A propósito del debate actual sobre el envejecimiento en Cuba

El envejecimiento poblacional constituye uno de los logros y uno de los retos más importantes del desarrollo de las sociedades. La principal causa del envejecimiento es el descenso de la fecundidad de las mujeres, y en menor proporción la emigración externa, sobre todo de jóvenes. En Cuba, ya mueren más que los que nacen, debido fundamentalmente a los bajos niveles de reemplazo en la fecundidad, situación agravada en los años de la pandemia de COVID-19. Entre las consecuencias negativas del envejecimiento poblacional, se identifican cuatro principales: sanitarias, económicas, socioculturales y legales; entre las positivas, hay algunos reportes de cohortes de personas que llegan a edades avanzadas en mejor estado físico y mental. Los cambios ocurridos en la institución familiar en muchas sociedades y la discriminación por edad de los mayores, tienen consecuencias graves para la salud, el bienestar y los derechos humanos de los ancianos. Se considera que existe mucha información sobre el "diagnóstico" y el "pronóstico" del envejecimiento poblacional, pero hay menos acerca de acciones eficaces para su "tratamiento", aspecto complejo y difícil de enfrentar. Se exponen algunas propuestas de mitigación de estos inevitables cambios demográficos. El propósito de esta comunicación es comentar determinados aspectos del envejecimiento de la población cubana.

Population aging constitutes one of the achievements and one of the most important challenges in the development of societies. The main cause of aging is the decrease in the fertility of women and to a lesser extent external emigration, especially of young people. In Cuba, more people die than are born, mainly due to low replacement levels in fertility, a situation aggravated in the years of the COVID-19 pandemic. Among the negative consequences of population aging, four main ones are identified: health, economic, sociocultural and legal; among the positive ones, there are some reports of cohorts of people who reach advanced ages in better physical and mental condition. The changes that have occurred in the family institution in many societies and the age discrimination of the elderly have serious consequences for the health, well-being and human rights of the elderly. It is considered that there is a lot of information about the "diagnosis" and "prognosis" of population aging, but there is less about effective actions for its "treatment", a complex and difficult aspect to face. Some proposals are presented to mitigate these inevitable demographic changes. The purpose of this communication is to comment on certain aspects of the aging of the Cuban population.

La salud y los cuidados: un análisis interseccional de género y vejeces a partir del trabajo realizado en CEPRAM (2022) / Health and care: an intersectional analysis of gender and old age from the work done at CEPRAM (2022)

INTRODUCCION: Nuestra región, y Argentina, se encuentra atravesando un momento de rápido envejecimiento demográfico. Se trata de un proceso contextualizado social e históricamente de representaciones, estereotipos y significados particulares. El presente trabajo tiene por objetivo describir y analizar las posibles articulaciones entre la perspectiva de salud integral, redes en salud y los cuidados a y entre personas adultas mayores a partir de la experiencia de trabajo en el CEPRAM (Centro de Promoción del Adulto Mayor) en el que las mujeres ocupan un rol central. MÉTODOS: Investigación cualitativa interaccionista con entrevistas sobre experiencias y significados. RESULTADOS: Refieren mejoras en su autoestima, flexibilidad, apertura y escucha como reconocimiento del otro/a. La cantidad y la calidad de cobertura en servicios de cuidados recae mayoritariamente sobre las familias y especialmente, sobre las mujeres y disidencias, perpetuando la desigualdad de género en la distribución de tareas, las condiciones en que se llega y transita la vejez. Ellas vieron este espacio como uno de cuidados, dando sustento a formas más integrales de entenderlos como eje de la salud. CONCLUSIONES: CEPRAM logró captar y solucionar necesidades ­socioafectivas­ de mujeres mayores, insatisfechas y no atendidas por el Estado. Promueve la autonomía relacional donde la participación y la construcción de redes basadas en los vínculos, fundamentales para su salud integral. Los entornos extrahospitalarios como oportunidad de acercamiento al sistema de salud, deben resolver necesidades de cuidado con perspectiva de envejecimiento saludable, fomentando la habilidad funcional, así como los atributos relacionados con el proceso diferenciado por género y salud que permiten a la persona ser y hacer (AU)

INTRODUCTION: Our region, and Argentina, is going through a period of rapid demographic aging. It is a socially and historically contextualized process of representations, stereotypes and particular meanings. The aim of this paper is to describe and analyze the possible articulations between the integral health perspective, health networks and care for and among older adults based on the experience of working in the CEPRAM (Center for the Promotion of Older Adults) in which women play a central role. METHODS: Qualitative interactionist research with interviews on experiences and meanings. RESULTS: They report improvements in their self-esteem, flexibility, openness and listening as recognition of the other. The quantity and quality of coverage in care services falls mostly on families and especially on women and dissidents, perpetuating gender inequality in the distribution of tasks, the conditions in which old age arrives and passes. Women saw this space as one of care, giving support to more comprehensive ways of understanding it as the axis of health. CONCLUSIONS: CEPRAM was able to capture and solve the social and emotional needs of older women, unsatisfied and unmet by the State. It promotes relational autonomy where participation and the construction of networks based on bonds are fundamental for their integral health. The out-of-hospital environments as an opportunity to approach the health system, should solve care needs with a healthy aging perspective, promoting functional ability, as well as the attributes related to the process differentiated by gender and health that allow the person to be and to do (AU)

Avaliação das Instituições de Longa Permanência para Idosos no Brasil: um panorama das desigualdades regionais / Evaluation of Long-Term Institutions for Older People in Brazil: an overview of regional inequalities

Resumo O objetivo deste artigo é avaliar as Instituições de Longa Permanência para Idosos (ILPI) brasileiras, segundo o Modelo Teórico Multidimensional Integrado de Qualidade e Atendimento (MIQA), e comparar o desempenho alcançado entre as regiões do país. Estudo ecológico descritivo realizado com dados secundários públicos das ILPI participantes do Censo do Sistema Único da Assistência Social de 2018. Uma Matriz de Avaliação foi construída a partir das variáveis do Censo e do Modelo Teórico MIQA. Parâmetros de qualidade foram empregados para classificar o desempenho das instituições para cada indicador em "incipiente", "em desenvolvimento" ou "desejável. O índice de disparidade foi obtido para cada indicador. Foram analisadas 1.665 instituições. Observaram-se diferenças nos percentuais de ILPI com desempenho "desejável" entre as regiões brasileiras, e a necessidade de aprimoramento na maioria das ILPI em relação à proporção de cuidadores de pessoas idosas, a composição da equipe multiprofissional, a acessibilidade e a oferta de ações de promoção de saúde. Verificou-se a necessidade de apoio governamental para a supressão dos critérios de diferenciações excludentes e para a expansão dos serviços para superar as superlotações.

