Gerontogeriatría en el curso propio "Envejecimiento". Plan de estudios "D" de la carrera de Medicina / Gerontogeriatrics in the own course "Aging". Study plan "D" of the Medicine career

Fundamento: el sector cubano de salud, además de garantizar una atención médico-social al adulto mayor, tiene la misión de formar los recursos humanos especializados en esta área del conocimiento, desde el pregrado en las carreras de las ciencias médicas, y de forma continua y sostenida hasta el posgrado; por lo que se precisa observar el tratamiento de los contenidos relacionados con la Gerontogeriatría en los planes de estudio. Objetivo: caracterizar la representación de la Gerontogeriatría en el curso propio "Envejecimiento" del Plan de estudios "D" de la carrera de Medicina en Cuba. Métodos: se realizó una investigación educativa observacional, descriptiva. Se desarrolló una amplia revisión documental de los planes de estudio y el diseño del curso propio "Envejecimiento" del Plan de estudios "D", precisando el análisis de sus contenidos y su aporte a la Gerontogeriatría. Resultados: se constató que el curso permite la enseñanza de la Gerontología y Geriatría, diseñado con tres objetivos y cinco temas, y contenidos que favorecen la formación gerontogeriátrica en el desempeño de la función de atención médica integral al particular proceso salud enfermedad que se expresa en el adulto mayor. Conclusiones: la Gerontogeriatría está presente en el curso propio "Envejecimiento", representada fundamentalmente con este diseño académico en todo el vigente Plan de estudios "D".

Background: the Cuban health branch, in addition to guaranteeing medical-social care for the elderly, has the mission of training specialized human resources in this area of knowledge, from undergraduate in medical sciences careers, and continuously and sustained until postgraduate; Therefore, it is necessary to observe the treatment of the contents related to Gerontogeriatrics in the study plans. Objective: to characterize the representation of Gerontogeriatrics in the own course "Aging" of the Study Plan "D" of the Medicine career in Cuba. Methods: an observational, descriptive educational research was carried out. An extensive documentary review of the study plans and the design of the own course "Aging" of the Study Plan "D" was carried out, specifying the analysis of its contents and its contribution to Gerontogeriatrics. Results: it was verified that the course allows the teaching of Gerontology and Geriatrics, designed with three objectives and five topics, and contents that favor gerontology and geriatric training in the performance of the function of comprehensive medical attention to the particular health-disease process that is expressed in the elderly. Conclusions: Gerontogeriatrics is present in the own course "Aging", fundamentally represented with this academic design throughout the current Curriculum "D".

Protección al adulto mayor: necesario enfoque multidimensional por profesionales de la salud en Cuba / Protection of the elderly: a necessary multidimensional approach by health professionals in Cuba

RESUMEN Introducción: los pronósticos demográficos avizoran que el envejecimiento será uno de los más serios problemas que enfrente la humanidad en este siglo: de allí la necesidad del enfoque multidimensional por los profesionales de la salud. Objetivo: analizar con fines educativos los mecanismos existentes de protección del adulto mayor para un enfoque multidimensional por los profesionales de la salud en Cuba. Métodos: se realizó una revisión de fuentes bibliográficas en SciELO, Google Académico y artículos de revistas impresas y digitales. Se seleccionaron 25 textos por su pertinencia con el estudio. Se evaluaron publicaciones en idioma español de autores cubanos y extranjeros, fundamentalmente de países iberoamericanos. El análisis se centró en libros, tesis, documentos legales y artículos publicados en los últimos 10 años, aunque también se referencian otros de más larga data, por ser clásicos en el tema. Desarrollo: Se constató la existencia de varias políticas médicas y sociales para proteger los adultos mayores e instituciones jurídicas que pueden utilizarse. Para una correcta evaluación multidimensional, los profesionales del sector cubano de la salud necesitan conocer las regulaciones jurídicas referentes a los adultos mayores y el código de familia que regula el derecho de la población de la tercera edad. Conclusiones: Cuba se ubica entre los países con un estado de envejecimiento avanzado; la respuesta estatal al crecimiento del envejecimiento poblacional se ha dirigido, fundamentalmente, a la atención médica y la protección a través de la seguridad social.

ABSTRACT Introduction: demographic forecasts predict that aging will be one of the most serious problems facing humanity in this century: hence the need for a multidimensional approach by health professionals. Objective: to analyze for educational purposes the existing protection mechanisms for the elderly for a multidimensional approach by health professionals in Cuba. Methods: a review of bibliographic sources was carried out in SciELO, Google Scholar and articles from printed and electronic magazines. 25 texts were selected for their relevance to the study. Publications in Spanish by Cuban and foreign authors, mainly from Ibero-American countries, were evaluated. The analysis focused on books, theses, legal documents and articles published in the last 10 years, although others of longer standing are also referenced, as they are classics on the subject. Development: The existence of several medical and social policies to protect older adults and legal institutions that can be used was verified. For a correct multidimensional evaluation, professionals in the Cuban health branch need to know the legal regulations regarding the elderly and the family code that regulates the right of the elderly population. Conclusions: Cuba is located among the countries with a state of advanced aging; The state response to the growth of the aging population has been directed, fundamentally, at medical care and protection through social security.

