Yoga como terapia complementaria para el Adulto Mayor / Yoga as a complementary therapy for older adult

Introducción: El yoga es una actividad que trata de un ejercicio el cual contiene una intensidad baja a moderada, la cual no se centra exclusivamente en el entrenamiento físico, sino que también en el desarrollo de la mente y el espíritu de uno mismo. El yoga puede obtener un mayor impacto en el equilibrio y en la ganancia de fuerza de la parte superior del cuerpo, además, demuestra mejora en la aptitud cardiorrespiratoria y flexibilidad. Metodología: El enfoque de desarrollo fue de tipo cuantitativo en donde se realizó una revisión sistemática como metodología de búsqueda de información, relacionada al yoga como una terapia complementaria y los beneficios que éste aportaba al bienestar de las personas mayores. Resultados: En cada uno de los ensayos controlados aleatorizados que fueron recabados para fines de esta revisión sistemática. Se destaca la importancia y los beneficios del yoga en la movilidad, fuerza, flexibilidad y espiritualidad de los usuarios que practican esta terapia. Discusión: Los artículos analizados pertenecen a ensayos clínicos o estudios aleatorizados, los cuales permitieron responder de manera efectiva a nuestra pregunta de investigación, la cual consiste en reconocer si el yoga es efectivo para disminuir el riesgo de dependencia funcional y eliminar hábitos que no son saludables para las personas mayores, además de mejorar la calidad de vida actual. Gracias a ello se pudo evidenciar que esta terapia en adultos mayores genera cambios positivos respecto a estado y condición física, la ejecución de esta práctica mejora la calidad de vida en un 80% Conclusión: La yoga como terapia complementaria si entrega beneficios en la calidad de vida de la población adulta mayor, dado que, que hubo una mejora tanto en la movilidad, calidad de vida y autovalencia de los adultos mayores[AU]

Introduction: Yoga is an activity that deals with a low to moderate intensity exercise, which is not exclusively focused on physical training, but also on the development of the mind and spirit itself. Yoga may have a greater impact on balance and upper body strength gains, and have shown improvements in cardiorespiratory fitness and flexibility. Methodology:the development approach was of a quantitative type where a systematic review was carried out as a methodology for searching for information related to yoga as a complementary therapy and the benefits that it brought to the well-being of the elderly. Results:The importance and benefits of yoga on the mobility, strength, flexibility and spirituality of users who practice this therapy are highlighted in each of the randomized controlled trials that were collected for the purposes of this systematic review. Discussion: The articles analyzed belong to clinical trials or randomized studies, which allowed us to effectively answer our research question. The activity of yoga in older adults generates positive changes regarding state and physical condition, the execution of this practice improves the quality of life by 80% Conclusion: Yoga as a complementary therapy delivers benefits in the quality of life of the adult population elderly, it can be said that there was an improvement in mobility, quality of life and self-valence of the elderly[AU]

Introdução: O Yoga é uma atividade que trata de um exercício de intensidade baixa a moderada, que não se foca exclusivamente no treino físico, mas também no desenvolvimento da mente e do espí-rito. A ioga pode ter um impacto maior no equilíbrio e nos ganhos de força da parte superior do corpo e mostrou melhorias na apti-dão cardiorrespiratória e flexibilidade. Metodologia: a abordagem de desenvolvimento foi do tipo quantitativo onde foi realizada uma revisão sistemática como metodologia de busca de informações re-lacionadas ao yoga como terapia complementar e os benefícios que trouxe para o bem-estar dos idosos. Resultados: A importância e os benefícios do yoga na mobilidade, força, flexibilidade e espiri-tualidade dos usuários que praticam esta terapia são destacados em cada um dos ensaios clínicos randomizados que foram coletados para fins desta revisão sistemática. Discussão: Os artigos analisa-dos pertencem a ensaios clínicos ou estudos randomizados, o que nos permitiu responder de forma eficaz à nossa questão de inves-tigação. A atividade de yoga em idosos gera mudanças positivas quanto ao estado e condição física, a execução desta prática mel-hora a qualidade de vida em 80% Conclusão: o yoga como terapia complementar traz benefícios na qualidade de vida da população adulta idosa, pode-se dizer que houve melhora na mobilidade, qualidade de vida e autovalência dos idosos[AU]

Propiedades psicométricas de la escala de resiliencia de Wagnild y Young en personas adultas mayores costarricenses / Psychometric Properties of The Wagnild and Young Resilience Scale in Costa Rican Older Adults / Propriedades psicométricas da escala de resiliência wagnild e young em pessoas idosas da Costa Rica

Resumen Objetivo: Analizar las propiedades psicométricas de la escala de resiliencia de Wagnild y Young, versión argentina, en un grupo de personas adultas mayores costarricenses. Materiales y métodos: Se contó con un grupo piloto (N = 40, X = 69.38) y otro para el análisis de las propiedades psicométricas (N = 100, X = 69.31). Se utilizó la escala de resiliencia de Wagnild y Young, versión argentina, de 25 ítems. Se efectuó un análisis por juicio de personas expertas y un estudio piloto, para establecer la escala por validar; posterior a esto, se realizó el estudio de validación completo. Se aplicaron análisis factoriales y alfa de Cronbach. Resultados: El análisis factorial extrajo dos factores denominados: a) "capacidad de autoeficacia" y b) "capacidad de propósito y sentido de vida". La consistencia interna en el nivel global fue 0.84 (21 ítems); para el primer factor, 0.81, y para el segundo factor, 0.74. Conclusiones: El instrumento es confiable y válido para valorar los niveles de resiliencia desde una óptica integral e interdisciplinaria, en una población de personas adultas mayores con las características similares a las de la muestra estudiada. A futuro, se recomienda realizar análisis cualitativos para delimitar mejor los constructos, con base en las características de la población.

Abstract Purpose: To analyze the psychometric characteristics of the Wagnild and Young Resilience Scale Argentine version in a Costa Rican elderly group. Materials and methods: The study had two groups, one for the pilot study (N = 40, X = 69.38), and another for the analysis of the psychometric properties (N = 100, X = 69.31). The 25-item Wagnild and Young Resilience Scale, Argentine version, was used. An analysis by expert judgment and a pilot study were carried out to establish the scale to be validated, after which, the complete validation study was carried out. Factor analyzes and Cronbach's alpha were applied. Results: They were obtained two factors named: a) "selfefficacy capacity", and b) "purpose in life capacity". The global internal consistency was 0.84, for the first factor was 0.81 and for the second factor was 0.74. Conclusions: The scale generated is reliable and valid to assess resilience in an elderly people with similar characteristics to the present study. In the future, it is recommended to carry out qualitative analyzes to better define the constructs based on the characteristics of the population.