Abstract This article aims to evaluate the Brazilian Long-Term Institutions for Older People (LTIE), according to the Integrated Multidimensional Theoretical Model of Quality and Service (MIQA), and compare the performance achieved between the regions of the country. Descriptive ecological study carried out with public secondary data from the LTIE participating in the 2018 Census of the Unified Social Assistance System. An Evaluation Matrix was constructed from the Census variables and the MIQA Theoretical Model. Quality parameters were used to classify the institutions' performance for each indicator as "incipient", "developing" or "desirable". The disparity index was obtained for each indicator. 1,665 institutions were analyzed. Differences were observed in the percentages of LTIE with "desirable" performance between Brazilian regions, and the need for improvement in most LTIE in relation to the proportion of caregivers of older people, the composition of the multidisciplinary team, accessibility and supply of health promotion actions. There was a need for government support for the suppression of exclusionary differentiation criteria and for the expansion of services to overcome overcrowding.

Correlation of Body Mass Index and age with Mild Cognitive Impairment (MCI) in elderly of Guwahati City, Assam

Introduction: Obesity is on rise globally and may have a impact on cognition. Very limited research was done on the association of weight with neurocognition among the elderly. The study purpose was to determine the correlation between BMI and age with MCI and after stratifying for BMI and socio-demographic characteristics.Methods: This cross-sectional study was conducted among 576 elderly (≥60 years) in Guwahati city using a multi-stage sampling technique. Hindi Mini-Mental State Examination (HMMSE) tool was used for screening for dementia and MCI. Results: HMMSE scores were not significantly correlated with BMI (r =0.07). However, when strati-fied, a significantly negative correlation of BMI with HMMSE scores was seen for illiterates (r =-0.21), primary school education (r =-0.48) and unskilled workers (r =-0.49). There was a significant negative correlation between age and cognition for elderly belonging to OBC, (r =-0.21), Lower middle (III), (r =-0.39), Upper Lower (r =-0.17), Lower (V), (r =-0.26), Graduate, Post Graduate,(r = -0.23), Middle School, (r =-0.36), Illiterate, (r =-0.34), Clerical, (r =-0.60), Semi Professional, (r =-0.62), skilled worker (r=-0.68), Unemployed, (r =-0.15) and Obese, (r =-0.30). Conclusion: Various factors like age, category, socioeconomic status, and Body Mass Index (BMI) were found to be predictors of cognition among the elderly.

Representação de professoras em Mário de Andrade: Loucura e velhice / Representation of female teachers in Mário de Andrade: Madness and old age

O presente artigo busca analisar as representações de professoras presentes no conto "Atrás da Catedral de Ruão" (1947) e no romance Amar, verbo intransitivo (1944), ambos de Mário de Andrade, com ênfase nas questões insertas sobre a noção de velhice e loucura. São textos escritos sob a égide do Modernismo e que tematizaram as respectivas práticas pedagógicas, mas ressaltam também as angústias de mulheres trabalhadoras e itinerantes, que são malvistas por exercerem funções de natureza pública em espaços privados. Se por um lado era emblemático o fato de ser mulher, por outro, eram ainda mais acentuados os destaques feitos pelo escritor, pois a idade estava à mostra e a loucura era vista como condição inata de um gênero supostamente inferior. A literatura no presente estudo significou importante artefato cultural, também serviu como peculiar fonte para interpretação pelos historiadores do presente, de modo que o método aqui utilizado foi aquele sintetizado na noção de operação historiográfica preconizada por Michel de Certeau (1975/2020).

This paper analyzes the representations of female teachers in the short story "Behind Ruão's Cathedral" (1947) and in the novel "To Love, intransitive verb" (1944), both by Mário de Andrade, with emphasis on the questions about the notion of old age and madness. These texts were written under the aegis of Modernism, and they thematize the respective pedagogical practices, but also highlight the anguish of working and itinerant women, who are disliked for performing public functions in private spaces. If on the one hand it was emblematic that she was a woman, on the other, the writer's highlights were even more pronounced, for age was on display and madness was seen as an innate condition of a supposedly inferior gender. Literature in the present study meant an important cultural artifact, and also served as a peculiar source for interpretation by historians of the present, so that the method used here was that synthesized in the notion of historiographical operation advocated by Michel de Certeau (1975/2020).

