Transforming the invisible into the visible: disparities in the access to health in LGBT+ older people

Abstract Objectives: To compare variables of access to healthcare between the LGBT+ population aged 50 and over and those non-LGBT+. Methods: A cross-sectional study was carried out in Brazil through a confidential online questionnaire. The use of the health system was characterized by the number of preventive tests performed and measured by the PCATool-Brasil scale (a 10-point scale in which higher scores were associated with better assistance in healthcare). The association between being LGBT+ and access to health was analyzed in Poisson regression models. Results: 6693 participants (1332 LGBT+ and 5361 non-LGBT+) with a median age of 60 years were included. In the univariate analysis, it was observed not only lower scores on the PCATool scale (5.13 against 5.82, p < 0.001), but a greater proportion of individuals among those classified with the worst quintile of access to healthcare (< 4 points), 31% against 18% (p < 0.001). Being LGBT+ was an independent factor associated with worse access to health (PR = 2.5, 95% CI 2.04‒3.06). The rate of screening cancer, for breast, colon, and cervical cancer was also found to be lower in the LGBT+ population. Conclusion: Healthcare access and health service experiences were worse in the LGBT+ group than in their non-LGBT peers. Inclusive and effective healthcare public policies are essential to promote healthy aging for all.

Adaptation to the driving simulator and prediction of the braking time performance, with and without distraction, in older adults and middle-aged adults

Abstract Context: Many studies show the importance of evaluating the adaptation time of subjects in a virtual driving environment, looking forwards to a response as closest as a possible real vehicle. Objectives: This study aimed to identify and analyze the adaptation to the driving simulator in older adults and middle-aged adults with and without a distraction, and a secondary aim was to identify predictors of safe performance for older adults' drives. Design: Male and female middle-aged adults (n = 62, age = 30.3 ± 7.1 years) and older adults (n = 102, age = 70.4 ± 5.8 years) were evaluated for braking time performance in a driving simulator; cognition performance assessment included the Mini-Mental State Examination; motor evaluation included ankle flexor muscle strength with the isokinetic dynamometer and handgrip strength; the postural balance was evaluated with Timed Up and Go test, with and without a cognitive distraction task. Results: Older adults (men and women) and middle-aged adult women require more time to adapt to the driving simulator. The distractor increases the adaptation time for all groups. The main predictors of braking time for older women are age, muscle strength, and postural balance associated with distraction, and for older men, muscle strength. Conclusions: Age, sex, and distractor interfere in the adaptation of the virtual task of driving in a simulator. The evaluation model developed with multi-domains demonstrated the ability to predict which skills are related to braking time with and without the presence of the distractor.

Aspectos demográficos e acesso aos projetos pedagógicos dos cursos de Medicina no Brasil / Demographic aspects and access to the pedagogical projects of medical courses in Brazil

Resumo: Introdução: A ampliação da educação superior no Brasil é recente. Na área médica, com o advento do Programa Mais Médicos, essa expansão tornou-se viável e culminou com a publicação de novas Diretrizes Curriculares Nacionais (DCN) para o curso de graduação em Medicina. O projeto pedagógico do curso (PPC) traduz o que se realiza no curso e funciona como instrumento de comunicação entre a instituição e a sociedade. A análise dos PPC das instituições de ensino superior propicia a identificação de elementos que apontam para convergência ou se afastam do preconizado nas mudanças pretendidas pelas DCN de 2014. Objetivo: Este estudo descreve demograficamente no Brasil o número de cursos de Medicina públicos e privados por estado e região da Federação, o número de vagas disponíveis e o acesso aos PPC dessas escolas por meio de metodologia sistematizada. Método: Realizou-se um levantamento de todas as faculdades com curso de Medicina no Brasil, no ano de 2021. A procura dos PPC foi realizada no site institucional. Em caso de ausência da informação, encaminhamos mensagem eletrônica à coordenação do curso de Medicina. Na indisponibilidade de contato direto com a coordenação pelo site institucional, encaminhamos mensagem ao coordenador por meio do acesso ao seu Currículo Lattes. Resultado: Foram identificadas 336 escolas médicas, 115 (34,2%) públicas e 226 (65,8%) privadas. Observamos a maior concentração de cursos na Região Sudeste (41,3%), seguida da Região Nordeste (24,6%). Das instituições públicas, o Nordeste é a região que mais concentra as escolas (35,6%), seguida da Região Sudeste (26%). Quanto às instituições privadas, ocorre o inverso. Obteve-se um total de 134 PPC (39,8%), sendo 111 (83%) das escolas públicas e 23 (17%) das privadas. Conclusão: Embora a disponibilização do documento de informação pedagógica no site da instituição seja obrigatória, isso não foi verificado em realidade, o que corrobora a necessidade de políticas de valorização e fiscalização da disponibilidade do PPC para facilitar o seu acesso pelos maiores interessados: alunos, comunidade acadêmica e pesquisadores da área da educação médica.

