Resultados quirúrgicos de la herniorrafia inguinal en los pacientes mayores de 80 años: Revisión sistemática y metaanálisis / Surgical outcomes of inguinal herniorrhaphy in patients over 80 yearsof age: Systematic review and meta-analysis

Introducción. Los pacientes octogenarios y nonagenarios conforman un grupo etario en progresivo crecimiento. La hernia inguinal es una patología que aumenta progresivamente con la edad. Este trabajo tuvo como objetivo conocer los resultados quirúrgicos de los pacientes mayores de 80 años a quienes se les realizó herniorrafía inguinal. Métodos. De acuerdo con las guías PRISMA, se realizó una revisión sistemática de PubMed, Embase y Google Scholar. Se incluyeron estudios que reportaron la incidencia de complicaciones y mortalidad después de una herniorrafía inguinal en los pacientes octogenarios y nonagenarios. Se calculó la proporción de pacientes con complicaciones después de una herniorrafía inguinal según los datos presentados, con su respectivo intervalo de confianza del 95 %. Resultados. Catorce estudios reportaron un total de 19.290 pacientes, entre quienes se encontró una incidencia acumulada de infección del sitio operatorio de 0,5 % (IC95% 0,460 - 0,678), seroma de 8,7 % (IC95% 6,212 - 11,842), hematoma de 2,6 % (IC95% 2,397 - 2,893), dolor crónico de 2,1 % (IC95% 0,778 - 4,090) y recidiva de 1,2 % (IC95%0,425 - 2,284), para una morbilidad de 14,7 % (IC95% 9,525 - 20,833). Conclusión. Las complicaciones de la herida quirúrgica, el dolor crónico y la recidiva en los pacientes mayores de 80 años a quienes se les realiza herniorrafia inguinal son comparables con las de la población general.

Introduction. Octogenarian and nonagenarian patients constitute a progressively growing age group. Inguinal hernia is a pathology that increases with age. This study aims to understand the surgical outcomes of inguinal herniorrhaphy in patients over 80 years of age. Methods. A systematic review of PubMed, Embase, and Google Scholar was conducted following PRISMA guidelines. Studies reporting the incidence of complications and mortality after inguinal herniorrhaphy in octogenarian and nonagenarian patients were included. The proportion of patients with complications after inguinal herniorrhaphy was calculated based on the data presented, with its respective 95% confidence interval. Results. Fourteen studies reported a total of 19,290 patients, among whom a cumulative incidence of surgical site infection of 0.5 (95% CI 0.460 ­ 0.678), seroma of 8.7% (95% CI 6.212 ­ 11.842), hematoma of 2.6% (95% CI 2.397 ­ 2.893), chronic pain 2.1% (95% CI 0.778 ­ 4.090), recurrence 1.2% (95% CI 0.425 ­ 2.284), and morbidity 14.7% (95% CI 9.525 ­ 20.833) were found. Conclusion. Surgical wound complications, chronic pain, and recurrence in patients over 80 years of age undergoing inguinal herniorrhaphy are comparable to those in the general population.

Suplementação de ácidos graxos ômega-3 na saúde cognitiva de idosos: revisão integrativa / Omega-3 Fatty Acid Supplementation in Cognitive Health of Older Adults: Integrative Review / Suplementación de ácidos grasos ômega-3 em la salud cognitiva de adultos mayores: revisión integradora

Introdução:O envelhecimento da população está associado ao aumento da prevalência de demências, incluindo a doença de Alzheimer. O diagnóstico precoce é crucial para intervenções terapêuticas eficazes. Estudos recentes investigam o impacto da suplementação de ácidosgraxos ômega-3 na função cognitiva de idosos, devido à falta de tratamentos farmacológicos conhecidos para prevenir ou retardar o início da demência. Objetivo:Analisar os resultados de diversos estudos sobre a suplementação de ácidos graxos ômega-3 na função cognitiva de idosos. Metodologia:Revisão integrativa da literatura a partir das bases de dados BVS, PubMed e Scielo nos últimos dez anos (2013-2023), a partir dos descritores: (Fatty Acids, Omega-3) AND (Cognitive Aging) sem restrição quanto ao idioma e de acesso livre. Foram identificados 107 artigos, dos quais, 32 foram analisados e 14 utilizados nesta revisão. Resultados:O ômega-3, encontrado em peixes e oleaginosas, está associado à saúdecognitiva, especialmente os componentes EPA e DHA. Fatoresgenéticos, como o gene APO E4, podem influenciar sua eficácia na prevenção de doenças como Alzheimer. Estudos variam sobre seus benefícios na cognição em idosos, com resultados mistos. Conclusões:Os estudos revisados apresentam achados divergentes sobre os efeitos da suplementação de ácidos graxos ômega-3 na função cognitiva de idosos. Enquanto alguns sugerem benefícios, outros não identificam diferenças significativas (AU).

Introduction:The aging population is associated with an increased prevalence of dementia, including Alzheimer's disease. Early diagnosis is crucial for effective therapeutic interventions. Recent studies are investigating the impact of omega-3 fatty acid supplementation on the cognitive function of older adults, due to the lack of known pharmacological treatments to prevent or delay dementia onset. Objective:To analyze the results of various studies on omega-3 fatty acid supplementation in the cognitive function of older adults. Methodology:Integrative literature review from the databases BVS, PubMed, and Scielo in the last ten years (2013-2023), using the descriptors: (Fatty Acids, Omega-3) AND (Cognitive Aging) with no language restrictions and open access. A total of 107 articles were identified, of which 32 were analyzed, and 14 were used in this review. Results:Omega-3, found in fish and nuts, is associated with cognitive health, especially the EPA and DHA components. Genetic factors, such as the APO E4 gene, may influence its effectiveness in preventing diseases like Alzheimer's. Studies vary on its benefits in cognition in older adults, with mixed results. Conclusions:The reviewed studies present conflicting findings on the effects of omega-3 fatty acid supplementation on the cognitive function of older adults. While some suggest benefits, others do not identify significant differences (AU).