Intervención educativa comunitaria para un envejecimiento activo y con calidad de vida / Community educational intervention for active and life quality aging

RESUMEN Fundamento: el envejecimiento poblacional caracteriza la sociedad cubana actual, por lo que se hace necesario promover acciones educativas para este grupo etario. Objetivo: elaborar una intervención educativa comunitaria que contribuya a un envejecimiento activo y con calidad de vida en los adultos mayores del Consejo Popular Falcón-Miller. Métodos: se realizó una investigación acción-participación en el Consejo Popular Falcón Miller, del municipio Placetas, Villa Clara, Cuba, entre septiembre 2019-junio 2020. Se emplearon métodos teóricos: histórico-lógico, análisis-síntesis e inductivo-deductivo; empíricos: análisis documental, entrevista a dirigentes locales y cuestionario a adultos mayores; y matemático-estadísticos, para los valores absolutos y relativos. Resultados: se diagnosticaron potencialidades y carencias en el consejo popular para fortalecer la calidad de vida en los adultos mayores que residen en la demarcación, y las necesidades de capacitación de algunos dirigentes locales, por lo que se elaboró una intervención educativa que responde a indicadores de salud, seguridad, participación, información y conocimientos de este grupo social en los diversos ámbitos. Fue valorada por criterios de especialistas. Conclusiones: el sistema de acciones propuesto en la intervención educativa es variado desde una concepción terapéutica, de capacitación y promoción de salud. Está dirigido a estimular la participación y a socializar conocimientos respecto a temáticas importantes para los adultos mayores, a la deconstrucción de estereotipos de vejez, así como a potenciar actividades educativas y de comunicación para aprender a convivir en un ambiente intergeneracional. Fue valorado como muy adecuado para su aplicación por los especialistas.

ABSTRACT Background: population aging characterizes current Cuban society, so it is necessary to promote educational actions for this age group. Objective: to develop a community educational intervention that contributes to active and life quality aging in the elderly of the Falcón-Miller People´s Council. Methods: an action-participation investigation was carried out in the Falcón Miller People´s Council, of the Placetas municipality, Villa Clara, Cuba, from September 2019 to June 2020. Theoretical methods were used: historical-logical, analysis-synthesis and inductive-deductive; empirical: documentary analysis, interview with local leaders and questionnaire for the elderly; and mathematical-statistical, for absolute and relative values. Results: potentialities and shortcomings were diagnosed in the People´s council to strengthen the quality of life in the elderly residing in the demarcation, and the training needs of some local leaders, for which an educational intervention was developed that responds to indicators of health, safety, participation, information and knowledge of this social group in the various fields. It was evaluated by criteria of specialists. Conclusions: the system of actions proposed in the educational intervention is varied from a therapeutic, training and health promotion concept. It is aimed at stimulating participation and socializing knowledge regarding important issues for the elderly, deconstructing old age stereotypes, as well as promoting educational and communication activities to learn to live together in an intergenerational environment. It was valued as very suitable for its application by the specialists.

Longevidade e custo da assistência: o desafio de um plano de saúde de autogestão / Longevity and cost of care: the challenge of a self-managed health plan

Resumo O objetivo deste artigo é analisar a relação entre o custo da assistência e o envelhecimento da população assistida por um plano de autogestão, refletindo sobre possibilidades de enfrentamento do desafio advindo dessa conjunção de fatores. Trata-se de um estudo descritivo do período 1997 a 2016, efetivado a partir de dados secundários provenientes da operadora do plano de saúde em estudo, e outro banco administrativo de operadora de autogestão de grande abrangência nacional. Os idosos (mais de 60 anos) aumentaram no período do estudo 55,5%. Já os chamados "muito idosos" (acima de 80 anos) cresceram em quantidade 332,8%. A população acima de 60 anos corresponde a 25,7% do total sendo responsável por 68,8% das despesas. A grande maioria da população atendida (84,6%) está localizada no Estado no Rio de Janeiro, o qual tem o mais alto custo per capita em saúde no País. Foi encontrada relação entre o envelhecimento da população beneficiária e o aumento das despesas. É imperioso investir em iniciativas de promoção da saúde e prevenção de doenças como forma de melhora da qualidade de vida e viabilidade financeira do plano, além de definir um sub-sistema que delimite e discipline o acesso à rede e seja aceito pelos beneficiários.

