Organização da atenção à saúde da pessoa idosa - relato de experiência a partir da técnica do arco de maguerez / Organization of health care for elderly people - experience report using the maguerez arch technique / Organización de atención en salud a personas mayores - reporte de experiencia utilizando la técnica del arco de maguerez

Uma das características mais marcantes da atual dinâmica demográfica mundial é o processo de envelhecimento populacional. Nessa lógica, em 2050, cerca de um quarto da população brasileira terá mais de 60 anos, indicando um aumento progressivo de demandas em saúde. Ocorre que as equipes de Atenção Primária à Saúde, ainda apresentam dificuldades de organização e oferta de ações específicas para esse público. Nesse sentido, por meio de pesquisa-ação, utilizando a técnica do Arco de Maguerez, foram desenvolvidas oficinas para profissionais do município de Camboriú/SC, com o objetivo de reorganizar a atenção à Saúde da pessoa idosa no município. As etapas demonstram forte influência do modelo biomédico, e ausência de ações específicas para a população idosa, porém, também foi possível desenvolver reflexões e propostas de reorganização do processo de trabalho a partir dos atributos da Atenção Primária à Saúde, o que potencialmente pode produzir melhorias nos indicadores de saúde da pessoa idosa.

One of the most remarkable characteristics of the current global demographic dynamics is the process of population aging. In this context, by 2050, approximately a quarter of the Brazilian population will be over 60 years old, indicating a progressive increase in healthcare demands. However, Primary Health Care teams still face difficulties in organizing and providing specific actions for this population. On this subject, through Research-Action method using the Maguerez Arch technique, workshops were developed for professionals in the municipality of Camboriú/SC, with the aim of reorganizing healthcare for the elderly in the municipality. The stages demonstrate a strong influence of the biomedical model and a lack of specific actions for the elderly population. However, it was possible to develop reflections and proposals for reorganizing the work process based on the attributes of Primary Health Care, which potentially can result in improvements in health indicators for the elderly.

Una de las características más llamativas de la actual dinámica demográfica global es el proceso de envejecimiento de la población. Así, en 2050, alrededor de una cuarta parte de la población brasileña tendrá más de 60 años, lo que indica un aumento progresivo de las demandas de salud. Resulta que los equipos de Atención Primaria de Salud aún tienen dificultades para organizarse y ofrecer acciones específicas para este público. En este sentido, a través de la investigación acción, utilizando la técnica del Arco de Maguerez, se desarrollaron talleres para profesionales de la ciudad de Camboriú/SC, con el objetivo de reorganizar la atención a la salud de las personas mayores de la ciudad. Las etapas evidencian una fuerte influencia del modelo biomédico, y la ausencia de acciones específicas para la población adulta mayor, sin embargo, también fue posible desarrollar reflexiones y propuestas de reorganización del proceso de trabajo a partir de los atributos de la Atención Primaria de Salud, que puede potencialmente producir mejoras en los indicadores de salud de las personas mayores.

Quality of life of older adults in Family Health Strategy: a cross-sectional study

ABSTRACT BACKGROUND: With the increase in the older adult population, it is essential to identify the living and health conditions that can impact the quality of life of these individuals. OBJECTIVES: To identify the domains and factors associated with the quality of life of older adults under the Family Health Strategy program. DESIGN AND SETTING: This was a cross-sectional analytical study was conducted in the municipality of Palmas, Tocantins, Brazil. METHODS: We assessed 449 older adults enrolled in the Family Health Strategy program. Data were collected between April and July, 2018. World Health Organization Quality of Life Assessment (WHOQOL-OLD) was used to assess the quality of life (QoL) and multiple linear regression was used to estimate the factors associated with QoL. RESULTS: The QoL domain with the highest score was death and dying (mean = 70.4), and the lowest score was for sensory functions (mean = 61.0 points). The factors associated with QoL were single marital status (β = -4.55; P = 0.014), level of independence for daily living activities (β = 4.92; P < 0.001), self-assessment of regular health (β = 5.35; P < 0.001), and poor health (β = -8.67; P < 0.001). CONCLUSION: The death and dying domain of QoL presented the highest score. Marital status, impairment in daily activities, and health self-assessment were associated with QoL.

Modelo de co-construcción intergeneracional de cápsulas comunicacionales en base a comidas tradicionales

Introducción: La valoración de las comidas tradicionales resulta esencial para mantener el patrimonio gastronómico, sin embargo, su divulgación es limitada, por lo que se requiere de estrategias comunicacionales que promuevan la difusión de las culturas inmateriales. Objetivo: Elaborar un modelo de co-construcción de cápsulas comunicacionales intergeneracionales para difundir preparaciones culinarias significativas de personas mayores. Material y métodos: El estudio se enmarca en la investigación aplicada del tipo tecnológico. Se realizó una búsqueda teórica de aspectos relevantes en el uso de cápsulas comunicacionales (videos), así como el uso de TICs en personas mayores, siguiendo los lineamentos del diseño cualitativo a través de un análisis de contenido temático. Luego se construye un modelo, que es validado por profesionales del área gerontológica, para ser aplicado en un proyecto piloto que incluyó a una diada constituida por una persona mayor y un descendiente, los que guiaron y grabaron una entrevista en profundidad focalizada. Resultados: Se co-construyeron 6 videos con preparaciones culinarias tradicionales en el que participaron 5 mujeres y 1 hombre, de las Regiones del Biobío y Metropolitana. Se siguió modelo teórico que incorporó 7 pasos para su elaboración: identificación de diada intergeneracional, capacitación, realización del video, primera edición del video, presentación del video a la diada, edición final y difusión del video en redes sociales. Conclusiones: Como estrategia para un envejecimiento saludable, la realización de un video intergeneracional con una receta preferida se visualiza como una oportunidad para entrelazar cultura, patrimonio y emociones entre los participantes y la comunidad.