Introducción: El envejecimiento de la población está asociado con un aumento en la prevalencia de demencia, incluida la enfermedad de Alzheimer. El diagnóstico temprano es crucial para intervenciones terapéuticas efectivas. Estudios recientes investigan el impacto de la suplementación de ácidos grasos omega-3 en la función cognitiva de adultos mayores, debido a la falta de tratamientos farmacológicos conocidos para prevenir o retrasar el inicio de la demencia. Objetivo:Analizar los resultados de diversos estudios sobre lasuplementación de ácidos grasos omega-3 en la función cognitiva de adultos mayores. Metodología: Revisión integrativa de la literatura en las bases de datos BVS, PubMed y Scielo en los últimos diez años (2013-2023), utilizando los descriptores: (Ácidos Grasos Omega-3) Y (Envejecimiento Cognitivo) sin restricciones de idioma y de acceso abierto. Se identificaron un total de 107 artículos, de los cuales se analizaron 32 y se utilizaron 14 en esta revisión. Resultados: El omega-3, presente en pescados y frutos secos, está asociado con la salud cognitiva, especialmente los componentes EPA y DHA. Factores genéticos, como el gen APO E4, pueden influir en su eficacia para prevenir enfermedades como el Alzheimer. Los estudios varían en cuanto a sus beneficios en la cognición en adultos mayores, con resultados mixtos. Conclusiones:Los estudios revisados presentan hallazgos contradictorios sobre los efectos de la suplementación con ácidos grasos omega-3 en la función cognitiva de adultos mayores. Mientras que algunos sugieren beneficios, otros no identifican diferencias significativas (AU).

Association between cognitive impairment and socioeconomic and sociodemographic factors in Colombian older adults.

INTRODUCTION: Worldwide, because of the demographic transition, the proportion of older adults has increased, which has been reflected in an increase in the prevalence of major neurocognitive disorder (MND). This phenomenon is especially important in low- and middle-income countries such as Colombia, given the high economic and social costs it entails. The objective was to analyse the association between socioeconomic variables with the presence of cognitive impairment in Colombian older adults. METHODS: The records of 23,694 adults over 60 years-of-age surveyed for SABE Colombia 2015, that took a stratified sample by conglomerates and were representative of the adult population over 60 years-of-age. This instrument assessed cognitive impairment using the abbreviated version of the Minimental (AMMSE) and collected information on multiple socioeconomic variables. RESULTS: 19.7% of the older adults included in the survey were reviewed with cognitive impairment by presenting a score <13 in the AMMSE. There was a higher prevalence of cognitive impairment in women (21.5%) than in men (17.5%). The socioeconomic variables were shown to impact the prevalence of deterioration, especially being currently working (OR = 2.74; 95%CI, 2.43-3.09) as a risk factor and having attended primary school as a protective factor (OR = 0.30; 95%CI, 0.28-0.32), differentially according to gender. CONCLUSIONS: An association between socioeconomic and sociodemographic factors with cognitive impairment in Colombian older adults was evidenced. Despite the above, a differential impact dependent on sex is suggested.

A case management strategy to reduce falls in older people with a history of falls: A randomized controlled trial.

The present study aimed to determine whether a remotely delivered intervention, based on an individual case management, can reduce falls and their consequences in community-dwelling older people with a history of multiple falls. In this randomized controlled trial, 32 participants were randomized to the intervention group, which comprised a 16-week case management program involving a multidimensional assessment, targeted interventions according to the identified fall risk factors, and development of individualized care plans. The intervention was performed by trained gerontologists, under weekly supervision of professionals with experience in falls. The control group (n = 30) received usual care. Falls were monitored over 12 months with monthly falls calendars and telephone calls. Remotely delivered case management presented an 82 % uptake of recommendations. There was a trend toward a reduced fall incidence in the intervention vs control group, with lower fall, fall injury and fracture rates in the intervention group compared with the control group at both the 16-week and 12-month time-points, with the difference statistically significant for injurious fall rates at 12 months - IRR=0.18 (95 % CI = 0.04 to 0.74).

Feeding and Nutrition for People with Dementia in Gerontological Services: A Focus Group Study.

Purpose: This work sought to describe the experience of managers and caregivers with feeding and nutrition for older adults with dementia, in Colombian gerontological services. Participants and Methods: This is a qualitative focus group study with fourteen gerontological care centers for people with dementia. Results: The study reveals that care related to food and nutrition for people with dementia is organized based on the comprehensive assessment of the resident. Although there are basic support strategies, each caregiver requires specific knowledge, attitudes, behaviors, and institutional support, to generate a context that favors the health and quality of life of those involved. Conclusion: The experience of caring for people with dementia in aspects related to their food and nutrition, seen from the perspective of managers and caregivers of gerontological services in a developing country, strengthens specific strategies and public policies. This, in turn, reduces the burden on caregivers.

