Estado de salud y nutrición del adulto mayor que concurre al Hospital Geriátrico del Seguro Social en la Asunción. Paraguay / Health status of older adults attending the Geriatric Hospital of the Social Security, in Asunción, Paraguay

Resumen El aumento de la población de adultos mayores y su mayor demanda de atención en salud en Paraguay, requiere de una evaluación multidimensional que identifique sus condiciones de riesgo o deterioro. El objetivo de esta investigación, fue evaluar el estado de salud y nutrición de una muestra de adultos mayores que acudieron a la consulta ambulatoria del Hospital Geriátrico de la Previsional, en la Asunción, Paraguay. La investigación tuvo un diseño observacional, descriptivo y de corte transverso, de 108 adultos mayores a quienes se les realizó la Valoración Geriátrica Integral (VGI) y se evaluaron parámetros nutricionales. La edad promedio fue de 71 años con predominio del sexo femenino. De acuerdo al IMC, el 64% presentó sobrepeso u obesidad. De acuerdo a la VGI, 18% presentó riesgo nutricional, 43% dependencia leve para las actividades de la vida diaria y 12% para las actividades instrumentales. El 18% mostró déficit cognitivo, el 6% depresión y el 30% riesgo social. La población se caracterizó por presentar altas frecuencias de exceso de peso e hipertensión, con una baja frecuencia de riesgo de desnutrición, las mayores limitaciones se dieron en las actividades básicas de la vida diaria y en el riesgo social. El ser mujer y el exceso de peso se asociaron significativamente con las limitaciones básicas funcionales. Este trabajo constituyó uno de los primeros en el país sobre adultos mayores ambulatorios, permitiendo configurar una línea de base de las áreas comprometidas o en riesgo de declinación y desarrollar estrategias y acciones preventivas para promover un envejecimiento saludable.

Abstract The increase in the population of older adults and their more significant demand for health care in Paraguay requires a multidimensional evaluation to identify risks or deteriorating conditions. The objective of this research was to evaluate the health and nutrition status of a sample of older adults who attended the Geriatric Hospital of the Social Security for outpatient consultation. The research had a cross-sectional descriptive observational design, which included 108 older adults who underwent the Comprehensive Geriatric Assessment (CGA) and whose nutritional parameters were evaluated. Their average age was 71 years, with a predominance of females. According to their BMI, 64% were overweight or obese. As for the CGA, 18% presented a nutritional risk, 43% had mild dependence on activities of daily living and 12% on instrumental activities, 18% had a cognitive deficit, 6% had depression, and 30% had social risk. The population was characterized by a high prevalence of overweight and hypertension and a low frequency of risk of malnutrition. The most significant limitations were in the basic activities of daily life and social risk. Being female and being overweight were significantly associated with basic functional limitations. This work was one of the first in the country on ambulatory older adults, allowing the establishment of a baseline for areas where health is compromised or at risk of decline and the development of preventive strategies and actions to promote healthy aging.

Dependencia en adultos mayores con enfermedad de Alzheimer en el Hospital Civil de Tepic, Nayarit, México / Dependence in Aged Adults Suffering from Alzheimer Disease at Tepic Civil Hospital, Nayarit, México

Introducción: El mundo ha experimentado un proceso de cambio que implica múltiples transiciones, como la demográfica y epidemiológica. En México, la prevalencia de las enfermedades demenciales como el Alzheimer tiene una tendencia al aumento, de ahí que sea necesario estudiar y analizar sus repercusiones en la población. Objetivo: Determinar el grado de dependencia en adultos mayores con enfermedad de Alzheimer en un hospital de segundo nivel en Nayarit, México. Métodos: Estudio descriptivo, corte transversal y enfoque cuantitativo. Se aplicó el índice de Barthel para evaluar las actividades básicas de la vida diaria a 29 cuidadores principales de los pacientes registrados en la base de datos del hospital. Las variables elegidas fueron: sexo, edad, municipio y grado de dependencia. El análisis de los datos se realizó mediante el programa SPSS de IBM versión 20. Resultados: La edad media fue de 79 años; el 62,1 por ciento fueron mujeres y el 37,9 por ciento hombres; el municipio con mayor número de pacientes fue Tepic (44,8 por ciento); con respecto al grado de dependencia, la independencia fue la más frecuente (27,6 por ciento), seguido de dependencia total (24,1 por ciento). Se evidenció correlación entre defunciones y grado de dependencia con un nivel de significancia por debajo de 0,000 (error α). Conclusiones. En Nayarit existe dependencia en los adultos mayores con enfermedad de Alzheimer. Los cuidadores primarios reciben poca o ninguna capacitación para el cuidado de estos pacientes. El subdiagnóstico de esta enfermedad de alguna manera favorece la dependencia, pues no se orienta o no se otorgan las medidas básicas terapéuticas a la familia para el apoyo del enfermo, esto a su vez es de especial interés debido a que existe una correlación estrecha entre defunción y dependencia(AU)

