in the medical and health sciences and to provide insights to guide the authors who wish to submit these types of study. A non-systematic review was conducted to present a brief historical overview on reports published in the literature and to provide data on the main difficulties faced by authors trying to publish in the current scenario and on the contributions of case reports and case series to scientific progress. Finally, we address the current paradox of the simultaneous depreciation of this type of publication and reinforcement of the importance of publishing emblematic cases with major impact on the progress of medical science.
Keywords: case reports, case studies; health communication; Journal Article.
The purpose of this study was to understand the different meanings attributed by older adults to old age and their expectations for the future. This was a qualitative descriptive study of 34 older adults involved in senior activities in the urban area of Pau dos Ferros, a municipality located in the state of Rio Grande do Norte, northeastern Brazil. Using a semi-structured interview, the participants were asked about their perceptions of old age and expectations for the future. Two thematic categories emerged throughout the analysis process: ‘Meanings attributed to old age' and ‘Expectations for the future'. The results showed that older adults' perceptions of old age are constantly influenced by the individual experiences accumulated over a lifetime, and that the triad of old age, health, and disease, in the majority of cases, is the factor that most influences the responses. It is our hope that the present study will contribute to the development of further studies that include older adults' perceptions of their own aging process, and that these studies will provide knowledge that will translate into benefits for older adults, whether they participate or not in group-based senior activities.
Keywords: aging; aged; health of the elderly; senior centers.
OBJECTIVE: To analyze the relationship between active aging and social determinants of health in older people living in the catchment area of a primary health care facility.
METHODS: A cross-sectional study was conducted to assess exposure variables of the schematic model by Dahlgren and Whitehead; the outcome variable active aging was created by means of latent class analysis. Participants were categorized as highly, moderately, and minimally active. Data analysis was performed using a forward multinomial regression model.
RESULTS: Overall, 155 elderly people participated in the study, most of them classified as highly active. Older subjects had a higher chance for being minimally active (OR = 5.72) and moderately active (OR = 3.27). Lack of a family life (OR = 3.90) and education level of 4 years or less (OR = 2.90) were shown to be risk factors for moderate levels of active aging.
CONCLUSION: The present study demonstrated that advanced age, lack of family life, and an education level of 4 years or less were associated with a higher chance for elderly attending Family Health Strategy units to present low levels of active aging. It is suggested that these factors should be taken into account when directing public policies aimed at active aging.
Keywords: epidemiology; aging; health of the elderly; social determinants of health.
OBJECTIVE: To describe and identify sociodemographic factors and health behaviors associated with a negative perception of self-care in community-resident older adults in seven Brazilian cities.
METHODS: This is a cross-sectional analysis of data from the Frailty in Brazilian Older Adults (FIBRA) study. Sociodemographic characteristics, health-related behaviors, and perception of self-care in health were assessed. For analysis, percentage distributions and respective 95% confidence intervals were estimated, at a significance level of 5%. Univariate and multivariate logistic regression analyses were carried out, with stepwise variable selection.
RESULTS: Of 2,552 older adults in the overall sample, most (65.8%) were women, with a mean age of 72.3 ± 5.5 years. The worst perception of self-care was associated with non-use of dental care services (OR = 1.48, p < 0.001), income range from 1.1 to 3 times the minimum wage (OR = 1.46, p = 0.049), smoking (OR = 1.41, p = 0.030), sedentary lifestyle (OR = 1.32, p = 0.003), and male gender (OR = 1.24, p = 0.023).
CONCLUSION: Although no high frequencies of negative health behaviors were found, the association of poor perception of self-care with modifiable factors, such as sedentary lifestyle and smoking, stands out. Failure to seek dental care continues to be a challenging aspect among the elderly. These results point to a potential subjective indicator for clinical and health research surveys throughout the aging process.
Keywords: healthy behavior; life style; self-care; perception; elderly; aging.
OBJECTIVE: The present study aimed to identify the needs of the family caregiver of dependent elderly in a different cultural dimension, integrating the social, political and economic reality of each community.
METHODOLOGY: This phenomenological study was carried out with two groups of caregivers of dependent family members from Portugal and Brazil, using focus group as a data collection instrument.
RESULTS: From the analysis of the narratives of the 12 caregivers who participated in the study a set of categories emerge: the need to learn alone, the need for time to maintain the roles, the need for a support network, resilience in imbalances family, and the resources to care for them.
CONCLUSION: In this work it was possible to highlight similarities in the needs of the caregivers of the two countries.
Keywords: family caregivers; elderly; needs assessment; nursing.
OBJECTIVE: In Brazil, 70% of older adults have at least one chronic disease and, of these, 60% use more than four medications regularly, characterizing polypharmacy. Potentially inappropriate medications (PIMs) are used by 40% of this population. Both polypharmacy and PIM use are associated with negative outcomes, such as increased frequency of drug interactions, falls, frailty, malnutrition, and in some cases, death.
