BACKGROUND: Tablet splitting appears common in older adults, but its safety, and the factors associated with this practice, remain unclear.
OBJECTIVE: To identify which psychotropic drugs are most often split, which doses are intended with this practice, and whether these doses are provided by the Brazilian Unified Health System (SUS) or commercially available.
METHODS: Cross-sectional descriptive study of 632 geriatric outpatients. The number of individuals who split tablets was identified, as well as the psychotropic drugs they used and split. The availability of these drugs on the SUS network and on the market was assessed by checking the 2017 National Formulary of Essential Medicines (RENAME 2017) and the Dictionary of Proprietary Medicinal Products (Dicionário de Especialidades Farmacêuticas) "respectively.
RESULTS: Tablet splitting was reported by 178 patients (28.2%). This practice was significantly more common among those aged 80 years or older. Tablet splitting was significantly associated with a greater number of medical visits and a higher pill burden. The most commonly affected therapeutic classes were antipsychotics (23.9%), other psychotropic drugs (18.7%) and antidepressants (12.3%). Of the 20 psychotropic drugs split, 45% were available on the SUS.
CONCLUSIONS: Tablet splitting poses a challenge, as there is no guarantee of uniformity of concentration of the active ingredient in the split halves. Although the psychotropic drugs that were split in this sample are commercially available, most were not available from SUS in the desired dose forms for older adults.
Keywords: psychotropic drugs; aged; drugs, essential; Unified Health System; fractionated drugs.
OBJECTIVE: This study aimed to investigate self-esteem among older adults treated at Basic Health Units (BHU) and associated factors.
METHODS: This cross-sectional study evaluated 654 older people treated at BHUs in the municipality of Maringá, state of Paraná, in Brazil. A sociodemographic questionnaire, the International Physical Activity Questionnaire (IPAQ), and the Rosemberg Self-esteem Scale were used as instruments. The data analysis was performed using the Kolmogorov-Smirnov test, the Spearmans rank correlation, the Chi-squared test and the Binary Logistic Regression.
RESULTS: The results showed a significant association between self-esteem (p < 0.05) and self-perceived health, which is related to going to BHUs, history of falls and near-falls, and the level of physical activity. The logistic regression showed that the older patients with no history of "near-falls are more likely to have good self-esteem as well as very active older adults. Having high self-esteem was significantly correlated with the variables related to the practice of low-intensity and moderate physical activities.
CONCLUSION: It was concluded that health conditions, especially the history of near-falls and physical activity level are factors associated with a higher self-esteem. In addition, the performance of low-intensity and moderate activities is associated with good self-esteem.
Keywords: public health services; aged; accidental falls; physical activity.
OBJECTIVES: To investigate the association between Frailty syndrome, lipid profile, anthropometric variables, and the functional capacity of older adults; and to analyze an explanatory model of variables with higher predictive capacity for Frailty syndrome.
METHODS: This cross-sectional study included 36 and 86 older adults residing in long-term care facilities and in their households, respectively. Anamnesis was followed by evaluation of anthropometric data, risk of falls, functional tests, and biochemical tests. Frailty syndrome was determined according to the criteria suggested by Fried et al.
RESULTS: Geriatric patients classified as frail "were older; had higher medication consumption; and presented lower performance in handgrip strength, sit-to-stand, and gait J2 speed tests as compared to pre- and non-frail older adults.
CONCLUSION: Gait speed and sit-to-stand tests were significant predictors of Frailty syndrome. Specifically, a good performance in these tests represents a protection factor against Frailty syndrome. Furthermore, gait speed performance was explained by age, handgrip strength performance, and frailty status, while sit-to-stand performance was explained by risk of falls and muscular strength.
Keywords: frail older adults; aging; health of the elderly.
OBJECTIVE: The prevalence of falls and associated factors were determined in a large cohort of community-dwelling older adults.
METHODS: The sample included adults at least 65 years old who resided in the city of Rio de Janeiro, Brazil. A total of 742 individuals were investigated by inverse random sampling and were stratified by gender and age. The prevalence of falls was calculated by the history of falls in the last year. Data on clinical, psychosocial, sociodemographic and functional characteristics were also gathered. After bivariate analysis, statistically relevant variables were included in groups in 4 models for multivariate analyses.
RESULTS: The prevalence of falls was 29%. The mean age was 76.7; 70.2% were female; 43.4% were married; 80.3% had ≥ 5 years of education;48.3% had an income, of which ≥ 5.1 were minimum wage. All of the variables were associated with falls, except fair self-rated "health. In contrast, when all these variables were adjusted (model 2), almost all lost the statistical significance, except for functional dependency-IADL (OR = 1.51; 95%CI 1.02-2.21) and poor/very poor self-rated health (OR = 2.36; 95%CI 1.06-5.25). For psychosocial variables in model 1, only fear of falling and activity level were significantly associated with falls. However, when these variables were adjusted (model 3), only fear of falling remained significant. In the final model, functional dependency (OR = 1.48; 95%CI 1.01-2.17), poor/very poor self-rated health (OR = 2.33; 95%CI 1.05-5.21) and fear of falling (OR = 2.14; 95%CI = 1.47-3.12) were associated with falls.