Resumo Objetivo: Analisar as propriedades psicométricas da Escala de Resiliência Wagnild e Young, versão argentina, em um grupo de pessoas idosas costarriquenhas. Materiais e métodos: Um grupo piloto (N = 40, X = 69,38) e outro grupo para a análise das propriedades psicométricas (N = 100, X = 69,31) foram utilizados. A Escala de Resiliência Wagnild e Young, versão argentina, com 25 itens, foi utilizada. Para estabelecer a escala a ser validada, foi realizada uma análise de julgamento por especialistas e um estudo piloto, após o qual foi realizado o estudo de validação completo. A análise fatorial e o alfa de Cronbach foram aplicados. Resultados: A análise fatorial extraiu dois fatores: a) "capacidade de autoeficácia" e b) "capacidade de propósito e significado na vida". A consistência interna ao nível global foi de 0,84 (21 itens); para o primeiro fator foi de 0,81 e para o segundo fator foi de 0,74. Conclusões: O instrumento é confiável e válido para avaliar níveis de resiliência a partir de uma perspectiva holística e interdisciplinar em uma população de idosos com características semelhantes às da amostra estudada. Recomendam-se futuras análises qualitativas para melhor delimitar as construções com base nas características da população.

Promoción de actividades físicas para adultos mayores: Una estrategia educativa para estudiantes de Gerontología

En la actualidad, existe una tendencia progresiva al envejecimiento de la población. El propósito de esta investigación consistió exponer una estrategia educativa para los estudiantes del 5.º nivel de Gerontología que contribuya a la promoción de la actividad física en el adulto mayor. La investigación se enmarcó en una metodología mixta y un diseño descriptivo de corte transversal. Se emplearon métodos científicos que en el orden teórico se encuentran análisis-síntesis, inductivo-deductivo y el sistémico estructural, y como métodos empíricos la revisión documental, la observación, la encuesta y entrevistas, las cuales fueron aplicadas a una muestra de 38 sujetos y revelan la importancia de la actividad física como estrategia que permite alcanzar un envejecimiento activo y con calidad de vida en la tercera edad. Según estos resultados, la aplicación de una estrategia educativa estructurada en tres etapas y dos fases contribuye a la autogestión del aprendizaje de los estudiantes, donde el contexto profesional se convierte en un auténtico espacio de formación.

Atualmente, há uma tendência progressiva de envelhecimento da população. O objetivo desta pesquisa foi apresentar uma estratégia educacional para estudantes do 5º nível de Gerontologia que contribua para a promoção da atividade física em idosos. A pesquisa foi enquadrada em uma metodologia mista e um desenho descritivo transversal. Foram utilizados os métodos científicos teórico, indutivo-dedutivo e sistêmico-estrutural, e os métodos empíricos foram revisão documental, observação, inquérito e entrevistas, que foram aplicados a uma amostra de 38 sujeitos e revelam a importância da atividade física como estratégia para alcançar o envelhecimento ativo e a qualidade de vida dos idosos. De acordo com esses resultados, a aplicação de uma estratégia educacional estruturada em três etapas e duas fases contribui para o autogerenciamento da aprendizagem dos alunos, em que o contexto profissional se torna um autêntico espaço de treinamento.

Currently, there is a progressive trend towards population aging. The purpose of this research was to present an educational strategy for students of the 5th level of Gerontology that contributes to the promotion of physical activity in older adults. The research was framed in a mixed methodology and a cross-sectional descriptive design. Scientific methods were used that in the theoretical order include analysis-synthesis, inductive-deductive and structural systemic and as empirical methods documentary review, observation, survey and interviews, applied to a sample of 38 subjects. The study revealed the importance of physical activity as a strategy that allows achieving active aging with quality of life. According to these results, the application of an educational strategy, structured in three stages and two phases, contributes to the self-management of student learning, where the professional context becomes an authentic training space.

Calidad de atención de enfermería en el adulto mayor hospitalizado: Revisión sistemática / Quality of nursing care for hospitalized elderly: a systematic review / Calidad de los cuidados de enfermería a ancianos hospitalizados: una revisión sistemática

El adulto mayor hospitalizado requiere atención especial debido a sus necesidades de salud, como manejar diversas condiciones médicas, evitar caídas y úlceras, dolor y discapacidad. Por lo tanto, el personal de enfermería desempeña un rol vital en el cuidado de estos pacientes, pues les brindan atención directa y constante en todos los aspectos fundamentales para su bienestar general. Objetivo. Identificar los factores que influyen en la calidad de atención del personal de enfermería al adulto mayor hospitalizado. Metodología. Se realizó una revisión sistemática en las siguientes bases de datos: Scopus, Scielo y Wos. Se analizaron 83 documentos luego de aplicar los criterios de inclusión y exclusión planteados; en las publicaciones se demuestra que, la calidad referida a la atención de enfermería, actualmente, es influenciada por los siguientes factores: coordinación y continuidad de cuidados, profundización en el conocimiento especializado, integración de tecnología e innovación, cuidado centrado en el paciente y colaboración interdisciplinaria y ambiente de práctica. Conclusión. La atención a adultos mayores hospitalizados requiere coordinación, continuidad y formación especializada para abordar enfermedades complejas y adaptarse a necesidades individuales. La tecnología mejora la atención, pero debe protegerse la privacidad. Enfoque en el paciente, colaboración interdisciplinaria y un ambiente colaborativo son esenciales para una atención efectiva.

Hospitalized older adults require special attention due to their health needs, such as managing various medical conditions, preventing falls and ulcers, pain and disability. Therefore, nurses play a vital role in the care of these patients, as they provide direct and constant attention to them in all aspects fundamental to their overall well-being. Objective. To identify the factors that influence the quality of care provided by nursing staff to hospitalized older adults. Methodology. A systematic review was carried out in the following databases: Scopus, Scielo and Wos. Eighty-three documents were analyzed after applying the proposed inclusion and exclusion criteria; the publications show that the quality of nursing care is currently influenced by the following factors: coordination and continuity of care, deepening of specialized knowledge, integration of technology and innovation, patient-centered care, interdisciplinary collaboration and practice environment. Conclusion. Care of hospitalized older adults requires coordination, continuity, and specialized training to address complex illnesses and adapt to individual needs. Technology improves care, but privacy must be protected. Patient focus, interdisciplinary collaboration, and a collaborative environment are essential for effective care.