Potentially inappropriate medication on communitydwelling older adults: Longitudinal analysis using the International Mobility in Aging Study. / Medicación potencialmente inapropiada en adultos mayores de la comunidad: análisis longitudinal del estudio IMIAS

Introduction: Medications are a fundamental part of the treatment of multiple pathologies. However, despite their benefits, some are considered potentially inappropriate medications for older people given their safety profile. Epidemiological data differences related to potentially inappropriate medications make it difficult to determine their effects on elderly people. Objective: To estimate the prevalence and types of potentially inappropriate medications using the 2019 Beers Criteria® in a cohort of adults older than 65 years. Materials and methods: We performed an observational, multicenter, retrospective, longitudinal study of a four-year follow-up of potentially inappropriate medications in community-dwelling older adults. Results: We followed 820 participants from five cities for four years (2012-2016) and evaluated them in three different moments (m1 = 2012, m2 = 2014, and m3 = 2016). The average age was 69.07 years, and 50.9% were women. The potentially inappropriate medication prevalence in the participants was 40.24%. The potentially inappropriate medications' mean among the studied subjects in the first moment was 1.65 (SD = 0.963), in the second was 1.73 (SD = 1.032), and in the third was 1.62 (SD = 0.915). There were no statistical differences between measurements (Friedman test, value = 0.204). The most frequent potentially inappropriate medications categories were gastrointestinal (39.4%), analgesics (18.8%), delirium-related drugs (15.4%), benzodiazepines (15.2%), and cardiovascular (14.2%). Conclusions: About half of the population of the community-dwelling older adults had prescriptions of potentially inappropriate medications in a sustained manner and without significant variability over time. Mainly potentially inappropriate medications were gastrointestinal and cardiovascular drugs, analgesics, delirium-related drugs, and benzodiazepines.

Introducción. Los fármacos son parte fundamental del tratamiento de múltiples enfermedades. Sin embargo, a pesar de sus beneficios, algunos se consideran medicamentos potencialmente inapropiados en adultos mayores, dado su perfil de seguridad. Las diferencias en los datos epidemiológicos relacionados con los medicamentos potencialmente inapropiados dificultan el establecimiento de sus efectos en adultos mayores. Objetivo. Estimar la prevalencia longitudinal y los tipos de medicamentos potencialmente inapropiados, utilizando los criterios Beers® del 2019 en una cohorte de adultos mayores de 65 años. Materiales y métodos. Se realizó un estudio observacional, multicéntrico, retrospectivo y longitudinal, de cuatro años de seguimiento de los medicamentos potencialmente inapropiados en adultos mayores de la comunidad. Resultados. Se evaluaron 820 participantes de cinco ciudades durante cuatro años (2012 a 2016) en tres momentos (m1: 2012, m2: 2014 y m3; 2016). La edad promedio fue de 69,07 años y el 50,9 % eran mujeres. La prevalencia de medicamentos potencialmente inapropiados en los participantes fue del 40,24 %. El promedio de estos medicamentos entre los sujetos estudiados en el primer momento fue de 1,65 (DE = 0,963), en el segundo fue de 1,73 (DE = 1,032) y en el tercero fue de 1,62 (DE = 0,915). No hubo diferencias estadísticas entre las mediciones (prueba de Friedman, p = 0,204). Las categorías de los medicamentos potencialmente inapropiados más frecuentes fueron: gastrointestinales (39,4 %), analgésicos (18,8 %), relacionados con delirium (15,4 %), benzodiacepinas (15,2 %) y cardiovasculares (14,2 %). Conclusiones. En cerca de la mitad de la población de adultos mayores de la comunidad, se prescribieron medicamentos potencialmente inapropiados de manera sostenida y sin variabilidad importante en el tiempo. Los más recetados fueron aquellos para tratar malestares gastrointestinales y cardiovasculares, analgésicos, para el delirium y benzodiacepinas.

Effectiveness of Internet-Based or Mobile App Interventions for Family Caregivers of Older Adults with Dementia: A Systematic Review.

INTRODUCTION: Global aging presents socioeconomic and health challenges. Dementia, a growing concern, affects millions of older adults, intensifying the burden on family caregivers. E-health interventions offer hope through technological solutions, although current research is limited. This study evaluated the effectiveness of internet-based or mobile app interventions for family caregivers of older adults with dementia. METHODOLOGY: A systematic review with a narrative synthesis was conducted using databases (PubMed, CINAHL, Scopus, LILACS, and PsycInfo) and the bibliographies of retrieved articles, with no restrictions on time or language. RESULTS: The search yielded 2092 results, of which 22 studies met the inclusion criteria, encompassing a total of 2761 family caregivers. Twenty-one different outcomes were evaluated and classified into three main types of interventions: psychoeducational, psychotherapeutic, and multicomponent. CONCLUSIONS: The study highlights the importance of internet-based and mobile app interventions in supporting family caregivers of older adults with dementia. These interventions positively affect many aspects of caregiver well-being, suggesting their utility in addressing this group's emotional, social, and self-care needs.

Effects of a Multifactorial Program with Case Management for Falls Prevention on Functional Outcomes in Community-Dwelling Older People: A Randomized Clinical Study.

