Analysis of the fight against the COVID-19 pandemic in long-term care facilities in the pre-vaccination period.

INTRODUCTION: The COVID-19 pandemic has disproportionately affected individuals residing in Long-Term Care Facilities (LTCFs), necessitating tailored strategies to manage outbreaks. This study examines the outcomes of the ILPI BH project, a collaborative effort between the Municipal Health Department and the Hospital das Clínicas of the Federal University of Minas Gerais, designed to mitigate COVID-19 spread within LTCFs. METHODS: Prospective cohort of secondary data: 1,794 old residents in 99 long-term care facilities of Belo Horizonte, Brazil, were followed from May 2020 to January 2021. The study analyzed the prevention strategies, residents' clinical data, and the characteristics of the long-term care facilities, correlating these variables with the number of infections, hospitalizations, and deaths from COVID-19. It checked absolute numbers and rates of incidence, hospitalization, mortality, and lethality. RESULTS: There have been 58 COVID-19 outbreaks in long-term care facilities. There were 399 cases among residents, 96 hospitalizations for COVID-19 and 48 deaths from COVID-19 (2.7 % of the cohort), with a case fatality rate of 12 %. After multivariate analysis, the intrinsic variables to residents associated with higher mortality risk were higher degree of frailty (OR=1.08; p = 0.004) and the fact of living in a long-term care facility with a considerable proportion of residents' coverage by health plans (OR = 1.01; p = 0.028). Early geriatric follow-up showed an association with a reduction in the number of hospitalizations due to COVID-19. CONCLUSION: The correct classification of the degree of frailty of institutionalized older people seems to have been relevant for predicting mortality from COVID-19. The extensive assistance by private health plans, contrary to what is supposed, did not result in better health protection. Early geriatric follow-up was beneficial and may be an attractive strategy in the face of health emergencies that affect long-term care facilities to reduce hospital admissions.

Intrinsic capacity as proposed by the World Health Organization and 30-month mortality among older adults in long-term care facilities / Capacidade Intrínseca proposta pela Organização Mundial de Saúde e mortalidade em residentes de Instituição de Longa Permanência para Idosos em 30 meses

Objetivo: Analisar o efeito da Capacidade Intrínseca na mortalidade de 30 meses em residentes idosos de Instituição de Longa Permanência. Metodologia: Estudo de coorte prospectivo realizado de julho de 2020 a dezembro de 2022 com análise de sobrevivência de idosos residentes de ILPIs brasileiras. Na avaliação inicial (M0) foram avaliados 209 idosos residentes quanto aos dados demográficos e clínicos (doenças diagnosticadas e medicações utilizadas); capacidade intrínseca segundo ICOPE nos domínios cognição, psicológico, audição, visão, vitalidade e locomotor; capacidade funcional pelas atividades básicas de vida diária (índice de Katz) e fragilidade (escala FRAIL). Após 30 meses, foi avaliada a ocorrência de óbito. Resultados: Em M0, a média da idade dos residentes era de 82 anos (±11,21), 65,07% eram do sexo feminino, 94,26% de cor branca e 88,04% tinham multimorbidade. Apresentaram alteração em quatro ou mais domínios da capacidade intrínseca 54,07% (n = 113) dos residentes, sendo o domínio mais alterado a locomoção (82,78%). Eram totalmente dependentes para as atividades básicas de vida diária 43,54% dos idosos, e 42,58% eram frágeis. Após 30 meses de acompanhamento, 33,49% (n = 70) dos idosos evoluíram para óbito. Na análise da sobrevida para óbito, houve associação estatisticamente significativa do evento com alteração em quatro ou mais domínios da capacidade intrínseca (p = 0,044). Conclusão: a alteração de quatro ou mais domínios da capacidade intrínseca está associada com óbito em residentes de ILPI. (AU)

