Avaliação da qualidade de vida de pessoas idosas com HIV assistidos em serviços de referência / Quality of life evaluation of elderly people with HIV assisted in referral services

Resumo O objetivo deste estudo foi avaliar a qualidade de vida de pessoas idosas que vivem com HIV em Recife-PE. Estudo descritivo, quantitativo de corte transversal com amostra de conveniência e aleatória composta por 241 sujeitos. Aplicou-se o instrumento HIV/AIDS Target Quality of life (HAT-Qol). A qualidade de vida esteve comprometida nos domínios preocupações com o sigilo (51, 89), função sexual (63) e preocupações financeiras (64, 74). As melhores pontuações foram em preocupações com a medicação (87, 91), preocupações com a saúde (86, 80) e aceitação do HIV (82, 78). Os homens apresentaram pontuações para uma melhor qualidade de vida em todos os domínios. Conclui-se que dentre os fatores associados à melhor qualidade de vida nos homens está a escolaridade, a situação financeira, sua autopercepção e o estigma relacionado ao HIV, que parece ser mais forte em relação às mulheres.

Abstract This study aimed to evaluate the quality of life of elderly living with HIV in Recife (PE), Brazil. This is a descriptive, quantitative cross-sectional study with convenience and random sample of 241 subjects. The HIV/AIDS Target Quality of Life (HAT-QoL) instrument was applied. The quality of life was compromised in the areas of confidentiality (51.89), sexual function (63) and financial concerns (64.74). The best scores were medication concerns (87.91), health concerns (86.80), and HIV acceptance (82.78). Men scored for a better quality of life in all realms. We can conclude that among the factors associated with better quality of life in men are schooling, financial situation, self-perception and HIV-related stigma, which seems to be stronger compared with women.

Relationship between obesity, sarcopenia, sarcopenic obesity, and bone mineral density in elderly subjects aged 80 years and over / Relação entre obesidade, sarcopenia, obesidade sarcopênica e densidade mineral óssea em idosos com 80 anos ou mais

ABSTRACT Objective This study sought to analyze the relationship between the components and aggravations of body composition (obesity, sarcopenia, and sarcopenic obesity) and bone mineral density in elderly subjects aged ≥80 years. Methods A cross-sectional study design was utilized to assess 128 subjects aged between 80 and 95 years. Body composition and bone mineral density were measured by dual energy X-ray absorptiometry. Gait speed was assessment by walking test. The statistical analyses included Spearman's correlation, one-way analysis of variance, the chi-squared test, and binary logistic regression analysis. Results The elderly subjects with sarcopenia had lower bone mineral density compared to the obesity group, with higher risk for presence of osteopenia/osteoporosis in the spine (OR: 2.81; CI: 1.11-7.11) and femur (OR: 2.75; CI: 1.02-7.44). Obesity was shown to be a protective factor for osteopenia/osteoporosis in the spine (OR: 0.43; CI: 0.20-0.93) and femur (OR: 0.27; CI: 0.12-0.62). Conclusion It was found that lean mass is more directly related to bone mineral density (total, femur, and spine) and sarcopenia is associated with osteopenia/osteoporosis. Obesity represents a possible protective factor for osteopenia/osteoporosis in elderly subjects aged 80 years and over.

RESUMO Objetivo Analisar a relação entre os componentes e agravos da composição corporal (obesidade, sarcopenia e obesidade sarcopênica) com a densidade mineral óssea em idosos com idade ≥ 80 anos. Métodos Estudo com delineamento transversal que avaliou 128 sujeitos entre 80 e 95 anos. A composição corporal e densidade mineral óssea foram mensuradas por meio da técnica de absorciometria de raios X de dupla energia. A velocidade de caminhada foi avaliada pelo teste de caminhada usual. Para análise estatística foram feitos os testes de correlação de Spearman, análise de variância com um fator, teste qui-quadrado e análise de regressão logística binária. Resultados Os idosos com sarcopenia apresentaram valores menores de DMO quando comparados com o grupo obesidade com maior chance de risco para a presença de osteopenia/osteoporose na coluna (OR: 2,81; IC: 1,11-7,11) e fêmur (OR: 2,75 IC: 1,02-7,44). Obesidade apresentou fator de proteção para osteopenia/osteoporose na coluna (OR: 0,43; IC: 0,20-0,93) e fêmur (OR: 0,27; IC: 0,12-0,62). Conclusão Observou-se que a massa magra está diretamente relacionada com a DMO (total, fêmur e coluna) e que a sarcopenia está associada à osteopenia/osteoporose em idosos com 80 anos ou mais.