Abstract Introduction: The expansion of higher education in Brazil is recent. In the medical field, with the advent of the "Mais Médicos" Program, this expansion became feasible and culminated with the publication of new National Curricular Guidelines (DCN, Diretrizes Curriculares Nacionais) for undergraduate medical courses. The Pedagogical Course Project (PCP) translates what is accomplished in the course and works as an instrument of communication between the institution and society. The analysis of the PCPs of Higher Education Institutions provides the identification of elements that point to the convergence or move away from the changes proposed by the DCN 2014. Objective: To describe demographically in Brazil the number of public and private medical courses by state and region of the federation, the number of available vacancies, and access to the PCPs of these schools through a systematized methodology. Method: A study was carried out in all institutions with medical courses in Brazil by the year 2021. The search for the PCPs was carried out in the institutional website. In case of lack of information, an electronic message was sent to the medical course coordination. When it was not possible to contact the coordinator directly through the institutional website, a message was sent to the coordinator by accessing their curriculum lattes. Results: A total of 336 medical schools were identified, 115 (34.2%) of which were public and 226 (65.8%) private ones. A higher concentration of courses was observed in the southeast region (41.3%), followed by the northeast region (24.6%). Of the public institutions, the northeast region has the highest concentration of schools (35.6%), followed by the southeast region (26%). The opposite was observed regarding the private institutions. A total of 134 PCPs were obtained (39.8% of the total), 83% from public schools and 17% from private ones. Conclusion: Although the availability of the pedagogical information document on the institution's website is an obligation, this was not verified in reality, which makes it necessary to implement policies for valuing and monitoring PCP availability, thus facilitating its access by the most interested parties: students, the academic community and researchers in the field of medical education.

Impact of oral health on frailty syndrome in frail older adults

ABSTRACT Objective This study aimed to correlate oral and general health in frail and non-frail older adults. Methods This observational study included 52 older adults, of whom 35 were frail (Frail Group), and 17 were non-frail (Non-Frail Group), according to Fried's self-reported test addressing oral health variables, number of systemic diseases, and medications in use. The geriatric oral health assessment index was used to assess the oral hygiene of the groups. Results The number of preserved teeth in dentulous older adults was significantly higher in the Non-Frail Group (p=0.048). No significant differences were observed between the two groups in the use of dental prostheses or in the detection of soft tissue lesions. Overall, 74.3% of the Frail Group had a "bad" geriatric oral health index score, which significantly differed from that of the Non-Frail Group (p=0.045). The numbers of systemic diseases and medicines used were higher in the Frail Group than in the Non-Frail Group (p<0.001), demonstrating the pathophysiological characteristics of multimorbidity and polypharmacy in frailty syndrome. Conclusion The results showed a clear correlation between oral and general health conditions and frailty syndrome.

Microcephaly measurement in adults and its association with clinical variables

ABSTRACT OBJECTIVE To establish a microcephaly cut-off size in adults using head circumference as an indirect measure of brain size, as well as to explore factors associated with microcephaly via data mining. METHODS In autopsy studies, head circumference was measured with an inelastic tape placed around the skull. Total brain volume was also directly measured. A linear regression was used to determine the association of head circumference with brain volume and clinical variables. Microcephaly was defined as head circumference that were two standard deviations below the mean of significant clinical variables. We further applied an association rule mining to find rules associating microcephaly with several sociodemographic and clinical variables. RESULTS In our sample of 2,508 adults, the mean head circumference was 55.3 ± 2.7cm. Head circumference was related to height, cerebral volume, and sex (p < 0.001 for all). Microcephaly was present in 4.7% of the sample (n = 119). Out of 34,355 association rules, we found significant relationships between microcephaly and a clinical dementia rating (CDR) > 0.5 with an informant questionnaire on cognitive decline in the elderly (IQCODE) ≥ 3.4 (confidence: 100% and lift: 5.6), between microcephaly and a CDR > 0.5 with age over 70 years (confidence: 42% and lift: 2.4), and microcephaly and males (confidence: 68.1% and lift: 1.3). CONCLUSION Head circumference was related to cerebral volume. Due to its low cost and easy use, head circumference can be used as a screening test for microcephaly, adjusting it for gender and height. Microcephaly was associated with dementia at old age.

COVID-19 containment management strategies in a nursing home

ABSTRACT Objective: To describe the first COVID-19 pandemic at Casa Ondina Lobo, a philanthropic nursing home in São Paulo city, and the containment measures against the pandemic that proved to be effective. Methods: Several preventive measures were taken before and during the pandemic, with emphasis on universal testing by reverse transcription polymerase chain reaction for COVID-19. All residents and employees were tested twice in a D9 period. Results: Among the 62 residents and 55 employees, in both testing, eight residents and nine employees tested positive for COVID-19. Of 22% of employees and 75% of residents evolved asymptomatic, emphasizing the importance of universal testing for the detection and isolation of these cases. A quarter of residents evolved without any symptoms, however, with COVID-19 signs, reinforcing the importance of monitoring vital signs. The second testing did not detect any new cases among residents, demonstrating the effectiveness of the containment measures, however, it found four new cases among employees. This emphasized their role in COVID-19 outbreaks in nursing homes. Only one patient died, a 12.5% lethality among those known to be infected and a 1.6% mortality in the total population of residents were seen. Conclusion: The adoption of appropriate containment measures enabled to contain an COVID-19 pandemic in studied nursing home. Universal reverse transcription polymerase chain reaction testing for COVID-19 has proved to be particularly important and effective.

