Experiencias de personas adultas con discapacidad intelectual sobre el derecho a la vida independiente: Un estudio de caso / Experiences of adults with intellectual disabilities on the right to independent living: A case study

Resumen En el ámbito de la discapacidad intelectual, el desarrollo de una vida independiente se ha configurado como un derecho humano y civil que permite a estas personas articular planes de vida deseados. Esta investigación analiza, mediante un estudio de caso, los significados que un grupo asesor compuesto por ocho personas adultas con discapacidad intelectual tiene sobre el concepto de vida independiente en el contexto chileno. Para la recopilación de los datos se diseñó una entrevista grupal semiestructurada acompañada de moodboards que facilitaron la verbalización de las respuestas. Sobre los relatos obtenidos a partir de las entrevistas se realizó un análisis de contenido temático. Los resultados muestran cómo el desempeño de una actividad laboral remunerada o el establecimiento de relaciones afectivas sólidas se conforman como elementos imprescindibles para la independencia personal. La dificultad para ser económicamente independientes o la falta de accesibilidad en el entorno laboral se identifican también como principales barreras para la concreción de este derecho. Igualmente, se destaca el rol que desempeñan la pareja y las amistades como figuras de apoyo constante a la independencia y al empoderamiento personal. Estos resultados sugieren algunas orientaciones para la planificación de intervenciones sobre este constructo, las cuales deben procurar la adquisición de habilidades que fortalezcan la capacidad de autocuidado de este colectivo, promover el incremento de oportunidades para la realización de elecciones significativas en el ámbito laboral, personal y comunitario, y adaptarse a los espacios en los que se desenvuelven las personas con discapacidad intelectual en la edad adulta.

Abstract In the field of intellectual disability, the development of an independent life has been configured as a human and civil right that allows these people to articulate desired life plans. Despite the advances, at the international level, research on aspects related to independent living in people with intellectual disabilities continues to be very scarce. Generally, the approaches to the study of this construct are based on broader investigations dedicated to evaluating the levels of quality of life or self-determination of this population in residential services or sheltered housing. Precisely, this study analyzes, through a case study, the meanings that an advisory group made up of eight adults with intellectual disabilities has on the concept of independent living in the Chilean context in order, on the one hand, to identify relevant elements for the definition of the construct from the perceptions and experiences of this population; and on the other, to propose guidelines at various levels that allow progress in the realization of this right. To collect the data, a semi-structured group interview was designed whose questions were grouped around four themes: previous conceptions of the participants about the construct of independent life, satisfaction with life and possibilities of the context for the development of personal independence, role of family, friendship and partner in independent life, and opportunities of the work context for the achievement of personal independence. During the interview, another strategy was incorporated in which visual language gained more relevance. Specifically, a set of ten moodboards were used that allowed participants to delve into the different topics addressed. The results of the code validation process were calculated using Krippendorff's alpha statistics (.954) and Cohen's kappa (.953), which showed a high level of inter-judge agreement. As a result of this process, categories (N = 6) and subcategories (N = 17) were established. The results show how various needs, barriers and facilitators for the development of independent life are identified from the interviews of the interviewees. Among the main needs is the performance of a paid work activity or the establishment of solid affective relationships. With regard to the barriers that hinder personal independence, the most notorious are related to the difficulty of being financially independent or to the lack of accessibility in the work environment. Regarding the elements that facilitate the development of an independent life, the role of the couple stands out as a constant figure of support for independence and personal empowerment. These results suggest some guidelines for planning interventions on this construct. Among others, they should seek the acquisition of skills that strengthen the self-care capacity of this group; should promote increased opportunities for making meaningful choices in the workplace, personal and community; and they must adapt to the spaces in which people with intellectual disabilities operate in adulthood. On the other hand, it is assumed that one of the main limitations of this research is that the results are not generalizable. However, this study has some strengths. Among others, it contributes to enriching the bulk of research on independent living, this being an aspect barely addressed in the literature. It also complements the results of other research regarding the elements that can condition the development of skills for personal independence. This allows for the design of interventions that provide opportunities for independent living based on the felt needs of these people. In addition, it raises future lines of research related, for example, to the importance of the informed choice of the residential environment or to the study of the possibilities of the digital world as an incident phenomenon in the acquisition of skills for personal independence.

Pressupostos epistemológicos das cidades amigas das pessoas idosas: revisão de escopo / Presupuestos epistemológicos de las ciudades amigables con las personas mayores: revisión de alcance / Epistemological assumptions of age-friendly cities: a scoping review

Resumo Objetivo Identificar os conceitos e perspectivas teóricas que fundamentam os estudos sobre Cidade Amiga da Pessoa Idosa. Métodos Revisão de escopo utilizando seis bancos de dados para identificar estudos publicados em revistas indexadas entre 2007 e 2021 usando as palavras-chave 'age-friendly' OR 'age friendly' OR 'cidade amiga'. Resultados Foram encontrados 2.975 estudos que após aplicação de critérios de exclusão resultaram em 227. Observou-se ampla variação no conceito do termo, porém muitos autores o fizeram replicando a OMS, sendo que em 59,5% dos estudos não houve menção de nenhuma perspectiva teórica. A teoria ecológica foi o referencial mais frequente (26%), sendo o termo usado como um equivalente a envelhecimento ativo. Autores de quatro países respondem pela maioria dos artigos (61%). Conclusão É necessário articular o conceito de Cidade Amiga da Pessoa Idosa com uma abordagem teórica e cultural para compreender mais profundamente as perspectivas do urbano e do social sob a lógica do envelhecimento populacional principalmente para a América Latina. A análise teórica nestes estudos e na gerontologia favorecerão discussões mais críticas sobre o envelhecimento, o idadismo e a crescente desigualdade social em curso.

Resumen Objetivo Identificar los conceptos y perspectivas teóricas que fundamentan los estudios sobre Cuidades Amigables con las Personas Mayores. Métodos Revisión de alcance utilizando seis bancos de datos para identificar estudios publicados en revistas indexadas entre 2007 y 2021, con las palabras clave 'age-friendly' OR 'age friendly' OR 'ciudad amigable'. Resultados Se encontraron 2975 estudios que, luego de aplicar los criterios de exclusión, quedaron 227. Se observó una amplia variación del concepto del término, aunque muchos autores replicaron a la OMS. En el 59,5 % de los estudios no se mencionó ninguna perspectiva teórica. La teoría ecológica fue la referencia más frecuente (26 %), y el término se usó como un equivalente al envejecimiento activo. La mayoría de los artículos (61 %) son de autores de cuatro países. Conclusión Es necesario unir el concepto de Cuidades Amigables con las Personas Mayores con un enfoque teórico y cultural para comprender más profundamente las perspectivas de lo urbano y lo social de acuerdo con la lógica del envejecimiento poblacional, principalmente en América Latina. El análisis teórico en estos estudios y en la gerontología permitirán discusiones más críticas sobre el envejecimiento, el edadismo y la creciente desigualdad social en curso.