Repercussões físicas, emocionais e sociais produzidas pelo HIV/AIDS na vida dos idosos / Physical, emotional and social repercussions caused by HIV/AIDS in the lives of the elderly: thematic oral history perspectives

Introdução: os dados epidemiológicos mostram um aumento da população idosa vivendo com HIV/AIDS no Brasil. Esta doença impacta de diferentes formas a vida da pessoa constituindo um desafio para os serviços de saúde. Objetivo: verificar as alterações físicas, emocionais e sociais produzidas pelo HIV/AIDS na vida de idosos. Metodologia: estudo qualitativo com método história oral temática. Realizado no Serviço de Atendimento Especializado (SAE) em HIV/AIDS de uma cidade do Oeste Catarinense com a inclusão de três idosos, duas mulheres e um homem, com média de idade de 66 anos e diagnóstico do HIV/AIDS há mais de cinco anos. Foram realizados cinco encontros, dois de observação no domicílio e três para realização da entrevista em profundidade com validação de todas as etapas. A análise dos dados foi realizada por meio da análise de conteúdo temática. A pesquisa foi aprovada no comitê de ética. Resultados e discussão: os idosos apresentaram sintomas físicos decorrentes da imunossupressão sendo o principal deles o emagrecimento, que se constituiu como um sinal de alerta para o diagnóstico do HIV/AIDS. As repercussões emocionais foram o medo e a angústia, mais presentes no momento do diagnóstico e início dos tratamentos. As repercussões sociais estiveram atreladas ao isolamento social, saída de grupos e perda do papel no trabalho. Considerações finais: o HIV/AIDS repercute na vida dos idosos e produz diferentes alterações, quer sejam físicas, emocionais e/ou sociais. Nessa direção, incluir essas demandas no planejamento de ações para esse grupo populacional tornará a assistência à saúde mais resolutiva.(AU)

Introduction: epidemiological data show an increase in the elderly population living with HIV/AIDS in Brazil. This disease affects people's lives in different ways and constitutes a challenge for health services. Objective: To verify the physical, emotional, and social repercussions caused by HIV/AIDS in the lives of the elderly. Methodology: a qualitative study which used thematic oral history as a method. The research was carried out at the Specialized Care Service (SAE) on HIV/AIDS in a city in western Santa Catarina, which included three elderly diagnosed with HIV/AIDS for more than five years. Two meet-ings were held for approximation and three moments of in-depth interviews with validation in all stages. Data analysis had performed through thematic content analysis, according to Minayo (2014). Results and discussion: The elderly presented physical symptoms resulting from immunosuppression, the main one being weight loss, which constitutes a warning sign for the diagnosis of HIV/AIDS. The emotional repercussions were the fear and anguish most present at the time of diagnosis and the beginning of treatments. The social repercussions were linked to social isolation, leaving groups, and losing the social role of work, being partially reintroduced. Final considerations: HIV/AIDS affects the lives of the elderly, producing different changes, whether physical, emotional, and social, and health services and an interprofessional team need to ensure a broader view of this whole context to qualify assistance.(AU)

Terceira idade e potência de vida: internação e (re)existência numa instituição de longa permanência / The elder's and the potency of life: hospitalization and existence in a long-term institution

Este relato resulta do estágio de Psicologia requerido aos alunos do Curso de Psicologia Clínica de uma faculdade angolana, realizado dentro de um lar da terceira idade, com vista a contribuir para a melhoria da qualidade de vida dos idosos institucionalizados. Nele discutimos, a partir do relato de um estágio, a produção de estratégias de resistência dentro de uma instituição de longa permanência angolana. Nesta, a capacidade de resistir transforma-se num mecanismo de preservação acionado pelo próprio sujeito, que ao se enxergar diante de uma situação que o ameaça, reage como pode, resistindo e reexistindo, por meio de estratégias que permitem a afirmação da potência de vida da pessoa institucionalizada, preservando-a física, psicológica e fundamentalmente.(AU)

This article is the result of a Psychology internship required for students of the Clinical Psychology of an Angolan university, held in a nursing home, to contribute to the improvement of the quality of life of institutionalized elderly. Based on the report of an internship, we discuss resistance strategies within a long-term Angolan institution, where the capacity to resist becomes a preservation mechanism, triggered by the subject, who is faced with a situation that threatens him. He reacts as he can by resisting and preexisting, through strategies that allow the affirmation of the institutionalized person's life power, preserving him physically and fundamentally psychologically.(AU)

Muertes por suicidio en Personas Mayores y género masculino en Chile: Una reflexión pendiente

Introducción: Los avances tecnológicos y científicos del último siglo, entre otras cosas, han permitido aumentar la esperanza de vida al enfrentar exitosamente la mortalidad por causas infecciosas. No obstante, hoy se enfrentan nuevos desafíos en torno a la mortalidad, como las crecientes tasas de suicidios globales que afectan con más énfasis a hombres y personas mayores. Desarrollo: La mayor incidencia de muertes por suicidio en hombres mayores, profundiza la necesidad de analizar aquellos factores que puedan estar relacionados, para luego articular respuestas oportunas en la prevención de este. La vivencia de género y de vejez asoman como factores a revisar para la comprensión del fenómeno. En este caso, el entendimiento de la vivencia de masculinidad hegemónica dominante podría aproximarnos a la relación emergente entre género masculino, vejez y suicidio. Conclusión: Los constructos sociales de vejez y masculinidad podrían aportar relevantes antecedentes para aproximarse al fenómeno global que relaciona a los hombres mayores con las muertes por suicidio, factores necesarios de revisar para comprender cómo estos imaginarios sociales pueden influir en sujetos a lo largo del curso de vida. El análisis con perspectiva de género podría facilitar la prevención y respuesta oportuna frente al fenómeno, favoreciendo la salud mental de las personas diseñando e implementando planes y programas integrales de salud pública que consideren las variables como sexo, género, factores sociales y biológicos, con una perspectiva de curso de vida, abordando sus condicionantes desde etapas tempranas y disminuyendo así el impacto durante la vejez.

Introduction: The technological and scientific advances of the last century, among other things, have increased life expectancy by successfully coping with mortality from infectious causes. However, today new challenges are being faced around mortality, such as the growing global suicide rates, which affect men and the elderly more emphatically. Development: The higher incidence of deaths by suicide in older men deepens the need to analyze those factors that may be related, in order to articulate timely responses in its prevention. The experience of gender and old age appear as factors to review for the understanding of the phenomenon. In this case, the understanding of the experience of dominant hegemonic masculinity could bring us closer to the emerging relationship between the masculine gender, old age, and suicide. Conclusion: The social constructs of old age and masculinity could provide relevant background to approach the global phenomenon that relates older men to suicide deaths, factors that need to be reviewed to understand how these social imaginaries can influence subjects throughout lifetime. Analysis with a gender perspective could facilitate prevention and timely response to the phenomenon, favoring people's mental health by designing and implementing comprehensive public health plans and programs that consider variables such as sex, gender, social and biological factors, with a life course perspective, addressing its conditions from early stages and thus reducing the impact during old age.