Use of potentially inappropriate medications and adverse events in older outpatients with acute conditions

ABSTRACT Objective To examine associations between potentially inappropriate medication, use and the risk of falls, unplanned hospitalization and death in older patients receiving initial care in a geriatric day hospital due to acute conditions. Methods Cohort study with older adults referred to a geriatric day hospital from 2014 to 2017 due to acute conditions. Patients were submitted to comprehensive geriatric assessment. Use of medications was analyzed according to Beers Criteria 2019. Outcome assessment was based on monthly follow-up telephone calls made over the course of one year. Results In this sample, 40.6% of patients had been prescribed at least one potentially inappropriate medication, particularly proton pump inhibitors (66.5%). Over the course of follow-up, 44.7% of patients receiving potentially inappropriate medications sustained at least one fall (p=0.0043) and 70% visited the emergency department (p=0.0452). These outcomes were more common among patients using two or more of drugs. Use of potentially inappropriate medication was associated with a 64% increase in the odds of unplanned hospitalization and a two-fold increase in risk of death. Conclusion Associations between potentially inappropriate medication use and unfavorable outcomes such as falls and unplanned hospitalizations within one year of admission to a geriatric day hospital support the application of Beers Criteria and emphasize the importance of periodic prescription review, deprescription and rational use of these drugs whenever possible.

Palliative care over the rainbow: perspectives of middleage and older LGBT+ adults regarding their end-of-life / Cuidados paliativos além do arco-íris: perspectivas de pessoas idosas LGBT+ relacionadas com o final de suas vidas

Objective: Reports show that LGBT+ people may face several struggles during their endof-life (EOF) preparations, reporting higher rates, for example, of harassment and fear of feeling pain during these moments. We thus aimed to investigate variables related to EOF preparations among LGBT+ people and compare them with heterosexual cisgender individuals. Methods: This is a cross-sectional study in which Brazilians aged 50 or older were invited to answer an anonymous online survey between August 2019 and January 2020. The survey was widely distributed in neighbourhood associations, nongovernmental organizations, and social media. Those who identified as homosexual, bisexual, pansexual, non-heterosexual, transgender, travesti, or non-binary were grouped as LGBT+; cisgender and heterosexual participants were grouped as non-LGBT+. Results: The questionnaire was answered by 6693 participants with a median age of 60 years. Out of all respondents, 1332 were LGBT+ (19.90%) and 5361 were non-LGBT+ (80.10%). Compared to their non-LGBT+ peers, LGBT+ people reported higher rates of loneliness (25.30% vs 16.32%, p < 0.001), fear of dying alone (15.69% vs 9.79%, p < 0.001) or in pain (35.21% vs 25.74%, p < 0.001), and less social support (19.44% vs 13.48%, p < 0.001). Conclusions: Being LGBT+ was associated with challenges and inequalities regarding EOF preparations and discussions. Sexuality and diversity should be addressed in palliative training programs to address the needs of the LGBT+ population and to provide them with a dignified death

Objetivos: Estudos observacionais mostram que pessoas LGBT+ enfrentam diversas barreiras e desafios em suas preparações de fim de vida, como, por exemplo, taxas maiores de discriminação e medo de sentir dor nesses momentos. Dessa forma, nosso objetivo foi investigar variáveis relacionadas às preparações de fim de vida entre pessoas LGBT+ e compará-las com as de indivíduos não LGBT+. Metodologia: Este foi um estudo de corte transversal, no qual brasileiros com 50 anos ou mais foram convidados a responder a um questionário online anônimo entre agosto de 2019 e janeiro de 2020. O link para respostas foi distribuído amplamente em associações, organizações não governamentais e mídias sociais. Aqueles que se identificassem como homossexuais, bissexuais, pansexuais, não heterossexuais, transgênero, travestis ou com gênero não binário foram agrupados no grupo LGBT+; pessoas cisgênero e heterossexuais constituíram o grupo não LGBT+. Resultados: O questionário foi respondido por 6693 participantes, com mediana de idade de 60 anos. Entre eles, 1332 eram LGBT+ (19,90%) e 5361 não LGBT+ (80,10%). Comparadas com seus contemporâneos não LGBT+, as pessoas LGBT+ referiram maiores taxas de solidão (25,30% vs. 16,32%, p < 0,001), medo de morrer sozinhas (15,69% vs. 9,79%, p < 0,001) ou com dor (35,21% vs. 25,74%, p < 0,001) e menor suporte social (19,44% vs. 13,48%, p < 0,001). Conclusões: Ser LGBT+ esteve associado com iniquidades e desafios relacionados às preparações e discussões de fim de vida. Sexualidade e diversidade devem ser abordadas em programas de formação em cuidados paliativos para se acessarem as necessidades e particularidades da população LGBT+ e, dessa forma, ser proporcionada uma morte com dignidade a todos.