Falls are among the top 10 causes of years lived with disability in people aged 75 and over. Preventive programs like case management (CM) are crucial. OBJECTIVES: To evaluate the effects of a multifactorial fall prevention program based on CM on physical performance, the presence of pain, and the risk of falls and fractures in older people who have suffered falls. METHODS: This randomized, single-blind clinical trial with parallel groups, Intervention Group (IG) and Control Group (CG), was composed of 55 older people with a history of falling, living in the community. All participants underwent an initial assessment via video call (containing anamnesis, timed up-and-go test, falls risk score, short physical performance battery, and clinical frax). The IG underwent CM, the physical exercise protocol, and the cognitive stimulation protocol. The CG was monitored through telephone calls and received general health and fall guidance. RESULTS: No significant results were found in the physical capacity, the presence of pain, the risk of falls, or the fractures between the Intervention and Control Groups and between assessments. CONCLUSION: This program was not effective in improving functional performance, but it was important for characterizing pain and the probability of fracture in the next 10 years in this population.

Instruments to Assess the Comfort of Hospitalized Elderly People: A Scoping Review.

Background and Purpose: The purpose of this study was to map the instruments for assessing the comfort of hospitalized older adults in the scientific literature, identifying those instruments validated and transculturally adapted to the realities of Brazil. Methods: This was a scoping review of 14 articles and a website retrieved from the following databases: MEDLINE/PubMed, CINAHL, EMBASE, Web of Science, Scopus, Science Direct/Elsevier, and gray literature (Oasisbr, Catalog of Theses and Dissertations [CAPES], OATD, BDBTD, and The Comfort Line). Results: Seventeen instruments for assessing the comfort of hospitalized older adults were mapped; however, none were specifically designed for this population, as they were originally intended for adults or individuals with neuropsychiatric conditions. Among these, three have been validated and transculturally adapted to the Brazilian context. Conclusions: This study reveals the need for a specific instrument tailored for hospitalized older adults without neuropsychiatric conditions.

A brief research report of suicide rates in the Brazilian elderly over a 12-year period: the lack of association of the "Setembro Amarelo" campaign for suicide prevention.

Objectives: Aiming to disseminate information related to suicide prevention in Brazil, the "Setembro Amarelo" campaign has been conducted since 2015. The objective of this study is to assess the association between this campaign and elderly suicide rates over a 12-year period. Methods: Data were gathered from the Mortality Information System and the Notifiable Diseases Information System, established by public institutions in Brazil. An interrupted time-series framework was applied to assess the association between the "Setembro Amarelo" campaign and suicide mortality rates in the elderly population (60 et plus) in the southeastern region of Brazil. We consider three monthly outcomes: all suicides, suicides in males and suicide in females. We operationalize the campaign assuming three effects: short-term, declining and sustained. The period of analysis was from 2011-2022. Results: The suicide-mortality rate over time has remained stable; the average rate in the pre-campaign period was 0.028 and increased slightly to 0.035. Regardless of the campaign's operationalization and the outcome used, results show no significant associations between the campaign and elderly suicide rates. The campaign was associated with non-significant decreased effects of 15% (P=0.532) in the short term, and 16% (P=0.446) assuming the campaign was sustained. Conclusions: There is a lack of association between the campaign and suicide rates, among the elderly in Brazil's southeastern region. As suicide is complex and multifactorial, more research is needed. The campaign, while raising awareness and reducing stigma, may not reduce suicides. To reduce the suicide rate in the elderly requires addressing social, economic and cultural factors, multisectoral interventions, and upholding basic human rights.

Exploring the effect of sedentary behavior on increased adiposity in middle-aged adults.

BACKGROUND: Sedentary behavior is linked to excess fat mass; however, this association may be inconclusive due to potential measurement errors in self-reported sedentary behavior. OBJECTIVE: To assess the association between changes in sedentary behavior and fat mass in a Cohort of Health Workers (HWCS) from 2004 to 2010. METHODS: A total of 1,285 adults participating in the Cohort of Health Workers were evaluated in 2004 and 2010. Fat mass (kg) was measured by dual X-ray absorptiometry. A self-administered questionnaire was used to estimate the sedentary behavior. Sedentary behavior was also estimated using accelerometry in a sample of 142 health workers. Accelerometry data were used to correct self-reported sedentary behavior using a generalized linear model, which included values for sleeping time, age, sex, sedentary behavior, glucose, and triglycerides. Concordance between both methods was assessed using a kappa and Bland-Altman analysis. Once sedentary behavior was corrected, the values were used to evaluate the association between changes in sedentary behavior and body fat mass using a fixed effect model in the cohort, adjusting for confounders. RESULTS: Self-reported sedentary behavior was 2.8 ± 1.8 and 2.3 ± 1.6 h/day, and body fat mass was 24.9 ± 8.1 and 26.8 ± 8.5 kg in 2004 and 2010, respectively. After applying the correction model, the self-reported sedentary behavior was 7.6 ± 1.2 and 7.5 ± 1.2 h/day in 2004 and 2010, respectively. For every hour increase in corrected sedentary behavior, there was an observed increase of 0.847 (p > 0.001) kg in body fat mass during the 6.8 years in the Cohort of Health Workers from 2004 to 2010. Conversely, non-corrected self-reported sedentary behavior was associated with a non-significant reduction of 0.097 kg (p = 0.228) for every hour of sedentary behavior. CONCLUSIONS: Increased sedentary behavior was associated with increased body fat mass when corrected self-reported sedentary behavior was used. Implementing public health strategies to reduce sedentary behavior is imperative.

What is the most appropriate handgrip strength testing protocol for sarcopenia screening in older adults with cognitive impairment?