Os idosos hospitalizados requerem uma atenção especial devido às suas necessidades de saúde, tais como a gestão de várias condições médicas, a prevenção de quedas e úlceras, a dor e a incapacidade. Por conseguinte, os enfermeiros desempenham um papel vital nos cuidados prestados a estes doentes, prestando uma atenção direta e constante a todos os aspectos fundamentais para o seu bem-estar geral. Objetivo. Identificar os factores que influenciam a qualidade dos cuidados prestados pela equipa de enfermagem aos idosos hospitalizados. Metodologia. Foi efectuada uma revisão sistemática nas seguintes bases de dados: Scopus, Scielo e Wos. Foram analisados 83 documentos após a aplicação dos critérios de inclusão e exclusão propostos; as publicações mostram que a qualidade dos cuidados de enfermagem é atualmente influenciada pelos seguintes factores: coordenação e continuidade dos cuidados, aprofundamento do conhecimento especializado, integração da tecnologia e inovação, cuidados centrados no doente e colaboração interdisciplinar e ambiente de prática. Conclusões. Os cuidados prestados aos idosos hospitalizados requerem coordenação, continuidade e formação especializada para tratar doenças complexas e adaptar-se às necessidades individuais. A tecnologia melhora os cuidados, mas a privacidade deve ser protegida. A centralidade no doente, a colaboração interdisciplinar e um ambiente de colaboração são essenciais para a eficácia dos cuidados.

Physical activity, protein consumption, and loss of muscle mass in older adult participants of the ELSA-Brazil study / Atividade física, consumo de proteínas e perda de massa muscular em idosos do ELSA-Brasil

Objetivo: Objetiva-se avaliar a relação entre consumo de proteínas (CP), atividade física (AF) e massa muscular (MM) em indivíduos com 60 anos ou mais de idade. Metodologia: Trata-se de um estudo prospectivo a partir da linha de base e segunda onda do estudo ELSA-Brasil. O CP foi avaliado por meio de um questionário de frequência alimentar semiquantitativo (QFA). A AF foi mensurada pelo International Physical Activity Questionnaire (IPAQ). A MM foi estimada por meio de equação de predição, e calculada a diferença de MM entre a 2a e a 1a onda. Análises bivariadas foram realizadas adotando o valor de p < 0,05. Para as análises multivariadas, utilizou-se a regressão de Poisson, com quatro modelos distintos, que incluíram as covariáveis com valor de p < 0,20. Utilizou-se o pacote estatístico SPSS versão 21. Resultados: A amostra foi constituída de 2216 idosos, sendo 55,10% de mulheres, com média de idade de 65,20 ± 4,15. Indivíduos com redução de MM entre as duas ondas estão situados no primeiro quartil de consumo de proteína. Além disso, a média de AF mostrou diferença significativa entre os grupos e a AF no lazer apenas para as mulheres (p < 0,05). Após ajuste por variáveis sociodemográficas, de saúde e hábitos de vida, indivíduos com menor consumo de proteínas apresentaram risco de 1,45 (1,29 ­ 1,63) de apresentar MM diminuída. Conclusões: O menor CP e AF forte estão associados à MM diminuída, e aqueles com menor CP no primeiro e segundo quartis apresentam maior risco de possuir MM diminuída. (AU)

Objective: The objective was to evaluate the relationship between protein consumption, physical activity, and muscle mass in individuals aged ≥ 60 years. Methods: This prospective study was based on the baseline and second wave of the ELSA Brazil study. Protein consumption was assessed using a semiquantitative food frequency questionnaire. Physical activity was measured using the International Physical Activity Questionnaire. Muscle mass was estimated using a prediction equation, and the difference in MM between the first and second waves was calculated. Bivariate analyses were performed, with p < 0.05 considered significant. Multivariate analysis consisted of 4 Poisson regression models including covariates with p < 0.20. The statistical analysis was performed in IBM SPSS Statistics 21. Results: The sample included 2216 older adults, 55.10% of whom were women, with a mean age of 65.20 (SD, 4.15). Participants whose muscle mass decreased between the waves were in the first quartile of protein consumption. Mean physical activity significantly differed between the groups, while leisure-time physical activity differed only for women (p < 0.05). After adjusting for sociodemographic, health, and lifestyle variables, participants with lower protein intake had a 1.45 (1.29­1.63) relative risk of muscle mass loss. Conclusions: Lower protein consumption and higher physical activity were associated with decreased muscle mass, and those with protein consumption in the first and second quartiles are at higher risk of muscle mass loss. (AU)

Efeitos do treinamento multicomponente na capacidade intrínseca de idosos residentes na comunidade: protocolo de estudo quase-experimental / Effects of multicomponent training on the intrinsic capacity of communitydwelling older adults: quasi-experimental study protocol

Objetivo: Protocolo para avaliar os efeitos de exercícios multicomponentes na capacidade intrínseca de idosos. Metodologia: Pessoas idosas (≥ 60 anos) cadastradas em um programa de treinamento multicomponente de Porto Alegre (RS) serão selecionados para avaliação da capacidade intrínseca nos seus cinco domínios: vitalidade (teste de força de preensão manual (FPM), índice de massa corpórea (IMC) e nutrição) sensorial (perguntas autorrelatadas), psicológico (Escala de Depressão Geriátrica, GDS-15), cognitivo (MoCA teste) e locomotor (teste de sentar e levantar e TUG). A pontuação composta da capacidade intrínseca será realizada por meio da soma dos domínios em escore de 0 a 10 pontos. Ao fim de 12 semanas de intervenção com exercícios multicomponentes, os participantes serão reavaliados. Para comparar os efeitos do treinamento multicomponente na capacidade intrínseca composta e por domínio serão utilizados os testes t de Student e ANOVA para comparar os efeitos de diversos tipos de treinamento. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa sob parecer no 5.517.315. Resultados esperados: Ao fim de 12 semanas de intervenção com os exercícios multicomponentes, esperamos um aumento na pontuação composta da capacidade intrínseca e em seus domínios, especialmente o locomotor. Relevância: O risco de dependência, quedas e mortalidade aumenta com o declínio da capacidade intrínseca, suscitando a necessidade de implementar intervenções para limitar esses desfechos negativos. A prática de exercícios multicomponentes é uma estratégia simples, eficaz, com boa adesão e amplamente recomendada para evitar o declínio da capacidade intrínseca e melhorar a saúde e a funcionalidade das pessoas idosas. (AU)

Objective: This is a protocol for assessing the effects of multicomponent exercise on the intrinsic capacity of older adults. Methods: Older adults (≥ 60 years old) will be selected for a multicomponent training program in Porto Alegre, RS, Brazil to evaluate the 5 domains of intrinsic capacity: vitality (handgrip strength, body mass index, and nutrition) sensory perception (self-reported questions), psychology (the 15-item Geriatric Depression Scale), cognition (the Montreal Cognitive Assessment) and locomotion (the sit-to-stand test and the Timed Up and Go test). The composite intrinsic capacity score will be obtained by summing the domains, with total scores ranging from 0 to 10 points. After 12 weeks of the multicomponent exercise intervention, the participants will be reassessed. Student's t-test and ANOVA will be used to compare the effects of different types of training on intrinsic capacity. This study was approved by the research ethics committee of the involved institution. Expected results: After the 12-week multicomponent exercise intervention, we expect scores for composite intrinsic capacity and its domains, especially locomotion, to increase. Relevance: The risk of dependence, falls, and mortality increases with reduced intrinsic capacity, indicating a need for interventions to limit these negative outcomes. Multicomponent exercise, a simple, widely recommended, and effective strategy with good adherence, is designed to prevent intrinsic capacity decline in older people and improve their health and functionality. (AU)

