Predictive value of mNUTRIC score for chronic critical illness in elderly patients with sepsis / 中华急诊医学杂志

Objective:To explore the predictive value of the modified NUTrition risk in the critically ill (mNUTRIC) score for chronic critical illness (CCI) in elderly sepsis patients.Methods:A prospective observational study was conducted. Elderly sepsis patients admitted to Medical Intensive Care Unit (MICU) of General Hospital of Southern Theatre Command for more than 24 h from August 2019 to January 2021 were enrolled. Age, sex, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, acute gastrointestinal injury (AGI) score, clinical frailty score and mNUTRIC score at admission, length of ICU stay, usage of mechanical ventilation and renal replacement therapy were recorded. According to the occurrence of CCI, patients were divided into the CCI group and rapid recovery (RAP) group, and the differences between the two groups were compared. The risk factor of CCI after sepsis in elderly patients were analyzed by log-binomial regression analysis. Receiver operating characteristic (ROC) analysis was performed for mNUTRIC score. Differences were considered significant at P<0.05. Results:Of the enrolled 91 sepsis patients, 14 (15%) patients died within the first week, 37 (41%) exhibited RAP and 40 (44%) developed CCI. The CCI patients were significantly older and presented a higher APACHE Ⅱ score, CFS score, mNUTRIC score, and usage of mechanical ventilation and renal replacement therapy compared with the RAP patients ( P<0.05). Multivariate regression analysis revealed that mNUTRIC score was an independent risk factor for the development of CCI in elderly sepsis patients, prevalence ratio was 1.503 (95% CI: 1.007-2.244). The area under the curve (AUC) of mNUTRIC score was 0.706 (95% CI: 0.592-0.805). Conclusions:The mNUTRIC score at the time of admission in the intensive care unit can be used to predict CCI after sepsis in elderly sepsis patients.

Propósito de vida, dor e cognição de idosos domiciliados de uma cidade do interior do Amazonas / Purpose of life, pain and cognition of elderly householders in a city inside Amazonas

Introdução: O envelhecimento é um processo natural e universal inerente ao desenvolvimento, caracterizado por um declínio fisiológico. Objetivos: Caracterizar e analisar o propósito de vida, dor e cognição dos idosos domiciliados da cidade de Coari/AM. Métodos: Estudo de corte transversal descritivo realizado com idosos, acima de 60 anos. Avaliou-se a função cognitiva pelo Mini-Exame de Estado Mental, Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), Teste de Fluência Verbal, Reconhecimento de Figuras, Teste de Trilha, e Escala de Depressão Geriátrica, para dor a Escala Numérica da dor e Escala de Faces, e Escala de Satisfação Global e CAPS19 para o propósito de vida. Resultados: 50 idosos, sendo 80% (40) mulheres, com idade entre 60 a 69 anos 48% (24). Segundo o MEEM 70% (35) dos idosos têm grave declínio cognitivo, pelo GDS 42% (21) são depressivos. Caracterizou-se a dor 31 (62%) de moderada a insuportável, sendo a coluna 28% (19) e o joelho 24% (12) os locais mais frequentes. Contudo, 72% (36) dos idosos estão satisfeitos com a vida. Conclusão: Há um grave déficit cognitivo associado à baixa escolaridade, altas prevalências de dor, e ainda assim têm boa perspectiva de vida. (AU)

Introduction: Aging is a natural and universal process inherent in development, characterized by a physiological decline. Objectives: To characterize and analyze the purpose of life, pain, and cognition of the elderly living in the city of Coari/AM. Methods: Descriptive cross-sectional study conducted with elderly over 60 years. Cognitive function was assessed by the Mini Mental State Examination Questionnaire on the Cognitive Decline in the Elderly (IQCODE), Verbal Fluency Test, Figure Recognition, Track Test, and Geriatric Depression Scale for Numerical Scale Pain. Pain and Face Scale, and Global Satisfaction Scale and CAPS19 for life purpose. Results: 50 elderly, 80% (40) women, aged 60 to 69 years 48% (24). According to MMSE 70% (35) of the elderly have severe cognitive decline, by GDS 42% (21) are depressive. Moderate to unbearable pain 31 (62%) was characterized, with spine 28% (19) and knee 24% (12) being the most frequent sites. However, 72% (36) of the elderly are satisfied with life. Conclusion: There is a severe cognitive deficit associated with low education, high prevalence of pain, and yet have a good life perspective. (AU)