Objective: To analyze the impact of intrinsic capacity on 30-month mortality among older adults living in long-term care facilities (LTCFs). Methods: Prospective cohort study with survival analysis conducted from July 2020 to December 2022 among older adults living in Brazilian LTCFs. At baseline (T0), 209 older residents were evaluated for demographic profile, clinical data (diagnosed diseases and current medications), intrinsic capacity according to ICOPE (cognitive capacity, psychological capacity, hearing capacity, visual capacity, vitality, and locomotor capacity domains), functional capacity (Katz Index of Independence in Activities of Daily Living), and frailty (FRAIL scale). At 30 months, mortality in the sample was assessed. Results: At T0, the mean age of residents was 82 (SD, 11.21) years; 65.07% were female, 94.26% were white, and 88.04% had multimorbidity. Overall, 54.07% (n = 113) of residents exhibited changes in four or more domains of intrinsic capacity, with locomotor capacity being the most commonly impaired domain (82.78%); 43.54% were completely dependent for basic activities of daily living, and 42.58% were frail. At 30-month follow-up, 33.49% (n = 70) of residents had died. Survival analysis revealed a statistically significant association between death and impairment in four or more domains of intrinsic capacity (p = 0.044). Conclusion: Impairment in four or more domains of intrinsic capacity is associated with death in LTCF residents. (AU)

Factors associated with inflamm-aging in institutionalized older people.

The increase in inflammatory cytokines associated with a reduction in the bioavailability of zinc has been used as a marker for inflammation. Despite the high inflammatory state found in institutionalized older individuals, few studies have proposed verifying the factors associated with this condition in this population. To verify the factors associated with inflamm-aging in institutionalized older people. A total of 178 older people (≥ 60 years old) living in nursing homes in Natal/RN were included in the study. Cluster analysis was used to identify three groups according to their inflammatory state. Analysis anthropometric, biochemical, sociodemographic, and health-related variables was carried out. In sequence, an ordinal logistic regression was performed for a confidence level of 95% in those variables with p < 0.20 in the bivariate analysis. IL-6, TNF-α, zinc, low-density lipids (LDL), high-density lipids (HDL), and triglycerides were associated with inflamm-aging. The increase of 1 unit of measurement of LDL, HDL, and triglycerides increased the chance of inflammation-aging by 1.5%, 4.1%, and 0.9%, respectively, while the oldest old (≥ 80 years old) had an 84.9% chance of presenting inflamm-aging in relation to non-long-lived older people (< 80 years). The association between biochemical markers and inflamm-aging demonstrates a relationship between endothelial injury and the inflammatory state. In addition, the presence of a greater amount of fat in the blood may present a higher relative risk of death.

The impact of COVID-19 on the elderly dependent population in Spain with special reference to the residential care sector. / El impacto de la Covid-19 en la población mayor dependiente en España con especial referencia al sector residencial.

The objective of this study is to analyze the residential care crisis in Spain in the context of the COVID-19 pandemic and its impact on high mortality and abandonment of the user population. The direct, indirect and structural causes are analyzed. Specifically, precarious employment in residences over the past decade was analyzed as one of the main explanatory causes of the structural crisis of nursing homes. The theoretical focus of analysis is the comprehensive and person-centered care (CPCC) model based on the autonomy of people and the centrality of their rights. The methodology combines a quantitative analysis of employment and a qualitative analysis of documents and debates. The study concludes by proposing a comprehensive reform of long-term care that includes both a change in residential care in the form of small cohabitation units and reinforcement of care in the home and the community as a growing preference for the elderly population. An optimal combination of residential and home care is the basic proposal of this work.

Este artículo tiene como objeto analizar la crisis de la atención residencial en España en el contexto de la Covid-19 y su impacto en una elevada mortalidad y el abandono de la población usuaria. Se analizan sus causas inmediatas, mediatas y estructurales. De manera específica se analiza la precariedad en el empleo en las residencias a lo largo de la pasada década como una de las principales causas explicativas de la crisis estructural de las residencias. El enfoque teórico de análisis es el modelo de atención integral y centrada en la persona (AICP) basado en la autonomía de las personas y en la centralidad de sus derechos. La metodología combina el análisis cuantitativo en lo referente al empleo junto con una metodología cualitativa basada en el análisis de documentos y debates. El artículo concluye proponiendo una reforma integral de los cuidados de larga duración que incluya tanto un cambio en la atención residencial bajo la forma de pequeñas unidades de convivencia, como un reforzamiento de la atención en el domicilio y la comunidad en cuanto preferencia creciente la población mayor. La combinación óptima de la atención residencial y domiciliaria es la propuesta básica de este trabajo.

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.