Prognostic Accuracy of the GRACE Score in Octogenarians and Nonagenarians with Acute Coronary Syndromes / Acurácia Prognóstica do Escore GRACE em Octogenários e Nonagenários com Síndromes Coronarianas Agudas

Abstract Background: The GRACE Score was derived and validated from a cohort in which octogenarians and nonagenarians were poorly represented. Objective: To test the accuracy of the GRACE score in predicting in-hospital mortality of very elderly individuals with acute coronary syndromes (ACS). Methods: Prospective observational study conducted in the intensive coronary care unit of a tertiary center from September 2011 to August 2016. Patients consecutively admitted due to ACS were selected, and the very elderly group was defined by age ≥ 80 years. The GRACE Score was based on admission data and its accuracy was tested regarding prediction of in-hospital death. Statistical significance was defined by p value < 0,05. Results: A total of 994 individuals was studied, 57% male, 77% with non-ST elevation myocardial infarction and 173 (17%) very elderly patients. The mean age of the sample was 65 ± 13 years, and the mean age of very elderly patients subgroup was 85 ± 3.7 years. The C-statistics of the GRACE Score in very elderly patients was 0.86 (95% CI = 0.78 - 0.93), with no difference when compared to the value for younger individuals 0.83 (95% CI = 0.75 - 0.91), with p = 0.69. The calibration of the score in very elderly patients was described by χ2 test of Hosmer-Lemeshow = 2.2 (p = 0.98), while the remaining patients presented χ2 = 9.0 (p = 0.35). Logistic regression analysis for death prediction did not show interaction between GRACE Score and variable of very elderly patients (p = 0.25). Conclusion: The GRACE Score in very elderly patients is accurate in predicting in-hospital ACS mortality, similarly to younger patients.

Resumo Fundamento: O Escore GRACE foi derivado e validado por coorte de questionável representatividade de indivíduos octogenários e nonagenários. Objetivo: Testar a acurácia do Escore GRACE na predição de óbito hospitalar em indivíduos muito idosos com síndromes coronarianas agudas (SCAs). Métodos: Coleta prospectiva realizada em unidade coronariana de hospital terciário, durante o período de setembro de 2011 a agosto de 2016. Indivíduos consecutivamente internados com SCA foram selecionados e o grupo muito idoso definido por idade ≥ 80 anos. A acurácia do Escore GRACE foi testada quanto à predição de óbito hospitalar. A significância estatística foi definida por valor p < 0,05. Resultados: Foram estudados 994 indivíduos, sendo 57% do sexo masculino, 77% com SCA sem supradesnível do segmento ST e 173 pacientes muito idosos. A média geral de idade foi 65 ± 13 anos, e a média de idade dos pacientes muito idosos, 85 ± 3,7 anos. A estatística-C do Escore GRACE em indivíduos muito idosos foi de 0,86 (95% IC = 0,78 - 0,93), sem diferença em relação aos indivíduos mais jovens (0,83; 95% IC = 0,75 - 0,91), com p = 0,69. A calibração do escore em muito idosos foi descrita por Teste χ2 de Hosmer-Lemeshow = 2,2 (p = 0,98), enquanto os demais pacientes apresentaram χ2 = 9,0 (p = 0,35). A análise de regressão logística para predição de óbito não revelou interação entre Escore GRACE e a variável muito idoso (p = 0,25). Conclusão: O Escore GRACE em indivíduos muito idosos é acurado para predição de mortalidade hospitalar em SCA, semelhante para indivíduos mais jovens.

The clinico-pathologic characteristics of the very elderly Chinese patients with kidney disease / 中华老年医学杂志

Objective To evaluate the clinico-pathologic presentations and prognosis in the very elderly patients undergoing renal biopsy.Methods The patients who underwent renal biopsy in Nephrology Center of the First Affiliated Hospital of Zhengzhou University were screened from May 2012 to March 2016.All patients were divided into observation group (aged ≥80 years) and control group (aged 65-70 years).The clinico-pathological classifications and prognosis were compared between the two groups.Results Primary glomerulopathy was the most frequent pathologic diagnosis in observation and control groups[20(60.6％) and 64(64.0％),respectively,P=0.726].Among primary glomerulopathy,membranous nephropathy was the most frequent histopathological type[10(50.0％) and 40 (62.5％)] in observation and control groups,respectively,(P =0.320).Among secondary glomerulopathy,the number of patients in observation group were 10 cases (30.3％) and were 13 cases (13.0％) in control group (t=5.194,P＜0.05),with no significant differences between the two groups in amyloid degeneration,ANCA-associated vasculitis,HBV-associated Glomerulonephritis,and nephritis of Schonlein-Henoch purpura.In the very elderly patients with nephrotic syndrome,glomerular minimal change was the most common histological type [7 (30.4％)],followed by membranous nephropathy[6 (26.1％)].Furthermore,there were no side effects of perinephric hematoma,gross hematuria,arteriovenous fistula or other complications.Conclusions The pathological types distribution of patients aged ≥ 80 versus 65-70 years is different.And the renal biopsy is relatively safe and has an important role for the very elderly patients.