Abstract Objective To identify the concepts and theoretical perspectives that underlie studies on age-friendly city. Methods This is a scoping review using six databases to identify studies published in indexed journals between 2007 and 2021 using the keywords 'age-friendly' OR 'age friendly' OR 'cidade amiga'. Results A total of 2,975 studies were found, which, after applying the exclusion criteria, resulted in 227. There was wide variation in the concept of the term, but many authors did so by replicating the WHO, and in 59.5% of studies there was no mention of any theoretical perspective. The ecological theory was the most frequent reference (26%), the term being used as an equivalent to active aging. Authors from four countries account for most articles (61%). Conclusion It is necessary to articulate the concept of age-friendly city with a theoretical and cultural approach to understand more deeply the urban and social perspectives under the logic of population aging, mainly for Latin America. Theoretical analysis in these studies and in gerontology will favor more critical discussions about aging, ageism and the growing social inequality in progress.

Los años dorados en la actualidad: Un estudio de caso / The golden years today: A case study

La investigación tuvo por objetivo identificar, analizar y sistematizar las experiencias teóricas con respecto al estudio de casos como metodología investigativa. El objetivo primario fue evidenciar el estigma y el estereotipo sobre los adultos mayores contrastado con la realidad actual. Para esto se realizó una serie de estudios de casos a adultos mayores de manera remota y presencial debido a la reciente pandemia de COVID-19 donde fueron seleccionados los más destacados. Los resultados obtenidos fueron utilizados para comparar con la estigmatización social atribuida a este grupo etario. Se considera que mediante la entrega de herramientas necesarias para el desarrollo social a las personas mayores para que logren manejar su salud y su estilo de vida, un adulto mayor puede ser capaz de gestionar su autonomía e incluirse en la sociedad de forma eficaz y placentera[AU]

The objective of the research w as to identify, analyze and systematize the theoretical experiences regarding the case study as a research methodology. The primary objective was to demonstrate the stigma and stereotype about the elderly over reality. For this, a series of case studies were carried out on elderly people remotely and in person due to the recent COVID-19 pandemic, where the most prominent were selected. The results obtained were used to contrast the social stigmatization attributed to this age group. We believe that by providing the necessary tools for social development to older people so that they can manage their health and lifestyle, an older adult may be able to manage their autonomy and include themselves in society in an effective and pleasant way[AU]

A pesquisa teve como objetivo identificar, analisar e sistematizar as experiências teóricas sobre o estudo de caso como metodologia de pesquisa. O objetivo principal foi destacar o estigma e estereótipo sobre os idosos sobre a realidade. Para isso, foi realizada uma série de estudos de caso em idosos de forma remota e presencial devido à recente pandemia de COVID-19, onde foram selecionados os mais destacados. Os resultados obtidos foram utilizados para contrastar com a estigmatização social atribuída a essa faixa etária. Em conclusão, propomos que, ao fornecer as ferramentas necessárias para o desenvolvimento social dos idosos, para que eles possam gerenciar sua saúde e estilo de vida, o idoso poderá gerenciar sua autonomia e se incluir na sociedade de maneira eficaz e agradável[AU]

Efectos de un programa de telerehabilitación sobre la funcionalidad en personas mayores / Effects of a telerehabilitation program on functionality in the older people

Resumen: Objetivo: Determinar los efectos de un programa de telerehabilitación (TR) en el nivel de independencia funcional y el número de caídas en personas mayores, asistentes a un centro de cuidados diurno. Materiales y método: 14 personas mayores ( χ =74 años), sometidas a un programa de kinesiterapia/fisioterapia/ terapia física (TF) a través de tele rehabilitación por un período de 12 semanas. El grupo control recibió intervención educativa a través de un cuadernillo de actividad física que debieron desarrollar de forma autónoma, con supervisión telefónica semanal; mientras que el grupo experimental recibió 15 sesiones de kinesiterapia/fisioterapia/terapia física por video llamada mediante aplicación WhatsApp TM . Ambos grupos fueron evaluados pre y post intervención con escala índice de Barthel (IB) y el número de caídas, mediante el cuestionario de la valoración geriátrica integral (VGI). Resultados: El grupo experimental aumentó el puntaje del índice de Barthel (↑3.6), mientras que el grupo control disminuyó este puntaje (↓6.9). Ambos grupos disminuyen el número de caídas, sin encontrar diferencias entre grupos. Al comparar ambos grupos, las personas mayores sometidas a un programa de kinesiterapia/fisioterapia/ terapia física a través de tele rehabilitación presentaron mejoras significativamente mayores en el índice de Barthel que el grupo control (p<0.05). Conclusión: Las personas mayores que participaron en un programa kinesiterapia/ fisioterapia/ terapia física a través de tele rehabilitación presentaron un mayor nivel de independencia funcional que las personas con la intervención con cuadernillo de actividad física guiado por llamada telefónica, lo que sugiere considerar a los programas de terapia física como una alternativa terapéutica para mejorar el nivel de independencia en personas mayores.

Abstract: Objective: To determine the effects of a telerehabilitation (TR) program on the level of functional independence and the number of falls in older people attending a day care center. Materials and method: 14 older people ( χ = 74 years), submitted to a kinesitherapy / physiotherapy / physical therapy (PT) program through telerehabilitation for a period of 12 weeks. The control group received educational intervention through a physical activity booklet which they had to develop independently, with weekly telephone supervision, while the experimental group received 15 kinesitherapy / physiotherapy / physical therapy sessions via video calls through WhatsApp TM application. Both groups were evaluated pre and post intervention with the Barthel index scale (BI) and the number of falls using the comprehensive geriatric assessment (CGA). Results: The experimental group increased the Barthel index scale score (↑3,6) while the control group decreased this score (↓6,9). Both groups decreased the number of falls, without differences between groups. When comparing both groups, the elderly who underwent a kinesitherapy / physiotherapy / physical therapy program through telerehabilitation showed significantly greater improvements in Barthel index scale than the control group (p <0.05). Conclusion: Older people who participated in a kinesitherapy / physiotherapy / physical therapy program through telerehabilitation presented a higher level of functional independence compared to participants in the intervention with a phone call-guided physical activity booklet, which suggests a telerehabilitation programs as an alternative therapeutics to improve the level of independence in older people.

