Determinants of socioeconomic factors for quality of life and depressive symptoms in community-dwelling older people: A cross-sectional study in Brazil and Portugal.

Our aim was to analyze the association between socioeconomic status and quality of life (QoL) among older people with depressive symptoms treated through the Primary Health Care (PHC) system in Brazil and Portugal. This was a comparative cross-sectional study with a nonprobability sample of older people in the PHC in Brazil and Portugal conducted between 2017 and 2018. To evaluate the variables of interest, the socioeconomic data questionnaire, the Geriatric Depression Scale and the Medical Outcomes Short-Form Health Survey were used. Descriptive and multivariate analyses were performed to test the study hypothesis. The sample consisted of n = 150 participants (Brazil n = 100 and Portugal n = 50). There was a predominance of woman (76.0%, p = 0.224) and individuals between 65 and 80 years (88.0%, p = 0.594). The multivariate association analysis showed that in the presence of depressive symptoms, the QoL mental health domain was most associated with the socioeconomic variables. Among the prominent variables, woman group (p = 0.027), age group 65-80 years (p = 0.042), marital status "without a partner" (p = 0.029), education up to 5 years (p = 0.011) and earning up to 1 minimum wage (p = 0.037) exhibited higher scores among brazilian participants. The portuguese participants showed an association between the general health status domain and woman group (p = 0.042) and education up to 5 years (p = 0.045). The physical functioning domain was associated with income of up to 1 minimum wage (p = 0.037). In these domains, the portuguese participants exhibited higher scores than the brazilian participants. We verified the association between socioeconomic profile and QoL in the presence of depressive symptoms, which occurred mainly among woman, participants with low levels of education and low income, with QoL aspects related to mental, physical and social health and self-perceived health. The group from Brazil had higher QoL scores than the group from Portugal.

Loss of Muscle Mass and Vulnerability in Institutionalized Older Adults.

This study aimed to evaluate the association between muscle mass and vulnerability in institutionalized older adults. A cross-sectional study was carried out in eight philanthropic Long-Term Care Facilities (LTCF) located in the metropolitan area of Natal, Rio Grande do Norte, Brazil. The participants were individuals aged 60 years or older who were present in the institutions at the time of data collection. To assess muscle mass, the calf circumference was categorized into loss of muscle mass (<31 cm) and preserved muscle mass (≥31 cm). The vulnerability was assessed by The Vulnerable Elders Survey (VES-13). Of the 250 older adults evaluated, 46.1% presented loss of muscle mass, which was associated with the presence of physical limitation, vulnerability, and age group (p < 0.05). The presence of vulnerability was the main factor contributing to loss of muscle mass (R2 = 8.8%; B = 0.781; 95% CI 0.690−0.884; p < 0.001). Loss of muscle mass is associated with disability in institutionalized older adults.

Segurança do ambiente domiciliar e ocorrência de quedas em pessoas idosas / The home environment safety and the occurrence of falls in elderly people / La seguridad en el entorno domiciliario y la ocurrencia de caídas en los ancianos

Introdução:A ocorrência de quedas em pessoas idosas é considerada um problema de saúde pública, acarretando prejuízos para a saúde, mas que pode ser prevenida a partir da manutenção de um ambiente seguro. Objetivo:Identificar condições relacionadas a ocorrência de quedas e segurança do ambiente domiciliar de pessoas idosas residentes na zona rural de um município do Rio Grande do Norte. Metodologia:Foi realizada uma pesquisa-ação com uma das etapas de diagnóstico feito a partir de um estudo analítico e observacional. O estudo foi realizado com Agentes Comunitários de Saúde e idosos. Foram realizadas capacitações com os agentes para reconhecimento e identificação dos riscos ambientais de quedas nos domicílios dos idosos. Para coleta de dados, utilizou-se o questionário de avaliação ambiental e quedas da Caderneta de Saúde da Pessoa Idosa. Resultados:Participaram do estudo 288 idosos, dos quais 24,7% relataram ter sofrido queda e desses, 23,9% tiveram fratura óssea. 47,9% das quedas ocorreram dentro de casa, principalmente no banheiro (42,2%). A maioria dos itens de segurança do ambiente domiciliar não estava adequado. Foram encontradas diferenças significativas entre a ocorrência de queda e a ausência de pisos uniformes e tapetes bem fixos (p<0,001), interruptores acessíveis nas entradas de cômodos (p<0,001), área do chuveiro com antiderrapante (p=0,026) e armários baixos sem necessidade do uso de escadas (p<0,001). Conclusões:A maioria das pessoas idosas vive em um ambiente que favorece a ocorrência de quedas. Enfatiza-se a necessidade de ações de prevenção de quedas e segurança domiciliar tendo em vista suas implicações na qualidade de vida dessas pessoas (AU).