Posturographic measures did not improve the predictive power to identify recurrent falls in community-dwelling elderly fallers

OBJECTIVE: This study aimed to evaluate if posturography can be considered a recurrent fall predictor in elderly individuals. METHODS: This was a cross-sectional study. A total of 124 subjects aged 60 to 88 years were evaluated and divided into two groups—the recurrent fallers (89) and single fallers (35) groups. Patients' sociodemographic characteristics were assessed, and clinical testing was performed. The functional test assessment instruments used were timed up and go test (TUGT), Berg Balance Scale (BBS), five times sit-to-stand test, and Falls Efficacy Scale (to measure fear of falling). Static posturography was performed in a force platform in the following three different situations—eyes open (EO), eyes closed (EC), and EO dual task. RESULTS: There were significant differences between the single and recurrent fallers groups regarding the fear of falling, the Geriatric Depression Scale score, the mean speed calculated from the total displacement of the center point of pressure (COP) in all directions with EO, and the root mean square of the displacement from the COP in the mediolateral axis with EC. Based on the hierarchical logistic regression model, none of the studied posturographic variables was capable of significantly increasing the power of differentiation between the recurrent and single fallers groups. Only TUGT with a cognitive distractor (p<0.05) and the BBS (p<0.01) presented with significant independent predictive power. CONCLUSION: TUGT with a cognitive distractor and the BBS were considered recurrent fall predictors in elderly fallers.

Development of a word accentuation test for predicting cognitive performance in Portuguese-speaking populations / Desenvolvimento de um teste de acentuação de palavras em português para predição de desempenho cognitivo

ABSTRACT The Word Accentuation Test (WAT) has been used to predict premorbid intelligence and cognitive performance in Spanish-speaking populations. It requires participants to read a list of words without the accent marks that indicate the stressed syllable. Objective: As Portuguese pronunciation is also strongly based on accent marks, our aim was to develop a Brazilian version of the WAT. Methods: An initial pool of 60 items was constructed and a final version of 40 items (named WAT-Br) was derived by item response theory. A sample of 206 older adults underwent the WAT-Br and a standardized neuropsychological battery. Independent ratings were performed by two observers in 58 random participants. Results: The items showed moderate to high discrimination (α between 0.93 and 25.04) and spanned a wide range of difficulty (β between −2.07 and 1.40). The WAT-Br was shown to have an excellent internal consistency (Kuder-Richardson Formula 20 = 0.95) and inter-rater reliability (intraclass correlation coefficient = 0.92). It accounted for 61% of the variance in global cognitive performance. Conclusion: A version of the WAT for Portuguese-speaking populations was developed and proved to be a valuable tool for estimating cognitive performance.

RESUMO O Teste de Acentuação de Palavras (TAP) tem sido utilizado para predizer inteligência pré-mórbida e desempenho cognitivo em populações de língua espanhola. Requer que os sujeitos leiam uma lista de palavras sem os sinais gráficos de acentuação que indicam a sílaba tônica. Objetivo: Como a pronúncia da língua portuguesa também é fortemente baseada em acentos gráficos, nosso objetivo foi desenvolver uma versão brasileira do TAP. Métodos: Um conjunto inicial de 60 itens foi construído e uma versão final de 40 itens (denominada TAP-Br) foi derivada por teoria da resposta ao item. Uma amostra de 206 idosos foi submetida ao TAP-Br e a uma bateria neuropsicológica padronizada. Registros de pontuação independentes foram realizados por dois observadores em uma subamostra de 58 participantes aleatórios. Resultados: Os itens apresentaram moderada a alta discriminação (α entre 0,93 e 25,04) e abrangeram uma ampla gama de dificuldades (β entre −2,07 e 1,40). O TAP-Br apresentou excelente consistência interna (Fórmula de Kuder-Richardson 20 = 0,95) e confiabilidade inter-examinador (Coeficiente de Correlação Intraclasse = 0,92). O escore do TAP-Br explicou 61% da variância do desempenho cognitivo global. Conclusão: Uma versão do TAP para as populações de língua portuguesa foi desenvolvida e mostrou-se uma ferramenta útil para estimar desempenho cognitivo.

Estimulação cognitiva em idosos com demência: qual o impacto na saúde de seus cuidadores? / Cognitive stimulation in older adults with dementia: what is the impact on their caregivers' health?

