Long-term follow-up results and risk factors of bleeding among very elderly patients with non-valvular atrial fibrillation / 中华全科医师杂志

Objective:To investigate the long-term follow-up results and the risk factors of bleeding among very elderly patients with non-valvular atrial fibrillation (NVAF).Methods:A total of 177 patients with NVAF admitted in Beijing Hospital from January 2016 to July 2016 were enrolled in the study, including 107 very elderly patients (aged≥80 years) and 70 elderly patients (aged 65-80 years). The demographic information, comorbid diseases, lifestyles, antithrombotic therapy, thromboembolism risks, bleeding risks, and medical history were documented. Patients were followed up for 5 years and the events of death, thromboembolism, bleeding and major bleeding were recorded.Results:There was no significant difference in the incidence of thromboembolic events between the two groups (15.9%(17/107) vs. 14.3%(10/70), P>0.05). The proportions of bleeding events and severe bleeding events in the very elderly group were higher than those in the elderly group (45.8%(49/107) vs.10.0%(7/70), 14.0%(15/107) vs. 1.4%(1/70), both P<0.05). According to the bleeding events during follow-up, very elderly patients were divided into bleeding group ( n=49) and non-bleeding group ( n=58). Compared with the non-bleeding group, patients in the bleeding group had an older age, a higher proportion of chronic cardiac insufficiency, chronic kidney disease, malignant tumor, bleeding history and higher bleeding risk score (HAS-BLED score) (all P<0.05). Multivariate logistic regression model analysis showed that age, HAS-BLED score, history of bleeding, and complicated malignant tumor were independent risk factors for bleeding events in very elderly patients with NVAF (all P<0.05). Conclusions:Very elderly patients with NVAF have a similar risk of thromboembolism compared with the younger elderly, but have significantly higher risk of the bleeding and major bleeding. Age, HAS-BLED score, bleeding history, and malignant tumor are independent risk factors for bleeding events in very elderly NVAF patients.

Capacidade funcional de idosos longevos: análise transversal baseada em um modelo de decisão / Functional capacity in the oldest old: cross-sectional analysis based on a decision model

INTRODUÇÃO: Idosos com 80 anos ou mais, ou longevos, são o subgrupo etário que mais cresce no mundo. Nesse segmento, a incapacidade funcional (IF) é mais prevalente que em outras faixas etárias. OBJETIVO: Caracterizar a capacidade funcional e analisar potenciais associações em idosos longevos de uma capital brasileira, com base em um modelo de decisão. MÉTODO: Estudo transversal com 100 idosos longevos, não institucionalizados, assistidos pela Estratégia Saúde da Família do Recife (PE), selecionados por amostra probabilística. Foram avaliados dados sociodemográficos, econômicos e clínicos coletados por meio de entrevistas domiciliares, aferição de medidas antropométricas e buscas nos prontuários. Para análise bivariada, foi empregado o teste χ2 de Pearson, considerando o nível de significância p < 0,05, e para a multivariada foi construída uma árvore de decisão com base em um algoritmo Exhaustive CHAID. RESULTADOS: A prevalência de IF na amostra correspondeu a 67,0%. Na análise bivariada, contribuíram para esse desfecho: renda (p = 0,032), situação previdenciária (p < 0,01), situação nutricional (p = 0,010), doenças neurológicas (p < 0,01), neoplasias (p < 0,01), saúde autopercebida (p = 0,025) e rede de apoio social (p = 0,032), permanecendo na análise multivariada: renda (p = 0,003), rede de apoio social (p = 0,032) e situação nutricional (p = 0,040). A árvore de decisão possibilitou a identificação das variáveis mais associadas ao desfecho, sendo capaz de prever adequadamente a dependência moderada, com assertividade de 72,1%. CONCLUSÃO: O modelo de decisão mostrou-se uma ferramenta oportuna na dedução dos determinantes mais relevantes da IF. Seu uso potencialmente contribui para ampliar a precisão diagnóstica e identificação de populações de risco.