Introduction:The occurrence of falls in elderly people is considered a public health problem, causing harm to health, but thiscan be prevented by maintaining a safe environment.Objective:To identify conditions related to the occurrence of falls and home environment safety of elderly people living in the rural area of a city in Rio Grande do Norte, Brazil.Methodology:We performed an action-research with one of the diagnostic stagesmade from an analytical and observational study. The study was conducted with Community Health Workers and the local elderlypopulation. Training was accomplishedwith theseworkersto recognize and identify the environmental risks of falls in the elderly's homes. In order to collect data,we used the environmental assessment and falls questionnaire from the Elderly Person's Health Booklet.Results:A total of 288 older adults participated in the study, of whom 24.7% reported having suffered a fall;and of these, 23.9% had a bone fracture. A percentage of 47.9% of falls occurred indoors, mainly in the bathroom(42.2%). Most homesafety items were not adequate.Significant differences were found between the occurrence of falls and the absence of uniform floors and well-fixed mats(p<0.001), accessible switches at the entrances of rooms (p<0.001), non-slip shower area (p=0.026) and low closetswithout the need to use stairs (p<0.001). Conclusions:Most elderly people live in an environment that favors the occurrence of falls. Fall prevention and home safety actions are necessary due totheir implications onthe quality of life of this population (AU).

Introducción: La ocorruencia de caídas em los ancianosse considera un problema de salud pública, que causa daños a la salud, pero que puede prevenirse manteniendo un entorno seguro.Objetivo: Identificar las condiciones relacionadas con la ocurrencia de caídas y la seguridad em el entorno domiciliariode los ancianos que viven em um árearural de un municipio de Rio Grande doNorte, Brasil.Metodología: Se realizó una investigación-acción con una de las etapas de diagnóstico realizada a partir de un estudio analítico y observacional. El estudio se realizócon Agentes de Salud Comunitariosy ancianos. Los agentes recibieron formación para reconocer e identificar los riesgos ambientales delascaídas en las residenciasde los ancianos. Para la recogidade datos, se utilizó el cuestionario de evaluación ambiental y caídas de la Cartillade Salud de los Ancianos.Resultados: El estudio incluyó a 288 ancianos, de los cuales el 24,7% sufrieroncaída;y, de estos,el 23,9% tuvieron fractura ósea. El 47,9% de las caídas se produjeron en un entorno interior, principalmente en el baño (el42,2%).La mayoría de los elementos de seguridad en el entorno domiciliario no eran adecuados. Se encontraron diferencias significativas entrela ocurrencia de caída y la ausencia de suelosuniformes y alfombras bien fijadas(p<0,001), interruptores accesibles en las entradas de las habitaciones (p<0,001), zonade ducha con antideslizante (p=0,026) y armarios bajos sin necesidadde utilizarescaleras (p<0,001).Conclusiones: Muchos ancianos viven en entornosque favorecen la ocurrencia de caídas. Lasacciones de prevención de caídas y de seguridad em el hoharson necessárias porsus implicaciones en la calidad de vida de esta población (AU).

Health conditions of potential risk for severe Covid-19 in institutionalized elderly people.

The objective of this study was to identify the health conditions considered potential risk factors for severe Covid-19 and analyze its association with the BMI of elderly people living in Long-Term Care Facilities (LTCF). This is a descriptive and cross-sectional study, with a quantitative approach, carried out in eight LTCF in the Metropolitan Region of Natal, Rio Grande do Norte, with a population of 267 elderly people, between the months of February and December 2018. The Elderly Health Handbook was used to collect data on sociodemographic, health and risk factors. The Pearson's Chi-square test and odds ratio were used for the analysis. A higher frequency of low weight was observed in elderly people with cognitive impairment (24.6%), and overweight in those hypertensive (23.3%) and diabetics (12.9%). BMI was associated with the age group of 80 years or over, hypertension and diabetes (p = 0.013; p < 0.001; p = 0.001). Hypertensive elderly people were more likely to have low weight when compared to non-hypertensive individuals (RC = 3.6; 95% CI 1.5-8.6). The institutionalized elderly individuals present health conditions that may contribute to the occurrence of adverse outcomes in case of infection by Covid-19. The importance of protective measures for this population must be reinforced, in view of the devastating action of this disease in these institutions.

Fatores de risco para forma grave da COVID-19 em pessoas idosas institucionalizadas / Risk factors for the severe form of COVID-19 in institutionalized elderly people