METHOD: This was a cross-sectional study with retrospective data collection of all older patients admitted for clinical reasons to a tertiary care hospital in Brazil from March 2015 to February 2016. We evaluated patients for the presence of polypharmacy and PIM use, correlating these findings with other variables of interest.
RESULTS: The medical records of 456 patients were analyzed. Mean patient age was 83 years, and 71.3% were women. The mean Charlson comorbidity index (CCI) was 2.38, and dementia was the most prevalent comorbidity (36.6%). Polypharmacy was present in 56.5% of patients, and 46.4% of them used at least one PIM. Antipsychotics were the most frequently used PIM (46.2%), followed by benzodiazepines (33.0%). Drug interactions were detected in 53.5% of patients. The presence of polypharmacy was associated with the use of PIMs (p < 0.001). Additionally, both polypharmacy and PIM use were associated with drug interactions (p < 0.01), poorer functional status (p < 0.01), and higher CCI (p = 0.015).
CONCLUSION: In this study population, the prevalence of polypharmacy was 56.5%, and 46.5% of cases included the use of PIMs. Both conditions were associated with drug interactions, poorer functional status, and higher CCl.
Keywords: health of the elderly; inappropriate prescribing; polypharmacy
OBJECTIVE: This study aimed to investigate self-perceived health among a sample of institutionalized and a sample of community-dwelling elderly in two cities of the São Paulo State, Brazil: Bauru and Botucatu.
METHODS: Ninety-five elderly individuals from ten long-term care homes from Bauru, SP and Botucatu, SP and 101 community-dwelling elderly users of three centers for the elderly in Bauru, SP were assessed. After obtaining the personal and health data, the evaluation of self-perception of health was performed by asking how the elderly person perceived his health in the most recent days; the response options were very poor, poor, fair, good or excellent.
RESULTS: There was a statistically significant difference (< 0.001) between institutionalized and community-dwelling elderly considering self-perceived health.. After adjusting the model of ordinal logistic regression, it was observed that institutionalized individuals who regularly used prescription medications had a chance 7.5 times greater than nonusers of having a worse self-perceived health [OR = 7.5; 95%Cl (2.1-26.6; p = 0.002)]. In the community-dwelling group it was observed that individuals who regularly used prescription medications had a chance 4.5 times greater than nonusers of having a worse self-perceived health [OR = 4.5; 95%Cl (1.5-13.7; p = 0.008)].
CONCLUSIONS: Worse self-perceived health was associated with taking prescription medications among both institutionalized and community-dwelling elderly.
Keywords: self concept; health; aged; Brazil.
INTRODUCTION AND OBJECTIVE: Plasmacytoma is a neoplastic proliferation of a plasma cell clone which produces monoclonal immunoglobulin. Solitary plasmacytoma of bone is defined by the presence of a single plasmacytoma in the absence of multiple osteolytic lesions or other findings compatible with multiple myeloma. We report an older patient with solitary plasmacytoma of the sternum associated with atypical clinical findings which complicated diagnosis and possible progression to multiple myeloma.
CASE REPORT: A 74-year-old woman sought medical care due to mental confusion, tachydyspnea, and chest pain after a fall with blunt trauma to the anterior chest. During admission, the patient developed refractory hyponatremia, superficial thrombophlebitis in the left upper limb, periorbital cellulitis, endophthalmitis, and sternal osteomyelitis. Serum protein electrophoresis showed a polyclonal increase in gamma globulins. Biopsy result was compatible with plasmacytoma. A computed tomography scan showed no additional lesions. Progression was poor, with chronic renal failure exacerbated by probable tumor lysis syndrome, resulting in death.
CONCLUSION: The present findings emphasize the importance of considering a diagnostic hypothesis of plasmacytoma/multiple myeloma in older patients with a set of varied clinical signs, such as anemia, renal failure, pathological fracture, and repetitive infections.
Keywords: plasmacytoma; multiple myeloma; thrombophlebitis; hyponatremia.
Hoarding disorder can be defined as a persistent difficulty in discarding items, due to distress associated with such disposal or a perceived need to save items regardless of their actual value. Such behavior must result in the accumulation of clutter, which significantly compromises living conditions, causing distress and/or functional impairment. The most frequently hoarded items are objects and animals. The point prevalence of clinically significant hoarding was estimated to be 1.5 to 2.1% in the general population, and may exceed 6% in the elderly. HD poses a range of health and safety hazards to individuals, especially older adults, generating significant costs to society. The diagnosis of HD is clinical, and should only be established after general medical conditions and other mental disorders that can lead to accumulating behavior have been ruled out. HD appears to follow a chronic, progressive course, and is commonly associated with psychiatric comorbidities. Studies indicate that genetic, familial, cognitive, and traumatic factors are implicated in the etiology of HD. To date, psychotherapies have been the most widely studied therapeutic approaches, but the results of these studies show small effects. Research into pharmacological approaches to HD is still incipient, precluding any conclusions of efficacy.
Keywords: hoarding disorder; collecting; psychopathology.