Better alone? The impact of living arrangements on mortality of Costa Rican older adults / Melhor sozinho? O impacto de arranjos domiciliares na mortalidade de idosos costarriquenhos / ¿Mejor solo? El impacto de los arreglos de vivienda en la mortalidad de las personas adultas mayores costarricenses

Abstract Previous research has shown differentiated effects of living arrangement types on mortality. However, little is known about this phenomenon in Latin America and its multigenerational households. This study measures the relationship between older adults' living arrangement types and subsequent mortality. Gompertz event history models were performed to estimate mortality differences across living arrangements. We used the Costa Rica Longevity and Aging Study (CRELES) pre-1945 cohort in the 2005, 2007, and 2009 waves. The results show that older adults who live with a partner have the highest survival rates among the categories tested. When controlling for sex and age in the model, the effect of living alone is not different from partnered living. When controlling for socioeconomic and health factors as well, older adults living with their children or others show an increased risk of death by at least 40% (p-value<0.05). The study demonstrates an association between living arrangements and older adult mortality in Costa Rica. Results show that the highest survival chances rely on being partnered and suggest that support exchanges with other family members are not equally effective. Including this variable type in mortality studies is crucial to better understanding how household conditions relate to health and mortality outcomes.

Resumo Pesquisas anteriores mostraram efeitos diferenciados dos tipos de arranjos residenciais sobre a mortalidade. Entretanto, pouco se sabe sobre os fenômenos na América Latina e suas residências multigeracionais. Este estudo aborda a relação entre os tipos de arranjos residenciais de idosos e a mortalidade subsequente. A análise de sobrevivência foi realizada por meio do modelo Gompertz, estimando as diferenças de mortalidade entre os diferentes arranjos domiciliares. Foi utilizado o Estudo da Longevidade e Envelhecimento da Costa Rica (CRELES) pré-1945, de 2005, 2007 e 2009. Os resultados mostram que os idosos que vivem com companheiro apresentam as maiores taxas de sobrevivência entre as categorias testadas. Ao controlar por sexo e idade no modelo, o efeito de morar sozinho não é diferente de morar com companheiro. Se os fatores socioeconômicos e de saúde forem controlados, os idosos que vivem com seus filhos ou outras pessoas possuem um risco aumentado de morte em pelo menos 40% (p-valor <0,05). O estudo demonstra que existe uma associação entre os arranjos domiciliares e a mortalidade de idosos na Costa Rica. Os resultados mostram que as maiores chances de sobrevivência estão entre os idosos que possuem um parceiro, sugerindo que os cuidados providos por membros da família não são igualmente efetivos. A inclusão desse tipo de variável nos estudos de mortalidade é crucial para entender como as condições domiciliares se relacionam com os resultados de saúde e mortalidade.

Resumen La literatura anterior a este artículo ha mostrado efectos diferenciados de los tipos de arreglos de vivienda en la mortalidad. Sin embargo, poco se sabe sobre el fenómeno en Latinoamérica y sus viviendas multigeneracionales. Este estudio mide la relación entre los tipos de arreglos de vivienda de las personas adultas mayores y la subsecuente mortalidad. Modelos de historia de eventos Gompertz se hicieron para estimar las diferencias de mortalidad entre los arreglos de vivienda. Se utilizó el Estudio de Longevidad y Envejecimiento Saludable (CRELES) en la cohorte pre-1945 y las rondas 2005, 2007 y 2009. Los resultados muestran que las personas adultas mayores que viven con una pareja tienen las mayores tasas de sobrevivencia entre las categorías comparadas. Al controlar por sexo y edad en el modelo, el efecto de vivir solo no es diferente del de estar emparejado. Si también se controlan los factores socioeconómicos y de salud, los las personas adultas mayores que viven con hijos o hijas o con otros muestran un riesgo de muerte al menos 40 % mayor (p-valor <0,05). El estudio demuestra que existe una relación entre los arreglos de vivienda y la mortalidad de las personas adultas mayores en Costa Rica. Los resultados muestran que las mayores probabilidades de supervivencia recaen en estar emparejado y sugieren que los intercambios de apoyo con otros miembros de la familia no son igualmente efectivos. La inclusión de este tipo de variables en los estudios de mortalidad es crucial para entender cómo se relacionan las condiciones de vivienda con los resultados de salud y mortalidad.

Itinerário terapêutico de idosos vivendo com HIV/Aids: perspectivas da história oral / Therapeutic Itinerary of Elderly Living with HIV/Aids: Oral History Perspectives

Resumo Objetivo: Analisar o itinerário terapêutico de idosos vivendo com HIV em assistência num município do Oeste Catarinense. Metodologia: Estudo qualitativo com método história oral temática. A população foi composta por idosos que vivem há mais de cinco anos com HIV/Aids, assistidos em um Serviço de Atendimento Especializado. Foram realizados dois encontros para aproximação e três momentos de entrevistas em profundidade abordando questões relacionadas as trajetórias assistenciais dos sujeitos e sua relação com a doença. A análise de dados foi realizada por meio da análise temática de conteúdo. Resultados e Discussão: Os idosos tiveram seu diagnóstico em fase tardia o que mostra a dificuldade dos serviços de saúde em identificar precocemente o HIV na pessoa idosa. O tratamento foi centralizado na medicação com antirretrovirais, de maneira setorializada em serviço especializado e com equipe constituída por profissional médico, enfermeiro e farmacêutico. Também foi evidenciado baixo acesso a recursos não farmacológicos, como assistência psicoterapêutica. Considerações finais: A trajetória assistencial precisa ser qualificada na direção de garantir maior acesso as redes de saúde e as equipes interprofissionais para uma atenção à saúde integral que realize o diagnóstico precoce com vistas a reduzir os riscos de complicações e ofereça um cuidado integral e humanizado, que extrapole o uso de medicamentos.