El impacto de la Covid-19 en la población mayor dependiente en España con especial referencia al sector residencial / The impact of COVID-19 on the elderly dependent population in Spain with special reference to the residential care sector

Resumen Este artículo tiene como objeto analizar la crisis de la atención residencial en España en el contexto de la Covid-19 y su impacto en una elevada mortalidad y el abandono de la población usuaria. Se analizan sus causas inmediatas, mediatas y estructurales. De manera específica se analiza la precariedad en el empleo en las residencias a lo largo de la pasada década como una de las principales causas explicativas de la crisis estructural de las residencias. El enfoque teórico de análisis es el modelo de atención integral y centrada en la persona (AICP) basado en la autonomía de las personas y en la centralidad de sus derechos. La metodología combina el análisis cuantitativo en lo referente al empleo junto con una metodología cualitativa basada en el análisis de documentos y debates. El artículo concluye proponiendo una reforma integral de los cuidados de larga duración que incluya tanto un cambio en la atención residencial bajo la forma de pequeñas unidades de convivencia, como un reforzamiento de la atención en el domicilio y la comunidad en cuanto preferencia creciente la población mayor. La combinación óptima de la atención residencial y domiciliaria es la propuesta básica de este trabajo.

Abstract The objective of this study is to analyze the residential care crisis in Spain in the context of the COVID-19 pandemic and its impact on high mortality and abandonment of the user population. The direct, indirect and structural causes are analyzed. Specifically, precarious employment in residences over the past decade was analyzed as one of the main explanatory causes of the structural crisis of nursing homes. The theoretical focus of analysis is the comprehensive and person-centered care (CPCC) model based on the autonomy of people and the centrality of their rights. The methodology combines a quantitative analysis of employment and a qualitative analysis of documents and debates. The study concludes by proposing a comprehensive reform of long-term care that includes both a change in residential care in the form of small cohabitation units and reinforcement of care in the home and the community as a growing preference for the elderly population. An optimal combination of residential and home care is the basic proposal of this work.

Seroprevalence of SARS-CoV-2 infection among residents and workers of long-term care facilities in Ribeirão Preto, Brazil: an epidemiological survey / Soroprevalência de infecção por SARS-CoV-2 em residentes e trabalhadores de instituições de longa permanência em Ribeirão Preto, Brasil: um inquérito epidemiológico

OBJECTIVE: Residents and workers in long-term care facilities (LTCF) for older adults share the same space, and residents are more susceptible to COVID-19 complications. The aim of this study was to determine the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies as an indication of previous infection of both residents and workers in LTCFs, as well as associated factors. METHODS: This epidemiological survey was conducted in Ribeirão Preto, Brazil, a medium-sized city. Stratified sampling was performed, with data collected on demographics, health, LTCF protective measures, activities of daily living, and cognition. A serological test was carried out on all selected individuals. RESULTS: The mean resident and worker ages were 80.62 (SD, 9.66) and 37.41 (SD, 12.42) years, respectively. The serological test was positive in 13.33% of the residents, who had 2.91 (SD, 1.28) chronic diseases and used 5.65 (SD, 2.79) medications. Dementia screening was negative in only 11.1%, and only 20% were independent in activities of daily living. The serological test results were positive in 25.93% of the workers, although SARS-CoV-2 had been previously detected in only 6.9%. The LTCF did not perform systematic screening of worker respiratory symptoms. CONCLUSIONS: There was a higher seroprevalence of SARS-CoV-2 among LTCF workers than residents. Systematic screening of worker symptoms before each shift was not regularly performed. The high prevalence of cognitive changes among LTCF residents can impede adherence to personal protection measures.

Residentes e trabalhadores compartilham o mesmo espaço em instituições de longa permanência para idosos (ILPI), sendo os residentes mais suscetíveis às complicações por COVID-19. O objetivo deste estudo foi determinar a soroprevalência de anticorpos para a síndrome respiratória aguda grave por coronavírus 2 (SARS-CoV-2) como uma indicação de infecção anterior de residentes e trabalhadores nas ILPI, bem como fatores associados. METODOLOGIA: Inquérito epidemiológico realizado em Ribeirão Preto, Brasil, uma cidade de médio porte. Amostragem estratificada foi realizada, com informações obtidas sobre dados demográficos, de saúde e condutas protetivas da ILPI. Dados básicos em relação às atividades de vida diária e cognição foram coletados. Um teste sorológico foi realizado em todos os indivíduos selecionados. RESULTADOS: Os residentes idosos da amostra tinham 80,62 ± 9,66 anos e os trabalhadores 37,41 ± 12,42 anos. Teste sorológico positivo foi de 13,33% entre os residentes que apresentavam 2,91 ± 1,28 doenças crônicas e usavam 5,65 ± 2,79 medicamentos, com apenas 11,1% com rastreamento de demência negativo e 20% sendo independentes. Entre os trabalhadores, 25,93% tiveram resultado positivo, sendo o SARS-CoV2 detectado previamente em apenas 6,9% deles. Triagem sistemática de sintomas respiratórios do trabalhador não foi realizado pela ILPI. CONCLUSÕES: Houve uma maior soroprevalência do SARS-CoV-2 entre os trabalhadores das ILPIs do que entre os residentes. A triagem sistemática dos sintomas do trabalhador antes de cada turno de trabalho não era regularmente realizada. Houve uma alta prevalência de alterações cognitivas que podem dificultar cumprir as medidas de proteção individual das ILPIs.