Introdução: A COVID-19 caracteriza-se por uma síndrome respiratória com variações no grau de gravidade. Porém, essa doença tem afetado, de forma desproporcional, pessoas idosas institucionalizadas, levando a uma elevada mortalidade nessa população. Objetivo: Analisar as condições consideradas de risco para forma grave e morte pela COVID-19 em pessoas idosas institucionalizadas e sua associação com o estado nutricional. Métodos: Foram realizadas duas análises: 1) estudo descritivo, transversal com abordagem quantitativa, realizado em oito instituição de longa permanência para idosos da região Metropolitana de Natal, Rio Grande do Norte, com população de 267 pessoas idosas, entre os meses de fevereiro e dezembro de 2018, que utilizou como instrumento para coleta de dados sociodemográficos, saúde e fatores de risco a Caderneta de Saúde da Pessoa Idosa, e realizados os testes Qui-quadrado de Pearson e Razão de Chance para análise das variáveis; 2) revisão sistemática da literatura de estudos epidemiológicos observacionais publicados entre os meses janeiro de 2020 a 10 de fevereiro de 2021, para qual foram realizadas buscas nas bases de dados Biblioteca Virtual em Saúde (BVS), PubMed, Scopus e Web of Science, utilizando o padrão DeCS/MeSH (Descritores em Ciências da Saúde), e avaliado o risco de viés por instrumentos do Instituto Joanna Briggs. Resultados: 1) Das 267 pessoas idosas avaliadas, as condições de risco mais prevalentes foram a deficiência cognitiva (57,5%), hipertensão (55,6%) e diabetes (27,5%), sendo observada maior frequência de baixo peso em idosos com deficiência cognitiva (24,6%), e sobrepeso naqueles hipertensos (23,3%) e diabéticos (12,9%). O índice de massa corporal (IMC) apresentou associação com a faixa etária 80 anos ou mais (p=0,013), hipertensão (p<0,001) e diabetes (p=0,001). Pessoas idosas hipertensas têm mais chances de apresentar baixo peso quando comparado às não hipertensas (RC=3,6; IC95% 1,5-8,6). 2) Foram identificadas 171 publicações, das quais nove atenderam aos critérios de elegibilidade. A busca complementar na lista de referências desses estudos resultou em dois artigos. Com isso, 11 artigos foram incluídos na revisão. Foram identificados diferentes fatores de risco agrupados em fatores sociodemográficos, manifestações clínicas e condições de saúde, sendo o sexo masculino, a apresentação de uma maior sintomatologia da doença, a presença de sintomas respiratórios e de doenças cardiovasculares diferentes da hipertensão como os principais fatores de risco. Considerações finais: Pessoas idosas institucionalizadas apresentam condições de saúde que os tornam mais vulneráveis a evoluir para forma grave da COVID-19 caso sejam infectados, o que requer a adoção de medidas protetivas e protocolos para oportunizar o tratamento desses indivíduos e prevenção de agravos para aqueles em maior risco de evoluir para forma grave da doença (AU).

Introduction: COVID-19 is characterized by a respiratory syndrome with severity variations. However, this disease has disproportionately affected institutionalized elderly people, leading to a high mortality in this population. Objective: To analize the conditions considered at risk for severe form and death by COVID-19 in institutionalized elderly people and their association with nutritional status. Methods: Two analysis were performed: 1) descriptive study, crosssectional with quantitative approach, carried out in eight long-stay institution for the elderly in the Metropolitan region of Natal, Rio Grande do Norte, with a population of 267 elderly people, between February and December 2018, which used as an instrument to collect sociodemographic data, health and risk factors the Elderly Health Handbook, and Pearson's chi-square and Chance Ratio tests were performed to analyze the variables; 2) systematic review of the literature of observational epidemiological studies published between January 2020 and February 10, 2021, for which searches were conducted in the databases Virtual Health Library (BVS), PubMed, Scopus and Web of Science, using the Standard DeCS/MeSH (Descriptors in Health Sciences), and evaluated the risk of bias by instruments of the Joanna Briggs Institute. Results: 1) Of the 267 elderly people evaluated, the most prevalent risk conditions were cognitive impairment (57.5%), hypertension (55.6%) and diabetes (27.5%), with a higher frequency of low birth weight in elderly with cognitive impairment (24.6%), and overweight in those hypertensive (23.3%) diabetics (12.9%). Body mass index (BMI) was associated with the age group over 80 years (p=0.013), hypertension (p<0.001), and diabetes (p=0.001). Hypertensive elderly people are more likely to have low weight when compared to non-hypertensive people (CR=3.6; IC95% 1.5-8.6). 2) 171 publications were identified, nine of which met the eligibility criteria. The complementary search in the list of references of these studies resulted in two articles. With this, it included 11 articles in the review. It identified different risk factors grouped into sociodemographic factors­male gender, age over 80 years and institutionalization itself; clinical manifestations­presence of symptoms, loss of appetite, fever, diarrhea, altered mental status, lethargy, respiratory symptoms, and shorthand; and health conditions - cardiovascular diseases, diabetes, kidney disease, functional and cognitive decline, Parkinson's disease, frailty, depression, and chronic obstructive pulmonary disease. Final considerations: Institutionalized elderly people present health conditions that make them more vulnerable to develop to a severe form of COVID-19 if infected, which requires the adoption of protective measures and protocols to provide opportunities to treat these individuals and prevention of injuries for those at higher risk for severe form of the disease (AU).