Introduction: The appreciation of traditional foods is essential in the maintenance of gastronomic heritage; however, its dissemination is limited, which is why communication strategies are required to promote the dissemination of intangible cultures. Objective: To develop a model for the co-construction of intergenerational communication capsules that allow the dissemination of significant culinary preparations for the elderly. Material and methods: The study is part of an applied technological research. In order to consolidate knowledge and use it for educational purposes, a theoretical search of relevant aspects in the use of communication capsules (videos) was carried out, following the guidelines of qualitative design through thematic content analysis. Then, a model is constructed and validated by professionals from the gerontological area to be applied to a pilot project that included a dyad made up of an elderly person and a descendant, who guided and recorded an in-depth focused interview. Results: A total of 6 videos about traditional culinary preparations made by 5 women and 1 man from the Biobío and Metropolitana Regions were co-constructed. A theoretical model that incorporated 7 steps for its elaboration was followed: identification of intergenerational dyad, training, making of the video, first edition of the video, presentation of the video to the dyad, final edition, and dissemination of the video on social networks. Conclusions: As a strategy for healthy aging, making an intergenerational video with a favorite recipe is seen as an opportunity to intertwine culture, heritage and emotions between participants and the community.

Correlación entre la Velocidad de Marcha y Largo del Paso en Personas Mayores de la Cuarta Edad que Viven en la Comunidad / Correlation between Walking Speed and Step Length in Seniors Living in the Community

Introducción. La población de personas mayores de la cuarta edad (≥80 años) crece a gran velocidad. Esta se diferencia de la tercera edad en cuanto a su funcionalidad. Es sabido que mientras menor sea la velocidad de la marcha en esta población, mayor es el riesgo de deterioro cognitivo, sarcopenia, discapacidad e institucionalización. La velocidad de marcha disminuida es un predictor importante de deterioro en el rendimiento físico. Objetivo. Determinar la correlación entre la velocidad de marcha, fuerza de miembros inferiores y largo del paso en personas mayores de cuarta edad que viven en la comunidad. Métodos. Estudio transversal en personas mayores saludables de la cuarta edad (n=14; 8 mujeres; 88 ± 3 años; 26,3 ± 3,4 kg·m-2) que fueron sometidas a evaluaciones de rendimiento físico, tales como largo del paso; fuerza de miembros inferiores a través de 1 Repetición Máxima (1RM) de extensión de rodilla en ambos miembros inferiores y velocidad de marcha en 4 metros. Los datos se presentan como media±desviación estándar. Se consideró un valor de P significativo < 0.05. Resultados. Se observó una correlación positiva moderada entre el largo del paso y la velocidad de marcha (R=0,794; P=0,001). No existieron correlaciones entre la fuerza de miembros inferiores y largo del paso (R=0,478; P=0,084), tampoco entre las variables de fuerza y velocidad de marcha (R=0,441; P=0.115). Conclusión. Las personas mayores de cuarta edad presentan una correlación positiva entre su velocidad de marcha y largo del paso.

Background. The population of people older than the fourth age (≥80 years) is growing rapidly. This differs from the third age in terms of its functionality. It is known that the lower the gait speed in this population, the greater the risk of cognitive impairment, sarcopenia, disability and institutionalization. Decreased gait speed is an important predictor of deterioration in physical performance. Objetive. To determine the correlation between gait speed, lower limb strength and stride length in fourth age people (≥80 years) who live in the community. Methods. Cross-sectional study in healthy older people of the fourth age (n=14; 8 women; 88 ± 3 years; 26.3 ± 3.4 kg·m-2) who underwent physical performance evaluations, such as long of the step; strength of lower limbs through 1 Maximum Repetition (1RM) of knee extension in both lower limbs and walking speed in 4 meters. Data are presented as mean ± standard deviation. A significant P value < 0.05 was considered. Results. A moderate positive correlation was observed between stride length and gait speed (R=0.794; P=0.001). There were no correlations between the strength of the lower limbs and stride length (R=0.478; P=0.084), nor between the variables of strength and gait speed (R=0.441; P=0.115). Conclusion. Fourth age older people older present a positive correlation between their walking speed and stride length.

El envejecimiento poblacional: una mirada desde la práctica de enfermería basada en el modelo de Nola J. Pender

El envejecimiento poblacional no es un fenómeno exclusivo de la sociedad moderna; ha estado presente en todas las etapas del desarrollo social y ha sido siempre de interés para la filosofía, el arte y la medicina. Se presenta una revisión bibliográfica, con el objetivo de valorar la aplicación del modelo de Nola J. Pender en la promoción de salud y su aplicabilidad desde su visión teórica en la práctica de enfermería comunitaria en el envejecimiento poblacional. Se analizan los aspectos teóricos expresados por ella, sus principales supuestos y su relación con el envejecimiento poblacional, además de exponer sus aportes teóricos, la importancia de su aplicación para la familia, la comunidad y su contribución al desarrollo de la enfermería no solo de Cuba sino en el mundo; si partimos de que Cuba está entre los países más envejecidos de Latinoamérica. La promoción de la salud motivada por el deseo de aumentar el bienestar y actualizar el potencial humano, es considerada en la actualidad una poderosa herramienta que permite promover actitudes, motivaciones y acciones a partir del concepto de autoeficacia, del compromiso de los individuos con el cambio de conductas para fomentar salud, no solo sobre el envejecimiento en sí, sino desde el envejecimiento. Los principales supuestos de Nola J. Pender en el modelo de promoción de salud la sitúan como marco de referencia en la investigación, al fortalecer la profesión y fundamentar su quehacer de manera objetiva hacia los intereses de los profesionales y las necesidades de las personas.

