740 research outputs found
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Intrinsic capacity as proposed by the World Health Organization and 30-month mortality among older adults in long-term care facilities
No full textOBJECTIVE: 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.</p
Moving from an "anti-aging" paradigm toward the concept of "disease-free aging": the role of senolytics in modern medicine
No full textSenescent cells increase with aging and are related to the promotion of inflammation and neoplasia through the senescence-associated secretory phenotype (SASP). These cells are closely related to the biological aging process and, most importantly, to age-associated diseases, such as osteoporosis and osteoarthritis. Senolytics are a new drug class that kills senescent cells by targeting senescent cell anti-apoptotic pathways (SCAPs), which are biological systems that avoid cellular destruction and host innate defenses. Senolytic therapy requires strong evidence in human trials, and dasatinib and quercetin have shown good results in phase II trials with idiopathic pulmonary fibrosis and diabetic renal disease. However, these trials are small and merely represent a proof-of-concept for these drugs. Nevertheless, this evidence calls for an overview of senescent cells and senolytics. We briefly discuss these related topics, summarizing the best evidence for clinical practitioners.</p
Path analysis of urinary incontinence in older adults living in nursing homes
No full textOBJECTIVE: To investigate the factors associated with urinary incontinence in older adults living in nursing homes.
METHODS: This exploratory, cross-sectional, observational, and quantitative study used exploratory and path analysis (PA). Eighty-six older adults living in nursing homes in the city of Salvador, Brazil, and the city of Brasília, Brazil, were included. Data were collected from January to March 2020, before the Covid-19 pandemic. The following variables were evaluated: sex, age group, functional performance, global cognitive function, comorbidities, and health conditions. We considered urinary incontinence for older adults who answered affirmatively to the “In the last 12 months, have you had an involuntary loss of urine?”. Data were initially analyzed by descriptive analysis and nonparametric statistical tests. A PA was performed using generalized structural equation modeling to investigate the relationship between the variables of interest and the direct and indirect effects of the independent variables and UI according to the theoretical model. Subsequently, the statistical distributions of the variables and the connections were defined for the regression estimation. After the analysis, the model was respecified, excluding the variables and paths that were not statistically significant to determine the best model. The final model was designed after statistical adjustments, corroborating or not with the theoretical model.
RESULTS: Urinary incontinence was associated with educational level, marital status, hypertension, one or more difficulties in basic activities of daily living, mood, insomnia, loss of appetite, fecal incontinence, and difficulty swallowing. In the PA, depression and difficulty swallowing were directly associated with urinary incontinence, and urinary incontinence was directly and significantly associated with insomnia and fecal incontinence.
CONCLUSION: Given the variety of social and health components associated with urinary incontinence, it is necessary to assess, prevent, treat, and rehabilitate this condition in Brazilian nursing homes. Interventions in urinary incontinence demand integrated actions in functional, clinical, and mental health aspects to promote the well-being of older adults living in nursing homes.</p
Effects of endurance training combined with blood flow restriction on functionality in older adults: a systematic review
No full textThe aim of this review was to verify the effects of aerobic exercise combined with blood flow restriction on older adult functionality. Systematic searches were performed in PubMed, Web of Science, and Embase between July and December 2023. Randomized studies with participants aged ≥ 60 years who were evaluated before and after the experimental protocols were included. We registered this systematic review at the International Prospective Register (PROSPERO CRD42022347205). The search strategy identified 2698 studies, four of which were included in the review, with 80 participants. The results suggested that aerobic exercise combined with blood flow restriction increased performance on specific functional tests. However, these results should be interpreted with caution due to the low-to-moderate study quality, as well as the low number of participants and studies. In conclusion, aerobic exercise and blood flow restriction may increase functional capacity in older adults. Further studies are needed to confirm such findings..</p
Drug-drug interactions in hospitalized older adults with acute coronary syndrome – a real-world study in Brazil
No full textOBJECTIVE: Our aim was to determine the frequency of drug-drug interactions in clinical practice among hospitalized older adults diagnosed with acute coronary syndrome.
METHODS: This cross-sectional and descriptive study included 119 older adults with acute coronary syndrome who were admitted to a Brazilian public hospital. Potential drug-drug interactions were identified and classified using computerized databases. Adverse events were characterized according to severity, temporal relationship, causality, interactions as a determining factor, and traceability criteria.
RESULTS: Of the total sample, 30.25% of participants had ≥ 1 real drug-drug interaction. A total of 53 real drug-drug interactions were identified. The median number of real drugdrug interactions was 1 (maximum 3) per patient; 5.56% of those who experienced real drugdrug interactions died and 94.44% were discharged from hospital. Of the real drug-drug interactions, 47.17% were moderate and 41.51% were serious.
CONCLUSIONS: Drug-drug interactions resulted in adverse reactions in hospitalized older adults with acute coronary syndrome in a real-world scenario in Brazil.</p
Prevalence of positive serology for sexually transmitted infections among older adults
No full textOBJECTIVE: To determine the seroreactivity profile for sexually transmitted infections (STIs) in a sample of community-dwelling older adults.