BACKGROUND: Handgrip strength (HGS) testing is a highly recommended method for screening for sarcopenia in older adults. However, there is no consensus on the optimal protocol and number of trials for screening sarcopenia in older adults with cognitive impairment. OBJECTIVE: To investigate the use of the first trial (FT), the mean of three trials (MT), and the highest value (HT) from three trials of the HGS test to screen for sarcopenia in older adults with cognitive impairment. Additionally, to analyze the consistency, agreement, and measurement error in the diagnosis of muscle weakness. METHODS: 176 older adults with cognitive impairment were evaluated. The HGS test was repeated three times. Analyses were performed using the Friedman repeated measures test with Wilcoxon post-hoc, intraclass correlation coefficient (ICC), Standard Error of Measurement (SEM), Minimal Detectable Change (MDC95), and Kappa index tests. RESULTS: There was no significant difference between the first trial (FT) and the mean of three trials (MT) (d = 0.17 [95 % CI: -0.08, 0.42]), but both differed significantly from the highest value (HT) (p < 0.001). The ICC indicated a reliability of 0.97 (95 % CI: 0.95, 0.98) across all participants, while the kappa index demonstrated over 80 % agreement. The SEM for the first measure of HGS ranged from 0.59 to 2.12 kgf. The MDC95 ranged from 1.64 to 5.87 kgf. CONCLUSION: For HGS testing, there was excellent consistency between the FM and MT. All three testing methods demonstrated excellent agreement in diagnosing muscle weakness. The measurement errors confirm that FT can be reliably used to monitor changes during rehabilitation.

Estratégias de educação alimentar e nutricional em um grupo intergeracional: um relato de experiência / Food and nutrition education strategies in an intergenerational group: an experience report / Estrategias de educación alimentaria y nutricional en un grupo intergeneracional: un reporte de experiencia

O Brasil vive uma transição demográfica que favorece o aparecimento e desenvolvimento de doenças crônicas não transmissíveis (DCNT). Em um cenário em que as DCNT estão entre as principais causas de mortes, reforçar a importância de uma alimentação saudável é imprescindível, e medidas preventivas tomam lugar de destaque. Pensando nisso, foram realizadas 11 intervenções de educação alimentar e nutricional em um grupo de atividade física intergeracional, com o objetivo de promover autonomia alimentar. O estudo contou com 25 participantes, na faixa etária de 37 a 83 anos, sendo a maior incidência de 61 a 69 anos (n=12) e predominância de pessoas do gênero feminino (92%). Os parâmetros para avaliar o grupo foram os feedbacks das(os) participantes e o grau de adesão, no qual houve aumento significativo ao longo do período interventivo. Destaca-se a importância de ampliar a abordagem dos hábitos alimentares saudáveis em diversos ambientes, sendo os grupos de atividades físicas um campo fértil, que requer a adaptação da linguagem e formato das atividades, considerando o nível de escolaridade das(os) participantes. Assim, a educação alimentar e nutricional pode ser usada como ferramenta efetiva para a promoção da saúde, a prevenção e o tratamento de DCNT.

Brazil is undergoing a demographic transition that favors the onset and development of chronic non-communicable diseases (NCDs). In a scenario where NCDs feature among the main causes of death, reinforcing the importance of healthy eating is essential and preventive measures should take place. Consequently, eleven Food and Nutritional Education interventions were conducted with an intergenerational physical activity group to promote food autonomy. A total of 25 individuals aged 37 to 83 years participated in the study, with the highest prevalence of 61 to 69 years (n=12) and women (92%). Evaluation parameters were participant feedback and the degree of adherence, which increased significantly over the interventional period. Results highlight the importance of broadening the approach to healthy eating habits in various environments, with physical activity groups being a fertile setting which requires adapting language and the format of activities according to participants' schooling level. Nutritional Food Education can be used as an effective tool for health promotion, prevention and treatment of NCDs.

Brasil vive una transición demográfica que favorece la aparición y desarrollo de enfermedades crónicas no transmisibles (ECNT). En un escenario en que entre las principales causas de muerte están las ECNT, se hace imprescindible reforzar la importancia de una alimentación saludable; para ello se destacan las medidas preventivas. Así, se realizaron 11 intervenciones de educación alimentaria y nutricional en un grupo de actividad física intergeneracional, con el objetivo de promover la autonomía alimentaria. Este estudio contó con una muestra de 25 participantes, en la franja etaria de 37 a 83 años, siendo la mayor prevalencia de los de entre 61 y 69 años (n=12), y predominancia de personas del género femenino (92%). Los parámetros que evalúan al grupo fueron las respuestas de las(los) participantes y el grado de adhesión, en el cual hubo un aumento significativo a lo largo de la intervención. Se destaca la importancia de ampliar el foco en los hábitos alimentarios saludables en diversos ambientes, y los grupos de actividades físicas son un campo fértil que requiere la adaptación del lenguaje y el formato de las actividades, considerando el nivel de escolaridad de las(los) participantes. Así, la educación alimentaria nutricional puede ser utilizada como herramienta efectiva para la promoción de la salud, la prevención y el tratamiento de las ECNT.