Population aging is not an exclusive phenomenon of modern society; it has been present in all social development stages and has always been of interest to philosophy, art and medicine. A bibliographical review is presented for evaluating the Nola J. Pender model application in health promotion, and its applicability from its theoretical vision in the community nursing practice in aging population. The theoretical aspects expressed by her, her main assumptions and her relationship with population aging are analyzed, in addition to exposing her theoretical contributions, the importance of her application for the family, the community and her contribution to the development of nursing not only in Cuba but in the world; if we start from the fact that Cuba is among the oldest countries in Latin America. Health promotion motivated by the desire to increase well-being and update human potential is currently considered a powerful tool that allows promoting attitudes, motivations and actions based on the concept of self-efficacy, the commitment of individuals to change of behaviors to promote health, not only about aging itself, but from aging. The main assumptions of Nola J. Pender in the health promotion model place it as a reference framework in research, by strengthening the profession and basing its work objectively on the interests of professionals and the people needs.

Efecto de la implementación de programas de gerontología comunitaria sobre el envejecimiento saludable o activo en adultos mayores en México: Revisión sistemática y meta-análisis / Effect of the implementation of community gerontology programs on healthy or active aging in older adults in Mexico: Systematic Review and meta-analysis

Introducción: El incremento de la población de adultos mayores y el aumento de la esperanza de vida han sido determinantes para la incidencia de las enfermedades crónico no trasmisibles en la vejez, lo que conlleva al riesgo de tener una limitación funcional física, psicológica y social. Por tal motivo, la intervención comunitaria para el Envejecimiento Saludable (ES) y Envejecimiento Activo (EA), es una oportunidad para que el adulto mayor mantenga, prolongue o recupere la capacidad funcional (CF), elemento clave del ES Método: se realizó una búsqueda de artículos científicos en las bases de datos PubMed, Scopus, SciELO, LILACS, TESIUNAM. Resultados: Se encontraron 378 artículos (PubMed n=173, Scopus n=95, SciELO n=56, LILACS n=54, TESIUNAM n=17), de los cuales ocho cumplieron los criterios para el análisis cualitativo (revisión sistemática), solo 2 estudios fueron incluidos en el análisis cuantitativo (Meta-análisis). Respecto al MA los parámetros incluidos; concentración sanguínea de glucosa y colesterol (CL)así como en las cifras de presión arterial diastólica (PAD), índice de masa corporal (IMC) y peso. Es así como se encontró una disminución estadísticamente significativa después de la intervención en la concentración sanguínea, TG (-40.91, IC95% -53.90, -27.93 p<0.0001); CL (-19.39, IC95% -30.14, -8.63 p<0.0004) y PAS (-11.21 IC95% -20.29, -2.13 y p<0.02). Conclusiones: Nuestros hallazgos muestran un efecto positivo de los programas de intervención comunitaria de ES y EA, sobre las CF físicas, psicológicas y sociales, aunque existe una alta heterogeneidad en los métodos, tiempo de intervención y parámetros de medición, es a cabo estudios con una metodología similar.

Introduction: The increase in the population of older adults and the increase in life expectancy have been decisive for the incidence of chronic non-communicable diseases in old age, which entails the risk of having a physical, psychological and social functional limitation. For this reason, the community intervention for Healthy Aging (ES) and Active Aging (EA) is an opportunity for the elderly to maintain, prolong or recover functional capacity (FC), a key element of ES Method: a search of scientific articles was carried out in the PubMed, Scopus, SciELO, LILACS, TESIUNAM databases. Results: 378 articles were found (PubMed n=173, Scopus n=95, SciELO n=56, LILACS n=54, TESIUNAM n=17), of which eight met the criteria for qualitative analysis (systematic review), only 2 studies were included in the quantitative analysis (Meta-analysis). Regarding the MA, the parameters included; blood glucose and cholesterol (CL) concentration, as well as diastolic blood pressure (DBP), body mass index (BMI) and weight. This is how a statistically significant decrease was found after the intervention in blood concentration, TG (-40.91, 95% CI -53.90, -27.93 p<0.0001); CL (-19.39, 95%CI -30.14, -8.63 p<0.0004) and PAS (-11.21 95%CI -20.29, -2.13 and p<0.02). Conclusions: Our findings show a positive effect of SE and EA community intervention programs on physical, psychological and social CF, although there is a high heterogeneity in the methods, intervention time and measurement parameters, it is carried out studies with a similar methodology.

Introdução: O aumento da população de idosos e o aumento da esperança de vida têm sido decisivos para a incidência de doenças crónicas não transmissíveis na velhice, o que acarreta o risco de ter uma limitação funcional física, psicológica e social. Por esta razão, a intervenção comunitária para o Envelhecimento Saudável (ES) e o Envelhecimento Ativo (EA) constitui uma oportunidade para os idosos manterem, prolongarem ou recuperarem a capacidade funcional (CF), elemento fundamental do ES. Método: foi realizada busca de artigos científicos nas bases de dados PubMed, Scopus, SciELO, LILACS, TESIUNAM. Resultados: foram encontrados 378 artigos (PubMed n=173, Scopus n=95, SciELO n=56, LILACS n=54, TESIUNAM n=17), dos quais oito atenderam aos critérios de análise qualitativa (revisão sistemática), apenas 2 estudos foram incluídos na análise quantitativa (Meta-análise). Em relação ao MA, os parâmetros incluídos; concentração de glicemia e colesterol (CL), bem como pressão arterial diastólica (PAD), índice de massa corporal (IMC) e peso. Foi assim que foi encontrada uma diminuição estatisticamente significativa após a intervenção na concentração sanguínea, TG (-40,91, IC 95% -53,90, -27,93 p<0,0001); CL (-19,39, IC95% -30,14, -8,63 p<0,0004) e PAS (-11,21 IC95% -20,29, -2,13 e p<0,02). Conclusões: Nossos resultados mostram um efeito positivo dos programas de intervenção comunitária de SE e EA na FC física, psicológica e social, embora haja uma alta heterogeneidade nos métodos, tempo de intervenção e parâmetros de medição, são realizados estudos com metodologia semelhante.