Study of etiology, clinical features and outcome following treatment of hyponatremia in elderly in intensive care unit

Background: Hyponatremia is a common electrolyte disturbance in the hospitalized elderly sick patients. Objectives: To study etiology, clinical features and outcome following treatment of hyponatremia in elderly hospitalized patients. Materials and methods: All elderly patients being admitted to ICU were screened for hyponatremia and 100 patients with severe hyponatremia (<125 meq/L) were included in this study, these patients were investigated as per the protocol and were treated as per the standardized regimen. Results: 100 patients with severe hyponatremia (<125 mEq/L) were studied. There was female preponderance of cases (55%). The common causes of hyponatremia were SIADH (30%) and drugs (24%) of which diuretics (79%) was a major chunk. The common CNS symptoms were drowsiness, lethargy and irrelevant talk. The common co-morbid conditions were hypertension (62%) and diabetes mellitus (51%). Females tolerated hyponatremia better than males with mortality of 9.09% in females and 33.33% in males (p=0.0026). 20 (20%) patients succumbed to their primary illness with a possible contribution attributable to hyponatremia or its treatment. M. Krishna Naik, Md. Yousuf Khan, D. Prathima Raj, D. Venkatesh, Krishna Kumar T V. Study of etiology, clinical features and outcome following treatment of hyponatremia in elderly in intensive care unit. IAIM, 2017; 4(11): 144-152. Page 145 Conclusion: Hyponatremia is common in females and they seem to better tolerate it than their male counterparts. Early detection, strict adherence to treatment protocol is required. Diuretics should be used with caution in elderly.

Curative Effect Observation of Transfer Factor Oral Solutions as Adjunctive Therapy in Elderly Patients with Recurrent Respiratory Tract Infection (RRTI) / 中国药师

Objective:To observe the curative effect of transfer factor oral solutions as the adjunctive therapy in ederly patients with recurrent respiratory tract infection ( RRTI) . Methods:Totally 74 ederly patients with RRTI were selected and divided into the observation group and the control group randomly. The patients in the two groups were given anti-infection and symptomatic treatment during the acute stage of attack. The patients in the observation group were additionally given transfer factor oral solutions 10ml, po, tid for 3 months. The changes in serum immunoglobulin IgG, IgA and IgM levels in the two groups before and after the medical treat-ment were compared, and the clinical curative effect and adverse drug reactions ( ADR) were observed as well. Results: After the medical treatment, the serum IgG, IgA and IgM levels in the observation group were obviously increased than before (P0. 05). The total clinical efficiency in the observation group was much higher than that in the control group (P0. 05). Conclusion:Transfer factor oral solutions as the adjunctive therapy in ederly patients with RRTI has the favorable clinical curative effect and safety, and the underlying mechanisms may be concerned with the effect of enhancing serum immunoglobulin IgG, IgA and IgM levels, as well as humoral immune function.

Un estudio piloto sobre el efecto diferencial de la fatiga por conducción en personas mayores / Effects of fatigue on simulated high speed driving for prolonged periods

Hay indicios de que la fatiga, uno de los principales efectos de la conducción prolongada, es más notable en mayores. El presente artículo recoge un estudio sobre el efecto de la conducción prolongada utilizando un simulador, en un grupo de sujetos mayores de 55 años. Los sujetos fueron evaluados médica y psicológicamente antes y después de la prueba de conducción. Se aplicaron las pruebas médicas de tensión arterial, pulso y saturación de oxígeno en sangre y como prueba psicológica, el Driver-Test. Resultados preliminares indican que existe una disminución del rendimiento después de conducir, afectando especialmente a la capacidad de toma de decisiones.