Frailty and mortality in long-term care facilities for older people in Brazil: a survival analysis / Fragilidade e mortalidade em instituições de longa permanência para idosos no Brasil: estudo de sobrevivência

OBJECTIVES: To investigate the effect of frailty on 1-year mortality in long term-care facility (LTCF) residents. METHODS: This was a prospective cohort study with survival analysis of 209 participants living in 15 Brazilian LTCFs. Data on chronic diseases, age, sex, medication use, dependence in activities of daily living (ADLs; Katz index), and frailty (FRAIL scale) were collected at baseline, and death after 1 year was the outcome measure. Kaplan-Meier estimate and log-rank test were used to analyze the survival of residents. RESULTS: In the initial assessment, 65.07 of the residents were women, and the median age was 82 (interquartile range, 71­88) years, with 55% being over 80 years old. Overall, 88% had 2 or more diseases, 59.81% were using 5 or more medications, 42.11% were considered frail, 34.92% pre-frail, and 22.97% robust, and 69.94% were dependent in 3 or more ADLs. During the 12-month follow-up, 19.61% of the residents (n=41) died. In the survival analysis for death, there was a statistically significant association with frailty (p=0.03) and dependence in ADLs (p=0.04). CONCLUSIONS: In this population of LTCF residents, frailty and functional dependence were associated with death.

OBJETIVOS: Investigar o efeito da fragilidade na mortalidade em 1 ano em residentes de instituições de longa permanência para idosos (ILPIs). METODOLOGIA: Estudo de coorte prospectivo com análise de sobrevivência de 209 participantes residentes em 15 ILPIs brasileiras. Dados sobre doenças crônicas, idade, sexo, uso de medicamentos, dependência nas atividades da vida diária (AVDs; índice de Katz) e fragilidade (escala FRAIL) foram coletados no início do estudo, e morte após 1 ano foi a medida de desfecho. A estimativa de Kaplan-Meier e o teste de log-rank foram usados para analisar a sobrevida dos residentes.. RESULTADOS: Na avaliação inicial, 65,07% dos residentes eram mulheres e a mediana da idade era de 82 (intervalo interquartil, 71­88) anos, 55% com mais de 80 anos. Em geral, 88% tinham 2 ou mais doenças, 59,81% usavam 5 ou mais medicamentos, 42,11% foram considerados frágeis, 34,92% pré-frágeis e 22,97% robustos e 69,91% eram dependentes em 3 ou mais AVDs. No decorrer do seguimento de 12 meses, 19,61% dos residentes (n =41) evoluíram para óbito. Na análise de sobrevivência para evento morte, houve associação estatisticamente significativa com fragilidade (p=0,03) e dependência para AVDs (p=0,04). CONCLUSÕES: Nesta população de residentes de ILPIs, fragilidade e dependência funcional estiveram associadas ao óbito.

Estimates of infection and mortality from COVID-19 in care homes for older people in Brazil / Estimativas de infecção e mortalidade por COVID-19 em lares de idosos no Brasil

OBJECTIVE: To describe infection and mortality rates associated with COVID-19 in older people living in Brazilian care homes. METHODS: A descriptive cross-sectional study was conducted using primary and secondary data sources. Nationwide care home administrators were invited to report, via an online questionnaire, the occurrence of infection and mortality associated with COVID-19 from April to August 2020. State Public Prosecutor Offices, State Health Departments, and the Unified Social Security System were also contacted for information. Data were analyzed using descriptive statistics. RESULTS: Data were collected from 2154 care homes located in 14 states, covering 59878 older residents. The incidence rate of COVID-19 was 6.57%, and 883 deaths were recorded in the period, with a case-fatality rate of 22.44%. CONCLUSIONS: The incidence and mortality rates observed in this study were lower than those observed in other (high-income) countries. Data sources related to COVID-19 outbreaks in Brazilian care homes are currently limited to self-report. Structuring and systematizing data recording and reporting in these settings is essential to better understand the spread of the virus and to protect care home residents in Brazil.

