Demandas clínicas e intervenções de enfermagem em consultas gerontológicas: Revisão integrativa / Demandas Clínicas e intervenciones de Enfermería en consultas gerontológicas: Una revisión integrativa / Clinical demands and nursing interventions in gerontological consultations: An integrative review

Resumen Introdução: A criação de guias que unificam as demandas clínicas prevalentes em consultas de enfermagem gerontológica e, das suas respectivas intervenções, se faz presente, devido a heterogeneidade das patologias emergentes no processo de envelhecimento, que irão precisar de cuidados. Objetivo: Identificar as demandas clínicas em consultas de enfermagem gerontológica e, as intervenções implementadas pelos(as) enfermeiros(as). Método: Revisão integrativa de pesquisas originais, publicadas entre 2018 e 2022, em inglês, espanhol e português, disponíveis nas bases de dados Scopus, MEDLINE/PubMed, BIREME/LILACS/BDENF/IBECS/BVS, SciELO e Google Scholar, pelos descritores DeCS/MESH: "Idoso"; "Enfermagem no Consultório"; "Enfermagem Geriátrica" e "Geriatria". O Rating System for the Hierarchy of Evidence for Intervention foi usado para determinar o nível de evidência da amostra final. Foram excluídos editoriais, estudos de revisão e artigos duplicados. A análise dos dados se deu pela leitura analítica e interpretativa, guiadas por um checklist. Resultados: Oito artigos foram selecionados e trouxeram demandas clínica tais como: o déficit no autocuidado para banho; autonegligência; fadiga; risco de integridade da pele prejudicada; desesperança; tristeza e depressão. As intervenções se relacionaram ao incentivo ao autocuidado; otimização dos medicamentos; estímulo a atividade física; cuidados com a pele; aconselhamento; musicoterapia e reabilitação psicossocial. Conclusão: Demandas clínicas atendidas nas consultas de enfermagem gerontológica possuem grande variação, com prevalência no domínio atividade/repouso, tais como intervenções voltadas para o tratamento e prevenção de doenças e ações visando a promoção da saúde, tendo o domínio comportamental mais expressivo.

Resumen Introducción: La creación de guías que unifiquen las demandas clínicas prevalentes en las consultas de enfermería gerontológica y sus respectivas intervenciones es necesaria, debido a la heterogeneidad de patologías emergentes en el proceso de envejecimiento que requerirán cuidados. Objetivo: Identificar las demandas clínicas en las consultas de enfermería gerontológica y las intervenciones implementadas por el personal de enfermería. Método: Revisión integrativa de investigaciones originales, publicadas entre 2018 y 2022, en inglés, español y portugués, en las bases de datos Scopus, MEDLINE/PubMed, BIREME/LILACS/BDENF/IBECS/BVS, SciELO y Google Scholar. Se utilizaron los descriptores DeCS/MESH: "Idoso"; "Enfermagem no Consultório"; "Enfermagem Geriátrica" e "Geriatria". Para determinar el nivel de evidencia de la muestra final, se usó el Rating System for the Hierarchy of Evidence for Intervention. Además, se excluyeron los editoriales, los estudios de revisión y los artículos duplicados. Los datos se analizaron mediante lectura analítica e interpretativa, guiada por una lista de verificación. Resultados: Se seleccionaron ocho artículos que aportaron demandas clínicas como déficit en el autocuidado para el baño, autodescuido, fatiga, riesgo integridad de la piel perjudicada; desesperanza, tristeza y depresión. Las intervenciones estaban orientadas al fomento del autocuidado, la optimización de la medicación, el fomento de la actividad física, el cuidado de la piel, el asesoramiento, la musicoterapia y la rehabilitación psicosocial. Conclusión: Las demandas clínicas atendidas en las consultas de enfermería gerontológica son muy variadas, con predominio en el dominio actividad/reposo, como intervenciones dirigidas al tratamiento y prevención de enfermedades y acciones dirigidas a la promoción de la salud, siendo más expresivo el dominio conductual.

Abstract Introduction: The creation of guidelines that unify the prevalent clinical demands from gerontological nursing consultations and their corresponding interventions are necessary due to the heterogeneity of emerging pathologies in the aging process that will require nursing care. Objective: To identify clinical demands in gerontological nursing consultations and the interventions implemented by nurses. Method: An integrative review of original research published from 2018 and 2022, in English, Spanish, and Portuguese, in Scopus, MEDLINE/PubMed, BIREME/lilacs/BDENF/IBECS/VHL, SciELO, and Google Scholar databases, using the DeCS/MESH descriptors: "Elderly", "Nursing in the Office", "Geriatric Nursing", and "Geriatrics". The Rating System for the Hierarchy of Evidence for Intervention was used to determine the level of evidence of the final sample. Editorials, review studies, and duplicate articles were excluded. The data were analyzed by analytical and interpretative reading, guided by a checklist. Results: Eight articles were selected that showed clinical demands such as deficits in self-care for bathing, self-negligence, fatigue, risk of damaged skin integrity, hopelessness, sadness, and depression. Interventions were related to encouraging self-care, medication optimization, encouragement of exercise, skin care, counseling, music therapy, and psychosocial rehabilitation. Conclusion: There are many different clinical demands in gerontological nursing consultations, especially associated with the domain of activity/rest. These include interventions to treat and prevent diseases, and actions aimed at health promotion, in most cases associated with the behavioral domain.