Incidence of Muscular Strength, Anthropometry, and Asymmetry in the General Index of Autonomy in Older Chilean Women

SUMMARY: Frailty affects the functional autonomy (FA) of older adults and could manifest itself in muscle imbalances in the limbs, resulting in a disparity in size and strength between them. In Chile, information on the relationship between muscle strength (MS) levels and FA asymmetries in older women is limited. This study related the levels of MS, anthropometric parameters, and asymmetries of the lower and upper limbs, with the FA of a group of older Chilean women. The study included 39 women who participated, and their FA was evaluated using the GDLAM index (IG). Based on the score obtained in the IG, they were classified by percentiles as Group 1 with favorable FA (P ≤ 50) and Group 2 with low FA (P > 50). Anthropometric parameters were BMI, fat percentage, bone mass, circumferences (arm, thigh, calf), diameters (humerus, femur) and upper/lower limb strength was evaluated to determine asymmetries. The differences between the covariates of both groups were evaluated using the student's t test and the Mann-Whitney test for independent samples. G1 presented less asymmetry (p > 0.05) in the lower limbs and greater calf circumference than G2 (p < 0.05). G1 presented greater bilateral strength (dominant and non-dominant limb) compared to G2 (p < 0.05). The covariates of age, anthropometry, MS, and lower/upper limb asymmetries influence FA in older women.

La fragilidad afecta la autonomía funcional (AF) de las personas mayores y podría manifestarse en desequilibrios musculares en los miembros, dando lugar a una disparidad de tamaño y fuerza entre ellos. En Chile, la información que relaciona los niveles de fuerza muscular (FM) y las asimetrías con la AF en mujeres mayores es limitada. Este estudio relacionó los niveles de FM, parámetros antropométricos y asimetrías de los miembros inferiores y superiores, con la AF de un grupo de mujeres mayores chilenas. Participaron 39 mujeres, cuya AF se evaluó mediante el índice GDLAM (IG). En función de la puntuación obtenida en el IG, se clasificaron por percentiles en Grupo 1 con AF favorable (P ≤ 50) y Grupo 2 con AF baja (P > 50). Los parámetros antropométricos fueron IMC, porcentaje de grasa, masa ósea, circunferencias (brazo, muslo, pantorrilla), diámetros (húmero, fémur) y se evaluó la fuerza de los miembros superiores/ inferiores para determinar asimetrías. Las diferencias entre las covariables de ambos grupos se evaluaron mediante la prueba t de student y la prueba de Mann-Whitney para muestras independientes. G1 presentó menor asimetría (p > 0,05) en los miembros inferiores y mayor perímetro de pantorrilla que G2 (p < 0,05). G1 presentó mayor fuerza bilateral (miembro dominante y no dominante) en comparación con G2 (p < 0,05). Las covariables de antropometría, FM y asimetrías de extremidades inferiores/superiores influyen en la AF en mujeres mayores.

Use of potentially inappropriate medications and medications of concern in older adults with multiple myeloma / Utilização de medicamentos potencialmente inapropriados e medicamentos que requerem cautela em idosos com mieloma múltiplo

Objetivo: Analisar o uso de medicamentos potencialmente inapropriados (MPIs) e o uso de medicamentos usados em terapia de suporte que requerem cautela em idosos com câncer (MTSRCICs), determinando os fatores associados. Visou-se também determinar a concordância entre os critérios explícitos empregados na identificação de MPI. Metodologia: Estudo transversal com indivíduos com mieloma múltiplo (MM), idade ≥ 60 anos em tratamento ambulatorial. Os MPI foram identificados de acordo com os critérios AGS Beers 2019, PRISCUS 2.0 e o Consenso Brasileiro de Medicamentos Potencialmente Inapropriados (CBMPI). Os MTSRCIC foram definidos de acordo com a National Comprehensive Cancer Network. Os fatores associados ao uso de MPI e MTSRCIC foram identificados por regressão logística múltipla. O grau de concordância entre os três critérios explícitos empregados no estudo foi mensurado pelo coeficiente kappa Cohen. Resultados: As frequências de MPI foram 52,29% (AGS Beers 2019), 62,74% (CBMPI), 65,36% (PRISCUS 2.0) e 52,29% (MTSRCICs). As concordâncias entre AGS Beers 2019 com PRISCUS 2,0 e com CBMPI foram altas, enquanto a concordância entre CBMPI e PRISCUS 2.0 foi excelente. No modelo final de regressão logística polifarmácia foi associada positivamente ao uso de MPI por idosos para os três critérios explícitos utilizados, além de associado à utilização de MTSRCICs. Conclusões: A frequência do uso de MPI e de MTSRCIC foi elevada. A concordância em relação ao uso de MPI entre os critérios AGS Beers 2019, CBMPI e PRISCUS 2.0 foi alta ou excelente. A polifarmácia apresentou associação independente e positiva com uso de MPIs e de MTSRCICs por pacientes idosos com MM. (AU)

Objectives: To analyze the use of potentially inappropriate medications (PIMs) and medications used in supportive therapy that require caution in older adults with cancer, in addition to determining associated factors the agreement between criteria sets used to identify PIMs. Methods: This cross-sectional study included individuals with multiple myeloma aged ≥ 60 years who were undergoing outpatient treatment. PIMs were identified according to American Geriatric Society Beers 2019, PRISCUS 2.0, and Brazilian Consensus on Potentially Inappropriate Medicines criteria. Medications of concern were defined according to National Comprehensive Cancer Network criteria. Factors associated with the use of PIMs and medications of concern were identified using multiple logistic regression. The degree of agreement between the 3 criteria sets was measured using Cohen's kappa coefficient. Results: The frequency of PIM use was 52.29% according to American Geriatric Society Beers criteria, 62.74% according to Brazilian Consensus criteria, and 65.36% according to PRISCUS criteria, while 52.29% of the patients were using medications of concern. Agreement between American Geriatric Society Beers, PRISCUS, and Brazilian Consensus criteria was high, while it was excellent between Brazilian Consensus and PRISCUS criteria. In the final logistic regression model, polypharmacy was associated with PIM use according to each criteria set, as well as the use of medications of concern. Conclusions: The frequency of PIMs and medications of concern was high. Agreement about PIM use between the American Geriatric Society Beers, Brazilian Consensus, and PRISCUS criteria was high or excellent. There was an independent association between polypharmacy and the use of PIMs and medications of concern by older patients with multiple myeloma. (AU)