CONCLUSION: The prevalence of falls is high among community-dwelling older adults. Associations with socio-demographic and biological factors have been identified and confirmed in the literature. Social activities were considered a protective factor.
Keywords: falls; prevalence; elderly
OBJECTIVE: To verify the effect of change and/or maintenance of poor sociodemographic factors, lifestyle and health conditions on the incidence of functional dependence for instrumental activities of daily living (lADLs) in people aged 50 years or older living in urban settings.
METHODS: The relationship between IADLs and risk factors was analyzed in a prospective 4-year follow-up study involving 412 participants. Relative risk (RR) and 95% confidence intervals (95%CI) were calculated using Poisson regression models, adjusted for sex, age and education.
RESULTS: The incidence of dependence for IADLs was 18.9%. Functional dependence was independently associated with lower socioeconomic status (RR = 2.03, 95%CI 1.24-3.32), lack of occupational activity (RR = 2.46, 95%CI 1.31-4.61), inadequate fruit and vegetable intake (RR = 1.90, 95%CI 1.06-3.38) and poor performance in the Mini Mental "State Examination (RR = 2.52, 95%CI 1.53-4.17). The association between functional dependence and diabetes mellitus approached statistical significance (RR = 1.39, 95%CI 0.92-2.10).
CONCLUSIONS: The results showed that worse socioeconomic conditions and chronic health issues were associated with the incidence of dependence for IADLs. These findings highlight the importance of comprehensive and interdisciplinary health care for populations with these characteristics.
Keywords: prospective studies; disability; middle age; risk factors.
OBJECTIVE: Respiratory muscle training has been considered one of the main strategies to alleviate sarcopenia in older adults. Therefore, the present study aimed to verify which respiratory muscle training protocols are most used in this population and their main benefits described in the literature.
METHODS: A literature search was performed in the electronic databases PubMed, Latin American and Caribbean Health Sciences Literature (LILACS) and Scientific Electronic Library Online (SciELO). For this, we used the terms: respiratory muscle training, older adults, and muscle weakness. A total of 80 articles were studied, of which only 8 met the inclusion criteria of this study, whose methodology, variables studied, and outcome were analyzed.
RESULTS: Among the 8 articles analyzed, we can observe an important diversity of the studied protocols; and all articles showed the most varied gains possible with respiratory muscle training.
CONCLUSION: The protocols used in the various studies depend directly on the objective to be achieved with respiratory muscle training; and the main outcomes were improvements in strength, lung function, physical fitness level, quality of life, inflammatory markers and glucose intake.
Keywords: breathing exercises; aged; muscle weakness.
As aging progresses, there is a consequent increase in chronic diseases, such as osteoporosis and osteopenia, and vitamin D (cholecalciferol) supplementation is routinely prescribed. However, indiscriminate use of this supplement can lead to intoxication and systemic changes. Seeking to raise awareness among prescribing physicians and especially older patients, the purpose of this case report was to describe the systemic symptoms and damage that can occur from intoxication due to uncontrolled use of vitamin D, such as hypercalcemia and kidney injury. This report describes the case of an older woman who reported using a cholecalciferol- containing formula for ten years to treat osteoarthritis. She arrived at the hospital with weight loss, acute kidney "injury and hypercalcemia. After ruling out neoplastic diseases, she was diagnosed with vitamin D poisoning. The symptoms and laboratory results improved after treatment. Based on this report, we conclude that geriatricians play a key role in demystifying the use of vitamins and should only prescribe them when medically indicated.
Keywords: vitamin D; iatrogenic disease; hypercalcemia; acute kidney injury; aged.
It is common to find stigmatising terms being used to describe older people with dementia and / or living in care homes in the Brazilian literature, such as ‘demented person’, ‘patient in asylum’, or ‘institutionalised elderly’. Historically, both mental illnesses and long-term care settings for older people have had negative connotations in society. The use of terms that historically refer to social segregation, institutionalization, or that reduce the individual to their disease can therefore contribute to the perpetuation of the stigma, prejudice, depersonalization and discrimination experienced by these people. This opinion paper aims to stimulate discussions about the use of such terms by the Brazilian scientific community and the media, as well as to foster reflections on the impact of the use of such language as part of current academic and clinical environments. The author mentions examples of stigmatizing phrases and words that are commonly found in the literature and mentions some of the consequences of stigma for people with dementia and those living in care homes. The author also refers to international documents which can be used as references for more inclusive and ethical writing.
Keywords: social stigma; dementia; Alzheimer disease; aged; empathy; palliative care.