Abstract Objective: To analyze the therapeutic itinerary of elderly people living with HIV assisted in a municipality in Western Santa Catarina. Methodology: Qualitative study with thematic oral history method. The population was consisted of elderly people who have been living with HIV/Aids for more than five years, assisted in a Specialized Care Service. Two meetings were held for approximation and three moments of in-depth interviews. Data analysis was performed through thematic content analysis. Results and Discussion: The elderly had their diagnosis at a late stage, use antiretrovirals in their therapeutic journey, they have the specialized service as the central treatment space and greater contact with the medical professional, nurse and pharmacist. Final considerations: The therapeutic itineraries were built in a way that diagnoses happen late, with treatment focused on medication, in a sectorized way and without a diverse interprofessional team.

Effect of high altitude on PEF and inflammatory response in elderly patients with heart failure and respiratory tract infection / 公共卫生与预防医学

Objective To investigate the effect of high altitude on peak expiratory flow (PEF) in elderly patients with heart failure and respiratory tract infection and its relationship with inflammatory response. Methods A total of 380 elderly patients over 60 years old with heart failure and respiratory tract infection admitted to our hospital from January 2020 to September 2022 were selected by cluster sampling method as research objects, including 190 long-term residents in high-altitude areas and 190 long-term residents in non-high-altitude areas.Information on current diseases, peak expiratory flow (PEF) levels, and inflammatory status (serum TNF) were collected- α， CRP, PCT and IL-6 levels) and other potential influencing factors; The relevant test indexes were collected at the time of enrollment (baseline) and at the time of discharge after treatment (the shortest hospital stay of 6 days and the longest hospital stay of 21 days); To compare the effects of long-term living at high altitude on PEF level and inflammatory state. The study used spss19 0 statistical software package for analysis. Results In this study, 380 elderly patients over 60 years old with heart failure and respiratory tract infection were enrolled, including 190 long-term residents in high-altitude areas (high-altitude group) and 190 long-term residents in non-high-altitude areas (control group). The mean age of patients in the high altitude group was (66.20±6.56) years old, the proportion of male patients was 53.16%, and the proportion of patients with heart failure duration less than 5 years was 70.00%. The average age of the control group was (66.93±6.77) years old, the proportion of male patients was 53.85%, and the proportion of patients with heart failure duration less than 5 years was 71.79%. The levels of PEF, FEV1 and FVC in 2 groups were higher than the baseline level at discharge (t=2.095, 7.139, 11.047, 14.594, 14.104, 12.250, all P<0.05). And the high altitude group was significantly lower than the control group (t=5.260, 6.912, 6.262, P<0.05). The baseline levels of TNF-α, CRP, PCT and IL-6 in the high altitude group were higher than those in the control group. After treatment, the levels of several inflammation-related factors decreased in both groups, but the high altitude group was still higher than the control group. The expression levels of inflammation-related factors (TNF-α, CRP, IL-6, PCT) in subjects at high altitude were negatively correlated with the levels of lung function related indicators (PEF, FEV1, FVC) (r=-0.453, -0.496, -0.379, -0.563, -0.467, -0.522, -0.497, -0.518, -0.419, -0.416, -0.438, -0.480), and the correlation coefficients were statistically significant (P<0.05). Conclusion High altitude living factors are associated with the decrease of PEF. At the same time, it indirectly aggravates the inflammatory state of patients, and it is more difficult for therapeutic intervention to control the inflammation to the ideal level within the same time, which is worthy of clinical attention.

Epidemiological characteristics and psycho-psychological factors of senile arrhythmia in Xining area / 公共卫生与预防医学

Objective To understand the epidemiological characteristics and psychological factors of senile arrhythmia in Xining area, and provide theoretical basis for the prevention and treatment of senile arrhythmia. Methods A total of 518 elderly patients treated in the department of Cardiology in Xining area from June 2018 to June 2020 were selected and divided into control group (without arrhythmia) and study group (with arrhythmia) according to whether the patients were complicated with arrhythmia. All subjects underwent 24h electrocardiographic monitoring to record heart rate, heart rate lead electrocardiogram and 24h dynamic electrocardiogram examination. Refer to the patient's medical records for general information, including age, gender, coronary heart disease, hypertension, etc.; Psychological factors such as depression, anxiety, sleep and quality of life were analyzed. The correlation between PSQI score, HAMA-14 score, HAMD-17 score and arrhythmia was analyzed by Pearson correlation analysis. Results Among 518 patients, 305 (58.89%) were complicated with arrhythmia, including 155 males and 150 females, with an average age of 76.15±3.79. Atrial arrhythmia accounted for 38.36% (117/305), sinus tachycardia accounted for 28.52% (87/305). Ventricular arrhythmias accounted for 11.48% (35/305); The incidence of arrhythmia in 70-79 year olds was significantly higher than that in 60-69 year olds (χ2=8.358 , P2=6.801, P2=1.534, P>0.05). The incidence of arrhythmia was significantly higher in patients with hypertension and coronary heart disease (χ2=16.401, χ2=9.772 , P<0.05). There were significant differences in PSQI score, HAMA-14 score, HAMD-17 score between the two groups (P<0.05). Pearson correlation analysis showed that PSQI score, HAMD-14 score and HAMD-17 score were positively correlated with the occurrence of arrhythmia in the elderly population in Xining area, with correlation coefficients r=0.417 , 0.607 , 0.653 (P<0.05). Conclusion The incidence of arrhythmia increases in the elderly population in Xining area, mainly in the rural elderly population, which is associated with depression and anxiety and sleep disorders and other psychological factors. Early detection and early intervention can improve the response to treatment and accessibility.