METHODS: Epidemiological survey using serological screening tests for reactivity to Treponema pallidum, HIV 1/2, and hepatitis B and C viruses in 495 older individuals (59.9% women) investigated regardless of signs or symptoms of STIs.
RESULTS: Reactivity rates for the etiological agents of AIDS and viral hepatitis B and C were compatible with the usual prevalence of these STIs in the Brazilian population. However, there was a very high prevalence of reactivity to syphilis (symptomatic or asymptomatic) in the group, equivalent to approximately 1290 cases per 10 000 older population, which suggests a proportionally greater exposure of older adults to infection with T. pallidum and to the risk of morbidity and mortality associated with STIs.
CONCLUSIONS: This scenario indicates that adjustments are needed in geriatric centers to consider screening for STIs as an integral part of the routine clinical care of older people.</p
Associations of social isolation with sociodemographic aspects and health indicators in Brazilian middle-aged and older adults: ELSI-Brazi
No full textOBJECTIVES: To investigate the prevalence of social isolation and its associations with sociodemographic and health indicators in Brazilian middle-aged and older adults recruited from households.
METHODS: A cross-sectional study of baseline data (2015–2016) of 7886 Brazilian adults aged 50 years and older from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) was conducted. Social isolation was the dependent variable, as defined by living arrangement, frequency of contact with children, relatives, and friends, and degree of participation in social activities within the community. The independent variables were sociodemographic aspects, healthrelated behaviors, and health status. Associations between social isolation and independent variables were estimated using Poisson regression analysis.
RESULTS: The prevalence ratio (PR) of high level of social isolation was 23.13%. Significant positive associations were observed between high level of social isolation and male sex (PR 1.27; 95%CI 1.16–1.40); being 70 to 79 years old (PR 1.22; 95%CI 1.07–1.39) or 80 years or older (PR 1.56; 95%CI 1.32–1.85); having no formal education (PR 3.15; 95%CI 2.69–3.68) or having a maximum of 4 years (PR 2.11; 95%CI 1.82–2.46) or 5 to 8 years of formal education (PR 1.54; 95%CI 1.30–1.84); fair self-rated health (PR 1.25; 95%CI 1.12–1.39); depressive symptoms (PR 1.22; 95%CI 1.07–1.40); and poor-quality diet (PR 1.37; 95%CI 1.19–1.58). Fair sleep quality was negatively associated with social isolation (PR 0.87; 95%CI 0.78–0.98).
CONCLUSIONS: The group most at risk for social isolation comprises men, aged 70 or older, with low educational attainment, fair self-rated health, and an unhealthy diet. Future research should use longitudinal study designs to investigate causal relationships and develop interventions for older adults who are socially isolated.</p
Study of the clinical profile of older patients with bipolar disorder in a tertiary care center in the Midwest of Brazil
No full textOBJECTIVE: This study aimed to describe the clinical and psychiatric characteristics of older outpatients with bipolar disorder (BD), including psychiatric history (age of onset of symptoms, length of time with the illness, and number of psychiatric hospitalizations), mood state, and cognitive function.
METHODS: This was a cross-sectional study where clinical and demographic data were obtained by a psychiatric interview with each patient and family members as well as by a review of medical records. The sample consisted of 20 individuals aged 60 years or older with a diagnosis of BD type I according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Descriptive data analysis was performed, with categorical variables expressed as absolute and relative frequencies.
RESULTS: No patient had manic or depressive symptoms at the time of the evaluation; 15 (75.0%) had an early onset while 5 (25.0%) had a late onset of the disease. Nine patients (45.0%) showed no cognitive decline whereas 11 (55.0%) showed mild cognitive impairment.
CONCLUSIONS: This study presents an understudied group of patients with BD. Considering the personal impact and burden on the health system related to this psychiatric condition, it is recommended that further studies be conducted in this area to better evaluate this growing population.</p
Dynapenic abdominal obesity is associated with negative clinical outcomes in older patients with type 2 diabetes: a prospective cohort study
No full textOBJECTIVE: To evaluate the association between dynapenic abdominal obesity (DAO) and the following negative outcomes in older patients with type 2 diabetes (T2D): prolonged length of stay (LOS), readmission within 30 days, in-hospital mortality, and mortality within 1 year after hospital discharge.
METHODS: This prospective cohort study included hospitalized older patients with T2D. DAO was defined as a combination of abdominal obesity (high waist circumference [WC]: ≥ 102 cm for men and ≥ 88 cm for women]) and dynapenia (reduced hand grip strength [HGS]: < ≤27 kg for men and < 16 kg for women]). The association between clinical outcomes and DAO was evaluated using multivariate analyses adjusted for confounders. The Kaplan-Meier curve was used to compare 1-year survival in the presence of DAO.
RESULTS: We included 309 patients with T2D (mean age 73.3 ± 6.4 years; 50.5% female; 32.4% with DAO). In multivariate analyses, patients with DAO had a 5.29- and 4.71-fold increase in LOS (≥ 14 days) and 1-year mortality than those without DAO, respectively. Moreover, patients with DAO had a higher risk of 1-year mortality (log-rank test, p < 0.05).
CONCLUSIONS: Older patients with T2D and DAO are more likely to have prolonged hospitalization and 1-year mortality compared to those without DAO.</p
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