OBJETIVOS: Identificar e avaliar o efeito das intervenções de estimulação cognitiva (EC) em idosos com demências na saúde dos cuidadores. MÉTODO: Revisão sistemática da literatura conduzida de acordo com as diretrizes do Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA). A busca foi realizada em maio de 2018, por dois pesquisadores independentes, nas bases de dados Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Escala da Base de Dados de Evidência em Fisioterapia (PEDro), PsycINFO e PubMed. Os descritores utilizados foram "dementia" AND "cognitive stimulation" e seus equivalentes em português e espanhol. Foram incluídos apenas artigos experimentais, publicados entre janeiro de 2007 e abril de 2018, que realizaram EC em idosos com demência, conduzida por profissional ou pelo próprio cuidador e cujo desfecho incidisse no cuidador. A qualidade dos estudos selecionados foi avaliada pela Escala PEDro. RESULTADOS: A amostra foi composta de 10 estudos, sendo que apenas dois verificaram benefícios da EC sobre a saúde do cuidador do idoso com demência. CONCLUSÃO: Este estudo não encontrou evidências consistentes sobre os reais benefícios da realização de EC no idoso com demência para a vida do seu cuidador.

OBJECTIVES: To identify and evaluate the effect of cognitive stimulation (CS) interventions for older adults with dementia on caregivers' health. METHOD: This systematic literature review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA) guidelines. A search was performed by two independent researchers in May 2018, using Scientific Electronic Library Online (SciELO), Latin American and Caribbean Health Science Literature Database (LILACS), Physiotherapy Evidence Database (PEDro), PsycINFO, and PubMed databases. The terms used were "dementia" AND "cognitive stimulation" and their equivalents in Portuguese and Spanish. For inclusion, articles should have been experimental, published from January 2007 to April 2018, with CS delivered to older adults with dementia by a professional or by a caregiver, and outcome measured in the caregiver. Quality of selected studies was assessed using the PEDro scale. RESULTS: The sample consisted of 10 studies, and only two reported CS benefits to the health of caregivers of older adults with dementia. CONCLUSION: This study found no consistent evidence of actual benefits of CS in older adults with dementia to their caregivers' health.

Abordagem das particularidades da velhice de lésbicas, gays, bissexuais e transgêneros / An approach to the peculiarities of lesbian, gay, bisexual, and transgender aging

A invisibilidade do envelhecimento de lésbicas, gays, bissexuais e pessoas transgêneras (LGBT) é uma realidade. Sofrem com os etarismos da sociedade, por diversas formas de discriminação e pela presunção de que todos são heterossexuais e cisgêneros. Ademais, eles expressam maiores riscos de estarem morando sozinhos, de não terem filhos e de não apresentarem alguém para chamar em caso de uma emergência. Poucos são os estudos que abordam esse tema, principalmente na literatura médica brasileira. Além disso, o geriatra e o gerontólogo podem se deparar com situações desafiadoras em suas práticas ao cuidarem de uma pessoa idosa LGBT saudável, com demência ou até mesmo em fase final de vida. Assim, este artigo de revisão bibliográfica teve como objetivos: abordar o envelhecimento dessa população, reforçar as definições apropriadas e discutir sobre as discriminações que sofrem nos serviços de saúde, sobre as medidas para a promoção de sua saúde e sobre as especificidades no cuidado da pessoa idosa LGBT com demência, em fase final de vida ou residente de uma instituição de longa permanência

The invisibility of lesbian, gay, bisexual, and transgender people (LGBT) aging is a reality. These individuals suffer from ageism, from various forms of discrimination, and from the assumption that all are heterosexual and cisgender. They are also at higher risk of living alone, being childless, and having no one to call in an emergency. Few studies have addressed the subject, especially in the Brazilian medical literature. Additionally, geriatricians and gerontologists may encounter challenging situations when caring for LGBT older adults who are healthy, or have dementia, or are even at the end of life. Thus, this review article aimed to investigate the aging process of the LGBT population; to reinforce appropriate terminology; and to discuss the discrimination that they face in health care services, measures for health promotion, and the specific care of the LGBT older person with dementia, at the end of life, or living in a long-term care facility

Hypertension is the underlying cause of death assessed at the autopsy of individuals / La hipertensión arterial es causa subyacente de muerte evaluada en la autopsia de individuos / A hipertensão arterial é causa subjacente de morte avaliada na autópsia de indivíduos

ABSTRACT Objective: To analyze hypertension and its relationship with the causes of death identified by the autopsy. Method: Cross-sectional study analyzed 356 participants belonging to the Brazilian Aging Brain Study Group, over 50 years of age, autopsied at the Sao Paulo Autopsy Service between 2004 to 2014. A clinical interview was conducted with the informant of the deceased. Hypertension was defined by reporting the disease and/or use of antihypertensive medication, by the informant of the deceased. Descriptive analyzes and bivariate and multivariable associations were performed. Results: The prevalence of hypertension was 66.2% and it was the second leading cause of death (25.6%) identified by autopsy, preceded by atherosclerosis (37.8%). The variables associated with hypertension were: female gender (OR=2.30 (1.34-3.90)); living with partner [OR=0.55 (0.32-0.92)]; Body Mass Index [OR=1.14 (1.08-1.22)] and history of diabetes [OR=2.39 (1.34-4.27)]. Conclusion: The prevalence of hypertension was high, and it was the second most common underlying cause of death. The gold standard for the definition of cause of death, the autopsy, shows important results, which confirmed the relevance of hypertension as a public health problem.