As diferentes tipologias do comportamento sedentário estão associadas ao histórico de problemas no sono em idosos comunitários? / Are different typologies of sedentary behavior associated with history of sleep problems in community-dwelling elderly? / ¿Las diferentes tipologías del comportamiento sedentario están asociadas al historial de problemas de sueño en ancianos de comunidades con pocos recursos?

Alterações no sono são comuns em idosos e alguns fatores de risco podem agravar essa condição. Entender a associação do comportamento sedentário com o histórico de problemas de sono poderá auxiliar na elaboração de programas de intervenção. Verificar a associação entre tipologias do comportamento sedentário e histórico de problemas no sono em idosos comunitários brasileiros. Estudo transversal, com dados de 43.554 idosos participantes da Pesquisa Nacional de Saúde (PNS), de 2019. As tipologias do comportamento sedentário foram avaliadas por: (1) tempo assistindo televisão; (2) atividades de lazer; e (3) tempo despendido total (televisão + lazer). O comportamento sedentário foi categorizado em < 3; 3-6 e > 6 horas/dia. O desfecho foi histórico de problemas de sono (dificuldade para adormecer, acordar frequentemente à noite ou dormir mais do que de costume) avaliados por meio do autorrelato nos últimos 15 dias. As associações foram verificadas pela regressão logística multivariável. Idosos que permaneceram tempo > 6 horas/dia em comportamento sedentário assistindo televisão tiveram 13% (OR = 1,13; IC95%: 1,02; 1,26) maiores probabilidades de relatarem problemas de sono. Referente ao comportamento sedentário total, idosos que permaneceram entre 3-6 horas e mais do que 6 horas/dia apresentaram 13% (OR = 1,13; IC95%: 1,04; 1,22) e 11% (OR = 1,11; IC95%: 1,01; 1,23) maiores probabilidades de problemas de sono, respectivamente. Os idosos amostrados que relataram permanecer por períodos superiores a 6 horas por dia em comportamento sedentário assistindo à televisão e > 3 horas em comportamento sedentário total tiveram maiores chances de terem problemas no sono. Estes achados podem contribuir nas orientações sobre a necessidade de redução no comportamento sedentário em idosos.

Alterations in sleep are common in older persons, and some risk factors may aggravate this condition. Understanding the association between sedentary behavior and history of sleep problems can assist the elaboration of intervention programs. The study aimed to verify the association between typologies of sedentary behavior and history of sleep problems in community-dwelling older Brazilians. A cross-sectional study was performed with data from 43,554 older persons participating in the Brazilian National Health Survey (2019). Typologies of sedentary behavior were assessed by: (1) time watching television; (2) leisure-time inactivity; and (3) total inactivity (TV + leisure-time inactivity). Sedentary behavior was categorized as < 3, 3-6, and > 6 hours/day. The outcome was history of sleep problems (difficulty falling asleep, waking up frequently at night, or sleeping more than usual) assessed by self-report in the last 15 days. Associations were verified with multivariate logistic regression. Older persons that spent more 6 hours/day watching TV had 13% higher odds (OR = 1.13, 95%CI: 1.02; 1.26) of reporting sleep problems. For total sedentary behavior, older persons that were inactive 3-6 hours and more than 6 hours/day showed 13% (OR = 1.13; 95%CI: 1.04; 1.22) and 11% (OR = 1.11; 95%CI: 1.01; 1.23) higher odds of sleep problems, respectively. Older persons in the sample that reported more than 6 hours a day watching TV and > 3 hours in total sedentary behavior had higher odds of sleep problems. The findings call attention to the need to reduce sedentary behavior in the elderly.

Las alteraciones en el sueño son comunes en ancianos y algunos factores de riesgo pueden agravar esa condición. Entender la asociación del comportamiento sedentario con el historial de problemas de sueño podrá ayudar en la elaboración de programas de intervención. El objetivo fue verificar la asociación entre tipologías del comportamiento sedentario y el historial de problemas en el sueño en ancianos de comunidades con pocos recursos brasileños. Estudio transversal, con datos de 43.554 ancianos participantes en la Encuesta Nacional de Salud (2019). Las tipologías del comportamiento sedentario se evaluaron por el: (1) Tiempo viendo televisión; (2) Actividades de ocio y (3) Tiempo invertido en total (televisión + ocio). El comportamiento sedentario se categorizó en < 3; 3-6 y > 6 horas/día. El resultado fue el historial de problemas de sueño (dificultad para dormirse, despertarse frecuentemente por la noche o dormir más que de costumbre), evaluados a través del autoinforme en los últimos 15 días. Las asociaciones se verificaron a través de una regresión logística multivariable. Los ancianos que permanecieron tiempo > 6 horas/día en comportamiento sedentario viendo televisión tuvieron un 13% (OR = 1,13; IC95%: 1,02; 1,26) de mayores probabilidades de que informaran problemas de sueño. En lo referente al comportamiento sedentario total, los ancianos que permanecieron entre 3-6 horas y más de 6 horas/día presentaron un 13% (OR = 1,13; IC95%: 1,04; 1,22) y un 11% (OR = 1,11; IC95%: 1,01; 1,23) mayores probabilidades de problemas de sueño, respectivamente. Los ancianos de la muestra que informaron permanecer por períodos superiores a 6 horas al día en comportamiento sedentario viendo televisión y > 3 horas en comportamiento sedentario total tuvieron mayores probabilidades de tener problemas de sueño. Estos resultados pueden contribuir al fortalecimiento en la necesidad de reducción en el comportamiento sedentario en ancianos.