Abstract This paper aims to analyze the relationship between the cost of health care and the aging of the population assisted by a self-managed plan, reflecting on the ways to address the challenge arising from this conjunction of population demographic changes. This is a descriptive study of the 1997-2016 period based on secondary data from the management operator of the health plan under study and from another administrative database of a self-managing provider with broad nationwide coverage. Older adults (over 60 years) increased 55% during the study period. On the other hand, the so-called "very old" (over 80 years) grew 332.8%. The population above 60 years corresponds to 25.7% of the total, and accounts for 68.8% of expenses. Most of the population covered (84,6%) is located in the State of Rio de Janeiro, which has the highest per capita health care cost in Brazil. We found a relationship between aging of the beneficiary population and increased expenditure. It is imperative to invest in health promotion and disease prevention initiatives as a way of improving the quality of life and financial sustainability of the plan, and define a subsystem that delimits and regulates access to the network and is accepted by the beneficiaries.

Conhecimento e atitude sobre a diatebes tipo 2 em idosos: estudo de base populacional / Knowledge and attitude towards type 2 diabetes among older adults: a population-based study

Resumo Esta pesquisa teve por objetivo verificar os fatores associados entre o conhecimento e a atitude sobre diabetes mellitus tipo 2 em idosos com a doença. Realizou-se um estudo transversal de base populacional com 204 idosos da rede pública de saúde de Passo Fundo, RS. Para a coleta de dados utilizou-se os questionários: sociodemográfico, de conhecimento DKN-A, de atitudes psicológicas do diabetes ATT-19 e o IPAQ para atividade física. Foi utilizada a regressão logística para as variáveis sociodemográficas, de saúde e os indicadores de adiposidade corporal. Foram realizadas análises brutas e ajustadas com um intervalo de confiança de 95%. Os resultados deste estudo identificaram que o bom conhecimento está associado com a idade maior ou igual 70 anos (OR = 0,44; IC95%: 0,18-1,08), ter atitude positiva para o tratamento da diabetes (OR = 10,4 IC95%: 4,20-18,70) e ser ativo fisicamente (OR = 12,7; IC95%: 6,8-30,10). Na associação com a atitude positiva se manteve associada significativamente a idade maior ou igual 70 anos (OR = 0,35; IC95%: 0,15-0,78), ter um bom conhecimento da diabetes (OR = 8,9; IC95%: 4,30-18,9) e ser ativo fisicamente (OR = 10,1; IC95%: 6,34-20,1). Portanto, o bom conhecimento e a atitude positiva estão associados à idade de 70 anos a mais e ser ativo fisicamente.

Abstract The aim of this study was to identify the factors associated with knowledge and attitude towards type 2 diabetes mellitus among older adults with the disease. A cross-sectional population-based study was conducted on 204 older adults from the public healthcare network of Passo Fundo, RS. Sociodemographic data were collected and the DKN-A, ATT-19 and IPAQ were used for the assessment of diabetes knowledge, psychological attitudes towards diabetes and physical activity, respectively. Logistic regression was applied to evaluate the association with sociodemographic and health variables and indicators of body adiposity. Crude and adjusted analyses were performed with a 95% confidence interval. The results showed that good knowledge is associated with age ≥ 70 years (OR = 0.44; 95%CI: 0.18-1.08), having a positive attitude towards diabetes treatment (OR = 8.9; 95%CI: 4.3-18.9), and being physically active (OR = 10.1; 95%CI: 6.34-20.1). In conclusion, good knowledge and a positive attitude towards diabetes are associated with age older than 70 years and being physically active.

Necesidades de aprendizaje sobre el cuidado del enfermo de Parkinson en su ambiente familiar / Learning needs on the care of Parkinson's patients in their family environment

RESUMEN Fundamento: modificar estilos no saludables y alcanzar mayor y mejor calidad de vida en los adultos mayores con la enfermedad de Parkinson, incluye hacer intervenciones a nivel familiar partiendo de diagnósticos sobre su preparación para enfrentar esa sensible encomienda. Objetivo: determinar el nivel de conocimientos de las familias y sus necesidades de aprendizaje para el manejo del paciente con enfermedad de Parkinson. Métodos: se realizó un estudio descriptivo, retrospectivo y longitudinal en el Consultorio Médico 2, del Policlínico Universitario "Luis Ángel Ortiz", en el municipio de Manzanillo, periodo enero-julio de 2017. Se emplearon métodos teóricos: análisis-síntesis e inductivo-deductivo; empíricos: la técnica de grupo focal y la encuesta en forma de cuestionario a los cuidadores; y matemático-estadísticos para los valores absolutos y relativos. Resultados: los grupos focales opinaron que los cuidadores tienen insuficiencia de conocimientos clínicos sobre la enfermedad, sus factores de riesgo, el tratamiento higiénico-dietético y rehabilitador, y valoraron como regular la asistencia de los enfermos con sus cuidadores a las consultas; estos constituyentes esenciales de necesidades de aprendizaje fueron corroborados por los propios cuidadores en el cuestionario aplicado. Conclusiones: se determinó la pertinencia de la elaboración de un programa educativo de orientación familiar, con énfasis en la promoción de salud, que contribuya a mejorar el manejo de los cuidadores a los enfermos de parkinson.