Introduction: The world has undergone a process of change that involves multiple transitions, such as demographic and epidemiological. In Mexico, the prevalence of dementia diseases such as Alzheimer's has an increasing trend, hence it is necessary to study and to analyze its impact on the population. Objective: To determine the degree of dependence in aged adults with Alzheimer's disease in a second-level hospital in Nayarit, Mexico. Methods: This is a descriptive study with cross-sectional and quantitative approach. The Barthel index was applied to assess the basic activities of daily living to 29 main caregivers of the patients registered in the hospital database. The variables chosen were sex, age, municipality and degree of dependency. Data analysis was performed using the IBM SPSS version 20 program. Results: The mean age was 79 years; 62.1percent were women and 37.9percent men; the municipality with the highest number of patients was Tepic (44.8percent). Regarding the degree of dependence, independence was the most frequent (27.6percent), followed by total dependence (24.1percent). Correlation between deaths and degree of dependence was evidenced with a level of significance below 0.000 (α error). Conclusions: In Nayarit there is dependence in aged adults suffering from Alzheimer's disease. Primary caregivers receive little or no training in caring for these patients. The underdiagnoses of this disease in some way favors dependence, since the family is not guided or the basic therapeutic measures are not given to support the patient, this in turn is of special interest because there is close correlation between deaths and dependency(AU)

Relación entre dependencia en pacientes con enfermedad de Alzheimer y la sobrecarga en el cuidador principal / Relationship between dependence in patients with Alzheimer's disease and primary caregiver overload

RESUMEN Introducción: El envejecimiento poblacional ha traído como consecuencia un aumento de las enfermedades en adultos mayores, entre ellas la enfermedad de Alzheimer, que resulta una amenaza para los cuidadores del paciente y la familia. Objetivo: Demostrar la relación que existe entre la dependencia del paciente con enfermedad de Alzheimer para realizar las actividades básicas de la vida diaria con la sobrecarga percibida por el cuidador principal, Métodos: Se realizó un estudio descriptivo correlacional. Fue seleccionada una muestra de 35 cuidadores principales de pacientes con enfermedad de Alzheimer pertenecientes al Policlínico "Carlos Manuel Portuondo", en Marianao. Los familiares eran encargados y responsables de la realización de los cuidados del paciente y residentes en el domicilio, sin recibir retribución económica a cambio, brindando cuidados por más de seis meses y dieron su consentimiento para la participación en el estudio. Se aplicó el Índice de Katz y la entrevista de sobrecarga del cuidador: Escala de Zarit. Para el procesamiento de la información se utilizó el SPSS 15.0. Se utilizó la estadística descriptiva y el coeficiente de correlación de Pearson para la relación entre variables. Resultados: Predominaron los cuidadores con sobrecarga y los pacientes que requieren asistencia para realizar las actividades básicas de la vida diaria. Los mismos requirieron asistencia para bañarse, trasladarse y alimentarse, variables que se relacionaron significativamente con la sobrecarga. Conclusiones: Existe una relación significativa entre la dependencia para las actividades básicas de la vida diaria de los pacientes con enfermedad de Alzheimer y la sobrecarga percibida por el cuidador principal(AU)

ABSTRACT Introduction: The aging population has resulted in an increase of disease in older adults. Including Alzheimer's disease, which is a threat to patient caregivers and family. Objective: To demonstrate the relationship between the patient's dependence with Alzheimer's disease to perform the basic activities of daily life with the perceived overload the primary caregiver, at the Polyclinic Carlos Manuel Portuondo, in Marianao. Methods: A descriptive correlational study. It was selected a sample of 35 primary caregivers of patients with Alzheimer's disease who were familiar charge and responsible for the realization of patient care and resident at home, without receiving financial compensation in return, providing care for more than six months and they gave their consent for participation in the study. Zarit Scale: Katz Index and caregiver burden interview was applied. For information processing SPSS 15.0 was used. Descriptive statistics and Pearson correlation coefficient for the relationship between variables was used. Results: predominated overloaded caregivers and patients who require assistance to perform basic activities of daily life. They required assistance with bathing, moving and feeding, variables that were significantly related to overloading. Conclusions: There is a significant relationship between dependence for basic activities of daily living of patients with Alzheimer's disease and perceived overload the primary caregiver(AU)