Desfechos funcionais após craniectomia descompressiva secundária à acidente vascular encefálico / Functional outcomes after secondary decompressive craniectomy to vascular brain accident

Introdução: A craniectomia descompressiva (CD) é o procedimento cirúrgico capaz de reduzir a mortalidade em pacientes com edema cerebral secundário a um AVE maligno, porém não garante a recuperação funcional. Objetivo: Descrever o perfil clínico e funcional de pacientes submetidos a CD durante o tempo de internação hospitalar. Métodos: Estudo transversal realizado em uma Unidade de Acidente Vascular Cerebral (U-AVC) no período de setembro de 2018 a março de 2019. Coletaram-se dados sociodemográficos, estudo detalhado dos prontuários e dados referentes à funcionalidade, incapacidade e alcances funcionais por meio de questionários e avaliação física e neurológica. Resultados: A amostra foi composta por 21 participantes. A maioria do sexo masculino, idade média de 55±10 anos, casados, baixa escolaridade, exerciam algum tipo de atividade remunerada com renda de um a dois salários mínimos. Os fatores de risco mais prevalentes foram hipertensão arterial sistêmica, tabagismo, etilismo, sedentarismo e sobrepeso. Durante o período de internação hospitalar, a maioria dos pacientes evoluiu com altos índices de incapacidade e baixos níveis de independência e funcionalidade cognitiva e motora. Conclusão: Além de apresentarem combinações de diferentes fatores de risco relacionados ao desenvolvimento de AVE, a maioria dos pacientes avaliados apresentaram altos índices de incapacidade e baixos níveis de independência e funcionalidade, necessitando de assistência máxima ou total para realizar a maioria de suas atividades de vida diária. (AU)

Introduction: Decompression craniectomy (DC) is a surgical procedure that can reduce mortality in patients with cerebral edema secondary to malignant stroke, but does not guarantee functional recovery. Objective: To describe the clinical and functional profile of patients undergoing DC during their hospital stay. Methods: It is a cross-sectional study conducted in a Stroke Unit from September 2018 to March 2019. Sociodemographic data, detailed study of medical records, and data on functionality, disability and functional range were collected through questionnaires and physical and neurological evaluation. Results: The sample consisted of 21 participants. Most were male, mean age 55 ±10 years, married, with low education, had paid activity with income of one to two minimum wages. The most prevalent risk factors were systemic arterial hypertension, smoking, alcoholism, physical inactivity and overweight. During hospitalization, most patients evolved with high levels of disability and low levels of independence and cognitive and motor functionality. Conclusion: In addition to presenting combinations of different risk factors related to the development of stroke, most of the patients evaluated had high levels of disability and low levels of independence and functionality, requiring maximum or total assistance to develop most of their daily living activities. (AU)

Aging with health: aging in place strategies of a Portuguese population aged 65 years or older / Envelhecer com saúde: estratégias de ageing in place de uma população portuguesa com 65 anos ou mais

ABSTRACT OBJECTIVE: To identify the strategies developed by people in the aging process to keep living in their own home, despite the weaknesses and difficulties they face. METHODS: The research was carried out based on a survey of population aged 65 years or older in the Portuguese municipality of Portimão. Data were collected by questionnaire, in 2017, and submitted to statistical and content analysis. RESULTS: Most respondents own their household, where they feel safe and satisfied, and they show awareness and concern about the changes they have to make in their home to stay there. In addition to housing and livability conditions, health, economic resources, social network, and available services play a major role in the community. CONCLUSIONS: We identified several strategies used by older adults to stay in their households as they age and the ways they mobilize their available resources, as well as constraints of aging in place.

RESUMO OBJETIVO: Identificar as estratégias desenvolvidas por pessoas em processo de envelhecimento para se manter residindo na própria casa, apesar das fragilidades e das dificuldades com que deparam. MÉTODOS: A pesquisa foi realizada a partir de um inquérito a uma população com 65 anos ou mais no município português de Portimão. Os dados foram recolhidos por questionário, em 2017, e submetidos a análise estatística e análise de conteúdo. RESULTADOS: A maioria dos inquiridos tem habitação própria, onde se sente segura e satisfeita, e revela ter consciência e preocupação em relação às alterações que deve executar em sua casa para ali poder permanecer. Além das condições habitacionais e de habitabilidade, as condições de saúde, os recursos económicos, a rede social e os serviços disponíveis assumem um papel preponderante no envelhecimento na comunidade. CONCLUSÕES: Foi possível identificar uma diversidade nas estratégias utilizadas para permanecerem em suas casas à medida que envelhecem e uma multiplicidade de formas como mobilizaram os recursos que têm à disposição, bem como constrições do ageing in place.

Leisure-time physical activity as a protective factor for functional capacity loss in community dwelling elders

ABSTRACT Populational aging led to the emergence of chronic diseases, all potentially incapacitating, thus affecting functional capacity (FC) of elders. Despite health evidences in favour of having regular physical activity, the majority of elders are not sufficiently active. Baseline data of an urban elder cohort in Brazil showed that only 28% were active and 68% had some functional loss, a figure that went up to 73% among the inactives. FC was associated with a network of sociodemographic, health and behavioral factors. In a multivariate analysis, the inactives showed twice the odds of being severely dependent when compared to the actives. Noteworthy that inactivity is as a modifiable factor that might prevent FC loss. Longitudinal studies are needed to verify.

RESUMO O envelhecimento populacional gera o surgimento de doenças crônicas, todas potencialmente incapacitantes, afetando a capacidade funcional (CF) dos idosos. Apesar das evidências de saúde em favor da atividade física regular, a maioria dos idosos não é suficientemente ativa. Dados da linha de base de uma coorte de idosos no Brasil mostraram que 28% eram ativos e 68% tiveram alguma perda funcional, número que subiu para 73% entre os inativos. A CF se associou a uma rede de fatores sociodemográficos, de saúde e comportamentais. Na análise multivariada, os inativos mostraram duas vezes mais chances de serem dependentes graves quando comparados aos ativos. Destaca-se a inatividade como um fator modificável que pode prevenir a perda da CF. Estudos longitudinais são necessários para verificar a causalidade.

RESUMEN El envejecimiento poblacional causa aparición de enfermedades crónicas, potencialmente incapacitantes, afectando la capacidad funcional (CF) del anciano. A pesar de evidencias se salud a favor de la actividad física regular, la mayoría de los ancianos no son suficientemente activos. Una cohorte de ancianos brasileños mostró que 28% estaban activos y 68% tenían alguna pérdida funcional, cifra que subió al 73% entre los inactivos. La CF se ha asociado con una red de factores sociodemográficos, de salud y comportamiento. En análisis multivariante, los inactivos tenían el doble de probabilidades de ser dependientes severos comparándolos con los activos. La inactividad se destaca como un factor modificable que puede prevenir la pérdida de CF. Se necesitan estudios longitudinales para verificar la causalidad.