Envejecimiento saludable: un primer acercamiento a la revisión de indicadores subjetivos de salud en zonas urbanas y rurales en Costa Rica / Healthy aging: An initial review of subjective health indicators in urban and rural areas in Costa Rica

Resumen En este artículo se presentan los resultados de una primera aproximación al análisis del efecto moderador del contexto social, cultural y geográfico en indicadores subjetivos del envejecimiento saludable en personas mayores de 46 años residentes en territorios con características diferenciadas en Costa Rica. Se trabajó con una muestra de 305 personas residentes en tres áreas geográficas: una urbana, una semiurbana y una tercera principalmente rural. La diferenciación de las tres zonas se basó en criterios de densidad poblacional, infraestructura y acceso a bienes y servicios. Los indicadores subjetivos del envejecimiento saludable analizados fueron: participación social, apoyo social, salud percibida, espiritualidad, autoeficacia, comportamientos de autocuidado, bienestar subjetivo (satisfacción con la vida y bienestar psicológico) y estado de ánimo; todas las variables fueron condicionadas por zona de residencia, edad y sexo. Para analizar los indicadores subjetivos se estimó un análisis de covarianza (ANCOVA) o un análisis multivariado de covarianza (MANCOVA), dependiendo del número de variables dependientes analizadas. En general, se identificaron indicadores subjetivos de envejecimiento saludable altos en las personas participantes del estudio, quienes reportaron altos niveles de participación social, satisfacción con la vida y estados de salud y ánimo positivos. Se encontraron diferencias por edad entre los grupos. Sin embargo, no se evidenciaron diferencias estadísticamente significativas en los indicadores subjetivos analizados según la zona de residencia o el sexo. En síntesis, este estudio encontró que los indicadores subjetivos de envejecimiento saludable analizados eran muy similares en residentes de tres zonas geográficas con características distintas. Estos hallazgos iniciales se discuten desde una perspectiva cultural y geográfica y en relación con los modelos de envejecimiento saludable.

Abstract This review exposes the results of a first approximation to the analysis of the moderator effect of the geographical, social, and cultural context on subjective indicators of healthy aging in the Costa Rican context. Costa Rica is a middle-income democratic country that is in an advanced demographic changing process; this phenomenon makes it one of the aged countries in the Latin American region. Therefore, studying healthy aging becomes relevant in the context of population demographic change in the present and future aging societies. The study compared several subjective indicators of healthy aging among people older than 46 who resided in three different geographical areas in the country. Participants were 305 healthy people from three locations: one urban (Heredia Central City), one semi-urban (Santa Ana Central City), and one mainly rural (Nicoya). Participants completed standardized assessment scales to evaluate social participation, social support, perceived health, spirituality, self-efficacy, self-care behaviors, and subjective well-being (life satisfaction and psychological well-being). All variables were conditioned by geographical zone (urban, semi-urban, and mainly rural), age, and gender. Either Analysis of Covariance (ANCOVA) or Multivariate Analysis of Covariance (MANCOVA) were estimated depending on the number of dependent variables analyzed to test the effect of the zone of residence, gender, and age, over the subjective indicator of healthy aging studied. In general, participants evidenced high scores on subjective indicators such as self-care, social support, spirituality, life satisfaction, and psychological well-being, which have been associated with health and well-being during the aging process. Participants reported high levels of social participation and perceived that they received adequate support for their daily life needs. Likewise, participants evidenced a general state of well-being, a positive state of health, high levels of self-efficacy, and positive moods. Differences were found among the groups by comparing age. However, no significant differences were found in the variables studied related to geographical areas of residence and sex, suggesting invariant comparison evidence by zone of residence and sex. Nevertheless, the results indicate that the subjective indicators of healthy aging studied are key to promoting healthy aging at the national level. It is considered necessary to improve opportunities for social participation aimed at older adults, to strengthen community and family social networks, to promote socio-economic support such as financial and instrumental support for activities of daily living, and finally emotional support such as listening, empathy and advice. Although the differences among geographical areas of residence of the people studied were not statistically significant in this study, the evidence suggested a trend of high well-being indicators mainly in the rural areas studied, and particularly more in males than in females. As this study only reached preliminary data, further research must obtain conclusive evidence, as previous research had suggested older people living in rural areas with high longevity indicators in Costa Rica might enjoy unusual environmental characteristics and personal protective factors that could be absent in most of the urban areas in the country. On the other hand, it will be necessary to include the historical and socio-cultural determinants focusing on context-specific review analyses in the mainstream research on healthy aging, even more in aged countries like Costa Rica. The findings are discussed within the inter-cultural emphasis and healthy aging models in order to contribute to a better understanding of how the context (physical-constructed and social/cultural) influences the differences, although subtle, in the study´s variables and participants, and how the process of aging might be different according to the multiple contextual conditions in which people live and adapt their capacities and abilities for coping with daily life demands.

Implementación de una jornada virtual de telesalud y capacitación masiva para personas mayores chilenas y estudiantes de la salud. Impacto en la cobertura / Implementation of a virtual telehealth course for Chilean older adults and health students

Background: Aging increases the vulnerability to diseases and environmental changes such as the COVID-19 pandemic. Telehealth and tele-education are vital to prevent the deleterious effects of prolonged confinement, and to train the community, and constantly rotating medical students and health professionals. Aim: To assess the perception and impact of an online course about healthy aging aimed at the community and health care professionals. Material and Methods: An open online one-day course to promote healthy aging was carried out. A cross-sectional online survey about the course was answered by 386 attendants and a knowledge test was applied to 114 people. Results: Seventy-five percent of respondents attended the course synchronously. Of these, 79% were women, 20% were older people and 53% were caregivers of an older person. All respondents acquired new knowledge and were willing to participate again. The frequency of interest about self-care is three times greater than about caring for another person, In an older person, the interest is 101 more times about self-care than caring for another person. Ninety five percent of respondents felt more active and 84% felt more accompanied. Conclusions: The course facilitated access to information on the promotion of active and healthy aging in the community with a favorable perception and a positive impact. The coverage for older people with a digital gap should be improved.