OBJETIVO: Descrever as taxas de infecção e mortalidade associadas a COVID-19 em idosos residentes em lares geriátricos brasileiros. MÉTODOS: Foi realizado um estudo transversal descritivo, utilizando fontes primárias e secundárias de dados. Os administradores de lares geriátricos em todo o país foram convidados a relatar, por meio de um questionário online, a ocorrência de infecção e mortalidade associadas a COVID-19 de abril a agosto de 2020. Os gabinetes dos Procuradores Regionais da República, as Secretarias Estaduais de Saúde e o Sistema Único de Assistência Social também foram contatados para informações. Os dados foram analisados por meio de estatística descritiva. RESULTADOS: Foram coletados os dados de 2154 lares de idosos localizados em 14 estados, cobrindo 59 878 idosos residentes. A taxa de incidência de COVID-19 foi de 6,57%, e foram registrados 883 óbitos no período, com uma taxa de letalidade dos casos de 22,44%. CONCLUSÕES: As taxas de incidência e mortalidade observadas neste estudo foram inferiores às observadas em outros países (de alta renda). As fontes de dados relacionadas a surtos de COVID-19 em lares geriátricos brasileiros são atualmente limitadas a autorrelato. Estruturar e sistematizar o registro e a notificação de dados nesses locais é essencial para um melhor entendimento da disseminação do vírus e para a proteção dos residentes de lares geriátricos no Brasil.

A puertas cerradas: La vejez en instituciones en Buenos Aires y el Interior: 1850-1950 / Behind closed doors: Old age in institutions in Buenos Aires and in the country: 1850-1950

Un aspecto clave de la historia de la vejez es el de la asistencia a los ancianos pobres, enfermos o sin familia, sobre todo durante el siglo XIX y principios del XX que constituyen la edad de oro del asilo de ancianos. Partiendo de esa constatación y de los principales problemas historiográficos involucrados, se propone como objetivo principal reconstruir la oferta de instituciones existentes y la proporción de personas atendidas. Para ello explora, en primer lugar las posibilidades y límites de las escasas fuentes estadísticas disponibles. En segundo término, propone una comparación exploratoria con el interior del país y con la asistencia a otros grupos de edad, en particular los niños. Tanto por la centralidad de los procesos históricos involucrados (crecimiento urbano, impacto de la inmigración, desarrollo de políticas sociales), como por la consecuente disponibilidad de fuentes, el caso porteño constituye el eje central de la indagación. (AU)

Estimates of the impact of COVID-19 on mortality of institutionalized elderly in Brazil. / Estimativas de impacto da COVID-19 na mortalidade de idosos institucionalizados no Brasil.

The COVID-19 pandemic poses difficulties for long-term care institutions for the elderly, with increased mortality rates for the residents. This study aims to estimate the impact of COVID-19 on mortality of institutionalized elderly in Brazil. Estimates of the percentage of elderly deaths occurring in care homes were calculated for Brazil, States and Regions using estimates for the total number of deaths. The estimation was based upon information available for other countries. The weighted percentage was 44.7% and 107,538 COVID-19 deaths were estimated for the elderly in these institutions in Brazil in 2020. Higher numbers of deaths were expected in the Southeast Region (48,779 deaths), followed by the Northeast Region (28,451 deaths); São Paulo was the most affected State (24,500 deaths). The strong impact of COVID-19 on the elderly population living in long-term care facilities is clear. Estimates for the country exceeded 100,000 elderly people, potentially the most fragile and vulnerable, and are based upon a conservative number of total deaths, in view of other estimates and the alarming situation of death growth in Brazil from COVID-19.

COVID-19 in long-term care facilities for the elderly: laboratory screening and disease dissemination prevention strategies. / COVID-19 nas instituições de longa permanência para idosos: estratégias de rastreamento laboratorial e prevenção da propagação da doença.

An infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the 2019 Novel Coronavirus Disease (COVID-19) pandemic has unveiled a hitherto hidden reality: the vulnerability of the population living in long-term care facilities for the elderly (LTCF). To date, several scientific publications have revealed a concentration of up to 60% of deaths attributed to COVID-19 in such institutions. Most LTFC residents share the primary risk factors currently associated with increased morbimortality due to the COVID-19 infection. It is crucial to define actions to prevent SARS-CoV-2 spread in this environment, besides the usual measures of social distancing and isolation of the carriers of this disease. This paper proposes strategies for the investigation of this infection in LTCF residents and workers using laboratory tests available in Brazil. The early identification of individuals with SARS-CoV-2, who may actively and continuously spread the virus, allows adopting measures aimed at interrupting the local transmission cycle of this infection.

Prevalence of Malnutrition and Depression in Older Adults Living in Nursing Homes in Mexico City.

This study evaluated the association between nutritional status, depressive symptoms, and the number of prescription drugs taken by older adults living in nursing homes in Mexico City. In a cross-sectional study, 262 participants were subjected to anthropometric and nutritional (Mini Nutritional Assessment (MNA)) evaluations; additionally, their depression (Geriatric Depression Scale (GDS)) and functional status were assessed. Multiple logistic regression was used for identifying factors associated with the risk of malnutrition/malnourishment. The mean age of participants was 83.1 ± 8.6 years. A total of 59.9% and 21.1% were at risk of malnutrition and malnourished, respectively. With respect to depression, 27.9% of the participants had mild depression, while 11.4% showed severe depression. An inverse correlation between MNA evaluations and depression scores was found (Spearman's ρ = -0.4624, p < 0.001); residents with a better nutritional status had lower depression scores. Individuals with depressive symptoms were approximately five times more likely to be at risk of malnutrition or malnourished (OR = 5.82, 95% CI = 2.27-14.89) than individuals without depression. Residents taking three or more prescription drugs daily (OR = 1.83, 95% CI = 1.27-2.63, p < 0.001) were more likely to be at risk of malnutrition or malnourished. In summary, poor nutritional status was associated with depression, while the intake of numerous prescription drugs was associated with being at risk of malnutrition or malnourished.

Estimativas de impacto da COVID-19 na mortalidade de idosos institucionalizados no Brasil / Estimates of the impact of COVID-19 on mortality of institutionalized elderly in Brazil

Resumo O presente estudo tem como objetivo estimar o impacto da COVID-19 na mortalidade de idosos institucionalizados no Brasil. Foram estimados números de óbitos pela doença para o País, Unidades da Federação e Regiões, com base nas estimativas calculadas e efetuadas neste trabalho do percentual de óbitos de idosos que ocorreriam em instituições de longa permanência de acordo com os totais. Essa estimativa foi baseada em informações disponíveis para uma série de países. O percentual ponderado foi de 44,7%. Estimaram-se 107.538 óbitos de idosos nestas instituições no Brasil em 2020, por COVID-19. São previstos maiores números de óbitos na Região Sudeste (48.779 óbitos), seguida da Região Nordeste (28.451 óbitos); São Paulo é a Unidade da Federação que na estimativa será mais afetada (24.500 óbitos). Fica claro o forte impacto da COVID-19 na população idosa residente em instituições de longa permanência para idosos. As estimativas ultrapassam para o país 100 mil idosos, potencialmente os mais frágeis e vulneráveis, e são baseadas em número de óbitos totais conservador, tendo em vista outras estimativas e a situação alarmante de crescimento dos números de óbitos no Brasil.

Abstract The COVID-19 pandemic poses difficulties for long-term care institutions for the elderly, with increased mortality rates for the residents. This study aims to estimate the impact of COVID-19 on mortality of institutionalized elderly in Brazil. Estimates of the percentage of elderly deaths occurring in care homes were calculated for Brazil, States and Regions using estimates for the total number of deaths. The estimation was based upon information available for other countries. The weighted percentage was 44.7% and 107,538 COVID-19 deaths were estimated for the elderly in these institutions in Brazil in 2020. Higher numbers of deaths were expected in the Southeast Region (48,779 deaths), followed by the Northeast Region (28,451 deaths); São Paulo was the most affected State (24,500 deaths). The strong impact of COVID-19 on the elderly population living in long-term care facilities is clear. Estimates for the country exceeded 100,000 elderly people, potentially the most fragile and vulnerable, and are based upon a conservative number of total deaths, in view of other estimates and the alarming situation of death growth in Brazil from COVID-19.