Aferição da circunferência da panturrilha no rastreio da sarcopenia em idosos / Assessment of the scope circumference in the screening of sarcopenia in elderly people / Medición de la circunferencia de la pantorrilla en el cribado de sarcopenia en ancianos

Objetivo: Analisar a prática do enfermeiro da atenção primária à saúde acerca da aferição da circunferência da panturrilha no rastreio da sarcopenia em idosos. Métodos: Estudo descritivo de abordagem qualitativa, realizado com enfermeiros que atuam na atenção primária à saúde. As entrevistas foram realizadas mediante utilização de roteiro semiestruturado, nos meses de maio a julho de 2019. Resultados: Participaram do estudo 24 enfermeiros com idade média de 31,4 anos, predominantemente do sexo feminino. O tempo de formação dos participantes variou de cinco meses a 15 anos e, a maioria dos entrevistados relatou possuir pós-graduação (n=18), principalmente nas áreas de saúde da família e urgência e emergência. A maioria não utilizava em sua prática diária a avaliação da circunferência da panturrilha e alguns a realizavam apenas em idosos hipertensos e diabéticos. Conclusão: Há uma escassa utilização da aferição da circunferência da panturrilha na prática clínica do enfermeiro, o que compromete o rastreio da sarcopenia, e consequentemente dificulta a realização de ações que minimizam as complicações desta doença. (AU)

Objective: To analyze the practice of nurses in primary health care about measuring the circumference of the calf in screening for sarcopenia in the elderly. Methods: Descriptive study with a qualitative approach, carried out with nurses who work in primary health care. The interviews were conducted using a semi-structured script, from May to July 2019. Results: 24 nurses with a mean age of 31.4 years, predominantly female, participated in the study. Participants' training time ranged from five months to 15 years, and most respondents reported having a postgraduate degree (n=18), mainly in the areas of family health and urgency and emergency. Most did not use calf circumference assessment in their daily practice and some performed it only in hypertensive and diabetic elderly. Conclusion: There is little use of calf circumference measurement in clinical nursing practice, which compromises sarcopenia screening and, consequently, makes it difficult to carry out actions that minimize the complications of this disease. (AU)

Objetivo: Analizar la práctica de enfermeras de atención primaria de salud sobre la medición de la circunferencia de la pantorrilla en el cribado de sarcopenia en el anciano. Métodos: Estudio descriptivo con abordaje cualitativo, realizado con enfermeras que laboran en la atención primaria de salud. Las entrevistas se realizaron mediante un guión semiestructurado, de mayo a julio de 2019. Resultados: Participaron del estudio 24 enfermeras con una edad promedio de 31,4 años, predominantemente mujeres. El tiempo de formación de los participantes osciló entre cinco meses y 15 años, y la mayoría de los encuestados informó tener un título de posgrado (n = 18), principalmente en las áreas de salud familiar y urgencia y emergencia. La mayoría no utilizó la evaluación de la circunferencia de la pantorrilla en su práctica diaria y algunos la realizaron solo en ancianos hipertensos y diabéticos. Conclusión: La medición del perímetro de la pantorrilla es escasa en la práctica clínica de enfermería, lo que compromete el cribado de sarcopenia y, en consecuencia, dificulta la realización de acciones que minimicen las complicaciones de esta enfermedad. (AU)

Integrative geriatric assessment. A narrative review of the scales and their use in Ecuador

This study aims to describe the main tools for integrative geriatric assessment and their use in Ecuador. We performed a narrative review with a comprehensive and systematic literature search. 261 original articles were obtained from the primary search, and after the discrimination by the researchers, 76 articles were included in the final analysis. Integrative geriatric assessments cover different areas, including cognitive function, affective function, nutritional status and functionality, and seve-ral tools that are used worldwide for this purpose. In Ecuador, a deeper analysis of their use is required to evaluate their diagnostic efficacy and applicability to impro-ve health outcomes for the elderly population.

Este estudio tiene como objetivo describir las principales herramientas de evalua-ción integral geriátrica y su uso en el Ecuador. Realizamos una revisión narrativa con una búsqueda bibliográfica exhaustiva y sistemática. De la búsqueda primaria se obtuvieron 261 artículos originales, y luego de la discriminación por parte de los investigadores, se incluyeron 76 artículos en el análisis final. La evaluación ge-riátrica cubre diferentes áreas, incluida la función cognitiva, la función afectiva, el estado nutricional y la funcionalidad, y se utilizan varias herramientas en todo el mundo para este propósito. En Ecuador se requiere un análisis más profundo de su uso para evaluar su eficacia diagnóstica y aplicabilidad con el fin de mejorar los resultados de salud de la población adulta mayor.

Fracturas de fémur distal en población geriátrica: Evaluación de estadía hospitalaria y morbimortalidad / Distal femoral fractures in the elderly: assessment of length of stay and morbimortality

INTRODUCCION Las fracturas de fémur distal (FFD) son un problema importante de salud pública. Con el envejecimiento de la población, se espera un incremento de esta lesión en los próximos años. Objetivo Describir las complicaciones y la mortalidad de las FFD en un grupo de pacientes geriátricos. MATERIALES Y METODOS Estudio descriptivo y retrospectivo de pacientes mayores de 60 años operados por FFD, todos tratados en un mismo centro, entre 2011 y 2015, con al menos 1 año de seguimiento. Se excluyeron pacientes con ficha incompleta. Se analizaron los datos demográficos y radiológicos, las complicaciones locales y sistémicas, la estadía hospitalaria y la mortalidad. RESULTADOS En total, 16 pacientes cumplieron con los criterios de selección; tenían una mediana de edad de 73 (rango: 61 a 93) años, y 14 (87,5%) eran mujeres. La clasificación de la Asociación para el Estudio de la Fijación Interna (Arbeitsgemeinschaft für Osteosynthesefragen, AO, en alemán) de las fracturas fue: A ­12 (75%); B ­ 2 (12,5%); y C ­ 2 (12,5%). No hubo casos de fractura expuesta. Un total de 9 (56,3%) pacientes fueron operados con placa condilar dinámica, 4 (25%), con placa bloqueada, y 3 (19%), con clavo retrógrado. La mediana de latencia quirúrgica fue de 10 (rango: 3 a 27) días, con una mediana de hospitalización de 14 (rango: 5 a 47) días. Complicaciones fueran presentadas por 6 (37,5%) pacientes: 2 (12,5%) casos de tromboembolismo pulmonar y 4 (25%) casos que requirieron reintervención (2 fallos de osteosíntesis, 1 artrofibrosis y 1 no unión aséptica). No hubo complicaciones infecciosas. La mortalidad a 12 meses fue de 0%. CONCLUSIONES Los pacientes con FFD en esta cohorte geriátrica presentaron una larga estadía hospitalaria, con una alta tasa de complicaciones, que incluye un 25% de reintervenciones. Pese a esto, la mortalidad a 12 meses fue de 0%