Strengths, weaknesses, opportunities, and threats analysis of the national program for health care of the elderly

Background: The National Program for the HealthCare of the Elderly (NPHCE) was adopted by the Ministry of Health and Family Welfare in 2010 to provide promotional, preventive, curative, and rehabilitative health-care services for the fast-growing older population in India. As literature about the assessment of NPHCE is lacking, the present study was conducted to perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis of the program. Methods: The SWOT of the NPHCE program is analyzed using available literature and relevant documents. Results: Although this program embraces strategies to provide specialized training and services at primary health center, community health center, and district levels, including dedicated bedded wards, equipment, consumables, and pharmaceuticals but home-based care for the elderly, and the role of caregivers is overlooked in this program. NPHCE program can utilize the framework and take support of various ongoing healthy aging initiatives of international agencies to augment the health-care strategies for the elderly in India. Integrating schemes developed by the government for the upliftment of the elderly and the inclusion of traditional medicine systems in the program can serve as an opportunity for meeting unmet needs and improving the quality of life and well-being of the elderly. However, the growing elderly population, rise in nuclear families, and dual disease burden are significant threats to the program’s implementation. Conclusion: This program can be more effective in providing comprehensive health care to the elderly if more emphasis is given to community participation, home‑based care, and integrating digital health technologies and other existing welfare schemes.

High performance older adults in a population-based sample with low education: Pietà study / Idosos de alta performance cognitiva em uma amostra de base populacional com baixa escolaridade: estudo Pietà

Abstract Background Healthy brain aging can be defined as aging without neurological or psychiatric disorders, sustaining functional independence. In addition to the absence of disease and preserved functionality, there are individuals who stand out for their superior performance to that considered normal for their age in cognitive tests. These individuals are called "high-performance older adults" (HPOA). Objectives To investigate the presence of HPOA in an oldest-old population with low education, and if present, to investigate associations with sociodemographic, clinical, and lifestyle variables. Methods We evaluated 132 cognitively healthy individuals from the Pietà Study, a population-based investigation with 639 participants. We used the delayed recall from the Rey Auditory-Verbal Learning Test to verify the existence of HPOA and to classify participants based on their performance. Sociodemographic, clinical, and lifestyle variables associated with HPOA were investigated. Results We identified 18 individuals fulfilling HPOA criteria (age: 77.4 ± 2.6 years old; 14 women; education: 4.6 ± 3.4 years). The other participants, 114 total (age: 79.8 ± 4.5 years old; 69 women; education: 3.0 ± 2.7 years) were classified as "standard performance older adults" (SPOA). In multivariate analysis, younger age (odds ratio [OR] =0.672; 95% confidence interval [CI]: 0.462-0.979; p = 0.037) and lower scores on the Geriatric Depression Scale (OR = 0.831; 95%CI: 0.688-0.989; p = 0.038) were associated with HPOA. Conclusions The present study identifies for the first time HPOA with low educational level, thereby reinforcing the existence of biological substrates related to this condition. Furthermore, the data suggest an association between younger age and less depressive symptoms with HPOA.

Resumo Antecedentes Envelhecimento cerebral saudável pode ser definido como envelhecimento sem transtornos neurológicos ou psiquiátricos e com independência funcional. Além da ausência de doença e funcionalidade preservada, existem indivíduos que se destacam pelo desempenho superior ao normal em testes cognitivos. Estes indivíduos são chamados de "high performance older adults" (HPOA, na sigla em inglês). Objetivos Investigar a presença de HPOA em uma população de idosos com baixa escolaridade e, se presente, investigar associações com variáveis sociodemográficas, clínicas e de estilo de vida. Métodos Avaliamos 132 indivíduos cognitivamente saudáveis do Estudo Pietà (n = 639). Foi utilizado o Teste de Aprendizagem Auditivo-Verbal de Rey para verificar a existência de HPOA e classificar os participantes em dois grupos com base em seu desempenho. Variáveis sociodemográficas, clínicas e de estilo de vida associadas a HPOA foram investigadas. Resultados Identificamos 18 indivíduos que preencheram critérios para HPOA (idade: 77,4 ± 2,6 anos; 14 mulheres; escolaridade: 4,6 ± 3,4 anos). Os demais, 114 no total (idade: 79,8 ± 4,5 anos; 69 mulheres; escolaridade: 3,0 ± 2,7 anos), foram classificados como "standard performance older adults" (SPOA, na sigla em inglês). Na análise multivariada, menor idade (odds ratio [OR] =0,672; intervalo de confiança [IC] 95%: 0,462-0,979; p = 0,037) e menor pontuação na Escala de Depressão Geriátrica (OR = 0,831; IC95%: 0,688-0,989; p = 0,038) foram associados ao grupo HPOA. Conclusões O presente estudo identifica pela primeira vez HPOA entre indivíduos de baixa escolaridade, reforçando a existência de substratos biológicos relacionados a esta condição. Além disso, os dados sugerem uma associação entre idade mais jovem e menos sintomas depressivos com HPOA.