The course of COVID-19 in patients with hematological malignancies and risk factors affecting mortality: A cross-sectional study

Objective This study aimed to determine the clinical outcomes and risk factors affecting mortality in patients with COVID-19 following hematological malignancy (HM). Methods Patients diagnosed with HM and hospitalized for COVID-19 were included in this retrospective study. The age, demographic and clinical characteristics, prognosis and treatment of surviving and non-surviving patients were compared. Results A total of 49 patients were included in this study, 17 (34.6%) of whom died within 28 days of being diagnosed with COVID-19. Older age (p = 0.001), diabetes (p = 0.001), chronic obstructive pulmonary disease (p = 0.002), secondary infection (p < 0.001) and secondary bacterial infection (p = 0.005) were statistically significantly higher in non-survivors. The remission status of HM was higher in surviving patients (p < 0.001). In multivariate regression analysis, age (OR: 1.102, p = 0.035) and secondary infection (OR: 16.677, p = 0.024) were risk factors increasing mortality, the remission status of HM (OR: 0.093, p = 0.047) was a protective factor from mortality. Conclusion The older age, the remission status of HM and secondary infection due to COVID-19 were determined as prognostic factors predicting mortality in HM patients with following COVID-19.

Interacciones potenciales entre productos herbolarios con fármacos hipoglucemiantes en adultos mayores con diabetes mellitus, en una zona rural mexicana / Potenciais interacções entre produtos à base de plantas e medicamentos hipoglicemiantes em adultos mais velhos com diabetes mellitus no Mexico rural / Potential interactions between herbal products with hypoglycemic drugs in older adults with diabetes mellitus in rural Mexico

Introducción: El 50% de la población mundial usa tratamientos alternativos como productos herbarios. El 20% los consume de manera simultánea con algún tratamiento farmacológico para el control la Diabetes Mellitus tipo 2; enfermedad prevalente en adultos mayores. Es escasa la información acerca de las interacciones medicamentosas que pudieran producirse, siendo responsables de más de 7,000 muertes al año. Objetivo: Identificar los productos herbarios de mayor consumo del Adulto Mayor con Diabetes Mellitus Tipo 2, en Chapulco, Puebla, México y describir las posibles interacciones medicamentosas entre fármaco hipoglucemiante ­ producto herbario reportados en la literatura científica. Metodología: Estudio observacional, prolectivo, transversal, descriptivo, en una población de 35 adultos mayores diabéticos, con edad promedio de 70±7 años. Para la identificación de los productos herbarios de uso común y sus aplicaciones terapéuticas se aplicó el cuestionario U-PLANMED. Resultados: Se identificaron 50 productos herbarios y 18 combinaciones entre estos a la vez. El 40% de los participantes consumen simultáneamente más de dos productos herbarios con uno o dos fármacos hipoglucemiantes. Entre los productos de mayor consumo se encuentran el nopal (Opuntia ficus-indica L.), la manzanilla (Matricaria chamomilla L.) y el zacate de limón (Cymbopogon citratus DC. Stapf.). Las interacciones medicamentosas potenciales identificadas, principalmente en estudios experimentales en animales, sugieren que, existe una acción hipoglucemiante del producto herbario al aumentar la capacidad orgánica sobre la secreción/liberación de insulina endógena. Conclusiones: Se ha evidenciado la presencia de interacciones medicamentosas ante el consumo simultaneo de fármacos prescritos para el control de la diabetes mellitus tipo 2 con productos herbarios. Es necesario que, los profesionales en atención a la salud identifiquen el uso de dichos productos y orienten a los adultos mayores sobre las posibles repercusiones en los niveles de glucosa ante el consumo.

Introduction: 50% of the world's population uses alternative treatments such as herbal products. Twenty percent use them in conjunction with some form of pharmacological treatment to control type 2 diabetes mellitus, a disease prevalent in older adults. There is little information on the drug interactions that may occur, which are responsible for more than 7,000 deaths per year. Objective: To identify the most consumed herbal products among older adults with type 2 diabetes mellitus in Chapulco, Puebla, Mexico, and to describe the possible drug-drug interactions between hypoglycemic drugs and herbal products reported in the scientific literature. Methodology: Observational, prospective, cross-sectional, descriptive study in a population of 35 diabetic older adults with a mean age of 70±7 years. The U-PLANMED questionnaire was used to identify commonly used herbal products and their therapeutic applications. Results: Fifty herbal products and 18 combinations of them were identified. Forty percent of the participants used more than two herbal products simultaneously with one or two hypoglycemic drugs. The most used products included prickly pear cactus (Opuntia ficus-indica L.), chamomile (Matricaria chamomilla L.), and lemon grass (Cymbopogon citratus DC. Stapf.). Potential drug-drug interactions identified mainly in experimental animal studies suggest that there is a hypoglycemic effect of the herbal product by increasing the organic capacity on endogenous insulin secretion/release. Conclusions: The presence of drug-drug interactions has been demonstrated with the simultaneous consumption of drugs prescribed for the control of type 2 diabetes mellitus with herbal products. It is necessary for health care professionals to recognize the use of such products and to inform older adults about the possible repercussions on glucose levels when consuming them.

Introdução: 50% da população mundial utiliza tratamentos alternativos como os produtos à base de plantas. Vinte por cento utilizam-nos em conjunto com algum tipo de tratamento farmacológico para controlar a diabetes mellitus tipo 2, uma doença prevalente em adultos mais velhos. Há pouca informação sobre as interacções medicamentosas que podem ocorrer e que são responsáveis por mais de 7.000 mortes por ano. Objetivos: Identificar os produtos fitoterápicos mais consumidos entre os idosos com diabetes mellitus tipo 2 em Chapulco, Puebla, México, e descrever as possíveis interações medicamentosas entre medicamentos hipoglicemiantes e produtos fitoterápicos relatados na literatura científica. Metodologia: Estudo observacional, prospetivo, transversal e descritivo numa população de 35 idosos diabéticos com uma idade média de 70±7 anos. O questionário U-PLANMED foi utilizado para identificar os produtos fitoterápicos mais utilizados e suas aplicações terapêuticas. Resultados: Foram identificados 50 produtos à base de plantas e 18 combinações dos mesmos. Quarenta por cento dos participantes utilizaram mais de dois produtos à base de plantas em simultâneo com um ou dois medicamentos hipoglicemiantes. Os produtos mais utilizados foram o cato de figo da Índia (Opuntia ficus-indica L.), a camomila (Matricaria chamomilla L.) e o capim-limão (Cymbopogon citratus DC. Stapf.). As potenciais interacções medicamentosas identificadas principalmente em estudos experimentais em animais sugerem que existe um efeito hipoglicémico do produto à base de plantas através do aumento da capacidade orgânica na secreção/libertação de insulina endógena. Conclusões: A presença de interacções medicamentosas foi demonstrada com o consumo simultâneo de medicamentos prescritos para o controlo da diabetes mellitus tipo 2 com produtos à base de plantas. É necessário que os profissionais de saúde reconheçam o uso de tais produtos e informem os idosos sobre as possíveis repercussões nos níveis de glicose ao consumi-los.