INTRODUCTION Distal femoral fractures (DFF) are a relevant problem for public health worldwide. As the population ages, an increase in the rate of these lesions is expected in the next few years. Objective To describe the complications and mortality from DFF in geriatric patients. MATERIALS AND METHODS A descriptive and retrospective study with patients aged 60 years or older who underwent surgery due to DFF. All subjects received treatment in the same trauma center from 2011 to 2015 and underwent a minimum follow-up of 1 year. Patients with incomplete medical records were excluded. We analyzed demographics, radiological findings, local and systemic complications, length of stay, and mortality rates. RESULTS In total, 16 patients met the inclusion criteria; their median age was of 72 (range: 61 to 93) years, and 14 subjects (87,5%) were female. The classification of the Association for the Study of Internal Fixation (Arbeitsgemeinschaft für Osteosynthesefragen, AO, in German) was as follows: A ­ 12 patients (75%); B ­ 2 patients (12.5%); and C ­ 2 patients (12.5%). There were no open fractures. The devices used in the operations included dynamic condylar screw (DCS) plates (9 subjects; 56%), distal femur locking compression plates (LCPs) (4 subjects; 25%), and retrograde distal femoral nails (DFNs) (3 subjects; 19%). The median time until surgery was of 10 (range: 3 to 27) days, with a median length of stay of 14 (range: 5 to 47) days. Complications were presented by 6 (37.5%) patients: 2 (12.5%) cases of pulmonary thromboembolism and 4 (25%) cases which required reintervention (2 due to hardware failure, 1 because of arthrofibrosis, and 1 due to aseptic nonunion); there were no cases of infection. The mortality rate at 12 months was of 0%. CONCLUSION The patients with DFF in this geriatric cohort presented a long length of stay, with a high rate of complications, including a rate of 25% of reintervention. Nevertheless, the 1-year mortality rate was of 0%

Variação da velocidade de marcha e fatores clínicos associados em pessoas idosas da atenção primária à saúde: estudo longitudinal / Variation in gait speed and associated clinical factors in elderly people in primary health care: longitudinal study

Resumo: analisar a variação da velocidade da marcha e os fatores clínicos associados em pessoas idosas da Atenção Primária à Saúde, no período mínimo de dois anos. Materiais e método: estudo longitudinal prospectivo, do tipo quantitativo, subprojeto do projeto de pesquisa matriz intitulado "As variações da fragilidade física e da funcionalidade de idosos da atenção primária à saúde", desenvolvido com 389 idosos da atenção primária à saúde. As coletas de dados foram realizadas nos anos de 2019 (1ª onda) e 2022 (2ª onda), com idosos assistidos em uma Unidade Básica de Saúde de Curitiba-PR. Aplicou-se questionário com variáveis sociodemográficas e clínicas, incluindo autorrelato de agravos em saúde e história pregressa; teste Timed Up and Go para verificar o risco de queda; e avaliação do fenótipo da fragilidade física, com destaque para a velocidade da marcha. Os dados foram analisados de forma descritiva, a partir da distribuição de frequência absoluta e relativa, média e desvio padrão; bem como análise inferencial por meio de testes não paramétricos qui-quadrado, Wilcoxon Signed Rank e Exato de McNemar, para amostras pareadas, a fim de comparação entre os dois momentos (1ª e 2ª avaliação); e regressão logística para propor modelo preditivo, o qual considerou a entrada de variáveis que apresentaram p-valor =0,20 (técnica enter hierárquico), permanecendo no modelo as variáveis que apresentaram valor de p=0,05 ou que ajustassem o modelo. Considerou-se o nível de significância de 5%. O estudo recebeu parecer favorável do Comitê de Ética em Pesquisa. Resultados: a prevalência de VM reduzida na 1ª onda (n=389) foi de 20,8% (n=81). Com relação à 2ª onda (n= 128), 21 (16,4%) participantes apresentaram VM reduzida, dos quais 13 (61,9%) já dispunham dessa condição na baseline e 8 (6,25%) da amostra apresentaram redução da VM durante o seguimento (incidência). Ainda, 8 (7,5%) idosos com VM reduzida na 1ª onda apresentaram melhora desse parâmetro , indicando VM preservada na 2ª onda. Observou-se acréscimo na média de velocidade de marcha dos idosos de 0,04m/s durante o seguimento (de 1,03 m/s para 1,07m/s), no entanto, a variação não foi estatisticamente significativa (p=1,00). Os fatores clínicos, embora associados à VM reduzida na 1ª onda de avaliação, não apresentaram relação estatisticamente significativa à mudança na VM dos idosos durante o seguimento do estudo. O modelo preditivo de VM reduzida indicou que as variáveis comprometimento cognitivo sugestivo (OR:19,62; IC95%=1,93-209,92; p=0,014), força de preensão manual (OR:1,97; IC95%=1,04-3,71; p=0,036) risco de queda (OR:4,07; IC95%=2,27-7,28; p<0,001), histórico de quedas no último ano (OR:1,81; IC95%=0,99-3,26; p=0,050), problemas metabólicos (OR:1,97; IC95%=1,09-3,55; p=0,024), auditivo (OR:0,33; IC95%=0,14-0,80; p=0,013) e cardiovascular (OR:2,08; IC95%=1,02-4,26; p=0,044), aumentaram as chances de as pessoas idosas apresentarem VM reduzida. Conclusão: não houve variação significativa da VM no período investigado e os fatores clínicos se mostraram associados à VM reduzida apenas na 1ª onda de avaliação. É importante que a equipe de saúde da atenção primária desenvolva ações de acompanhamento, bem como de rastreio da velocidade da marcha e das condições clínicas relacionadas à saúde, com vistas a evitar a progressão da síndrome da fragilidade das pessoas idosas.