Differences in determinants of active aging between older Brazilian and English adults: ELSI-Brazil and ELSA / Diferenças nos determinantes do envelhecimento ativo entre idosos brasileiros e ingleses: ELSI-Brasil e ELSA / Diferencias en los determinantes del envejecimiento activo entre personas mayores brasileñas e inglesas: ELSI-Brasil y ELSA

Abstract: This study aimed to investigate differences in determinants of active aging between older Brazilian and English adults and to verify the association of behavioral, personal, and social determinants with physical health. This cross-sectional study was based on the ELSI-Brazil (2015-2016) and ELSA (2016-2017) cohorts. Active aging determinants included behavior (smoking, sedentary lifestyle, and poor sleep quality), personal (cognitive function and life satisfaction), and social determinants (education, loneliness, and volunteering), according to the World Health Organization. Physical health included activities limitation and multimorbidity. We estimated age- and sex-adjusted prevalence for each indicator and mean score, and used the negative binomial regression for statistical analysis. We included 16,642 participants, 9,409 from Brazil and 7,233 from England. Overall, all active aging determinants were worse in Brazil than in England, except for life satisfaction (no difference). The most remarkable difference was found for social determinants score in Brazil (mean difference of 0.18; p < 0.05), mainly due to a significantly lower education level in Brazil (70.6%; 95% confidence interval - 95%CI: 69.7-71.5) than England (37.1%; 95%CI: 35.1-39.1). All determinants (behavioral, personal, and social) were associated with health in Brazil and in England. However, the behavioral domain was stronger associated with health in England (coefficient = 2.76; 95%CI: 2.46-3.10) than in Brazil (coefficient = 1.38; 95%CI: 1.26-1.50; p < 0.001). Older English adults beneficiate more from healthier behaviors than Brazilians, which depend more on social policies.

Resumo: Este estudo transversal objetivou investigar as diferenças nos determinantes do envelhecimento ativo entre idosos brasileiros e ingleses, e verificar a associação de determinantes comportamentais, pessoais e sociais com a saúde física. A pesquisa baseou-se nas coortes ELSI-Brasil (2015-2016) e ELSA (2016-2017). Os determinantes do envelhecimento ativo incluíram os determinantes comportamentais (tabagismo, sedentarismo e má qualidade do sono), pessoais (função cognitiva e satisfação com a vida) e sociais (educação, solidão e voluntariado), de acordo com a Organização Mundial da Saúde. A saúde física incluiu limitação de atividades e multimorbidade. Prevalências ajustadas por idade e sexo foram calculadas para cada indicador e escores médios, utilizando-se a regressão binomial negativa para a análise estatística. A pesquisa incluiu 16.642 participantes, sendo 9.409 do Brasil e 7.233 da Inglaterra. No geral, todos os determinantes do envelhecimento ativo foram piores no Brasil do que na Inglaterra, exceto a satisfação com a vida (sem diferença). A diferença mais marcante refere-se ao escore de determinantes sociais no Brasil (diferença média de 0,18; p < 0,05), principalmente devido à escolaridade significativamente menor no Brasil (70,6%; intervalo de 95% de confiança - IC95%: 69,7-71,5) do que na Inglaterra (37,1%; IC95%: 35,1-39,1). Todos os determinantes (comportamentais, pessoais e sociais) estiveram associados à saúde no Brasil e na Inglaterra. No entanto, o domínio comportamental foi mais fortemente associado à saúde na Inglaterra (coeficiente = 2,76; IC95%: 2,46-3,10) do que no Brasil (coeficiente = 1,38; IC95%: 1,26-1,50) (p < 0,001). Idosos ingleses se beneficiam mais de comportamentos mais saudáveis do que os brasileiros, que dependem mais de políticas sociais.

Resumen: Este estudio transversal tuvo como objetivo investigar las diferencias en los determinantes del envejecimiento activo entre personas mayores brasileñas e inglesas, y verificar la asociación de determinantes conductuales, personales y sociales con la salud física. La investigación se basó en las cohortes ELSI-Brasil (2015-2016) y ELSA (2016-2017). Los determinantes del envejecimiento activo incluyeron determinantes conductuales (tabaquismo, sedentarismo y mala calidad del sueño), personales (función cognitiva y satisfacción con la vida) y sociales (educación, soledad y voluntariado), según la Organización Mundial de la Salud. La salud física incluyó la limitación de actividades y la multimorbilidad. Se calcularon las prevalencias ajustadas por edad y sexo para cada indicador y los puntajes medios, usando la regresión binomial negativa para el análisis estadístico. La encuesta incluyó a 16.642 participantes, 9.409 de Brasil y 7.233 de Inglaterra. En general, todos los determinantes del envejecimiento activo fueron peores en Brasil que en Inglaterra, salvo la satisfacción con la vida (sin diferencia). La diferencia más llamativa se refiere al puntaje de los determinantes sociales en Brasil (diferencia media de 0,18; p < 0,05), sobre todo debido al nivel educativo significativamente más bajo en Brasil (70,6%; intervalo de 95% de confianza - IC95%: 69,7-71,5) que en Inglaterra (37,1%; IC95%: 35,1-39,1). Todos los determinantes (conductuales, personales y sociales) se asociaron con la salud en Brasil y en Inglaterra. Sin embargo, el dominio conductual se asoció más fuertemente con la salud en Inglaterra (coeficiente = 2,76; IC 95% 2,46-3,10) que en Brasil (coeficiente = 1,38; IC95%: 1,26-1,50) (p < 0,001). Las personas mayores inglesas se benefician más de comportamientos más saludables que los brasileños, que dependen más de las políticas sociales.