Prevalence of commuting physical activity and associated factors in long-lived older adults / Prevalência de atividade física de deslocamento e fatores associados em idosos longevos

Abstract The aim of this study was to estimate the prevalence of commuting physical activity and associate sociodemographic, behavioral and health characteristics in long-lived older adults of Florianópolis/SC. This cross-sectional epidemiologic study included 343 individuals aged 80 and older; these individuals are members of community groups registered in the municipality of Florianópolis/SC. Sociodemographic information and health and behavior data were collected. To assess physical activity, the “commuting” domain of the International Physical Activity Questionnaire (IPAQ) was used, adapted for older adults. Data were analyzed using Stata 11.0 with Logistic regression expressed in odds ratios and 95% confidence interval. The prevalence of commuting physical activity was 19.5%. The oldest members of the group (p= 0.011; OR= 0.90; 95%CI= 0.83/0.98), with worse health perception (p< 0.001; OR= 0.33, 95%CI= 0.18/0.60) and with hypertension diagnosis (p= 0.009; OR=0.47; 95%CI= 0.27/0.83) had lower odds ratio of commuting physical activity. Knowledge about sociodemographic, behavioral and health characteristics associated with commuting physical activity can serve as a basis for the development of programs and actions to encourage commuting physical activity among long-lived older adults.

Resumo O objetivo deste estudo foi estimar a prevalência da realização de atividades físicas de deslocamento e associar as características sociodemográficas, comportamentais e de saúde de idosos longevos de Florianópolis/SC. Trata-se de um estudo epidemiológico transversal, com 343 idosos, com 80 anos ou mais de idade, participantes dos grupos de convivência, cadastrados na Prefeitura Municipal de Florianópolis/SC. Foram obtidas informações sociodemográficas, de saúde e comportamentais. Para avaliar a realização de atividade física, utilizou-se o domínio “deslocamento” do Questionário Internacional de Atividade Física (IPAQ), adaptado para idosos. Os dados foram analisados no programa estatístico Stata 11.0, por meio de regressão logística expresso em Odds Ratio e intervalo de confiança de 95%. A prevalência da realização de atividade física no deslocamento foi de 19,5%. Os longevos com maior idade (p= 0,011; OR= 0,90; IC95%= 0,83/0,98), pior percepção de saúde (p< 0,001; OR= 0,33; IC95%= 0,18/0,60) e com diagnóstico de hipertensão arterial sistêmica (p= 0,009; OR= 0,47; IC95%= 0,27/0,83) apresentaram menores chances de realização de atividades físicas de deslocamento. O conhecimento sobre as características sociodemográficas, comportamentais e de saúde, associadas à realização de atividade física de deslocamento de idosos longevos, pode servir de base para a elaboração de ações que promovam a atividade física de deslocamento em idosos longevos.

Analysis of serum microelement in patients aged 80 years and over / 中华老年医学杂志

Objective To compare the serum microelement changes between patients aged ≥80years and adults aged ＜ 60 years,and to compare the levels of serum microelement,total protein,albumin,hemoglobin between the long term in-bed and non in-bed oldest patients.Methods Beijing Bohui BH5100 type atomic absorption spectrometer was used to determine serum microelement.Total protein,albumin,hemoglobin were also determined.Results The amounts of ferrum,zinc,calcium,copper,magnesium were (7.21 ± 1.21) mmol/L,(93.29 ± 10.96)mmol/L,(1.63 ± 0.21)mmol/L,(17.31±3.61)mmol/L,(1.49±0.20)mmol/L in people aged over 80 years,(8.91±1.25)mmol/L,(121.85±11.24)mmol/L,(1.51±0.23)mmol/L,(15.89±3.87)mmol/L,(1.51±0.21)mmol/L in people aged less than 60 years,respectively.The ratios of Ferrum deficiency were 42.9 ％,zinc deficiency 14.3％,calcium deficiency 21.4％,copper deficiency 14.3％ in oldest-old,whereas were 9.1％,13.6 ％,31.8％,27.3％ in people aged less than 60 years.The amount of ferrum was significantly lower in people aged over 80 years than in people aged less than 60 years (P＜0.01).Proportion of ferrum deficiency was higher in patients aged over 80 years (P＜0.01).The amount of calcium and copper was markedly lower in people aged less than 60 years than in people aged over 80 years (P＜0.01).The proportions of calcium,copper deficiency were higher in people aged less than 60 years (P＜0.01).The amounts of ferrum,zinc,total protein,albumin,hemoglobin of the patients aged over 80 years in long-term in-bed group were significant decreased as compared with those of people in non long-term in-bed group [(6.44±0.89)mmol/L vs.(8.16±1.16)mmol/L,(84.48±8.98)mmol/L vs.(103.62±10.31)mmol/L,(62.8±3.9)g/L vs.(66.3±1.7)g/L,(33.7±2.6)g/L vs.(36.7±l.8)g/L,(109.0±12.5)g/L vs.(132.0±5.2)g/L,all P＜0.01].The amount of calcium of people in none long-term group was much lower [(1.57±0.23)mmol/L vs.(1.71±0.19)mmol/L,P＜0.01].Ferrum,zinc,calcium and copper deficiencies were 60.9％,18.8％,13.0％,13.0％ in long-term in-bed group,21.1％,8.8％,31.6％,15.8％ in non long-term in-bed group.Proportion of ferrum deficiency was higher in long term in-bed group than non long-term in-bed group (P＜0.01).Proportion of calcium deficiency was higher in non long-term in-bed group than long-term in bed group (P＜0.01).There was no significant difference in the amount of copper between people in long term in bed group and non long-term in-bed group (P＞0.05).There was no absence of magnesium in both two groups.Conclusions There is more absence of ferrum,zinc,total protein,albumin,hemoglobin in the patients aged 80 years and over in long-term in-bed.There is more calcium and copper absence of people aged less than 60 years.So it is necessary to supply high ferrum food and nutrients in order to get well sooner,especially to patients aged over 80 years.