Clinical features and prognosis of 93 elderly patients with multiple myeloma / 中华血液学杂志

Objective@#To explore the clinical features and prognostic factors of elderly MM patients.@*Methods@#A retrospectively analysis of clinical characteristics in 93 newly diagnosed MM patients with more than 70 years of old between August 2011 and August 2016. Based on age, basic activities of daily living scale, instrumental activities of daily living scale, Charlson comorbidity index at diagnosis, patients were divided into three groups: Fit (score=0, n=15) , Intermediate fitness (score=1, n=31) , Frail (score≥2, n=47) according to a geriatric assessment system proposed by Antonio Palumbo et al. The treatment response rate, progression free survival time (PFS) and overall survival (OS) of the three groups were analyzed.@*Results@#Complete remission was 60.0% in Fit, 22.6% in Intermediate fitness and 12.8% in Frail (Fisher χ2=12.398, P=0.002) . The median PFS for the three groups were 31 months, 24 months and 13 months (χ2=17.832, P<0.001) . The median OS was not reached for Fit, 58 months for Intermediate fitness and 25 months for Frail (χ2=40.678, P<0.001) . In 47 Frail cases, patients who received chemotherapy containing new drugs (proteasome inhibitor or immune-modulator) had a longer PFS (17 months vs 9 months, χ2=6.454, P=0.011) and patients who achieved CR had prolonged PFS and OS than non-CR (PFS: 24 months vs 12 months, χ2=4.117, P=0.042; OS: 37 months vs 25 months, χ2= 6.507, P=0.011) .@*Conclusion@#The health status of the elderly MM patients was associated with better response and longer PFS and OS. Given on those with poor health status, new drugs may have better PFS and prolonged OS.

Nivel de funcionalidad en actividades básicas e instrumentales de la vida diaria del adulto mayor / Level of functionality in basic and instrumental daily life activities of elderly adult

La población en general tiene tendencia al envejecimiento, por lo que el Perú debe prepararse con políticas públicas que permitan a este segmento gozar de una vejez digna y con las debidas atenciones. Objetivos: determinar el nivel de funcionalidad en actividades básicas e instrumentales de la vida diaria del adulto mayor del Club CORESAMI en el año 2013. Material y métodos: estudio de tipo cuantitativo, descriptivo, de nivel aplicativo y de corte transversal. La población estuvo conformada por 35 adultos mayores, que concurrían al club antes mencionado, perteneciente a la Jurisdicción del Centro de Salud de San Juan de Miraflores. La técnica que se utilizó fue la encuesta y como instrumento un cuestionario. Resultados: del 100% (35), un 49% (17) tiene un nivel medio, un 34% (12), un nivel alto, y un 17% (6) un nivel bajo de funcionalidad para realizar actividades básicas e instrumentales de la vida diaria, prevaleciendo las primeras sobre los segundas, para las cuales requieren más apoyo. Conclusiones: se recomienda realizar estudios descriptivos en los diferentessectores y establecimientos de salud ya que tienen distintas realidades, así mismo programas de intervención dirigidos a estos adultos mayores de carácter inter y multidisciplinario que incluyan a la familia y comunidad.

The tendency of the general population is aging, so that Peru should be prepared with public policies that this segment are allowed to enjoy a decent and fairly old-age care. Objectives: to determine the level of functionality in basic and instrumental daily life activities of older adult in CORESAMI Club in 2013. Material and Methods: quantitative and descriptive level application and cross-section study. The population is composed of 35 older adults who were attended in the aforementioned Club, belonging to the jurisdiction of the Health Center of San Juan de Miraflores. The technique used was the survey and a questionnaire as an instrument. Results: of 100% (35), 49% (17) having an average level , 34% (12), a high level, and 17% (6) a low level of functionality to perform basic and instrumental activities of daily living . Prevailing the first on seconds, for which they require more support. Conclusions: descriptive studies are recommended in different sectors and health facilities as they have different realities, also intervention programs targeting these elderly people, inter and multidisciplinary involving the family and community.