Cenário das políticas públicas para hemocromatose hereditária no Brasil / Public policy scenario for hereditary hemochromatosis in Brazil

Resumo Hemocromatose hereditária (HH) é a doença genética mais comum em descendentes de europeus e sua epidemiologia em nosso país é incerta. Considerando o cenário das políticas públicas em HH no mundo contemporâneo, este artigo propõe uma reflexão sobre o tema, com objetivo de fazer uma revisão bibliográfica narrativa sobre a abordagem adotada para essa doença em países desenvolvidos e a nível nacional. Além disso, discute sobre o custo-benefício da incorporação do índice de saturação da transferrina (ST) e ferritina sérica (FS) no nosso sistema de saúde, com a finalidade de identificar a HH antes que surjam suas complicações, bem como seu rastreio em campanhas nacionais de prevenção. O valor gasto para o screening da HH com dosagem de ST e FS pelo Sistema Único de Saúde (SUS) é muito menor do que os custos gerados quando o dano por excesso de ferro já está estabelecido. Nos casos suspeitos de HH, deveria ser viabilizada pelo SUS a pesquisa da mutação genética para o gene HFE, que atualmente só está disponível de forma privada. Com essas medidas, modifica-se a história natural da doença, reduzindo a morbimortalidade dos portadores e custos ao sistema público de saúde.

Abstract Hereditary hemochromatosis (HH) is the most common genetic disease among European descendants and its epidemiology in Brazil is unclear. Considering the contemporary public policy scenario aimed at HH, this narrative bibliographic review reflects on the approach adopted for this disease at the national level in developed countries. It also discusses the cost-effectiveness of incorporating transferrin saturation (TS) and serum ferritin (SF) indexes in the Brazilian healthcare system for early HH identification, as well as its screening in national prevention campaigns. The amount spent on ST- and FS-based HH screening by the Brazilian National Health System (SUS) is much lower than the costs generated by the already established iron overload. In suspected cases, genetic mutation research of the HFE gene, which is currently only performed privately, should be made available by the SUS. These measures can modify the natural history, reducing HH morbidity and mortality and its costs to the public health system.

Relationship between anticholinergic load and self-perceived health in a population aged 44 years or older / Relação entre carga anticolinérgica e autopercepção de saúde em população com mais de 44 anos

OBJECTIVE: To investigate the relationship between anticholinergic load (ACL) and self-perceived general health in adults in a medium-sized municipality in southern Brazil. METHODS: This cross-sectional study was based on 2015 data from a medium-sized municipality in southern Brazil. All respondents aged 44 years or older who reported using drugs in the 2 weeks before the interview were included (n = 662). The Anticholinergic Drug Scale was used to measure the ACL. Self-perceived health was categorized as positive self-perception (PSP) or negative self-perception (NSP). Crude and adjusted Poisson regression analyses were conducted to investigate the association between ACL and self-perceived health. RESULTS: NSP was found in 50.91% of 662 respondents. Significant ACL, older age, lower economic status, lower education, polypharmacy, and depression correlated with a higher frequency of NSP. Individuals with significant ACL had a prevalence of NSP of 1.27 (95% confidence interval: 1.02 ­ 1.58), and each additional ACL level represented a 6.10% higher chance of worse self-perceived health, regardless of confounding factors. CONCLUSIONS: An association was found between significant ACL and NSP, with an effect dependent on ACL level

OBJETIVO: Investigar a relação entre carga anticolinérgica (CAC) e autopercepção de saúde em adultos de um município de médio porte do sul do Brasil. METODOLOGIA: Trata-se de um estudo transversal com dados de 2015, realizado em um município de médio porte do sul do Brasil. Todos os entrevistados com 44 anos ou mais que relataram uso de drogas nas duas semanas anteriores à entrevista foram incluídos (n = 662). A Anticholinergic Drug Scale (ADS) foi utilizada para medir a CAC. A autopercepção da saúde foi categorizada em autopercepção positiva (APP) ou autopercepção negativa (APN). Análises de regressão de Poisson bruta e ajustada foram realizadas para investigar a associação entre CAC e autopercepção de saúde. RESULTADOS: Entre os 662 participantes, a CAC foi encontrada em 50,91% dos respondentes. CAC significativa, idade avançada, situação econômica mais baixa, menor escolaridade, polifarmácia e depressão foram correlacionados com maior frequência de APN. Indivíduos com CAC significativo apresentaram prevalência de APN de 1,27 (intervalo de confiança de 95%: 1,02 ­ 1,58), e cada nível adicional de CAC representou uma chance 6,10% maior de pior autopercepção de saúde, independentemente de fatores de confusão. CONCLUSÕES: Encontrou-se associação entre ACL significativo e APN, com efeito dependente do valor do CAC

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

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

Equity throughout the life course and the evolving role of the Pan American Health Organization / Equidad a lo largo del curso de vida y la evolución del papel de la Organización Panamericana de la Salud / Equidade ao longo da vida e a evolução do papel da Organização Pan-Americana da Saúde

ABSTRACT The objective of this article is to summarize the evolution of the regional commitments of the Pan American Health Organization (PAHO) on health promotion and strategies to improve the health and well-being of women, children, adolescents, and older persons. PAHO regional strategies approved by Member States in the last 20 years are used as the main source of information. The article presents the challenges of making health promotion a public health strategy widely applied in the Region of the Americas and the efforts to renew Member States' collective actions. The article also describes current PAHO efforts to include the positive aspects of health (i.e., well-being, optimal development, and functional ability) and the life course approach as opportunities to advance equity. The article reflects on immunization as a public good and the urgency to address the current challenges as a core element of the regional efforts to transform health systems after more than two years of the COVID-19 pandemic.

RESUMEN El objetivo de este artículo es resumir la evolución de los compromisos regionales de la Organización Panamericana de la Salud (OPS) en materia de promoción de la salud y estrategias para mejorar la salud y el bienestar de mujeres, niños y niñas, adolescentes y personas mayores. Se han empleado como principal fuente de información las estrategias regionales de la OPS aprobadas por los Estados Miembros en los últimos 20 años. En el artículo se presentan los desafíos de convertir la promoción de la salud en una estrategia de salud pública de amplia ejecución en la Región de las Américas y los esfuerzos para renovar las medidas colectivas de los Estados Miembros. Asimismo, se describe la labor actual de la OPS para incluir los aspectos positivos de la salud (como el bienestar, el desarrollo óptimo y la capacidad funcional) y el enfoque del curso de vida como oportunidades para fomentar la equidad. Finalmente, se reflexiona sobre la inmunización como bien público y la urgencia de abordar los desafíos actuales como elemento central de los esfuerzos regionales para transformar los sistemas de salud tras más de dos años de pandemia de COVID-19.