Prevalence and risk factors for falls among older Chinese adults in the community: findings from the CLHLS study

Older adults have a high prevalence of falls due to a decline in physiological functions and various chronic diseases. This study aimed to investigate the prevalence of and risk factors for falls among older individuals in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We collected information from 9737 older individuals (average age=84.26 years) from the CLHLS and used binary logistic regression analysis to explore the independent risk factors and protective factors for falls. The logistic regression analysis results are reported as adjusted odds ratios (aORs) and 95% confidence intervals (95%CIs). The prevalence of falls among older adults in China was 21.6%, with women (24.6%) having a higher prevalence than men (18.1%). Logistic regression analysis revealed that never (or rarely) eating fresh fruit, difficulty with hearing, cataracts, and arthritis were the common independent risk factors for falls in older Chinese men and women. Among men, age ≥80 years (aOR=1.86), never doing housework (aOR=1.36), and dyslipidemia (aOR=1.47) were risk factors, while eating milk products once a week was a protective factor. Alcohol consumption (aOR=1.40), physical labor (aOR=1.28), and heart disease (aOR=1.21) were risk factors for falls in women, while a daily sleep duration of 6-12 h and garlic consumption once a week were protective factors. The prevalence of falls among older adults in China is 21.6% and is greater in women than in men. These risk and protective factors can be used to formulate reasonable recommendations for living habits, diet, and chronic disease control strategies.

Asociación de la fragilidad con el uso de servicios de salud en adultos mayores. Un análisis secundario del Estudio Nacional sobre Salud y Envejecimiento en México / Association of frailty with the use of health services in older adults. A secondary analysis of the Mexican Health and Aging Study

Resumen Antecedentes: La fragilidad se ha relacionado con desenlaces adversos, pero aún es escasa la evidencia sobre su asociación con el uso de servicios de salud. Objetivo: Evidenciar la asociación de la fragilidad con el uso de servicios de salud en adultos mexicanos mayores de 60 años. Material y métodos: Análisis del Estudio Nacional sobre Salud y Envejecimiento en México para 2015 (basal) y 2018 (seguimiento). La fragilidad se definió con el índice de fragilidad. Fueron incluidos los siguientes desenlaces: hospitalización, visitas médicas, cirugía mayor, procedimientos quirúrgicos menores y visitas al dentista. Se utilizaron modelos de riesgos competitivos y de número de eventos (regresión negativa binomial). Resultados: Se incluyeron 8526 individuos, cuya edad promedio fue de 70.8 %; 55.8 % correspondió al sexo femenino. De acuerdo con los resultados, los días de hospitalización y el número de procedimientos menores se asociaron a fragilidad. Conclusiones: La fragilidad podría ser un parámetro útil en la planeación de los servicios de salud para los adultos mayores. Por otro lado, su evaluación permitiría priorizar la atención a quienes presenten mayor riesgo de desenlaces adversos.

Abstract Background: Frailty has been related to adverse outcomes, but evidence on its association with the use of health services is still scarce. Objective: The purpose of this work was to determine the association of frailty with the use of health services in Mexican adults older than 60 years. Material and methods: Analysis of the Mexican Health and Aging Study for the years 2015 (baseline) and 2018 (follow-up). Frailty was defined with the frailty index. The following outcomes were included: hospitalization, medical visits, major surgery, minor surgical procedures, and dental visits. Competing risk and count analyses (negative binomial regression) were performed. Results: A total of 8,526 individuals were included, whose average age was 70.8%; 55.8% corresponded to the female gender. According to the results, hospitalization days and the number of minor procedures were associated with frailty. Conclusions: Frailty could be useful in the planning of health services for older adults. On the other hand, its evaluation would allow prioritizing care for those who are at higher risk of adverse outcomes.

Asociación entre la depresión y variables sociodemográficas en el adulto mayor en el Perú / Association between Depression and Sociodemographic Variables in the Elderly in Peru / Associação entre depressão e variáveis sociodemográficas em idosos no Peru

en el artículo se analizan la depresión, variables sociodemográficas y su asociación entre ellas en adultos mayores en el Perú. Materiales y métodos: se usó un estudio transversal, descriptivo y correlacional a una submuestra de 5247 adultos mayores. Se emplearon los datos generados por la Encuesta Demográfica y de Salud (endes) del 2019, utilizando el instrumento de investigación: Patient Healtth Questionnarie (phq-9) de nueve preguntas y las variables sociodemográficas, incluidas en los cuestionarios de salud, características del hogar y la vivienda, de la endes 2019. Para el estudio estadístico se usó el modelo de regresión logística múltiple,para establecer si existía asociación entre depresión y variables sociode-mográficas. Resultados: los resultados señalan que el 15.3 % de las personas de 60 años a más presenta una depresión moderada, moderadamente severa y severa. Asimismo, se encontró que la depresión y las variables sociodemográficas (nivel de instrucción, diabetes, índice de riqueza, sexo y grupo etario) están relacionadas; sin embargo, no están relacionadas con las variables hábito de fumar, obesidad, tener pareja y lugar de residencia. Conclusiones: la depresión está relacionada con algunas variables sociodemográficas consideradas en este estudio. La depresión en adultos mayores se está convirtiendo en un significativo problema de salud pública, más frecuente en mujeres, edades avanzadas, áreas rurales, niveles socioe-conómicos bajos, menores niveles educativos, presión arterial, discapacidad y consumo problemático de alcohol; condiciones que deben tenerse en cuenta para la implementación de políticas públicas.