RESUMEN Objetivo: Analizar la hipertensión y su relación con las causas de muerte identificadas por la autopsia. Método: Estudio transversal, que analizó a 356 participantes del Biobanco para Estudios en el Envejecimiento, con edad mayor a 50 años, autopsiados en el Servicio de Verificación de Defunciones entre los años 2004 y 2014. Una entrevista clínica fue realizada con el informante del fallecido. La hipertensión fue definida por el relato de la enfermedad y/o uso de medicación antihipertensiva por el informante del fallecido. Se llevaron a cabo análisis descriptivos y asociaciones bivariadas y multivariables. Resultados: La prevalencia de hipertensión arterial fue del 66,2% y fue la segunda causa básica de defunción (25,6%) identificada en la autopsia, precedida de aterosclerosis (37,8%). Las variables asociadas con la hipertensión fueron: género femenino (OR = 2,30 (1,34-3,90); tener a una pareja [OR = 0,55 (0,32-0,92)]; índice de masa corporal [OR = 1,14 (1,08-1,22)] e historia de diabetes [OR = 2,39 (1,34-4,27)]. Conclusión: La prevalencia de hipertensión fue elevada y representó la segunda causa básica de defunción más frecuente. El uso de la autopsia como regla de oro para definir la causa de la muerte confirmó la relevancia de la hipertensión como un problema de salud pública.

RESUMO Objetivo: Analisar a hipertensão e sua relação com as causas de morte identificadas pela autópsia. Método: Estudo transversal, que analisou 356 participantes do Biobanco para Estudos no Envelhecimento, com idade maior do que 50 anos, autopsiados no Serviço de Verificação de Óbitos entre os anos de 2004 a 2014. Uma entrevista clínica foi realizada com o informante do falecido. A hipertensão foi definida pelo relato da doença e/ou o uso de medicação anti-hipertensiva pelo informante do falecido. Foram realizadas análises descritivas e associações bivariadas e multivariáveis. Resultados: A prevalência de hipertensão arterial foi de 66,2% e foi a segunda causa básica de óbito (25,6%) identificada na autópsia, precedida de aterosclerose (37,8%). As variáveis associadas à hipertensão foram: gênero feminino (OR = 2,30 (1,34-3,90); ter um parceiro [OR = 0,55 (0,32-0,92)]; índice de massa corporal [OR = 1,14 (1,08-1,22)] e história de diabetes [OR = 2,39 (1,34-4,27)]. Conclusão: A prevalência de hipertensão foi elevada e representou a segunda causa básica de óbito mais frequente. O uso da autópsia como padrão-ouro para definir a causa da morte confirmou a relevância da hipertensão como um problema de saúde pública.

Quantitative sensory testing in elderly: longitudinal study / Teste sensitivo quantitativo em idosos: estudo longitudinal

ABSTRACT Objective: To evaluate elderly patients in a geriatric service, along with their sensory characteristics and their association with clinical aspects. Methods: This was a descriptive longitudinal study. We enrolled 36 healthy participants of both sexes in this study. The following instruments were used and evaluations performed: clinical evaluation, Mini-Mental State Exam, and quantitative sensory testing. Results: During the follow-up, there was reduction of mean corpuscular volume at each evaluation (p < 0.001) and significant increase in mean corpuscular hemoglobin concentration (p < 0.001). There was an increase of the olfactory (p < 0.001), salty (p = 0.024), sour (p = 0.020), bitter (p = 0.001), facial cold (p = 0.019), hand cold (p = 0.004), facial tactile (p < 0.001), hand tactile (p = 0.012) and facial vibration (p = 0.018) thresholds. Previous existing morbidities were associated with sensitivity changes in the individuals in this sample. Conclusion: This longitudinal study suggests that the loss of sensitivity with aging may be associated with the presence of morbidities in elders.

RESUMO Objetivo: Avaliar pacientes idosos em um serviço de geriatria, juntamente com as características sensitivas e sua associação com aspectos clínicos. Métodos: Este é um estudo longitudinal descritivo. Foram avaliados 36 sujeitos saudáveis de ambos os sexos. Os seguintes instrumentos e avaliações foram realizados: Avaliação clínica, Mini Exame de Estado Mental (Mini-Mental) e testes sensitivos quantitativos. Resultados: Durante o acompanhamento houve redução do volume corpuscular médio (VCM) em cada avaliação (P < 0,001) e aumento significativo das concentrações de hemoglobina corpuscular média (CHCM) (P < 0,001). Houve aumento dos limiares olfativos (p < 0,001), salgado (p = 0,024), azedo (p = 0,020), amargo (p = 0,001), frio face (p = 0,019), frio mão (p = 0,004), tato face (p < 0,001), tato mão (p = 0.012) e vibração face (p = 0,018). Morbidades prévias foram associadas às alterações de sensibilidade nos indivíduos desta amostra. Conclusão: Este estudo longitudinal sugere que a perda de sensibilidade no envelhecimento pode estar associada à presença de morbidades em idosos.