Development and Evaluation of a Software Designed by a Nursing and Technology Team to Assess the Health Status of Adults over 65 Years of Age / Desarrollo y evaluación de un software diseñado por un equipo de enfermería y tecnología para la valoración del estado de salud de los adultos mayores de 65 año / Desenvolvimento e avaliação de um software desenvolvido por uma equipe de enfermagem e tecnologia para avaliação do estado de saúde de adultos com mais de 65 anos

Objective. This work sought to develop the Actuasalud platformas a useful tool for nursing that permits assessing health, in term of frailty, in population over 65 years of age. Methods. For the design and development of Actuasalud, two working groups were formed: one from nursing with different profiles, to identify the scientific content and a computer science group responsible for the software programming and development. Both teams adapted the scientific content to the technology so that the tool would allow for population screening with detection of health problems and frailty states. Results. The software was developed in three large blocks that include all the dimensions of frailty: a) sociodemographic variables, b) comorbidities, and c) assessment tools of autonomy-related needs that evaluate the dimensions of frailty. At the end of the evaluation, a detailed report is displayed through bar diagram with the diagnosis of each of the dimensions assessed. The assessment in the participating elderly showed that 44.7% (n = 38) of the population was considered not frail, and 55.3%; (n = 47) as frail. Regarding associated pathologies, high blood pressure (67.1%; n = 57), osteoarthritis and/or arthritis (55.3%; n = 47), diabetes (48.2%; n = 41) and falls during the last year (35.3%; n = 30) were highlighted. Conclusion.Actuasalud is an application that allows nursing professionals to evaluate frailty and issue a quick diagnosis with ordered sequence,which helps to provide individualized care to elderly individuals according to the problems detected during the evaluation.

Objetivo. Desarrollar la plataforma Actuasalud como una herramienta útil para enfermería que permita evaluar la salud, en términos de fragilidad, en población mayor de 65 años. Métodos. Para el diseño y desarrollo de Actuasalud,se constituyeron dos grupos de trabajo: uno de enfermería con diferentes perfiles para identificar el contenido científico y uno informático que se responsabilizó de la programación y desarrollo del software. Ambos equipos adaptaron el contenido científico a la tecnología de manera que la herramienta permitiese hacer un cribado poblacional con detección de problemas de salud y estados de fragilidad. Resultados. Se desarrolló el software en tres grandes bloques que incluyen todas las dimensiones de fragilidad: a) variables sociodemográficas, b) comorbilidades y c) herramientas de evaluación de necesidades relacionadas con la autonomía que evalúan las dimensiones de fragilidad. Al finalizar la evaluación, se visualiza un informe detallado mediante diagrama de barras con el diagnóstico de cada una de las dimensiones evaluadas. La evaluación en los mayores participantes mostró que el 44.7% (n = 38) de la población se consideró como no frágil, y un 55.3%; (n = 47) como frágiles. En cuanto a las patologías asociadas, destacaron hipertensión arterial (67,1 %; n = 57), artrosis y/o artritis (55.3%; n = 47), diabetes (48.2 %; n = 41) y caídas en el último año (35,3 %; n = 30). Conclusión.Actuasalud es una aplicación que permite a los profesionales de enfermería evaluar fragilidad y emitir un diagnóstico de forma ágil con secuencia ordenada que ayuda a brindar cuidados individualizados a personas mayores de acuerdo los problemas detectados en la evaluación.

Objetivo. Desenvolver a plataforma Actuasalud como uma ferramenta útil para a enfermagem que permite avaliar a saúde, em termos de fragilidade, numa população com mais de 65 anos. Métodos. Para a concepção e desenvolvimento do Actuasalud foram formados dois grupos de trabalho: um grupo de enfermagem com perfis diferentes, para identificar o conteúdo científico, e um grupo de informática que foi responsável pela programação e desenvolvimento do software. Ambas as equipas adaptaram o conteúdo científico à tecnologia para que a ferramenta permitisse o rastreio da população para detectar problemas de saúde e estados de fragilidade. Resultados. O software foi desenvolvido em três grandes blocos que incluem todas as dimensões da fragilidade: a) variáveis sociodemográficas, b) comorbidades ec) instrumentos de avaliação de necessidades relacionadas à autonomia que avaliam as dimensões da fragilidade. Ao final da avaliação é apresentado um relatório detalhado através de um diagrama de barras com o diagnóstico de cada uma das dimensões avaliadas. A avaliação nos idosos mostrou que 44.7% (n=38) da população foi considerada não frágil e 55.3%; (n=47) como frágil. Quanto às patologias associadas, destacaram-se a hipertensão arterial (67.1%; n=57), a osteoartrite e/ou artrite (55.3%; n=47), a diabetes (48.2%; n=41) e as quedas no último ano (35.3%; n=30). Conclusão. Actuasalud é um aplicativo que permite ao profissional de enfermagem avaliar a fragilidade e emitir um diagnóstico de forma ágil e com sequência ordenada que auxilia no atendimento individualizado ao idoso de acordo com os problemas detectados na avaliação.

Effect of Self-transcendence, Self-distancing, and Family Functionality on Self-care Agency in Older Adults / Efecto de la autotrascendencia, autodistanciamiento y funcionalidad familiar en la agencia de autocuidado en adultos mayores / Efeito da autotranscendência, do autodistanciamento e da funcionalidade familiar na agência do autocuidado em idosos

Objective. To determine the effect of self-distancing, self-transcendence, and family functioning on self-care agency in Mexican older adults. Methods. Correlational-explanatory design, with a sample of 253 elderly, collecting data through a simple random sampling. A personal data questionnaire was applied, the scale of: self-transcendence, the self-distancing subscale, the family APGAR and the ability to self-care in Mexican population from different demographic groups. Descriptive and inferential statistics were applied (Mann-Whitney U and a structural equation model) and the study was approved by a registered ethics committee. Results.The study had participation from 253 elderly, with a mean age of 68.02 years, with prevalence of the female sex (60.1%); the level of education was primary school or lower (51.4%). It was observed that the group of chronic diseases had lower self-distancing (U = 4.449.5, p = 0.038) and greater self-transcendence (U = 4177.0, p = 0.008), and selfcare (U = 4365.5, p = 0.024) than the group without chronic diseases. It was also found that self-transcendence, self-distancing, and family functionality produce a positive effect of 37% on selfcare. Conclusion. Self-distancing, self-transcendence, and family functionality explain an important proportion of selfcare in the elderly. Said knowledge permits understanding the care behavior of the elderly and, thus, propose future educational interventions by nursing to prevent or avoid functional, cognitive loss and social effects.