ABSTRACT Background: modifying unhealthy styles and achieving greater and better life quality in the elderly with Parkinson's disease includes making interventions at the family level based on diagnoses on their preparation to face this sensitive task. Objective: to determine the level of knowledge of families and their learning needs for the management of patients with Parkinson's disease. Methods: a descriptive, retrospective and longitudinal study was carried out in the doctor´s Office 2, "Luis Ángel Ortiz", University Polyclinic in Manzanillo municipality, from January-to July 2017. Theoretical methods were used: analysis-synthesis and inductive-deductive; Empirical ones: the focal group technique and the questionnaire survey to caregivers; and mathematical-statistics for absolute and relative values. Result: the focal groups were of the opinion that caregivers have insufficient clinical knowledge about the disease, its risk factors, hygienic-dietary and rehabilitative treatment, and valued as so-so the attendance of patients with their caregivers to consultations; these essential constituents of learning needs were corroborated by the caregivers themselves in the questionnaire applied. Conclusions: the relevance of the elaboration of an educational program of family orientation was determined, with emphasis on health promotion, which contributes to improve the management of caregivers to Parkinson's patients.

Pertinencia de la superación posgraduada en la atención al adulto mayor / Relevance of postgraduate upgrading in the care of the elderly

RESUMEN El envejecimiento poblacional que enfrentan Cuba en general y su provincia de Villa Clara como la de más habitantes envejecidos, requiere una mayor preparación de los especialistas en Medicina General Integral para la atención a este grupo poblacional que necesita un cuidado particular para lograr un envejecimiento saludable y con calidad de vida; por tal motivo los autores consideraron pertinente informar sobre una investigación realizada en tres etapas: la identificación de necesidades de aprendizaje de los referidos médicos, el diseño de un grupo de actividades de superación posgraduada para contribuir a elevar su preparación en la atención integral al adulto mayor, y su aprobación por criterios de especialistas para su implementación, a fin de solucionar la problemática que se analiza.

ABSTRACT The population aging that Cuba faces in general and its province of Villa Clara as that of more aging inhabitants, requires a greater preparation of the specialists in Comprehensive General Medicine for the attention to this age group that needs a particular care to achieve a good high quality and healthy ; for this reason, the authors considered it pertinent to report on an investigation carried out in three stages: the identification of learning needs of the referred doctors, the design of a group of postgraduate upgrading activities to help raise their preparation in comprehensive care for the elderly, and its approval by specialists criteria for its implementation, in order to solve the problem that is analyzed.

Envejecimiento poblacional: su pertinencia en el currículo de las ciencias médicas / Population aging: its relevance in the medical sciences curriculum

Se analizan presupuestos teóricos sobre la relación entre la sociedad y la universidad y la pertinencia de la inserción de temas que demandan su presencia en los planes de estudio y proyectos de investigación de estas instituciones. Se contextualiza el envejecimiento poblacional como una de las responsabilidades sociales de obligada introducción en los programas de estudio de la carrera de Medicina, lo cual posibilita ratificar el carácter científico, tecnológico y humanístico de la educación superior cubana al asumir en sus procesos sustantivos la formación de un profesional integral, competente, con preparación científica para aceptar los retos de la modernidad, y con amplio desarrollo humanístico para vivir en una sociedad con una población envejecida. Los autores se propusieron como objetivo reflexionar acerca de la pertinencia del tema en el currículo de la carrera, como expresión del vínculo universidad-sociedad.

Theoretical foundations about the relationship between university and society and the pertinence of the insertion of topics that demand their presence in the study plans and research projects of these institutions are analyzed. Population aging is contextualized as one of the social responsibilities of necessary introduction in the study programs of the Medicine career, which makes it possible to ratify the scientific, technological and humanistic character of Cuban higher education by assuming in its core processes the formation of a comprehensive professional, competent, with scientific preparation to accept the challenges of modernity, and with ample humanistic development to live in a society with an aging population. The authors set out to reflect on the relevance of the topic in the career curriculum as an expression of the university-society link.