The Physical Activity Level, Body Composition and Diabetes Mellitus Influence the Association Between Depression and Hypertension in Community-Dwelling Elders

Depression and hypertension are highly prevalent among elderly people. Although the relationship between these conditions is well recognized, however, the factors that may influence such association are not clearly understood. Objective: To analyze the association between depression and hypertension in community-dwelling elders. Methods: Two-hundred and thirty-one community-dwelling elders provided information regarding the following variables: sex, age, ethnicity, smoking habit, physical activity level (PA), body mass index (BMI) and diabetes mellitus (DM). These variables can potentially influence depression and hypertension, as well as its relationship. Screening for depression was made using the Geriatric Depression Scale (GDS). The presence of hypertension was defined based on self-reported data and/or the use of antihypertensive drugs. The logistic regression technique was applied, using hypertension as the dependent variable and depressive state as a predictive variable. Logistic regression was applied with and without adjustment for the potential intervening variables. Results: The prevalence of depressive state and hypertension in the studied population was 14% and 59%, respectively. The association between depression and hypertension without adjustments was not significant (odds ratio [OR] = 2.28, 95% confidence interval [95%CI] = 0.98 - 5.32; p = 0.06). However, after adjusting for PA, BMI and DM, the strength of association between depression and hypertension significantly increased (OR = 3.08, 95%CI = 1.12 - 8.46; p = 0.03). Conclusion: The association between depression and hypertension in the elderly is directly influenced by PA, BMI and DM. This finding may guide strategies to increase the adherence to a healthier lifestyle

Contextual income and incidence of disability: results of EpiFloripa Elderly Cohort / Renda contextual e incidência de incapacidade: resultados da Coorte EpiFloripa Idoso

ABSTRACT OBJECTIVE: Evaluate the association between contextual income and the incidence of disability in basic and instrumental activities of daily living. METHODS: This is a cohort study, with sample of elderly individuals (n = 1,196) residing in Florianópolis, state of Santa Catarina, Brazil. The incidence of disabilities was evaluated using reports of difficulty or inability to perform six basic activities of daily living and nine instrumental activities of daily living after four years. Contextual income was obtained from the 2010 Census. We conducted multilevel logistic regression analyses with adjustment models for individual variables. RESULTS: The incidence of disability in basic activities of daily living was 15.8% (95%CI 13.8-17.9) and in instrumental activities of daily living incidence was 13.4% (95%CI 11.6-15.5). We observed significant association between contextual income and incidence of disability in basic activities of daily living. Having as reference the elderly living in the lower income tercile, those who lived in the intermediary terciles and in that of highest income had 37% (95%CI 0.41-0.96) and 21% (95%CI 0.52-1.19) lower chances of developing disability, respectively. For the incidence of disability in instrumental activities of daily living we observed no statistically significant associations. CONCLUSIONS: Contextual income influences the development of disability in basic activities of daily living in the elderly and should be the subject of actions to reduce socioeconomic inequalities and promote longevity with independence.

RESUMO OBJETIVO: Avaliar a associação entre a renda contextual e a incidência de incapacidade nas atividades básicas e instrumentais da vida diária. MÉTODOS: Trata-se de estudo de coorte, com amostra de idosos (n = 1.196) residentes em Florianópolis, SC. As incidências de incapacidades foram avaliadas por meio do relato de dificuldade ou inabilidade para realizar seis atividades básicas da vida diária e nove atividades instrumentais da vida diária após quatro anos. A renda contextual foi obtida a partir do Censo Demográfico 2010. Foram realizadas análises de regressão logística multinível com modelos de ajuste para variáveis individuais. RESULTADOS: A incidência de incapacidade nas atividades básicas da vida diária foi de 15,8% (IC95% 13,8-17,9) e nas atividades instrumentais da vida diária de 13,4% (IC95% 11,6-15,5). Houve associação significativa entre a renda contextual e a incidência de incapacidade nas atividades básicas da vida diária. Tendo como referência os idosos residentes no tercil inferior de renda, aqueles que moravam nos tercis intermediários e no de maior renda tiveram 37% (IC95% 0,41-0,96) e 21% (IC95% 0,52-1,19) menores chances de desenvolver incapacidade, respectivamente. Para a incidência de incapacidade nas atividades instrumentais da vida diária não foram verificadas associações estatisticamente significativas. CONCLUSÕES: A renda contextual influencia no desenvolvimento de incapacidade nas atividades básicas da vida diária em idosos, devendo ser alvo de ações para redução de iniquidades socioeconômicas e promoção da longevidade com independência.

Effect of mobile phone-based health education on independent living ability of postoperative patients with hypertensive intracerebral hemorrhage / 现代临床护理

Objective To explore the effect of mobile phone-based health education on independent living ability of postoperative patients with hypertensive intracerebral hemorrhage. Methods Sixty patients with postoperative hypertensive intracerebral hemorrhage who underwent craniotomy in our hospital during March 2016 and December 2017 were divided into experimental and control groups, 30 cases in each group, according to the random number table method. Functional training conducted during hospitalization in both groups. After discharge, the control group used a telephone for follow-ups every 2 weeks and took part in a face-to-face training in the first month to implement continuous nursing intervention for a total of 3 months. After discharge, in the experimental group, various information forms of rehabilitation training for hypertensive intracerebral hemorrhage were comprehensively integrated, and mobile phone education was used for a total of 3 months in addition to the training as in the control group. The two groups were compared in terms of independent living ability between the two groups. Result The scores of independent living ability and self-care ability, action ability, metastatic ability, social cognitive ability and communication ability of the experimental group were significantly higher than those of the control group (P＜0.05). Conclusion The mobile phone-based education can promote the effect of rehabilitation exercise in patients with hypertensive intracerebral hemorrhage, so as to promote the independent living ability of patients.

Factors Influencing Activities-specific Balance Confidence in Community-dwelling Old Adults

PURPOSE: The purpose of this study is to identify factors influencing activities-specific balance confidence in community-dwelling older adults. METHODS: This is secondary analysis of data from an intervention study for improving cognitive function. The data were collected from March 2 to September 30, 2017 at a senior center. Data of 131 older adults were included for this secondary analysis, and were analyzed by using t-test, ANOVA, and multiple regression. RESULTS: The mean score of activities-specific balance confidence is 65.08 out of a possible range of 0–100. The significant factors affecting activities-specific balance confidence among old adults include ‘more than 85 years old’, ‘waist circumference’, ‘depressive symptoms’, ‘activity restriction due to fear of falling’, and ‘self-rated health’ which explained 52.8% of the variance. CONCLUSION: The study results indicate that psychologic factors as well as physical condition should be considered for interventions to increase activities-specific balance confidence.