Dificuldades no uso de medicamentos por idosos acompanhados em uma coorte do Sul do Brasil / Difficulties in the use of medications by elderly people followed up in a cohort study in Southern Brazil

RESUMO Objetivo: Este estudo visou avaliar a necessidade de ajuda dos idosos para tomar seus medicamentos, bem como as dificuldades relacionadas com a sua utilização, e a frequência de esquecimento de doses. Ainda, avaliar fatores associados à necessidade de ajuda dos idosos com os medicamentos. Métodos: Corte transversal em uma coorte de idosos (60 anos ou mais — estudo "COMO VAI?"), em que foi avaliada a necessidade de ajuda para tomar medicamentos de forma adequada e as dificuldades apresentadas na sua utilização. Utilizou-se regressão de Poisson para estimar as razões de prevalência (RP) brutas e ajustadas dos desfechos e seus intervalos de confiança de 95% (IC95%) de acordo com as características da amostra. Resultados: Participaram 1.161 idosos. A prevalência de idosos que relataram necessidade de ajuda com os medicamentos foi de 15,5% (IC95% 13,5-17,8), sendo que os mais idosos, com menor escolaridade e em pior situação econômica, em uso de quatro medicamentos ou mais e com pior autoavaliação de saúde foram os que mais necessitaram de ajuda. O uso contínuo de medicamentos foi referido por 83,0% (IC95% 80,7-85,1) e a maioria (74,9%; IC95% 72,0-77,5) nunca se esqueceu de tomar seus medicamentos. Conclusão: Observou-se a influência de determinantes sociais e econômicos e de saúde sobre a necessidade de ajuda para a utilização dos medicamentos. Estudos que estimem as dificuldades no uso de medicamentos por idosos são importantes para subsidiar políticas e práticas norteadoras de ações para melhorar a adesão e o uso racional de medicamentos.

ABSTRACT Objective: This study aimed to assess the need for help by elderly people to take their medications, the difficulties related to this activity, the frequency of forgotten doses, and factors associated. Methods: Cross-sectional study conducted with a cohort of elderly people (60 years and over — "COMO VAI?" [How do you do?] study), where the need for help to properly take medication and the difficulties faced in using them were evaluated. The Poisson regression model was used to estimate the crude and adjusted prevalence ratios (PR) of the outcomes and respective 95% confidence intervals according to the characteristics of the sample. Results: In total, 1,161 elderly people were followed up. The prevalence of participants who reported requiring help with medication was 15.5% (95%CI 13.5-17.8), and the oldest subjects, with lower educational levels, in worse economic situations, on four or more medications and in bad self-rated health were the ones who needed help the most. Continuous use of medication was reported by 83.0% (95%CI 80.7-85.1) of the sample and most participants (74.9%; 95%CI 72.0-77.5) never forgot to take their medications. Conclusion: The need for help to use medications was shown to be influenced by social and economic determinants. Studies assessing the difficulties in medication use by the elderly are important to support policies and practices to improve adherence to treatment and the rational use of medications.

Revisión sistemática del concepto: envejecimiento saludable / Systematic review of the concept: healthy aging / Revisão sistemática do conceito: envelhecimento saudável

El siguiente estudio, dará a conocer los resultados de la revisión sistemática en la literatura, en torno al concepto envejecimiento saludable, considerando que la forma de envejecer de muchos adultos es preocupante, por las repercusiones en la salud conforme se envejece. Para esto, se realizó una búsqueda en algunas bases de datos como, Pubmed.ncbi, ScienceDirect, Medline, BIREME - Portal Regional de la BVS, e-Libro de la Universidad de Panamá, Scholarly Journals, Google académico, páginas oficiales de organismos internacionales como la OPS, OMS y CEPAL, artículos en scielo.org, Revistas Especializadas de Geriatría, Gerontología y Salud Pública. Seguidamente se seleccionaron estudios empíricos y teóricos relacionados al envejecimiento y así, analizar el concepto. Se concluye que la Década del Envejecimiento Saludable 2021-2030, es una propuesta centrada en cuatro esferas de acciones fundamentales, para proteger la salud, el bienestar y están fuertemente conectadas entre sí, que persiguen mejorar la vida de las personas mayores, sus familias y comunidades. Y desde la investigación, constituye un reto para la disciplina y la profesión de Enfermería, al generar cuidados a partir de teorías, que a su vez faciliten el entendimiento y abordaje del fenómeno. Igualmente, en la cooperación técnica a nivel nacional e internacional, en la salud de la población envejecida y las políticas globales. Esta revisión sistemática nos permitió identificar las dimensiones esenciales del concepto envejecimiento saludable, las cuales se resumen en tres dimensiones: 1. Capacidad funcional, física y mental, que le permite a la persona adulta ser y hacer lo que prefiere, 2. Actitud que no enfatice la edad cronológica como un impedimento para lograr metas, 3. Práctica sistemática de promoción de estilos de vida saludables, y de prevención de enfermedades crónicas no transmisibles.

Abstract The following study will present the results of the systematic review of the literature around the concept of healthy aging, considering that the way many adults age is a concern due to the repercussions on health as they age. As a result, a search was carried out in some databases such as Pubmed.ncbi, ScienceDirect, Medline, BIREME - Regional Portal of the VHL, e-Book of the University of Panama, Scholarly Journals, academic Google, official pages of international organizations such as PAHO, WHO, and ECLAC, articles in scielo.org, Specialized Journals of Geriatrics, Gerontology and Public Health. Next, empirical and theoretical studies related to aging were selected to analyze the concept. It is concluded that the Decade of Healthy Aging 2021-2030 is a proposal focused on four spheres of fundamental actions to protect the health and well-being which are strongly connected to each other, which seek to improve the lives of older people, their families, and communities. And from research, the proposal constitutes a challenge for the discipline and the Nursing profession by generating care based on theories that facilitate the understanding and approach to the phenomenon. Likewise, in technical cooperation at the national and international level, in the health of the elderly population and global policies. This systematic review allows us to identify the essential dimensions of the healthy aging concept, which are summarized in three dimensions. 1. Functional, physical, and mental capacity, which allows the adult to be and do what they prefer, 2. An attitude that does not emphasize chronological age as an impediment to achieving goals, 3. The systematic practice of promoting healthy lifestyles and preventing chronic non-communicable diseases.