Prevalence and factors associated with alcohol and tobacco use among non-institutionalized elderly persons / Prevalência e fatores associados ao consumo de álcool e de tabaco em idosos não institucionalizados

Abstract Objective: The present study aims to evaluate the prevalence of and factors associated with the use of tobacco and alcohol among elderly people living in the northern part of the city of Juiz de Fora, Minas Gerais, Brazil. Method: A cross-sectional study conducted through a home survey was performed with a sample of 423 elderly citizens. Interviews were conducted through a questionnaire including the Fagerström and Audit-C tests. The data were subjected to descriptive statistical analysis and multinomial regression. Results: The prevalence of elderly smokers was 9.0%, 32.0% were former smokers, 26.7% of the sample consumed alcoholic beverages and 3.2% used alcohol and smoked. In the multinomial logistic regression model, the factors that were significantly associated with smoking were the male gender, an age of 60 to 70 years old; the presence of self-reported health problems; while the consumption of alcohol was associated with the male gender and frailty. Conclusion: There was a low prevalence of elderly people living in the community who consumed alcoholic beverages and/or were smokers. Such individuals, however, almost exclusively suffered from impaired health and potentially a poor quality of life. Regarding the profile of such elderly persons, there were similarities between the socio-demographic and health variables, suggesting the possibility of a more targeted approach to these individuals.

Resumo Objetivo: Avaliar a prevalência e os fatores associados ao consumo de tabaco e de álcool em uma amostra de idosos residentes do município de Juiz de Fora (MG), Brasil. Método: Estudo transversal, realizado por meio de inquérito domiciliar, com uma amostra de 400 idosos, com os quais foram realizadas entrevistas por meio de questionário, incluindo os testes de Fagerström e Audit C. Os dados foram submetidos à análise estatística descritiva e regressão multinomial. Resultados: A prevalência de tabagismo foi de 9,0%, ex-tabagista 32,0%, consumo de álcool foi de 26,7% e uso concomitante de álcool e tabaco de 3,2%. No modelo de regressão logística multinomial, as características que permaneceram associadas significativamente ao tabagismo foram sexo masculino, idade de 60 a 70 anos; e presença de problemas de saúde autorreferida; e quanto ao consumo de álcool, as características que permaneceram associadas foram sexo masculino e fragilidade. Conclusão: O idoso que vive na comunidade, que consome bebidas alcoólicas e/ou que é tabagista representa uma baixa prevalência, porém, de maneira quase exclusiva, apresenta comprometimento do estado de saúde e potencialmente da qualidade de vida. Quanto ao perfil, há semelhanças dos aspectos sociodemográficos e de saúde, sugerindo a possibilidade de um enfoque mais direcionado quanto à abordagem desses indivíduos.

El envejecimiento, la vejez y la calidad de vida: ¿éxito o dificultad? / Aging, Elderly and Quality of Life: Success or Difficulty?

En el presente siglo se vive, lo que muchos han llamado como, "momento único", porque por primera vez en la historia de la humanidad conviven varias generaciones. Esa dinámica demográfica en el mundo y en Cuba en lo particular, es un logro y a la vez un desafío. Reconocer que este fenómeno involucra a la salud, y a otros sectores de la sociedad, y que además necesita de recursos incluyentes y creativos en las políticas públicas, para que esa prolongación de la vida sea de calidad, es indispensable para la sostenibilidad. Las nuevas concepciones en el campo gerontológico nos conducen a la necesidad de integrarnos de forma multidisciplinar y multisectorial, no solo para enfrentar este fenómeno del envejecimiento poblacional desde el punto de vista social, sino también, en el orden individual, para aprender a envejecer con calidad. El objetivo del trabajo es exponer algunos de los retos que implica enfrentar el envejecimiento poblacional, para que los adultos mayores puedan envejecer con mayor calidad de vida.

In this century, life is something that many have called a "unique moment" because for the first time in history various generations coexist. This demographic dynamics in the world and in Cuba in particular, is an achievement and at the same time a challenge. Identifying that this phenomena involves the health area and other sectors of the society and in addition it requires inclusive and creative resources in public policies so this is life extension with quality, is indispensable for sustainability. The new conceptions in gerontologic field lead us to a need of multidiscipline and multisectorial integration, not only to face the population aging from the social point of view but also, from the individual perspective, to learn aging with quality. The objective of this work is present some of the challenges it implies to facing the population aging so that older adults may age with a higher quality if life.

Perfil sociodemográfico e clínico de idosos acompanhados por equipes de Saúde da Família sob a perspectiva do gênero / Perfil sociodemográfico y clínico de años acompañados por equipos de Salud de la Familia bajo la perspectiva del género / Sociodemographic and clinical profile of elderly persons accompanied by Family Health teams under the gender perspective

Objective: to evaluate the sociodemographic and clinical profile of elderly diabetic and/or hypertensive assisted by family health teams from a gender perspective. Method: it is a quantitative, cross-sectional study included 381 elderly enrolled in the twenty Health Basic Units in District Health Northwest of Belo Horizonte, Minas Gerais. Data were collected between October 2011 to March 2012. A Research Ethics Committee, approved the research project, number 0043.0.410.203-10 and 0043.0.410.203-10A. Results: The women are more prevalent, indicating the feminization phenomenon of old age, being mostly from countryside, widowed, with low education and income, and also high burden of disease and mortality. Conclusion: It is necessary to extend of public health studies and policies which should incorporate the gender concept in favor of building a less ageist and sexist society.