Abstract: to analyze the variation in gait speed and associated clinical factors in elderly people in Primary Health Care, over a minimum period of two years. Materials and method: prospective longitudinal study, quantitative, subproject of the main research project entitled "Variations in physical frailty and functionality of elderly people in primary health care", developed with 389 elderly people in primary health care. Data collection was carried out in 2019 (1st wave) and 2022 (2nd wave), with elderly people cared for in a Basic Health Unit in Curitiba-PR. A questionnaire was applied with sociodemographic and clinical variables, including self-report of health problems and past history; Timed Up and Go test to check the risk of falling; and assessment of the physical frailty phenotype, with emphasis on gait speed. The data were analyzed descriptively, based on absolute and relative frequency distribution, mean and standard deviation; as well as inferential analysis using non-parametric chi-square tests, Wilcoxon Signed Rank and McNemar's exact tests, for paired samples, in order to compare the two moments (1st and 2nd assessment); and logistic regression to propose a predictive model, which considered the entry of variables that presented a p-value =0.20 (hierarchical enter technique), with variables that presented a p-value =0.05 or that adjusted the model remaining in the model. A significance level of 5% was considered. The study received a favorable opinion from the Research Ethics Committee. Results: the prevalence of reduced MV in the 1st wave (n=389) was 20.8% (n=81). In relation to the 2nd wave (n= 128), 21 (16.4%) participants presented reduced MV, of which 13 (61.9%) already had this condition at baseline and 8 (6.25%) of the sample presented a reduction of MV during follow-up (incidence). Furthermore, 8 (7.5%) elderly people with reduced MV in the 1st wave showed improvement in this parameter, indicating preserved MV in the 2nd wave. An increase in the elderly's average walking speed of 0.04 m/s was observed during the follow-up (from 1.03 m/s to 1.07 m/s), however, the variation was not statistically significant (p=1 ,00). Clinical factors, although associated with reduced MV in the 1st wave of evaluation, did not present a statistically significant relationship to the change in the elderly's MV during the study follow-up. The predictive model of reduced MV indicated that the variables suggestive cognitive impairment (OR:19.62; CI95%=1.93-209.92; p=0.014), handgrip strength (OR:1.97; CI95%= 1.04-3.71; p=0.036) risk of falling (OR:4.07; 95%CI=2.27-7.28; p<0.001), history of falls in the last year (OR:1.81; CI95%=0.99-3.26; p=0.050), metabolic problems (OR:1.97; CI95%=1.09-3.55; p=0.024), auditory (OR:0.33; CI95 %=0.14-0.80; p=0.013) and cardiovascular (OR:2.08; 95%CI=1.02-4.26; p=0.044), increased the chances of elderly people having reduced MV. Conclusion: there was no significant variation in MV during the period investigated and clinical factors were associated with reduced MV only in the 1st wave of evaluation. It is important that the primary care health team develops follow-up actions, as well as tracking the speed of MV. gait and healthrelated clinical conditions, with a view to preventing the progression of frailty syndrome in elderly people.

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

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

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

Evaluación de la prueba G8 como tamizaje para valoración geriátrica integral en pacientes adultos mayores con cáncer / Evaluation of the G-8 test as a screening tool for comprehensive geriatric assessment in elderly patients with cancer

RESUMEN Objetivo: evaluar la sensibilidad y especificidad del test G8 en el tamizaje de adultos mayores con cáncer para la realización de la valoración geriátrica integral (VGI). Materiales y métodos: el presente estudio observacional y retrospectivo se realizó en el Servicio de Geriatría del Hospital Almenara de Lima, Perú. Se revisaron los informes de VGI en las historias clínicas electrónicos de adultos mayores (> 60 años) con cáncer, ambulatorios y hospitalizados, durante noviembre de 2022 y julio de 2023. Los pacientes se clasificaron según los criterios SIOG-1 (Sociedad Internacional de Oncología Geriátrica), formando dos grupos: pacientes aptos y pacientes no aptos o unfit (vulnerables + frágiles + muy enfermos). Del test G8 se estimó la sensibilidad, especificidad y valor predictivo positivo, área bajo la curva característica operativa del receptor (AUC). Resultados: ingresaron al estudio 201 pacientes, 91 mujeres (45,3%) y 110 (54,7%) varones, la media de la edad fue de 76,2 ± 7,4 años. Las neoplasias más frecuentes fueron colorrectal, estómago, próstata y vías biliares. La prevalencia de pacientes aptos y no aptos (unfit) fue del 23,4 y 76,6%, respectivamente. Cuando el puntaje de la prueba G8 fue ≤11, la sensibilidad, especificidad, valor predictivo positivo y AUC fueron 73,4% (intervalo de confianza al 95%: 65,7-80,2%), 91,5% (79,6%-97,6%), 96,6% (91,7-98,6%) y 89% (84-93%), respectivamente. Conclusiones: el test G8 con puntaje ≤11 tendría una alta sensibilidad y especificidad, para identificar adultos con cáncer vulnerables o frágiles, que podrían beneficiarse de la VGI.

ABSTRACT Objective: To evaluate sensitivity and specificity of the G8 test in screening older adults with cancer who may benefit from a Comprehensive Geriatric Assessment (CGA). Material and methods: This observational retrospective study was carried out in the Geriatrics Service of the Guillermo Almenara Hospital in Lima, Peru. CGA reports were reviewed in the electronic medical records of older adults (> 60 years) with cancer, both outpatients and inpatients, between November 2022 and July 2023. Patients were classified according to the SIOG-1 (International Society of Geriatric Oncology) criteria into two groups: fit and non-fit patients (vulnerable + frail + too sick). Sensitivity, specificity, and positive predictive value, area under the receiver operating characteristic curve (AUC), were estimated for the G8 test. Results: 201 patients entered the study, 91 women (45.3%) and 110 (54.7%) men; their mean age was 76.2 ± 7.4 years. The most frequent neoplasms were colorectal, stomach, prostate, and bile ducts. The prevalence of eligible and unfit patients was 23.4% and 76.6%, respectively. When the G8 test score was ≤11, sensitivity, specificity, positive predictive value, and AUC were 73.4% (95% Confidence Interval: 65.7- 80.2%), 91.5% (79.6%-97.6%), 96.6% (91.7-98.6%), and 89% (84-93%), respectively. Conclusions: The G8 test with a score ≤11 would have high sensitivity and specificity for identifying vulnerable or frail patients with cancer who could benefit from the CGA.