COVID-19 nas instituições de longa permanência para idosos: estratégias de rastreamento laboratorial e prevenção da propagação da doença / COVID-19 in long-term care facilities for the elderly: laboratory screening and disease dissemination prevention strategies

Resumo A pandemia da "novel coronavirus disease" 2019 (COVID-19), infecção causada pelo coronavírus 2 da síndrome respiratória aguda grave (SARS-CoV-2), tem descortinado uma realidade até então oculta: a vulnerabilidade da população residente em instituições de longa permanência para idosos (ILPI). Diversas publicações científicas têm revelado a concentração de até 60% dos óbitos atribuídos à COVID-19 em tais instituições. A maioria dos residentes em ILPI reúnem os principais fatores de risco para morbimortalidade pela COVID-19, o que torna imprescindível a definição de ações voltadas à prevenção da transmissibilidade do SARS-CoV-2 neste ambiente, além das medidas usuais de distanciamento social e isolamento dos portadores da doença. Propõem-se, no presente artigo, estratégias de rastreamento da infecção em residentes e trabalhadores de ILPI por meio de testes laboratoriais disponíveis no Brasil. A identificação precoce de indivíduos portadores do SARS-CoV-2 com possibilidades de transmissão ativa e continuada do vírus permite a adoção de medidas que interrompam o ciclo de transmissão local da infecção.

Abstract An infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the 2019 Novel Coronavirus Disease (COVID-19) pandemic has unveiled a hitherto hidden reality: the vulnerability of the population living in long-term care facilities for the elderly (LTCF). To date, several scientific publications have revealed a concentration of up to 60% of deaths attributed to COVID-19 in such institutions. Most LTFC residents share the primary risk factors currently associated with increased morbimortality due to the COVID-19 infection. It is crucial to define actions to prevent SARS-CoV-2 spread in this environment, besides the usual measures of social distancing and isolation of the carriers of this disease. This paper proposes strategies for the investigation of this infection in LTCF residents and workers using laboratory tests available in Brazil. The early identification of individuals with SARS-CoV-2, who may actively and continuously spread the virus, allows adopting measures aimed at interrupting the local transmission cycle of this infection.

Characterization of the self-perception of oral health in the Brazilian adult population / Caracterização da condição percebida de saúde bucal na população adulta brasileira

Abstract This article aims to perform an analysis of the factors that determine the self-perception of oral health of Brazilians, based on a multidimensional methodology basis. This is a cross-sectional study with data from a national survey. A household interview was conducted with a sample of 60,202 adults. Self-perception of oral health was considered the outcome variable and sociodemographic characteristics, self-care and oral health condition, use of dental services, general health and work condition as independent variables. The dimensionality reduction test was used and the variables that showed a relationship were submitted to logistic regression. The negative oral health condition was related to difficulty feeding, negative evaluation of the last dental appointment, negative self-perception of general health condition, not flossing, upper dental loss, and reason for the last dental appointment. The use of a multidimensional methodological basis was able to design explanatory models for the self-perception of oral health of Brazilian adults, and these results should be considered in the implementation, evaluation, and qualification of the oral health network.

Resumo O objetivo deste artigo é realizar uma análise dos fatores que determinam a autopercepção de saúde bucal dos brasileiros sob base metodológica multidimensional. Estudo transversal, com dados provenientes de inquérito em âmbito nacional. Foi realizada entrevista domiciliar com uma amostra de 60.202 adultos. Considerou-se a autopercepção de saúde bucal como variável desfecho e características sociodemográficas, de autocuidado e condição de saúde bucal, de utilização de serviços odontológicos, de condição de saúde geral e de trabalho como variáveis independentes. Empregou-se o teste de redução de dimensionalidade e as variáveis que apresentaram relação passaram pelo teste de regressão logística. A autopercepção negativa de saúde bucal apresentou-se relacionada à dificuldade para se alimentar, avaliação negativa do atendimento recebido durante a última consulta odontológica, autopercepção ruim da condição de saúde geral, não utilização de fio dental, perda dental superior e motivo da última consulta com o cirurgião dentista. A utilização de base metodológica multidimensional foi capaz de (re)desenhar modelos explicativos para a condição percebida de saúde bucal de adultos brasileiros, devendo, os seus resultados serem considerados na implementação, avaliação e qualificação da rede de saúde bucal.