Objetivo. Determinar el efecto del autodistanciamiento, autotrascendencia y funcionamiento familiar sobre la agencia de autocuidado en adultos mayores mexicanos. Métodos. Diseño correlacional-explicativo, con una muestra de 253 adultos mayores, recolectado mediante un muestreo aleatorio simple. Se aplicó un cuestionario de datos personales, la escala de: autotrascendencia, la subescala de autodistanciamiento, el APGAR familiar y la capacidad de autocuidado en población mexicana de diferentes grupos demográficos. Se aplicó estadística descriptiva e inferencial (U de Mann-Whitney y un modelo de ecuación estructural) y contó con la aprobación de un comité de ética registrado. Resultados. Participaron 253 adultos mayores, con una media de 68.02 años, predominó el sexo femenino (60.1 %) y el grado de estudio de primaria o menor (51.4 %). Se observó que el grupo de enfermedades crónicas tuvo menor autodistanciamiento (U = 4.449,5, p = 0.038) y mayor autotrascendencia (U = 4.177,0, p = 0,008) y autocuidado (U = 4.365,5, p = 0.024) que el grupo sin enfermedades crónicas. También se encontró que la autotrascendencia, autodistanciamiento y funcionalidad familiar producen un efecto positivo de un 37 % sobre el autocuidado. Conclusión. El autodistanciamiento, autotrascendencia y la funcionalidad familiar explican una importante proporción del autocuidado en los adultos mayores. Dicho conocimiento permite entender la conducta del cuidado del adulto mayor y de esta manera proponer a futuro intervenciones educativas por enfermería con miras a prevenir o evitar la pérdida funcional, cognitiva y afectaciones sociales.

Objetivo. Determinar o efeito do autodistanciamento, da autotranscendência e do funcionamento familiar na capacidade de autocuidado em idosos mexicanos. Métodos. Desenho correlacional-explicativo, com amostra de 253 idosos, coletada por meio de amostragem aleatória simples. Aplicou-se um questionário de dados pessoais, a escala de autotranscendência, a subescala de autodistanciamento, o APGAR familiar e a capacidade de autocuidado na população mexicana de diferentes grupos demográficos. Estatísticas descritivas e inferenciais (U de Mann-Whitney e modelo de equações estruturais) foram aplicadas e tiveram aprovação de um comitê de ética registrado. Resultados. Participaram 253 idosos, com idade média de 68.02 anos, predominou o sexo feminino (60.1%) e o nível de escolaridade era fundamental ou inferior (51.4%). Observou-se que o grupo com doenças crônicas apresentou menor autodistanciamento (U=4.449.5, p=0.038) e maior autotranscendência (U=4177.0, p=0.008) e autocuidado (U=4365.5, p= 0.024) que o grupo sem doenças Crônicas. Verificou-se também que a autotranscendência, o autodistanciamento e a funcionalidade familiar produzem um efeito positivo de 37% no autocuidado. Conclusão. O autodistanciamento, a autotranscendência e a funcionalidade familiar explicam uma proporção importante do autocuidado em idosos. Esse conhecimento permite compreender o comportamento de cuidar do idoso e desta forma propor futuras intervenções educativas pela enfermagem com vistas a prevenir ou evitar perdas funcionais, cognitivas e efeitos sociais.

Effects of a case management-based intervention on non-motor risk factors for falls in older people with history of falls: a randomised clinical trial.

BACKGROUND: Falls are directly related to morbidity and mortality of older people. Multifactorial approaches that are individualised and based on fall risk factors are necessary. This study aims to verify the effects of a case management-based intervention on non-motor risk factors for falls in community-dwelling older people with a history of falls. METHODS: The intervention applied a multidimensional assessment of risk factors for falls, a discussion about the identified risk factors, the preparation of an individualised plan with the participant, and the application, monitoring and review of the plan. RESULTS: There was a significant interaction between groups and assessments only in the visuospatial domain (P = 0.031). After simple main effects analysis, differences between groups and assessments were not significant, although there was a tendency of worse visuospatial performance in the control group in the follow-up assessment (P = 0.099). There were no significant differences between groups or between assessments in other variables. CONCLUSION: The intervention has the potential to maintain non-motor risk factors for falls in community-dwelling older people with a history of falls. However, more clinical trials are needed to prove its effects.

A Controlled Clinical Trial on the Effects of Aquatic Exercise on Cognitive Functions in Community-Dwelling Older Adults.