Exploration and practice of the course of Geriatric Nursing: taking Peking Union Medical College as an example / 中华医学教育探索杂志

The Peking Union Medical College School of Nursing has been dedicated to exploring the education of undergraduate students specializing in geriatric nursing since 2016. Through seven years of exploration and practice, aiming at the pain points and difficulties in the process of cultivating geriatric nursing students, the teaching team has developed a progressive and modular curriculum system, with the goal of training geriatric nursing professionals with specialized knowledge and practical innovation abilities, on the platform of a seamless teaching practice base connecting settings from laboratory to community/elderly care institutions/hospital to society, with an emphasis on the integration of ideological and political education with geriatric nursing education. Moreover, a specialized faculty team has been established. This course serves as a model for nurturing excellent nursing professionals possessing the right values and outlook on life as well as ability to cope with the national challenges posed by aging populations.

Current situation and training demands for geriatric nursing ability of clinical nursing teachers / 中华医学教育探索杂志

Objective:To investigate the current situation of geriatric nursing ability of clinical nursing teachers and analyze the influencing factors, and to identify demands of geriatric nursing training.Methods:From May to June 2023, a cross-sectional study was conducted among 2 408 clinical nursing teachers in 50 tertiary hospitals from 9 provinces and cities in East China, South China, Central China, North China, and Southwest China using the general information questionnaire, Geriatric Nursing Competence Scale for Clinical Nurses, and Geriatric Nursing Training Demands Questionnaire.Results:Among the clinical nursing teachers surveyed, there were 269 (11.17%), 938 (38.95%), and 1 201 (49.88%) teachers at low, medium, and high levels of geriatric nursing ability, respectively. The results of multinomial Logistic regression analysis showed that age, years of working in geriatric nursing, geriatric nursing related training, satisfaction with clinical nursing work, and interest in geriatric nursing work were common influencing factors in the low and medium level groups ( P<0.05), and professional title was a specific influencing factor in the medium level group ( P<0.05). The top three demands of geriatric nursing training content were geriatric nursing service model, knowledge of chronic disease management, and comprehensive geriatric assessment techniques. The top three demands of training forms were live streaming, field visits, and offline lectures. Conclusions:For clinical nursing teachers, demand-oriented geriatric nursing training should be strengthened, and attention should be paid to the satisfaction and interest in nursing work, so as to improve the teachers' geriatric nursing ability and strengthen the level of geriatric service.

Current situation and future countermeasures for implementing experiential teaching in geriatric nursing education / 中华医学教育探索杂志

Experiential teaching is a practical, reflective, and situational teaching method. Based on the systematic review of literature published worldwide, this paper summarizes the characteristics and organizational forms of experiential teaching, with a focus on its current application and existing problems in teaching geriatric nursing. This review provides suggestions for the reform of teaching methods of geriatric nursing in China.

Application of mind mapping in combination with scenario simulation teaching based on symptom management theory in geriatric symptom nursing education / 中华医学教育探索杂志

Objective:To evaluate the application of mind mapping in combination with scenario simulation teaching based on symptom management theory (SMT) in geriatric symptom nursing education, and to provide a basis for improving the quality of geriatric symptom nursing education.Methods:A total of 80 nursing students who interned in the Department of Geriatric Medicine of Peking Union Medical College Hospital from August 2022 to April 2023 were included in the study. They were divided into control group and experimental group according to the order of enrollment, with 40 students in each group. The control group employed traditional teaching methods, while the experimental group implemented a method of mind mapping in combination with scenario simulation teaching based on SMT. The general data, training assessment results, and teaching quality satisfaction were compared and analyzed between the two groups. SPSS 22.0 statistical software was used for t-test and chi-square test. Results:There were no significant differences between the two groups in general data such as age, gender, educational background, academic performance, and school of study. The experimental group showed higher scores in geriatric symptom nursing theory assessment [(86.57±8.41) vs. (80.83±9.16), P=0.018] and comprehensive skill assessment [(91.26±7.29) vs. (81.92±8.64), P<0.001], as compared with the control group. The experimental group also showed higher scores in teaching process [(24.52±1.56) vs. (20.18±0.98), P<0.001], teaching methods [(24.49±1.72) vs. (20.65±1.02), P<0.001], teaching effectiveness [(24.35±1.19) vs. (20.01±0.86), P<0.001], teaching content [(24.31±1.83) vs. (20.27±1.21), P<0.001], and overall satisfaction [(97.67±2.80) vs. (81.11±2.53), P<0.001]. Conclusions:The method of mind mapping in combination with scenario simulation teaching based on SMT has a significant positive effect on geriatric symptom nursing education. This method can improve the theoretical and comprehensive skill levels as well as the teaching quality satisfaction of nursing interns.

Comprehensive Geriatric Assessment and Strategy of Diagnosis and Treatment in Elderly Patients with Cancer / 医药导报

Elderly patients are often complicated with a variety of underlying diseases.Because aging can impact the pharmacokinetics and pharmacodynamics of drugs,and affect the immune effect,conventional anti-tumor treatment modes such as radiotherapy,chemotherapy,targeted therapy,or immunization,can not achieve optimal efficacy.Comprehensive geriatric assess-ment(CGA)is a multi-dimensional and multidisciplinary diagnostic process,which is currently regarded as the core of the as-sessment of elderly patients with cancer.By utilizing a variety of tools and scales,comprehensive assessment of elderly patients with cancer can facilitate early intervention,guide reasonable treatment,increase the chances of benefit,and improve the quality of life for some elderly patients.Moreover,CGA can help reasonably allocate medical resources and reduce the economic burden on the community.