Consenso brasileiro de fragilidade em idosos: conceitos, epidemiologia e instrumentos de avaliação / Brazilian consensus on frailty in older people: concepts, epidemiology and evaluation instruments

O objetivo do presente trabalho foi descrever as definições conceitual e operacional da síndrome de fragilidade recomendadas pelo Consenso Brasileiro de Fragilidade em Idosos. Em 2015, uma força-tarefa composta de especialistas brasileiros em envelhecimento humano conduziu uma revisão bibliográfica sobre fragilidade em idosos no Brasil e estabeleceu um consenso acerca dos principais achados por meio de reuniões periódicas. No total, 72 artigos foram incluídos para análise, entre os quais, uma revisão sistemática, duas discussões conceituais, duas descrições metodológicas, quatro estudos longitudinais focando mortalidade e piora do perfil de fragilidade, oito estudos de adaptação transcultural e 55 estudos transversais ou de prevalência. Quarenta e cinco estudos (62,5%) utilizaram a escala de fragilidade do Cardiovascular Health Study (EFCHS), dos quais sete (15,2%) usaram pontos de corte não ajustados para a amostra e 17 (36,9%) modificaram pelo menos um dos cinco itens que compõem o instrumento. A prevalência de fragilidade variou entre 6,7 e 74,1%. Quando utilizada a EFCHS, a ampla variação de prevalência ­ de 8 a 49,3% ­ dependeu dos pontos de corte empregados para classificar as alterações na velocidade de marcha e na força de preensão palmar, bem como do cenário de investigação. Os estudos foram baseados em quatro grandes modelos conceituais de fragilidade. A fragilidade em idosos representa um estado de vulnerabilidade fisiológica e não deve ser confundida com incapacidades ou multimorbidades. Na população brasileira, a prevalência de fragilidade ainda não está adequadamente estimada, e os pontos de corte dos itens que compõem as escalas de fragilidade devem ser adaptados aos parâmetros dessa população.

The aim of the present study was to describe the conceptual and operational definitions of the frailty syndrome recommended by the Brazilian Consensus on Frailty in Older People. In 2015, a task force consisting of Brazilian specialists on human aging conducted a bibliographical review on frailty among older people in Brazil and established a consensus on the main findings through periodic meetings. A total of 72 articles were included in the analysis, comprising one systematic review, two conceptual discussions, two methodological descriptions, four longitudinal studies focusing on mortality and worsening of the frailty profile, eight cross-cultural adaptation studies, and 55 cross-sectional or prevalence studies. Forty-five studies (62.5%) used the Cardiovascular Health Study (CHS) frailty scale, of which seven (15.2%) used unadjusted cut-off points for their samples and 17 (36.9%) modified at least one of the five items of the instrument. The prevalence of frailty varied between 6.7 and 74.1%. When the CHS frailty scale was used, the wide range of prevalence ­ from 8 to 49.3% ­ depended on the cut-off points used to classify changes in gait speed and handgrip strength, as well as the research setting. The studies were based on four major conceptual models of frailty. Frailty in older people represents a state of physiological vulnerability and should not be confused with disabilities or multi-morbidities. In the Brazilian population, the prevalence of frailty has not yet been adequately estimated, and the cut-off points of the items of the frailty scales should be adapted to the parameters of this population.

Comparison between subjective and objective evaluations of self-care performance in elderly inpatients / Comparação entre avaliações subjetivas e avaliação objetiva do desempenho de autocuidados em idosos internados

ABSTRACT Objetive To identify the functional status in self-care performance of elderly inpatients, through subjective and objective evaluations. Methods Fifty-five pairs of elderly and their respective caregivers of both sexes were submitted to subjective (self-rating and rating by caregivers) and objective assessment. The Performance Test of Activities of Daily Living and items in the Instrumental Activities of Daily Living scale were used. Functional status was rated 1 (unable to perform task), 2 (able to perform task with assistance) or 3 (able to perform task unassisted). The agreement rate among different self-rating and rating by caregivers, and objective assessment was calculated by dividing the number of identical responses by the total. Results Most elderly patients and caregivers were women (58.2% and 83.6%, respectively). The mean age was 80 years for elderly patients and 58.7 years for caregivers. Low schooling levels (1 to 4 years) prevailed among elderly patients (65.4%), while caregivers often had complete high education (32.7%). Functional status (FN=1, 2 and 3) varied between tasks, and the agreement rate between assessment methods ranged from 58 to 98.1%, particularly in comparisons involving objective assessment. Conclusion Self-reported data and data contributed by caregivers must be compared with performance data collected via objective assessment for a reliable appreciation of the true functional status of older adults.