Potential and clinical relevant drug-drug interactions among elderly from nursing homes: a multicentre study in Murcia, Spain.

This study purposes to determine the prevalence of potential and clinical relevant Drug-Drug-Interactions (pDDIs) in institutionalized older adults and to identify the pertinent factors associated. We conduct an observational, multicenter and cross-sectional study during the last quarter of 2010. We selected a sample of 275 subjects (aged ≥ 65 years) from 10 nursing homes of Murcia (Spain) by a two-stage complex sampling. pDDIs were identified using the College of Pharmacists Database. We only considered pDDIs of clinical relevance, and thereafter the relevant factors were identified through uni-level and multi-level regression analyses. A total of 210 pDDIs were identified, 120 of which were considered clinically relevant (57.1%), affecting a total of 70 elderly (25.8%). Eight pharmacological groups made up 70.2% of the clinically relevant pDDIs. More clinically relevant DDIs were found in people suffering several pathologies (OR = 2.3; 95%CI = 1.4-4.5), and also in people who take ten or more drugs daily (OR = 9.6; 95%CI = 4.8-19.1), and people who take anti-inflammatory drugs (OR = 3.9; 95%CI = 1.4-10.4). This study reveals that clinically relevant pDDIs are very common in institutionalized elderly people, and that caregivers should aim at improving their practice in order to reduce the prevalence of this phenomenon.

Potential and clinical relevant drug-drug interactions among elderly from nursing homes: a multicentre study in Murcia, Spain / Interações medicamentosas potenciais e clinicamente relevantes em instituições de longa permanência para idosos: um estudo multicêntrico em Murcia, Espanha

Abstract This study purposes to determine the prevalence of potential and clinical relevant Drug-Drug-Interactions (pDDIs) in institutionalized older adults and to identify the pertinent factors associated. We conduct an observational, multicenter and cross-sectional study during the last quarter of 2010. We selected a sample of 275 subjects (aged ≥ 65 years) from 10 nursing homes of Murcia (Spain) by a two-stage complex sampling. pDDIs were identified using the College of Pharmacists Database. We only considered pDDIs of clinical relevance, and thereafter the relevant factors were identified through uni-level and multi-level regression analyses. A total of 210 pDDIs were identified, 120 of which were considered clinically relevant (57.1%), affecting a total of 70 elderly (25.8%). Eight pharmacological groups made up 70.2% of the clinically relevant pDDIs. More clinically relevant DDIs were found in people suffering several pathologies (OR = 2.3; 95%CI = 1.4-4.5), and also in people who take ten or more drugs daily (OR = 9.6; 95%CI = 4.8-19.1), and people who take anti-inflammatory drugs (OR = 3.9; 95%CI = 1.4-10.4). This study reveals that clinically relevant pDDIs are very common in institutionalized elderly people, and that caregivers should aim at improving their practice in order to reduce the prevalence of this phenomenon.

Resumo Este estudo pretende identificar a prevalência de interações medicamentosas potenciais (IMP) em idosos institucionalizados e seus fatores associados. Realizamos um estudo observacional, multicêntrico e transversal, durante o último trimestre de 2010. Selecionamos uma amostra de 275 sujeitos (≥ 65 anos) de 10 instituições para idosos de Murcia (Espanha) mediante amostragem aleatória complexa em duas etapas. As IMP foram identificadas usando a base de dados do College of Pharmacists. Estimamos a prevalência de IMP de relevância clínica e analisamos os fatores associados com análise de regressão uni e multinível. Identificamos 210 IMP, das quais 120 foram consideradas clinicamente relevantes (57,1%) e afetaram 70 idosos (25,8%). Oito grupos farmacológicos constituíram 70,2% das IMP clinicamente relevantes. A prevalência de IMP esteve associada à multimorbidade (OR = 2,3; IC 95% = 1,4-4,5) e tomar dez ou mais medicamentos diariamente (OR = 9,6; IC95% = 4,8-19,1) e uso de medicamentos anti-inflamatórios (OR = 3,9; IC 95% = 1,4-10,4). Este estudo revela que as IMP clinicamente relevantes são muito comuns em idosos institucionalizados e que os serviços devem melhorar seus processos para reduzir a prevalência deste fenômeno.