Construction of domain knowledge graph of dementia care / 中华护理杂志

Objective To construct a domain knowledge graph of dementia care,so as to provide the foundation and guarantee for the next intelligent application based on the knowledge graph.Methods A top-down approach was adopted to construct a domain knowledge graph of dementia care.Firstly,the ontology concept is constructed from the top level,namely the schema layer of knowledge graph.Then,instances are filled,and knowledge extraction is carried out from the existing data sources,and the extracted entities and relationships are filled into the pattern layer ontology database to complete the data layer construction of the knowledge graph.Finally,the"entity relationship entity"triplet data was input into the Neo4j graph database for storage.Results In this study,the personalized care plan set of 1 012 dementia cases was used as the corpus to construct a domain knowledge graph of dementia care.The knowledge graph takes people with dementia as the core,and unfolds,one by one,around basic characteristics,care problems,and care plans in a standardized"entity-relationship-entity"triplet format,forming a large knowledge network,which contains a total of 1 522 specific dementia care knowledge entities and 8 kinds of inter-entity relationships.Conclusion The domain knowledge graph of dementia care constructed in this study clearly and intuitively shows the global pedigree and logical path of knowledge,which provides an efficient and intelligent basic guarantee for the browsing,retrieval and application of dementia care knowledge,so as to realize personalized and intelligent management of people with dementia,break through the bottleneck of lack of professionals,improve the health outcomes of people with dementia,promote the implementation of inclusive pension services,and promote healthy aging.

Correlation between geriatric nutritional risk index and adverse events in elderly hemodialysis patients / 中华老年心脑血管病杂志

Objective To explore the relationship between geriatric nutritional risk index(GNRI)and adverse outcomes in elderly patients undergoing maintenance hemodialysis(MHD).Methods A prospective cohort trial was conducted on 337 MHD patients aged ≥60 years in hemodialysis centers of 11 hospitals in Beijing from April to June 2017.Their baseline data were collected,and they were divided into non-malnutrition(GNRI≥98,226 cases),mild malnutrition(92≤GNRI＜98,81 cases),and major malnutrition groups(GNRI＜92,30 cases).All of them were followed up until June 2018.The endpoint events were all-cause mortality and cardiovascular disease(CVD)mortality.Kaplan-Meier survival analysis was used to compare the cumulative survival rate among the 3 groups.Multivariate Cox regression model was employed to analyze the relationship of GNRI with all-cause and CVD mortality.Results The mild and major malnutrition groups had significantly lower BMI,serum albumin level and GNRI(P＜0.01).During the median follow-up of 52(4.4-52.0)weeks,56(16.6％)patients died of all-cause death and 25(44.6％)of CVD death.Kaplan-Meier survival curve showed significant differences in all-cause mortality(x2=30.484,P＜0.01)and CVD mortality(x2=22.398,P＜0.01)in the 3 groups.Multivariate Cox regression analysis indicated that,as a continuous variable,elevated GNRI was a protective factor for all-cause mortality(HR=0.910,95％CI:0.870-0.952,P=0.000)and CVD mortality(HR=0.895,95％CI:0.852-0.940,P=0.000),and as a categorical variable,mild and major malnutri-tion were independently correlated with all-cause and CVD mortality(P＜0.05).Conclusion GNRI is an independent risk factor for all-cause and CVD mortality in elderly MHD patients.Mo-nitoring the nutritional status using GNRI can predict the risk of adverse prognosis.

Impact of common geriatric syndromes on adverse prognosis in hemodialysis patients / 中华老年医学杂志

With population aging and advances in dialysis technology, the proportion of elderly people among hemodialysis patients is getting higher, making concurrent geriatric syndromes an important issue that deserves particular consideration in the management of dialysis patients in clinical practice.Common geriatric syndromes, such as frailty, sarcopenia, malnutrition, physical dysfunction, cognitive impairment and depression, have a high prevalence in hemodialysis patients and are associated with poor prognosis.Comprehensive geriatric assessment of elderly hemodialysis patients can identify high-risk patients early, help implement stratified care, and serve as a valuable guide in the improvement of patients' prognosis and quality of life.

Assessing Correlations among Repetitive Standing Test on a Dining Room Seat, Daily Walking, Balance Function, and Walking Endurance in Geriatric Health Services Facility Residents / The Japanese Journal of Rehabilitation Medicine

Objective：To evaluate the relationship among repetitive standing tests in a dining room seat, daily walking, balance function, and walking endurance in geriatric health service facility residents.Methods： Eighty-six geriatric health service facility residents. Participants were categorised into wheelchair, assistance, modified independence, and independent groups based on walking in the functional independence measure. The repetitive standing test in a dining room seat was compared. Cut-off values were determined based on differences between consecutive groups. Correlations among the repetitive standing test on a dining room seat, Berg balance scale score, and 6-minute walk distance were determined.Results：The repetitive standing test on a dining room seat was higher in the assistance group than in the wheelchair group and higher in the modified independence group than in the assistance group, with cut-off values of 5 and 20 times, respectively. The repetitive standing test on a dining room seat was positively correlated with the Berg balance scale and 6-minute walk distance.Conclusion：The repetitive standing test on a dining room seat was correlated with balance function and walking endurance. Five and twenty repetitions of the standing test on a dining room seat were needed for assisted and modified independent walking, respectively.