Handgrip Strength and Its Associated Factors among Community-dwelling Elderly in Sri Lanka: A Cross-sectional Study

PURPOSE: Low muscle strength is central to geriatric physical disabilities and mortality. The purpose of the present study was to examine handgrip strength (HGS) and its associated factors among community-dwelling older people in Sri Lanka. METHODS: A cross-sectional study was conducted in the Kandy district using multistage sampling. A total of 999 older people were recruited, with a female preponderance. Data were collected using interviewer-administered questionnaires on demographic characteristics, depression, and physical activity. Anthropometric measurements including weight, height, mid-upper arm circumference, calf circumference, and HGS were recorded. Complex sample general linear model was used to examine the association between HGS and its associated factors. RESULTS: The mean highest HGS of the study group was 12.56 kg (95% confidence interval: 11.94–13.19). Male older people had a higher HGS (17.02, 95% confidence interval: 15.55–18.49 kg) than females (10.59, 95% confidence interval: 10.12–11.06 kg). For both men and women, older age was associated with lower HGS, while mid-upper arm circumference was associated with better HGS. Diabetes mellitus, vegetarian diet, and alcohol consumption were associated with HGS for women only. CONCLUSION: Men had a higher HGS compared with women. Age, mid-upper arm circumference, diabetes mellitus, vegetarian diet, and alcohol consumption were factors associated with HGS among community-dwelling older people in Kandy district, Sri Lanka. HGS can be used as a feasible strategy to improve health status of older people by community health nurses.

Relato de um caso de associação de VACTERL e discussão acerca de seus aspectos prognósticos / Case report of VACTERL association and discussion about its prognostic aspects

Associação de VACTERL corresponde à combinação de três ou mais das seguintes malformações: Vertebrais, atresia Anal, alterações Cardíacas, fístula Traqueo-esofágica com atresia de Esôfago, anomalias Renais e de membros (Limbs). Sua etiologia ainda é desconhecida, mas acredita-se que seja multifatorial, associada a mutações em genes como FOXF1 e ZIC3 e a fatores de risco maternos. No presente relato, descreve-se um caso de associação de VACTERL diagnosticado no Hospital Universitário Regional de Maringá (HURM). Paciente L.P.N., sexo feminino, um dia de vida, foi referenciada para UTI neonatal devido ao quadro de desconforto respiratório, cianose e salivação intensa na sala de parto, sendo diagnosticada com atresia de esôfago. No 9º dia de vida realizou-se correção cirúrgica da atresia esofá- gica e fístula traqueo-esofágica. Outras malformações foram observadas, detectando-se comunicação interventricular perimembranosa moderada e rim direito ausente, sugerindo diagnóstico de VACTERL. Com três anos e nove meses, apresenta-se eutrófica, saudável e em acompanhamento multiprofissional. Apesar de ser uma afecção rara, esta associação necessita de expertise dos profissionais de saúde, para que haja detecção precoce e tratamento de suas alterações e complicações. Além disso, se manejada da forma correta, a criança apresenta boa evolução e perspectivas de uma vida normal. O prognóstico depende da extensão e da gravidade das anomalias associadas, bem como da capacitação dos pais e equipe profissional (AU)

VACTERL Association corresponds to the combination of three or more of the following defects: Vertebral, Anal atresia, Cardiac changes, Tracheo-esophageal fistula, Esophagus atresia, Renal anomalies and Limbs. Its etiology is still unknown, but believed to be multifactorial, associated with mutations in genes as FOXF1 and ZIC3 and maternal risk factors. This report describes a case of VACTERL diagnosed in the Regional University Hospital of Maringá (HURM). L.P.N. female patient, 1 day in life, was referred to neonatal ICU due to respiratory discomfort, cyanosis and salivation in the delivery room, and diagnosed with esophageal atresia. On the 9th day of life surgical repair of esophageal atresia and tracheoesophageal fistula was performed. Other malformations were observed by detecting moderate perimembranous ventricular septal defect and absent right kidney, suggesting perimembranous ventricular septal defect and absent right kidney, suggesting VACTERL diagnostic. At the age of 3 years and 9 months, presents eutrophic, healthy, and in multiprofessional follow up. Despite being a rare disease, this association requires expertise of health professionals, in order to be early detected and to treat its alterations and complications. Also, if handled correctly, the child shows good performance and prospects of a normal life. The prognosis depends on the extent and severity of associated anomalies, as well as the training of parents and professional staff (AU)

Influence of proximal femur fractures in the autonomy and mortality of elderly patients submitted to osteosynthesis with cephalomedullary nail / Influência das fraturas do fêmur proximal na autonomia e mortalidade dos pacientes idosos submetidos a osteossíntese com haste cefalomedular

Abstract Objective To determine the autonomy and mortality of elderly patients submitted to proximal femoral osteosynthesis with cephalomedullary nail after hip fracture. Methods Retrospective study with 61 patients with proximal femoral fractures submitted to cephalomedullary nail osteosynthesis. The authors analyzed the medical records and collected information from the preoperative period. Patients were questioned regarding pain, postoperative autonomy, and degree of satisfaction. The total number of deaths was verified. The results were then correlated. Results The mean age was 84 years, predominantly female (82%). In the postoperative evaluation, 45% of the patients presented worsened levels of autonomy. The majority of patients presented mild pain (61%) on the VAS scale. The mortality rate was 24.6%, and the mean time of preoperative hospitalization was three days. The factors that presented statistical significance regarding postoperative autonomy were the time elapsed from the trauma until the moment of surgery, ASA score, fracture stability, and previous functional status of the patients. The mortality rate was associated with three main factors: advanced age, ASA score, and preoperative hospitalization time. Conclusion The patient's previous autonomy positively influenced the functional outcome and postoperative recovery. Unstable fractures presented worse results for pain and ambulation in a follow-up of 27 months. Hip fracture is a risk factor associated with mortality and decreased independence in patients over 65 years of age.