Adults and Elderly with Multiple Disabilities

In Singapore and worldwide, large numbers of people live with disabling illness. In the first part of this paper, we address the assessment of activities of daily living (ADL). Disability charting is important as a clinical tool to document functional recovery as well as to assess the effectiveness of medical and rehabilitation interventions. Disability assessment is also important epidemiologically, in developing social policies, planning disability resources and in medical research and education. We review the concepts and general principles of disability assessment with reference to the WHO International Classification of Functioning, Disability and Health (ICF) as well as to local contexts. We also describe in further detail 6 basic ADLs of feeding, dressing, toileting, transfers and mobility used in disability-related national schemes. In the second part of this article, we introduce how the concepts of frailty have changed the paradigm in which we approach geriatric rehabilitation, through interactive overlaps with the psychosocial, disability and comorbidity domains. We describe the consequences of functional deterioration in the frail elderly, and how to screen for frailty. We also outline therapeutic exercise as a form of prehabilitation to improve the resilience of these vulnerable people and possibly return them to robust health. Family physicians are best equipped in the management of frailty, as they have the holistic and comprehensive medical skill set to treat the associated comorbidity, disability and psychosocial domains in integrative geriatric rehabilitation.

A funcionalidade dos mais idosos (>75 anos): conceitos, perfis e oportunidades de um grupo heterogêneo / The functioning of the oldest old (>75 years): concepts, profiles and opportunities of a heterogeneous group

OBJETIVOS: Conhecer a funcionalidade de dois grupos de idosos (75-84 anos e >85 anos) e sua associação com idade e gênero. MÉTODOS: Trata-se de estudo observacional do tipo analítico e transversal, cuja amostra foi constituída por indivíduos de ambos os sexos com idade >75 anos. Foi recolhida informação relativa a condição de saúde e funcionalidade pré-morbilidade. Os instrumentos de coleta de dados foram um questionário de caracterização sociodemográfica e o Método de Avaliação Biopsicossocial. RESULTADOS: A amostra foi constituída por 262 idosos com média de idade de 82,9 ± 4,86 anos, dos quais 161 (61,5%) eram mulheres. Os mais velhos (>85 anos) viviam mais isolados (p=0,020) e tinham menores habilitações literárias (p=0,027), apresentando mais limitações em utilizar escadas (p=0,015), no banho (p=0,008), na continência fecal (p=0,015) e em todas as atividades instrumentais (p<0,031). As mulheres apresentavam maior vulnerabilidade no estado civil (p<0,001) e no status econômico (p=0,009), enquanto os homens tinham piores resultados nas quedas (p=0,003) e nos comportamentos de risco (p<0,001). O desempenho na locomoção e nas atividades básicas e instrumentais era semelhante entre os sexos. CONCLUSÕES: As variáveis de natureza social apresentaram-se diferentes quanto à idade e ao gênero. As componentes da funcionalidade -locomoção, atividades diárias básicas e atividades instrumentais - apresentaram maiores limitações nos idosos com idade > 85 anos, sobretudo as instrumentais. Não se encontraram diferenças na funcionalidade em relação ao gênero.

OBJECTIVES: To know the functioning of two groups of seniors (75-84 and >85 years) and its association with age and gender. METHODOLOGY: This is an observational, analytical and transversal study, with sample composed by elderly individuals with 75 years or older. Data concerned health condition and functioning pre morbidity status. Data collection instruments were a social and demographic characterization questionnaire and the Biopsychosocial Assessment Method. RESULTS: The study sample was composed of 262 elderly, with a mean age of 82,9 ± 4,86 years, and 161 individuals (61,5%) were women. The oldest old (>85 years) lived more isolated (p=0,020) and had fewer educational qualifications (p=0,027), showed greater limitations in climbing stairs (p=0,015), personal hygiene (p=0,008), and faecal continence (p=0,015) and in all instrumental activities (p<0,031). Women were more vulnerable at marital (p<0,001) and economic status (p=0,009), while men had worse results in falls (p=0,003) and risk factors (p<0,001). The functional status in mobility and daily activities was similar between the sexes. CONCLUSIONS: The oldest old studied had different social state variables vulnerability related to age and gender. However, the difference in functional variables vulnerability was only related to age. The oldest old had more difficulties in some activities, especially those that are instrumental.