Analysis on the training programs of geriatric clinical pharmacists in China and the United States / 中国药房

OBJECTIVE To compare the general status of training programs for geriatric clinical pharmacists in China and the United States， and provide a reference for further optimizing training programs of geriatric clinical pharmacists in China. METHODS Retrieved from the American Society of Health-System Pharmacists （ASHP） website and the Chinese Hospital Association website， the detailed information and data on training outline， institution type/scale， enrollment number， training contents， project application conditions and graduation assessments for clinical pharmacists in geriatric field were collected and statistical analysis was performed using Excel software. RESULTS & CONCLUSIONS As of January 12， 2024， ASHP provided 24 geriatric clinical pharmacist training programs and 25 positions available for application in the postgraduate year two training， which provided compensation. The training base involved hospitals and pharmaceutical colleges， with varying scales. Applicants needed to obtain a doctor of pharmacy and complete postgraduate year one training. ASHP had designed detailed training objectives for the four essential skills of basic patient care， advanced patient care， leadership and management skills， and knowledge education and teaching dissemination. Each training base could appropriately add optional skills such as academic skills， long-term care skills and other skills according to its characteristics， developed a student rotation plan， and conducted assessments and evaluations at multiple time points during the training process. There were 5 training programs for geriatric clinical pharmacists in China， with 15 positions， which didn’t provide compensation； training bases were all third-grade class A hospitals with relatively large scale. The applicant needed to obtain a bachelor’s degree or above， and different years of work were required based on their major and degree level. The Pharmaceutical Specialized Committee of the China Hospital Association had established a detailed training outline， proposing specific training objectives on theoretical knowledge， practical skills， scientific research thinking， etc. The training base organized assessments and evaluations at the time of enrollment， completion of specified content training， and graduation. According to the experience of the US， it is recommended to provide differentiated knowledge and skills training for students at different levels， flexibly arrange rotating departments， require students to work independently and deeply participate in clinical teaching and research work， conduct multiple and various forms of assessments， and adjust learning plans in a 13264273306@126.com timely manner to comprehensively enhance their abilities.

Avaliação da mortalidade associada ao status tireoidiano em uma coorte de pessoas idosas eutireoidianas de ambulatório de geriatria em hospital universitário / Assessment of mortality associated with thyroid status in a cohort of euthyroid older adults from a geriatric outpatient clinic at a university hospital

Resumo Objetivo Avaliar associações entre a média da tireotropina (TSH) e tiroxina livre (T4L) mantida durante follow-up, e mortalidade em pacientes idosos eutireoidianos definidos de acordo com a faixa de referência específica para a idade (FR-e) do TSH. Método Coorte retrospectiva tipo análise de sobrevivência incluindo pacientes idosos eutireoidianos acompanhados no ambulatório de hospital universitário entre 2010 e 2013. Todos os participantes haviam sido avaliados quanto ao risco de incapacidade funcional como critério para admissão nesse ambulatório. As médias dos valores de TSH e T4L foram calculadas através das dosagens obtidas no período de acompanhamento. Cada FR-e de TSH foi dividida em quatro partes iguais, considerando níveis mais baixos como variável de exposição (≤1,75 mUI/L para <80 e ≤2,0 mUI/L para ≥80 anos). Os níveis de T4L foram dicotomizados em duas categorias (< e ≥1,37 ng/dL). O desfecho foi o tempo até a morte. A regressão de risco proporcional de Cox foi empregada para estimar a hazard ratio (HR) e o intervalo de confiança (IC) de 95% Resultados 285 participantes (73% mulheres, idade média =80,4 anos) seguidos pela mediana de 5,7 anos (IQR =3,7-6,4; máximo =7), sendo que 114 faleceram. Após o modelo final ajustado, a mortalidade esteve associada ao TSH no limite inferior (HR=1,7; IC=1,1-2,7; p=0,016) e ao T4L mais elevado. (HR=2,0; IC=1,0-3,8; p=0,052). Conclusão Níveis médios de T4L mais altos e de TSH mais baixos foram associados ao risco de morte em coorte de idosos eutireoidianos usando FR-e de TSH.

Abstract Objective To assess the associations between the mean thyrotropin (TSH) and mean free thyroxine (FT4), detected during follow-up, and mortality in a group of older euthyroid patients according to age-specific reference range (as-RR) for TSH. Method Retrospective survival analysis cohort including euthyroid elderly patients who were being monitored at the outpatient clinic of a university hospital from 2010 to 2013. All participants had been assessed for the risk of functional disability as a criterion for admission to this outpatient clinic. Mean TSH and FT4 values were calculated using hormone dosages obtained during the follow-up period. Each as-RR for TSH was divided into four equal parts, considering the lower levels as the main exposure variable (≤1.75 mlU/L for <80, and ≤2.0 mlU/L for ≥80 years). FT4 levels were explored according to two categories (< e ≥1.37 ng/dL). The outcome was time to death. We used Cox proportional hazard regression to estimate the hazard ratio (HR) and 95% confidence interval (CI). Results 285 participants (73% females, mean age =80.4 years) followed by a median of 5.7 years (IQR =3.7-6.4; maximum =7), of which 114 died. After the adjusted final model, mortality was associated with the lowest mean TSH (HR=1.7; CI=1.1-2.7; p=0.016) and with the upper mean of FT4 (HR=2.0; CI=1.0-3.8; p=0.052). Conclusions Higher FT4 and lower TSH mean levels were associated with risk of death in a cohort of euthyroid older adults using an as-RR of TSH.

Percepção sobre abandono afetivo em idoso institucionalizado / Perception of emotional neglect in institutionalized elderly / Percepción del abandono afectivo en adultos mayores institucionalizado

Objetivo: Compreender a percepção dos idosos institucionalizados quanto ao abandono afetivo por parte de seus familiares.Método: Trata-se de um estudo exploratório, comabordagemqualitativa. Conduzido por meio de entrevistas semiestruturadas. A organização e análise dos dados foram baseadas na técnica de Minayo. O estudo foi realizado em uma Instituição de Longa Permanência para Idosos, localizada em uma cidade do nordeste de Santa Catarina.Resultados: Participaram do estudo nove idosos, com idades entre 60 e 89 anos, com diferentes estados civis (viúvos, casados e divorciados), variando sua escolaridade do nível básico ao superior, além de serem aposentados ou pensionistas. Foram identificadas quatro categorias analíticas: (1) vivência na instituição, (2) motivos para a institucionalização, (3) relacionamento familiar e (4) percepção do abandono familiar.Conclusão: alguns idosos enfatizaram sentir-se esquecidos na instituição, o que os deixa tristes e deprimidos. É crucial para a prática de a enfermagem compreender a realidade dos idosos nas Instituições de Longa Permanência, pois essa compreensão está diretamente ligada à prestação de cuidados em todos os níveis de assistência à saúde