Resumo O estudo a seguir apresentará os resultados da revisão sistemática na literatura, em torno do conceito de envelhecimento saudável, considerando que a forma de envelhecer de muitos adultos é preocupante, devido às repercussões na saúde à medida que envelhecem. Para isso, foi realizada uma pesquisa em algumas bases de dados como Pubmed.ncbi, ScienceDirect, Medline, BIREME - Portal Regional do VHL, e-Book da Universidade de Panamá, Revistas Académicas, Académicos do Google, páginas oficiais de organizações internacionais como a OPAS, a OMS e a ECLAC, artigos em scielo.org, Revistas Especializadas de Geriatria, Gerontologia e Saúde Pública. Em seguida, foram selecionados estudos empíricos e teóricos relacionados com o envelhecimento e, assim, o conceito foi analisado. Conclui-se que a Década do Envelhecimento Saudável 2021-2030, é uma proposta focada em quatro áreas fundamentais de ações para proteger a saúde, o bem-estar e estão fortemente ligadas entre si, e procuram melhorar a vida dos idosos, das suas famílias e suas comunidades. E a partir da pesquisa, constitui um desafio para a disciplina e a profissão de Enfermagem, gerando cuidados a partir de teorias, que por sua vez facilitam a compreensão e abordagem do fenómeno. Da mesma forma, na cooperação técnica a nível nacional e internacional, na saúde da população envelhecida e nas políticas globais. Essa revisão sistemática permitiu identificar as dimensões essenciais do conceito de envelhecimento saudável, que são resumidas em três dimensões: 1. Capacidade funcional, física e mental, que permite que a pessoa adulta seja e faça o que preferir, 2. Atitude que não enfatiza a idade cronológica como impedimento para atingir objetivos, 3. Prática sistemática de promoção de estilos de vida saudáveis, e prevenção de doenças crónicas não transmissíveis

Síntomas de depresión y calidad de vida relacionada con la salud en personas mayores: una revisión / Depression symptoms and health-related quality of life in older people: a review

Resumen. El objetivo de este estudio fue sintetizar la evidencia de la literatura científica sobre la calidad de vida relacionada con la salud (CVRS) en las personas mayores con síntomas de depresión. Se realizó una revisión sistemática de la literatura científica publicada entre 2015 y 2020 en las bases de datos Pubmed, Scielo y Scopus. Se incluyeron 35 artículos en los cuales se reportó una estrecha relación entre la calidad de vida relacionada con la salud y los síntomas de depresión, mediada por condiciones físicas y psicosociales entre las cuales se encuentran tener enfermedades crónicas, dolor persistente, comorbilidades, disminución de la independencia, bajos ingresos, alto porcentaje de grasa corporal, sedentarismo, vivir solo, pertenecer al género femenino y carecer de cuidadores empáticos. En conclusión, las personas mayores con presencia de síntomas depresivos reportan en general menor CVRS. Los hallazgos de este estudio son un aporte a la comprensión de la relación entre CVRS y depresión en la población adulta mayor en diferentes contextos, además, el estudio puede aportar evidencia importante para las intervenciones clínicas enfocadas en los aspectos emocionales de los pacientes con diferentes patologías.

Abstract. This study aimed to synthesize the scientific evidence on health-related quality of life in older people with symptoms of depression. This systematic review included studies published between 2015 and 2020. We used Pubmed, Scielo, and Scopus search engines. We included a total of 35 articles that addressed the relationship between health-related quality of life and symptoms of depression. Furthermore, those studies selected included the analysis of variables such as physical psychosocial and socioeconomic conditions, and comorbidities such as chronic diseases, persistent pain, decreased independence, high body fat percentage, sedentary lifestyle, living alone, belonging to the female gender, and lacking empathetic caregivers. Our findings show that older people with depressive symptoms generally report lower HRQoL. This study contributes to understanding the relationship between HRQL and depression in older persons in different contexts, in addition, the study can provide important evidence for clinical interventions focused on the emotional aspects of patients with different pathologies.

A Study on Prevalence of Selected Mental Disorders (Anxiety, Depression, Dementia) Among Residents of Old Age Home in Jabalpur City, Madhya Pradesh, India

Introduction: Ageing is a normal phenomenon and an inescapable process. According to WHO. World-wide over 20% of adults aged 60 and over suffer from a mental or neurological disorder and according to the National Mental Health Survey of India (2015-16) the prevalence of mental disorders in geriatric population in our country is 10.90%. Thus, this study aims to assess anxiety, depression and cognitive disorders among persons living in OAH and to explore the various factors associated with it. Methodology: A descriptive cross-sectional study was conducted in OAH Jabalpur. All residents of OAH were included in the study so no need for sampling. The sample size was 73. A Predesigned semi-structured Questionnaire was used which comprised of the socio-demographic profile with using GAD-7, GDS-15 & MMSE-30 for screening of psychiatric morbidity. Data analysis was done by using IBM SPSS-23. Results: The result shows the mean age of the study subject was 72.14 ±7.48. The prevalence of Anxiety was 19.2%, prevalence of depression was 41.1% and prevalence of cognitive impairment was 23.3%. Conclusion: In this study it was found out that substantial proportion of older adults were suffering from anxiety, depression and cognitive impairment, most of older adults were widowed and there is a need to provide psychological support, a positive environment and proper care to improve mental health.