Some evidences show that fatigue, that is one of the main effects of prolonged driving, can be more evident on elderly people. This work describes a study on the effects of prolonged driving using a driving simulator within a group of individuals older than 55 years. These individuals underwent medical and psychological examinations before and after the driving experience: on the one hand, Blood Pressure and PulseOximetry were monitored and they took the Driver-Test. Preliminary results suggest a decreasing performance after driving, especially affecting decision-making capacity.

Construção de indicadores avaliativos de políticas de atenção à saúde da pessoa idosa vítima de acidentes e violência / Construction of indicators for assessing the policy of reducing accidents and violence for the elderly care

O presente artigo apresenta a metodologia de construção de indicadores avaliativos da implantação da Política Nacional de Redução da Morbimortalidade por Acidentes e Violências, das políticas de saúde dirigidas ao idoso e de Saúde Mental foco da pesquisa Análise Diagnóstica de Sistemas Locais de Saúde para Atender aos Agravos Provocados por Acidentes e Violências contra Idosos. Esses indicadores foram aplicados em serviços de saúde que atendem idosos vítimas de acidentes e violência em cinco capitais brasileiras: Brasília, Curitiba, Manaus, Recife e Rio de Janeiro. Inicialmente, foram criados 124 indicadores para os níveis de atendimento pré-hospitalar, hospitalar, reabilitação e Centros de Atenção Psicossocial (CAPS). Um dos critérios de seleção foi eliminar os não discriminantes. Também foram flexibilizados alguns critérios criando-se novas categorizações. Após essa etapa, elaboraram-se questionários que foram repassados a experts para validação por meio da Técnica Grupo Nominal. Realizou-se o teste de Kruskal-Wallis e uma análise gráfica. Na rodada final, os indicadores foram aglutinados por semelhança construindo índices, restando sessenta indicadores. Essas ferramentas podem ser utilizadas em outras unidades para avaliar e adequar seu atendimento ao cumprimento dessas políticas públicas de saúde.

The follow article presents the methodology used to construct indicators to assess the implementation of the National Policy of Mortality Reduction by Accidents and Violence, of public health policies aimed at the elderly and the Mental Health Policy developed in the research entitled Diagnostic Analysis of Local Health Systems to Meet the Problems Caused by Accidents and Violence against Elderly. These indicators were applied in health services that meet elderly victims of accidents and violence in five Brazilian cities: Brasília, Curitiba, Manaus, Recife and Rio de Janeiro. It started with 124 indicatives to assistance level pre-hospital, hospital, rehabilitation and CAPS. There was a selection phase where indicatives without discriminatory capability were eliminated. It was also decided by the relaxation of some criteria are creating new categories. After this step, a group of the experts validate the questionnaires created with these indicators by using Nominal Technical Group. We performed the Kruskal-Wallis test and a graphical analysis. In the final round, the indicators were grouped by similarity, building synthetic indices, 60 indicatives left. These methods can be used in other organizations to evaluate and adjust their health care based on public policies.

Principais síndrome geriátricas / Main geriatric syndromes

Revisão acerca das grandes síndromes geriátricas: incapacidade cognitiva, instabilidade postural, imobilidade e incapacidade comunicativa, com enfoque nos aspectos etiológicos, diagnóstico e condutas terapêuticas. A saúde do idoso está estritamente relacionada com a sua funcionalidade global, definida como a capacidade de gerir a própria vida ou cuidar de si mesmo. Essa capacidade de funcionar sozinho é avaliada por meio da análise das atividades de vida diária, que são tarefas do cotidiano realizadas pelo paciente. A saúde do idoso é determinada pelo funcionamento harmonioso de quatro domínios funcionais: cognição, humor, mobilidade e comunicação. A perda dessas funções resulta nas grandes síndromes geriátricas abordadas.

Review about major geriatric syndromes: cognitive impairment, postural instability, immobility and communicative disability, focusing on the etiology, diagnosis and therapeutic aspects. The health of the elderly is closely related to their overall functionality, defined as their ability to manage their own life or take care of themselves. This ability of functioning alone is evaluated by the analysis of the daily activities, which are the daily tasks carried out by the patient. The elderly health is determined by the harmonic functioning of four functional domains: cognition, mood, mobility and communication. The loss of these functions results in the major geriatric syndromes addressed.