Objective: To understand the perception of institutionalized elderly individuals regarding the emotional abandonment by their family members.Methodology: This is an exploratory study, using qualitative methods. Conducted through semi-structured interviews. Data organization and analysis were based on Minayo's technique. The study was conducted at a Long-Term Care Institution for the Elderly located in a city in northeastern Santa Catarina.Results: Nine elderly individuals participated in the study, ranging in age from 60 to 89 years old, with different marital statuses (widowed, married, and divorced), ranging in education from basic to higher levels, and being retirees or pensioners. Four analytical categories were identified: (1) experience in the institution, (2) reasons for institutionalization, (3) family relationships, and (4) perception of family abandonment.Conclusion: Some elderly individuals emphasized feeling forgotten in the institution, which makes them feel sad and depressed. Understanding the reality of the elderly in Long-Term Care Institutions is crucial for nursing practice, as this understanding is directly linked to providing care at all levels of healthcare assistance in the Health Care Network

Objetivo: Comprender la percepción de las personas mayores institucionalizadas con respecto al abandono afectivo por parte de sus familiares. Metodología:Se trata de un estudio exploratorio, utilizando métodos cualitativos. Realizado a través de entrevistas semiestructuradas. La organización y análisis de los datos se basaron en la técnica de Minayo. El estudio se llevó a cabo en una Institución de Larga Estadía para Personas Mayores lubicada en una ciudad del noreste de Santa Catarina. Resultados:Nueve personas mayores participaron en el estudio, con edades comprendidas entre 60 y 89 años, con diferentes estados civiles (viudos, casados y divorciados), variando en educación desde niveles básicos hasta superiores, y siendo jubilados o pensionistas. Se identificaron cuatro categorías analíticas: (1) experiencia en la institución, (2) motivos para la institucionalización, (3) relaciones familiares y (4) percepción del abandono familiar. Conclusión:Algunas personas mayores enfatizaron sentirse olvidadas en la institución, lo que los hace sentir tristes y deprimidas. Es crucial para la práctica de enfermería comprender la realidad de los adultos mayores en las Instituciones de Larga Estancia, ya que esta comprensión está directamente vinculada con la prestación de cuidados en todos los niveles de asistencia sanitaria en la Red de Atención a la Salud.

Prevalência e fatores associados à fragilidade em pessoas idosas hipertensas por meio da Escala de Fragilidade de Edmonton e Índice de Vulnerabilidade Clínico Funcional-20 / Prevalence and factors associated with frailty in older adults with hypertension using the Edmonton Frail Scale and the Clinical Functional Vulnerability Index-20

Resumo Objetivo Avaliar a prevalência de fragilidade e comparar as variáveis associadas a essa fragilidade em pessoas idosas hipertensas comunitárias brasileiras por meio da Escala de Fragilidade de Edmonton (EFE) e o Índice de Vulnerabilidade Clínico-Funcional-20 (IVCF-20). Métodos Trata-se de um estudo transversal e analítico, conduzido com pessoas idosas hipertensas comunitárias com idade ≥60 anos, residentes na cidade de Montes Claros, Minas Gerais, Brasil. A seleção da amostra seguiu o modelo probabilístico por conglomerado. Os dados foram coletados entre novembro de 2016 e fevereiro de 2017 por meio de aplicação de questionário em domicílio. Foram analisadas variáveis demográficas, socioeconômicas e clínico-assistenciais. Utilizou-se a regressão de Poisson com variância robusta para obter as razões de prevalência brutas e ajustadas. Resultados Participaram 281 pessoas idosas hipertensas. A prevalência geral de fragilidade pela EFE foi de 31,3% e pelo IVCF-20 foi de 22,1%. As variáveis, que após a análise múltipla, foram estatisticamente associadas à fragilidade em idosos hipertensos, pela EFE e IVCF-20 simultaneamente, foram: idade avançada (80 anos ou mais), apresentar como comorbidade artrite reumatoide/artrose, acidente vascular encefálico, autopercepção de saúde negativa, quedas e internações nos últimos 12 meses. Apenas pela EFE, menos de 4 anos de estudo, não ter prática religiosa e não possuir renda própria foram as variáveis associadas. Enquanto pelo IVCF-20, somente a renda familiar mensal associou-se à fragilidade. Conclusão Verificou-se que a fragilidade avaliada pela EFE e pelo IVCF-20 possui similaridade, no entanto, a EFE é mais sensível. Esses resultados demonstram a necessidade dos profissionais da saúde identifiquem precocemente a fragilidade.

Abstract Objective To assess the prevalence of frailty and compare the variables associated with frailty in Brazilian community-dwelling older adults with hypertension using the Edmonton Frail Scale (EFS) and the Clinical Functional Vulnerability Index-20 (IVCF-20). Methods This is a cross-sectional analytical study conducted with community-dwelling older adults with hypertension aged ≥60 years residing in the city of Montes Claros, Minas Gerais, Brazil. Sample selection followed a probabilistic cluster sampling model. Data were collected between November 2016 and February 2017 through in-home questionnaire administration. Demographic, socioeconomic, and clinical-care variables were analyzed. Poisson regression with robust variance was used to obtain crude and adjusted prevalence ratios. Results A total of 281 older adults with hypertension participated in the study. The overall prevalence of frailty as assessed by the EFS was 31.3%, and by the IVCF-20 was 22.1%. Variables that were statistically associated with frailty in older adults with hypertension, as determined by both the EFS and IVCF-20 simultaneously, were: advanced age (80 years or older), comorbidities such as rheumatoid arthritis/osteoarthritis, stroke, negative self-perception of health, falls, and hospitalizations in the last 12 months. Only by the EFS, variables associated with frailty included less than 4 years of education, absence of religious practice, and lack of personal income. Meanwhile, according to the IVCF-20, only monthly family income was associated with frailty. Conclusion It was found that frailty assessed by EFS and IVCF-20 exhibits similarity; however, EFS is more sensitive. These findings underscore the imperative for healthcare professionals to early identify frailty.