A comparative study on quality of life of elderly among those living with families and in old age homes in a District in South India

Introduction: The elderly population in India is steadily increasing and it is expected to triple in 2050 as of the census 2011. Drastic improvements in health care made betterment in physical health but their subjective well?being remains unaccounted. Therefore, the present study aims to assess the quality of life (QoL) among elderly and to compare the differences in QoL among elderly population residing in homes and in old age homes. Methodology: An analytical cross?sectional study among elderly above the age of 60 years residing with families and other 40 elderly population residing in old age homes. A questionnaire-based interview was conducted using a standard semistructured World Health Organization-BREF QoL questionnaire. Results: In the study, most of the participants 45 (56.3%) were male and 35 (43.8%) belonged to the age group of 70–79 years with a mean (standard deviation) age of 73.96 (7.44) years. The study found that there is nil significant difference in QoL among elderly living in old age homes and in family setups. The domain scores of psychological, social, and environmental domains showed a slight nonsignificant increase in elderly among old age homes. Conclusion: The study showed nil significant difference in QoL score in all domains for the elderly. The concept of QoL needs to be looked into with more preference to psychological, social, and environmental domains.

Programa Nacional de Prevención del Suicidio: el caso del suicidio en la vejez / National suicide prevention programme: The case of suicide in old age

En la búsqueda de problematizar algunos de los ejes del Programa Nacional de Prevención del Suicidio del año 2013, aun en vigencia, se abordan temas como: a) el criterio de edad como principio de selección y focalización de las actividades preventivas, y b) la ausencia en sus lógicas de intervención y ámbitos de acción que consideren elementos reactivos frente a factores contingentes, se busca instalar la necesidad de incorporar a la población envejecida dentro del segmento de población prioritaria en pos de la prevención del suicidio. Mediante un análisis de contenido del Programa Nacional de Prevención del Suicidio, este texto tiene como objetivos analizar la problemática del suicidio en personas mayores, mediante una revisión de políticas públicas.

In the search to problematize some of the axes of the National Suicide Prevention Program of 2013, still in force, issues such as: a) the age criterion as a principle of selection and targeting of preventive activities, and b) the absence in its logic of intervention and areas of action that consider reactive elements in the face of contingent factors, it seeks to install the need to incorporate the elderly population into the priority population segment in pursuit of suicide prevention. Applying a narrative review of the National Suicide Prevention Programme, this text aims to analyze the problem of suicide in the elderly through an examination of public policies.

Evidencias de validez del Inventario NEO-FFI en adultos mayores colombianos / Validity evidence of the Inventory NEO-FFI in Colombian older adults

Resumen El uso de instrumentos para evaluar la personalidad es una práctica común en psicología, de ahí que su validación y adaptación a diferentes grupos poblacionales sea fundamental. El objetivo de la presente investigación fue evaluar la validez de constructo del NEO Five Factor Inventory (NEO-FFI) en un grupo de 617 personas adultas mayores en Bogotá, Colombia. Se realizaron análisis factoriales confirmatorios, así como un análisis bifactorial. Los resultados mostraron que el inventario no logra un ajuste adecuado en ninguno de los modelos de primer orden, ni en el modelo bifactorial, como tampoco en el análisis de los factores por separado. Solamente, presentó un ajuste adecuado en los modelos AFC modificados que evalúan cada factor como individual, a excepción del factor Amabilidad. Precisamente, los ítems que tuvieron bajas cargas factoriales son aquellos ítems negativos o reversos, y, dado que la comprensión de este tipo de ítems requiere de mejores habilidades lingüísticas, se infiere que el bajo nivel educativo de las personas que conformaron la muestra pudo interferir en el logro de un ajuste adecuado de los modelos; en consecuencia, se recomienda estudiar este aspecto en futuras investigaciones.

Abstract The use of instruments to assess personality is a common practice in psychology, therefore its validation and adaptation to different population groups is fundamental. The aim of the current research was to evaluate the construct validity of the NEO-FFI Inventory in a group of 617 elderly people in Bogotá, Colombia. First ordered confirmatory factor analyses and bi-factor models were performed. The results showed that the Inventory does not achieve an adequate adjustment in any of the first-order models, nor in the bi-factorial model, nor in the analysis of the factors separately. Only in the modified CFA models that evaluate each factor individually, with the exception of Agreeableness, an adequate fit was achieved. The items registering low factor loadings are especially those negative or reverse items, and since the understanding this type of items requires better linguistic skills, it is inferred that the low educational level of the sample could interfere in achieving an adequate adjustment of the models. Consequently, it is recommended to study this aspect in future research.

A Cross Sectional Study on Assessment of Cognitive Impairment and Behavioural Risk Factors Among Senior Citizens Living in Old Age Homes in Chengalpattu District, Tamilnadu

Background: Ageing is an irreversible, unavoidable, universal phenomenon accompanied by gradual reduction in functional capacity of the elderly. The number of elderly populations in India is expected to triple reaching 2 billion. This study aims to estimate the prevalence of cognitive impairment and evalu- ate the association between various socio demographic and behavioural risk factors. Methodology: This descriptive cross-sectional study was carried among 330 senior citizens living in old age homes by using a two-stage multistage sampling method. A standardized pretested structured ques- tionnaire containing Brief Interview for Mental Status (BIMS) scale was used. Data was analysed using SPSS (Version 22). Results: Among 330 study respondents, around 44% had mild -to- moderate cognitive impairment and 36% had severe cognitive impairment. Nearly 74.8% have their habit of regular physical activity. Among the study subjects approximately 4% of them were current smokers, 5.2% had the habit of regular alco- hol consumption previously. Conclusion: Integration of NPHCE and NMHP can be beneficial in early diagnosis of mild cognitive im- pairment during weekly outpatient visits at PHC. Level of attention given towards Alzheimer’s disease (AD) is more when compared to screening for cognitive impairment which is an early precursor for AD.