Integração sensorial, limite de estabilidade corporal e melhora clínica em idosos vestibulopatas submetidos a dois programas de reabitação vestibular / Sensory organization, limits of postural stability and clinical improvement in elderly with vestibulopathy submitted to two vestibular rehabilitation programs

Forma de estudo: Ensaio clínico randomizado cego. Objetivo: Comparar a variação dos limites de estabilidade corporal, integração sensorial e melhora clínica dos pacientes após terapia de Reabilitação Vestibular (RV), segundo dois métodos distintos: a reabilitação vestibular clássica com treinamento global do sistema de equilíbrio (RVC) e a adaptação do Reflexo Vestíbulo-ocular (RVO). Casuística e Método: 39 pacientes, acima de 65 anos, com distúrbio de equilíbrio e indicação de tratamento pela RV foram selecionados e alocados aleatoriamente em dois grupos: Protocolo de Cawthorne e Cooksey modificado (Grupo RVC), e adaptação do RVO (Grupo RVO). Os pacientes foram avaliados antes e após o tratamento pelos protocolos de Integração Sensorial e Limite de Estabilidade da Posturografia Dinâmica Computadorizada (PDC), pela escala clínica Disability Index (DI) e por auto-avaliação fundamentada na porcentagem referida de melhora. Resultados: Dentre os 39 pacientes alocados, completaram adequadamente o estudo 16 indivíduos do Grupo RVC e 16 do Grupo RVO. Os grupos mostraram-se homogêneos quanto à faixa etária, sexo e alterações de equilíbrio observadas. Após o tratamento, ambos os grupos apresentaram variações semelhantes dos parâmetros posturográficos e da escala clínica adotada, bem como da auto-avaliação. Conclusão: Os dois protocolos foram semelhantes quanto a sua eficácia para o restabelecimento do equilíbrio corporal dos pacientes.

Study design: Blind randomized clinical trial. Objective: To compare the variation of the sensory organization, limits of postural stability and clinical improvement in elderly patients after Vestibular Rehabilitation (VR) therapy using two different methods: classical vestibular rehabilitation (CVR) with global training of balance system and adaptation of vestibulo-ocular reflex (VOR). Material and Method: Thirty-nine patients aged over 65 years with balance disorders and indication of VR therapy were selected and randomly allocated into two groups: Cawthorne-Cooksey modified protocol (CVR Group) and adaptation of VOR protocol (VOR Group). Patients were assessed before and after treatment with Sensory Organization Test (SOT) and Limits of Stability (LOS) by Computerized Dynamic Posturography (CDP), using clinical scale Disability Index (DI) and self-assessment based on reported percentage of improvement. Results: The study comprised 16 subjects in the CVR group and 16 in the VOR group who fully complied with the treatment. The groups showed similar age range, gender and balance abnormalities. After treatment, both groups presented similar variations of CDP tests and similar results in the clinical scale and in the self-assessment. Conclusion: Both VR protocols showed similar results in effective expansion of limits of stability, scores of sensory organization test and subjective clinical improvement of patients.

The Effect of Cervical Kyongrak Massage on Shoulder Pain, Shoulder Exercise Range and Mood in the Elderly / 성인간호학회지

PURPOSE: This study was to identify the effect of Cervical Kyongrak Massage on Shoulder pain, shoulder Exercise Range and Mood in the elderly. METHOD: This study used a quasi- experimental pre-test and post-test design. Data were collected from 13 April to 30 June in 2003. There were 58 elderly subjects,(30 experimental group, 28 control group) in Pusan. The experimental group took Kyongrak Massage at Cervical Kyonghyul sites around neck and shoulder for 10 minutes daily during 5days. RESULT: In the experimental group, shoulder pain(t=-9.80, p=.000), shoulder exercise Range (Flexion t=3.10, p=.003; Abduction t=7.95, p=.000; External Rotation t=5.00, p=.000) and Mood(t=-9.80, p=.000) were significantly better than control group after Cervical Kyongrak Massage. CONCLUSION: These findings indicate that Cervical Kyongrak Massage may be an effective adjunct therapy for improving shoulder pain, shoulder exercise range and mood, and is considered as a independent and available nursing intervention for elderly.