RESUMO O objetivo deste artigo é resumir a evolução dos compromissos regionais da Organização Pan-Americana da Saúde (OPAS) relativos à promoção da saúde e estratégias para melhorar a saúde e o bem-estar de mulheres, crianças, adolescentes e pessoas idosas. As estratégias regionais da OPAS aprovadas pelos Estados Membros nos últimos 20 anos são a principal fonte de informação. O artigo apresenta os desafios enfrentados para fazer da promoção da saúde uma estratégia de saúde pública amplamente aplicada na Região das Américas e os esforços para renovar as ações coletivas dos Estados Membros. O artigo também descreve os atuais esforços da OPAS para incluir os aspectos positivos da saúde (isto é, bem-estar, desenvolvimento ideal e habilidade funcional) e a abordagem de curso da vida como oportunidades para promover a equidade. O artigo faz reflexões sobre a imunização como um bem público e a urgência de abordar os desafios atuais como um elemento central dos esforços regionais para transformar os sistemas de saúde após mais de dois anos da pandemia de COVID-19.

The relationship between diabetes burden and successful ageing in diabetic elderly patients

SUMMARY OBJECTIVE: The aim of this study was to determine the diabetes burden in elderly individuals along with successful ageing, which defines how well individual ages contribute to coping with the disease and diabetes management. This study also aimed to evaluate the relationship between diabetes burden and successful ageing in elderly individuals with type 2 diabetes. METHODS: The data for this descriptive study were collected from 526 individuals who were 65 years old patients diagnosed with type 2 diabetes in the diabetes polyclinic of a research and training hospital between January and June 2021. RESULTS: It was found that the Successful Ageing Scale score was higher in women, those who had regular diabetes control, and those who had easy access to health services. Elderly Diabetes Burden Scale scores were found to be higher in men, those whose diabetes treatment was insulin, and those with poor perceived health status. No statistically significant relationship was determined between the Elderly Diabetes Burden Scale total score and the Successful Ageing Scale total score (p>0.05). CONCLUSION: Accordingly, by enabling the elderly to have easy access to healthcare services, preventing complications, and providing elderly healthcare services, it will be possible to reduce the diabetes burden in the elderly and enable them to age successfully.

Reflections on the Pain Points of Elderly Care during the Epidemic Prevention and Control Stage from Two Cases of Disease Narration / 中国医学伦理学

The COVID-19 has had a profound impact on human society, the elderly, as a vulnerable group, are the most affected. Based on two cases of disease narrative collected by the department of neurology of a hospital in Guiyang, this paper analyzed the shortcomings of elderly care in the context of epidemic prevention and control. The overall health information literacy of the elderly was low, which made it difficult to obtain correct epidemic related information. The lifestyle of the elderly has changed during the epidemic prevention and control stag. The long time isolation at home has reduced their constitution and made them prone to illness, thus affecting the quality of healthy elderly care. In this stage, the psychological burden of the middle-aged and elderly people has been increasing, which reduced the life satisfaction and subjective well-being of the elderly, and increased the risk of depression. In view of these outstanding problems, this paper proposed corresponding measures, aiming to improve the quality of life and physical and mental health of the elderly during the epidemic prevention and control stage, and provide reference for realizing healthy aging in China.

Research progress of physical resilience in the elderly / 中华全科医师杂志

With the increase of the elderly population, health problems of the elderly are more prominent and the health needs of the elderly are more complex and diverse, therefore, how to maintain their physical functional status has become the focus of research. Physical resilience and successful aging are closely related. This article reviews the concept of physical resilience, the relationship between physical resilience and frailty and intrinsic capacity, and its impact on the health status of the elderly. The aim of the article is to provide a reference for the assessment of physiological resilience and the related interventions to promote healthy aging.

Chemistry-led investigations into the mode of action of NAMPT activators, resulting in the discovery of non-pyridyl class NAMPT activators

The cofactor nicotinamide adenine dinucleotide (NAD+) plays a key role in a wide range of physiological processes and maintaining or enhancing NAD+ levels is an established approach to enhancing healthy aging. Recently, several classes of nicotinamide phosphoribosyl transferase (NAMPT) activators have been shown to increase NAD+ levels in vitro and in vivo and to demonstrate beneficial effects in animal models. The best validated of these compounds are structurally related to known urea-type NAMPT inhibitors, however the basis for the switch from inhibitory activity to activation is not well understood. Here we report an evaluation of the structure activity relationships of NAMPT activators by designing, synthesising and testing compounds from other NAMPT ligand chemotypes and mimetics of putative phosphoribosylated adducts of known activators. The results of these studies led us to hypothesise that these activators act via a through-water interaction in the NAMPT active site, resulting in the design of the first known urea-class NAMPT activator that does not utilise a pyridine-like warhead, which shows similar or greater activity as a NAMPT activator in biochemical and cellular assays relative to known analogues.

Mechanisms Underlying Brain Aging Under Normal and Pathological Conditions / 神经科学通报·英文版

Aging is a major risk factor for many human diseases, including cognitive impairment, which affects a large population of the elderly. In the past few decades, our understanding of the molecular and cellular mechanisms underlying the changes associated with aging and age-related diseases has expanded greatly, shedding light on the potential role of these changes in cognitive impairment. In this article, we review recent advances in understanding of the mechanisms underlying brain aging under normal and pathological conditions, compare their similarities and differences, discuss the causative and adaptive mechanisms of brain aging, and finally attempt to find some rules to guide us on how to promote healthy aging and prevent age-related diseases.