We analyzed depression, sociodemographic variables, and the association between them in older adults in Peru. Materials and methods: A cross-sectional, descriptive, and correlational study was conducted, including 5,247 older adults. The data was extracted from the 2019 Demographic and Health Survey (endes) using the Patient Health Questionnaire (phq-9) of nine questions. The health questionnaires also included sociodemographic variables, household characteristics, and housing-related questions. A multiple logistic regression model was used to determine if there was an association between depression and sociodemographic variables. Results: Approximately 15.3% of older adults had a history of depression (moderate, moderately severe, and severe). We identified a relationship between depression and some sociodemographic variables (education level, diabetes, wealth index, sex, and age group). However, depres-sion was not related to smoking habits, obesity, having a partner, and place of residence. Conclusions: Depression was related to some of the sociodemographic variables considered in this study. Depression in older adults is becoming a significant public health problem, more frequent in women, advanced ages, rural areas, low socioeconomic levels, lower educational levels, blood pressure, disability, and problem-atic alcohol consumption. These conditions must be considered in the implementation of public policies

Introdução: no presente artigo analisa-se a depressão, variáveis sociodemográficas e a associação entre elas em idosos no Peru. Materiais e métodos: estudo transversal, descritivo e correlacional, com uma suba-mostra de 5247 idosos. Foram utilizados os dados gerados pela "Pesquisa Demográfica e de Saúde" (do espanhol endes) do ano de 2019, utilizando como instrumento de pesquisa o: Patient Health Questionnarie (phq-9) de nove questões e as variáveis sociodemográficas, incluídas nos questionários de saúde, domiciliar e características de moradia, do endes 2019. Para o estudo estatístico, foi utilizado o modelo de regres-são logística múltipla para verificar se havia associação entre depressão e variáveis sociodemográficas. Resultados: os resultados indicam que 15,3 por cento das pessoas com 60 anos ou mais apresentam um nível de depressão moderada, moderadamente grave e grave. Da mesma forma, verificou-se que a depressão e as variáveis sociodemográficas (escolaridade, diabetes, índice de riqueza, sexo e faixa etária) estão relacionadas; entretanto, não estão relacionados com as variáveis hábito de fumar, obesidade, ter companheiro e local de residência. Conclusões: a depressão está relacionada com algumas das variáveis sociodemográficas consideradas neste estudo. A depressão em idosos está se tornando um problema sig-nificativo de saúde pública, mais frequente em mulheres, idades avançadas, áreas rurais, níveis socioeco-nómicos baixos, níveis educacionais mais baixos, pressão arterial, deficiência e consumo problemático de álcool; condições que devem ser levadas em conta para a implementação de políticas públicas.

Effects of cognitively stimulating activities on the cognitive functioning of older people with mild cognitive impairment: A meta-analysis

Background@#The number of individuals with mild cognitive impairment (MCI), or those people without dementia who are experiencing age-related cognitive decline, has increased in recent years. Conveniently, several interventions to delay cognitive decline exist, where cognitively stimulating activities (CSA) have been receiving too much attention. However, its beneficial effects have not been well established among older people with MCI due to conflicting findings. @*Objectives@#This study aimed to assess and summarize the available evidence on the effects of CSA on the overall cognitive functioning of older people with MCI. Specifically, it sought to answer the PICO question, “In older people with MCI, does engagement in cognitively stimulating activities improve cognitive function?”@*Methods@#A systematic review and meta-analysis of randomized controlled trials examining the effects of CSA on older people with MCI were conducted. Three studies met the inclusion criteria from the 1,328 records from BioMed Central, CINAHL, Cochrane Library, Health Source: Nursing/Academic Edition, MEDLINE, and PubMed databases and 156 articles from WorldCat, DSpace Saint Louis University, and Google Scholar databases and catalogs. Effect size values were inspected using the random-effects model. Data were summarized as standardized mean difference (SMD) with corresponding 95% confidence intervals in the forest plot. @*Results@#This meta-analysis which compared studies that employed similar methodologies, found that CSA has a significant, large effect in improving cognitive functioning among older people with MCI, evidenced by an SMD of 0.798 (95% CI = 0.510-1.085, p = 0.001). While its superiority over other interventions that improve cognitive function was not observed in this study, it was still found that using CSA was helpful in terms of its cost-effectiveness. Also, heterogeneity across studies was non-significant (Cochran’s Q = 0.151, df = 2, p = 0.927, I2 = 0.00%). These results mean that clinical heterogeneity was absent even though a diverse range of CSA was employed. Additionally, methodological diversity was not present since there were no variations in the study design and minimal variability in the risk of bias assessment. @*Conclusion@#Overall, it is acknowledged that CSA are effective and practical, inexpensive, non-pharmacologic cognitive training approaches to delay cognitive decline among older people with MCI. However, interpreting this study’s significant, large effect, and non-significant heterogeneity warrants caution.

Association of short-term exposure to ambient PM1 with hospital admissions for angina in older adults / 公共卫生与预防医学

Objective To quantitatively evaluate the association of short-term exposure to ambient submicron particulate matter (PM1) with hospital admissions for angina in older adults. Methods A case-crossover study was conducted among 46 687 older adults hospitalized for angina from 2016 to 2019 in Guangzhou medical institutions. Grid data on ambient PM1 concentrations in Guangzhou were obtained from the ChinaHighAirPollutants (CHAP) dataset. Exposure to PM1 was assessed according to each subject's residential addresses. Conditional logistic regression model was used to analyze the the exposure-response association between PM1 and hospital admissions for angina. Results From 2016 to 2019, the average exposure level of PM1 on the same day of hospital admissions (lag 0) for angina was 21.0 ± 11.5 μg/m3. The results of main model analysis showed that lag 0 day exposure to ambient PM1 was significantly associated with a higher odds of hospital admissions for angina in older adults. Each 10 μg/m3 increase of PM1 exposure level was significantly associated with a 1.31% (95% CI: 0.05%, 2.59%) increased odds of angina admissions. Results from a two-pollutant model adjusting for O3 showed that the association between short-term exposure to PM1 and odds of hospitalization for angina remained stable. According to the results of the above model, it was estimated that the excess hospitalization attributable to ambient PM1 exposure accounted for 2.46% (95% CI: 0.09%, 4.76%) of the total admissions in Guangzhou during 2016-2019, corresponding to 1539 (95% CI: 54, 2976) admissions. No significant effect modification on the associations was observed by sex, age, or season. Conclusion Short-term exposure to ambient PM1 was significantly associated with an increased odds of hospital admissions for angina in older adults.

Health benefit of mindfulness intervention for older adults with insomnia disorders: a systematic review / 中国康复理论与实践

ObjectiveTo conduct a systematic review of the health benefits of mindfulness interventions for older adults with insomnia disorders. MethodsThematic keyword search was conducted in databases including Web of Science, PubMed, Embase, EBSCO, CNKI, VIP and Wanfang data, for literature on the impact of mindfulness intervention on sleep quality in older adults with insomnia disorders, published up to August, 2023. The methodological quality of the researches was evaluated using the Physiotherapy Evidence Database (PEDro) scale. Insomnia disorders, sleep function and mindfulness interventions were coded using International Classification of Diseases 11th Revision, International Classification of Functioning, Disability and Health, and International Classification of Health Interventions Beta-3； and a systematic review was conducted following the PRISMA. ResultsNine researches from four countries were included, involving 800 participants, and all the researches were randomized controlled trials. The average score of PEDro scale was 7.1. The health-related conditions were insomnia disorders and insomnia disorders complicated with mild cognitive impairment. Mindfulness interventions used included mindfulness-based therapy for insomnia, mindfulness-based stress reduction, mindfulness-based cognitive therapy and mindfulness meditation. Interventions were implemented in institutions or health centers, care facilities, and community health service centers, varying from six to eight weeks. Health benefits of mindfulness intervention included improvements in sleep quality and psychological and behavioral health. ConclusionMindfulness interventions effectively improve sleep quality in older adults with insomnia disorders, alleviate negative emotional states such as depression, anxiety and perceived stress, and improve the quality of life.