INTRODUCTION: The oldest old adults, aged 80 years and above, is the fastest growing age group in the world. In this section of the population, functional disability (FD) is more prevalent compared to other age groups. OBJECTIVE: To characterize functional capacity and analyze potential associations in the oldest old from a Brazilian capital city, based on a decision model. METHODS: Cross-sectional study of 100 non-institutionalized oldest old participants assisted at the Family Health Strategy of Recife, in the Brazilian northeastern state of Pernambuco, selected by probabilistic sample. Sociodemographic, economic, and clinical data were collected by means of home interviews, anthropometric measurements, and medical records. For bivariate analysis, Pearson's chi-square test was used, establishing significance at p < 0.05. For the multivariate analysis, a decision tree was built from the Exhaustive CHAID algorithm. RESULTS: The prevalence of FD in the sample corresponded to 67.0%. In the bivariate analysis, the following data contributed to this outcome: income (p = 0.032), social security status (p < 0.01), nutritional status (p = 0.010), neurological diseases (p < 0.01), neoplasms (p < 0.01), self-perceived health (p = 0.025) and social support network (p = 0.032), remaining in the multivariate analysis: income (p = 0.003), social support network (p = 0.032), and nutritional status (p = 0.040). The decision tree allowed the identification of the variables most strongly associated with the outcome, being able to adequately predict moderate dependence, with 72.1% assertiveness. CONCLUSION: The decision model proved to be a timely tool in deducing the most relevant determinants of FD. Its use potentially contributes to increase the accuracy of the diagnosis and to identify populations at risk.

Capacidade funcional no idoso longevo: revisão integrativa / The functional capacity in the older elderly person: an integrative review / Capacidad funcional en ancianos de larga vida: revisión integradora

Este artigo tem como objetivo analisar, tanto a produção científica que versa sobre a manutenção da capacidade funcional em idosos longevos, quanto aquela que trata dos possíveis agravantes à saúde desse grupo etário. Para tanto, foi realizada uma revisão integrativa; houve, porém, muita dificuldade em encontrar literatura cientifica voltada para este grupo etário. Pode-se observar que, além das doenças que acometem estes idosos, fatores psicossociais, como a depressão e o isolamento são responsáveis pela perda de autonomia e independência deste grupo.

This article aims to analyze both the scientific production that deals with the maintenance of functional capacity in the elderly, as well as the one that deals with the possible health problems of this age group. To this end, an integrative review was performed; However, it was very difficult to find scientific literature for this age group. It can be observed that, in addition to the diseases that affect these elderly, psychosocial factors such as depression and isolation are responsible for the loss of autonomy and independence of this group.

Este artículo tiene como objetivo analizar tanto la producción científica que se ocupa del mantenimiento de la capacidad funcional en los ancianos, como la que se ocupa de los posibles problemas de salud de este grupo de edad. Con este fin, se realizó una revisión integradora; Sin embargo, fue muy difícil encontrar literatura científica para este grupo de edad. Se puede observar que, además de las enfermedades que afectan a estos ancianos, los factores psicosociales como la depresión y el aislamiento son responsables de la pérdida de autonomía e independencia de este grupo.

Blood pressure level, hypertension prevalence and control status in oldest old in China / 中华流行病学杂志

Objective@#To investigate blood pressure level, hypertension prevalence and control status in the oldest old in China.@*Methods@#A cross-sectional data set of Chinese Longitudinal and Health Longevity Study (CLHLS) in 2014 was used to investigate the blood pressure level and hypertension prevalence and control status in the oldest old.@*Results@#A total of 4 587 elderly people aged ≥80 years were surveyed with mean age (91.3±7.8) years old, including 1 896 males (41.3%). The mean SBP was (139.5±22.0) mmHg, DBP was (79.6±11.8) mmHg, and the pulse pressure difference was (60.0±18.7) mmHg. The prevalence rate of hypertension was 56.5% (95%CI: 55.1%- 58.0%), the awareness rate of hypertension was 52.2% (95%CI: 50.3%-54.1%), the control rate was 11.5% (95%CI: 10.3%-12.5%), and the control rate of those with awareness of hypertension was 22.2% (95%CI: 19.9%-24.4%). Age, gender, BMI, residence place and living area were related to blood pressure level and control status of the oldest old.@*Conclusions@#The blood pressure level and the prevalence of hypertension in the oldest old in China were different from those in developing countries and adults in China, while similar to that in the younger elderly in China. The prevalence rate of hypertension was high and the control rate was low. Age, gender, BMI, residence place and living area were related with blood pressure level, hypertension prevalence and control status.