Objetivo: avaliar o perfil sociodemográfico e clínico de idosos diabéticos e/ou hipertensos acompanhados pelas equipes de Saúde da Família sob a perspectiva do gênero. Métodos: estudo quantitativo, transversal envolvendo 381 idosos cadastrados nas vinte Unidades Básicas de Saúde do Distrito Sanitário Noroeste de Belo Horizonte, Minas Gerais. Coleta de dados ocorreu em outubro de 2011 a março de 2012. Utilizado questionário estruturado com variáveis sociodemográficas, clínicas e comportamentais. Projeto de pesquisa aprovado por Comitê de Ética, Parecer n° 0043.0.410.203-10 e 0043.0.410.203-10A. Resultados: o sexo feminino foi prevalente, indicando o fenômeno feminilização da velhice, sendo a maioria proveniente do interior de Minas Gerais, viúva, com baixa escolaridade e renda e, ainda, alta carga mórbida. Conclusão: É necessária ampliação de estudos e políticas de saúde pública que incorporem o conceito gênero, em prol da construção de uma sociedade menos gerofóbica e sexista.

Objetivo: evaluar el perfil sociodemográfico y clínico de ancianos diabetes y/o hipertensos acompañados por equipos de salud de la familia desde una perspectiva de género. Métodos: estudio cuantitativo, transversal, que incluyó 381 ancianos inscritos en las veinte Unidades Básica en el Distrito de Salud Noroeste de Belo Horizonte, Minas Gerais. Los datos fueron recogidos entre octubre de 2011 a marzo de 2012. Se utilizaron cuestionario estructurado con variables sociodemográficas, clínicas y comportamiento. El Comité de Ética en Investigación aprobó el proyecto, número 0043.0.410.203- 10 y 0043.0.410.203-10A. Resultados: sexo femenino fue predominante, lo que indica el fenómeno de feminización de la vejez, y la mayoría provenía del interior de Minas Gerais, viuda, con bajo nivel de educación e ingresos, y también de alta carga mórbida. Conclusión: Es necesario expansión de estudios y políticas de salud pública que incorporan el concepto de género, para la construcción de un sociedad menos gerofóbica y sexista.

Nuevos retos de los servicios de medicina de laboratorio por el envejecimiento poblacional / New challanges of Laboratory Medicine due to population aging

El envejecimiento poblacional implica graves consecuencias para la sociedad y el sistema de salud. La medicina de laboratorio, como parte de él, es afectada en sus tres fases: preanalítica, analítica y postanalitica. Tanto por la multimorbilidad que posee el adulto mayor, como por la dificultad para cumplir con algunos requisitos para el diagnóstico por la edad avanzada (determinadas limitaciones dietéticas) constituyen serios problemas para realizar los análisis correctamente. Sin duda alguna, el envejecimiento demográfico trae consigo nuevos retos para los servicios de medicina de laboratorio. El presente trabajo expone los efectos que provoca el fenómeno para el sistema de salud y propone soluciones para enfrentar sus consecuencias.

Population aging implies impacting consequences for the society and the health system. Laboratory Medicine as part of it, is affected in its three phases: Preanalytical, analytical and postanalytical. This is a serious problem to perform these analysis correctly because of the elderly multimorbidity so as the difficulty to comply with some requierements for the dignosis due to age ( certain dietary limitations). Undoubtely demographic aging brings about new challanges for the laboratory medical services. The present work shows the effects of this phenomenun for the health system and proposes solutions to mitigate its consquences.

The Effect of Population Ageing on Healthcare Expenditure in Korea: From the Perspective of ‘Healthy Ageing’ Using Age-Period-Cohort Analysis / 보건행정학회지

BACKGROUND: People who were born in different years, that is, different birth cohorts, grow in varying socio-historical and dynamic contexts, which result in differences in social dispositions and physical abilities. METHODS: This study used age-period-cohort analysis method to establish explanatory models on healthcare expenditure in Korea reflecting birth cohort factor using intrinsic estimator. Based on these models, we tried to investigate the effects of ageing population on future healthcare expenditure through simulation by scenarios. RESULTS: Coefficient of cohort effect was not as high as that of age effect, but greater than that of period effect. The cohort effect can be interpreted to show ‘healthy ageing’ phenomenon. Healthy ageing effect shows annual average decrease of −1.74% to 1.57% in healthcare expenditure. Controlling age, period, and birth cohort effects, pure demographic effect of population ageing due to increase in life expectancy shows annual average increase of 1.61%–1.80% in healthcare expenditure. CONCLUSION: First, since the influence of population factor itself on healthcare expenditure increase is not as big as expected. Second, ‘healthy ageing effect’ suggests that there is a need of paradigm shift to prevention centered-healthcare services. Third, forecasting of health expenditure needs to reflect social change factors by considering birth cohort effect.