Effect of active music therapy on cognitive function for older adults with cognitive impairment: a systematic review based on ICD-11 and ICF / 中国康复理论与实践

ObjectiveTo conduct a systematic review of the effect of active music therapy on cognitive function for older adults with cognitive impairment based on International Classification of Diseases, the 11th Revision (ICD-11), and International Classification of Functioning, Disability and Health (ICF). MethodsA PICO framework was constructed. Thematic keyword searches were conducted in databases including PubMed, Web of Science, Embase, CNKI, VIP, and Wanfang data, for literature on the effect of active music therapy on cognitive function for older adults with cognitive impairment, published up to November 5th, 2023. Information on authors, countries, publication date, sample characteristics, study designs, intervention methods, measurement tools and outcomes were extracted. The methodological quality of the researches was evaluated using the Physiotherapy Evidence Database (PEDro) scale. ResultsEight researches from six countries were included, which were all randomized controlled trials involving 356 older adults with mild cognitive impairment and dementia. The articles were published from 2014 to 2020, with an average of 7.4 of the PEDro scale. Active music therapy was used by singing and playing instruments. Interventions took place in hospitals, nursing homes, and health centers. The intervention duration ranged from mostly 30 to 60 minutes a time, with a few 120 minutes a time. Interventions were implemented mostly one to three times a week, lasting from eight to twelve weeks. Health outcomes focused on cognitive function, including overall cognitive function, executive function, attention function and memory function. ConclusionA theoretical framework for the benefits of active music therapy on the cognitive function for older adults with cognitive impairment has been constructed based on ICD-11 and ICF. Active music therapy can improve overall cognitive function, executive function, attention function and memory function for older adults with cognitive impairment.

Barriers and Drivers of Physical Activity Participation Among Older Adults in Malaysia: A Systematic Review

@#Introduction: Ageing is commonly linked with physical inactivity. This review was performed to identify the factors associated with participation in physical activity among older adults in Malaysia. Methods: A systematic review was conducted using five databases; Pubmed, Sagepub, Scopus, Cochrane Library and Science Direct. Observational and intervention studies published between January 2010 and December 2020 were included, with Malaysian older adults aged 55 years and older being the main subject. Results: A total of 9 articles were included in the review. Analysis was guided by the Social Ecological Model for Health Promotion. The review had successfully identified gender, age, education level, health reasons, ethnicity and attitude as intrapersonal factors, social support (friend) and marital status as interpersonal factors, and locality as well as availability of facilities as environmental factors. Conclusions: Physical activity participation among Malaysian older adults were mainly determined by intrapersonal factors, particularly gender, health condition and educational level.

Effectiveness of Tocilizumab in COVID-19 patients with pneumonia: A systematic review

Background and Objective@#COVID-19 contributes significantly to global morbidity and mortality. Age-related comorbidities elevate the risk of severe cases. Studies have recently demonstrated that widely available medications, including tocilizumab (TCZ), can manage severe symptoms. However, its effectiveness is unclear, particularly among the older population. Therefore, this review aimed to evaluate TCZ’s efficacy in managing severe pneumonia in individuals aged 50 and older.@*Methods@#We systematically search several databases and gray literature including Web of Science, CINAHL, Academic Search Complete, PsycINFO, PsycArticles, SocINDEX, CENTRAL/Cochrane Library, PubMed/MEDLINE for original research articles in English across several study designs published in the year 2020-2022. A narrative synthesis was conducted to summarize the evidence. We employed the NIH quality assessment tool for observational cohort studies to evaluate risk of bias. Additionally, we utilized GRADE to appraise the certainty of evidence.@*Results@#Among 539 screened articles, only five studies met the selection criteria. Tocilizumab's impact on severe COVID-19 pneumonia revealed a diverse effect on mortality rate, with 29% in the TCZ group, and 40% in the controls died within 30 days of intubation (OR 0.61; 95% CI, 0.27-1.36). It is also reported that TCZ was not associated with mortality, despite faster decline in pulmonary function and prolonged fever. Hospital mortality in the TCZ group was significantly lower than in the controls, and age over 60 was the only significant risk factor. Moreover, administering TCZ reduced mechanical ventilation needs, with 82% extubated compared to 53% in controls. However, 45% in TCZ group was associated with a higher ventilator-associated pneumonia rate than in the untreated group which was 20% (P < 0.001). Despite this, TCZ-treated patients had shorter hospital stays.@*Conclusions@#The effects of tocilizumab on reducing mortality risk and improving the survival rate of COVID-19 patients with pneumonia remained inconclusive. Yet, the majority of results suggested that giving tocilizumab leads to shorter hospital stays, lowers the requirement for mechanical ventilation, and decreases the likelihood of ICU transfer. Tocilizumab is linked to the incidence of secondary infections; hence, this medication should be closely monitored for side effects.

Impact of a Tailored Self-Management Education Programme for Older Adults with Knee Osteoarthritis in a Multi-Ethnic Country / Jurnal Sains Kesihatan Malaysia

@#Self-management education program (SMEP) is essential in the knee osteoarthritis (OA) management. While the benefits of tailored SMEP have been highlighted in the literature, evidence on the effects of tailored knee OA SMEP for multiethnic populations, such as in Malaysia, remains limited. Therefore, the aim of this study was to conduct an intervention study on a tailored SMEP among Malaysian older adults who aged 60 years and above with knee OA. Participants aged 60 years and over with a diagnosis of knee OA were recruited. The intervention comprised four weekly structured group SMEP which was developed specifically for the multicultural population in Malaysia. Symptom’s severity and functional performance were assessed at baseline and six-week follow-up using the Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS), 30 seconds sit to stand (30sST), time up and go (TUG), chair sit and reach (CSR), back stretch (BS), handgrip strength (HGS) and two-minute walk (2MW) tests. Of the 32 individuals recruited, 30 participants, mean age of 66.77 (±6.42) years, completed the post-intervention assessment. Improvements in mean KOOS domains scores were observed by between 1.3% - 8.6% from baseline to follow-up. Significant differences between baseline and followup scores were identified for 30sST (p < 0.05), TUG ( p < 0.001) and 2MW (p < 0.001) tests. A 4-week tailored SMEP delivered face to face by a physiotherapist, improved lower limb muscle strength, mobility, balance and endurance. Larger randomized controlled trials regarding the long-term effects of SMEP for older adults with OA is warranted.