Several therapies have been developed to reduce cognitive decline associated with aging. Aquatic exercises, which are widely used to enhance functional capacity, may play a role in stimulating cognitive functions. This study investigated the effects of a 3-month aquatic exercise program on cognitive functions in community-dwelling older adults. In this prospective, single-blinded, controlled clinical trial, 31 participants were allocated to either the experimental (aquatic exercises) or control (no-exercise) group. The intervention program consisted of exercises conducted twice a week in a 1.2 m deep indoor pool. The main outcome measures were cognitive functions, assessed using Raven's Progressive Matrices test and the Wisconsin Card Sorting Test. A repeated-measures analysis of variance was used to assess the impact of the exercise program. The effect sizes (η2p) were reported when a level of significance was achieved (p < 0.05). Compared with the control group, the participants who underwent aquatic exercises showed positive outcomes in Raven's Progressive Matrices test (p = 0.046; η2p = 0.131) and the Wisconsin Card Sorting Test (p = 0.001, η2p = 0.589). Complementary analyses of the Wisconsin Card Sorting Test indicated that the benefits of the aquatic exercise were observed in terms of the number of trials (p = 0.001, η2p = 0.478), number of errors (p = 0.001, η2p = 0.458), and number of non-perseverative errors (p = 0.001, η2p = 0.302). The results indicate that a period of three months of aquatic exercise was beneficial for stimulating specific aspects of the cognitive function of community-dwelling older individuals. Aquatic exercise should be prescribed to this population.

Effects of Pilates exercises on postural balance and reduced risk of falls in older adults: A systematic review and meta-analysis.

BACKGROUND: and Purpose: Pilates exercises have been recommended to improve postural balance and reduce the risk of falls in older adults. However, the certainty of these recommendations remains unclear. In this sense, our objective was to update the literature and verify the effects of Pilates on postural balance and the risk of falls in this population. METHODS: A systematic search was conducted across multiple databases, including PubMed, EMBASE, CENTRAL, CINAHL, Web of Science, SPORTDiscus, LILACS, and PEDro, on April 17, 2023. The methodological quality of the studies was assessed using the PEDro scale, and the certainty of evidence was evaluated using the GRADE system. Meta-analysis calculations were performed by standardized mean difference (SMD). RESULTS: A total of 39 studies, involving 1770 participants, were included in the systematic review. Only 14 studies exhibited satisfactory methodological quality. Evidence with very low to moderate certainty showed that Pilates was significantly superior to control groups on indicators of dynamic postural balance (SMD = 1.60 to 0.72), static postural balance (SMD = 0.37 to 0.25), and general state of balance (SMD = 0.76), but not to reduce the number and fear of falls. Furthermore, Pilates was comparable to other forms of exercise for these outcomes. CONCLUSIONS: Pilates can be recommended to enhance static and dynamic postural balance in older adults, but not to reduce the number of falls or the fear of falling. Given that no outcomes showed high certainty of evidence, future studies may alter these findings.

Reference values for heart rate variability in older adults: A systematic review.

Heart rate variability (HRV) is an early marker of risk for various health conditions, and its analysis serves as a valuable tool for assessing older adults. This study aimed to describe the reference values of HRV parameters in older adults through a systematic review of the literature. The review included searches in MEDLINE (via PubMed®), EMBASE, Latin American and Caribbean Health Literature, Scopus, and Web of Science (WOS). Studies presenting reference values for at least one HRV linear analysis measure in older adults were considered eligible. Out of 1618 studies identified, only 11 met the inclusion criteria. Sample sizes of older adults ranged from 21 to 6250 subjects. The HRV measures assessed (mean RR intervals, SDNN, RMSSD, PNN50, LF, HF, and LF/HF ratio) varied significantly between studies, with no standardized methods for HRV analysis. We concluded that reference values for HRV measures in older adults vary widely between studies. The scientific literature on HRV reference values in older adults is still limited, and future studies should standardize assessment methods for HRV measures in this population.

Pharmacotherapy assessment and adverse drug reactions in older patients admitted to intensive care.

INTRODUCTION: Older patients are more susceptible to medication use, and physiological changes resulting from aging and organic dysfunctions presented by critically ill patients may alter the pharmacokinetic or pharmacodynamic behavior. Thus, critically ill older people present greater vulnerability to the occurrence of pharmacotherapeutic problems. OBJECTIVE: To evaluate pharmacotherapy and the development of potential adverse drug reactions (ADRs) in older patients admitted to an intensive care unit (ICU). METHOD: A cohort study was conducted in an ICU for adults of a Brazilian University Hospital during a 12-month period. The patients' pharmacotherapy was evaluated daily, considering the occurrence of ADRs and drug-drug interactions (DDIs), the use of potentially inappropriate medications (PIMs) for older people, and the pharmacotherapy anticholinergic burden (ACB). A trigger tool was used for active search of ADRs, with subsequent causality evaluation. PIM use was evaluated by means of the Beers criteria and the STOPP/START criteria. The ABC scale was employed to estimate ACB. The Micromedex® and Drugs.com® medication databases were employed to evaluate the DDIs. RESULTS: The sample of this study consisted of 41 patients, with a mean age of 66.8 years old (±5.2). The 22 triggers used assisted in identifying 15 potential ADRs, and 26.8% of the patients developed them. The mean estimated ACB score was 3.0 (±1.8), and the patients used 3.1 (±1.4) and 3.3 (±1.6) PIMs according to the Beers and the STOPP criteria, respectively. A total of 672 DDIs were identified, with a mean of 16.8 (±9.5) DDIs/patient during ICU hospitalization. Our findings show an association between occurrence of ADRs in the ICU and polypharmacy (p=.03) and DDIs (p=.007), corroborating efforts for rational medication use as a preventive strategy. CONCLUSIONS: Using tools to evaluate the pharmacotherapy for older people in intensive care can assist in the recognition and prevention of pharmacotherapeutic problems, with emphasis on the identification of ADRs through the observation of triggers and subsequent causality analysis.