10 Anos do Estudo SABE: antecedentes, metodologia e organização do estudo / 10 Years of SABE Study: background, methodology and organization of the study

RESUMO: O Estudo Saúde, Bem-Estar e Envelhecimento (SABE) teve início em 2000 sob coordenação da Organização Pan-Americana da Saúde como um estudo multicêntrico desenvolvido em sete centros urbanos da América Latina e Caribe para traçar o perfil das condições de vida e saúde das pessoas idosas na região. No Brasil, foi realizado na cidade de São Paulo, onde foram entrevistadas 2.143 pessoas (coorte A), com idade igual ou superior a 60 anos, por amostra probabilística. Em 2006, o Estudo SABE - Brasil transformou-se em longitudinal. Nesse momento, foram localizadas e reentrevistadas 1.115 pessoas, introduzindo-se uma nova amostra probabilística de idosos com idade de 60 a 64 anos (coorte B, n = 298), o transformando em longitudinal de múltiplas coortes com o objetivo principal de identificar as transformações que ocorrem no processo de envelhecimento entre as diferentes gerações. No ano 2010 foi desenvolvido o seguimento longitudinal das coortes A e B e introduzida nova coorte de 60 a 64 anos (coorte C, n = 355). Nas três coletas (2000, 2006 e 2010) utilizou-se um instrumento sob a forma de questionário, avaliação antropométrica e testes funcionais, introduzindo-se a coleta de sangue para avaliação de parâmetros bioquímicos, imunológicos e genéticos e, também, o acelerômetro para medir objetivamente o gasto calórico dos idosos.

ABSTRACT: The Health, Wellbeing and Aging Study (SABE) began in 2000 under the coordination of the Pan American Health Organization as a multicenter study developed in seven urban centers of Latin America and the Caribbean, to determine the health and living conditions of elderly in this region. In Brazil, the study was developed in the city of São Paulo, where 2,143 individuals (cohort A) aged 60 years or older were selected through probabilistic sampling. In 2006, 1,115 of these individuals were interviewed a second time, and a new probabilistic cohort of individuals aged 60 to 64 years was added (cohort B; n=298). Thus the SABE Study - Brazil was transformed into a multi-cohort longitudinal study, with the objective of identifying changes that occur in the aging process among different generations. In 2010, a longitudinal follow-up was developed with cohorts A and B, with the addition of a new cohort of individuals aged 60 to 64 years (cohort C; n=355). Thethree surveys (2000, 2006 and 2010) involved the application of a questionnaire, anthropometric evaluation and functional tests, with the subsequent inclusion of blood collection for the evaluation of biochemical, immunological and genetic variables, as well as an accelerometer for the measuring of caloric expenditure.

Aging demographic profile in municipalities in the state of Pará, Brazil / Perfil demográfico del envejecimiento en los municipios del estado de Pará, Brasil / Perfil demográfico do envelhecimento nos municípios do estado do Pará, Brasil

ABSTRACT Objective: To investigate socioeconomic and demographic differences regarding population aging in municipalities of the state of Pará, Brazil. Method: Ecological study with secondary demographic, socioeconomic and health data from the 144 municipalities of the state of Pará, Brazil. Data were treated with segmentation analysis, the Mann-Whitney U test and logistic regression models, with a significance level of p ≤ 0.05. Results: Segmentation analysis provided a single variable to describe aging in the municipalities of Pará and originated two clusters, the high and low aging rate ones, with 104 (72.22%) and 40 (27.78%) municipalities in each, respectively. The fitted model revealed an association between aging and per capita income (p = 0.021), vulnerability to poverty (p = 0.003), rich to poor ratio (p = 0.012) and density of people (p = 0.019). Conclusion: There is heterogeneity in the population aging among the municipalities of Pará, mainly regarding socioeconomic conditions and number of people living in the municipalities.

RESUMEN Objetivo: Investigar las diferencias socioeconómicas y demográficas entre los municipios paraenses respecto del envejecimiento. Método: Estudio ecológico, con utilización de datos secundarios demográficos, socioeconómicos y de salud correspondientes a los 144 municipios del estado de Pará, Brasil. Datos tratados adoptándose el análisis de segmentación, el Test U de Mann-Whitney y los modelos de regresión logística, con nivel de significatividad establecido en p≤0,05. Resultados: El análisis de segmentación determinó una variable única para explicar el envejecimiento en los municipios paraenses, formando dos clústeres distintos: alto y bajo envejecimiento, respectivamente con 104 (72,22%) y 40 (27,78%) municipios. El modelo final ajustado demostró asociación entre envejecimiento e ingreso per cápita (p=0,021), vulnerables a la pobreza (p=0,003), razón ricos/pobres (p=0,012) y densidad de habitantes (p=0,019). Conclusión: Se concluye en que existe heterogeneidad en el envejecimiento de la población anciana entre los municipios de Pará, particularmente respecto de condiciones socioeconómicas y tamaño del municipio.