RESUMO Objetivo Identificar o nível de funcionalidade no desempenho dos autocuidados em idosos internados, por meio de avaliações subjetivas e objetivas. Métodos Cinquenta e cinco pares de idosos e respectivos cuidadores, de ambos os sexos, submeteram-se a: avaliação subjetiva dos idosos, avaliação subjetiva dos cuidadores e avaliação objetiva do idoso. Foi aplicada a Escala Ecológica de Desempenho de Atividades de Vida Diária, bem como itens das Atividades Instrumentais de Vida Diária. O nível de funcionalidade foi classificado em 1 para "não faz a tarefa", 2 para "faz com ajuda" e 3 para "faz sem ajuda". Calculamos o índice de concordância entre as avaliações subjetiva dos idosos, subjetiva dos cuidadores e objetiva do idoso dividindo o número de respostas idênticas pelo total. Resultados A maioria dos participantes era do sexo feminino entre os idosos (58,2%) e os cuidadores (83,6%). A média de idade dos idosos foi 80 anos e, dos cuidadores, 58,7 anos. A escolaridade baixa (1 a 4 anos) predominou entre os idosos (65,4%) e a alta (Ensino Superior), entre os cuidadores (32,7%). O nível de funcionalidade (FN=1, 2 e 3), oscilou entre as tarefas avaliadas e o índice de concordância variou de 58 a 98,1%, principalmente nas comparações com a avaliação objetiva. Conclusão As informações relatadas por idosos e cuidadores devem ser comparadas às obtidas objetivamente, para melhor identificar a real funcionalidade dos idosos.

Clinical and laboratory characteristics associated with referral of hospitalized elderly to palliative care / Características clínicas e laboratoriais associadas à indicação de cuidados paliativos em idosos hospitalizados

ABSTRACT Objective To investigate clinical and laboratory characteristics associated with referral of acutely ill older adults to exclusive palliative care. Methods A retrospective cohort study based on 572 admissions of acutely ill patients aged 60 years or over to a university hospital located in São Paulo, Brazil, from 2009 to 2013. The primary outcome was the clinical indication for exclusive palliative care. Comprehensive geriatric assessments were used to measure target predictors, such as sociodemographic, clinical, cognitive, functional and laboratory data. Stepwise logistic regression was used to identify independent predictors of palliative care. Results Exclusive palliative care was indicated in 152 (27%) cases. In the palliative care group, in-hospital mortality and 12 month cumulative mortality amounted to 50% and 66%, respectively. Major conditions prompting referral to palliative care were advanced dementia (45%), cancer (38%), congestive heart failure (25%), stage IV and V renal dysfunction (24%), chronic obstructive pulmonary disease (8%) and cirrhosis (4%). Major complications observed in the palliative care group included delirium (p<0.001), infections (p<0.001) and pressure ulcers (p<0.001). Following multivariate analysis, male sex (OR=2.12; 95%CI: 1.32-3.40), cancer (OR=7.36; 95%CI: 4.26-13.03), advanced dementia (OR=12.6; 95%CI: 7.5-21.2), and albumin levels (OR=0.25; 95%CI: 0.17-0.38) were identified as independent predictors of referral to exclusive palliative care. Conclusion Advanced dementia and cancer were the major clinical conditions associated with referral of hospitalized older adults to exclusive palliative care. High short-term mortality suggests prognosis should be better assessed and discussed with patients and families in primary care settings.

RESUMO Objetivo Investigar as características clínicas e laboratoriais associadas à indicação de cuidados paliativos exclusivos em idosos gravemente enfermos. Métodos Neste estudo retrospectivo de coorte, foram incluídas 572 admissões de pacientes gravemente enfermos com idade igual ou superior a 60 anos, em um hospital universitário, em São Paulo, no período de 2009 a 2013. O desfecho primário foi a indicação clínica de cuidados exclusivamente paliativos. Empregamos avaliações geriátricas amplas padronizadas para mensurar preditores de interesse, incluindo informações sociodemográficas, clínicas, cognitivas, funcionais e laboratoriais. Utilizamos modelos de regressão logística stepwise para identificar preditores independentes de cuidados paliativos. Resultados Foram indicados cuidados exclusivamente paliativos em 152 (27%) casos. No grupo de cuidados paliativos, a mortalidade hospitalar foi de 50%, sendo que a mortalidade acumulada em 12 meses atingiu 66%. Os diagnósticos mais frequentemente apontados como motivadores de cuidados paliativos foram demência avançada (45%), câncer (38%), insuficiência cardíaca congestiva (25%), insuficiência renal estágios 4 e 5 (24%), doença pulmonar obstrutiva crônica (8%) e cirrose (4%). As complicações mais comuns no grupo de cuidados paliativos foram delírio (p<0,001), infecções (p<0,001) e úlceras por pressão (p<0,001). Após análise multivariada, sexo masculino (OR=2,12; IC95%: 1,32-3,40), câncer (OR=7,36; IC95%: 4,26-13,03), demência avançada (OR=12,6; IC95%: 7,5-21,2) e níveis de albumina (OR=0,25; IC95%: 0,17-0,38) foram identificados como preditores independentes da indicação de cuidados exclusivamente paliativos. Conclusão Demência avançada e câncer foram as condições clínicas mais frequentemente associadas à indicação de cuidados paliativos exclusivos em idosos hospitalizados. A elevada mortalidade a curto prazo sugere que o prognóstico deva ser melhor avaliado e discutido com os pacientes e suas famílias no ambiente de Atenção Primária.