Resumo Objetivo Determinar a autonomia e a mortalidade de pacientes idosos após fratura do quadril submetidos a osteossíntese do fêmur proximal com haste cefalomedular. Métodos Estudo retrospectivo com 61 pacientes com fratura do fêmur proximal submetidos a osteossíntese com haste cefalomedular. Os prontuários foram analisados e os registros clínicos do pré-operatório foram coletados. Os pacientes foram reavaliados e perguntados em relação a dor, autonomia pós-operatória e grau de satisfação. Foi verificado o número total de óbitos. Os resultados foram então correlacionados. Resultados A média de idade foi de 84 anos, com predominância do sexo feminino (82%). Na avaliação pós-operatória, 45% dos pacientes apresentaram pioria em seu nível de autonomia. A maioria dos pacientes apresentou dor leve (61%) pela escala EVA. A taxa de mortalidade encontrada foi de 24,6% e o tempo médio de internação pré-operatória foi de três dias. Os fatores que apresentaram significância estatística quanto à autonomia pós-operatória foram o tempo decorrido do trauma até o momento da cirurgia, escore ASA, estabilidade da fratura e estado funcional prévio do paciente. A taxa de mortalidade foi associada a três fatores principais: idade avançada, escore ASA e tempo de internação pré-operatória. Conclusão A autonomia prévia do paciente influenciou positivamente o resultado funcional e a recuperação pós-operatória. Fraturas instáveis apresentaram piores resultados para dor e deambulação em um seguimento de 27 meses. A fratura do quadril é um fator de risco associado à mortalidade e diminuição da independência em pacientes acima de 65 anos.

Validity of questions about activities of daily living to screen for dependency in older adults / Validade das perguntas sobre atividades da vida diária para rastrear dependência em idosos

ABSTRACT OBJECTIVE To determine the criterion validity of the activities of daily living present in functionality questionnaires in older adults for population surveys and to identify which activities are valid to quantify the real daily need for help of this population. METHODS This is a population sample of older adults stratified by levels of functionality, according to self-perception of dependency in the activities of daily living. Self-perception was compared with the gold standard - direct observation of these activities in the household of older adults by a trained professional, blinded to the answers in the questionnaire. At the visit, it was decided if the older adult needed help to perform any of the activities of daily living for the research. The sensitivity of each activity of daily living was greater when the self-assessment that there was no need for help coincided with the assessment of the professional. Specificity indicates coincidence regarding the need for help in the activities of daily living - coefficients of sensitivity and specificity above 70% were considered as indicative of good validity. RESULTS Self-assessments showed better sensitivity than specificity - older adults and observers agreed more on daily independency than on dependency. All activities showed sensitivity above 70%. Some activities had low (go shopping: 55%) or very low specificity (brush the hair: 33%). The best specificities were to take a shower and dress up (95.8% for both), among the personal ones, and to use transportation and perform banking transactions (78% for both), among the instrumental ones. CONCLUSIONS Activities of daily living can be valid indicators of functional dependence. The best coefficients of validity were generally obtained for personal activities. Some activities with good sensitivities and specificities - walk 100 meters, take a shower, and lie down in and get out of the bed - can be used to classify older adults into low, average, and high need for help depending on the affected activities and, therefore, can help in the planning of health services aimed at them.

RESUMO OBJETIVO Determinar a validade de critério das atividades de vida diária constantes em questionários de funcionalidade em idosos para inquéritos populacionais e identificar quais atividades são válidas para quantificar a necessidade real de ajuda diária dessa população. MÉTODOS Amostra populacional de idosos estratificada por níveis de funcionalidade, segundo a autopercepção de dependência nas atividades de vida diária. Autopercepção foi comparada com o padrão ouro - observação direta no domicílio dos idosos nessas atividades por profissional treinado e cego para respostas no questionário. Na visita decidiu-se, para efeito da pesquisa, se o idoso precisava de ajuda para realizar alguma das atividades de vida diária. A sensibilidade de cada atividade de vida diária foi maior quando a autoavaliação de que não havia necessidade de ajuda coincidiu com a avaliação do profissional. A especificidade indica coincidência quanto à necessidade de ajuda na atividades de vida diária - coeficientes de sensibilidade e especificidade acima de 70% foram considerados indicativos de boa validade. RESULTADOS As autoavaliações mostraram sensibilidade melhor que especificidade - idosos e observadores concordaram mais quanto à independência do que quanto à dependência cotidiana. Todas as atividades mostraram sensibilidade acima de 70%. Algumas atividades tiveram uma especificidade baixa (fazer compras: 55%) ou muito baixa (pentear os cabelos: 33%). As melhores especificidades foram tomar banho e vestir-se (95,8% ambas), entre as pessoais, e utilizar transporte e realizar movimento bancário (ambas com 78%), entre as instrumentais. CONCLUSÕES Atividades de vida diária podem ser indicadores válidos de dependência funcional. Os melhores coeficientes de validade em geral foram obtidos pelas atividades pessoais. Destacam-se algumas atividades com boas sensibilidades e especificidades - andar 100 metros, tomar banho e levantar/deitar na cama - que podem servir para classificar os idosos em baixa, média e alta necessidade de ajuda dependendo das atividades afetadas e, dessa forma, auxiliar no planejamento dos serviços de saúde voltados aos idosos.

Concept Analysis of Self-reliance in Persons with Psychiatric Disabilities / 정신간호학회지

PURPOSE: The purpose of this study was to construct the clear definition of the concept 'self-reliance' among persons with psychiatric disabilities. METHODS: A hybrid model (comparative analysis between literature review findings and actual interview data) was employed to extract essential components of 'self-reliance' and develop its clear definition among those subjects. RESULTS: Self-reliance appeared to have complex nature and consist of multi-dimensional meaning units with 4 different levels (including 8 attributes and 21 indicators). 4 different levels of dimensions and their 8 attributes are suggested as follows: 1) Personal dimension (increasing insight, improving motivation for recovery); 2) Procedural dimension (encouraging empowerment and overcoming internalized stigma, self-esteem); 3) Institutional dimension (utilizing social and government support, formulating social-networks); 4) Consequential dimension (financial independence, planning for independent housing, self-determination). CONCLUSION: The findings of this study will contribute to developing valid measurements to examine self-reliance and establishing nursing interventions aiming at increasing self-reliance in persons with psychiatric disabilities.