RESUMO Objetivo: investigar as diferenças socioeconômicas e demográficas entre os municípios paraenses, em relação ao envelhecimento. Método: Estudo ecológico com a utilização de dados secundários demográficos, socioeconômicos e de saúde referentes aos 144 municípios do estado do Pará, Brasil. Os dados foram tratados adotando-se a análise de segmentação, o Teste U de Mann-Whitney e os modelos de regressão logística, com nível de significância estabelecido em p≤0,05. Resultados: A análise de segmentação criou uma variável única para explicar o envelhecimento entre os municípios paraenses, formando dois clusters distintos: alto e baixo envelhecimento, com respectivamente 104 (72,22%) e 40 (27,78%) municípios. O modelo final ajustado revelou associação entre envelhecimento e renda per capita (p=0,021), vulneráveis à pobreza (p=0,003), razão ricos/pobres (p=0,012) e densidade de moradores (p=0,019). Conclusão: Conclui-se que existe heterogeneidade no envelhecimento da população idosa entre os municípios do Pará, especialmente em relação às condições socioeconômicas e tamanho do município.

Envejecimiento demográfico en Cuba y los desafíos que presenta para el Estado / Challenges facing the Cuban State arising from demographic aging

El envejecimiento demográfico en Cuba, visualizado desde hace más de dos décadas, es indudablemente una conquista de las políticas de salud pública y del desarrollo social del país. Aunque el Estado instituyó un sistema de atención encaminado a garantizar a sus personas mayores condiciones favorables para su envejecimiento, el logro social de una mayor longevidad establece nuevos retos en materia de políticas sociales, infraestructuras y servicios de atención e inclusión social hacia el colectivo de los mayores. La población cubana se caracteriza por el decrecimiento y altos índices de esperanza de vida, que incrementan la proporción de personas de 60 y más años, aspecto que introduce un nuevo escenario gerontológico. El presente artículo se propone analizar algunos desafíos hacia el Estado cubano para la conformación de políticas que posibiliten la continuidad del logro social de una mayor longevidad en correspondencia con las condiciones coherentes con el modelo de desarrollo que el país refrenda.

Demographic aging in Cuba, which has been occurring for over two decades, is undoubtedly an achievement of the country's public health policies and social development. Although the State instituted a system of care aimed at guaranteeing elderly people favorable conditions for aging, the social achievement of greater longevity creates new challenges for social policy, infrastructure, healthcare systems and social inclusion. The Cuban population is diminishing and at the same time, life expectancy is increasing. These two conditions increase the proportion of people aged 60 and over, thus introducing a new scenario of an aging population. The present article analyzes some of the challenges that the Cuban State must face when developing policies that address and preserve the social achievement of a greater longevity, together with the conditions inherent in the development model that the country endorses.

Quedas em idosos: reflexões sobre as políticas públicas para o envelhecimento saudável / Falls with the elderly: thoughts on public policies for healthy aging

Este estudo teve por objetivo apresentar as reflexões acerca das políticas públicas relacionada às quedas para que a população idosa possa obter um envelhecimento saudável. Optou-se pelo método de revisão narrativa por entender que são publicações amplas, apropriadas para descrever e discutir o desenvolvimento ou o "estado da arte" de um determinado assunto, sob o ponto de vista teórico ou contextual, não informando as fontes utilizadas, a metodologia para busca de referências, nem os critérios utilizados na avaliação e seleção de trabalhos. Para compor a revisão delimitaram-se os seguintes tópicos: Envelhecimento como fenômeno demográfico; Envelhecimento e os eventos de quedas; Inaugurar um novo tempo de ação e de parcerias, em cooperação entre todos, pois se os problemas são multifacetados, como os eventos de quedas, as soluções também o são. A consolidação de parcerias efetivas com as famílias, a sociedade, os setores governamentais e/ou não governamentais, poderá fortalecer políticas públicas para o envelhecimento saudável. Tal proposição exigirá mudanças essenciais, não apenas no que fazemos, mas em como pensamos e conduzimos o envelhecimento em si, seja na dimensão pessoal e ou coletiva.

This study aimed at presenting the thoughts on public policies related to falls for the elderly population to have a healthy aging. The narrative review method was chosen since it is understood that they are broad publications, appropriate to describe and discuss the development or "state-of-the-art" of a certain subject from a theoretical or contextual point of view, not informing the used sources, the methodology for searching references, nor the criteria used in the evaluation and selection of papers. In order to compose the review, the following topics were defined: Aging as a demographic phenomenon; Aging and fall events; Inauguration of a new time for action and partnerships, in joint cooperation, since if the issues are multifaceted, such as fall events, so are the solutions. The consolidation of effective partnerships with families, society, government and/or non-governmental sectors could strengthen public policies for healthy aging. Such a proposition will require essential changes, not only in what we do, but in the manner we think and deal with aging itself, whether in a personal or collective dimension.