Convívio e cuidado familiar na quarta idade: qualidade de vida de idosos e seus cuidadores / Living together and family care at the fourth age: quality of life for seniors and their caregivers

É importante almejar qualidade de vida ou bem-viver aos idosos que já atingiram 80 ou mais anos de idade, com autonomia e independência. Com o avançar da idade, entretanto, torna-se mais frequente a dependência dos cuidados da família por parte dos idosos. OBJETIVO: Avaliar a dinâmica da família, a qualidade e o estilo de vida de idosos da quarta idade e de seus familiares cuidadores. Método: Estudo descritivo do qual participaram 100 idosos e seus cuidadores. Os dados foram coletados por meio do Questionário do Perfil da Família Cuidadora, o Family APGAR, Whoqol-Old, Whoqol-Breve e o Estilo de vida de Nahas. RESULTADO: A amostra de idosos caracterizou-se por ser a maioria mulher, com idade média de 84 anos, portadora de hipertensão arterial e cardiopatias. Os cuidadores (67%) viviam na casa dos próprios idosos, eram predominantemente mulheres, entre filhas e netas, sendo 20% idosos cônjuges de ambos os sexos. Embora os cuidadores tenham referido boa saúde e qualidade de vida, seu estilo de vida atingiu nível regular. Na ótica dos idosos, a família apresenta alta disfuncionalidade, embora tenham uma melhor qualidade de vida em alguns domínios e facetas. CONCLUSÃO: Com base na pesquisa, foi possível identificar a necessidade de redirecionar as políticas públicas e sociais a favor da rede de apoio à população idosa mais envelhecida, extensiva às famílias cuidadoras.

It is important to get the quality of life or well being to the elderly who reached the fourth age - 80 years or more - with autonomy and independence. However, as people grow old, reliance on family care for the elderly becomes more frequent. OBJETIVE: This study aimed to assess family dynamics, quality of life and lifestyle of elderly at the fourth age and of their family caregivers. Method: Descriptive study involving 100 elderly and their caregivers. Data were collected by applying the Family Caregiver Profile Questionnaire, Family APGAR, Whoqol-Old, Whoqol-Bref and Nahas Lifestyle. RESULTS: The elderly sample comprised mostly women, with mean age of 84 years, mostly of all with hypertension and heart diseases. Caregivers (67%) lived in the elderly's household, were mostly women, daughters and granddaughters; 20% were elderly caregivers partners from both sexes. Although caregivers have reported good health and quality of life at a good level, their lifestyle was regular. According to the elderly, families have high dysfunctionality, although they had better levels of quality life in some areas and facets. CONCLUSION: Based on the research it was possible to identify the needs of redirecting to the public and social policies, in favor of a supporting network to the aged population and their family.

The outcome and prognosis of surgical treatment for gastric carcinoma in the elderly / 中国普通外科杂志

Objective To analyze the clinicopathologic features,effect of surgical treatment and prognosis of elderly patients with gastric cancer.Methods The records of 84 elderly patients(aged 80 years or above) with gastric cancer who underwent operation in our hospital from 2000-2008 were analyzed retrospectively.Results Ten patients had early gastric cancer(1a,8 cases,1b,2cases),stage II 12 cases,stage III 45 cases(53.6%) and stage IV 17 cases.Among them,81% patients had one or more co-morbidities.Cardiovascular disease was present in 43 cases(51.2%).Resection rate was 85.7%(72/84).Radical resection rate was 60.7%(51/84).Limited nodal dissection(