Effects of an integrated geriatric group balance class within an entry-level Doctorate of Physical Therapy program on students' perceptions of geriatrics and geriatric education in the United States / 보건의료교육평가

This study was aimed at determining the effect of an integrated group balance class for community-dwelling older adults within entry-level physical therapist coursework on student perceptions of geriatric physical therapy and geriatric physical therapy education. Twenty-nine Doctor of Physical Therapy (DPT) students, 21–33 years old, in their second year of coursework in 2012, participated in an integrated clinical experience with exposure to geriatric patients at an outpatient facility at the Louis Stokes Cleveland Department of Veterans Affairs Medical Center in Akron, Ohio, USA. Student perceptions were collected before and after participation in the 8-week balance class. The Wilcoxon sign-ranked test was used to identify differences in perceptions after participation in the group balance class. Cohen's d-values were calculated to measure the size of the pre-participation to post-participation effect for each measure. At the conclusion of the group class, the DPT students demonstrated an increase in positive perceptions of geriatric physical therapy in 8 measures, with small effect sizes (d=0.15–0.30). Two perceptions of geriatric physical therapy demonstrated a significant positive increase (P<0.05) with moderate effect sizes (d=0.47 and d=0.50). The students’ perceptions of geriatric education in the curriculum demonstrated a large positive effect for quality (d=1.68) and enjoyment (d=1.96). Positive changes were found in most of the perceptions of geriatrics and geriatric education after participation, suggesting that integrated clinical experiences with geriatric patients are an effective way to positively influence perceptions of physical therapist practice with older adults.

Correlation between balance and the level of functional independence among elderly people / Correlação entre o equilíbrio e o nível de independência funcional em idosos

CONTEXT AND OBJECTIVE: As the overall number of elderly people increases there is a corresponding rise in the number of older persons with disabilities. In order to examine whether there is any relationship between balance and activities of daily living, we evaluated balance and daily activities among elderly people living in the community. DESIGN AND SETTING: Cross-sectional study at Universidade Estadual Paulista (Unesp), Marília, São Paulo, Brazil. METHODS: The study included 70 community-dwelling elderly people aged 65 and over. Balance was evaluated using the Berg Balance Scale (BBS) and physical independence in daily activities was evaluated using the Barthel Index (BI). The Spearman correlation coefficient was used to examine the relationship between the parameters evaluated. Significance was set at the level of 5% (P < 0.05). RESULTS: The population's mean age was 70.5 ± 5 years. The mean BBS score was 50.9 ± 4.1, whereas the mean BI score was 98.1 ± 2.8. Statistically significant relationships were found between the BBS and BI (r = 0.41; P = 0.0004); between age and BI (r = -0.24; P = 0.04); and between age and BBS (r = -0.57; P = 0.0001). CONCLUSIONS: The results showed that among elderly people, there are correlations between age, balance and independence level.

CONTEXTO E OBJETIVOS: Como está ocorrendo um aumento do número total de pessoas idosas, há um aumento correspondente de idosos com incapacidades. Para examinar se há alguma relação entre equilíbrio e atividades de vida diária, nós avaliamos o equilíbrio e as atividades de vida diária em idosos da comunidade. TIPO DE ESTUDO E LOCAL: Estudo transversal na Universidade Estadual Paulista (Unesp), Marília, São Paulo, Brasil. MÉTODOS: O estudo incluiu 70 idosos moradores da comunidade com 65 anos ou mais de idade. O equilíbrio foi avaliado por meio da Escala de Equilíbrio de Berg (EEB) e a independência nas atividades de vida diária foi avaliada usando o Índice de Barthel (IB). O coeficiente de correlação de Spearman foi usado para examinar a relação entre os parâmetros avaliados. Foi fixado um valor significante ao nível de 5% (P < 0,05). RESULTADOS: A média de idade da população foi de 70,5 ± 5,0 anos. O escore médio da EEB foi de 50,9 ± 4,1, enquanto o do Índice Barthel foi de 98,1 ± 2,8. Uma correlação significativa foi encontrada entre os escores da EEB e o IB (r = 0,41; P = 0,0004), entre idade e Índice de Barthel (r = -0,24; P = 0,04) e entre idade e escores da EEB (r = -0,57; P = 0,0001). CONCLUSÕES: Os resultados mostraram que, em idosos, há correlação entre idade, equilíbrio e nível de independência.

Ativismo e deficiência: um estudo sobre os repertórios que dão sentido à vida independente / Activismo y deficiencia: un estudio sobre los repertorios que dan sentido a la vida independiente / Activism and disability: a study on the meanings of independent living

Neste trabalho, buscou-se identificar os repertórios usados por ativistas do Movimento de Vida Independente para dar sentido à noção de vida independente. Para isso, foram analisados documentos de domínio público produzidos por esses ativistas, tais como livros, sítios de internet, livretos, material publicitário, jornais institucionais, etc., bem como foram realizados grupos focais com alguns de seus membros. Essa análise permitiu constatar que os principais repertórios usados para dar sentido a essa noção são: independência, autonomia, empoderamento, autodeterminação, participação e igualdade de oportunidade. Permitiu, também, concluir que vida independente é entendida como práxis, ou seja, não há filosofia sem a prática de vida independente e vice-versa. O uso desses repertórios indica que os ativistas buscam ser reconhecidos como atores sociais, participar ativamente da sociedade e assumir o controle de suas vidas.

The goal of this study was to identify the repertoires used by activists of the Independent Living Movement to convey the meaning of independent living. Documents of public domain produced by those activists, including books, websites, advertisement material and institutional papers, were reviewed, and two focal groups were created for analysis. The conclusion of the analysis identified the repertories used to convey the concept of independent living as independence, autonomy, empowerment, self-determination, participation and equal opportunity. Moreover, independent living was understood as praxis, in other words, as the process of transforming theoretical knowledge into practice. The use of those repertories indicates that the activists seek recognition as social actors, that is, they wish to be actively involved in society and control their own lives.

En este trabajo, se ha tratado de identificar los repertorios que los activistas del Movimiento de Vida Independiente utilizan para dar sentido a la noción de vida independiente. Para eso, fueron analizados documentos de dominio público producidos por estos activistas, tales como libros, sitios de Internet, folletos, anuncios, periódicos institucionales etc., así como fueron realizados dos grupos focales con algunos de sus miembros. Este análisis ha permitido constatar que los principales repertorios utilizados para dar sentido a esta noción son: independencia, autonomía, empoderamiento, autodeterminación, participación e igualdad de oportunidades. Ha permitido, también, concluir que la vida independiente es entendida como praxis, o sea, no hay filosofía sin la práctica de la vida independiente y viceversa. El uso de estos repertorios indica que los activistas tratan de ser reconocidos como actores sociales, participar activamente en la sociedad y tomar el control de sus vidas.